Ch. 38: peptic ulcers
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| binds to receptors associated with the stomach (H2 receptors). these receptors stimulate adenylate cyclase. the increased adenylate cyclase results in increased cMP, and the increased cAMP results in activation of protein kinase | histamine
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| activation of these receptors cause influx of calcium, which activates protein kinase | Ach and gastrin
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| stimulation of all htese resultin in hydrogen ion deposition into the stomach and lumen | histamine, Ach, gastrin stimulation
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| MOA of H2 blockers? | inhibt effects of histamine, competitively bind to the H2 receptor on parietal cells. thus, they effetively inhibit the effect of histamine.
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| H2 blockers used for.. | peptic ulcers (zollinger ellison syndrome), to prevent acute stress ulcers, and to treat GERD
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| efects of cimetidine? | anti androgenic, meaning they result in gynecomastia, glaactorrhea, and decreased sperm count.
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| these are H2 blockers. which is most potent? | Ranitidine, nizatidine. famotidine is hte most postent.
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| prostaglands to what to the stomach? | they are cytoprotective to the stomach, increasing mucous and bicarb secretion, decreasing HCL secretion.
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| this is an analog of PGE2, decreases HCL secretion. often used to treat elderly patients who have been on long term NSAID therapy. | misoprostol.
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| contraindication of misoprostol? | pregnancy, because primary side effect is uterine contractions.
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| PPIs? | omeprazole, esomeprazole, lansoprazole, pantoprazole, rabeprazole.
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| these act to inhibit AcH effect in hydrogen ion secretion. suually sresrved for patients with Zollinger ellison syndrome o rin patients with whom other treatments have failed. | antimuscarinics
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| this is an antimuscarinic that is specific for M1 receptors, and so affects the stomach without affecting the heart, eye, and salivary glands. | pirenzepine
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| weak bases that form water and salt when combined with HCl. they will also affect other drugs in that many drugs require a certain pH in order to be absorbed. | antacids
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| its initial effect is that of an antacid, it is actually counter protective, ultimately because it also works through the calcium it provides, to increase gastrin production. | calcium carbinate
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| antacids containing these elements cause constipation and diarrhea, respectively | aluminum and magnesium containing products
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| this results in systemic alkalosis, increased carbon dioxide production yielding flatulence and belching, and increased seru sodiu | sodium bicarb
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| provides mucosal protection. binds to positively charged groups in proteins o fhte normal necrotic mucosa. form a gel over the mucosa, preventing pepsin degradation of th emucus. muscus is a natural protector agianst HCl. | sucralfate
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| works to inhibit pepsin, increasing mucus interaction with necrotic tissues (coats and protects the crater). also toxic to H.pylori as well as many other types of bacteria | bismuth
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| overall, these two serve to prevent mucosal injury, to decrease inflammationa, and heal existing ulcers. | sucralfate and bismuth.
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