GI Pharma (Exam 3) Flashcards
Drug Therapy for GERD and PUD
H2 Receptor Antagonist
Proton Pump Inhibitors
Mucosal Protectants
Antacids
Antiemetics
Upper GI INcrease Protective Factors
Mucosal Protectant (Sucralfate)
Antacids
Upper GI Decrease Aggressive factors
Treat H. Pylori
H2 Blockers (idines)
Proton Pump Inhibitors (prazoles)
Treating H. Pylori
Antibiotics + gastric acid inhibitor (PPI) (H2)
Treat 10-14 days
Adherences is lower because it is expensive
What are the two ways drugs target gastric acid production
- Block H2 receptors
- Inhibit proton pump
H2 Receptor Antagonist:
Drugs
MOA
Indications
Cimetidine and Famotidine
Block H2 receptors in the stomach and reduces gastric acid secretion
GERD - PUD - Decrease the risk for ASPNA (less acidic)
H2 Receptor Antagonist:
Adverse Reaction
NSG considration
Famotidine and Cimetidine
CNS depression
cimetidine is a CYP450 inhibitor
Proton Pump Inhibitors
Omeprazole
Pantoprazole
Esomeprazole
PPI: MOA
Bind to proton pump and inhibit the hydrogen potassium ATPase enzyme system
Irreversibly inhibits the secretion of HCl
PPI: Indication
Short term treatment of PUD and GERD
PPI: Adverse Reactions
Short term: Safe
Long term: PNA, BONE LOSS, STOMACH CANCER (risk)
Mucosal Protectant
sucralfate
Unique drug composed of: Sucrose-base and aluminum hydroxide
sucralfate: MOA
Alters when exposed to gastric acid
Sticky, thick gel -> protective barrier within the stomach
sucralfate: Indiations
Duodenal ulcers (FDA approved)
Gastric ulcers (+evidence)
Antacids
Al = amphogel = constipation
Ca = Tums = constipation
Mg = Mild of Mag = Diarrhea
Al+Mg = Maalox-Mylanta = Balanced Approach
Antacids: Indicaitons
PUD
GERD
Antacids: NSG consideration
Chelation
(Taken with other drug alter gastric absorption) (Separate from other drugs by 1-2 h)
Drug Therapy for Nausea:
Serotonin Blocker
Antihistamines
Dopamine antagonist: Prokinetics
ondansetron
dimenhydrinate - meclizine - hydroxyzine
metoclopramide
Serotonin Blocker
ondansetron
ondansetron: MOA
Blocks serotonin receptors in the trigger zone of the brain and in the afferent vagal nerves in the stomach and small intestine
ondansetron: Indication
N/V
Chemo and Radiation induced
ondansetron: Adverse Reactions
Mild HA
Diarrhea
Dizziness
ondansetron: NSG considerations
SERIOUS: Serotonin syndrome. Be aware of other drugs that affect serotonin –> SSRIs, SNRI’s, TCA, MAIs, buspirone, tramadol
Antihistamines: ALl
Dimenhydrinate
Meclizine
Hydroxyzine
Block H1 receptor in the inner ear and is given to treat dizziness. MOtion sickness
Watch for drowsiness (fall risk)
Dopamine Antagonists: Prokinetic agent
metoclopramide
metoclopramide: MOA
Blocks dopamine receptors
increase the tone of lower ES (GERD)
Increases peristalsis in both the stomach and intestine (diabetic gastroparesis)
metoclopramide: Indications
N/V: chemo/ radiation/ opioids
GI motility issues and paralytic ileus
Diebtics
GERD/PUD
metoclopramide: Adverse Effects
Extrapyramidal Symptoms (EPS)
Neuroleptic malignant syndrome (EPS
Extrapyramidal Symptoms
Come with metoclopramide
Akathisia: Feel restless (Have to move)
Acute dystonia: Involuntary contraction
Parkinsonism
Tardive dyskinesia (Face movements
Neuroleptic malignant syndrome
Drug Therapy for Diarrhea: Name and MOA
Diphenoxylate with atropine
Decreased intestinal peristalsis
Diphenoxylate with atropine: Adverse Reactions and NSG consideration
Drowsiness and constipation
SERIOUS CARDIAC ARREST / ARRHYTHMIAS
FALL and DRIVING precautions
Atropine = Anticholgernic effects
IBD Medications
5 - Amino = Sulfasalazine
(Do not give to pt. with sulfa allergy)
DMARD - infliximab
(IMMUNE SUPPRESSION) (Therapeutic monitoring of CRP)
DMARD IS MOST COMMON
