Antacids, H2 Blockers, PPIs.txt-corissa

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  1. Antacids are rarely used as the first line treatment... why?
    Bc patients normally have already used these drugs OTC before coming to the provider
  2. The ability for antacids to neutralize gastric acid is called ______?
    • Acid neutralizing capability (ANC).
    • ANC is the amount of milliequivalents that can be brought to pH of 3.5 in 15 minutes.
  3. Antacids with high ____ are most effective
  4. What is the MOA of antacids?
    antacids are weak bases that neutralize gastric hydrocholoric acid by combining with it to form salt and water. 

    they decrease the amount of HCL and increase PH.  they do not assist with healing of ulcers, only reduce symptoms.

    REMEMBER---they do not coat the stomach.. they NEUTRALIZE THE ACID
  5. What is the MOA of sucralfate??
    -sucralfate is a compund with AL hydroxide forms polyvalent bonds with damaged tissues as well as normal GI mucosa.

    -Adheres to ulcer site, providing a barrier to prevent penetration of acid, pepsin, and bile into gastric mucosa.
  6. Sucralfate does what

    Common SE

    What concern for renal impaired?
    Adheres to ulcer site, providing a barrier to prevent penetration of acid, pepsin, and bile into gastric mucosa.


    Because of aluminum retention.
  7. When should you avoid prescribing Sucralfate?
    Sulfa allergies
  8. What is the most common side effect of Sucralfate?

    drug is mostly secreted in the stools -- minimal absorption.

    it does not help in the eradication of H-pylori
  9. As well as neutralizing acid, Antacids also have what effects?

    *Question from last year!
    cytoprotective effects which means they release prostaglandins which protect the stomach mucosa against injury by increasing gastric mucous secretion.. they also inhibit muscle contraction which causes decreased gastric empyting

    **this is counterproductive in GERD
  10. What are some nonpharmacological treatments for acid reflux?
    loose weight, stop smoking (smoking increases GI motility), raise HOB, no drugs, no drinking, increase activity
  11. Which are more effective (more potent) for healing PPI or H2s? Which is the first line treatment?

    **Question from last year
    • 1.PPI
    • 2.PPI

    *These drugs are not used long term... normally just on demand to treat symptoms.. May use PPI at lowest dose possible to control symptoms.
  12. When should you take antacids?

    *Question from last year!
    30 mins after meals for best results, antacids are not effective on an empty stomach

    *these drugs only work for 2 hours. Take 2 hours before or after other meds
  13. How long should PPI be taken?
    4-8 weeks and intermittently
  14. When should you take a PPI?
    • 30-60 mins before other  meds
    • and before meals
  15. Severe and erosive disease, what is DOC
    • PPI
    • Endoscopy is necessary now
  16. What should you prescribe for mild, intermittent signs and symptoms of heart burn?
    • Antacids if s/s <2 hours.
    • If >2 hours... H2 blocker or PPI at night.
    • OTC doses are usually sufficient.
  17. What should you prescribe for Moderate s/s of heartburn? (several times a week or daily)
    PPI (1xdaily) first line b/c more effective, or H2Blocker (2xdaily)

    • PPI usually first line bc they are more effective.
    • Treat for 4-8 weeks then intermittently.
  18. What are the plans for treatment for a patient with severe and erosive disease related to reflux disease?
    • Endoscopy is necessary.
    • PPI is DOC. May need to increase to BID.
    • Treat for 8-12 weeks.
    • May need maintenance therapy but should be the lowest dose possible.
    • May require antireflux therapy if no response to meds.
  19. Reglan can be provided for the treatment of GERD but ONLY when _____ . WHY?
    All other treatment yields no response bc of the serious side effects caused by Reglan.

    *Reglan increases LES ton to promote peristalsis and gastric emptying
  20. What is a side effect of all antacids? 

    **Question from last year
    Acid rebound
  21. When does acid rebound occur with antacids?

    *Question from last year
    2 hours after administration
  22. What is a side effect of Calcium and Aluminum compounds ?
  23. Magnesium based antacids can cause?  They should be avoided in patients with what disease ??
    • 1diarrhea
    • 2elderly with renal failure

    *lots of flatulence

    will often give two antacids together to counteract the side effects of each other
  24. Milk-alkali syndrome can result in
    renal failure, alkalosis, and hypercalcemia

    Occurs frequently in women who are taking calcium supplements above the recommended dosage.
  25. Calcium carbonate should not be given to patients with ____.
    dig toxicity
  26. Aluminum antacids should not be given with what 4 drugs considering that antacids decrease their action?

    *Question from last year
    digoxin, allopurinol, corticosteroids, antifungals, histamine
  27. Magnesium and Aluminum antacids should not be given with ____ and _____.

    *Question from last year!
    dig and corticosteriods
  28. Patients with GERD often have ___ as well. (What chronic disease??)

    82% of patients with asthma have GERD
  29. 78% of patients with GERD as have what symptoms?
    persistent hoarseness
  30. What are the alarm symptoms with GERD that require the need for endoscopy for evaluation?
    dysphagia, odynophagia (painful swallowing), unexplained weight loss, anemia, melana, hematemesis, hoarseness, asthma, unexplained lung disease.
  31. What are the 4 grades of Esophagitis?
    • 1. Erythema of the distal esophagus
    • 2. Scattered erosions
    • 3. Erosions covering 50% of diameter of esophagus
    • 4.  >50% of esophagus covered in erosions

    *a patient my have erosive esophagitis but may be asymptomatic.
  32. PUD is characterized by
    epigastric pain dyspepsia
  33. What two things can cause Peptic Ulcer Disease?
    • 1. long term use of NSAIDS
    • 2. Helicobacter pylori bacterium
  34. Routes of transmission for H pylori?
    • oral-oral
    • oral-fecal
    • iatrogenic
  35. What is the most often seen side effect of PPI or H2blockers?
    abdominal cramping

    may not occur till 6-8 hours after taking med
  36. What is the MOA of H2blockers?

    **Question from last year!
    H2receptor antagonists -- bind with H2 and displace histamine to prevent acid secretion
  37. Should you use PPI and H2 together for more effective treatment??
  38. What is the MOA of PPI?

    **Question on test last year!
    Bind to the proton pump of the parietal cells, irreversibly inhibiting secretion of hydrogen ions from gastric lumen and decrease gastric fluid volume=inhibition of acid secretion.  This DOES NOT EFFECT GASTRIC EMPYTING!!!
  39. When are PPIs taken for treatment of GERD and PUD?

    **Question last year!!
    30 - 60 mins before the first meal of the day for treatment of GERD

    • once or twice a day for treatment of PUD.
    • can be taken at bedtime for acute treatment of PUD -- thought to provide more protection this way to ulcers.
  40. What is the first step in treatment of PUD caused by H. pylori?
    • Step 1:
    • PPI before meals BID, Clarithromycin 500mg BID and Amoxicillin 1 gram BID for 7-14 days.

    Basically its PPI BID and two antibiotics.
  41. What is prescribed when you're RETREATING PUD caused by H.pylori?

    **Question from last year!
    • PPI before meals BID.
    • Bismuthsubsalicylate 525mg QID.
    • Tetracycline 500mg BID.
    • Metronidazole 500 mg QID.
    • for 7 to 14 days.

    Can be used as first line treatment but is typically reserved for RETREATMENT!!
  42. What is the second step in treating H.plyori??
    • continue PPI for 4-8 weeks after first step.
    • alternative drug is H2blocker.
  43. What are examples of H2 Blockers?

    Question from last year!
    • TIDINE***
    • Ranitidine (Zantac)
  44. What are examples of
  45. What is the goal of treatment with Hpylori?

    **Question from last year!
    Relieve, heal, erradicate
  46. What are side effects of PPI??

    What about some drug interactions/disease complications???

    Question from last year!!!
    Diarrhea, HA, abd pain, HTN, tachycardia

    Can decrease Vit B12, can cause osteoporosis, decreases effect of Plavix
  47. What preggo category is Prilosec?
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Antacids, H2 Blockers, PPIs.txt-corissa
2013-10-14 03:21:24

pharm midterm fall 2013
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