GI drugs Flashcards
1st line therapy for PUD
Clarithromycin + amox + PPI
2nd line therapy for puD
Bismuth + Flagyl + tetracycline + PPI or H2RA
H2 RA - names
ranitidine, cimetidine, famotidine, and nizatidine
H2RA MOA
blocking receptors reduces volume of gastric juice and it’s hydrogen ion concentration
H2RA - uses
gastric and duodenal ulcers - healing takes 4-6 weeks but may take 8-12 weeks
GERD - 1st choice to relieve symptoms
Zollinger -Ellison Syndrome
heartburn, acid indigestion, sour stomach
H2RA - pharm
food decreases absorption, some hepatic metabolism, excreted in urine
H2RA - AE
low and usually benign, antiadrenergic effects (decreased libido, gynecomastia, impotence - reversible)
Pneumonia
CNS effects with hepatic or renal impairment
H2RA - Interactions
cimetidine increases levels of warfarin, phenytoin, theophylline, and lidocaine. antacids decrease absorption of cimetidine
PPI (omeprazole) - pharm
hepatic metab and renal excretion, acid labile so formulated in a capsule
PPI (omeprazole) - uses
short term therapy of duodenal ulcers, gastric ulcers erosive esophagitis, and GERD - limit treatment to 4-6 weeks
long term therapy of Zollinger - Ellison
PPI - AE
PNA (increased risk for a few days) fractures rebound acid secretion hypomagnesemia diarrhea
PPI - interactions
clopidogrel
Sucralfate - Uses
acute and maintenance of duodenal ulcers
Sucralfate - AE
constipation
Sucralfate - interactions
give antacids 30 in apart, may impede absorption of phenytoin, theophylline, digoxin, warfarin, and fluoroquinolones - give 2 hours apart
Misoprostol (Cytotec) - uses
prevention of gastric ulcers caused by long term NSAID use
Misoprostol (Cytotec) - AE
diarrhea and abd pain, spotting, dysmenorrhea
BBW - do not give in pregnancy
Antacids - uses
PUD
Antacids AE
constipation or diarrhea, sodium loading
Antacids - Interactions
increase pH so interferes with cimetidine, ranitidine, and sucralfate, increase in pH in urine and increase or decrease secretion of certain drugs
Bulk Forming Laxatives - names
methylcellulose (citrucel), psyllium (metamucil) , polycarbophil (Fibercon)
Bulk Forming Laxatives - MOA
Absorb water, softens and enlarges fecal mass, promotes peristalsis - takes 1-3 days
Bulk Forming Laxatives - Uses
temporary treatment of constipation
diverticulitis and IBS, pts with an ostomy
Bulk Forming Laxatives - AE
minimal, should be taken with a full glass of water
Surfactant Laxatives - names
Colace
Surfactant Laxatives - MOA
softens stool - take with a full glass of water
Stimulant Laxatives - names
Biscodyl and senna
Stimulant Laxatives -MOA
stimulate intestinal motility and increasing amount of water and electrolytes in the intestine - takes 6-12 hours
Stimulant Laxatives -use
opioid use constipation and slow intestinal transit
Osmotic Laxatives - names
PEG (miralax), lactulose, Mg hydroxide
Osmotic Laxatives - MOA
draws water into intestine to soften fecal mass, stretches intestinal wall and stimulates peristalsis low doses - 6-12hrs high doses (for bowel prep) - 2-6 hrs
Osmotic Laxatives - AE
- dehydration, Mg toxicity in pts with renal failure, fluid retention with sodium salts