Module 5 -2 Flashcards
what are the three common forms of ARD?
Acid-related disorders (ARD)
- Dyspepsia - which is indigestion
- Heartburn - combination of acid + GERD
- Inflammation/Ulceration of the stomach lining by the proteolytic enzyme pepsin called PUD
these diseases are caused from over production of stomach acid
What are the contributing factors to GERD?
- aspiring and other NSAID use
- alcohol, cigarettes and caffeine
- H. pylori bacterial infection
- stress - both severe psychological and traumatic physical contributing factors worsening any of the ARDS
Drug therapy for ARD
- Oral antacids (tablets or liquids)
- they all neutralize excess HCL to varying degrees; calcium antacids can have the added benefit of supplementing those who need extra calcium in their diet (against osteoporosis)
1. aluminum and calcium antacids
2. magnesium salts like milk of magnesia
3. calcium salts like Tums - by combining various antacids the manufactures have tried to cut down on the tendency of single formulations to either produce loose stools or constipation(AL salt are constipating and Mg salts are laxating)
- Baking soda - very effective remedy but causes an acid rebound a few hours later
- simethicone is used for “gas”
- H2 blockers (1977) followed a little later by proton pump inhibitors
H2 Blockers
changed the entire face of ARD treatment. are antihistamines which work on the Histamine 2 rc rather than the Histamine 1 rc.
* Tagamet (cimetidine) introduced in 1977, was the first superstar drug of this class
ranitidine (Zantac)
H2 blockers drug to treat ARD - were introduced as $$$ Rx but now available OTC
Famotidine (Pepcid)
H2 blockers drug to treat ARD - were introduced as $$$ Rx but now available OTC
Proton Pump Inhibitors (PPIs)
are another way to decrease stomach acid, this time by shutting down the proton pump (H+ pump located in the stomach’s parietal cells) that puts the hydrogen in hydrochloric acid
PPIs drugs
- Prilosec (omeprazole) - first came to the market in 1988
- Prevacid (lansoprazole)
- Nexium (esomeprazole) - the purple pill
H2 blockers and PPIs drugs
are safe, reliable OTC remedies
What are the three rc that is activated will cause the release of stomach acid?
- Cholinergic - Acetycholine
- Gastrin
- Histamin type 2
Combination drugs for ARD
Pepcid complete (famotidine + Ca carbonate + Mg hydroxide)
but taking H2 blockers with PPIs can cause the condition called “Atrophic gastritis” - smooth lining of the stomach can be pre-cancerous
H. Pylori
Helicobactor Pylori is a bacterium which is highly associated with the development of Peptic Ulcers.
Treatment requires multiple antibiotics combined with either a PPI / H2 blocker and /or bismuth subsalicylate (Pepto-Bismol)
is now known to increase the amount of inflammation in the mucosal lining where it colonizes, thereby eroding the protective mucous barrier and exposing the underlying tissues to the harmful effects of the acid digestion. Through this combination of factors the stomach lining becomes damaged to the point of forming erosions, or ulcerations.
H. Pylori ulcerations
Not only do the ulcers cause pain and gastrointestinal distress, but they can bleed, sometimes silently, and sometimes very precipitously, requiring immediate blood transfusions and surgery to save the patient.
H. Pylori tests
H. pylori antibody test H. pylori antigen test H. pylori breatjh test CLO test Rapic urease test (RUT) for H. pylori
Combo drug to treat H. Pylori infections
PrevPac - blister pack combination of 3 drugs amoxicillin /clarithromycian and lansoprazole (Prevacid)
Drugs like “codeine” to treat diarrhea
anticholinergic effects and slow down the bowel
Paregoric
is a tincture of morphine - can also calm a colicky child.
Drugs to treat diarrhea are: Opioid Opioid like drug Surface acting agents Antibiotic
- Codeine
- Paregoric
- Lomotil (diphenoxylate + atropine) while Imodium is loperamide
- Pepto Bismol (bismuth sulfate)
- Kaopectate (Kaolin and Pectin)
- Cipro, Ceptra and doxycycline (vibramycin)
Pepto-Bismol (bismuth subsalicylate
is indicated for treating heartburn, but it actually has very weak antacid properties. good choice for travelers diarrhea
- has antisecretory activity in the gut (decreasing wather excretion in the stool), and the bismuth absorbs toxins caused by E.coli
Children’s Pepto
calcium carbonate / antacid
*** no bismuth subsalisylate - NOT the same formula as the adult version
Drugs to treat infectious diarrhea caused by bacteria
antibiotics are used along with fluid/electrolyte replacement
- TMP-SMX (Septra)
- ciprofloxacin (Cipro)
- doxycycline (Vibramycin)
Treatment of constipation - LAXATIVES
- bulk agents retain water in the stool
- stool softeners and lubricants
- Irritants and stimulants increase bowel peristalsis
- and salt solutions (Epson’s salts and other hypertonic magnesium salts, polyethylene glycol (PEG), saline laxatives including Fleets enema
Bulk agents
contain cellulost fibers similar to the Kaolin-Pectin fiber used for diarrhea.
- psyllium (Metamucil - and many others)
Stool softeners and Lubricants
- docusate (Colace)
- mineral oil, glycerine suppositories
do not actually stimulate bowel movements, they just slowly work to create a film around
Bowel stimulants
Sennosides (Ex-Lax), castor oil
Sennosides (Ex-Lax)
irritan/stimulant laxatives
sennas are a large group of flowering plants native to the middle east and Asia.
Salt solutions for laxatives
Epsom Salts and other hypertonic Mg salts (Mag Citrate) and PEG. Fleets Enema
Compazine (prochlorperazine)
is an older type of antipsychotic drug with dopamine antagonism properties - antinausea effect
what the two 5 HT3 rc antagonist “setron”
- Ondansetron (Zofran)
- dolasetron (Anzemet)
serononin type 3 rc antagonists are the most recently developed, and by far the most effective (and no longer expensive) antinausea drugs ont he market
Treatment of poisoning, by overdose or suicide attempt
Emetics must be given to a conscious pt and taken as soon as possible.
*** ipecac syrup - No longer recommended
the most common treatment for drug overdose is
administration of “absorbents” like activated coal (charcoal), which binds other drugs so they cannot be absorbed into the bloodstream.
Weight loss drugs
Amphetamine type drug like Fen-Phen 1997. Fen–Phen was the combination of a serotnergic drug and an amphetamine-like drug. The combination may have led to cardiac valvulopathies. drug was withdrawn.
Meridia
- wright loss drugs - suppress appetite via serotonin (and norepinephrine) re-uptake inhibition.
- SNRI antidepressant-like drug similar to Cymbalta
- pulled from the market in 2010 due to risk of heart attack or stroke.
Xenical (orlistat)
is a Rx drug for weigh loss - has been around since 1999. it’s the lipase inhibitors are the first non-stimulant weight loss drugs approved by FDA.
- **WORK TO DECREASE CALORIC ABSORPTION
- ALLI is a lower dose version available OTC sine 2007
