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Pharm test 3

chap 28

• Drugs for Peptic Ulcer Disease H2 receptor antagonists ;Proton Pump Inhibitors ;Gastric Antacids ;Cytoprotective Drugs
• Drugs for Inflammatory Bowel Diseases Mesalamine (Asacol) (Pentasa) (Rowasa) (Canasa) ;Sulfasalazine (Azulfidine) ;Budesonide (Entecort) ;Other steroids (hydrocortisone, et al) ;Biologics (infliximab and other -mabs)
• Prokinetic Drugs Metocloprapmide (Reglan)
• Drugs for constipation • Bisacodyl (dulcolax) • Fiber • Magnesium oxide and sodium phosphate) • Docusate (Colace, Surfak) • Lubiprostone (Amitiza) • Polyethylene glycol (Miralax)
• Antidiarrheal drugs • Loperamide (Imodium) • Diphenoxylate (Lomotil) • Alosetron (Lotronex)
• Antiemetic agents • Other anitemetics • Neurokinin-1 receptor antagonist • Serotonin 5HT-3 antagonists
H2 receptor antagonists • Ranitidine (Zantac) • Famotidine (Pepcid) • Rizatidine (Axid) • Cimetidine (Tagament)
• Proton Pump Inhibitors • Omeprazole (Prilosec) • Esomeprazole (Nexium) • Lansoprazole (Prevacid) • Deslansoprazole (Dexilent) • Pantoprazole (Protonix) • Rabeprazole (Aciphex)
• Gastric Antacids • Aluminum and magnesium hydroxides • Calcium carbonate
• Cytoprotective Drugs • Misoprostol (Cytotec) • Sucralfate (Carafate)
• Drugs for Inflammatory Bowel Diseases • Mesalamine (Asacol) (Pentasa) (Rowasa) (Canasa) • Sulfasalazine (Azulfidine) • Budesonide (Entecort) • Other steroids (hydrocortisone, et al) • Biologics (infliximab and other -mabs)
• Serotonin 5HT-3 antagonists • Ondansetron (Zofran) • Other -setrons
• Neurokinin-1 receptor antagonist • Aprepitant (Amend)
• Other anitemetics • Promethazine (Phenergan) • Dimenhyrinate (Dramamine) • Meclizine (Antivert) • Dronabinol (Marinol) • Dexamethasone (Decadron)
H2 Blockers Indications: GERD (gastroesophageal reflux disease), dyspepsia, PUD (peptic ulcer disease), H. pylori
H2 Blockers adverse effects HA, dizziness, constipation
Proton pump inhibitors Indications: PUD, Zollinger-Ellison, gastrinomas, GERD, dyspepsia, NSAID use, h. pylori
Proton pump inhibitors Adverse effects: skin rash, elevated liver enzymes, minor GI and CNS
Antacids Indications: PUD, acid indigestion, dyspepsia
Antacids Adverse effects: Magnesium – diarrhea ; Aluminum & calcium – constipation
Proton pumps are in the gastric parietal cells. Prevent secretion of gastric acid for an extended period of time.
hydrocortisone, sulfasalazine (Azulfadine), infiximab (Remicade), mesalamine (Pentasa) Indications: ulcerative colitis & Crohn’s
Glucocorticoids (hydrocortisone) – induce remission
Aminosalicylates (sulfasalazine (Azulfadine),) mesalamine (Pentasa) induce & maintain remission
Disease Modifying Antirheumatic Drugs (DMARDs) (infiximab (Remicade)) Maintain remission
GI Motility Disorders Constipation; Diarrhea; GERD; Gastroparesis; Chronic ; Acute; Diabetic; Irritable bowel disease (IBS)
o Metocloprapmide (Reglan) Indications GERD, diabetic gastroparesis, antiemetic, intubation of the bowel
Metocloprapmide (Reglan) ADVERSE CNS (drowsiness, EPS, seizures); Contraindications: seizure disorder, GI obstruction or hemorrhage, pheochromocytoma
docusate sodium (Colace) Surfactant: Soften stool
bisacodyl (Dulcolax) Stimulant - Adverse effects: abdominal cramping
lubiprostone (Amitiza) Indications: Chronic idiopathic constipation ; IBS
lubiprostone (Amitiza) Adverse effects: Nausea; Diarrhea
Opioid drugs diphenoxylate (Lomotil)-RX; loperamide (Imodium)-OTC
Serotonin 5-HT3 blockers: ondansetron (Zofran) Indications: Chemo-related/radiation N & V; Post-op ; Used in pregancy - Cat B
Serotonin 5-HT3 blockers Adverse effects HA Constipation Diarrhea
aprepitant (Emend)(Neurokinin – Blocker ) Indications: chemo; Use in combo with 5-HT blocker
Dopamine D2 Blockers (metoclopramide (Reglan); prochlorperazine (Compazine)) Indications: N & V
Dopamine D2 Blockers Adverse effects: Anticholinergic effects
Constipation laxatives
docusate sodium (surfactant laxatives) stool softeners: incorporate water into fatty intestinal material => soften feces => for those who have hard or dry, irritating or painful passage of stool
magnesium oxide (milk of magnesia) (osmotic laxatives) attract and retain water , stimulate peristalsis
bisacodyl (stimulant laxatives) evacuating the bowel before surgery or examination (oral or rectal)
bisacodyl adverse effect abdominal cramping, electrolyte and fluid depletion
bisadodyl short term treatment of constipation
magnesium and sodium adverse effects excessive eloss of fluid and electrolytes, not for chronic constipation
lubiprostone indications chronic idiopathic constipation: abdominal pain, bloating , hard or lumpy stool
lubiprostone adverse effects nausea, diarrhea
PPIs the most effective drugs fro treating GERD
PPIs special choice for pts with Zollinger-Ellison syndrome (a condition with severe ulcers resulting from gastrin-secreting tumors)
PPI moa inhibit the proton pump and prevent the secretion of gastric acid for an extended period of time.
gastric antacids neutralize stomach acid, raise GI pH to relieve the pain of dyspepsia and acid indigestion and enable PUD to heal
gastric antacids available without a prescription to treat acid indigestion and dyspepsia
PPI or H2 blockers PPI are preferred for PUD because they heal 80% to 100% of ulcers in 4 weeks whereas H2 blockers require 6 to 8 weeks
Sucralfate indications PUD: treat active ulcers and suppress recurrence ulcers
Sucralfate adverse effect constipation, GI, Laryngospasm
Sucralfate adverse effect cause Laryngospasm
Misoprostol: prevention of gastric and duodenal ulcers
Misoprostol contraindication Pregnancy
Misoprostol adverse effects diarrhea, intestinal cramping, GI reactions
metochopramide inhibit vomiting
metochopramide D2 recepter antagonist
dronabinol for cancer chemotherapy induced emesis, appetite stimulant for anorexic pt with AIDs
aprepitant prevent emesis , prevent acute and delayed nausea and vomiting occuring with highly emetogenic cancer chemotherapy
peptic ulcers too much of gastric acid secretions
primary gastric acid inhibitors H2 antagonist and Proton pump inhibitors
Gastric antacids relieve heartburn and dyspepsia
Created by: prinluu