4 Written Questions

1. Proton Pump Inhibitor
   Prodrug (needs to be metabolized to be active)
   MOA: recues acid secretion by irreversibly binding to enzyme H+/K+-ATPase, inhibit basal and stimulated acid release, inhibits H. pylori urease
   Indications: short term therapy of PUD, sympatomatic treatment of GERD, long term in patients with Zollinger-Ellison Syndrome (pancreatic tumor that secretes high levels of HCl)
2. Poorly absorbed and system pH is unaltered
   
   Sodium Bicarbonate: accelerate excretion of aspirin, can alter serum pH b/c readily absorbed-->be cautious with those with HTN, renal issues, etc.
   
   Magnesium: rapid acting, long duration, high ANC, diarrhea/laxative, Contra: renal impairment-->Mag toxicity-->decreased resp
   
   Calcium Carbonate: constipation, rapid acting, long duration, high ANC, high risk of acid rebound; can cause flatulence because CO2 released in stomach
   
   Aluminum:constipation, long duration, low ANC, slow onset, has strong affinity to phosphate-->decrease absorption of phosphate (hypophosphonemia)-->binds to pepsin (decreased mucosal cell damage-->facilitate healing)
3. Anticholinergic
   MOA: "selective" blockade of the muscarinic receptors that regulate gastric acid secretion, decreases gastric secretions, delays gastric emptying times
   ADR: dry mouth
4. This makes chemicals that allow it to stick tightly to the GI mucosa (adhesins)
   Can remain active for life, if not treated properly
   Eradication of the organism allows ulcers to heal more rapidly and prolongs periods of remission
   Two or more antibiotics are concurrently administered (acid + bacteria= work together)
   These are combined with a PPI or H2RA to increase pH
   Therapy generally continues for 7-14 days
   Most common antibiotics used are: Amoxil, Biaxin, Flagyl, Achromycin
   Bismuth compounds can be added to inhibit bacterial growth and prevent GI mucosa adhesion (pepto-bismol-->bacteriostatic)
   Combo packs are available to simplify the purchase and administration of multi-drug therapy

4 Multiple Choice Questions

1. Antacids
   MOA:alkaline, inorganic salts that neutralize stomach acid which inhibits pepsin activity, enhance mucosal protection by stimulating production of prostaglandins
   Therapeutic action: temporary relief from PUD and GERD
   Various kinds-all which are equally effective; differ in Acid Neutralizing Capacity (ANC)-->duration, onset, systemic effects, bowel/local effects
   1. Prilosec
   2. Maalox
   3. Carafate
   4. Zantac
2. Pain relief may not occur for several days after beginning therapy
   Avoid alcohol, tobacco and aspirin
   Monitor CBC d/t hematological effects (iron deficiency)
   Look at hemoglobin: MCV (cell size) and MCH (cell color); MC means mean complostular
   May increase risk of Pneumonia (b/c increase colonization of bacteria d/t increased gastric pH)
   1. Important Points regarding Antacids
   2. Important facts regarding H2RAs
   3. Types of Antacids
   4. Important facts regarding PPIs
3. Antipeptic Agent
   MOA: forms an ulcer-adherent complex at duodenal ulcer sites and inhibits pepsin activity
   Therapeutic: gel-like substance protects eroded ulcer sites from further damage by acid and digestive enzymes, plays and indirect role in promoting healing (no action on acid)
   Drug-Drug: should take 1 hour before or after other drugs, must be taken 4 times a day on empty stomach, constipation is only major effect
   1. Zantac
   2. Cytotec
   3. Carafate
   4. Maalox
4. Does not directly promote healing of ulcer
   Does not coat ulcer to protect it
   Take 2 hours before or after other oral drugs
   Some antacid preparations contain H2RAs or simethicone (antiflatulent agent) -->important for Ca Carbonate
   Dose must increase gastric pH to a minimum of 5 to have effect (decrease pepsin activity)
   1. Important Points regarding Antacids
   2. Types of Antacids
   3. Important facts regarding H2RAs
   4. Important facts regarding PPIs

3 True/False Questions

1. Cytotec → Prostaglandin E1 Agents
   MOA: binds to prostaglandin receptors (NSAIDS: inhibits prostaglandin synthesis (COX 2), increases bicarbonate and mucus production in the stomach (not duodenum, just gastric ulcers), maintains submucosal blood flow, also used as an abortifacient (category X) because uterine contractions-->miscarriage, does everything COX 1 (good one) does to GI
   Therapeutic: protects stomach lining and prevents the formation of gastric ulcers
   Other facts: administered to patients taking high doses of NSAIDS or corticosteroids, taken 4 times a day with meals and at bedtime
   ADR: diarrhea

   True        False

2. Zantac → Histamine-2 Antagonists (H2RAs)
   MOA: selectively blocks H2 receptors located on parietal cells (doesn't prevent release of histamine)
   Therapeutic action: suppresses volume and acidity of stimulated parietal cell secretions, inhibits both daytime and nocturnal basal gastric acid secretions, does NOT affect pepsin secretion or serum gastrin levels
   Should be taken after (30 mins.) or during meals because histamine has to be there to be blocked

   True        False

3. Important facts regarding PPIs → Pain relief may not occur for several days after beginning therapy
   Avoid alcohol, tobacco and aspirin
   Monitor CBC d/t hematological effects (iron deficiency)
   Look at hemoglobin: MCV (cell size) and MCH (cell color); MC means mean complostular
   May increase risk of Pneumonia (b/c increase colonization of bacteria d/t increased gastric pH)

   True        False