GI deck 3 Flashcards
Stimulants examples
cascara, senna, bisacodyl, and castor oil
stimulants action
Direct action on intestinal mucosa by stimulating the myenteric plexus
Osmotics example
magnesium hydroxide, magnesium citrate, sodium phosphate, polyethylene glycol electrolyte solution, and polyethylene glycol (PEG) 3350
Osmotic action
draw water into the intestinal lumen
bulk producing laxative example
psyllium, methylcellulose, and polycarbophil
bulk producing laxative action
Natural and semi-synthetic polysaccharides and cellulose that mix with water in the intestine
lubrcant example
mineral oil
lubricant action
Soften stool and lubricates intestine
surfactants example
docusate sodium, docusate calcium, and docusate potassium
surfactants action
Reduce the surface tension of the oil–water interface on the stool and facilitate admixture of fat and water into the stool
Hyperosmlar laxitive example
glycerine, lactulose
hyperosmolar laxitive action
Draws water into the intestine
Chloride channel activator example
lubiprostone
chloride channel activator action
activate CIC-2 chloride channels in the GI tract to produce chloride-rich secretions that soften the stool
Opioid-receptor antagonist example
methylnatrexone
opioid receptor antagonist action
Mu receptor antagonist
laxative contraindicated in
presence of nausea, vomiting, undiagnosed abdominal pain, or if bowel obstruction is suspected or diagnosed
Magnesium hydroxide CI in
renal dysfunction
Methylnaltrexone may
opioid withdrawal
ADR - Laxative
excessive bowel activity, cramping, faltulece and bloating
laxative Raid response and short-term use
Stimulants are the drugs of choice.
Osmotic laxatives also work well (magnesium hydroxide, PEG 3350).
Surfactants: docusate
Laxative slower response and long-term use
bulk forming are safest
Rapid-acting laxatives are best taken in the
am, lower-acting ones are best taken at bedtime!
laxatives patient edcution
– prevention is key as laxatives are a temporary fixes. FIBER!
pregnancy laxatives
Bulk-forming laxatives are safest
PEG (Miralax) or docusate may be used.
GERD a common problem
in primary care
GERD patho
Lower esophageal sphincter tone
Gastric content regurgitation into the esophagus
Complaints of burning substernal pain that radiates upward
Persistent acid reflux that occurs more than twice a week considered GERD
Goals of GERD tretment
reduce or eliminate symptoms, heal esophageal lesions, manage or prevent complications, prevent relapse
Best treatment combo for GERD
lifestyle modification and drug therapy
Drugs used for GERD
Histamine2 (H2) receptor antagonists Proton pump inhibitors (PPIs) Antacids Prokinetics Cytoprotective agents
Mild GERD
OTC antacid or H2RA
Moderate to severe GERD
Lifestyle and PPI for 8 weeks
no response to PPI
refer out
Pediatric GERD is
Very common in infants
Almost 100% in 3-month-old, 4% of 6-month-old, 20% of 12-month-old infants
Ped GERD most outgrow by
12 to 18 mo
Medical management reserved in those pediatrics who are experiencing
Poor weight gain
Feeding difficulties
Persistent irritability and pain, apnea, and cyanosis
Peptic Ulcer disease incidence
12% in men and 10% in women
Peptic ulcer disease patho
Increased acid and pepsin secretion
Impaired mucosal cytoprotection
Use of nonsteroidal anti-inflammatory drugs (NSAIDs), Helicobacter pylori
Gastric: antral stomach region erosion, raised gastrin
Duodenal: H. pylori releases toxins, phospholipase enzymes promoting inflammation and erosion
Peptic ulcer disease can be caused by
NSAID and H. Pylori
Peptic ulcer disase usualy presents as
chronic, upper abdominal pain – often related to eating a meal
Peptic ulcer disase Physical exam may show
epigastric tenderness or not, often exams show no other signs
Peptic ulcer diases in the absence of
red flag symptoms” testing for and treating H Pylori and/or empiric acid inhibition therapy is appropriate
Red flag symptoms for peptic ulcer diseases
Red flag symptoms are: weight loss, bleeding, anemia, vomiting, early satiety, dysphagia
All regimens for peptic ulcer disease include a PPI plus
antibiotics to treat H. pylori
Triple therapy - PPI plus (peptic Ulcer)
Clarithromycin: 500 mg twice daily, or
Metronidazole: 500 mg twice daily
Amoxicillin: 1 gm twice daily
Treatment for 10 to 14 days
Quadruple therapy – PPI plus
Metronidazole: 250 mg four times/day
Tetracycline: 500 mg four times/day
Bismuth subsalicylate: 525 mg four times/day
Treatment for 14 days
Usually used as second-line therapy in patients who fail first-line therapy
Levofloxacin-based trip therapy
PPI: twice daily Levofloxacin: 250 to 500 mg twice daily Amoxicillin: 1 g twice daily Treatment for 10 to 14 days Second-line or rescue therapy
Peptic ulcer uncomplicated
treatment with h. pylori with PPI
PPI is used for
8 to 12 weeks
Complicated peptic ulcer what would you do
refer for gastroenterologist for edocopy and treatment for H. pylori
When do you consider chronic supressive therapy with PPI or H2Ra
smokers >60, COPD, CAD, hx of bleeding or perforated ulcer, patients on NSAID
