Card Set Information
PUD GERD IBD
What are the three common forms of PUD?
Helicobacter pylori induced
What is the MOA for antacids?
neutralize gastic acid by raising the intragastric pH
inhibits conversion of pepsinogen to pepsin
stimulate the production of mucosal prostaglandins
increases LES tone
Explain what antacids are used for and how they are taken
Used for symptomatic relief
NO healing power
in suspensions (liquids), so absorped better
What side effects must you watch our for when using antacids?
Aluminum based = constipation
Magnesium based = diarrhea
What are some drug interactions for Antacids that cause chelation?
What is a drug interaction with antacids that cause inactivation
What drug interactions with antacids cause decrease absorption?
What are some antacid products?
Aluminum + Magnesium
*quick onset, short duration, need many doses
*may mask more serious problems
What is the MAO for Histamine-2 Receptor antagonists (H2RA)?
Inhibits histamine receptors on parietal cells
Decreases the secretion of H+ ions
When are H2RA indicated as 1st line treatment?
mild-moderate PUD or GERD
What is the MAO of proton pump inhibitors?
Irreversible inhibition of H+/K+ ATPase on parietal cells - decrease gastric acid
Protonation in small bowel necessary for drug to be activated
When is a PPI indicated as 1st line treatment?
Moderate-severe PUD or GERD
H2RA's can also be used for...
Maintenance of remission
treatment of NSAID ulcers
erosive or non-erosive esophagitis
treatment of DU/GU
PPI can also be used for..
Maintenance of remission
treatment of H. pylori
treatment of NSAID ulcers
treatment of DU/GU
treatment of erosive esophagitis only
What is the duration of treatment for DU, GU, and GERD for both PPIs and H2RA?
H2RA - DU 4-8wks, GU 8wks, GERD 8wks
PPI - DU 4-8wks, GU 4-8wks, GERD 8wks
When is the best time to take an H2RA?
Take a larger dose before bedtime
When is the best time to take a PPI?
Take 30-60 minutes before a meal
done to maximize inhibition of proton pump
What are the PPI drugs?
What are the adverse effects and drug interactions of lansoprazole?
Interactions - Theophylline, ketoconazole, iron, ampicillin, sucralfate
What are the adverse effects and drug interactions of Omeprazole?
AE-nause, HA, diarrhea
interactions - warfarin, phenytoin, diazepam, ketoconazole, sucralfate, clopidogrel
What are the adverse effects and drug interactions of Rabeprazole?
AE - Nausea, HA, diarrhea
interactions - Ketoconazole, iron, ampicillin
What are the adverse effects and drug interactions of pantoprazole?
interactions - ketoconazole, iron, ampicillin
What are the adverse effects and drug interactions of esomeprazole?
AE - HA and diarrhea
interactions - Ketoconazole, iron, ampicillin, clopidogrel
What is sucralfate and how does it work?
Promotes mucosal defenses by forming reacting with hydrochloric acid to form a paste like substance and and binds to surface of ulcer
barrier allows ulcer to heal
NO acid reducing capacity
How does the inhibition of COX-1 in nonspecific NSAIDS work?
Inhibits cyclo oxygenase which decreases prostaglandins and decreases inflammation
BUT by decreasing prostaglandins it decreases the protecting in GI tract
Where are COX-1 inhibitors found?
GI tract & Kidney
Where are COX-2 inhibitors found?
in sites of inflammation
What is the TX of NSAID induced ulcers?
D/C NSAIDS if possible
start a PPI or H2RA
*if you have to continue NSAID - use a PPI
How can you prevent NSAID induced ulcers and when is it indicated?
Use Misoprostol which causes bad diarrhea
Use in HIGH RISK pt w/ prior history, >60yo, high does NSAID therapy, receiving anticoag. corticosteriods
deal w/diarrhea with high risk patients
What is the MAO of Misoprostol?
Prostaglandins E 1 analog
Stimulates production of mucous and HCO3-
What are the adverse effects of Misoprostol?
What is the one contraindication for Misoprostol use?
Women of childbearing age!
What is the treatment of NSAID induced ulcers?
stop NSAID therapy when ulcer occurs
PPI - agent of choice when NSAIDS must be continued
Tx H.pylori when pt. taking NSAIDS who have ulcers and are infected with the organism
How do you treat H. pylori?
Combine 2 antibiotics plus a PPI or H2RA
Bismuth + metro + tetracycline x 2 weeks
Lansoprazole + clarithro + amoxicillin x 10 days
Omeprazole + clarithro + amoxi x 10 days
Esomeprazole + clarithro + amoxi x 10 days
Rabeprazole + clarithro + amoxi x 10 days
What is the duration of treatment for H. pylori?
The 2 antibiotics should be continued for 7-14 days
The PPI or H2RA should be continued for 2-5 weeks after anbx stops
What is bismuth based quadruple therapy?
Special therapy for H. pylori
uses a PPI or H2RA with bismuth, metro, and tetra for 10-14 days
What are the combination products used to treat H. pylori?
Ranitidine bismuth citrate - Tritec
lansoprazole, amoxicillin - Prevpac
Bismuth subsalicylate, metro, tetracycline - Helidac
What are four complications of GERD?
What is the Non-Pharm treatment of GERD?
Diet, avoid exercise, tight clothing, smoking
Avoid nicotine, iron, potassium, alcohol, and narcotics
What is the empiric treatment of GERD?
OTC antacids - OTC H2blockers or OTC PPI
Rx H2 blockers or PPI
When do you use an antacid for GERD?
infrequent mild sx
What is H2RA's role in treatment of GERD?
1st line for chronic, mild-moderate GERD
must monitor sx and AE's
What is PPI's role in the treatment of GERD?
1st line in moderate to severe GERD
when other agents fail
must not chew, take 30-60 minutes before meal
most monitor for sx and AE's
What is the MAO for metoclopramide?
Stimulates motility in upper GI
Increases LES tone
increases antral contractions
What are the AE's for Metoclopramide?
When is Metoclopramide contraindicated?
What are some drug interactions with Metoclopramide?
What should you monitor Metoclopramide for?
What drug classes are used in the treatment of Ulcerative Colitis (UC) and Crohns?
What is the MAO for aminosalicylates (ASA)?
1st line for UC and Crohns
reduce prostaglandin & leukotriene production
inhibits bacteria-induced chemotaxis
What are the agents classified as Aminosalicylates?
What do all Aminosalicylates do?
They are cleaved into products that provide anti-inflammatory activity in the colon/rectum
effects are primarily topical
Split products include 5-aminosalicyclic acid (5-ASA)
When are Corticosteriods used and what is a contraindiction?
Used for short-term use
Contra - LT use see cushing-like condition
What are the corticosteriods used in the treatment of IBD?
Prednisone, methyprednisone, hydrocortisone
What is the specific agent used in the treatment of UC and IBD?
high oral potency in UC use
Low bioavailabity - released in ileum for disease affecting ileum or ascending colon
What is the dosing of corticosteriods?
for MODERATE acute exacer - 40-60mg q24h
*prednisone is drug of choice
for SEVERE exacer - IV therapy
*Methylprednisone is drug of choice
taper does when withdrawing
Hydrocortisone is used in the treatment of UC and IBD
Oral or topical use
enema is more effective than suppository or foam
Foam - greater system absorption
What is Budesonide and how does it work?
Enteric coated oral product that allows drug to be released in the ileum and ascending colon
exerts local anti-inflammatory effect
Induces remission in mild-moderate Crohns disease of ileum and ascending colon
What are some AE's of corticosteriod use?
Increased fluid retention
What do we need to monitor corticosteriods for when treating IBD?
Acute- BP and Glucose
Chronic - Lipids, fasting glucose, Electrolytes, Bone density
What are the pros and cons of using Immunsuppresives to treat IBD?
Pros - maintain remission, reduce steriod use
Cons - very slow onset (3-12 months), Lots of AE's, Cost
What are the immunosuppresive agents used for treating IBD?
what is the MAO for Azathioprine/6-Mercaptopurine?
Inhibits purine synthesis
Inhibits DNA synthesis
Decreases cell replication
What is the time of onset for Azathioprine/6-Mercaptopurine and was are some side effects?
Time of onset - 3-6 months
SE's - lots of hemotologic effects 'penias', pancreatitis
What are some contraindications for the use of Azathioprine/6-mercaptopurine?
What are contraindictions to the use of Azathioprine/6-Mercaptopurine?
Active liver disease
Caution with severe renal impairment
What is the MAO for Methotrexate?
Inhibits dihydrofolate - important in folic acide production
Decreases further cell replication
What is the time of onset for Methotrexate?
time of onset - 12-16 weeks
What are the adverse effects of Methotrexate?
Most serious are hemotological
Folic acid def.
*Contraindicated in Pregnacy
What is the MAO for cyclosporine?
Binds to cyclophilin receptor
inhibits T-cell activation
decreases cytokine production
What is the time of onset for cyclosporine?
time of onset - 2-3 days IV
What are some AE's of Cyclosporine?
When are antibiotics used to treat IBD?
Used in Crohns disease only
used when microorganisms is suspected but not proven
What are the antibiotics used to treat Crohns disease?
What are the Monoclonal antibodies used in treating IBD?
What is the MAO for infliximab?
Neutralizes activity of soluble TNF alpha by binding to TNF alpha receptors and inhibit receptor binding
Reduces infiltration of inflammatory cells and TNF alpha production
Reduces mononuclear cell ability to express TNF alpha and interfero
How is infliximab dosed?
Given every week or every 2 weeks and slowly progress to give it every 8 or 9 weeks as maintenance
this treatment continues forever
What are some AE's to infliximab?
What can infliximab produce if used inproperly?
Information about other Monclonal antibodies
Adal - TNF alpha blocker, similar AE to inflix
Nata - leukocyte blocker for pt. who cant tolerate TNF blocker, careful of JC virus may lead to death