GI Medications Flashcards
Aggressive Gastritis factors
H. Pylori NSAIDS Acid Pepsin Smoking
Defensive Factors
Mucus
Bicarbonate
Blood flow
Prostaglandins
Antacids MOA
MOA: reacts with gastric acid to produce neutral salts
By neutralizing acid, antacids decrease destruction of the gut wall
Reduce pepsin activity, enhances mucosal protection by stimulating production of prostaglandins
Antacids ( medication )
Calcium carbonate ( tums) Sodium bicarbonate (alka-seltzer) Aluminum hydroxide Magnesium hydroxide ( milk of magnesia) - diarrhea Magnesium oxide ( mag-Ox)- constipation
Combo : maalox, mylanta,
Antacid ( admin and precaution, contra, preg)
Pt should take 1-2 hours after a meal or when symptom occur
Take 1 hour before or 2 hours after medication
Preacaution: kidney stones, geriatrics, renal impairment
Contraindications: hypercalcemia or hypophosohatemia
Preg: generally safe
Antacids ( adverse)
Sodium loading
Acid rebound
Milk-alkali syndrome - high blood calcium and metabolic alkalosis
Antacids with aluminum and calcium = constipation
Antacids with mag = diarrhea
Bulk Laxatives
Anti diarrhea
MOA: increases bulk and moisture content of stool, stimulates peristalsis
Adverse: bloating, cramping, flatulênce
Precaution : poor fluid intake
Safe in preg
Lomotil
Anti-diarrhea
MOA: slow GI motility and propulsion, allow fluid to be absorbed, decreasing fecal volume
Precautions: toxic megacolon
Scheduled V controlled substance
Low potential for physical dependence and abuse
Imodium
Anti-diarrhea
Best drug
MOA: slow GI motility and propulsion, allow fluid to be absorbed , decreasing fecal volume
Adverse : drowsiness dizziness, headache
Precaution: fluid rentention, and toxic megacolon
Bismuth Subsalicylate
MOA: anti-secretory antimicrobial
Adverse: darkening of stool and tongue
Precaution : caution in pt taking anticoagulation medication
Contra: 3rd trimester preg, allergy ASA, severe GI bleeding
Antidopaminergics
Compazine, Phenergan, Reglan
MOA: block D2 receptors in CTZ and other areas of brain
Adverse: extrapyramidal reactions ( tar dive dyskinesia)
Contraindications : Reye’s syndrome ( do not give in kids)
Preg: not reccomended
Reglan ( metoclopramide)
MOA: blocks D2 receptors, stimulates upper GI tract, increases peristalsis of Duodum and jejunem
Lowers sz control
Adverse: tardive dyskinesia
PrecautionL geriatrics increased risk for confusion
Contraindication : GI obstruction
Anticholinergics
Meclizine ( vertigo)
Dramamine ( motion sickness)
Scopolamine
MOA: reduce sensitivity of vestibular apparatus
Lots of side effects
NK1 Receptor Antagonist
Given ahead of chemo to prevent N/V. Will not treat N/V
Decreases effectiveness of oral contraceptives
5HT3 receptor antagonists
Zofran, Anzemet, Kytril, Aloxi
MOA: work peripherally intestinal wall by blocking 5HT3, work centrally in CTZ by blocking 5HT3 receptors
Zofran okay for < 4
Can give in pregnancy
Acute vomiting treatment
N = PO antiemetic
N/V : PR for short term period then switch to oral once vomiting is under control
Anticipated Vomiting treatment
Premedication, antidopinergics : start low and increase PRN for symptom control
Anticholinergics for motion sickness and vertigo
NK1 and 5HT3 for Chemo emesis
Stool softeners
MOA: lowers surface tension, permits easier defecation
Adverse: intestinal obstruction, diarrhea
Colas
Osmotic Laxatives
MOA: cause water the tissue into the bowel, increases peristalsis
Miralax
Amitiza
For opiod induced constiption and IBS in women
Not approved for children
Stimulants
MOA: directly stimulates sensory nerves in intestinal mucosa
Bulcolax, senna
Precaution: fluid and electrolyte abnormalities
Saline laxatives
Mag citrate
MOA: attract and retain water in bowel, índice contractions
Precautions: edema and HTN
Do not give to infants
Constipation short term management
Start with bulk laxative or saline agent
Stimulants are third line
Long term constipation management
- Bulk laxative and saline agent
- Opioid prophylaxis
- Add another stool softener
Do not take stimulants or saline laxatives long term
Peptic ulcer disease
Break in the gastric or duodenal mucosa
Increase in acid, pepsin
Causes: NSAIDS and H. Pylori ( most common cause of gastric and duodenal ulcers)
First line medication to eradicate H. Pylori
Quadruple bismuth RX
Very expensive
Long use and many pulls
PPI and 3 ABS,
Histamine -2 blockers
Zantac, Tagamet, Pepcid
For : duodenal and gastric ulcers, GERD
Give at night or BID
PPI
Omeprazole ( Prilosec) Nexium, Prevacid, Dexilant, Protonix, Aciphex
uses: gastric and duodenal ulcer, GERD, H. Pylori
Ad: 30-60 min before a meal, should not crush or chew capsules
Adverse: b12 deficiency , avoid grapefruit
How to d/c PPI therapy
Cut the dose by 50 percent every week
If patients on BID dosing the initial reduction can be accomplished by decreasing the once in the morning before breakfast
Once on the lowest dose for one week the patients instructed to stop the medication
Sucralfate ( calafate)
Anti-ulcer medication
Creates a protective barrier up to 6 hours against acid and pepsin
Uses for duodenal ulcer with NSAID for ulcer prevention
Anti acids may interfere with effects of sucralfate
Mistoprostol
MOA: synthetic prostaglandin, increased museus and bicarbonate production and enhances blood flow to stomach
NSAID and ASA gastric protection
Take with food
Be aware if cv disease
NSAID- induced Ulcer treatment
D/c NSAID if possible and add PPU or H2 blocker
If cant d/c then add a continuous PPR or H2 blocker or misiporstol
Consider COX-2 selective NSAID —> worry about CV risk
Drugs to manage GERD
PPI - 1 st line
H2 -blockers
Pharm treatment for cramping abd pain
Antispasmodic PRN
Bentyl and Levsin
MOA: relax smooth muscle tone , decrease HI motility
Pharm treatment for abd pain frequency or severe
TCA’s ( elavil, Pamelor, tofranil, normpramin
IBD pharm treatment
Aminosalicylates
Corticosteroids
Immunomodulator
Aminosalicylates
Mesalamine
MOA: topical, inhibit prostaglandin production in colon
Increases liver enzymes
