GI* Flashcards
Key drugs that can worsen GERD symptoms
-ASA/NSAIDs*
-Bisphosphonates*
-Dabigatran
-Estrogen products *
-Fish oil products
-Iron supplements
-Nicotine replacement therapy (gum)*
-Steroids
-Tetracyclines
Histamine -2 Receptor Antagonists (H2RAs) for GERD
–> famotidine (Pepcid) - can cause QT prolong with renal dysfunction
–> Ranitidine (Zantac) - can inc ALT
–> Nizatidine
–> Cimetidine * (avoid due to SEs & DDIs, can cause gynoclamestia and impotence)
SE: CNS effects (esp in elderly), vit B12 deficiency with prolonged use, (2 yrs), can cause agitation and vomiting in children < 1 y/o
-no need to use in combo with PPI
Proton Pump Inhibitors )PPIs) for GERD
–> Esomeprazole (Nexium) IV, OTC, suspen
–> Lansoprazole (Prevacid) OTC,ODT,suspen
–> Omeprazole (Prilosec) OTC, Rx, ODT, suspen
^^ take 30-60 mins before meals
–> Dexlansoprazole (Dexilant)
–> Pantoprazole (Protonix) IV, Rx
SE from chronic use: c. difficile associated diarrhea, osteoporosis-realted fractures, hypomagnesemia, vitamin B12 deficiency
Drugs that require an acidic gut (absorption dec by antiacids, H2RAs, PPIs)
-antiretrovirals: rilpivirine (NNRTIs), atazanavir (PI)
-Antivirals: ledipasvir, velpatasvir/sofosbuvir
-Azole antifungals: Sporanox (itraconazole caps), l=ketoconazole, posaconazole oral suspension
-Cephalosporins: cefpodoxime, cefuroxime
-iron products
-mesalamine
-risedronate delayed release
-Tyrosine kinase inhibitors: dasatanib, erlotinib, pazopanib
Oral drugs/drug classes that antacids bind
-Antiretrovirals (INSTIs): bictegravir, dolutegravir, elvitegravir
-Bisphosphonates
-Isoniazid
-Levothyroxine
-Mycophenolate
-Quinolones
-Sotalol
-Steroids (budesonide)
-Tetracyclines
PUD (H. pylori tx) 1st line Bismuth Quadruple therapy for 10-14 days
–> use 1st line especially if local resistence rates to clarithromycin are high (>15%), the pt has had a previous macrolide exposure or a penicillin allergy
–> Bismuth subsalicylate 300 mg QID +
–> Metronidazole 250-500 mg QID +
–> Tetracycline 500 mg QID +
–> PPI BID
OR
use a 3 - in - 1 combo product + PPI:
–> Pylera [bishmuth subcitrate potassium 420 mg + metronidazole 375 mg + tetracycline 375 mg] QID + PPI BID
Warnings: no alcohol with metronidazole, do not use tetracycline in children < 8yrs or pregos
Drug tx for H. pylori: concomitant therapy for 10-14 days
Use only if local resistance rates to claithyromycin are low (< 15%) and the pt has had no previous exposure to a macrolide
–> Amoxicillin 1,000 mg BID +
–> Clarithromycin 500 mg BID +
–> Metronidazole 500 mg BID +
–> PPI BID
Drug tx for H. pylori: Clarithromycin Triple THerapy: take for 14 days
use only if local resistance rates to clarithromycin are low (<15%) and the pt has had no previous exposure to macrolide
–> Amoxicillin 1000 BID +
–> Clarithromycin 500 mg BID +
–> PPI BID (or esomeprazole 40 mg daily)
-combo product = Prevpac (amoxicillin + clarithromycin + lansoprazole)
Risk factors for NSAID-induced Ulcers
-Elderly
-Hx of PUD
-high-dose NSAIDs
-Using > 1 NSAID (ibuprofen plus aspirin)
-Concomitant use of anticoagulants, steroids, SSRIs or SNRIs
Treatment of NSAID-Induced Ulcers
–> Misoprostol (Cytotec): prevention of PUD, BBW: abortifacrent (difficult to tolerate)
–> Sucralfate (Carafate): tx of PUD, SE: constipation
Drugs that are constipating
-Aluminum antacids (mag antacids can counter-effect)
-Anticholinergic drugs (TCAs, antihistamines, phenothiazines, antispasmodics, urge incontinence agents)
-NON- DHP CCBs (verapamil)
-Clonidine
-Colesevelam
-Iron *
-Opioids *
-Sucralfate (contained an aluminum complex)
What OTC product to recommend for constipation?
Adults: fiber (metamucil)
–> on opioids: Senna or a biscodyl suppository
–> on iron or stool is very hard: docusate
–> need to go soon but needs something gentle: glycerin suppository
Children: glycerin suppository
Pregnancy: fiber
*if no improvement in 7 days, go to MDO
What drugs are approved for IBS-C and chronic idiopathic constipation?
-Lubiprostone
-Linaclotide
-Plecanatide
Bulk forming agents
–> Psyllium (Metamucil)
–> Calcium polycarbophil (Fibercon)
–> Methylcellulose (Citrucel)
-onset of 12-72 hrs
-take 2 hrs before/after other drugs
SE: gas, bloating
Osmotic Laxatives
–> Magnesium hydroxide (MOM) - 30 min to 6hr onset
–> Polyethylene glycol (Miralax) - 24-96 hr onset
–> Glycerin (Supp) - works stat
–> Lactulose (Constulose) - also for hepatic encephalopathy
–> Sodium phosphates (Fleet enema)
SE: electrolyte imbalance
Stimulants
-Senna (Senokot)
-Bisacodyl (Dulcolax) - fast acting supp
-6+ hours to work, can give QHS to have BM in the am
SE: cramping, electrolyte imbalance
