GI RX-GERD, PUD, Constipation Flashcards
What are atypical sx w/ GERD?
Erosion of teeth enamel. 1. Less burn bc Barret esophagus 2. Haliosis
What RX inc GERD?
Anticholinergics, Benoz, Estrogen, Dopamine, Alendronate-bisphosphonate, Iron
Pregnant women have GERD bc?
pressure, slowed emptying, Transit is 4x faster
If NSAIDs is the problem with GERD what is TX?
H2 blocker, PPI, DEC Dose
These agents neutralize/buffer stomach HCL to form what?
Antacid form salt and H2O 1. Inc LES pressure 2. Inc PH
What are the Antacids?
Al, Mg, NaHCO(baking soda, alka seltzer
What antacid is combined with alginic acid, forms a viscous solution that floats on surface, create a barrier for the LES reflux?
Gaviscon
What is side effects of ADE?
- Gassy d/t CO2 production-TX simethicone 2. Gi upset, alkalosis, 3. Nephrolithiasis 4 TSH low bone marrow suppression-Al+
Why should Pt avoid taking antacids w/ PPI dosing?
- Avoid oral med 1-2hr of other RX 2. Reduce bioavailability of H2 blockers 3. INC pH-enteric coated drugs may be release early, goal is to get to duodenal to get absorbed, IF PH HIGH in stomach will not get absorbed in ideal location 4. INC urine PH
What agents competitively and selectively inhibit histamine form the ECL cells, which DEC signaling parietal cells to make HCL?
H2 blocker- Ranitidine and Famotidine
What are benefits for H2 blocker?
Rare ADE- safe 2. CNS mental confusion, dizzy w/ High does on elderly in ICU
Which H2RA has hihg DI w/ CYPs?
Cimetidine Tagamet- avoid all drugs warfarin, quinidine, SSRI
Which H2RA has less DIs?
Ranitidine- hepatotoxicity rare
What should be avoided with H2RA?
Antacid and PPI
What agent irreversibly bind to H/K-atpase enzyme that transports HCL across parietal cell, inhibit H+, thus INC PH?
Proton pump inhibitors- block 90% of 24 hr gastric acid secretion. ONLY drug to maintain pH>4 post prandial
WHat agents protect itself from acid of pH by enteric coating?
omeprazole/Prilosec, lansoprazole/Prevacid- coated granules. AVOID antacids or alkaline juices bc may break enteric coat. IDEAL Monotherapy and with a MEAL- bc only works when proton pumps engaged to work
What is best agent for nighttime GERD?
PPI-prazoles
What are ADEs of PPIs?
- CNS-ha dizzy 2. Lungs- PNA, 2- CVD MI , B12 deficiency 3. C. diff 4. Osteoporosi
What race group is warning w/PPI?
Asian- Dose DEC omeprazole d/t interaction w/ clopidogrel
Stress ulcers in scene in hospital from trauma, what agent mucosal protective agent is PREG X?
misoprostol- binds prostaglandin, INC blood flow. Produced uterine contractions. USED- NSAID induced PUD
What agent binds to damage ulcer and forms a barrier to injury?
Sucralfate
How does Pepto Bismol work?
Bismuth subsalicylate-coats ulcers and erosions, stimulates mucous prostaglandins, HCO3, binds to microbial
What can bismuth be used for?
Dyspepsia, Acute diarrhea, Travelers diarrhea. H.pylori- PPI+bismuth+ABX
What are the weird SIDE of bismuth?
Black stools and tongue. Ask pt if taking before DX with melena 2. AVOID in renal dysfunction- toxicity encephalopathy (CNS)
What agent kill H. Pylori?
ABX ONLY!. PPI only INC PH thus ABX can work better on H. pylori in the stomach. AVOID H2 blocker in h.pylori NO INC PH effects.
What is tX for H. Pylori?
Quad-PPI BID + Clari + amox+metronidazole x 14 days or Bismuth instead of PCN
What agent lower LES pressure, accelerated gastric emptying w/o stimulate gastric secretions. IF OD provide anticholinergic?
Metoclopramide- AND extrapyramidal effects d/t antagonizes Dopamine
What agent is used for gastric emptying/Diabetic gastroparesis?
Metoclopramide
What other agents INC gastric motility?
Bethanechol, neostigmine, erythromycin-ABC inc diarrhea. Used or endoscopic emergence?
What are the main approached for constipation
- Find their relative normal 2. Diet- INC fiber for bulk 3. Underlying condition 4 Surgery expectations
What class of drugs cause constipation?
Analgesic- OPIATES 2. Anticholinergics 3. Succinylcholine 4 Calcium antacids 5 CCB 6 Diuretics 7. IRON
Which agents is all much and no push and should not be RX with opiates?
Docusate and Senna
Name a few stool softeners that work 1-3d?
Psyllium, Docusate, Lactulose, Sorbitol, Mineral oil
Name a few stool softener w/ semi fluid stools that work 6-12?Too harsh for mild constipation
Senna, Mg-Sulfate, Bisacodyl
Name a few watery stool producers w/ 1-6h? Ideal for severe constipation
Mg+: citrate, H2O2, sulfate, 4.Na phosphate, Bisacodyl, Polyethethylene glycol
What is firstline in treating constipation?
Diet
What agents are indigestible, absorb water to form bulk, promote peristalsis?
Methylcellulose, polycarbophil, psyllium- ADE: Bloating, INC sugars(AVOID DM) USE- IBS DEC TC and LDL
Which laxative is least effective but good for pregnancy, reduce surface film tension, all mush and no push, prevent dry stools?
Emollient Docusates-softener only. NON STIMULANT ADE- skin, GI
Which Lax is AVOIDED in bed bound due to aspiration, AVOID LT due to ADEK impaired, Leaks?
Mineral oil- DEC stool transit time, so less water absorbed from feces. USE- fecal impaction short term
Which lax is USED for bed bound, neuro impaired, and not for pregnancy, appendicitis, lactation?
Castor oil
Which LAX discolors urine?
cascara, sagrade, senna- pink red red brown
Which LAX are for acute, chronic, and prevention, last resort bc potent?
Osmotic Mg and Na: prompt bowel evacuation, rapid water movement into distal small, leads to high stool vol.
AVOID this lax in elderly, frail, renal impaired, CHF pt?
Saline- no long term. ADE/ DD- reduce ciprofloxacin, alkalosis
What lax is non absorbable osmotic active sugar w/ Na+, K+, prevent water absorption in intestine, for bowel cleansing?
PEG(miralax, glycolax) -ADE- less GI
What lax stimulate this channel opening in intestine, inc liquid secretion, shorten transit time-produces diarrhea?
Cl channel activator-chronic constipation, IBS w/ constipation, OPioid non CA. ADE- NAUSEA, Preg C, LAST resort
Metoclopramide- ADE extrapyramidal effects d/t antagoinizes Dopamine
INC DDI d/t CYP3A4-ADE-GI issues. CY INDUCERS- DEC drug level, INHIB-INC Drug level
