Pharmacology of Upper GI tract

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  • Created by: Becca
  • Created on: 23-12-13 22:17
What is dyspepsia?
"Indegestion", dysfunction of the upper GI tract
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What is GORD? What is it caused by?
Gastro-oesophageal reflux disease, leading to oesophagitis ("heart burn"). Caused by obesity/pregnancy -> fat/foetus push up gastric contents, increase intra-abdominal pressure & cause reflux -or- drugs cause relaxation of gastric sphincter
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What are the two types of peptic ulceration?
Gastric & Duodenal
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What is gastritis? What it caused by & what are the symptoms?
Gastritis = inflammation. Causes: NSAIDs, oral steroids (induced damage). Symptoms: epigastric pain, hunger pain relieved by eating (duodenal), night pain relieved by food/milk/antacids, vomiting, haematemesis, pain after eating, worse bending foward
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What is the cause of gastritis? How do you test for it?
Helicobacter pylori: 90% duodenal ulcers, 70% gastric (infection -> chronic inflammation & gastritis -> ulceration). Test: urea breath test (carbon-13 urea), H. pylori contains urease which breaks down urea -> ammonia+CO2 -> C-13 detected exhaled CO2
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What increases acid secretion?
Histamine via H2 receptors, gastrin, acetylcholine via M-receptors - M3 on parietal cells
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What decreases acid secretion?
Prostaglandins (E2/I2), also cytoprotective via bicarbonate & mucous release
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What are the 4 treatment options for gastritis?
Antacids, alginates, histamine H2 antagonists, proton pump inhibitors (PPIs)
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How do antacids work?
Raise pH, rapid relief but not cure, sodium bicarbonate simplest, others include MgHCO3 ( cause diarrhoea) & AlHCO3 (cause constipation) -> use together
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How do alginates & histamine H2 antagonists work?
Alginic acids form viscous foam, floats on gastric contents (raft), protects oesphagus during reflux. H2 antagonists: OTC low dose, short term relief, H2 receptors increase cAMP which activated proton pump, antagonists block receptors preventing this
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How do proton pump inhibitors work?
Gold standard treatment, less side effects! Irreversible inhibition of proton pump (H+/K+ ATPase), activated by acidic pH (parietal cells), localised actions, increased risk of food poisoning
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What is the treatment for H. pylori eradication?
Triple therapy (2 antibiotics + PPI and/or H2 antagonist) for 1 week then PPI alone
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In the absence of H. pylori, which order should treatment be given?
Antacid/alginate + antacid -> H2 antagonist -> PPI
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What is the ulcerogenic effects of NSAIDS (and oral steroids)? How do they work?
Associated with peptic damage/ulceration. Inhibit both isoforms (1+2) of COX preventing the production of prostaglandins which are protective, inhibit acid release, stimulate production of mucus & bicarbonate (neutralising) -> excess acid production
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Card 2

Front

What is GORD? What is it caused by?

Back

Gastro-oesophageal reflux disease, leading to oesophagitis ("heart burn"). Caused by obesity/pregnancy -> fat/foetus push up gastric contents, increase intra-abdominal pressure & cause reflux -or- drugs cause relaxation of gastric sphincter

Card 3

Front

What are the two types of peptic ulceration?

Back

Preview of the front of card 3

Card 4

Front

What is gastritis? What it caused by & what are the symptoms?

Back

Preview of the front of card 4

Card 5

Front

What is the cause of gastritis? How do you test for it?

Back

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