Question | Answer |
• 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 |