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DU PA GI Pharm

Duke PA GI Pharmacology

peptic ulcer disease is a group of ulcerative disorders of the upper GI tract that require __ for their formation acid and pepsin
stimulants of acid secretion acetylcholine, histamine, gastrin
pretective forces in GI mucus secretion, bicarbonate secretion, mucosal blood flow, cell restitution, prostaglandin
Helicobacter pylori produces __ which forms an acid-neutralizing cloud that protects H. pylori but damages tissue urease
more than 95% of patients with DU and 80% with GU are infected with __ H. pylori
NSAID mechanism of injury to stomach direct action on the mucosa, inhibition of prostaglandins
clinical presentation of GU food worsens pain
clinical presentation of DU pain relieved by food/antacids
the more common ulcer DU
most __ are biopsied to r/o cancer GU
by neutralizing acid __ is inhibitied pepsinogen to pepsin
when used at proper doses, they are equally efficacious as histamine2 antagonists antacids
onset of antacids is usually __ after administration 5-15 min
duration of antacids is usually __ 1-2 hours
non-systemic antacids aluminum hydroxide, magnesium hydroxide, calcium carbonate
systemic antacids sodium bicarbonate (Alka-seltzer)
major side effect of Aluminum hydroxide (amphojel) constipation
major side effect of Magnesium Hydroxide (milk of magnesia) diarrhea
most common side effect of calcium carbonate constipation
can deliver large amounts of sodium to systemic circulation, can alter systemic pH, use only for short term Sodium Bicarbonate (Alka-Seltzer)
H2 Receptor Antagonists competitively bind to H2 receptors on the __ and decrease histamine stimulation of gastric acid parietal cells
properly taken H2A will heal __% of DU at 8 weeks and __% of GU at 12 weeks 90, 80
__ can cause alcohol to remain in your system for longer Zantac
block gastric acid secretion by inhibiting gastric H/K ATPase in gastric parietal cells PPI
produces profound, long lasting anti secretory effects PPI
indicated for treatment and maintenance of DU only. Many drug-drug interactions. Do not use for GU. Forms cytoprotective complex that covers ulcer site. No systemic absorption. Is a huge pill. Is used in the ICU for ventilated patients. Sucralfate (carafate)
a synthetic prostaglandin that increases mucus production and mucosal bicarb. Indicated for NSAID induced gastric ulcers. Misoprostol (cytotec)
AE's of misoprostol (Cytotec) Diarrhea, ab pain, flatulence, abortifacient
retrograde movement of gastric contents from the stomach into the esophagus GERD
drugs that decrease gastric acid antacids, H2A, PPI
drugs that increase LES pressure bethanechol, metoclopramide, cisapride
drugs that increase gastric emptying metoclopramid, cisapride
drugs that increase esophageal clearance cisapride, bethanechol
__ in GERD is less efficacious than in PUD H2A
esophagela healing __ for PPI as compared with H2A double
3 main causes of N/V visceral stimuli, chemoreceptor trigger zone, vestibular inpu
drug induced N/V chemotherapy (cisplatin), opiates, antibiotics, cardiac glycosides, SSRI's
best used for indegestion instead of N/V H2A, antacids
most practical for long-term treatment for N/V phenothiazines
serotonin antagonists are best for PONV and CINV
serotonin antagonists are not effective for __ motion sickness
examples of serotonin antagonists Zofran, Kytril
very expensive antiemetic serotonin antagonists
prokinetic agents are best used for gastric stasis or CINV
example of a prokinetic agent reglan
cannabinoids are best used for CINV
CINV chemo induced nausea and vomiting
PONV post-operative nausea and vomiting
glucocorticoids are best used for CINV and PONV
examples of glucocorticoids used for N/V decadron, prednisone
benzodiazepines are best used for anticipatory N/V
examples of bezno's used for N/V valium and ativan
butyrophenones are best used for PONV and CINV
example of butyrophenone used for N/V haldol
FDA approved for use in combination with conventional agents for highly emetogenic chemotherapy (cisplatin-based chemo) Neurokinin-1 antagonists
drugs that induce diarrhea antacids containing magnesium, antibiotics, antineoplastics, colchicine, laxatives, metoclopramide, prostaglandins
dietary management for adults withhold feeding (not for children)
pharmacologic treatment options for diarrhea antimotility agents, adsorbents, antisecretory agents, miscellaneous
bacterial diarrhea (C. dif), Colitis, children <2, are contraindications for use of __ antimotility agents
do not use antimotility agents more than __ in acute diarrhea 48 hours
more potent at slowing GI motility than other antimotility agents, newly a generic loperamide
used for symptomatic relief, not very effective for sever acute diarrhea, not systemically absorbed (Kaopectate, FiberCon) adsorbent agents
examples of antisecretory agent Bismuth subsalicylate, octreotide
common pathogens for traveler's diarrhea E. coli, shigella, Campylobacter, Salmonella, viruses
__ is not recommended for prevention of traveler's diarrhea prphylactic antibiotics
nonpharmacological management of constipation encourage 10g crude fiber in daily diet, 1 month trial
pharmacologic treatment options for constipation bulk forming laxatives, saline/hyperosmotic laxatives, emollient laxatives, lubricants, stimulants
bulk forming laxatives (metamucil) are best used for prevention of constipation
best used for acute evacuation of the bowel, pulls water into small and large intestines saline laxatives (Magnesium Citrate, (MOM)
facilitate mixing of aqueous and fatty materials within intestinal tract, best for patients who must avoid straining or to prevent constipation emollient laxatives (docusate(Colace))
not recommended for routine use, in the elderly, or children <6 years old. Coats stool for easier passage, inhibits colonic absorption of water, increase stool weight and decrease stool transit time. Take on empty stomach, not before bed lubricants (mineral oil)
not recommended for daily use or in the elderly for constipation stimulants
anthraquinone stimulants cascara sagrada, sennosides (Senakot), casanthrol (Peri-Colace)
diphenylemethane stimulants bisacodyl (dulcolax), phenolphthalein (removed from the marked due to carcinogenic capabilities)
Created by: bwyche