GI Drugs Flashcards
memorize
calcium carbonate
antacid (buffer)
poorly absorbed
impaired renal function: can build, become toxic
remember chelation
take drugs separate that need acid
side effects: constipation, bloating, farts, etc., kidney stone/hypercalcemia
aluminum hydroxide
antacid (buffer)
poorly absorbed
impaired renal function: can build, become toxic
remember chelation
take drugs separate that need acid
side effects: constipating, hypophosphatemia
magnesium hydroxide
antacid (buffer) poorly absorbed impaired renal function: can build, become toxic remember chelation take drugs separate that need acid side effects: diarrhea
ranitidine
H2 antagonist
For: GERD, PUD, dyspepsia, gastritis, esophagitis, zollinger-ellison syndrome
side effects: diarrhea/constipation, HA, drowsiness, fatigue, muscle pain. Rare: cns side effects
excreted by kidnes
could alter absorption of drugs that require acid
OTC, oral, IV, IM
famotidine
H2 antagonist
For: GERD, PUD, dyspepsia, gastritis, esophagitis, zollinger-ellison syndrome
side effects: diarrhea/constipation, HA, drowsiness, fatigue, muscle pain. Rare: cns side effects
excreted by kidnes
could alter absorption of drugs that require acid
OTC, oral, IV
nizatidine
H2 antagonist
For: GERD, PUD, dyspepsia, gastritis, esophagitis, zollinger-ellison syndrome
side effects: diarrhea/constipation, HA, drowsiness, fatigue, muscle pain. Rare: cns side effects (elderly) thrombocytopenia (rare)
excreted by kidneys
could alter absorption of drugs that require acid
not available OTC
cimetidine
H2 antagonist
For: GERD, PUD, dyspepsia, gastritis, esophagitis, zollinger-ellison syndrome
side effects: diarrhea/constipation, HA, drowsiness, fatigue, muscle pain. Rare: cns side effects
excreted by kidnes
could alter absorption of drugs that require acid
gynecomastia & galactorrhea: this drug inhibits binding of testosterone and inhibits estrodial hydroxylation
dexlansoprazole
-prazole suffix
PPI
for: GERD, erosive esophagitis, gstric/duodenal ulcers, H. pylori eradication, zollinger-ellison syndrome, upper GI bleeding
side effects: GI, nausea, ab pain, constipation/diarrhea, gas
chronic use: increase C. diff. & pneumonia
generally well tolerated
esomeprazole
-prazole suffix
PPI
for: GERD, erosive esophagitis, gstric/duodenal ulcers, H. pylori eradication, zollinger-ellison syndrome, upper GI bleeding
side effects: GI, nausea, ab pain, constipation/diarrhea, gas
chronic use: increase C. diff. & pneumonia
generally well tolerated
IV formulation available
omeprazole
-prazole suffix
PPI
for: GERD, erosive esophagitis, gstric/duodenal ulcers, H. pylori eradication, zollinger-ellison syndrome, upper GI bleeding
Zegerid is a form of omeprazole which is a PPI & bicarb buffer combined which makes it more effective & rapid delivery
pantoprazole
-prazole suffix
PPI
for: GERD, erosive esophagitis, gstric/duodenal ulcers, H. pylori eradication, zollinger-ellison syndrome, upper GI bleeding
IV formulations available
raberprazole
-prazole suffix
PPI
for: GERD, erosive esophagitis, gstric/duodenal ulcers, H. pylori eradication, zollinger-ellison syndrome, upper GI bleeding
misoprostol: prostaglandin analogue
GI cytoprotectant
protects mucosa and maintains blood flow
for: prevention of gastric ulcers do to NSAID’s
side effects: diarrhea (severe) ab cramping
BB warning: not for pregnant women (uterine cramping)
must administer 3-4xday: not good for compliance
sucralfate: coating agent
GI cytoprotectant stress ulcer prevention/recurrence enhances mucous secretion 1 hour before eating not absorbed=no systemic effects can reduce other drugs due to binding in GI tract
bismuth: coating agent
GI cytoprotectant
enhances mucous secretion
inhibits H. pylori
used for acute diarrhea, adjunctive therapy for H. pylori & heartburn.
side effects: black tarry stools, discolored tongue, constipation, tinnitus (higher doses)
contra: avoid in kids/teens w/viral infections
assoc w/salicylate & may be RF for Reyes
metoclopramide
dopamine antagonist
for: GI motility disorder, GERD, N&V prevention, small bowel intubation
side effects: hyperprolactinemia, extrapyramidal (EPS): tardive dyskinesia
Avoid prolonged tx (>12wks)
CNS effects
contra: GI obstruction or bleeding of perforation
loperamide
anti-diarrheal
side effects: constipation, abuse potential, CNS effects
doesn’t penetrate BBB
low solubility so less likely to be abused parenterally
diphenozylate/atropine
anti-diarrheal
side effects: constipation, abuse potential, CNS effects
doesn’t penetrate BBB
low solubility so less likely to be abused parenterally
difenoximide/atropine
anti-diarrheal
side effects: constipation, abuse potential, CNS effects
doesn’t penetrate BBB
low solubility so less likely to be abused parenterally
bismuth
part of the H. pylori quadruple tx protocol
may bind to diarrhea-causing bacteria/toxin and then eliminated through stool.
able to absorbe significant amounts of water.
sennosides (stimulants)
laxative
irritates intestinal wall=peristalsis
side effect: diarrhea
bisacodyl (stimulant)
laxative
irritates intestinal wall=peristalsis
side effect: diarrhea
psyllium (bulk)
laxative
fiber increases bulk of stool & promotes motility
magnesium citrate (osmotic)
laxative
electrolytes pull water into stool
can cause electrolyte abnormality: renal concern
onset of action: 30min-6 hrs
polyethylene glycol (osmotic)
laxative
pulls water into stool
ab distention, flatulence, improves w/use
must combine w/fluid before ingestion
docusate (softener, emollient, lubricant)
laxative
reduces surface tension of oil-water interface of stool resulting in enhanced incorporation of water & fat allowing for stool softening
promote fat/water in stools, lubricate fecal material/intestinal walls
mineral oil (softener, emollients, lubricant)
soften fecal contents by coating them
don’t take while reclining: lipid pneumonia from aspiration
glycerin (lubricant, osmotic laxative, stool softener)
effect due to local irritant & osmotic effect. increases peristalsis & water content of stool
given rectally
BM in 15min-1 hour
methylnaltrexone (peripheral opioid antagonist)
blocks constipation while delivering pain relief
lubiprostone
tx for idiopathic constipation in adult (IBS constipation-predominant in female pts)
locally acting chloride channel activator>enhances intestinal fluid secretion>increases motility
linaclotide
tx of IBS-C
LAST RESORT
guanylate cyclase-C agonist
contra: don’t use kids 6-17 years, don’t use in pts w/known mechanical GI obstruction
side effects: severe diarrhea, hole or stop
dronabinol
cannabinoid
for: N&V assoc w/chemo, anorexia assoc w/weight loss in AIDS pts
side effects: euphoria, drowsiness, impaired sensory perception, tachy
contra: hypersensitivity to sesame oil (dronabinol), serious cardivascular dz, psychiatric disorders, hx of pyschosis
nabilone
cannabinoid
for: N&V assoc w/chemo, anorexia assoc w/weight loss in AIDS pts
side effects: euphoria, drowsiness, impaired sensory perception, tachy
contra: hypersensitivity to sesame oil (dronabinol), serious cardivascular dz, psychiatric disorders, hx of pyschosis
pancrelipase
PERT
for: enzyme deficiency secondary to CF, chronic pancreatitis, after pancreatectomy, GI bypass surgery, duct obstruction due to tumor
side effects: diarrhea, ab pain, hyperuricosuria or renal stones
contains a mix of amylase, lipase,proteases
ondansetron
-setron suffix
serotonin antagonist
antagonist 5HT receptor>slows intestinal transit> decreases N&V
side effects: constipation, HA, lightheadedness
granisetron
-setron suffix
serotonin antagonist
antagonist 5HT receptor>slows intestinal transit> decreases N&V
side effects: constipation, HA, lightheadedness
alosetron
-setron suffix
serotonin antagonist
antagonist 5HT receptor>slows intestinal transit> decreases N&V
side effects: constipation, HA, lightheadedness
BB warning: ischemic colitis
dolasetron
-setron suffix
serotonin antagonist
antagonist 5HT receptor>slows intestinal transit> decreases N&V
side effects: constipation, HA, lightheadedness
palonosetron
-setron suffix
serotonin antagonist
antagonist 5HT receptor>slows intestinal transit> decreases N&V
side effects: constipation, HA, lightheadedness
scopolamine
anti-emetic
ACh blocker
for: motion sickness
diphenhydramine
anit-emetic
H1 receptor blocker
for: N&V, nonproductive cough, allergy sx, sedation
meclizine
anti-emetic
H1 receptor blocker
for: N&V, nonproductive cough, allergy sx, sedation
promethazine
anti-emetic
H1 receptor blocker
for: N&V, nonproductive cough, allergy sx, sedation
prochlorperazine
anti-emetic
neuroleptic agent
for: severe N&V, psychotic disorders, intractable hiccups
NOT FIRST CHOICE
