2 - Gastrointestinal Disorders Flashcards
What are some antacids?
- Aluminum hydroxide
- Magnesium hydroxide
- Calcium carbonate (Tums)
These are poorly absorbed
What are some magnesium products of antacids?
- Milk of Magnesia - neutralizes stomach
-
Maalox - magnesium trisilicate
- Slow acting, coats ulcerated area, neutralizes pH
What are the aluminum products of antacids?
- Amphojel - aluminum is astringent to stop bleeding
- Coats and protects ulcers from H+
- Aluminum glycinate + aspirin
How does the antacid sucralfate (Carafate) work?
- Form complexes with albumin, fibrinogen and globulin on ulcer surface, thus creating protective barrier to acid and pepsin
- Interferes with the absorption of many medications
What is the preferred histamine H2 receptor antagonist?
Zantac
What are indicated for use for prevention and treatment of NSAID-induced GI lesions?
Nexium - proton pump inhibitors
What class of drugs are Nexium, Prevacid, Prilosec, Prontonix, Aciphex?
proton pump inhibitors
How are antibiotics used for GI disorders? And what are the common ones?
Used in combination with other drugs to treat ulcers cause by Helicobacter pylori
- amoxicillin
- metronidazole
- clarithromycin
- tetracycline
What is a dental consideration of patients taking antacids?
- They interfere with absorption of many drugs = wait 2 hours
While taking antacids, what additional drug can cause GI distress and diarrhea?
Macrolide antibiotics - caution in patients with Inflammatory Bowel Disease
What can taking antacids with antibiotics cause?
Pseudomembranous colitis
What should you avoid in patients with a history of stomach ulcers?
Aspirin / NSAIDS
H pylori is associated with cancer of gastric mucosa which is?
Lymphoma
Atrophic gastritis caused by chronic use of proton pump inhibitors increases risk for what?
Stomach cancer
Once H. pylori is found in patients with peptic ulcers, what’s the normal procedure?
- Eradicate it
- Allow ulcer to heal
Triple therapy!
What’s the triple therapy used for stomach ulcers and h pylori?
- amoxicillin
- clarithromycin (Biaxin)
- a proton pump inhibitor
- Nexium, Prevacid, Protonix, Aciphex
- Prilosec
What do you change in the triple therapy if H pylori is resistant to clarithromycin?
levofloxacin (Levaquin)
What are some dental considerations of pts with ulcers?
- Avoid aspirin and NSAIDS
- H2 receptor blockers decrease metabolism of many dental drugs
What are some oral manifestations of peptic ulcer disease?
- Vascular malformations of lip
- Enamel erosion
- Taste alteration
- Blood dyscrasias
- Xerostomia
What are the 2 distinct conditions of IBS?
- Ulcerative colitis - large intestine and rectum
- Crohn’s disease - entire wall of bowel, autoimmune
What are the treatments for IBS?
- First line - anti-inflammatories, corticosteroids
- Second line - immunosuppressive agents, antibiotics
- Third line - monoclonal antibody, surgical resection
What are the unique oral manifestations of Crohn’s?
- Atypical mucosal uclerations
- Diffuse swelling of lips and cheeks
- Cobblestone mucosal lesions
What are common anti-diarrheal agents?
- Bismuth subsalicylate (Pepto-Bismol)
- codeine and diphenoxylate (in Lomotil) = prescription drug
- Imodium
What’s the caution while taking pepto-bismol?
Caution with salicylate allergy
What are the different types of laxatives?
- Bulk - carboxymethyl cellulose with psyllium
- Osmotic - magnesium salts
- Contact - bisacodyl (Dulcolax), castor oil
- Lubricants - mineral oil, glycerin
