2016 Treatments for Acid-Peptic Diseases

*N.B. Links are provided where possible. Some of these objectives require you to integrate information from several pages, making it difficult to provide links.

1. Identify diseases treated with “anti-ulcer” drugs and their causes, and distinguish which diseases are associated with H. pylori infection. Be able to contrast strategies and objectives for the treatment of peptic ulcer disease with the treatment goals for hypersecretory diseases and GERD.

2. List strategies to eliminate the cause, reduce the pain, and/or heal the mucosal lesions of H. pylori-induced peptic ulcer disease and be able to prioritize them according to effectiveness (esp. be able to identify the most effective drugs for eliminating H. pylori, and for reducing intragastric acidity).  Be able to give examples of drugs that exemplify each strategy (HINT:  pay attention to suffixes!) and be able to differentiate among drugs in each group, as well as between drugs in different groups, based on mechanism of action, therapeutic uses and side effects.

3. Regarding the treatment of H. pylori infection:
   • Be able to identify the unique properties of the specific antimicrobial agents chosen to treat of H. pylori infection i.e., understand why the combinations comprising current treatment regimens were chosen instead of alternatives.
   • For penicillins, macrolide antibiotics, tetracyclines and metronidazole, define (briefly) the mechanism of action, antibacterial spectrum, relevant aspects of distribution and major toxicities.

4. Compare and contrast the mechanisms of action and duration of action of different classes of drugs that are used to raise intragastric pH (proton pump inhibitors, H₂ blockers and antacids). Relate these differences to the therapeutic uses of these agents. Explain why antimuscarinic agents are not good antiulcer drugs (although they are great for testing GI physiology on boards!).

5. Based on an understanding of the pharmacokinetics, explain why timing is critical in the administration of proton pump inhibitors. Be able to debate both sides of the argument: esomeprazole is a significant improvement over omeprazole.

6. Contrast the side effects of PPIs with those of H₂ blockers. List the side effects that are unique to cimetidine. Outline the side effects that are common among agents that decrease intragastric acidity, with particular attention to effects on absorption and elimination of other drugs.

7. Be able to identify factors that differentiate among antacids, including advantages, disadvantages and severe side effects.

8. Distinguish among the "anti-ulcer" agents that act by protecting the mucosa, based on mechanism of action, pharmacokinetics and side effects.

9. Explain how MISOPROSTOL facilitates ulcer healing without interfering with NSAID actions on inflammation. List the side effects of  MISOPROSTOL, and understand why they limit its use.
   

10. Identify the key features of treatment regimens for H. pylori-induced ulcers, and the main reasons for treatment failure. Outline key drug interactions that can occur among anti-ulcer drugs.