B5 GI-Renal Pharmacology Final Exam

B5 GI-Renal Pharmacology Final Exam Promoters of Gastric Acid Secretion - - Ach from vagus n (PS) - Hist from enterochromaffin-like (ECL) cells - Gastrin from G cells Inhibitors of Gastric Acid Secretion - - Somatostatin from delta cells - PGE2 from gastr muc Pathophysiology & Common Sx of GERD - AKA acid reflux, heartburn - Pathophys = stom cont/gastr ac reflux into esoph -- sx+complics; maybe by decr LES press/musc tone -- treat by 1). incr LES press, 2). decr stom ac secr - Common Sx = heartburn, hypersal, ac regurg, acidic taste Alarm Sx & Complications of GERD - - Alarm sx = CP, dysphag, odynoph, anemia, GIB, wt loss - Complics = esoph eros, strics, bl, Barrett's esoph, adenocarc (rare) 2 Types of GERD - - Eros reflux dis = sx w/ muc dam - Non-eros reflux dis (NERD) = sx w/o muc dam Foods/Beverages Worsening GERD Sx by Decr LES Pressure - - fatty meal - carminatives (ie. peppermint, spearmint) - choc - coffee, cola, tea - garlic - onions - chili peppers - EtOH esp wine Meds Worsening GERD Sx by Decr LES Pressure - - Antichols - Barbs - Caffeine - Dihydropyridine CCBs - Dopa - Estrogen - Nic - Nitrates - Progesterone - Tetracyc - Theophylline Foods & Drugs Worsening GERD Sx by being Direct Irritants to Esophageal Mucosa - - Spicy foods - Orange juice - Tomato juice - Coffee - Tobacco B5 GI-Renal Pharmacology Final Exam - Asp - Bisphosphonates - NSAIDs - Fe - Quinidine - Potassium chloride Non-pharmacological Treatments for GERD - - Lifestyle mods = wt loss if overwt; elev head of bed, avoid meals 2-3hr before bed if nocturnal sx; psych stress red; avoid smoking, trig foods+meds - Surg = laparoscopic fundoplic, gastric bypass in obes gen not rec if not resp to PPIs Pharmacologic Treatment Options for GERD - - Antacids -- neutr stom ac - Hist-2 R Antags (H2RAs, ie. Cimetidine) -- block H2 rec basolat memb -- (-) adenylyl cyclase, (-) cAMP -- (-) prot pump activ - PPIs (ie. Omeprazole) -- prev ac secr by dir block H+ chann - Sucralfate & Bismuth comps -- prot coat over ulcers - Misoprostol -- stim PGE2 rec -- (+) Gi prot -- (-) AC & cAMP Pharmacological Treatment Guidelines for GERD - - initial self-treat w/ OTC antac/PPI/H2RA - further treat if alarm sx, recur sx 2wks lifestyle mods/self-treat - Pref empir ther = 8wks PPI QD - Maint/Cont ther if recur sx 8wks PPI/eros esoph/BE -- PPI BID if unresp to QD, H2RA if NERD but less effec than PPI Pathophysiology of PUD - muc def gastr/duod wall from innermost muc into deeper lays - epis gnaw epig pain relieved by eating if duod ulc, relieved by not eating if gastr ulc - bl = most freq+sev complic; also perf, gastr out obstr Common Causes & Dx of PUD - - H. pyl, chron NSAIDs incl Asp, physical stress - dx via endoscopy; also H. pyl test by urea breath test, stool Ag H. pylori General Features, Sx, Risk Factors - G- fec-or bac surv in ac EVRs by env in neutr EVR by urea metab due to high urease activ conv urea to ammonia+CO2 - ammonia prev D cells antral gl sensing acidity -- (-) somatostatin -- (+) gastrin -- (+) ac secr - Sx = dyspep, epig abd p, GIB - RFs = smoking, chron NSAIDs Preferred First-Line Therapy Regimen for H. Pylori - Bismuth Quadruple Therapy x10- 14d - Bismuth Salicylate - Metronidazole - Tetracyc - PPI B5 GI-Renal Pharmacology Final Exam -Doxy can be used in place of Tetracyc - Tinidazole can be used in place of Metro Concomitant Quadruple Therapy for H. Pylori - x10-14d - Clarithro - Amox - Metronidazole - PPI - Tinidazole can be used in place of Metro Triple Therapy for H. pylori - 2 abx+PPI x14d - Clarithro - Amox - PPI OR - Clarithro - Metronidazole - PPI **AVOID in areas Clarithro resis15% OR pts w/ prior Macrolide expos for any indic** - Tinidazole can be used in place of Metro Rule for Abx Rx for H. pylori - must have @ least 2 abx agents in quadruple ther w/ each abx having diff MOA NSAID-Associated Ulcer Sx & Treatment - most w/ asymp pep ulc, less w/ complics like bl, perf - Treatment = discont NSAID if poss 1). 8wks H2RA or PPI for rap ulc heal - erad ther if +H.pyl - if NSAID must be cont, PPI better for ulc heal but consid COX-2 sel NSAID (ie. Celecoxib) but incr thromb risk Examples, MOA, Indications for Antacids in GERD & PUD - incl Al hydrox, Ca carb, Mg hydrox, Na bicarb, combos - MOA = weak bases neutr gastr ac to incr gastr pH - fast-acting w/in mins & short dur 30-60mins - Indics = mild infreq indig/GERD; CaCO3 (ie. Tums) for hypocal, off-lab for osteop; Mg(OH)2 (ie. Phillips Milk of Magnesia) for hypomagnesemia, constip; NaHCO3 for diarr, metab acid, drug tox **DOC for GERD in preg** B5 GI-Renal Pharmacology Final Exam AEs, CIs, Warnings for Antacids - - AEs = constip, hypercal, milk alkali synd for CaCO3; constip, hypophosph for Al(OH)3; diarr, hypermag for Mg(OH)2; gastr disten, belch, metab alk for NaCO3 & CaCO