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Ulcer
Open sores in the mucous membranes or mucosal linings of the body.
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What is the (GI) tract concerned primarily with?
The digestion and absorption of nutrients
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The stomach and small intestine (particularly the duodenum) secrete ______ ______ that aid in the digestion of food.
The stomach and small intestine (particularly the duodenum) secrete several enzymes that aid in the digestion of food.
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Specialized cells in the stomach produce _______ _____ and _______ enzymes (for example pepsin), which break down food particles into an absorbable form.
Specialized cells in the stomach produce hydrochloric acid (HCI) and proteolytic enzymes (for example pepsin), which break down food particles into an absorbable form.
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Gastric acid secretion is stimulated when food enters the stomach by action of the hormone ______.
Gastric acid secretion is stimulated when food enters the stomach by action of the hormone gastrin.
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Hydrochloric acid is responsible for.....
the acidity of the stomach
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Proteolytic enzymes are very important because .....
they are for the process and absorption of proteins. *They cause the decomposition or destruction of proteins.
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The more "food bulk" may then cause even more ____ _____.
acid secretion
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Digested mass passes from the stomach into the small intestine where the final phase of digestion occurs and ______ begins.
absorption
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When digestion is nearly complete the ______ secretes an _______ enzyme that stops gastric acid secretion which prevents damage accuring.
When digestion is nearly complete the duodenum secretes an inhibitory enzyme that stops gastric acid secretion which prevents damage accuring.
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Why is gastic acid also produced and secreted between meals?
Gastric acid secretion between meals is to reduce bacterial growth which may cause possible infections to occur.
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Why is the mucosal lining of organs very important?
Prevents autodigestion and self-destruction.
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Where do GI ulcers frequently occur?
The stomach and duodenum--- no simple cause.
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Hyperacidity
abnormally high degree of acidity--excessive secretion of gastric acid.
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Hyperchlorhydria
excessive hydrochloric acid in the stomach
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A decreased production of protectiv mucus or the inhibitory enzyme (which its function is to stop the acidity of the stomach after digestion has been completed) can cause.....?
ulcers
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anti-cholinergic "dries you up" increased cholinergic means increased secretions so if someone has increased ACID secretions then it is caused by.....
increased cholinergic activity
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Emotional stress, alcohol, smoking, increased cholinergic activity, certain medications such as ..... can cause ulcers.
NSAID's, ASA, & IBUPROFEN.... FYI: (which is why they came out with EC ASA because it does not disolve in the stomach it desolves in the intestines. these medications taken around the clock for a long period of time can cause erosion the stomach mucus lining. Tylenol does not do this but too much tylenol can effect the liver.)
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Symptoms of having an ulcer are....
dull, gnawing burning pain, nausea, loss of appetite, and vomiting. (not really specific but can diagnose using these symptoms if it was to accure over a long period of time and nothing else helps)
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Differintiating between a Duodenal ulcer
if you eat and the pain goes away.
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Differintiating between a stomach ulcer
if you eat and the pain gets worse
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Reason why ulcers are a concern is...
eventually there is chronic erosion of the mucosa can lead to perforation in the GI wall. A hole appears in the stomach due to erosion and patient then has internal bleeding. ( people have died from undiagnosed ulcers)
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Treatment management: the very first step is to .....
aliminate certain "lifestyle" issues. ex: smoking, alcohol etc. lifestyle changes then after that is accomplished or not accomplished with no results then drug therapy begins
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ulcers can be fully healed but it takes 4-8 weeks. once you've had an ulcer more susceptible to have another
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the major part of therapy is inhibiting .....
gastric acid and pepcin secretion and making lifestyle changes
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the types of drugs used for treatment of ulcers are.....
- H2 antagonist, prostaglandins, PPIs, anticholinergic drugs, &
- antacids
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Individuals that suffer from ulcers will have a bacteria present called.....
Helicobacter pylori. Many times when person is being treated with the standard treatment drugs for ulcers and they are not responding they will add an antibiotic to the "regimen" (common antibiotic is biaxon) FYI: PREV PACK has a combination of previcid, antacid and an antibiotic.
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GERD
GASTRO ESOPHAGEAL REFULX DISEASE- THE COMMON NAME FOR IT IS HEARTBURN
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GERD "heartburn" is caused by...
regurgitation of digestive juices into the esophagus caused by relaxation of the LES "lower esophagel sphincter"
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Treatment of GERD....
Lifestyle changes and diet
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Types of drugs used for treatment of GERD
Antacids, H2 blockers, PPI's, & GI stimulants.
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Antisecretory drugs "anti secretion" do what?
cut down on the amount of acid that is secreted in the stomach
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H2 blockers are used A LOT.... the generic for these drugs end in "tidine"
H= Histamine "acid production Histamine in the stomach is realesed by _____ and they bind to H2 receptors and then gastric acid and pepcid is secreated.
mast cells
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decreased acid production and decreased pepsin is accomplished by the H2 blocker drug binding to the H2 receptor that block histamine from doing so.
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Part of the H2 receptors are found on Parietal Cells which are responsible specifically for ......?
Hydrochloric acid production.... important because a lot of patients are suffering from hyperchlorhydria important bc a lot of the histamine receptors are found on parietal cells which produce hydrochloric acid.
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Histamine IS being secreted the drug is just blocking the histamine by binding to H2 receptor. It is still being released. H2 blockers decrease gastric acid secretion and volume.
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H2 blockers are known as ___________ drugs.
antisecretory drugs.
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H2 blockers dose routes are .....
orally and parenterally (except nizatidine)
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H2 blockers may be taken with or without food
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With H2 blockers patient needs to seperate doses from antacids by a couple hours because antacids like to bind to everything so if so H2 blockers will not be able to perform and will be secreated.
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Adverse effects: GI drugs have the lowest of all adverse effects. Very well tolerated; headache; or constipation.
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Drug interactions are minimal but be careful with cimetidine - Tagamet
Cimetidine have a lot of drug interactions!
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H2 blockers heal 60-80% of ulcers within 4 weeks of treatment
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Prostaglandin in the stomach are responsibile for the secretion of the .......
mucosal lining
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Drugs that inhibit prostaglandin synthesis.....
NSAIDs may induce gastric ulcers (this is why NSAIDs can cause ulcers)
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All Prostaglandins such as Misoprostol (Cytotec) is only approved for NSAID and aspirin induced gastric ulcers.
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Misoprostol (Cytotec) is an oral dosage form and its adverse effects are :
- abortifacient (causes miscarriage/abortion); diarrhea, abdominal pain, headache
- FYI: if given to a pregnant person it WILL abort the fetus. Not a "chance" that it will.... it WILL abort the fetus with ONE DOSE.
- If you ever see a script written for this drug for 3 tablets take one every hour they are not taking it for an NSAID induced ulcer. A pharmacist does not have to fill the sript if they dont feel like they ethically should.
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The exchange of hydrogen and potassium ions with the parietal cells is essential for the production of ....
HCI
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PPIs directly inhibit the enzyme-specific secretory system ** Block the exchange of hydrogen and potassium ions resulting in....
decrease of hydrochloric acid production.
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PPI drugs approved for Ulcer and GERD as well. Generic ending in "azole" The adverse effects are:
very well tolerated; headache; abdominal pain, diarrhea, nausea, constipation. No significant drug interactions.
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GI stimulants effect...
muscular contractions.
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A GI stimulant induces contractions whithin the upper GI tract that prevent reflux of acid into the esophagus and promote gastric emptying; moves damaging material away from the lower esophagus.
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Metoclopramide (Reglan); usually given ac and hs; well tolerated; may cause drowsiness, restlessness, diarrhea, headache. not used as much anymore.
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Anticholinergic, Antiserotonin & Antispasmodic Drugs (PG.383)
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Stimulation of the vagus nerve increases the secretion of gastric acid. When we give.....
an anticholingergic drug it decreases gastric acid secretion and intestinal motility.
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Stimulation of the _______ nerves increases intestinal motility.
parasympathetic
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Antispasmodic drugs relax...
intestinal smooth muscle
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Anticholinergic drug side effects:
dry eye; dry mouth; urinary retention and constipation because of this they are not used very often.
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Antispasmodic drugs primarily used in IBS.
caused by increased spasms in the GI tract.
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Tegaserod (Zelnorm) REDUCES abdominal pain and acts on serotonin receptors and normalizing altered....
GI function (IBS)
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Belladonna Alkaloids:
- atropine
- 1-hyoscyamine (Levsin)
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Synthetic Anticholinergics:
glycopyrrolate (Robinul)
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Synthetic Antispasmodics:
dicyclomine (Bentyl)
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Serotonin Antagonists:
tegaserod (Zelmac)
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Main ingredients found in antacids:
Magnesium, aluminum, calcium
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Antacids ex: tums, rolaids... OTC products. Nonsystemic drugs (working where you put it) It is used to .....
neutraliz gastric acid in the stomach
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When should antacids be taken?
1 hour after a meal
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A concern with taking antacids along with other drugs is it may....
alter absorption and excretion of other drugs.
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Sucralfate is a NON....
Systemic drug; does not alter gastric pH
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Sucralfate forms a protective barrier over damaged...
gastric mucosa "like a band-aid"
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The most common side effect of sucralfate:
Constipation
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Emetics cause...
vomiting (use when there is an over dose) ipecac syrup is the most commonly known emetic. A lot of pharmacies stopped carrying it bc want has may of been consumed may not be good for it to be vomitted back up.
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Emetics work on the CTZ "chemoreceptor trigger" in the brain.
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Antiemetics are used for....
treatment of vomiting.
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the most perscribed antiemetic is phenothiazine
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Promethazine (Phenergan) it binds to the histamine receptor bc of this one of the most common side effect....
sedation/drowsiness
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Phenergan should not be used in children under 2 bc it can cause neurological problems and seizures. It is contraindicated in small children
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Ondansetron (Zofran), granisetron (Kytril) are known as seretonin antagonists. Very expensive. Reserved for ppl undergoing chemotherapy. Also see this drug prescribed to children bc phenergan can not be used.
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A lot of insurance companies will not cover it with out--- prior authorizations.
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Another Antiemetic is Dronabino (Marinol)-- not used very much; is a controlled substance; chemically related to marijuana. The only OTC antiemetic is Emetrol which stops nausea sensation.
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