Drugs Flashcards
Treatment for GERD
- Pharmacological
- Non-pharmacological
Pharmacological tx
- PPI
- Antacids
- H2RA
- Reglan
- Alginic Acid
Non-pharmacological
- Eliminating acidic foods and EtOH
- Decrease weight
- Not lying down within 3H after meals
- Elevating the bed 6 inches
Cause of Peptic ulcer disease (PUD)
- H. Pylori
- ASA
- NSAIDs
- Corticosteroids
Treatment of PUD
- Antacid, H2 Blockers, PPI
- If pt is on NSAIDS, add misoprostol
- For H. Pylori: use ABX
- Sucralfate
Carafate
- Use
- Administer
- # 1 SE:
Sucralfate
- Bandaid for ulceration of PUD
- Take b/4 food ON EMPTY STOMACH up to QID
- # 1 SE: Constipation (xerostomia = dry mouth)
Antacid
- Agents
- DDIs
- SEs
- Pregnancy Cat
Agents:
- NaHCO3: do not take w/ high BP and pregnancy (Na retain water)
- CaCO3: Constipation
- Al(OH)3: Constipation. Do not give to renal imp pt
- Mg(OH)2: Diarrhea. Do not give to renal imp pt
DDIs - Chelation of Tetracycline => Tetracycline, minocyline, doxycyline => Do not give Antacids w/in 2H - Quinolones => Give 2H b/4 or 6H after antacids - Levothyroxine - Iron - Absorption of drugs require acid pH => Ketoconazole, itraconazole, etc
SEs
- HyperCa, HyperMg
- Constipation: Al, Ca
- Diarrhea - Mg
- Flatulence - NaHCO3
- Aluminum intoxication
- Na load
- Safe in pregnancy
Gaviscon
- Indication
Alginic Acid
- I: Protects esophageal mucosa (need to be in upright position)
Tagament
- Dose
- Forms
- SEs
- DDIs
Cimetidine
- Dose: 400-800mg/day
- Forms: IV/IM, tab, PO sol’n
- SEs: drowsiness, dizziness, agitation, gynecomastia
- DDIs: Inhibitor => has most DDI of all H2RAs
Zantac
- Forms
- Dose
Ranitidine
- Forms: IV/IM, tabs, caps, syrup
- Dose: 150mg BID or 300mg QHS PO
Pepcid
- Forms:
- Dose
Famotidine
- Forms: IV, tabs, suspension
- Dose: 20mg BID or 40mg QHS
Axid
- Forms
- Dose
Nizatidine
- Forms: Tabs, caps, sol’n
- Dose: 150mg BID or 300mg QHS
All H2RAs come in IV except:
- Except Nizatidine - Axid
All H2RAs take at HS except
Cimetidine - Tagament 400-800mg/day
H2RA
- Which cause endocrine SEs: galactorrhea, gynecomastia, impotence?
- Endocrine SEs: Cemetidine - Tagament
H2RA
- DOC in Pregnancy
- All Cat B
- DOC: Ranitidine - Zantac
H2RA
- Renal adjust
- Rec 1/2 dose
- Cemetidine: CrCl less 30
- All other: CrCl less than 50
H2RA
- SEs
- CNS: dizziness, sedation, HA, confusion
=> List in Beer criteria for elderly > 65y.o => worsen dementia and delirium
H2RAs
- Which drug has DDI?
- Cimetidine (CYP 1A2 inhibitor):
incr warfarin and theophylline
For nocturnal acid breakthrough, add what
Add H2RA QHS
Prilosec
Prilosec OTC
- Dose:
- DDI
Omeprazole
- Dose: 20mg PO QD on EMPTY stomach
- DDI:
- Inc diltiazem, warfarin, phenytoin.
- Decrease ketocontazole, itraconazole, iron, digoxin
Zegerid
Zegerid OTC
- Direction to take:
Omeprazole + Na Biocar
- Mix w/ 30mL of water and consume immediately
Nexium
- Dose
- Adm
Esomeprazole
- Dose: 20-40mg QD (Zollinger-Ellision 40mg BID)
- Adm: on empty stomach
Vimovo
Esomeprozole/Naproxen
Prevacid
Prevacid 24H
- NG tube
- Forms
- Dose
Lansoprazole
- NG tube: Suspension do not give through NG tube
- Forms: Cap, ODT, Suspension
- Dose: 15-30mg QD before meals
Dexilant
- Dose
Dexlansoprazole
- R-isomer of lansoprazole
- Dose: 30-60mg PO Daily w/ or w/o foods
Protonix
- Indication
- Dose
Pantoprazole
- GERD, PUD, Zollinger-Ellision
- Dose: 40mg QD
Aciphex
- Indication
- Dose
Rabeprazole
- Indication: GERD, PUD, Zollinger-Ellision
- Dose: 20mg QD (Zollinger-Ellision upto 60mg BID)
PPI
- Which available in OTC
- Omeprazole: Prilosec OTC
- Omeprazole/Na Biocar: Zegerid OTC
- Lansoprazole 24H: Prevacid-24H
PPI
- Agents come in IV
- SEs
- Renal dose adjuted
IV = LEP
- Lansoprazole
- Esomeprazole
- Pantoprazole
SEs
- HA, dizziness
- Chronic use = B12 deficiency
- May increase C.diff
- Decrease Ca, Mg
- Renal dose adjusted: No
Rapinex
- Omeprazole oral suspension
PPI
Tx Zollinger-Ellision
PER
- Pantoprazole - Protonix: 40 mg BID
- Esomeprazole - Nexium: 40mg BID
- Rabeprazole - Aciphex: up to 60 mg BID
PPI
- Can give via NG - PEL
=> Pantoprazole (Protonix): sus can give via NG-Tube
- Esomeprazole (Nexium) Cap & suspension
=> Lansoprazole also comes in suspension but DO NOT give via NG tube but CAP can open up and give thr NG-tube
PPI
- Come in ODT
- Lansoprazole - Prevacid
Prevpac
=> CAL
Lansoprazole 30 mg PLUS
Amoxicillin 500 mg PLUS
Clarithromycin 500 mg
Naprapac
Lansoprazole 15mg PLUS
Naproxen 500 mgoai
PPI
- Come only in PO
- Dexlansoprazole - Dexilant
- Omeprazole
- Lansoprazole
- Rabeprazold
IV
- Esomeprazole
- Protonix
PPI
- Can give with or without foods => RDP
- Dexlansoprazole - Dexilant
- Pantoprazole - Protonix
- Rabeprazole - Aciphex
PPI
- Can give to children w/ GERD
- Rabeprazole - Aciphex
- /= 15 kg: 10 mg PO QD up to 12 W
- > /= 12 y.o: 20 mg PO QD up to 8W
PPI DDI
- Inhibitors of 2C19
- Omeprazole
- Esomeprazole
=> Decr: diazepam, phenytoin, warfarin
=> Inhibit enzyme convert plavix to its active form
PPI DDI
- Dont interact w/ CYP450
=> PR
- Pantoprazole
- Rabeprazole
PPI
Preg Cat B
=> PRL
- Pantoprazole
- Rabeprazole
- Lansoprazole
PPI
Preg Cat C
- Omeprazole
- Esomeprazole
PPI
- Decrease bioavailability
- Ketoconazole
- Itraconazole
- Cefpodoxime
Misoprolol
- SEs
- Preg Cat
Cytotec
- SEs: diarrhea, uterine bleeding, spontaneous abortion
- Preg Cat: X
Cytoprotective agents
- Misoprolol
- Bismuth
- Sucralfate
GERD in children
- H2RA
- PPI - LEO
H2RA
- Famotidine: approve all age
- Ranitidine: > 1mo
PPI
- Lansorprazole
- Omeprazole
- Esomeprazole
GERD in Pregnancy
- Rec
- Antacids
- Alginate
- Sucrafate 1g TID (constipation)
- H2RA: Ranitidine (most study) => take after meal
- PPI: Lansoprazole 30 mg b/4 breakfast
