Digestive Flashcards
Antiulcer Drugs
Antacids, Antisecretory (Histamine receptor antagonists, proton pump inhibitors, anticholinergic drugs, prostaglandins), protective drugs (coating agents)
Antiaggressive drugs - Antacids
Aluminum salts, calcium salts, magnesium salts, sodium salts
Antisecretory drugs - Histamine receptor antagonists
Cimetidine, ranitidine, famotidine, nizatidine, roxatidine
Antisecretory drugs - proton pump inhibitors
omeprazole, lansoprazole, esomeprazole, pantoprazole, rabeprozole,
Antisecretory drugs - anticholinergic drugs
pyrenzepine
Antisecretory drugs - Prostaglandin agonists
misoprostol
Protective drugs - coating agents
bismuth salts, sucralfate
Antacid administration
rapid symptomatic relief (liquids more potent), one dose at one hour and three hours after meals (6 doses per day), decreased compliance, reduce absorption of other drugs (tetracyclines, iron, isoniazid)
Aluminum compounds/magnesium compunds
A: cause constipation/ M: cause diarrhea
Sodium bicarbonate
Is a treatment for dyspepsia, but no recommended because if used in large amounts can cause systemic alkalosis
H2 receptor agonists administration
ulcer 4-8 weeks, reflux esophagitis, Zollinger Ellison, dyspepsia (no clear organic lesion)
Bile acids
Chenodeoxycholic acid, ursodeoxycholic acid
Bile acid administration
PT unfit for surgery, dissolve only small, uncalcified stones, with diameter less than 15mm, 10-15 mg/kg per day for at least 6 months, recurrence common, expensive treatment
Laxatives and purgatives
Bulk forming agents, hyper osmotic agents, stool softeners, stimulant agents, new laxatives
Bulk forming agents: fibers; plant based foods
methylcellulose, psyllium seeds
Hyperosmotic agents
Polyethylene glycol (PEG, Macrogol), lactulose, magnesium/sodium salts
Stool softeners
Docusate, mineral oil
Stimulant agents
Senna, bisacodyl
New laxatives
Prucaloprid, linaclotid, methylnatrexone
Laxative administration
normal stool in 8-12 hours, administered in evening, abuse leads to dehydration, constipation, electrolyte imbalance
Laxative indications:
constipation (only treated with diet and education), hemorrhoids, hernia, anal lesion, heart disease.
Purgative administration
food or drug intoxication, before surgery/radiologic/endoscopic examination of the bowel. Results in liquid stool in 2-6 hours
Bulk forming agents
resist enzymatic digestion. Work in small and large intestine, absorb water, swell and increase stool volume with result of normal peristalsis. May take few days to act but there is no dependence
Hyperosmotic agents are
not absorbed, work in colon and create osmotic pressure that retains water
Stool softeners
soften and lubricate stool by allowing water and fats to be added, not first line drugs because they increase risk of aspiration pneumonia
Stimulant agents
increase peristaltism by acting on intestinal mucosa/ nerve plexus (exact mechanism unknown)
Methylnaltrexone
peripheral opioid antagonist used in constipation caused by opioids
Antidiarrheal drugs
Symptomatic and Etiological types
Symptomatic Antidiarrheal drugs
Opioids (Opium, morphine, loperamide); A antidiarrheal microorganisms (saccharomyces boulardii); mucoprotecting agents (diosmectite); anticholinergic drugs (atropine)
Etiologic Antidiarrheal drugs
Ciproflozacin (C. jejune, Salmonella, Shigella, V. cholerae); Metronidazole (C. difficile), Ampicillin (L. monocytogenes), Vancomycin (S. aureus)
Antidiarrheal administration
self limiting symptom caused by infection, traveling, drugs. Usually oral read ministration is sufficient (tea, lemonade cola without sodium)
Loperamide
reduces peristalsis by stimulating opioid receptors in bowel, stasis allows absorption of fluids and consolidation of stool, in overuse it will lead to constipation
Antidiarrheal microorganisms
should not be taken with hot or cold liquids (bind to bacteria, slow growth), disadvantages is allergic reaction or false positive microbiology testing of stool
Cimetidine
inhibit enzymes in liver and may increase effect and toxicity of drugs: phenytoin, theophylline, phenobarbital, some benzodiazepines, cyclosporin, carbamazepine, calcium channel blockers, propranolol, warfarin, tricyclic antidepressants
Proton pump inhibitors
most efficient acid suppressants, heal patients who do not respond to other drugs, high relapse rate in ulcer unless H. pylori is eradicated
Misoprostol
analogue of prostaglandin E1 acts by increasing mucosal blood flow and mucus and duodenal bicarbonate secretion, administrated in prophylaxis and treatment in ulcer caused by NSAIDS, contraindicated in pregnancy (miscarraige)
Protective drugs
form protective coating over ulcer crator, allow healing to occur underneath, adverse effects (metallic taste, back stool, encephalopathy after high doses, aluminum toxicity in renal failure), less convenient
Antiemetic drugs - Dopamine receptor antagonists
Substituted benzamides (metoclopramide), benzimidazol derivatives (domperidon); phenothiazines (prochroperazine, thiethylperazine);butirophenones (droperidol, haloperiod)
Antiemetic - Antihistamins H1
dimenhydrinate, meclozine
antiemetic - anticholinergic drugs
scopolamine
Antiemetic - Canabinoids
dronabinol, nabilone
Antiemetic - Neurokinin 1 antagonists
aprepitant, eosaprepitant
Antiemetic - 5-HT3 receptor antagonists
Granisetron, ondansentron, palonosetron, tropisetron
Antiemetic administration
symptomatic drugs in prophylaxis/treatment of nausea and vomiting caused by meningitis, ICP, surgery, metabolic disorders, pregnancy, chemotherapy, radiotherapy, treatments with opiods/ anesthetics
Metoclopramide can cause
headache, extrapyramidal reactions, increased prolactin concentration
Domperidone is
like Metoclopramide but less likely to cause extrapyramidal reactions
Scopalomine is
used in prevention of motion sickness, one patch applied to hairless area of skin behind ear 5-6 hours before travel, one patch can prevent sickness for up to 3 days
In the prophylaxis of nausea/ nom,itting due to chemotherapy
5-ht3 receptor antagonists or neurokinin 1 antagonists are effective
