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Test 3 PUD
Pharmacology
84
Health Care
Undergraduate 2
11/21/2008

Additional Health Care Flashcards

 


 

Cards

Term
A group of upper GI disorders characterized by varying degrees of erosion of the gut wall?
Definition
peptic ulcer disease
Term
Name two complications of PUD
Definition
Hemorrhage and perforation
Term
  Name two locations where peptic ulcers are most common
Definition
Lesser curvature of the stomach and the duodenum
Term
  When do peptic ulcers develop?
Definition

When there is an imbalance between

mucosal defensive factors and aggressive factors
Term
Name the two major defensive factors against ulceration
Definition

Mucus

bicarbonate (prevents blood from becoming acidic)
Term
   Name the four major aggressive factors for ulceration
Definition

H.pylori

 

Nonsteroidal anitinflammatory durgs (NSAIDs)

 

Gastric acid

 pepsin 
Term
 Name the two most important agents that can weaken defenses against ulceration
Definition
H.pylori   and   NSAIDs
Term
 Explain how prostaglandins play an important role in maintaining defenses.
Definition

They compound stimulate

secretion of mucus and bicarbonate,

and they promote vasodilation, which helps maintain submucosal blood flow.

 

They provide additional protection by suppressing secretion of gastric acid

Term
 What is Helicobacter pylori?
Definition
A gram negative bacillus that can colonize the stomach and duodenum.  By taking up residence in the space between epithelial cells and the mucus barrier that protects them, this organism manages to escape destruction by acid and pepsin
Term
 Explain how NSAIDs are the underlying cause of many gastric ulcers and some duodenal ulcers. 
Definition

Aspirin and other NSADs inhibit the biosynthesis of prostaglandins.

 

By doing so, they can decrease submucosal blood flow, suppress secretion of mucus and bicarbonate, and promote secretion of gastric acid Furthermore, NSAIDS can irritate the mucosa directly
Term
 True or False?  Patients with gastric ulcers produce an increased amount of gastric acid.  
Definition

False,

in most patients with gastric ulcers, acid secretion is normal or reduced
Term
  Name one life-style habit that delays ulcer healing and increases the risk of recurrence.

Definition
smoking
Term

Name the first and second most common causes of

gastric and duodenal ulcers. 
Definition

H.pylori

 NSAIDs
Term
 Name four goals of drug therapy for PUD.
Definition

1. Alleviate symptoms

 

2. Promote healing

 

3. Prevent complications (hemorrhage, perforation, obstruction)

 

        4. Prevent recurrence

Term
   Name the five classes of antiulcer drugs.
Definition

1. Antibiotics

 

2. Antisecretory agents (histamine2-receptor antagonists, proton  pump inhibitors, muscarinic anatagonists)

 

3. Mucosal protectants

 

4. Antisecretory agents that enhance mucosal defenses

 5. Antacids
Term

Name the three basic ways drugs used for PUD act to promote ulcer healing.  Identify classes of drugs that perform each action.

They can  
Definition

(1) eradicate H.pylori (antibiotics do this)

(2) reduce gastric acidity (antisecretory agents, misoprostol, and antacids do this)

(3) enhance mucosal defenses (sulcralfate and misoprostol do this)
Term
   What class of drugs are used to cure PUD caused by documented H. pylori infection?
Definition
antibiotics
Term

Name the 2 preferred drug options for prevention of

NSAID-Induced Ulcers.  
Definition

Misoprostol and the proton pump inhibitors

(eg omeprazole)

 Antisecretory agent should be given along with the antibiotics
Term

  Name the 2 preferred drug options for treatment of

NSAID-Induced Ulcers.  
Definition

Histamine2 – receptor blockers 

 

 proton pump inhibitors
Term

  What common diet restrictions have not been shown to accelerate healing of PUD? 

 What is one dietary change that may be beneficial?                  
Definition

Bland foods together with milk or cream, does not accelerate healing

Consumption of five or more small meals a day, rather than three larger ones, can reduce Fluctuations in intragastric pH, and may therby facilitate recovery.
Term
What life-style habit should be avoided by patients with PUD?
Definition
smoking
Term
 What group of patients with PUD may continue to take aspirin?  Why? 

    

Definition
    Use of aspirin to prevent cardiovascular disease;         In the low doses employed, aspirin is only a small factor in PUD
Term
 What restriction should be placed on alcohol consumption by patients with PUD?
Definition
If the patient notes a temporal relationship between alcohol consumption and exacerbation of symptoms, then alcohol use should stop 
Term
What invasive procedure is necessary to obtain a biopsy to conduct tests for H. pylori? 

         

Definition
 endoscopy
Term
Name three types of noninvasive tests used in the United States to test for H. pylori. 
Definition

Breath,

 

serologic,

 

stool
Term

 Name the five antibiotics used to treat PUD caused by Helicobacter pylori. 

Which ones can be used alone? 

Definition

Amoxicillin,

metronidazole,

clarithromycin,

tetracycline,

bismuth  (None is effective alone) 

Term

List the antibiotics used in order of

least resistance to most resistance

In order of

Most effective/ non-resistanttoleast effective/ most resistant
Definition

Tetracycline Resistance is rare  (less than 1%)

Highly active against H. pylori.

 

 Amoxicillin-   Resistance is low  (about 3%)

 

 Clarithromycin- Resistance is low  (about 10%)

 

Metronidazole- Over 40% of strains are now resistant

Term

 Name one common side effect that Amoxicillin and Clarithromycin have in common. 

Name two additional side effects of Clarithromycin. 
Definition
Diarrhea           Nausea and distortion of taste
Term
   What is one common brand name of bismuth subsalicylate? 
Definition
Pepto-Bismol
Term

What effect can Bismuth have on the tongue and stool? 

What serious symptom may be difficult to assess because of this side effect? 
Definition
a harmless black coloration of the tongue and stool

Stool discoloration may confound interpretation of

gastric bleeding 
Term
Why should Tetracycline not be used by pregnant women or young children?
Definition
Because it can stain developing teeth, it should not be used by pregnant women or young children. 
Term

What is disulfiram?

 

  What would be a disulfiram-like reaction? 
Definition

a sensitivity to alcohol which results in a highly unpleasant reaction when the patient under treatment ingests even small amounts of alcohol.

 

Accumulation of acetaldehyde in the blood produces a complex of highly unpleasant symptoms referred to as the disulfiram-alcohol reaction

 

severe hangover
Term
 Which of the 5 antibiotics used to treat PUD can cause a disulfiram-like reaction if is used with alcohol?
Definition
         Metronidazole
Term
To minimize emergence of resistance, how many different antibiotics should be used to treat PUD caused by Helicobacter pylori? 
Definition
At least two antibiotics, and preferably three
Term
 What other type of medication should be included along with the antibiotics? 
Definition

An antisecretory agent

 (histamine2-receptor antagonist or proton pump inhibitor)

should be included as well 
Term
 For how many days should the antibiotic regimen last? 
Definition
Eradication rates are consistently higher with a 14-day course of treatment than with a shorter course
Term
v   List some reasons why compliance with antibiotic therapy can be difficult  
Definition

First, antibiotic regimens are complex, requiring the patient to ingest as many as 12 pills a day.

Second, side effects – especially nausea and diarrhea – are common

Third, a course of treatment is somewhat expensive  
Term
 How do histamine2-receptor antagonists (H2RAs) promote ulcer healing?
Definition
By suppressing secretion of gastric acid.
Term

  Name the four H2RAs that are available. 

Which one(s) are most effective? 
Definition

Cimetidine

 

Ranitidine

 

Famotidine

 Nizatidine         All four are equally effective. Serious side effects are uncommon 
Term
What is the brand name of cimetidine?  
Definition
Tagamet
Term

What is the mechanism of action of cimetidine (Tagamet) and

the other H2RAs

Definition

H2 receptors, which are located on parietal cells of the stomach, promotes secretion of gastric acid.

 

by blocking H2 receptors, cimetidine reduces both the volume of gastric juices and its hydrogen ion concentration

 

 Cimetidine (Tagamet)  suppresses basal acid secretion and secretion stimulated by astrin and acetylcholine         

 

  Because cimetidine produces selective blockade of H2 receptors the drug cannot reduce symptoms of allergy


Term
    What will be the effect if cimetidine (Tagamet) is taken orally with meals?  
Definition

Food decreases the rate of absorption but not to the extent

if cimedtidine is taken with meals, absorption will be slowed and beneficial effects prolonged

Term
How long must cimetidine  (Tagamet)be taken to heal duodenal and gastric ulcers? 
Definition

Duodenal ulcers-4 to 6 weeks

 Gastric ulcers  - 8 to 12 weeks
Term
Name four other conditions besides PUD for which cimetidine  (Tagamet) might be used. 
Definition

Gastoresophageal Reflux Disease

 

Zollinger-Ellison Syndrome

 

Aspiration Pneumonitis

 Heartburn, Acid indigestion, and sour Stomach
Term
 Describe antiandrogenic effects. 
Definition

Cimetidine binds to androgen receptors, producing receptor blockade.

 

This causes gynecomastia, reduced libido, and impotence –all of which reverse following termination of treatment 
Term

What patients are most at risk for CNS effects during the use of cimetidine (Tagamet)?

 

 

What type of effects may occur? 

 

Definition

Elderly patients who have renal(kidney) or hepatic (liver) impairment. 

 

confusion, hallucination, CNS depression, and CNS excitation

Term

 If a patient is taking both cimetidine (Tagamet) and antacids how should the drugs be scheduled? 

 

 

Definition

Antacids can decrease absorption of cimetidine 

They should be administered at lease 1 hour apart 

Term
 What is the brand name of ranitidine? 
Definition
Zantac,   Zantac EFFERdose,  Zantac Geldose
Term
How does food effect the absoption of ranitidine (Zantac)? 
Definition
It is absorbed at the same rate in the presence or absence of food
Term

 How common are antiandrogenic effects with

ranitidine (Zantac)? 
Definition

Ranitidine (Zantac) does not bind to androgen receptors, and hence does not cause antiandrogenic effects

 

(eg. Gynecomastia, impotence)
Term
How do antacids effect ranitidine (Zantac)? 
Definition
Antacids have a small effect on ranitidine (Zantac)absorption
Term
What is the brand name of famotidine?
Definition
Pepcid, Pepcid AC, Pepcid RPD
Term
  What are proton pump inhibitors (PPIs) most effective at doing?  
Definition
Suppressing secretion of gastric acid
Term
What is the brand name of omeprazole?

       

Definition
   Prilosec  
Term
Explain in very simple terms the mechanism of action of omeprazole (Prilosec)
Definition
Enhibits the enzyme generates gastric acidBecause it blocks the final common pathway of gastric acid production, omeprazole can inhibit basal and stimulated acid release
Term
 Name two ways omeprazole  (Prilosec) is formulated to protect it from being destroyed by stomach acid. 
Definition
First consist of a capsule that contains protective eneric-coated granules

(the capsule dissolves in the stomach, but the granules remain intact until they reach the relatively alkaline environment of the duodenum)

 

 

 

Second is simply a powdered mixture of omeprazole with sodium bicarbonate, an antacid that elevates gastric pH
Term
 When should omeprazole be taken in relation to meals?
Definition
Should be taken before a meal
Term
What is the brand name of esomeprazole? 

 

Definition

Nexium,

Nexium I.V.

Term
What is the brand name of lansoprazole?


 

Definition
Prevacid
Term
What is the brand name of pantoprazole?
Definition

Protonix,

Protonix I.V.
Term
 What is the brand name of sucralfate?
Definition
Carafate
Term
Describe in simple terms how sucralfate works to promote ulcer healing. 
Definition

By creating a protective barrier against

 acid and pepsin
Term

 What is the most significant side effect of sucralfate

(Carafate)? 
Definition
constipation
Term
 Since sucralfate may impede the absorption of some drugs, what would be an appropriate nursing action to minimize this effect? 
Definition
Administering these drugs at least 30 minutes apart
Term
 How should sucralfate be administered in relation to meals?
Definition
Administered on an empty stomach at least 1 hour before meals and at bedtime
Term
 What form of the drug may be used if a patient finds the large tablets difficult to swallow?    

   

Definition
      Oral suspension
Term
 What is the brand name of misoprostol?
Definition
Cytotec
Term
What is misoprostol? 
Definition
An analog of prostaglandin E1
Term
 In the United States what is the only approved GI use for misoprostol? 
Definition
Prevention of Gastric ulcers caused by long term therapy with NSAIDs
Term
For what other use(s), unrelated to GI problems, is misoprostol used for?
Definition
 

Promote cervical ripening

 Induce abortion
Term
 In normal individuals, how does prostaglandins help protect the stomach? 
Definition

(1) suppressing secretion of gastric acid

(2) promoting secretion of bicarbonate and cytoprotective mucus

(3) maintaining submucosal blood flow (by promoting vasolidation) 
Term
How do aspirin and other NSAIDs cause gastric ulcers?
Definition
By inhibiting prostaglandin biosynthesis
Term
   How does misoprostol prevents NSAID-induced ulcers? 
Definition
By serving as a replacement for endogenous prostaglandins
Term

  Why is misoprostol (cytotec) contraindicated during pregnancy? 

What is the FDA Pregnancy Risk Category?


Definition

The risk of use by pregnant women clearly out weighs any possible benefits of use during pregnancy has caused partial or complete expulsion of the developing fetus

 

 it is categorized as a risk X
Term
v   When is misoprostol (Cytotec) administered in relation to meals? 
Definition
Administered with meals and at bedtime
Term
True or False:  Antacids neutralize acid and decrease destruction of the gut wall
Definition

True

Term
v   True or False:  Antacids may also enhance mucosal protection by stimulating production of prostaglandins. 
 
Definition
True
Term
True or False:  Antacids coat the ulcer crater to protect it from acid and pepsin. 
Definition
False,  Antacids do not coat the ulcer crater
Term
Because the objective of peptic ulcer therapy is to promote healing, and not simply to relieve pain how often should antacids be administered?  
Definition

On a regular schedule, not just in response to comfort

 In the usual dosing schedule, antacids are administered 7 times a day: 1 and 3 hours after each meal ant at bedtime
Term
v   What are the two most common adverse effects of antacids?  
Definition
Constipation and diarrhea 
Term
  Since antacids can influence the dissolution and absorption of many other drugs how should antacids be scheduled in relation to other drugs? 
Definition
Allowing 1 hour between taking antacids and these other drugs
Term
   Which of the 2 most common antacids causes diarrhea? 
Definition

Magnesium hydroxide

 Sodium bicarbonate ???
Term
Which of the 2 most common antacids causes constipation? 
Definition

Aluminum hydroxide

 Calcium Carbonate
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