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Anti-Ulcer Drugs: Mechanisms, Classifications, and Clinical Applications, Exams of Medicine

Frontier Nursing University (FNU)Medicine

A comprehensive overview of anti-ulcer drugs, focusing on their mechanisms of action, classifications, and clinical applications. it details various drug categories such as antacids, h2 receptor antagonists, and proton pump inhibitors, explaining their uses, side effects, and interactions. the document also includes important considerations for patient education and treatment strategies, making it a valuable resource for students of pharmacology and healthcare professionals.

Typology: Exams

2024/2025

Available from 05/26/2025

SERENAWILLIAMS 🇺🇸

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PC707 Module 3 Questions | 100% Correct

Answers | Verified | Latest 2025/26

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Anti-Ulcer drugs help by: - ✔✔

-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: - ✔✔

-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? - ✔✔-Antacids

-->these are typically not effective for persistant GERD and PUD

What are antacids? How do they work? - ✔✔-organic salts

-neutralize the hydrochloric acid in the stomach

-raises the gastric pH above 4.0

What are the main side effects of antacids? - ✔✔-diarrhea

-constipation

What are the different categories of antacids? - ✔✔-calcium carbonate

-sodium bicarbonate

-aluminum based

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Anti-Ulcer drugs help by: - ✔✔

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: - ✔✔
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? - ✔✔-Antacids -->these are typically not effective for persistant GERD and PUD What are antacids? How do they work? - ✔✔-organic salts
neutralize the hydrochloric acid in the stomach
raises the gastric pH above 4. What are the main side effects of antacids? - ✔✔-diarrhea
constipation What are the different categories of antacids? - ✔✔-calcium carbonate
sodium bicarbonate
aluminum based

magnesium based
aluminum hydroxide What is important teaching for patients taking antacids? - ✔✔-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: - ✔✔-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: - ✔✔-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: - ✔✔-Amphogel
can cause CONSTIPATION
requires adequate fluid intake to dissolve
Contraindicated in patients with renal insufficiency* Magnesium based antacids: - ✔✔-Milk of magnesia
suspension mixture is more effective
can cause DIARRHEA
Contraindicated in renal insufficiency*

Why should cimetidine (Tagamet) be avoided whenever possible? - ✔✔-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? - ✔✔-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? - ✔✔-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? - ✔✔-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? - ✔✔-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: - ✔✔-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: - ✔✔-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 is metoclorpramide (Reglan)? - ✔✔-dopamine antagonist
promotes gastric emptying (prokinetic)
tones the lower esophageal sphincter
occasionally is used in pregnancy
risk for tardive dyskinesia* BLACK BOX WARNING: Reglan - ✔✔-chronic use is associated with tardive dyskinesia
can be irreversible
should be avoided in all but rare cases where the benefits outweigh the risks Reglan using during lactation? - ✔✔-may help increase maternal prolactin release and used as a galactagogue to increase milk production significantly when effective--can work in 1-2 days!
AAP recommends avoiding use due to potential antidopaminergic effects on the infant
however, dose given & amounts actually in breastmilk is much less than standard dose given to an infant requiring the medication
must weigh risks versus benefits What is GERD? - ✔✔-dysfunction of the anti-reflux mechanism of the lower esophageal sphincter
goals are lifestyle changes & symptom relief What is the fastest treatment for a patient with acute gastric distress? - ✔✔-antacids
H2 antagonists & PPIs take more time to decrease the acid What is a GI cocktail? What must you ALWAYS rule out before giving it? - ✔✔-used for severe GI distress
contains Maalox/Mylanta, Lidocaine, Donnatal
Cardiac events must be ruled out--this cocktail could mask cardiac symptoms*

contraindicated in pregnancy (category X) UNLESS for cervical ripening--can cause uterine contractions*
not recommended in lactation--limited information What is mucosal protectant sulcrafate (Carafate)? - ✔✔-does not neutralize or decrease acid
promotes ulcer healing by coating the ulcers with a gel like substance that creates a barrier against pepsin & acids
very few drug-drug interactions or adverse effects—however, can decrease absorption of certain drugs in particular warfarin, theophylline, digoxin, phenytoin* What is important to remember if a patient is going to stop taking a PPI? - ✔✔-they must wean off of it slowly
if they abruptly stop--it could cause rebound hyperacidity* What is Peptic Ulcer Disease (PUD)? - ✔✔-erosion of the GI mucosa
typically caused by H. Pylori (gram - bacillus)*
multi-drug regimens are needed to treat due to high resistance (lack of compliance due to cost & multi- drug plan)*
goals are symptom relief, gastric & duodenal mucosa healing, and prevention of complications and reoccurrence H. Pylori increases the risk for: - ✔✔-gastric cancer—due to chronic inflammation What is the step-wise approach to managing GERD? - ✔✔-lifestyle changes-->antacids-->H2 blockers--

PPIs for 8 weeks then reassess to possibly wean-->if erosive esophagitis/Barrets continue on PPI and reassess every 6-12 months with potential referral-->if no response to PPI refer to GI specialist

important to remember--symptom severity dictates where you start in the treatment* Quadruple therapy is the new recommendation in the treatment for H. Pylori except in the rare case that: - ✔✔-local clarithromycin resistance rates are less than 20%
resistance rates are very important to consider when prescribing antibiotics*

Are PPIs safe in pregnancy and lactation? - ✔✔-limited data available but data is reassuring and indicates no teratogenicity

animal studies of Prilosec* have showed teratogenic effects but was not found in subsequent studies
only use if other choices do not work
potentially reassess for reasons H2 blockers and antacids didn't work and reconsider lifestyle
mixed safety in lactation--best to avoid if possible What are some lifestyle changes that can help with constipation? - ✔✔-increased fiber intake
fluids
regular exercise
set consistent bowel habits What is the first line treatment for constipation if lifestyle changes do not work? (Non-pregnant patient)
✔✔-hyperosmotic laxatives--safer profile What are the different classes of laxatives? - ✔✔-osmotic
bulk-forming
surfactant
stimulant
"lubricant"--glycerin suppositories
"others"--lactulose & mineral oil Contraindications for use of any class of laxatives: - ✔✔-undiagnosed abdominal pain, nausea, vomiting, or suspected bowel obstruction
symptoms could indicate appendicitis, regional enteritis, diverticulitis, ulcerative colitis, or bowel obstruction* Why is bowel obstruction a contraindication for using laxatives? - ✔✔-increasing peristalsis could cause bowel perforation* What are the different types of osmotic laxatives? What are the common side effects? - ✔✔-sodium & magnesium salts

potential to cause esophageal obstruction or bowel obstruction*
avoid in patients with narrow esophageal lumen* What are surfactant laxatives? - ✔✔-"stool softeners"
ducousate sodium (Colace)
decreases surface tension to allow water to move into stool
alters the stool consistency
works in 1 - 3 days
daily use may cause bowel dependence What is mineral oil used for? - ✔✔-used as a surfactant laxative
works in 1 - 3 days
it can cause decreased absorption of fat soluble vitamins causing vitamin deficiencies (A, D, E, K) What are stimulant laxatives? - ✔✔- Increases peristalsis by intestinal nerve stimulation
Increased water & electrolytes in the intestinal lumen
acts as an "irritant"
only use as last resort
use with caution--overuse can cause bowel dependence
works in 6 - 12 hours
Ex: bisacodyl (Dulcolax) & senna (Senokot or Ex-lax) & Castor oil What do some people abuse stimulant laxatives for? - ✔✔-eating disorders What is the first line for constipation in pregnancy--after lifestyle & diet changes? - ✔✔-bulk-forming laxatives
these have very low systemic absorption What is important to remember when choosing a laxative in pregnancy? - ✔✔-some laxatives can stimulate peristalsis and may cause uterine contractions

stimulant laxatives are contraindicated in pregnancy
Ex: castor oil--category X What is important to monitor when giving laxatives to the elderly? - ✔✔-monitor for dehydration Which laxatives are deemed the safest in pregnancy and lactation? - ✔✔-bulk-forming laxatives (Metamucil or Citrucel)
glycerin suppositories What alternative laxatives could be used in pregnancy & lactation? - ✔✔Pregnancy:
ducosate sodium (Colace) is category C in pregnancy Lactation:
Colace & Senokot is safe in breastfeeding Rectal enemas in pregnancy? - ✔✔-strictly contraindicated during pregnancy--may cause pre-term labor Functional constipation? - ✔✔-infrequent or painful defecation, fecal incontinence, and abdominal pain
no underlying organic cause
common in children What are some red flags in children who come in with "constipation"? - ✔✔-constipation starting < month old
passage of meconium >48 hours old
family history of Hertzsprung Disease (HD)
blood in stool
failure to thrive
fever
bilious vomiting
severe abdominal distention

What treatment options are available for travelers diarrhea? - ✔✔-if bacterial--first line is now a macrolide (azthromycin)*

if salmonella, giardia, E. histolyic--Flagyl could be used (no alcohol with use)* Should you treat every person with travelers diarrhea? - ✔✔-there is faster relief with antibiotics & anti motility drugs
however, do not treat unless it's severe
it may cause acute retention of the offending pathogen Would you give a patient an antibiotic to "prevent" travelers diarrhea before they travel? - ✔✔-NO
this leads to antibiotic resistance What is the first line anti-motility drug in pregnancy & lactation? - ✔✔-loperamide (Imodium)-category B--minimal oral absorption and minimal in breast milk AVOID Pepto-Bismol in pregnancy & lactation due to salicylate content What are some potential herbals that could be used for constipation? - ✔✔-black psyllium
blond psyllium
prunes Black psyllium: - ✔✔-can be used for constipation
adverse effects are transient flatulence & abdominal distention
make sure to consume enough water to avoid esophageal & bowel obstructions* Blond psyllium: - ✔✔-can be used for constipation
as effective as Senokot & Colace
not as effective as prunes* Prunes: - ✔✔-can be used for mild or moderate constipation
safe, palatable, and more effective than psyllium

What is irritable bowel syndrome (IBS)? - ✔✔-functional

no specific organic pathology
abdominal pain, altered bowel habits, and abdominal distention
can be predominately constipation, diarrhea, or alternating
said to have "excessive" bacteria
goals are symptom relief* What treatments are available for IBS? - ✔✔-exercise
broad spectrum antibiotics (rifaximin-Xifaxan)--to help "reduce" the number of bacteria colonizing--to decrease symptoms
antispasmodics (dicyclomine-Bentyl)
peppermint oil
probiotics (bifidobacteria)
diet changes (low FODMAP)
antidepressant (SSRIs & try-cyclic)--decreases abdominal pain unrelated to decreasing depression*
anti-diarrheals (loperamide-Imodium) Why is a FODMAP used in treatment of IBS? - ✔✔-"fermentable, oligosaccharides, disaccharides, monosaccharides, and polyols"
foods high in these often cause bloating, abdominal pain, gas
eliminate all foods high in these for 3 - 8 weeks then slowly reintroduce them into diet to determine which are tolerable and which aren't What are the effectiveness of probiotics? - ✔✔-the effectiveness is species, dose, and disease specific
can help stabilize the "normal gut flora"
they can help decrease flatulence and abdominal pain Contraindicated in those who are immunocompromised What are the two most commonly used probiotics? - ✔✔-Bifidobacteria or Lactobacillus

5 - HT3 antagonists
NK1 antagonists
anticholinergics
accupressure
ginger How is N/V induced in the body? - ✔✔*Direct acting stimuli activate the vomiting center directly--signals from cerebral cortex (anticipation, fear, worry), signals from sensory organs (taste, smell, etc.), signals from vestibular inner ear *Indirect acting stimuli activate the chemoreceptor trigger zone which then activates the vomiting center--stomach and small intestine (vagal response), emetogenic drugs (opiods, etc.) *once the vomiting center is activated--coordinated response to the stomach, diaphragm and abdominal muscles to expel gastric contents How can peppermint oil be used in treatment of IBS? - ✔✔-causes antispasmodic effect on intestinal muscles, anti-inflammatory, antimicrobial, and reduces gastric motility
can decrease abdominal pain, distention, flatulence
can only take up to 8 weeks safely*
adverse effect--heartburn* Which anti-emetic medications must be used cautiously in patients with glaucoma, seizure disorder, and CVD? - ✔✔-antihistamines & anticholinergics these are contraindicated in patients with severe liver disease What are the common side effects of antihistamines & anticholinergics? - ✔✔-drowsiness
dry mouth
blurred vision
urinary retention
flushed

anticholinergic effects Antihistamines may produce what opposite effect in children? - ✔✔-hyperactivity What is the Black box warning for Promethazine? - ✔✔-respiratory depression can be SEVERE

deaths have occurred
contraindicated in children <2 years old*
use with extreme caution in children >2 years old Anti-histamines: - ✔✔-Ex: diphenhydramine (Benadryl)
helps reduce nausea and vomiting
blocks histamine receptors & can also block dopamine 2 receptors
main adverse effect is drowsiness
usually used for motion sickness and morning sickness
causes anticholinergic effects Phenothiazines: - ✔✔-Ex: promethazine (Phenergan)
helps reduce nausea and vomiting
blocks dopamine 2 receptors in the chemoreceptor trigger zone which blocks cholinergic, alpha 1, and histamine receptors
sedating
may cause extrapyramidal symptoms like tardive dyskinesia*
can suppress cough
contraindicated in children less than 2 years old and people with parkinsons* Anticholinergics: - ✔✔-Ex: transdermal scoplamine patch
help reduce nausea and vomiting, especially due to motion sickness
competitively inhibits muscarinic receptors in the parasympathetic nervous system
should be avoided in the elderly whenever possible*

crosses the BBB*
CYP 450 inhibitor & inducer--drug interactions are complex
usually for chemo-induced nausea
antidepressant, antianxyolytic, and antiemetic What is the step-wise approach when treating N/V in pregnancy? - ✔✔-lifestyle and diet changes first (small frequent meals, avoiding odors, foods, supplements that trigger nausea)
then try non pharmacological methods such as ginger or acupressure
then try OTC or prescription medications What is important pre-conception education to help prevent or reduce N/V in pregnancy? - ✔✔-taking prenatal vitamins one month before conception can greatly reduce N/V in pregnancy What is the recommendation for ginger use in pregnancy in the treatment of nausea? - ✔✔- 1 g/day spaced out over 24 hours (level B evidence)
works more effectively for nausea rather than vomiting What are Sea-bands? - ✔✔-passive acupressure bands applied to the wrist
particular pressure on the P6 pressure point (three cm on the inner side of the wrist between the two tendons)
can prevent and/or relieve nausea and vomiting How does B6 help reduce N/V? - ✔✔-helps the metabolism of fats & proteins
helps the body make certain neurotransmitters that may play a role What is in Diclectin or Diclegis? Is it safe in pregnancy? - ✔✔-combination of B6 (pyroxidine) & Doxylamine (antihistamine)
B6 alone or this combination together is safe and effective and considered a 1st line pharmacologic treatment for N/V in pregnancy (level A evidence) What is methylpredinisolone & dexamethasone? Are they safe in pregnancy? - ✔✔-steroids
sometimes used in the treatment of N/V

should only be used a last resort (level B evidence)
DO not use until at least 10 weeks gestation--could cause congenital defects What are oral ulcers? - ✔✔-aphthous ulcers
"canker sores"
open sores in the buccal mucosa related to mediators of inflammation
can be triggered by trauma, stress, vitamin/mineral deficiencies What is stomatitis? - ✔✔-open sores in the buccal mucosa related to inflammation from viruses
can be triggered by trauma, stress, vitamin/mineral deficiencies What is the goal for treatment of canker sores and stomatitis? What OTC medications could be used? - ✔✔-correct the potential underlying problem (vitamin deficiency etc)
pain control
peroxide half strength after meals for cleaning
orajel or orabase--contains benzocaine--avoid in children <2 or those with an allergy* What are some prescription medications to treat "few ulcers" such as canker sores? - ✔✔-aphthasol (Amlexanox) *discontinued in the US
topical steroid (triamcinolone dental paste)* What are some prescription mediations to treat "multiple ulcers in the case of stomatitis? - ✔✔-steroid solution (dexamethasone elixir) used as a mouth rinse
magic mouthwash--mixture of lidocaine, maalox, and diphenhydramine--swish and swallow 5 mL no more than every 4 hours (most common)* What are DMARDS? - ✔✔-immunosuppressive drugs that target specific components of the inflammatory process (TNF cells, T cells, B cells, etc.)
most patients who use these drugs show improvement but some have a paradoxical effect that aggravates or worsens*

Anti-Ulcer Drugs: Mechanisms, Classifications, and Clinical Applications, Exams of Medicine

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Partial preview of the text

Download Anti-Ulcer Drugs: Mechanisms, Classifications, and Clinical Applications and more Exams Medicine in PDF only on Docsity!

PC707 Module 3 Questions | 100% Correct

Answers | Verified | Latest 2025/

Version