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PC707- MODULE 3 QUESTIONS AND ANSWERS
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PC707- MODULE 3 QUESTIONS AND ANSWERS
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PC707- MODULE 3 QUESTIONS AND ANSWERSAnti-Ulcer drugs help by: - Answers- -altering gastric pH by decreasing acid secretion
-protecting the stomach wall lining by increasing mucosal protection
-eradicating harmful bacteria Ex: H. Pylori
What are the main pharmacologic categories of drugs we used to manage gastric acid
secretion and the effects: - Answers- -antacids
-H2 receptor antagonists
-proton pump inhibitors (PPIs)
-prostoglandin analogs
-mucosal protectant sulcrafate (Carafate)
What is the first OTC medication tried by patients with dyspepsia? - Answers- -Antacids
-->these are typically not effective for persistant GERD and PUD
What are antacids? How do they work? - Answers- -organic salts
-neutralize the hydrochloric acid in the stomach
-raises the gastric pH above 4.0
What are the typical order of interventions for pregnancy heartburn? - Answers- -
lifestyle changes then try antacids
-Milk of magnesia is first line* --category B
-Tums--category C
-make sure to consider if she has diarrhea or constipation
-if antacids fail to work--H2 receptor antagonists are next
-Zantac is the most studied and deemed the safest H2 blocker in pregnancy*—however,
Zantac currently is being investigated to have a carcinogen—Pepcid is a great
alternative
What are H2 receptor antagonists? How is it different from H1 receptor antagonists? -
Answers- -H2 receptors are primarily in the parietal cells of the stomach and when
stimulated increase the secretion of gastric acid
-H2 blockers help to competitively block the binding to these receptors--therefore
decreasing acid secretion*
-this is different from H1 blockers--which primarily blocks the histamine that is involved
in allergic reactions
What are the different types of H2 receptor antagonists? - Answers- -cimetidine
(Tagamet)
-famotidine (Pepcid)
-ranitidine (Zantac)
-nizatidine (Axid)
,Why should cimetidine (Tagamet) be avoided whenever possible? - Answers- -it is a
potent CYP enzyme inhibitor causing deceased metabolism of many drugs--increasing
drug levels*
-many drug to drug interactions: warfarin, phenytoin, propanolol, nifidepine,
chlondiapoxide, diazepam, lidocaine, tricyclic antidepressants, theophylline,
metronidazole*
Why is famotidine (Pepcid) a good go to drug for H2 antagonist? - Answers- -least CYP
inhibitor effect
-fewer drug to drug interactions
Why is it important to document a thorough assessment of different drugs the patient
has tried to relieve dyspepsia? - Answers- -many insurance companies require a step-
wise approach to prescribing before approving
-antacids-->H2 blockers-->PPIs
What are the only lifestyle changes that could reduce the symptoms of GERD? -
Answers- -elevation of HOB
-weight loss
-avoiding meals 2-3 hours before bed
Plans for treating GERD begins with determining the severity of symptoms. True or
false? - Answers- -true
-if a patient comes in with moderate-severe GERD OR erosive disease and they most
likely have already tried antacids and/or H2 blockers--next step is PPIs*
-if a patient comes in with mild GERD they may or may not have tried antacids, if so--try
H2 blockers*
It's very important to educate patients to take antacids & vitamins/iron supplements: -
Answers- -at least 2 hours apart
-taking them together can cause little to no absorption of the vitamins/supplements and
may cause deficiencies
Pepto-Bismol (bismuth subsalicylate) take aways: - Answers- -not known to be effective
for dyspepsia
-may change the color of stool to black
-Contraindicated in pregnancy, lactation, and children <12 due to aspirin content*
-antimicrobial, antisecretory, mild anti-inflammatory
-May cause black tongue
-could be used as adjunctive in tx of H. Pylori
What are the main side effects of antacids? - Answers- -diarrhea
-constipation
, What are the different categories of antacids? - Answers- -calcium carbonate
-sodium bicarbonate
-aluminum based
-magnesium based
-aluminum hydroxide
What is important teaching for patients taking antacids? - Answers- -decreasing the
stomach pH can cause the decrease absorption of drugs that rely on acidic conditions
-if taking enteric coated medications--reducing stomach acid can cause the medication
to dissolve and absorb in the stomach instead of the intestine
**always separate antacids from other medications by 2 hours**
Calcium carbonate antacids: - Answers- -Tums
-can cause CONSTIPATION
-require adequate fluid intake to dissolve
-can be used in patients needing to take an antacid who also could benefit from extra
calcium intake. -potential for milk "alkali" syndrome, metabolic alkalosis
Sodium Bicarbonate antacids: - Answers- -Alka Seltzer
-contains aspirin (ASA)
-potential to WORSEN GI distress. -increased risk for water retention and fluid overload
-potential to cause hypertension
-Contraindicated in pregnancy, children, patient with CVD*
Aluminum based antacids: - Answers- -Amphogel
-can cause CONSTIPATION
-requires adequate fluid intake to dissolve
-Contraindicated in patients with renal insufficiency*
Magnesium based antacids: - Answers- -Milk of magnesia
-suspension mixture is more effective
-can cause DIARRHEA
-Contraindicated in renal insufficiency*
Aluminum hydroxide antacids: - Answers- -may decrease the absorption of warfarin*. -
can cause a chelating affect with drugs such as tetracyclines, warfarin, and digoxin—
potentially decreasing their absorption & effectiveness -high affinity for phosphate—may
cause hypophasphatemia
What can cause heartburn in pregnancy? - Answers- -hormonal fluctuations
-anatomic changes
Are antacids safe in pregnancy? - Answers- -Yes, due to poor absorption
-EXCEPT sodium bicarbonate (AlkaSeltzer) due to aspirin content, risk for fetal and
maternal metabolic alkalosis, and fluid retention and overload*
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