GI Flashcards
GERD drug classes
-Antacids
-H2 receptor antagonists
-PPIs
-Mucosal protectant
-Promotility agents
Antacids-meds
Aluminum, calcium carbonate, sodium bicarbonate, and magnesium OTC
alginic acid (Gaviscon) - forms a protective layer
Be weary of sugar and sodium contents for dm and htn
Histamine-2 Receptor Antagonists
Cimetidine, Famotidine, Nizatidine, Ranitidine
tolerance over time, renal dosing required, cimetidine interaction with plavix and known for impotence and gynocomastia
Proton Pump Inhibitors
-meds
-adverse effects
Esomeprazole, omeprazole, omeprazole + sodium bicarbonate, lansoprazole, rabeprazole, pantoprazole, dexlansoprazole
decreased calcium absorption, hypomagnesemia, increased risk of c-diff
Promotility agents
metoclopramide-
therapy >12 weeks not recommended due to risk of irreversible tardie dyskinesia
confusion, dizziness, fatigue, headache, hyperprolactinemia, and extrapyramidal symptoms
erythromycin- Qt prolongation
Mucosal Protectant
Sucralfate-
forms protective coating
two predominant causes of peptic ulcer disease
Helicobacter pylori and NSAIDs
Primary treatment for H. pylori
quadruple therapy for 14 days
preferred quadruple therapy for H. pylori
PPI BID
Clarithromycin 500mg BID
Amoxicillin 1000mg BID
Metronidazole 500mg BID
quadruple therapy for H. pylori if previous exposure to macrolide or allergy to pnc
PPI BID
Bismuth subsalicyclate 262mg QID
Tetracycline 500mg QID
Metronidazole 250mg QID
triple therapy for H. pylori if no prior exposure to macrolide and regional resistance to Clarithromycin < 15%
PPI BID
Clarithromycin 500mg BID
Amoxicillin 1000mg BID
or Metronidazole 500mg BID
Risk factors for NSAID-induced ulcers
age > 65
male gender
previous GI hx
-recent pud or previous GIB
coexisting significant dx
-cardiovascular or hepatic/renal
impairment
concomitant therapy with:
-aspirin
-anticoagulants
-coritcosteroids
-SSRIs
medications for prevention of GI mucosal injury with PUD
PPI, Misoprostol, high dose H2-receptor antagonist like famotidine
Potential causes of diarrhea
abx
metformin
misoprostol
colchicine
others..
medications for diarrhea
Loperamine (Imodium) - OTC
Diphenoxylate and atropine (Lomotil)
Bismuth subsalicylate (Pepto Bismol) - OTC
Bile salt-binding resins
Octreotide (Sandostatin)
Medications associated with causing constipation
Aluminum or calcium-containing antacids
Anticholinergic agents
Beta-blockers
Calcium-channel blockers
Calcium supplements
Oral iron supplements
Opioids
Medication classes to help with constipation
Fiber/bulk laxatives
Osmotic laxatives
Stimulant laxatives
Stool softeners
Saline laxatives
Chloride channel activator
Guanylate cyclase-C agonists
Fiber/Bulk Laxatives
Hold water in the stool, increase stool weight, increase colonic distention, and improve frequency of bowel movements
-Methylcellulose (Citrucel), calcium polycarbophil (FiberCon), psyllium (Metamucil)
-bloating, cramping
-onset 12-72 hours
Osmotic Laxatives
Promote secretion of water into the lumen of the colon and stimulates movement of the bowel
-lactulose, polyethylene glycol (Miralax)
-Diarrhea
-Onset 12-96 hours
Stimulant Laxatives
Increase intestinal motility and colonic secretions
-bisacodyl (Dulcolax), sennosides (Senokot)
-Cramping
-Onset: oral- 6-10 hours, rectal- 15-60 mins
Drug class of choice to prevent opioid induced constipation
Stool Softeners
Improve interaction of water and stool
-Docusate (Colace)
-Diarrhea, cramping
-Onset 12-72 hours
Saline laxatives
Draw water into intestines and colon by osmosis to increase motility
-magnesium hydroxide, mag citrate, oral sodium phosphate liquid
-cramping, dehydration, electrolyte disturbances
-Onset- 30 mins to 6 hours
Chloride channel activator
Increase intestinal fluid secretion and improve fecal transit
-lubiprostone (Amitiza)
-headache, nausea, diarrhea
Guanylate cyclase-C agonist
Increase intestinal fluid secretiopn and improve feccal transit
-linaclotide (Linzess), plecanatide (Trulance)
-diarrhea
Diarrhea-predominant IBS- medications, fiber?, associated with what?
-no benefit for adding fiber
-loperamide, non-systemically absorbed abx (rifaximin), serotonin-3 agonist (alosetron-Lotronex), opioid agonist )eluxadoline- Viberzi)
-can be associated with psychological symptoms such as anxiety and depression
Constipation-predominant IBS
-OTC laxatives- Miralax
-Selective C-2 chloride channel activators- lubiprostone (Amitiza), linaclotide (Linzess)
-5-HT4 agonists- tegaserod (Zelnorm)-emergency use only due to increased risk of MI, unstable angina, and stroke
Both types of IBS
Antispasmodics- hyoscyamine (Levsin), dicyclomine (Bentyl) - dry mouth, dizziness, blurred vision
Antidepressants- SSRIs and tricyclic though tricyclic can cause constipation and is predominantly used for diarrhea
Medications associated with causing nausea
-Chemo
-Opioids
-Glucagon-like 1 peptide agonists- liraglutide, exenatide
-Chantix
Non-prescription medication for nausea
Antacids
H1 Antagonists-
dimenhydrainate (Dramamine)
diphenydramine (Benaryl)
meclizine (Bonine)
Prescription nausea medications
-Anticholinergics
scopolamine (Transderm-scop)
-H1 Antagonist
promethazine (Phenergan)
hydroxyzine (Vistaril)
-Serotonin Antagonists
alosetron (Lotronex)
dolasetron (Anzemet)
granisetron (Granisol)
ondansetron (Zofran)
palonosetron (Alexi)
-Antidopaminergics
-metoclopramide (Reglan)
Serotonin Antagonists for Nausea
Selevtively inhibit serotonin at the 5HT3 receptor in the small bowel, vagus nerve, and chemoreceptor trigger zone
-indications are for chemo-induced and post-op nausea/vomiting
-QT prolongation, headache
Nausea and Vomiting in Pregnancy
Monotherapy: vitamin B6 10-25 mg 3 or 4 times per day
Add: doxylamine 12.5mg 3 or 4 times per day
Add: promethazine 12.5mg every 4 hours OR dimenhydrinate 50-100mg every 4-6 hours not to exceed 200mg/day if also taking doxylamine
