GI Flashcards by Brianna Spahn

GERD Treatment

Antacids
Mucosal Protective Agents
H2 Receptor Antagonists
PPIs

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Antacids

Aluminum hydroxide (Gaviscon)
Magnesium hyrdoxide (Malox, Milk Mg)
Calcium carb (Tums)
Sodium bicarb (alka selzter)

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Antacid MOA

Local acid neutralization by weak bases (to form salt and water)

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Mg Hydroxide causes

Diarrhea

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Aluminum Hydroxide causes

Constipation

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Four Histamine Receptor Agonists (H2RAs)

Pepcid
Axid

Zantac
Tagamet

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H2RAs MOA

Competitively Inhibit parietal H2 receptors (Decreases HCL production)

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H2RAs Zantac Drug interactions

Warfarin
Procainamide
Ketoconazole
Glipizide

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H2RAs Tagamet Problems

P450 INHIBITOR

Interacts w drugs that require acid environment
Azoles**

ADRS
Gynecomastia
Cognitive
Bradycardia
Agranulocytosis
Dizzy, diarrhea, headache

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Pepcin and Axid ADRs

Headache
Dizziness
Diarrhea
Constipation

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PPIs

Prazoles! (Omepraole, Esomeprazole, Pantoprazole)

Prilosec (OTC)
Prevacid (OTC)

Nexium
Protonix
Dexilant

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PPI MOA

Irreversibly blocks proton pumps on parietal cells

Decreases acid production 80-90%

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ADRs
Nausea, diarrhea, constipation, flatulence, abdominal pain
Myopathy, arthralgia, headache
Decreased absorption of B12, magnesium
Increased incidence of C.diff
Increased fracture risk
Increased incidence of pneumonia (double)

PPI’s

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First Line treatment Gastric Ulcers

PPI
Amoxicillin
Clarithromycin

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Alternative / 2nd line treatment for Gastric Ulcers

PPI
Amoxicillin

Metronidazole / Tinidazole

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Cytoprotective Agents

Bismuth subsalycilate (Pepto Bismal) - BLACK TONGUE/STOOL

Sucralfate (Carafate) - GOOEY GEL, CXI renal disease

Misoprostol (Cytotec) - stimulates mucin and bicarb, PREG X

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Bismuth Subsalycilate Contraindications

Kid/Teen recovering from viral infection (Reyes)

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Short term treatment of duodenal ulcer. Creates a gooey gel that adheres to ulcer

Sucralfate

CONTRAINDICATED FOR RENAL DISEASE

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Used to prevent NSAID ulcer

Misoprostol (Cytotec)

PREGNANCY CATEGORY X - CAN INDUCE MISCARRIAGE

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PREGNANCY CATEGORY X - CAN INDUCE MISCARRIAGE

Misoprostol (Cytotec)

When to avoid bulk-forming laxatives

Fluid restricted diet
fecal impaction
megacolon

Caution for diabetes - dextrose content

Stool Softeners

Docusate Sodium (Colase)

Docusate Calcium (Kaopectate)

MOA stool softeners

Emollient

Increase “wetting” of intestine fluid

Stool softeners good for

Post Op
Post MI
Colostomy
(need to avoid straining)

Mineral Oil warnings

Do not take at bedtime (pneumonia) Do not take w meals (decrease Vitamin absorption) Anal leakage

Saline Laxatives

``` Magnesium citrate, sulfate, oxide, hydroxide) Sodium phosphate (Fleet) ```

Saline Lax MOA

Ions draw water into large intestine

2nd line option for occasional constipation

``` Glycerine (Fleet ,Ped Lax) Polyethylene Glycol (Miralax) ```

Prescription only lax, opioid constipation, chronic constipation. ***Also used for hepatic encephalopathy by lowering ammonia levels***

Lactulose

Sugar Alcohol LAx

Sorbitol Mannitol Xylitol Osmotic Lax

Stimulant Lax - increase peristaltic activity intestines via mucosal inflammation

3rd line, except in opioid use ``` Sennosides (Ex Lax) Bisacodyl (Ducolax) Castor Oil ** CXI Pregnancy** Aloe Cascara ```

Stimulant Lax that causes stool and urine discoloration

Sennosides / Senna (Ex Lax)

Best choice for opiod induced constipation

Emollient + Stimulant | Docusate + Senna

Oral Lax options for children 2-6 yrs

Docusate or Magnesium hydroxide (Milk Mg) or Senna Glycerin suppositories

First choice lax for elderly

Bulk / fiber **if fluid requirement can be tolerated** Otherwise, glycerin suppository

Lax for pregnancy

Senna, Bisacodyl (Ducolax) PEG (Miralax) Docusate (Colase, softener)

Intestinal Secretagogues (increases fluid and motility) for chronic idiopathic constipation and/or IBS

Lubiprostone - not for bowel obstruction or prego Lincaclotide - guanylate cyclase agonist Plecanatide ''

Antimotility Agents

Loperamide (Imodium) Diphenoxylate/atrophine (Lomotil) - contorlled substance Diphenoxine/atropine (Motofen) Morphine

Treatment of choice for most cases of diarrhea

Imodium (Loperamide)

Imodium MOA

``` Opioid agonist (slows motility, gives a chance to absorb water) *poorly absorbed by CNS* ```

Atropine

Anticholinergic - decreases peristalsis and secretions Controlled Substance - Causes sedation, potentiates barbituates / EToH

Antisecretory agents

Lactase Bismuth subsalycilate Probiotics Octreotide

Overdose of Bismuth subsalicylate

Neurotoxicity

Injectable Somastatin analog. Used for diarrhea associated w carcinoma. Acromegaly.

Somastatin analog

Anticholinergics for IBS

Dicyclomine Methscopalamine antispasmotics

Severe IBS-D in women who have not responded to standard treatments should try

Alosetron something w serotonin

Stop Alosetron immediately

CONSTIPATION - can cause obstruction

Drug of choice for ulcerative colitis with extensive disease (ACG guidelines)

Sulfasalazine

Tnf-α inhibitors Ratatouille My Little Pony

Remicade Simponi Crohn's / UC , last option