When there is an imbalance between

Mucus

H.pylori

Nonsteroidal anitinflammatory durgs (NSAIDs)

Gastric acid

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

Aspirin and other NSADs inhibit the biosynthesis of prostaglandins.

False,

Name the first and second most common causes of

H.pylori

1. Alleviate symptoms

2. Promote healing

3. Prevent complications (hemorrhage, perforation, obstruction)

        4. Prevent recurrence

1. Antibiotics

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

3. Mucosal protectants

4. Antisecretory agents that enhance mucosal defenses

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

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

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

Name the 2 preferred drug options for prevention of

Misoprostol and the proton pump inhibitors

(eg omeprazole)

  Name the 2 preferred drug options for treatment of

Histamine2 – receptor blockers 

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

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

Breath,

serologic,

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

Which ones can be used alone? 

Amoxicillin,

metronidazole,

clarithromycin,

tetracycline,

bismuth  (None is effective alone) 

List the antibiotics used in order of

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

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

What effect can Bismuth have on the tongue and stool? 

Stool discoloration may confound interpretation of

What is disulfiram?

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

An antisecretory agent

 (histamine2-receptor antagonist or proton pump inhibitor)

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

  Name the four H₂RAs that are available. 

Cimetidine

Ranitidine

Famotidine

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

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

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

Duodenal ulcers-4 to 6 weeks

Gastoresophageal Reflux Disease

Zollinger-Ellison Syndrome

Aspiration Pneumonitis

Cimetidine binds to androgen receptors, producing receptor blockade.

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

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

confusion, hallucination, CNS depression, and CNS excitation

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

Antacids can decrease absorption of cimetidine 

They should be administered at lease 1 hour apart 

 How common are antiandrogenic effects with

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

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

Nexium,

Nexium I.V.

Protonix,

By creating a protective barrier against

 What is the most significant side effect of sucralfate

Promote cervical ripening

(1) suppressing secretion of gastric acid

(2) promoting secretion of bicarbonate and cytoprotective mucus

  Why is misoprostol (cytotec) contraindicated during pregnancy? 

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

True

On a regular schedule, not just in response to comfort

Magnesium hydroxide

Aluminum hydroxide