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Pharmacology > GI Drugs > Flashcards

GI Drugs Flashcards

1
Q

what is the defence mechanism of the stomach

A
  • cells lining the stomach (chief cells) secrete thick mucous layer and bicarbonate
  • makes pH neutral close to surface
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2
Q

what is peptic ulcer disease

A
  • group of acid-peptic disorders of the upper GI tract primarily the esophagus, stomach and duodenum
  • gastric ulcer: in the stomach
  • duodenum ulcer: in the duodenum, more common than gastric ulcer
  • 90% of ulcers are due to a bacteria Called helicobacter pylori
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3
Q

what are symptoms of peptic ulcer disease

A
  • epigastric pain
  • food or antacids usually relieve the pain
  • feeling or being hungry
  • heartburn, belching and bloating
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4
Q

what is the secondary cause of peptic ulcer disease

A
  • histamine: secondary cause of ulcers
  • responsible for stimulation the production of gastric juices in the stomach
  • acidic gastric juices cause the ulcer in the mucosa
  • break down the protective barrier lining of the duodenum
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5
Q

what is the pharmacotherapy for PUD

A
  • antacids: symptomatic relief of gastric pain, especially heartburn, and will not really promote healing of the ulcers
  • antihistamines (histamine 2 receptor antagonists: H2RAs): the symptomatic relief of pain and promote healing of the ulcer
  • mucosal defense drugs: have no effect on gastric acid secretion
  • proton pump inhibitors: quick pain relief and accelerated healing of the ulcer
  • antibiotics: eradicate the h. pylori infection
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6
Q

what should ptes do if they are experiencing PUD

A
  • stop smoking
  • stop consuming alcohol (or reduce amount)
  • stop caffeine
  • stop use of NSAIDs (if they can)
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7
Q

what are antacids

A
  • treatment of dyspepsia and adjunctive therapy for duodenal ulcers
  • neutralize acids in the stomach
  • not the primary or sole drug of choice for tx
  • do not heal ulcers
  • use on an ‘as needed’ basis
  • the antacid of choice for tx and maintenance of PUD is bismuth subsalicylate (peptic bismol). it suppresses h.pylori infection by inhibiting bacterial adherence to mucosal cells and damage to bacterial cell walls
  • used in conjunction with antibiotics
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8
Q

what are H2 antihistamines antagonists

A
  • inhibit the release of gastric acid by blocking the action of histamine in the H2 receptor located on the parietal cell in the stomach
  • effective in healing ulcers in 6-12 weeks
  • also called H2 blockers
  • give symptomatic relief and healing of ulcers
  • alleviate symptoms of duodenal ulcers, gastric ulcer and GERD
  • used in conjunction with antibiotics to eradicate H. pylori
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9
Q

what are the four H2 receptor antagonists or blockers that are currently available by prescription and otc

A
  • cimetidine (tagamet)
  • ranitidine (Zantac)
  • famotidine (Pepcid)
  • nizatidine (axid)
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10
Q

what is cimetidine (Tagamet)

A
  • first h2 receptor antagonist introduced
  • otc
  • many drug drug interactions (inhibits the CYP1A2 enzymes in the liver)
  • increased levels: tricyclic antidepressants, tacrine, antipsychotics
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11
Q

what are proton pump inhibitors

A
  • rapid symptomatic relief with accelerating healing or duodenal ulcers, H pylori infections and GERD
  • reduce peak acid output (eg food stimulated acid output) without regard to administration time
  • bind irreversibly to the proton pump in the membrane of the acid producing cells in the stomach
  • provide long term and nearly total acid suppression
  • show high healing rates for PUD
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12
Q

what are some examples of proton pump inhibitors

A
  • esomeprazole (Nexium)
  • ilansopraxzole (prevacid)
  • omeprazole (losec)
  • pantoprazole (pantoloc)
  • rabeprazole (pariet)
  • highly bound to plasma proteins so there will be displacement of other highly protein bound drugs (ie phenytoin diazepam and warfarin)
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13
Q

what is prostaglandin supplementation

A
  • misoprostal (cytotec)
  • indicated for the prevention of NSAID-induced gastric and duodenal ulcers
  • CAUTION: women of child bearing age -> can cause abortion
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14
Q

what is sucralfate

A
  • protective barrier drugs
  • aluminum hydroxide-sucrose complex
  • function to form a protective barrier over the GI mucosal lining
  • do not alter the pH of gastric juices or inhibit gastric acid secretion
  • bind to the gastric mucosa and form a gel that protects the ulcer from gastric acids
  • indicated for the short-term maintenance of healing a DU
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15
Q

what are treatment guidelines for protective barrier drugs (sucralfate)

A
  • recommended therapy for duodenal ulcers is 2 antibiotics + H2 antagonist + antacids PRN
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16
Q

what are the principles of treatment for with antibiotics for PUD

A
  • eradicate H. pylori bacteria
  • multidrug regimens
  • adequate length of tx: 10-14 days recommended, compliance, tolerability (adverse side effects)
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17
Q

what is triple therapy of antibiotics

A
  • PUD tx
  • 2 week course
  • omeprazole or lansoprazole + metronidazole or amoxicillin + clarithromycin
  • ranitidine bismuth citrate + clarithromycin or metronidazole + tetracycline or amoxicillin
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18
Q

what is quadruple therapy of antibiotics

A
  • 2-Week Course
  • Bismuth subsalicylate (Pepto-Bismol) + metronidazole + tetraycyline + H2-antagonist
    Bismuth subsalicylate + metronidazole + tetraycycline + PPI (proton pump inhibitor)
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19
Q

what causes GERD

A
  • most common chronic conditions of the upper GI tract
  • reflux or ‘backing up’ of the gastric contents from the stomach into the esophagus
  • most common complaint or symptom is heartburn, but the individual may also complain of epigastric pain
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20
Q

what is reflux esophagitis

A
  • gastric contents stay in contact for prolonged periods of time with the mucosal tissue of the esophagus
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21
Q

what are risk factors for GERD

A
  • alcohol
  • smoking
  • spicy foods
  • medications: aspirin and NSAIDS, calcium channel blockers, alendronate, tetracycline
  • note: h.pylori infection does not increase the risk of GERD
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22
Q

what pharmacotherapy is available for GERD

A
  • change lifestyles before meds

- antacids and most H2 receptor inhibitors are available without a prescription

23
Q

what are antacids

A
  • for mild to moderate heart burn symptoms
  • sodium bicarbonate/alginic acid combination (gaviscon)
  • watch out or ‘rebound’ hyperacidity
  • effects of antacids last for about 30 mints, longer if take after meals and at bedtime
  • antacids must be taken frequently (every 2-4 hours)
24
Q

what are the substances in antacids that are responsible for neutralizing acids

A
  • sodium bicarbonate
  • calcium carbonate
  • bismuth, aluminum salts (hydroxide, phosphate)
  • magnesium salts (hydroxide, chloride)
25
Q

what does sodium bicarbonate do

A
  • contains sodium
  • absorbed ino general circulation
  • alka-seltzer
26
Q

what does calcium carbonate do

A
  • tums
  • not absorbed
  • rebound acid secretion
27
Q

what does magnesium hydroxide and aluminum hydroxide do

A
  • most common type

- maalox

28
Q

what does bismuth subsalicylate (BSS) do

A
  • peptic bismol
  • suppress h pylori infection
  • used in combination with antibiotics
  • antacid of choice in the tx and maintenance of PUD
29
Q

what are potential drug interactions for antacids

A
  • tetracyclines

- fluoroquinolone: do not take antacids together with these antibiotics

30
Q

what do H2 receptor antagonists do

A
  • reduce gastric secretion in the stomach, reducing the chance for reflux into the esophagus
  • antacids + H2 receptor antagonists
31
Q

what are pro kinetic drugs

A
  • alternative to H2RAs
  • increase the force of the contraction of the lower esophageal sphincter thus decreasing reflux of gastric juices and accelerating gastric emptying
  • ex. metoclopramide
32
Q

what are recommended therapies for GERD

A
  • lifestyle modifications (change in diet, eliminate foods that aggravate GERD, losing weight)
  • sleeping with an elevated pillow
  • exercise
33
Q

what is the first line drug therapy for GERD

A
  • antacids and a non prescription histamine 2 receptor antagonists such as famotidine (Pepcid) or a PPI such as omeprazole
34
Q

what is irritable bowel syndrome

A
  • non specific disease with symptoms lasting at least 12 weeks consisting of diarrhea, constipation and abdominal pain
  • disuse associated with IBS: fibromyalgia or chronic fatigue syndrome, sleep disturbances, migraines and chronic stress
  • treatment of IBS is a challenge
  • psychological issues must be addressed
35
Q

what is the pharmacologic treatment for IBS

A
  • antidiarrheal agents
  • antispasmodic/anticholinergic agents: chlordiazepoxide/clidinium bromide
  • anticonstipation agents: laxatives, increase fibre intake
36
Q

what is constipation and what can it be caused by

A
  • if waste stays in the colon for long periods -> reabsorption of too much water -> small hard stools -> difficult or infrequent bowel movements -> constipation

can be caused by:

  • lack of exercise
  • insufficient food or fluid intake
  • lack of sufficient insoluble dietary fibre
  • medications: narcotics, calcium channel blockers, anticholinergics, antacids
37
Q

what are laxatives

A
  • promote defecation
  • when chronic, infrequent or painful bowel movements
  • before surgery or procedures to cleanse the bowel
  • after surgery or MI to prevent straining
  • cathartic = strong and complete bowel emptying
  • few side effects if taken as prescribed
38
Q

what are the 5 classifications of laxatives

A
  1. bulk forming – absorb water -> increase in size (Metamucil)
  2. stimulant – pull water into fecal mass and irritate bowel to increase peristalsis (ducolax)
  3. saline/osmotic – water retained in fecal mass -> more watery stool (MOM)
  4. stool softeners/surfactants – bring water and fat into stool (colace)
  5. miscellaneous – act by mechanisms other than above (mineral oil)
39
Q

what are contraindications of laxatives

A
  • susceptive bowel obstruction -> perforation
  • acute abdominal cramping or diarrhea
  • overuse -> smooth muscle loses tone -> chronic constipation
40
Q

what is psyllium mucilloid (Metamucil)

A
  • bulk forming laxative
  • ingestible insoluble fiber
  • not absorbed by GI tract
  • take with water -> swells -> increases fecal mass by drawing water into intestine -> promote bowel movement
  • several doses needed for effect
  • take with sufficient amounts of water (obstructions in esophagus or intestines)
41
Q

what is diarrhea

A
  • colon not reabsorb enough water from fecal mass -> watery stools
  • increase in frequency and fluidity of bowel movements = diarrhea
  • prolonger -> loss of body fluids and electrolyte imbalances
42
Q

diarrhea can be a symptom of what underlying medical disorders

A
  • medications
  • infections
  • inflammatory bowel disease
  • superinfections
  • lactose intolerance
43
Q

what are the most common bacterias involved in food poisonings

A
  • salmonella and e coli
44
Q

what is chronic diarrhea

A
  • diarrhea lasting more than 4 weeks
  • can lead to dehydration and loss of important minerals and electrolytes
  • watch for C. difficile infections after antibiotic use or recently hospitalized patients
  • yogurt which has lactobacillus acidophilus culture pr acidophilus tablets (available in the vitamin section of store) are given to replace the bowel flora in ptes taking antibiotics
45
Q

what is ulcerative colitis

A
  • chronic, long lasting disease resulting in inflammation of the mucosa of the colon (large intestine) and rectum)
  • bloody diarrhea and abdominal pain
  • reduce the inflammation of th tissues of the colon by using anti-inflammatory drugs
  • patients with ulcerative colitis cannot take clindamycin
46
Q

what are antidiarrheals

A
  • depend on severity or cause
  • goal is to relax the colon’s smooth muscles to relieve cramping
  • -> slower movement through larger intestine = better formed stool
47
Q

what are some examples of antidiarrheals

A
  • opioids are the most effective for controlling severe diarrhea. they slow peristalsis in the colon though there is a slight risk of dependence
  • OTC for mild diarrhea:
  • bismuth subsalicylate (bind and absorb toxins)
  • psyllium and pectin (absorb fluid)
  • intestinal flora modifiers (active yogurt to restore normal flora)
48
Q

what is diphenoxylate with atropine (lomotil)

A
  • an opioid
  • has no analgesic properties and low potential for abuse
  • slows peristalsis -> more water reabsorbed -> more solid stools
  • moderate to severe diarrhea
  • atropine used to discourage clients from taking too much (drowsiness, dry mouth, tachycardia)
49
Q

what is nausea

A
  • the uncomfortable urge to vomit

- feeling in the throat that vomiting may happen

50
Q

what is vomiting

A
  • emesis
  • reflex controlled by medulla of brain = vomiting centre
  • expulsion of gastric contents through the mouth
  • enamel erosion
51
Q

what is nausea and vomiting associated with

A
  • food poisoning
  • early pregnancy
  • extreme pain
  • trauma to head or abdominal organs
  • inner ear disorder
  • emotional disturbances
52
Q

what are antiemetics

A
  • treat nausea, vomiting and motion sickness
  • remove the cause
  • during cancer therapy (multiple drugs)
  • IM, IV or suppository or oral
  • causes drowsiness
53
Q

what are the 5 classes of antiemetics

A
  1. phenothiazines
  2. antihistamines
  3. serotonin receptor agonists (most effective)
  4. glucocorticoids
  5. benzodiazepines
54
Q

what are the uses of ginger

A
  • obtained from root of zingiber officinale
  • tincture, tea, dried or fresh root, capsules
  • use ginger extract not artificial
  • treatment of nausea, vomiting, morning sickness, motion sickness
  • effectiveness comparable to OTCs
  • also anti-inflammatory, helps coughs and lowers fever, affects blood clotting

Pharmacology (21 decks)

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