Gastrointestinal Flashcards
Proton Pump Inhibitors
Proton pump inhibitors- reduce gastric acid secretion
I- peptic ulcer disease, GORD, dyspepsia, zollinger ellison syndrome, scleroderma oesophagus, H pylori eradication, prevention/treatment of NSAID ulcers, stress ulcer prophylaxis
D
Esomeprazole- 20-40mg od-bd
Lansoprazole- 15-30mg od-bd
Omeprazole-10-20mg od-bd (20-120mg/day in 2 doses for ZES)
Pantoprazole- 20-40mg od-bd (ZES 80-120mg bd or 80mg tds)
Rabeprazole 10-20mg od-bd
M- resolution of gastric symptoms/healing of gastric ulcer, urea breath test for H pylori eradication, LFTs (dose reduction in hepatic impairment, ongoing need/duration of treatment, C diff infection (increased risk), serum vit B12 level (low with long term PPI use), CKD (monitor renal function), fractures (monitor BMD, calcium and vit D)
C- swallow whole on empty stomach 30 min prior to food, tell dr about dark stools or blood in vomit, AE- headache, NVD, abdo pain, constipation, lifestyle advice for GORD- food avoidance, smaller meals stay up-right post meal
CALs- A, 5 (esomeprazole and omeprazole)
H2 receptor antagonists
H2 receptor antagonist- blocks Hr receptors in parietal cells reducing gastric acid secretion
I- Peptic ulcer disease, GORD, Dyspepsia, stress ulcer prophylaxis (rantitidine)
Cimetidine- 800mg/day in 1-4 doses.
Famotidine- 20-40mg once or twice daily
Nizatidine-150-300mg once or twice daily
Ranitidine- 300mg/day in 1-2 doses
Single doses are best taken in the evening
M- resolution of GORD/signs of GI bleed, duration and frequency of use, renal function (dose reduction required in impairment), Blood pressure (hypotension- infrequent AE), FBC (agranularcytosis), LFTS (hepatitis)
C- take in the evening, monitor of signs of GI bleed, can cause headache, tiredness, dizziness, confusion, lifestyle for GORD
CALs-
Cimetidine- 5
Dopamine Antagonists
C- Dopamine antagonist
Domperidone
I- Nausea/vomiting, gastroparesis (idiopathic/diabetic), lactation stimulation
D- 10mg tds (max 30mg/d). Take on empty stomach 30min before food
Metoclopramide-
I-nausea and vomiting, gastric paresis (eg after gastric surgery or diabetic gastroparesis), difficult small intestinal intubation, NV associated with migraine in combination with paracetamol
D- 10mg tds (max 30mg/day) for max 5 days
Prochlorperazine-
I- nausea/vomiting, vertigo, migraine associated NV
D- 5-10mg bd-tds (acute nausea- 20mg stat, then 10mg 2 hours later)
M- ECG (prolong QT- esp domperidone), parkinsons disease (avoid- domperidone is preferred), depression (avoid prolonged course of metoclopramide- may worsen), GI obstruction/perforation (CI- increases motility harmful), age (metoclopramide- only use <20yo if absolutely necessary- risk of EPSE), elderly (higher risk of EPSE), renal function (dose reduce in impairment), BP (risk of hypo/hypertension),
C- oral rehydration salts for vomiting, may cause dizziness/drowsiness dont drive until you know how you’re affected, if you notice any muscle rigidity/tremor/strange movements stop and see dr,
Domperidone- take 30min before food on an empty stomach
Prochlorperazine- label 1: causes drowsiness avoid driving. Increased effects of alcohol- avoid. Can cause dizziness on standing- avoid getting up from sitting or lying too fast.
CALs
Domperidone- 18, C
Metoclopramide- 12
Prochlorperazine- 1, 13, 16,
Ondansetron
5HT3 antagonist
I- nausea and vomiting associated with cancer chemotherapy/ radiotherapy, post surgical NV
D- 4-8mg tds (max 24mg/day)
M-hydration status/electrolytes for dehydration, QT prolongation, LFTs (transient increase in aminotransferases, dose reduce in impairment)
C- wafer/ODT- place on top of tongue allow to dissolve and then swallow, ask dr/pharm before taking other medications, AE- constipation, headache, dizziness, oral rehydration salts to avoid dehydration,
CAL- 5 (13 for wafer)
Other 5HT3 antagonists- Granisetron, Palonosetron, tropisetron
