Gastrointestinal Medications Flashcards
Describe the pathophysiology of gastroesophageal reflux disease (GERD)
acid regurgitation back into esophagus and oral cavity
Describe the pathophysiology of hypersecretory conditions
excessive acid production
Describe the pathophysiology of erosive esophagitis
ulceration of walls of esophagus
Describe the pathophysiology of stomach ulcers.
infection with H. pylori
What are some risk factors for peptic ulcer disease?
H. pylori infection, acid hypersecretion, stress, familial factors, smoking, heavy drinking, hyperparathyroidism, renal dialysis treatment, chronic use of NSAIDS
Describe the pathophysiology of Barrett’s Esophagus.
lining of esophagus altered to resemble that in intestines
Describe the symptoms of common gastrointestinal disorders.
acidic taste, pain/buring sensation, difficulties with digestion, GI ulceration and bleeding
Describe the oral symptoms of common gastrointestinal disorders.
tooth erosion, irritation of the buccal mucosa, glossitis, burning mouth/tongue, inflammation of oropharynx, ulceration of pillars and pharyngeal walls
Describe the mechanism of action of antacids used for the management of gastrointestinal disorders.
weak bases interact with stomach acid to form water and salt, they act locally to treat excess acidity and raise gastric pH
What are some limitations and adverse effects of antacids?
frequent dosing is necessary, they need HCl for digestion, and they do not inhibit HCl production by parietal cells: adverse effects may include constipation and increased caries (due to high sugar content in some antacids)
What are some examples of antacids?
Aluminum hydroxide, magnesium hydroxide or calcium carbonate (Tums), magnesium products including Milk of Magnesia and Maalox, Aluminum products including Amphojel and Aluminum glycinate, and others including milk and sucralfate (Carafate)
How does Milk of Magnesia function as an antacid?
hydroxide ions bind with HCl in stomach neutralizing the acid
What are some characteristics of Maalox (magnesium trisilicate) enabling it to serve as an antacid?
coats ulcerated area and protects ulcers from HCl, slow acting, neutralizes gastric pH, silica absorbs H+
What are two features of aluminum products that help to treat GI disorders?
aluminum is an astringent that helps stop bleeding, and products like Amphojel coat and protect ulcers from H+
Describe some effects of sucralfate (Carafate)
forms complexes with albumin, fibrinogen and globulin on ulcer surface, thus creating protective barrier to acid and pepsin (however it interferes with the absorption of many medications). It is not absorbed and also binds pepsin directly.
Describe the mechanism of action of H2 receptor antagonists used for the management of gastrointestinal disorders.
Histamine H2 receptor antagonists address multiple symptoms by aiding in nocturnal acid control.
Which H2 receptor antagonist is preferred by gastroenterologists?
Zantac. Others include Tagamet, Pepcid, and Axid (Tagamet is the one with the most adverse effects)
Describe the mechanism of action of proton pump inhibitors used for the management of gastrointestinal disorders.
Bind to H+/K+ ATPase enzyme system in parietal cells helping to reduce gastric secretions, neutralize gastric acid after release, and protect gastric mucosa from damage.
What are some examples of proton pump inhibitor medications?
Nexium, Prevacid, Prilosec, Protonix, Aciphex
What is a second generation proton pump inhibitor indicated for use in the prevention and treatment of NSAID-induced gastrointestinal lesions?
Nexium
State which antibiotics are used for the treatment of infection with H pylori.
amoxicillin, metronidazole, clarithromycin, tetracycline (these are used in combination with proton pump inhibitors and H2 receptor blockers to treat the ulcers)
Describe important dental drug interactions with gastrointestinal medications.
antacids neutralize pH thereby interfering with absorption of many drugs (wait 2 hours). They also interfere with bioavailability and elimination of many drugs. Histamine antagonists decrease effects of antifungals and alter warfarin. Proton pump inhibitors decrease absorption of systemic antifungals.
Tagamet (a histamine H2 receptor antagonist) increases serum concentration of which drugs commonly used in dentistry?
benzodiazepines, Lidocaine, Quinolone antibiotics (Cipro)
Discuss dental practice management considerations for treating patients with peptic ulcer disease.
Avoid aspirin/NSAIDS in patients with Hx of stomach ulcers
Describe the etiology Chrohn’s disease.
While the exact etiology is unknown, aspects that may be associated include allergies, destructive enzymes, bacterial and viral infections, stress, and immunologic factors
What are two distinct conditions of IBS?
ulcerative colitis and Crohn’s disease
What is the pathophysiology of Chrohn’s disease?
Autoimmune disease affecting entire wall of bowel; focal ulcerations along any point of alimentary canal from the mouth to the anus; most commonly involves the terminal ileum.
What is the pathophysiology of ulcerative colitis?
Ulcerative colitis is a chronic inflammatory condition characterized by relapsing and remitting episodes of inflammation limited to the mucosal layer of the colon. It almost invariably involves the rectum and typically extends in a proximal and continuous fashion to involve other portions of the colon.
Discuss dental practice management considerations for treating patients with inflammatory bowel disease
Macrolide antibiotics (erythromycin) cause GI distress and diarrhea so caution should be exercised in prescribing these medications to patients with inflammatory bowel disease.
Discuss risk factors associated with constipation.
inactivity, inadequate water intake, motility problems, medication-induced constipation, dependency upon laxatives, insufficient fiber intake
Identify common classes of laxatives.
Bulk (carboxymethyl cellulose with psyllium), Osmotic (magnesium salts such as OTC magnesium citrate), Contact (bisacodyl aka Dulcolax and castor oil), Lubricants (mineral oil and glycerin)
What are some common oral complications to GI disorders and associated medications?
xerostomia, taste alteration (metallic aftertaste), apthous stomatitis, candidiasis (esophageal), excessive salivation (mediated by vagus nerve in response to excessive gastric acid coming into the oral cavity)
What are some complications of peptic/duodenal ulcers with manifestations related to cancer?
H. pylori associated with cancer of gastric mucoas = lymphoma and atrophic gastritis caused by chronic use of proton pump inhibitors increases risk for stomach cancer
What is the standard first-line therapy for treatment of H. pylori?
One week triple therapy includes: amoxicillin, clarithromycin (Biaxin), and a proton pump inhibitor (Nexium, Prevacid, Protonix, Aciphex, Prilosec)
What are unique oral manifestations of Crohn’s?
atypical mucosal ulcerations, diffuse swelling of lips and cheeks, cobblestone mucosal lesions
