Gastrointestinal Drugs Review Sheet: Name several defenses for the GI system: Mucus- mucus is continuously secreted from

the GI mucosa, forming a protective barrier for the underlying cells from attack by pepsin and gastric acid. Bicarbonate- it is secreted by epithelial cells of the stomach and duodenum where it neutralizes hydrogen ions that penetrate the mucous. Prostaglandins- stimulates secretion of bicarbonate and mucus, promotes vasodilation and blood flow to the submucosal layer, and provides additional protection by suppressing the secretion of gastric acid. Names several aggressive/ detrimental factors in the GI system: Helicobacter pylori- Mechanism of the bacteria not firmly established, but it is likely that injury to mucosa and inflammation increase the likelihood of PUD. 6075% of those with PUD also have H. Pylori NSAIDs- Decrease the biosynthesis of prostaglandins --> decrease blood flow, suppress secretion of mucus and bicarbonate, and promote the secretion of gastric acid. Also, NSAIDs can irritate the mucosa directly. Gastric Acid- can directly injure cells and activates pepsin Pepsin- enzyme in gastric acid that can injure unprotected cells of the gastric and duodenal mucosa How is H. Pylori treated? Since it is a bacterium it is treated with antibiotics such as amoxicillin and tetracycline. Define Peptic Ulcer Disease (PUD): A group of upper GI disorders characterized by varying degrees of erosion of the gut wall. How does Cimetidine (Tagamet) work? It is an H2 antagonist (which are located on parietal cells of the stomach) and works to reduce both the volume of gastric juice and its hydrogen ion concentration. What class of drugs is the most effective in suppressing secretion of gastric acid? Proton Pump Inhibitors (PPIs)- they are well tolerated, and used for gastric and duodenal ulcers and GERD (gastroesophageal reflux disease). Most PPIs have similar mechanisms of action.

Describe the function of the PPI omeprazole (Prilosec): The drug causes irreversible inhibition of the enzyme ATPase (the proton pump). The drug blocks the final pathway of gastric acid production, inhibiting basal and stimulated acid release. Effects persist until new enzyme is synthesized. The drug is enteric coated so that the drug can be absorbed by the relatively alkaline environment of the duodenum.