Ep 79 Acid Reducers and Peptic Ulcer Disease Pharmacology Mnemonics

Acid Reducers and Peptic Ulcer Disease Pharmacology Mnemonics

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Peptic Ulcer Disease has several important concepts to remember; in this episode, I touch on some mnemonics to help you remember them. If you're interested in checking out the course online for a refresher you can go here: https://residency.teachable.com/p/mobile or if you need a credit course, here: https://www.dmacc.edu/programs/pdp/pre-pharmacy/Pages/online-pharmacology-class.aspx

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Auto Generated Transcript:

Hey, welcome to Memorizing Pharmacology Podcasts, Episode 79: GI Medications Pharmacology Mnemonics. So let's just talk a little bit about the ulcer and then we'll get on with it. The big thing is that once you get this ulcer, you can't really fix it as much as you can create an environment for it to heal. So the number of things that you can do to kind of do that include eradicating H. pylori which is found in a greater percentage of the ulcers, smoking cessation, alcohol reduction, stress reduction, spicy food reduction; all those things can help. But again, making it so that the body can heal itself.

So what are some drugs that cause ulcers? Again, alcohol is a drug so ETOH (ethanol), then bisphosphonates like alendronate, ibandranate (again watching for those stems), the NSAIDs ibuprofen, naproxen. Even though Celebrex or celecoxib is supposed to do it less, it still can be a problem. And then steroids like prednisone.

So we start with things that we could maybe not use a medication for to help deal with these kind of GI symptoms and issues and make things better. And so we'll use the mnemonic SAFER: SAFER for Smoking, Alcohol, Food diary, Exercise, Reducing stress and NSAIDs. I didn't really know how to put that in there because we're taking away a drug so is that non-drug? Sort of. So I just had a little breathe image here for smoking, alcohol just kind of reducing that; have your coffee instead. Here's your food diary, then getting some exercise, reducing some stress (yoga whatever it takes) but all the things that would make it so that there's less acidic environment and of course not using the NSAIDs if possible.

Antacids: You are probably familiar with these colorful chalky tasting limestone things and the big thing to know about antacids first is that they're the only drug whose generic name is their chemical name. So calcium carbonate is Tums, aluminum hydroxide is half of Maalox (it's really Amphojel) and then magnesium hydroxide would be Milk of Magnesia.

So when we talk about antacids we're really looking at which ones are constipating which ones cause diarrhea and you kind of have a little guess which is which here. So pick C or D and with calcium carbonate that one is constipating, aluminum hydroxide is constipating (again it's Amphojel is going to be the brand name) but if you mix them together magnesium hydroxide and aluminum hydroxide it makes Maalox and then magnesium hydroxide Milk of Magnesia.

So which cause constipation which cause diarrhea? So the idea is calcium carbonate is constipating, aluminum hydroxide constipating, magnesium hydroxide causes diarrhea. So if we mix constipating drug like aluminum and a diarrhea causing one like magnesium hydroxide then we end up with something that is more comfortable for the patient.

Alright H2 blockers: I've talked about the antihistamines NO MAN where one nose so that you remember the H1 antihistamines are the ones that are in the nose for allergies and the H2 (the buttons by his stomach) those are H2 blockers.

So H2 blockers all end into -dine so famotidine is Pepcid and now Zantac it used to be ranitidine nice addedine is acid and cymetidine is Tagamet and ranitidine and Zantac but again there's a reason I put them in this order and the reason is that it's the ones that we prefer versus the ones that we don't and the reason we don't is because of side effects.

So cymetidine can interact with diazepam lidocaine phenytone propranolol warfarin can cause gynecomastia and then ranitidine; the problem with the NDMA had it pulled off the shelves. Proton pump inhibitors: It's -prizol ending and then you might see Omeprazole with S Omeprazole and Lansoprazole would duck Pantoprazole and wondering those look awfully the same what's different and we're really talking about either changing the rotation of plane polarized light or an enantiomer more of an organic chemistry thing but basically there's a mirror image and the active one is the one that became the new drug but you know just having the active one versus having the mix of the active and inactive doesn't necessarily make it better so a lot of times like Dexilant hasn't really taken over for Prevacid and Nexium maybe to some extent over Prilosec so be careful here because the prizol it's not Azul you go on the internet and you find these drug cars and they say oh if it ends in a Zoll it's a proton pump inhibitor that is false if it ends in prazole it might be a proton pump inhibitor but if it ends in conazole It's actually an antifungal so Fluconazole which is Diflucan, Voriconazole which is Vfend both of those are antifungals so it's not the azol ending then Aripiprazole which is Abilify and Brexpiprazole which is Rexulti uh those are antipsychotics so really rare to see a stem within a stem that the prizole is in piprazole uh the World Health Organization frowns on such thing and it's really rare but just be careful make sure that you know if you're looking at something you know is it de fungal with conazole is it an antipsychotic with piprazole or is it a proton pump inhibitor with prazole so gobs of side effects gobs is our mnemonic or gastroenteritis and you're going to reduce the acidity which is great for that ulcer but it also allows bacteria to have a chance to thrive osteoporosis B for B12 deficiency and S for secretion rebound so once you stop taking that proton pump inhibitor acid can rebound quite a bit so G-O-B-S is our mnemonic uh H pylori therapy there are many therapies I just put a couple examples of triple and quad therapy so triple therapy is going to be two antibiotics and one acid reducer so Amoxicillin, Clarithromycin, and Esomeprazole makes ACE A C E is the first letter of each of those drugs Amoxicillin, Chlor thermice in the antibiotics, Acetomeprazole the acid reducer or Amoxicillin, Metronidazole, and Omeprazole so Amoxicillin, Metronidazole or the antibiotics Omeprazole the acid reducer again we want to reduce resistance so we use lower doses of more drugs now we can make a quad therapy here where we actually use you know three antibiotics and one acid reducer so a Tetracycline like Doxycycline uh that's not the brand name it's a tetracycline so uh it should have really put Tetracycline kind of a Doxycycline and then put the brand names in the parentheses uh that's antibiotic Omeprazole for Prilosec is NASA reducer Metronidazole is Flagyl which is an antibiotic and Bismuth Salicylate when put in this situation has antimicrobial effects so I put TOMB as the mnemonic Tetracyclin T, Omeprazole O, Metronidazole M, B for Bismuth because once this group comes together it's curtains for H pylori so it would be buried in a tomb uh Misoprostol or Cytotec so if you think of it as Miso protect all from NSAIDs it's really what it does and I was just thinking of miso soup delicious uh but that's the thing I could think of but Misoprostol and it prevents NSAID induced ulcers but it also can be used as a medication absorb abortion labor induction cervical ripening it's a prostaglandin analog so we see The Prost in the Misoprostol and it is pregnancy category X if you're not trying to use it for any of the above indications you don't want to risk it with a patient and that's why it's fallen out of favor when you have a Here is the corrected text:

"Medication that could, you know, harm a fetus, you really try to find something different. I'm going to Cisapride or Propulsid. Again, we don't really see the brand names but see the soccer ball being propelled through the goal so gastroparesis is usually what the issue is so that kind of stomach that just will not empty so it empties much faster and it's a prokinetic. So Pro meaning toward and or you know kind of helping out and then kinetic like Kinesiology movement so it is for movement.

The problem is that some of its mechanism is dopamine antagonist so dopamine antagonist can result in extrapyramidal symptoms (EPS) and the problem with that is that if someone has Parkinson's and they have a dopamine deficiency, the last thing you want to do is block the dopamine they do have. So what we want to do is make sure to tell the patient about that EPS and possibilities that come along with it but rarely used medication Sucralfate or Carafate. It sugar coats the crater is how I remember it. It's a GERD add-on so physician might say okay well let's give you, you know, Prilosec for the month and we'll give you a couple weeks of the Sucralfate so that with each meal we're putting that coating down. It coats the ulcers in that kind of sugary coat. It can cause Bezoars which is really kind of like it's just a knotted ball of stuff. It can be broken up or surgically removed and then the big issue is this isn't an absolute contraindication but if you're a diabetic and you're taking four sugar pills a day just have to account for that in however you're reducing the sugar in your bloodstream and then it's four times a day before meals so again getting that sugar may not be the best thing. So if you can think of Sucralfate or Carafate as a kind of candy, you can remember the concerns about diabetes.

This information is provided for you for your informational purposes only and not intended to provide and should not be relied upon for medical or any other advice. I urge readers to consult with a medical professional with any medical condition. Thanks again for listening to the memorizing pharmacology podcast.

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Here is the Link to my Pharmacy Residency Courses: residency.teachable.com