GI Drugs Flashcards
brand name for pantoprazole
protonix
generic name for Prilosec
omeprazole
major indications for proton pump inhibitors (PPI)
gastroesophageal reflux disease (GERD) and peptic ulcer disease
MOA for PPI
irreversible blocking the gastric proton pump of the gastric parietal cells
common adverse drug reactions for PPI
hypocalcemia, B12 defiency, and rebound
rare adverse drug reactions for PPI
bone fracture, interstitial nephritis and infections
counsel points for PPI
administer 30 minutes before a meal, ideally breakfast
histamine type 2 receptor antagonists (H2RA) generic name
famotidine
histamine type 2 receptor antagonists (H2RA) brand name
pepcid
major indications for H2RA
GERD
MOA for H2RA
block histamine at H2 receptor on the parietal cell
black box warnings for H2RA
ranitidine (zantac) removed from market d/t NDMA levels
common ADRs for H2RA
b12 defiency and tachyphylaxis
rare ADRs for H2RA
CNS effects
counseling points for H2RA
good for occassional heartburn b/c works quicker than PPI, don’t need to take on empty stomach before a meal
mucosal protectant generic name
sucralfate
mucosal protectant brand name
carafate
major indications for mucosal protectant
GERD and peptic ulcer disease
MOA for mucosal protectant
Forms a complex by binding with positively charged proteins in exudates, forming a viscous
paste-like, adhesive substance. This selectively forms a protective coating that acts locally to
protect the gastric lining against peptic acid, pepsin, and bile salts
counseling point for mucosal protectant
may block absorption of some medications
generic name for phenergan
promethazine
brand name for prochlorperazine
compazine
brand name for metoclopramide
reglan
generic name for zofran
ondansetron
major indication for antiemetics
promethazine, prochlorperazine, metoclopramide and ondansetron
nausea and vomiting
MOA for promethazine and prochlorperazine
phenergan and compazine
inhibit dopaminergic, histaminic and muscarinic activity in the CTZ (chemoreceptor trigger zone)
MOA for metoclopramide
reglan
dopamine antagonist, enhances response to acetylcholine in upper GI tract and blocks signals to CTZ that trigger vomiting
MOA for ondansetron
zofran
5-HT3-receptor antagonist which blocks serotonin, both in gut and centrally in the CTZ
major contraindication for promethazine
- children under 2
- compromised respiratory function
major contraindication for prochlorperazine
- children under 2
- presence of CNS depressants
major contraindications for metoclopramide (reglan)
history of dystonic reaction to metoclopramide administration
major contraindication for ondansetron
high IV doses should be avoided in congenital long QT syndrome
long QT: longer than usual for the heart to recharge between beats
black box warnings for promethazine
- respiratory depression: kids under 2
- severe tissue injury (IV and SC use not recommended)
black box warnings for prochlorperazine
elderly patients with dementia: increase risk of death with antipsychotics
black box warnings for metoclopramide
tardive dyskinesia (EPS)
repetitive, involuntary movements, such as grimacing and eye blinking.
common ADRs for promethazine and prochlorperazine
- CNS: drowsiness, dizziness, delirium
- anticholinergic effects
- orthostatic hypotension
common ADRs for metoclopramide
- CNS: drowsiness, fatigue, dizziness, confusion
- diarrhea
common ADRs for ondansetron
- constipation
- CNS: headache, fatigue
rare ADRs for promethazine
- respiratory depression
- tissue damage
- EPS
- QTc prolongation
rare ADRs for prochlorperazine
- EPS
- QTc prolongation
rare ADRs for metoclopramide
QTc prolongation
rare ADRs for ondansetron
QTc prolongation
key counseling points for promethazine
beers and KIDS list
key counseling points for prochlorperazine
- beers and KIDS list
- available as suppository
key counseling points for metoclopramide
- beers and KIDS list
- avoid long term use when possible
brand name for antidiarrheal agent
lomotil
generic name for antidiarrheal
diphenoxylate/atropine
major indication for lomotil
diarrhea
MOA for anti-diarrheal
- opiate derivative - works on μ and δ receptors in the gut
- atropine solely to reduce abuse potential
major contraindications for lomotil
- C. diff
- kids under 6
common ADRs for anti-diarrheal
CNS depression
rare ADRs for anti-diarrheal
atropinism (anticholinergic)
poisoning by atropine
key counseling points for anti-diarrheal
beers and KIDS list
generic name for constipation agent
polyethylene glycol
brand name for constipation agent
- miralax
- golytely
major indication
polyethylene glycol
- constipation - occasional and chronic idiopathic
- bowel prep before colonoscopy
MOA for constipation agent
osmotic agent: pulls water into stool
major contraindications for constipation agent
use only under the direction of a health care provider if kidney disease is present (OTC)
common ADRs for constipation agent
abdominal cramping, distension, pain, bloating, diarrhea, flatulence
key counseling points for constipation agent
dissolve a capful in at least 4 ounces of fluid
brand name for dicyclomine
bentyl
generic name for linzess
linaclotide
brand name for lubiprostone
amitiza
generic name for xifaxan
rifaximin
major indications for bentyl
IBS - associated abdominal pain
major indications for linzess and amitiza
- IBS-Constipation
- opiod induced constipation
- chronic idiopathic constipation
major indications for xifaxan
- IBS
- hepatic encephalopathy
loss of brain func occurs when a liver doesn’t remove toxins from blood.
MOA for bentyl
anticholinergic - blocks acetylcholine at muscarinic receptors in smooth muscle
MOA for linzess
Agonizes guanylate cyclase-C on the luminal surface of intestinal epithelium. Intracellular and extracellular cGMP concentrations are subsequently increased resulting in chloride and bicarbonate secretion into the intestinal lumen. Intestinal fluid increases and GI transit is accelerated
MOA for amitiza
Cl- channel activator – increases intestinal fluid and improves fecal transit
MOA for xifaxan
inhibits bacterial RNA synthesis by binding to bacterial DNA-dependent
RNA polymerase
major contraindications for bentyl
glaucoma
major contraindication for linzess
- kids under 2
- GI obstruction
major contraindication for amitiza
GI obstruction
black box warning
linzess
serious dehydration in kids under 2
common ADRs for bentyl
- nausea
- anticholinergic - dizziness, blurred vision, dry mouth
common ADRs for linzess
diarrhea
common ADRs for amitiza
- nausea
- diarrhea
rare ADRs for xifaxan
increased risk of resistant infections
key counseling for bentyl
anticholinergic side effecting counseling
key counseling points for xifaxan
use should be limited to 14 days for IBS
