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NURS 572 Ch 77

Pharm Ch 77 Peptic Ulcer Disease

peptic ulcers are degrees of erosion of the gut wall the occur here mostly duodenum, and stomach --> bleeding/perforation
what causes peptic ulcers imbalance between mucosal defenses and opposing aggressive factors
name 5 aggressive factors *H. pylori *NSAIDs *acid *pepsin *smoking
Name mediator of defensive factor and 3 processes it manages for defensive factors prostaglandin activation mediates mucous, bicarbonate and blood flow (all defensive factors)
name classes of anti-ulcer drugs *antacids *antisecretory *mucousal protectants *Pg enhancement of mucosal defenses *antibiotics
Two types of antisecretory agents *H2 Blockers *PPIs
bacteria that is 2nd most common infection in world --> peptic ulcer disease H. pylori
Antisecretory H2 blockers MOA blocks histamine from binding H2 -->cAMP 2nd messenger --> thereby blocking proton pump
another name for proton pump H+/K+/ATPase pump (H+ to lumen, K+ exchanged into parietal cell)
5 H2RA (H2 blocking) drugs *cimetidine *ranitidine *famotidine *nizatidine
which drug is shortest acting with most SEs/interactions in H2 blocking class cimetidine, which is Rx/OTC ---oral/inj
pharmokinetics of cimetidine hepatic CYP450 interactions, partially excreted in renal impaired (reduce dose in RF pts)
ADRs of cimetidine *endocrine - adrogeneric/estrogenic actions *CNS - confusion, hallucinations, depression- all more likely in elderly, renal impaired
do ranitidine, famotidine or nizatidine have endocrine or CNS SEs not, they are well tolerated, few interactions
cimetidine class H2 blocker - shortest acting - most interactions
ranitidine class H2 blocker - also available IV
famotidine class H2 blocker - longest acting
nizatidine class H2 blocker - similar to ranitidine
are H2 blocker drugs available OTC as well yes, this class available OTC
PPI = proton pump inhibitor (antisecretory)MOA this ACID LABILE class must be enterically coated so it can survive stomach acid before being released into bloodstream in duodenum where it travels through vasculature to directly inhibit PP
name 5 PPIs in class *omeptrazole *lansoprazole *patoprazole *rabeprazole *esomeprazole
ADRs of PPIs HA, A, N, D, V *carcinogenic potential ONLY seen in animals
which 2 PPIs are available OTC *omeprazole, lansoprazole
unusual feature about PPI half life this class has short half-life that is unrelated to duration of action
omeprazole class PPI - oral only - rx/otc
lansoprazole class PPI - oral/IV - rx/otc
patoprazole class PPI - oral/IV
rabeprazole class PPI like others in class
esomeprazole class PPI - isomer of omeprazole
MOA of mucosal protectant drug non-antisecretory - forms topical protective layer that lasts 6 hours (QID admin)
ADRs of mucosal protctant drug sucralfate *constipation very common *Al+++ component --> drug interactions
name of mucosal protectant drug sucralfate (carafate)
drug class that enhances action of mucosal protectants prostaglindins - non-antisecretory, act by increasing action of protective mechanisms
misoprostol class enhance mucousal protectant class
misoprostol indicated for prevention of NSAID induced gastric ulcer, as well as other applications from other chapters
misoprostol MOA exerts all protective effets that endogenous Pgs do for mucosal protection (+mucous, +bicarb, +blood flow). not-antisecretory
serious ADR misoprostol ABORTIFACIENT contraindicated in pregnancy
Created by: lorrelaws