GI DRUGS & Disorders Flashcards
1
Q
Goal of tx for N/V :
A
Treat cause but often have to treat symptoms
2
Q
For N/V, HX is critical. What are 5 essentials in getting a good HX?
A
- Onset
- PMH
- LMP(females)
- Appearance of emesis (coffee grounds or undigested food)
- recent bowel habits
3
Q
N/V diagnostics :
A
X-ray
KUB
Ultrasound
labs: LFT’s
4
Q
3 types of med can choose for N/V:
A
- Serotonin 5-HT Receptor antagonists (Zofran, Aloxi)
- Antidopaminergics
- Pepto
5
Q
Causes of N/V:
A
- GI DISORDER: GERD, gastritis, constipation, pancreatitis, hepatitis
- Intracerebral / CNS / ⬆️ ICP
- Illness: microbial; H. Pylori
- Medications: Oc’s, antidepressants (like Celexa), antibiotics, chemo
6
Q
How do the Serotonin 5 HT 3 receptor antagonists work (method of action/MOA)?
A
Selective 5-Ht3receptor antagonist, binds in both periphery and CNS, Reducing intestinal vagus nerve stimulation.
Not clear if result of CNS or peripheral antagonism.
blocks different NT than Compazine and Phenergan
7
Q
Pharmacokinetics of 5ht receptor antagonists:
A
Well absorbed po Enhanced with food SL And IV preps available Metab via liver 70% protein bound Excreted via urine
8
Q
Name 2 5Ht receptor antagonists:
A
Zofran and Aloxi
9
Q
Adverse effects of 5ht receptor antagonists:
A
Headache Diarrhea Dizziness Constipation ** QTprolongation **
10
Q
5ht receptor antagonists
Contraindicated in:
A
Congenital Long QT syndrome
Allergy
11
Q
Who might not tolerate Zofran due to the side effect of constipation?
A
A pregnant pt with morning sickness
12
Q
Pepto bismol (Bismuth Subsalicylate): MOA
A
= a derivative of salicylic acid, related to aspirin
- works to ⬇️ GI irritation»_space; ⬇ ️nausea
- also antidiarrheal properties / reduces bowel irritation (weak bacteriocidal activities for infectious diarrhea )
- also antacid properties
13
Q
Pharmacokinetics Pepto Bismol:
A
Bismuth poorly absorbed but coats ulcers well
Subsalicylate hydrolyzed in stomach to salicylate
Bismuth is excreted in stool ** Can CAUSE BLACK STOOLS!**
Sub salicylate excreted in urine as salicylate
14
Q
Side effects of PeptoBismol
A
Nausea
Constipation
Discolored tongue
Black stools
15
Q
Contraindications for Pepto Bismol
A
Pediatrics (risk of Reye Syndrome)
Allergy
16
Q
Phenothiazines: Phenergan, Compazine
A
MOA
- antidopaminergic / blocks dopamine receptors in brain thus blocking vagus nerve in GI tract
- Phenergan also has antihistamine effect on H 1 receptors
17
Q
Phenothiazine
Pharmacokinetics / pharmacodynamics
A
Metabolized by liver
Excreted in stool
18
Q
Side effects of phenothiazine
A
Sedation, dizziness, mood changes,constipation
19
Q
Contraindications of Phenothiazines
A
Allergy
Severe HTN
BPH
PTS
20
Q
Acid Reflux/ Gastritis:
prevalence, probable causes?
A
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
21
Q
Descriptions and symptoms of gastritis
A
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
22
Q
Other contributing factors to gastritis?
A
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
23
Q
4 Types acid reflux/ gastritis meds
A
- Antacids
- Carafate
- H2 receptor antagonists
- PPI’s
24
Q
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
A
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
25
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
26
Pregnancy category of antacids
B, safe for breastfeeding as well
27
Antacids: adverse effects
N/V, constipation, dependence
28
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
29
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
30
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
31
Carafate: adverse effects
CONSTIPATION! Gotta love it!
32
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
33
Carafate pregnancy category:
B ( off label for peds)
34
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
35
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
36
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
37
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
38
Pregnancy category for H2 receptor antagonists
B - also safe in peds
39
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
40
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
41
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
42
PPI's: contraindications
Allergy
43
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
44
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
45
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
46
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
47
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
48
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
49
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
50
Adverse effects of bulk laxatives:
N/V, abdominal fullness
51
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
52
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
53
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
54
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
55
Reglan: adverse effects
```
EPS secondary to dopamine blockade;
Elevated prolactin;
Galactorrhea;
GYNECOMASTIA 😜
Irreversible tardiness dyskinesia
```
56
Contraindications in Reglan
Allergy
| Concurrent use of drugs capable of causing EPS/TD
57
Reglan in pregnancy and breastfeeding?
Safe in pregnancy; off-label use in peds; not safe in breast feeding
58
Other thoughts about Reglan and drug / drug interactions:
Do not use Reglan and Compazine together related to both act on dopamine receptors
59
Constipation fun facts
= decreased passage of stool, straining, pellet-like stools,unable to pass
Causes can be related to MEDS, MEALS, Or METS (side effects, diet, tumors)
**MIRAlax= first line of TX
60
Even funner diarrhea facts
```
= loose liquid stools / defined as 3 + / day
Causes:
Infections
Meds
Inflammatory bowel diseases
```
61
Antidiarrheals: opioid agonists
(Loperamide /Immodium)
MOA?
Slows intestinal motility through opioid receptor activation, also reduces fecal volume and increases viscosity
62
Antidiarrheal
| Pharmacokinetics
- little po absorption
- significant first pass metab**
- excreted in stool
63
Adverse effects of antidiarrheals:
Fatigue, dizziness, constipation, nausea
64
Contraindications for antidiarrheals:
High fever
Bloody diarrhea
Acute UC flare
Age les than 2 yo
65
Pregnancy and antidiarrheals?
Safe in pregnancy unknown if distributed in breastmilk
66
Irritable Bowel Syndrome Basics
= functional GI DISORDER; no identifiable causes
>>Dx of exclusion, once other GI problems ruled out
3 types:
1. Diarrhea -predominant
2. Constipation-predominant
3. Mixed
Tx>> often lifestyle modifications, but some meds available
67
Meds for Irritable Bowel Syndrome
1. Antispasmodics
| 2. 5HT3 antagonists
68
Antispasmodics for Irritable Bowel Syndrome:
| MOA?
Dicyclomine, hyoscyamine
"Levsin"*** can be used in all 3 presentations of IBS!***
-inhibits cholinergic receptors on smooth muscle
-not specific to GI smooth muscle so at high doses have significant anti cholinergic side effects (dry mouth, dry mucous, urinary retention...it is NON selective)
69
```
5HT3 antagonist (Alosetron/ Lotronex)
MOA?
```
Modulates enteric nervous system slows GI activity
| **for diarrhea-predominant IBS ONLY**
70
Inflammatory Bowel Disease:
| What two diseases make up this category?
1. Crohn's Disease "TOP TO BOTTOM" can affect any portion of GI TRACT
2. Ulcerative Colitis (COLON ONLY)
71
What is the first line of TX For Inflammatory Bowel Disease?
Steroid
72
For inflammatory bowel disease, remission maintenance meds =
First line is Aminosalicylates;
| immunomodulators becoming popular because may allow pt to avoid a steroid
73
For Inflammatory Bowel- acute phase med & MOA
GLUCOCORTICOIDS FOR ACUTE FLARE
MOA= anti-inflammatory corticosteroids, reduces inflammation by suppressing migration of polymorphonuclear leukocyte so, decreases prostaglandin synthesis
74
Glucocorticoid-
| Pharmacokinetics
- not well absorbed, Enterocort has max 21% bioavailability
- metabolized extensively in liver
- excreted in urine
75
Glucocorticoid
| Adverse effects
H/A, N/V
76
Contraindications
| Glucocorticoid
Allergy
77
Glucocorticoids in Irritable Bowel Syndrome:
| What phase again?
ACUTE PHASE NOT FOR DISEASE REMISSION
78
Enterocort- 2 facts:
1. High fat meal will delay Enterocort absorption
| 2. Rectal preparations are the first line for UC FLARE
79
Inflammatory Bowel Disease:
| Maintenance meds are called- and MOA-
sulfasalazine (Azulfidine), mesalamine (ASACOL! ☎️! Your ass is calling!), balsalazide (Cozaal)
MOA is uncertain with these meds but thought to block prostaglandin synthesis,may also inhibit cellular functions of NK Cells, mucosal lymphocytes and macrophages
80
Aminosalicylates
| Pharmacokinetics
Well absorbed in small intestine but not much colonic absorption
Up to 78% protein bound
Metab via liver
Excreted via stool
81
Aminosalicylates
| Adverse effects
nausea, GI upset, H/A, **bone marrow suppression** ( leukopenia, anemia, thrombocytopenia)
82
Given that Aminosalicylates can cause bone marrow suppression, how can a provider determine if this is a med-related adverse event?
Establish a timeline- when started drug RX vs. when abnormal labs began
83
Inflammatory Bowel Disease: meds,MOA
Azathioprine (imuran), 6-MP (purinethol)
MOA: leads to immunocompromise, reduces immune response. Does this by blocking synthesis of purine, which then hinders DNA, RNA, and protein synthesis in fast growing cells like lymphocytes
84
Purine Analogs: pharmacokinetics
Imuran better absorbed than 6 MP
APPROX 30% protein bound
Metab via liver
Excreted via urine
85
Purine Analogs: adverse effects
**PANCYTOPENIA**, infection, hepatotoxicity, pancreatitis
86
Purine Analogs: contraindications
Pregnancy, breastfeeding;
| Active malignancy
87
Long term use of purine analogs can lead to
Malignancies, especially lymphoma
88
Acid Reflux/ Gastritis:
| prevalence, probable causes?
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
89
Descriptions and symptoms of gastritis
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
90
Other contributing factors to gastritis?
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
91
4 Types acid reflux/ gastritis meds
1. Antacids
2. Carafate
3. H2 receptor antagonists
4. PPI's
92
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
93
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
94
Pregnancy category of antacids
B, safe for breastfeeding as well
95
Antacids: adverse effects
N/V, constipation, dependence
96
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
97
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
98
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
99
Carafate: adverse effects
CONSTIPATION! Gotta love it!
100
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
101
Carafate pregnancy category:
B ( off label for peds)
102
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
103
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
104
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
105
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
106
Pregnancy category for H2 receptor antagonists
B - also safe in peds
107
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
108
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
109
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
110
PPI's: contraindications
Allergy
111
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
112
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
113
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
114
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
115
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
116
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
117
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
118
Adverse effects of bulk laxatives:
N/V, abdominal fullness
119
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
120
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
121
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
122
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
123
Acid Reflux/ Gastritis:
| prevalence, probable causes?
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
124
Descriptions and symptoms of gastritis
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
125
Other contributing factors to gastritis?
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
126
4 Types acid reflux/ gastritis meds
1. Antacids
2. Carafate
3. H2 receptor antagonists
4. PPI's
127
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
128
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
129
Pregnancy category of antacids
B, safe for breastfeeding as well
130
Antacids: adverse effects
N/V, constipation, dependence
131
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
132
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
133
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
134
Carafate: adverse effects
CONSTIPATION! Gotta love it!
135
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
136
Carafate pregnancy category:
B ( off label for peds)
137
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
138
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
139
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
140
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
141
Pregnancy category for H2 receptor antagonists
B - also safe in peds
142
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
143
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
144
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
145
PPI's: contraindications
Allergy
146
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
147
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
148
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
149
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
150
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
151
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
152
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
153
Adverse effects of bulk laxatives:
N/V, abdominal fullness
154
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
155
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
156
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
157
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
158
Acid Reflux/ Gastritis:
| prevalence, probable causes?
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
159
Descriptions and symptoms of gastritis
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
160
Other contributing factors to gastritis?
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
161
4 Types acid reflux/ gastritis meds
1. Antacids
2. Carafate
3. H2 receptor antagonists
4. PPI's
162
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
163
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
164
Pregnancy category of antacids
B, safe for breastfeeding as well
165
Antacids: adverse effects
N/V, constipation, dependence
166
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
167
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
168
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
169
Carafate: adverse effects
CONSTIPATION! Gotta love it!
170
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
171
Carafate pregnancy category:
B ( off label for peds)
172
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
173
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
174
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
175
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
176
Pregnancy category for H2 receptor antagonists
B - also safe in peds
177
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
178
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
179
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
180
PPI's: contraindications
Allergy
181
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
182
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
183
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
184
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
185
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
186
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
187
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
188
Adverse effects of bulk laxatives:
N/V, abdominal fullness
189
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
190
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
191
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
192
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
193
Acid Reflux/ Gastritis:
| prevalence, probable causes?
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
194
Descriptions and symptoms of gastritis
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
195
Other contributing factors to gastritis?
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
196
4 Types acid reflux/ gastritis meds
1. Antacids
2. Carafate
3. H2 receptor antagonists
4. PPI's
197
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
198
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
199
Pregnancy category of antacids
B, safe for breastfeeding as well
200
Antacids: adverse effects
N/V, constipation, dependence
201
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
202
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
203
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
204
Carafate: adverse effects
CONSTIPATION! Gotta love it!
205
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
206
Carafate pregnancy category:
B ( off label for peds)
207
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
208
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
209
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
210
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
211
Pregnancy category for H2 receptor antagonists
B - also safe in peds
212
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
213
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
214
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
215
PPI's: contraindications
Allergy
216
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
217
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
218
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
219
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
220
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
221
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
222
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
223
Adverse effects of bulk laxatives:
N/V, abdominal fullness
224
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
225
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
226
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
227
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
228
Acid Reflux/ Gastritis:
| prevalence, probable causes?
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
229
Descriptions and symptoms of gastritis
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
230
Other contributing factors to gastritis?
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
231
4 Types acid reflux/ gastritis meds
1. Antacids
2. Carafate
3. H2 receptor antagonists
4. PPI's
232
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
233
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
234
Pregnancy category of antacids
B, safe for breastfeeding as well
235
Antacids: adverse effects
N/V, constipation, dependence
236
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
237
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
238
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
239
Carafate: adverse effects
CONSTIPATION! Gotta love it!
240
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
241
Carafate pregnancy category:
B ( off label for peds)
242
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
243
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
244
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
245
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
246
Pregnancy category for H2 receptor antagonists
B - also safe in peds
247
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
248
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
249
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
250
PPI's: contraindications
Allergy
251
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
252
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
253
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
254
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
255
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
256
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
257
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
258
Adverse effects of bulk laxatives:
N/V, abdominal fullness
259
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
260
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
261
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
262
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
263
Acid Reflux/ Gastritis:
| prevalence, probable causes?
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
264
Descriptions and symptoms of gastritis
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
265
Other contributing factors to gastritis?
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
266
4 Types acid reflux/ gastritis meds
1. Antacids
2. Carafate
3. H2 receptor antagonists
4. PPI's
267
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
268
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
269
Pregnancy category of antacids
B, safe for breastfeeding as well
270
Antacids: adverse effects
N/V, constipation, dependence
271
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
272
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
273
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
274
Carafate: adverse effects
CONSTIPATION! Gotta love it!
275
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
276
Carafate pregnancy category:
B ( off label for peds)
277
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
278
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
279
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
280
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
281
Pregnancy category for H2 receptor antagonists
B - also safe in peds
282
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
283
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
284
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
285
PPI's: contraindications
Allergy
286
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
287
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
288
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
289
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
290
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
291
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
292
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
293
Adverse effects of bulk laxatives:
N/V, abdominal fullness
294
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
295
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
296
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
297
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
298
Acid Reflux/ Gastritis:
| prevalence, probable causes?
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
299
Descriptions and symptoms of gastritis
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
300
Other contributing factors to gastritis?
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
301
4 Types acid reflux/ gastritis meds
1. Antacids
2. Carafate
3. H2 receptor antagonists
4. PPI's
302
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
303
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
304
Pregnancy category of antacids
B, safe for breastfeeding as well
305
Antacids: adverse effects
N/V, constipation, dependence
306
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
307
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
308
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
309
Carafate: adverse effects
CONSTIPATION! Gotta love it!
310
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
311
Carafate pregnancy category:
B ( off label for peds)
312
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
313
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
314
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
315
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
316
Pregnancy category for H2 receptor antagonists
B - also safe in peds
317
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
318
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
319
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
320
PPI's: contraindications
Allergy
321
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
322
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
323
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
324
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
325
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
326
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
327
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
328
Adverse effects of bulk laxatives:
N/V, abdominal fullness
329
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
330
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
331
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
332
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
333
Acid Reflux/ Gastritis:
| prevalence, probable causes?
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
334
Descriptions and symptoms of gastritis
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
335
Other contributing factors to gastritis?
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
336
4 Types acid reflux/ gastritis meds
1. Antacids
2. Carafate
3. H2 receptor antagonists
4. PPI's
337
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
338
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
339
Pregnancy category of antacids
B, safe for breastfeeding as well
340
Antacids: adverse effects
N/V, constipation, dependence
341
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
342
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
343
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
344
Carafate: adverse effects
CONSTIPATION! Gotta love it!
345
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
346
Carafate pregnancy category:
B ( off label for peds)
347
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
348
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
349
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
350
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
351
Pregnancy category for H2 receptor antagonists
B - also safe in peds
352
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
353
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
354
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
355
PPI's: contraindications
Allergy
356
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
357
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
358
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
359
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
360
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
361
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
362
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
363
Adverse effects of bulk laxatives:
N/V, abdominal fullness
364
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
365
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
366
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
367
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
368
Acid Reflux/ Gastritis:
| prevalence, probable causes?
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
369
Descriptions and symptoms of gastritis
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
370
Other contributing factors to gastritis?
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
371
4 Types acid reflux/ gastritis meds
1. Antacids
2. Carafate
3. H2 receptor antagonists
4. PPI's
372
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
373
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
374
Pregnancy category of antacids
B, safe for breastfeeding as well
375
Antacids: adverse effects
N/V, constipation, dependence
376
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
377
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
378
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
379
Carafate: adverse effects
CONSTIPATION! Gotta love it!
380
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
381
Carafate pregnancy category:
B ( off label for peds)
382
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
383
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
384
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
385
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
386
Pregnancy category for H2 receptor antagonists
B - also safe in peds
387
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
388
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
389
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
390
PPI's: contraindications
Allergy
391
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
392
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
393
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
394
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
395
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
396
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
397
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
398
Adverse effects of bulk laxatives:
N/V, abdominal fullness
399
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
400
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
401
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
402
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
403
Acid Reflux/ Gastritis:
| prevalence, probable causes?
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
404
Descriptions and symptoms of gastritis
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
405
Other contributing factors to gastritis?
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
406
4 Types acid reflux/ gastritis meds
1. Antacids
2. Carafate
3. H2 receptor antagonists
4. PPI's
407
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
408
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
409
Pregnancy category of antacids
B, safe for breastfeeding as well
410
Antacids: adverse effects
N/V, constipation, dependence
411
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
412
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
413
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
414
Carafate: adverse effects
CONSTIPATION! Gotta love it!
415
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
416
Carafate pregnancy category:
B ( off label for peds)
417
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
418
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
419
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
420
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
421
Pregnancy category for H2 receptor antagonists
B - also safe in peds
422
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
423
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
424
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
425
PPI's: contraindications
Allergy
426
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
427
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
428
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
429
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
430
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
431
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
432
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
433
Adverse effects of bulk laxatives:
N/V, abdominal fullness
434
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
435
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
436
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
437
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
438
Acid Reflux/ Gastritis:
| prevalence, probable causes?
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
439
Descriptions and symptoms of gastritis
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
440
Other contributing factors to gastritis?
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
441
4 Types acid reflux/ gastritis meds
1. Antacids
2. Carafate
3. H2 receptor antagonists
4. PPI's
442
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
443
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
444
Pregnancy category of antacids
B, safe for breastfeeding as well
445
Antacids: adverse effects
N/V, constipation, dependence
446
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
447
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
448
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
449
Carafate: adverse effects
CONSTIPATION! Gotta love it!
450
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
451
Carafate pregnancy category:
B ( off label for peds)
452
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
453
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
454
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
455
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
456
Pregnancy category for H2 receptor antagonists
B - also safe in peds
457
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
458
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
459
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
460
PPI's: contraindications
Allergy
461
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
462
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
463
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
464
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
465
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
466
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
467
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
468
Adverse effects of bulk laxatives:
N/V, abdominal fullness
469
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
470
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
471
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
472
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
473
Acid Reflux/ Gastritis:
| prevalence, probable causes?
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
474
Descriptions and symptoms of gastritis
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
475
Other contributing factors to gastritis?
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
476
4 Types acid reflux/ gastritis meds
1. Antacids
2. Carafate
3. H2 receptor antagonists
4. PPI's
477
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
478
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
479
Pregnancy category of antacids
B, safe for breastfeeding as well
480
Antacids: adverse effects
N/V, constipation, dependence
481
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
482
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
483
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
484
Carafate: adverse effects
CONSTIPATION! Gotta love it!
485
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
486
Carafate pregnancy category:
B ( off label for peds)
487
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
488
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
489
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
490
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
491
Pregnancy category for H2 receptor antagonists
B - also safe in peds
492
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
493
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
494
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
495
PPI's: contraindications
Allergy
496
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
497
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
498
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
499
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
500
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
501
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
502
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
503
Adverse effects of bulk laxatives:
N/V, abdominal fullness
504
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
505
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
506
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
507
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
508
Acid Reflux/ Gastritis:
| prevalence, probable causes?
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
509
Descriptions and symptoms of gastritis
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
510
Other contributing factors to gastritis?
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
511
4 Types acid reflux/ gastritis meds
1. Antacids
2. Carafate
3. H2 receptor antagonists
4. PPI's
512
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
513
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
514
Pregnancy category of antacids
B, safe for breastfeeding as well
515
Antacids: adverse effects
N/V, constipation, dependence
516
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
517
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
518
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
519
Carafate: adverse effects
CONSTIPATION! Gotta love it!
520
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
521
Carafate pregnancy category:
B ( off label for peds)
522
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
523
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
524
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
525
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
526
Pregnancy category for H2 receptor antagonists
B - also safe in peds
527
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
528
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
529
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
530
PPI's: contraindications
Allergy
531
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
532
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
533
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
534
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
535
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
536
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
537
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
538
Adverse effects of bulk laxatives:
N/V, abdominal fullness
539
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
540
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
541
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
542
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
543
Acid Reflux/ Gastritis:
| prevalence, probable causes?
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
544
Descriptions and symptoms of gastritis
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
545
Other contributing factors to gastritis?
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
546
4 Types acid reflux/ gastritis meds
1. Antacids
2. Carafate
3. H2 receptor antagonists
4. PPI's
547
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
548
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
549
Pregnancy category of antacids
B, safe for breastfeeding as well
550
Antacids: adverse effects
N/V, constipation, dependence
551
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
552
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
553
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
554
Carafate: adverse effects
CONSTIPATION! Gotta love it!
555
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
556
Carafate pregnancy category:
B ( off label for peds)
557
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
558
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
559
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
560
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
561
Pregnancy category for H2 receptor antagonists
B - also safe in peds
562
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
563
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
564
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
565
PPI's: contraindications
Allergy
566
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
567
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
568
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
569
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
570
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
571
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
572
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
573
Adverse effects of bulk laxatives:
N/V, abdominal fullness
574
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
575
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
576
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
577
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
578
Acid Reflux/ Gastritis:
| prevalence, probable causes?
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
579
Descriptions and symptoms of gastritis
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
580
Other contributing factors to gastritis?
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
581
4 Types acid reflux/ gastritis meds
1. Antacids
2. Carafate
3. H2 receptor antagonists
4. PPI's
582
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
583
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
584
Pregnancy category of antacids
B, safe for breastfeeding as well
585
Antacids: adverse effects
N/V, constipation, dependence
586
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
587
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
588
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
589
Carafate: adverse effects
CONSTIPATION! Gotta love it!
590
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
591
Carafate pregnancy category:
B ( off label for peds)
592
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
593
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
594
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
595
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
596
Pregnancy category for H2 receptor antagonists
B - also safe in peds
597
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
598
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
599
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
600
PPI's: contraindications
Allergy
601
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
602
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
603
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
604
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
605
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
606
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
607
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
608
Adverse effects of bulk laxatives:
N/V, abdominal fullness
609
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
610
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
611
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
612
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
613
Acid Reflux/ Gastritis:
| prevalence, probable causes?
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
614
Descriptions and symptoms of gastritis
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
615
Other contributing factors to gastritis?
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
616
4 Types acid reflux/ gastritis meds
1. Antacids
2. Carafate
3. H2 receptor antagonists
4. PPI's
617
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
618
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
619
Pregnancy category of antacids
B, safe for breastfeeding as well
620
Antacids: adverse effects
N/V, constipation, dependence
621
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
622
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
623
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
624
Carafate: adverse effects
CONSTIPATION! Gotta love it!
625
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
626
Carafate pregnancy category:
B ( off label for peds)
627
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
628
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
629
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
630
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
631
Pregnancy category for H2 receptor antagonists
B - also safe in peds
632
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
633
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
634
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
635
PPI's: contraindications
Allergy
636
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
637
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
638
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
639
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
640
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
641
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
642
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
643
Adverse effects of bulk laxatives:
N/V, abdominal fullness
644
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
645
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
646
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
647
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
648
Acid Reflux/ Gastritis:
| prevalence, probable causes?
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
649
Descriptions and symptoms of gastritis
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
650
Other contributing factors to gastritis?
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
651
4 Types acid reflux/ gastritis meds
1. Antacids
2. Carafate
3. H2 receptor antagonists
4. PPI's
652
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
653
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
654
Pregnancy category of antacids
B, safe for breastfeeding as well
655
Antacids: adverse effects
N/V, constipation, dependence
656
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
657
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
658
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
659
Carafate: adverse effects
CONSTIPATION! Gotta love it!
660
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
661
Carafate pregnancy category:
B ( off label for peds)
662
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
663
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
664
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
665
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
666
Pregnancy category for H2 receptor antagonists
B - also safe in peds
667
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
668
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
669
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
670
PPI's: contraindications
Allergy
671
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
672
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
673
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
674
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
675
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
676
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
677
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
678
Adverse effects of bulk laxatives:
N/V, abdominal fullness
679
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
680
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
681
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
682
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
683
Acid Reflux/ Gastritis:
| prevalence, probable causes?
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
684
Descriptions and symptoms of gastritis
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
685
Other contributing factors to gastritis?
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
686
4 Types acid reflux/ gastritis meds
1. Antacids
2. Carafate
3. H2 receptor antagonists
4. PPI's
687
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
688
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
689
Pregnancy category of antacids
B, safe for breastfeeding as well
690
Antacids: adverse effects
N/V, constipation, dependence
691
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
692
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
693
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
694
Carafate: adverse effects
CONSTIPATION! Gotta love it!
695
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
696
Carafate pregnancy category:
B ( off label for peds)
697
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
698
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
699
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
700
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
701
Pregnancy category for H2 receptor antagonists
B - also safe in peds
702
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
703
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
704
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
705
PPI's: contraindications
Allergy
706
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
707
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
708
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
709
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
710
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
711
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
712
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
713
Adverse effects of bulk laxatives:
N/V, abdominal fullness
714
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
715
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
716
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
717
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
718
Acid Reflux/ Gastritis:
| prevalence, probable causes?
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
719
Descriptions and symptoms of gastritis
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
720
Other contributing factors to gastritis?
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
721
4 Types acid reflux/ gastritis meds
1. Antacids
2. Carafate
3. H2 receptor antagonists
4. PPI's
722
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
723
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
724
Pregnancy category of antacids
B, safe for breastfeeding as well
725
Antacids: adverse effects
N/V, constipation, dependence
726
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
727
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
728
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
729
Carafate: adverse effects
CONSTIPATION! Gotta love it!
730
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
731
Carafate pregnancy category:
B ( off label for peds)
732
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
733
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
734
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
735
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
736
Pregnancy category for H2 receptor antagonists
B - also safe in peds
737
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
738
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
739
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
740
PPI's: contraindications
Allergy
741
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
742
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
743
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
744
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
745
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
746
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
747
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
748
Adverse effects of bulk laxatives:
N/V, abdominal fullness
749
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
750
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
751
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
752
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
753
Acid Reflux/ Gastritis:
| prevalence, probable causes?
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
754
Descriptions and symptoms of gastritis
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
755
Other contributing factors to gastritis?
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
756
4 Types acid reflux/ gastritis meds
1. Antacids
2. Carafate
3. H2 receptor antagonists
4. PPI's
757
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
758
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
759
Pregnancy category of antacids
B, safe for breastfeeding as well
760
Antacids: adverse effects
N/V, constipation, dependence
761
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
762
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
763
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
764
Carafate: adverse effects
CONSTIPATION! Gotta love it!
765
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
766
Carafate pregnancy category:
B ( off label for peds)
767
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
768
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
769
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
770
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
771
Pregnancy category for H2 receptor antagonists
B - also safe in peds
772
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
773
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
774
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
775
PPI's: contraindications
Allergy
776
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
777
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
778
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
779
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
780
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
781
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
782
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
783
Adverse effects of bulk laxatives:
N/V, abdominal fullness
784
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
785
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
786
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
787
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
788
Acid Reflux/ Gastritis:
| prevalence, probable causes?
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
789
Descriptions and symptoms of gastritis
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
790
Other contributing factors to gastritis?
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
791
4 Types acid reflux/ gastritis meds
1. Antacids
2. Carafate
3. H2 receptor antagonists
4. PPI's
792
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
793
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
794
Pregnancy category of antacids
B, safe for breastfeeding as well
795
Antacids: adverse effects
N/V, constipation, dependence
796
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
797
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
798
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
799
Carafate: adverse effects
CONSTIPATION! Gotta love it!
800
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
801
Carafate pregnancy category:
B ( off label for peds)
802
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
803
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
804
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
805
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
806
Pregnancy category for H2 receptor antagonists
B - also safe in peds
807
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
808
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
809
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
810
PPI's: contraindications
Allergy
811
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
812
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
813
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
814
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
815
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
816
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
817
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
818
Adverse effects of bulk laxatives:
N/V, abdominal fullness
819
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
820
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
821
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
822
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
823
Acid Reflux/ Gastritis:
| prevalence, probable causes?
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
824
Descriptions and symptoms of gastritis
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
825
Other contributing factors to gastritis?
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
826
4 Types acid reflux/ gastritis meds
1. Antacids
2. Carafate
3. H2 receptor antagonists
4. PPI's
827
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
828
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
829
Pregnancy category of antacids
B, safe for breastfeeding as well
830
Antacids: adverse effects
N/V, constipation, dependence
831
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
832
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
833
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
834
Carafate: adverse effects
CONSTIPATION! Gotta love it!
835
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
836
Carafate pregnancy category:
B ( off label for peds)
837
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
838
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
839
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
840
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
841
Pregnancy category for H2 receptor antagonists
B - also safe in peds
842
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
843
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
844
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
845
PPI's: contraindications
Allergy
846
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
847
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
848
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
849
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
850
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
851
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
852
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
853
Adverse effects of bulk laxatives:
N/V, abdominal fullness
854
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
855
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
856
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
857
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
858
Acid Reflux/ Gastritis:
| prevalence, probable causes?
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
859
Descriptions and symptoms of gastritis
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
860
Other contributing factors to gastritis?
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
861
4 Types acid reflux/ gastritis meds
1. Antacids
2. Carafate
3. H2 receptor antagonists
4. PPI's
862
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
863
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
864
Pregnancy category of antacids
B, safe for breastfeeding as well
865
Antacids: adverse effects
N/V, constipation, dependence
866
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
867
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
868
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
869
Carafate: adverse effects
CONSTIPATION! Gotta love it!
870
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
871
Carafate pregnancy category:
B ( off label for peds)
872
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
873
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
874
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
875
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
876
Pregnancy category for H2 receptor antagonists
B - also safe in peds
877
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
878
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
879
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
880
PPI's: contraindications
Allergy
881
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
882
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
883
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
884
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
885
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
886
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
887
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
888
Adverse effects of bulk laxatives:
N/V, abdominal fullness
889
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
890
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
891
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
892
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
893
Acid Reflux/ Gastritis:
| prevalence, probable causes?
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
894
Descriptions and symptoms of gastritis
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
895
Other contributing factors to gastritis?
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
896
4 Types acid reflux/ gastritis meds
1. Antacids
2. Carafate
3. H2 receptor antagonists
4. PPI's
897
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
898
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
899
Pregnancy category of antacids
B, safe for breastfeeding as well
900
Antacids: adverse effects
N/V, constipation, dependence
901
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
902
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
903
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
904
Carafate: adverse effects
CONSTIPATION! Gotta love it!
905
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
906
Carafate pregnancy category:
B ( off label for peds)
907
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
908
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
909
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
910
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
911
Pregnancy category for H2 receptor antagonists
B - also safe in peds
912
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
913
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
914
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
915
PPI's: contraindications
Allergy
916
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
917
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
918
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
919
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
920
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
921
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
922
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
923
Adverse effects of bulk laxatives:
N/V, abdominal fullness
924
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
925
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
926
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
927
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
928
Acid Reflux/ Gastritis:
| prevalence, probable causes?
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
929
Descriptions and symptoms of gastritis
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
930
Other contributing factors to gastritis?
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
931
4 Types acid reflux/ gastritis meds
1. Antacids
2. Carafate
3. H2 receptor antagonists
4. PPI's
932
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
933
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
934
Pregnancy category of antacids
B, safe for breastfeeding as well
935
Antacids: adverse effects
N/V, constipation, dependence
936
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
937
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
938
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
939
Carafate: adverse effects
CONSTIPATION! Gotta love it!
940
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
941
Carafate pregnancy category:
B ( off label for peds)
942
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
943
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
944
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
945
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
946
Pregnancy category for H2 receptor antagonists
B - also safe in peds
947
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
948
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
949
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
950
PPI's: contraindications
Allergy
951
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
952
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
953
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
954
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
955
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
956
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
957
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
958
Adverse effects of bulk laxatives:
N/V, abdominal fullness
959
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
960
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
961
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
962
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
963
Acid Reflux/ Gastritis:
| prevalence, probable causes?
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
964
Descriptions and symptoms of gastritis
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
965
Other contributing factors to gastritis?
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
966
4 Types acid reflux/ gastritis meds
1. Antacids
2. Carafate
3. H2 receptor antagonists
4. PPI's
967
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
968
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
969
Pregnancy category of antacids
B, safe for breastfeeding as well
970
Antacids: adverse effects
N/V, constipation, dependence
971
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
972
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
973
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
974
Carafate: adverse effects
CONSTIPATION! Gotta love it!
975
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
976
Carafate pregnancy category:
B ( off label for peds)
977
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
978
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
979
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
980
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
981
Pregnancy category for H2 receptor antagonists
B - also safe in peds
982
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
983
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
984
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
985
PPI's: contraindications
Allergy
986
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
987
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
988
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
989
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
990
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
991
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
992
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
993
Adverse effects of bulk laxatives:
N/V, abdominal fullness
994
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
995
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
996
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
997
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
998
Acid Reflux/ Gastritis:
| prevalence, probable causes?
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
999
Descriptions and symptoms of gastritis
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
1000
Other contributing factors to gastritis?
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
1001
4 Types acid reflux/ gastritis meds
1. Antacids
2. Carafate
3. H2 receptor antagonists
4. PPI's
1002
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
1003
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
1004
Pregnancy category of antacids
B, safe for breastfeeding as well
1005
Antacids: adverse effects
N/V, constipation, dependence
1006
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
1007
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
1008
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
1009
Carafate: adverse effects
CONSTIPATION! Gotta love it!
1010
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
1011
Carafate pregnancy category:
B ( off label for peds)
1012
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
1013
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
1014
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
1015
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
1016
Pregnancy category for H2 receptor antagonists
B - also safe in peds
1017
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
1018
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
1019
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
1020
PPI's: contraindications
Allergy
1021
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
1022
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
1023
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
1024
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
1025
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
1026
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
1027
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
1028
Adverse effects of bulk laxatives:
N/V, abdominal fullness
1029
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
1030
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
1031
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
1032
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
1033
Acid Reflux/ Gastritis:
| prevalence, probable causes?
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
1034
Descriptions and symptoms of gastritis
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
1035
Other contributing factors to gastritis?
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
1036
4 Types acid reflux/ gastritis meds
1. Antacids
2. Carafate
3. H2 receptor antagonists
4. PPI's
1037
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
1038
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
1039
Pregnancy category of antacids
B, safe for breastfeeding as well
1040
Antacids: adverse effects
N/V, constipation, dependence
1041
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
1042
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
1043
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
1044
Carafate: adverse effects
CONSTIPATION! Gotta love it!
1045
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
1046
Carafate pregnancy category:
B ( off label for peds)
1047
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
1048
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
1049
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
1050
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
1051
Pregnancy category for H2 receptor antagonists
B - also safe in peds
1052
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
1053
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
1054
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
1055
PPI's: contraindications
Allergy
1056
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
1057
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
1058
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
1059
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
1060
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
1061
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
1062
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
1063
Adverse effects of bulk laxatives:
N/V, abdominal fullness
1064
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
1065
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
1066
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
1067
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
1068
Acid Reflux/ Gastritis:
| prevalence, probable causes?
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
1069
Descriptions and symptoms of gastritis
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
1070
Other contributing factors to gastritis?
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
1071
4 Types acid reflux/ gastritis meds
1. Antacids
2. Carafate
3. H2 receptor antagonists
4. PPI's
1072
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
1073
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
1074
Pregnancy category of antacids
B, safe for breastfeeding as well
1075
Antacids: adverse effects
N/V, constipation, dependence
1076
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
1077
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
1078
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
1079
Carafate: adverse effects
CONSTIPATION! Gotta love it!
1080
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
1081
Carafate pregnancy category:
B ( off label for peds)
1082
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
1083
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
1084
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
1085
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
1086
Pregnancy category for H2 receptor antagonists
B - also safe in peds
1087
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
1088
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
1089
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
1090
PPI's: contraindications
Allergy
1091
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
1092
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
1093
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
1094
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
1095
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
1096
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
1097
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
1098
Adverse effects of bulk laxatives:
N/V, abdominal fullness
1099
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
1100
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
1101
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
1102
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
1103
Acid Reflux/ Gastritis:
| prevalence, probable causes?
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
1104
Descriptions and symptoms of gastritis
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
1105
Other contributing factors to gastritis?
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
1106
4 Types acid reflux/ gastritis meds
1. Antacids
2. Carafate
3. H2 receptor antagonists
4. PPI's
1107
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
1108
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
1109
Pregnancy category of antacids
B, safe for breastfeeding as well
1110
Antacids: adverse effects
N/V, constipation, dependence
1111
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
1112
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
1113
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
1114
Carafate: adverse effects
CONSTIPATION! Gotta love it!
1115
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
1116
Carafate pregnancy category:
B ( off label for peds)
1117
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
1118
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
1119
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
1120
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
1121
Pregnancy category for H2 receptor antagonists
B - also safe in peds
1122
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
1123
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
1124
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
1125
PPI's: contraindications
Allergy
1126
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
1127
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
1128
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
1129
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
1130
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
1131
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
1132
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
1133
Adverse effects of bulk laxatives:
N/V, abdominal fullness
1134
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
1135
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
1136
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
1137
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
1138
Acid Reflux/ Gastritis:
| prevalence, probable causes?
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
1139
Descriptions and symptoms of gastritis
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
1140
Other contributing factors to gastritis?
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
1141
4 Types acid reflux/ gastritis meds
1. Antacids
2. Carafate
3. H2 receptor antagonists
4. PPI's
1142
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
1143
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
1144
Pregnancy category of antacids
B, safe for breastfeeding as well
1145
Antacids: adverse effects
N/V, constipation, dependence
1146
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
1147
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
1148
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
1149
Carafate: adverse effects
CONSTIPATION! Gotta love it!
1150
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
1151
Carafate pregnancy category:
B ( off label for peds)
1152
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
1153
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
1154
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
1155
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
1156
Pregnancy category for H2 receptor antagonists
B - also safe in peds
1157
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
1158
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
1159
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
1160
PPI's: contraindications
Allergy
1161
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
1162
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
1163
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
1164
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
1165
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
1166
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
1167
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
1168
Adverse effects of bulk laxatives:
N/V, abdominal fullness
1169
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
1170
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
1171
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
1172
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
1173
Acid Reflux/ Gastritis:
| prevalence, probable causes?
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
1174
Descriptions and symptoms of gastritis
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
1175
Other contributing factors to gastritis?
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
1176
4 Types acid reflux/ gastritis meds
1. Antacids
2. Carafate
3. H2 receptor antagonists
4. PPI's
1177
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
1178
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
1179
Pregnancy category of antacids
B, safe for breastfeeding as well
1180
Antacids: adverse effects
N/V, constipation, dependence
1181
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
1182
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
1183
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
1184
Carafate: adverse effects
CONSTIPATION! Gotta love it!
1185
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
1186
Carafate pregnancy category:
B ( off label for peds)
1187
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
1188
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
1189
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
1190
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
1191
Pregnancy category for H2 receptor antagonists
B - also safe in peds
1192
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
1193
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
1194
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
1195
PPI's: contraindications
Allergy
1196
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
1197
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
1198
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
1199
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
1200
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
1201
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
1202
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
1203
Adverse effects of bulk laxatives:
N/V, abdominal fullness
1204
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
1205
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
1206
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
1207
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
1208
Acid Reflux/ Gastritis:
| prevalence, probable causes?
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
1209
Descriptions and symptoms of gastritis
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
1210
Other contributing factors to gastritis?
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
1211
4 Types acid reflux/ gastritis meds
1. Antacids
2. Carafate
3. H2 receptor antagonists
4. PPI's
1212
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
1213
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
1214
Pregnancy category of antacids
B, safe for breastfeeding as well
1215
Antacids: adverse effects
N/V, constipation, dependence
1216
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
1217
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
1218
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
1219
Carafate: adverse effects
CONSTIPATION! Gotta love it!
1220
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
1221
Carafate pregnancy category:
B ( off label for peds)
1222
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
1223
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
1224
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
1225
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
1226
Pregnancy category for H2 receptor antagonists
B - also safe in peds
1227
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
1228
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
1229
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
1230
PPI's: contraindications
Allergy
1231
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
1232
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
1233
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
1234
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
1235
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
1236
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
1237
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
1238
Adverse effects of bulk laxatives:
N/V, abdominal fullness
1239
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
1240
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
1241
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
1242
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
1243
Acid Reflux/ Gastritis:
| prevalence, probable causes?
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
1244
Descriptions and symptoms of gastritis
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
1245
Other contributing factors to gastritis?
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
1246
4 Types acid reflux/ gastritis meds
1. Antacids
2. Carafate
3. H2 receptor antagonists
4. PPI's
1247
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
1248
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
1249
Pregnancy category of antacids
B, safe for breastfeeding as well
1250
Antacids: adverse effects
N/V, constipation, dependence
1251
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
1252
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
1253
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
1254
Carafate: adverse effects
CONSTIPATION! Gotta love it!
1255
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
1256
Carafate pregnancy category:
B ( off label for peds)
1257
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
1258
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
1259
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
1260
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
1261
Pregnancy category for H2 receptor antagonists
B - also safe in peds
1262
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
1263
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
1264
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
1265
PPI's: contraindications
Allergy
1266
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
1267
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
1268
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
1269
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
1270
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
1271
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
1272
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
1273
Adverse effects of bulk laxatives:
N/V, abdominal fullness
1274
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
1275
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
1276
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
1277
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
1278
Acid Reflux/ Gastritis:
| prevalence, probable causes?
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
1279
Descriptions and symptoms of gastritis
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
1280
Other contributing factors to gastritis?
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
1281
4 Types acid reflux/ gastritis meds
1. Antacids
2. Carafate
3. H2 receptor antagonists
4. PPI's
1282
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
1283
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
1284
Pregnancy category of antacids
B, safe for breastfeeding as well
1285
Antacids: adverse effects
N/V, constipation, dependence
1286
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
1287
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
1288
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
1289
Carafate: adverse effects
CONSTIPATION! Gotta love it!
1290
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
1291
Carafate pregnancy category:
B ( off label for peds)
1292
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
1293
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
1294
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
1295
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
1296
Pregnancy category for H2 receptor antagonists
B - also safe in peds
1297
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
1298
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
1299
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
1300
PPI's: contraindications
Allergy
1301
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
1302
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
1303
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
1304
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
1305
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
1306
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
1307
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
1308
Adverse effects of bulk laxatives:
N/V, abdominal fullness
1309
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
1310
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
1311
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
1312
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
1313
Acid Reflux/ Gastritis:
| prevalence, probable causes?
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
1314
Descriptions and symptoms of gastritis
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
1315
Other contributing factors to gastritis?
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
1316
4 Types acid reflux/ gastritis meds
1. Antacids
2. Carafate
3. H2 receptor antagonists
4. PPI's
1317
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
1318
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
1319
Pregnancy category of antacids
B, safe for breastfeeding as well
1320
Antacids: adverse effects
N/V, constipation, dependence
1321
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
1322
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
1323
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
1324
Carafate: adverse effects
CONSTIPATION! Gotta love it!
1325
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
1326
Carafate pregnancy category:
B ( off label for peds)
1327
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
1328
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
1329
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
1330
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
1331
Pregnancy category for H2 receptor antagonists
B - also safe in peds
1332
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
1333
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
1334
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
1335
PPI's: contraindications
Allergy
1336
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
1337
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
1338
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
1339
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
1340
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
1341
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
1342
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
1343
Adverse effects of bulk laxatives:
N/V, abdominal fullness
1344
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
1345
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
1346
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
1347
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
1348
Acid Reflux/ Gastritis:
| prevalence, probable causes?
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
1349
Descriptions and symptoms of gastritis
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
1350
Other contributing factors to gastritis?
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
1351
4 Types acid reflux/ gastritis meds
1. Antacids
2. Carafate
3. H2 receptor antagonists
4. PPI's
1352
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
1353
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
1354
Pregnancy category of antacids
B, safe for breastfeeding as well
1355
Antacids: adverse effects
N/V, constipation, dependence
1356
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
1357
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
1358
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
1359
Carafate: adverse effects
CONSTIPATION! Gotta love it!
1360
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
1361
Carafate pregnancy category:
B ( off label for peds)
1362
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
1363
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
1364
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
1365
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
1366
Pregnancy category for H2 receptor antagonists
B - also safe in peds
1367
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
1368
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
1369
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
1370
PPI's: contraindications
Allergy
1371
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
1372
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
1373
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
1374
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
1375
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
1376
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
1377
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
1378
Adverse effects of bulk laxatives:
N/V, abdominal fullness
1379
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
1380
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
1381
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
1382
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
1383
Acid Reflux/ Gastritis:
| prevalence, probable causes?
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
1384
Descriptions and symptoms of gastritis
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
1385
Other contributing factors to gastritis?
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
1386
4 Types acid reflux/ gastritis meds
1. Antacids
2. Carafate
3. H2 receptor antagonists
4. PPI's
1387
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
1388
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
1389
Pregnancy category of antacids
B, safe for breastfeeding as well
1390
Antacids: adverse effects
N/V, constipation, dependence
1391
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
1392
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
1393
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
1394
Carafate: adverse effects
CONSTIPATION! Gotta love it!
1395
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
1396
Carafate pregnancy category:
B ( off label for peds)
1397
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
1398
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
1399
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
1400
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
1401
Pregnancy category for H2 receptor antagonists
B - also safe in peds
1402
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
1403
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
1404
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
1405
PPI's: contraindications
Allergy
1406
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
1407
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
1408
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
1409
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
1410
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
1411
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
1412
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
1413
Adverse effects of bulk laxatives:
N/V, abdominal fullness
1414
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
1415
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
1416
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
1417
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
1418
Acid Reflux/ Gastritis:
| prevalence, probable causes?
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
1419
Descriptions and symptoms of gastritis
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
1420
Other contributing factors to gastritis?
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
1421
4 Types acid reflux/ gastritis meds
1. Antacids
2. Carafate
3. H2 receptor antagonists
4. PPI's
1422
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
1423
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
1424
Pregnancy category of antacids
B, safe for breastfeeding as well
1425
Antacids: adverse effects
N/V, constipation, dependence
1426
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
1427
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
1428
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
1429
Carafate: adverse effects
CONSTIPATION! Gotta love it!
1430
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
1431
Carafate pregnancy category:
B ( off label for peds)
1432
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
1433
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
1434
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
1435
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
1436
Pregnancy category for H2 receptor antagonists
B - also safe in peds
1437
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
1438
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
1439
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
1440
PPI's: contraindications
Allergy
1441
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
1442
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
1443
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
1444
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
1445
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
1446
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
1447
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
1448
Adverse effects of bulk laxatives:
N/V, abdominal fullness
1449
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
1450
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
1451
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
1452
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
1453
Acid Reflux/ Gastritis:
| prevalence, probable causes?
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
1454
Descriptions and symptoms of gastritis
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
1455
Other contributing factors to gastritis?
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
1456
4 Types acid reflux/ gastritis meds
1. Antacids
2. Carafate
3. H2 receptor antagonists
4. PPI's
1457
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
1458
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
1459
Pregnancy category of antacids
B, safe for breastfeeding as well
1460
Antacids: adverse effects
N/V, constipation, dependence
1461
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
1462
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
1463
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
1464
Carafate: adverse effects
CONSTIPATION! Gotta love it!
1465
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
1466
Carafate pregnancy category:
B ( off label for peds)
1467
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
1468
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
1469
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
1470
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
1471
Pregnancy category for H2 receptor antagonists
B - also safe in peds
1472
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
1473
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
1474
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
1475
PPI's: contraindications
Allergy
1476
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
1477
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
1478
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
1479
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
1480
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
1481
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
1482
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
1483
Adverse effects of bulk laxatives:
N/V, abdominal fullness
1484
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
1485
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
1486
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
1487
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
1488
Acid Reflux/ Gastritis:
| prevalence, probable causes?
Very prevalent (10%) US pop
Several probable causes:
1. Transient lower esophageal sphincter relaxtion
2. Low resting lower esophageal sphincter
3. Poor esophageal acid clearance
4. Defects in esophagastric motility
5. Impaired mucosal resistance and over protective defenses
1489
Descriptions and symptoms of gastritis
Burning sensation, nausea, chest pain, or globus (broad) sensation.
* can be very much like an MI ; differentiating SX - SOB, diaphoresis
1490
Other contributing factors to gastritis?
Intake of acidic foods; treatment begins with removing these offenders / lifestyle modifications then mess
1491
4 Types acid reflux/ gastritis meds
1. Antacids
2. Carafate
3. H2 receptor antagonists
4. PPI's
1492
Antacids: sodium bicarbonate, calcium carbonate, magnesium hydroxide, aluminum hydroxide
MOA?
These are weak bases that fact with gastric acid to form a salt and water, therefore decreasing gastric acidity
1493
Pharmokinetics/ dynamics of antacids
- Some po absorption; 25-35 % availability
- bicarbonate preps (bioavailability) improves with food bu hydroxide preparations poorly absorbed
- carbonate excreted via stool
- aluminum and mag excreted via urine
1494
Pregnancy category of antacids
B, safe for breastfeeding as well
1495
Antacids: adverse effects
N/V, constipation, dependence
1496
Contraindications for taking antacids:
Renal Failure (for those with aluminum and magnesium) - ie, the re ally excreted ones
1497
Carafate: MOA
Positively charged sucrose sulfate binds to negatively charged proteins in base of ulcers, forms an ADHERENT/ PROTECTIVE barrier from gastric acids and bile salts
1498
Carafate: pharmacokinetics
- very little absorption, so not metabolized
| - excreted in stool
1499
Carafate: adverse effects
CONSTIPATION! Gotta love it!
1500
Contraindications for use of Carafate-
Allergy; may use with caution with other meds... Can affect absorption
1501
Carafate pregnancy category:
B ( off label for peds)
1502
H2 receptor antagonists: Zantac, Pepcid, Tagamet
| MOA?
Competitive inhibitors of H2 receptors in gastric parietal cells causing a decrease in gastric acid. No H1 or H3 efficacy (therefore not sedating).
1503
H2 receptor antagonists: pharmacokinetics
- good po absorption
- metabolized via liver
- excreted in urine
1504
H2 receptor antagonists
| Adverse Effects
H/A, dizziness, confusion in elderly,
| .....GYNECOMASTIA (for real!?!?!)
1505
H2 receptor antagonists- contraindications
Potent P450 inhibitor!
| Use Tagamet with caution in elderly
1506
Pregnancy category for H2 receptor antagonists
B - also safe in peds
1507
Proton Pump Inhibitors- Prilosec / omeprazole, Prevacid / lansoprazole, Protonix / pantoprazole, Nexium/ esomeprazole
MOA?
Binds irreversibly to H+/ K+ exchanging ATPase pumps (proton pumps) in gastric parietal cells, decreasing both basal and stimulated gastric acid secretion
1508
PPI's: pharmacokinetics/ dynamics
- PRODRUG: must survive the acidic environment of stomach to be absorbed into small bowel
- all have fairly good bioavailability, decreased with po intake
- metab in liver / inhibits CYP2C19
- excreted in stool; **dose-adjust for hepatic disease**
- little renal excretion
1509
PPI's: adverse effects
H/A, diarrhea, constipation, nausea, increased risk C. diff infection, ⬇️Mg with prolonged use,
⬆️ risk osteoporosis-related fractures with prolonged use
1510
PPI's: contraindications
Allergy
1511
Types of laxatives:
1. Bulk (Metamucil, fibercon)
| 2. Osmotic laxatives ( milk of mag, lactulose, mg citrate, polyethylene glycol (miralax)
1512
Osmotic laxatives MOA:
Causes water retention in stool; soluble but no absorbable compounds
1513
Pharmacokinetics of osmotic laxatives
NO PO absorption/ excreted in stool unchanged
1514
Adverse effects of osmotic laxatives:
Diarrhea
| abdominal complaints
1515
Contraindications of osmotic laxatives:
- Existing electrolyte abnormality
| - Age under 2 yo
1516
Osmotic laxatives: great option for long or short term relief?
No adverse effects shown up to 12 months of daily use
1517
Bulk laxatives - MOA?
| Pharmacokinetics
Absorb water and enlarge stools which stimulates propulsive movement through the lower GI tract
-no po absorption; excreted through stool as unchanged drug
1518
Adverse effects of bulk laxatives:
N/V, abdominal fullness
1519
Contraindications of bulk laxatives:
Bowel obstruction, under age of 6
1520
Pregnancy Category bulk laxatives
B; safe in pregnancy and breastfeeding
1521
Gastric motility agent (Metoclopramide/ Reglan) MOA
Binds to dopamine D2 receptors in CNS, as well as some 5-HT3 antagonism: gastric motility is caused by the D2 antagonism
1522
Reglan: pharmacokinetics
Well-absorbed PO, 65-90% bioavailability
Metabolized via liver
Excreted via urine (decrease dose in renal insufficiency
