Pharm GERD IBD Motility Flashcards
Hydrocortisone
Topical corticosteriod or enema
IBD management
Budesonide
Topical foam or oral corticosteroid
IBD management
Prednisone
Oral corticosteriod
IBD management
Sulfasalazine
Class: Aminosalicylate
IBD Management
Mesalamine
Class: Aminosalicylate
IBD Management
Olsalazine
Class: Aminosalicylate
IBD management
Balsalazide
Class: Aminosalicylate
IBD management
IBD Management Sequence
Aminosalicylates Corticosteriods Immunomodulators TNF alpha inhibitors Antibiotics
Immunomodulators for IBD
Azathioprine
Mercaptopurine
Cyclosporine
Methotrexate
Sodium Bicarbonate
Antacid
GERD Management
Calcium Carbonate
Antacid
GERD Management
Magnesium hydroxide + Aluminum hydroxide
Antacid
GERD Management
Cimetidine
H2 Blocker
GERD Management
Famotidine
H2 Blocker
GERD Management
Ranitidine
H2 Blocker
GERD Management
Nizatidine
H2 Blocker
GERD Management
Omeprazole
PPI
GERD Management (1x day) PUD/H. Pylori (Multiple times a day)
Esomeprazole
PPI
GERD Management (1x day) PUD/H. Pylori (Multiple times a day)
Pantoprazole
PPI
GERD Management (1x day) PUD/H. Pylori (Multiple times a day)
Lansoprazole
PPI
GERD Management (1x day) PUD/H. Pylori (Multiple times a day)
Dexlansoprazole
PPI
GERD Management (1x day) PUD/H. Pylori (Multiple times a day)
Rabeprazole
PPI
GERD Management (1x day) PUD/H. Pylori (Multiple times a day)
Misoprostol
Analogue of PGE, stimulates secretion of mucus and bicarbonate
GERD Management of patients on NSAIDs
Contraindicated in pregnancy
Sucralafate
Salt of sucrose complexed to aluminum hydroxide which forms viscous paste that binds selectively on ulcers or erosions
GERD Management
Triple therapy
H. Pylori Management
High dose PPI plus
Antibiotics (Clarithromycin and [Amoxicillin or Metronidazole])
Prevpac
Triple therapy combination product for H. Pylori
Lansoprazole, amoxicillin, clarithromycin
Pylera
Triple therapy combination product for H. Pylori
Bismuth subcitrate potassium, metronidazole, tetracycline
Quadruple Therapy
H. Pylori management
High dose PPI plus
Bismuth subsalicylate plus
Metronidazole and [tetracycline or doxycycline]
Bethanechol
Cholinomimetic agent (stimulates muscarinic receptors and increases smooth muscle tone)
Motility Disorders
Neostigmine
Cholinomimetic agent (Acetylcholinesterase inhibitor and blocks destruction of ACh)
Motility Disorders
Metoclopramide
D2 receptor blocker
Requires renal adjustment
Motility Disorders
Domperidone
D2 receptor blocker
NOT FDA approved
Motility Disorders
Erythromycin
Macrolides (antibiotic)
Motility Disorders
Erythromycin (side effects)
- QTc prolongation, ventricular arrhythmias
- Abdominal pain/cramping, diarrhea
- Decreased efficacy with long term use (4+ weeks)
Erythromycin (Drug interactions)
Numerous, major CYP3A4 inhibitor
Macrolides (MOA)
- Mimics motilin, a potent contractile agent
- Cholinergic facilitation
Domperidone (Side effects)
- QTc prolongation, cardiac arrest
- Abdominal cramps
Domperidone (Drug interactions)
- CYP3A4 inhibitors
- QTc prolonging medications
Metoclopramide (Side effects)
Drowsiness, dystonic reaction, restlessness, bronchospasms, prolactin elevation
Metoclopramide (Drug interactions)
Antipsychotic agents
Atovaquone (antimalarial)
Droperidol
D2 Receptor Blockers (MOA)
Blockade of D2 receptors which leads to increased smooth muscle stimulation
- increased esophageal peristalsis
- increased lower esophageal sphincter pressure
- increased gastric emptying
D2 Receptor Blockers
Common for diabetic gastroparesis
Metoclopramide
Domperidone
Neostigmine (Drug Interactions)
Beta blockers
Corticosteroids
Succinylcholine
Neostigmine (Side Effects)
AV block, bradycardia
Dizziness
Diaphoresis
Bronchospasms
Bethanechol (Side Effects)
Abdominal pain, diarrhea
Urinary urgency
Asthma, bronchoconstriction
Flushing, headache, bradycardia
Bethanechol (Drug interactions)
Acetylcholinesterase inhibitors
Beta blockers
Misoprostol (Side Effects)
Diarrhea, abdominal pain
Detrimental to pregnancy
Misoprostol (Drug Interactions)
Antacids, magnesium containing
Sucralafate (Side Effects)
Constipation, aluminum toxicity (CKD patients)
Sucralafate (Drug Interactions)
Binds to multiple medications
PPIs (MOA)
Travel systemically to form irreversible disulfide bonds with proton pumps inactivating them
Taken on empty stomach
PPIs (Side Effects)
- Decreased B12, Ca and magnesium absorption
- Increased risk of bone fractures
- Increased risk of C. diff and pneumonia
- Increased risk of dementia and CKD
- Rebound acid hypersecretion with discontinuation
PPIs (Drug Interactions)
Drugs process via CYP2C19
Clopidogrel (Plavix): decreased antiplatelet activity
H2 Blockers (MOA)
Acid inhibition via reversible H2 receptor blockade on parietal cells
H2 Blockers (Side Effects)
Diarrhea, headache, fatigue, constipation, CNS effects (confusion, hallucinations, delirium)
Gynecomastia/impotence (cimetidine only)
H2 Blockers (Drug interactions)
Cimetidine (CYP2C9, CYP2D6, CYP1A2, CYP3A4 inhibitor)
Antacids (MOA)
Neutralize gastric acid by reacting with HCl
Sodium bicarbonate (Side effects)
Belching, metabolic alkalosis, fluid retention
Calcium carbonate (Side effects)
Belching, hypercalcemia, metabolic alkalosis
Magnesium hydroxide + Aluminum hydroxide (Side effects)
Diarrhea, constipation, aluminum accumulation in CKD
Sodium bicarbonate (Drug Interactions)
Elvitegravir (v)
Amphetamines (^)
Calcium-containing dairy products (v)
Calcium carbonate and Magnesium hydroxide + Aluminum hydroxide (Drug interactions)
Tetracyclines (v) Fluoroquinolones (v) Itraconazole (v) Iron (v) Calcium-containing dairy (^) Elvitegravir (v)
TNF alpha inhibitors
Adalimumab
Infliximab
Golimumab (ulcerative colitis only)
Certolizumab (Crohn’s only)
TNF alpha inhibitors (side effects)
Infections, injection site reactions, headache, nausea, hepatotoxicity
Immunomodulators
Azathioprine
Mercaptopurine
Methotrexate
Immunomodulators (side effects)
NVD, myelosuppression, hepatotoxicity
alopecia, photosensitivity, mucositis with methotrexate
