Duke PA GI Pharmacology
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| peptic ulcer disease is a group of ulcerative disorders of the upper GI tract that require __ for their formation | acid and pepsin
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| stimulants of acid secretion | acetylcholine, histamine, gastrin
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| pretective forces in GI | mucus secretion, bicarbonate secretion, mucosal blood flow, cell restitution, prostaglandin
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| Helicobacter pylori produces __ which forms an acid-neutralizing cloud that protects H. pylori but damages tissue | urease
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| more than 95% of patients with DU and 80% with GU are infected with __ | H. pylori
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| NSAID mechanism of injury to stomach | direct action on the mucosa, inhibition of prostaglandins
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| clinical presentation of GU | food worsens pain
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| clinical presentation of DU | pain relieved by food/antacids
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| the more common ulcer | DU
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| most __ are biopsied to r/o cancer | GU
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| by neutralizing acid __ is inhibitied | pepsinogen to pepsin
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| when used at proper doses, they are equally efficacious as histamine2 antagonists | antacids
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| onset of antacids is usually __ after administration | 5-15 min
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| duration of antacids is usually __ | 1-2 hours
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| non-systemic antacids | aluminum hydroxide, magnesium hydroxide, calcium carbonate
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| systemic antacids | sodium bicarbonate (Alka-seltzer)
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| major side effect of Aluminum hydroxide (amphojel) | constipation
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| major side effect of Magnesium Hydroxide (milk of magnesia) | diarrhea
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| most common side effect of calcium carbonate | constipation
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| can deliver large amounts of sodium to systemic circulation, can alter systemic pH, use only for short term | Sodium Bicarbonate (Alka-Seltzer)
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| H2 Receptor Antagonists competitively bind to H2 receptors on the __ and decrease histamine stimulation of gastric acid | parietal cells
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| properly taken H2A will heal __% of DU at 8 weeks and __% of GU at 12 weeks | 90, 80
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| __ can cause alcohol to remain in your system for longer | Zantac
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| block gastric acid secretion by inhibiting gastric H/K ATPase in gastric parietal cells | PPI
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| produces profound, long lasting anti secretory effects | PPI
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| 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)
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| a synthetic prostaglandin that increases mucus production and mucosal bicarb. Indicated for NSAID induced gastric ulcers. | Misoprostol (cytotec)
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| AE's of misoprostol (Cytotec) | Diarrhea, ab pain, flatulence, abortifacient
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| retrograde movement of gastric contents from the stomach into the esophagus | GERD
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| drugs that decrease gastric acid | antacids, H2A, PPI
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| drugs that increase LES pressure | bethanechol, metoclopramide, cisapride
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| drugs that increase gastric emptying | metoclopramid, cisapride
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| drugs that increase esophageal clearance | cisapride, bethanechol
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| __ in GERD is less efficacious than in PUD | H2A
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| esophagela healing __ for PPI as compared with H2A | double
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| 3 main causes of N/V | visceral stimuli, chemoreceptor trigger zone, vestibular inpu
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| drug induced N/V | chemotherapy (cisplatin), opiates, antibiotics, cardiac glycosides, SSRI's
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| best used for indegestion instead of N/V | H2A, antacids
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| most practical for long-term treatment for N/V | phenothiazines
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| serotonin antagonists are best for | PONV and CINV
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| serotonin antagonists are not effective for __ | motion sickness
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| examples of serotonin antagonists | Zofran, Kytril
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| very expensive antiemetic | serotonin antagonists
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| prokinetic agents are best used for | gastric stasis or CINV
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| example of a prokinetic agent | reglan
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| cannabinoids are best used for | CINV
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| CINV | chemo induced nausea and vomiting
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| PONV | post-operative nausea and vomiting
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| glucocorticoids are best used for | CINV and PONV
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| examples of glucocorticoids used for N/V | decadron, prednisone
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| benzodiazepines are best used for | anticipatory N/V
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| examples of bezno's used for N/V | valium and ativan
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| butyrophenones are best used for | PONV and CINV
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| example of butyrophenone used for N/V | haldol
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| FDA approved for use in combination with conventional agents for highly emetogenic chemotherapy (cisplatin-based chemo) | Neurokinin-1 antagonists
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| drugs that induce diarrhea | antacids containing magnesium, antibiotics, antineoplastics, colchicine, laxatives, metoclopramide, prostaglandins
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| dietary management for adults | withhold feeding (not for children)
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| pharmacologic treatment options for diarrhea | antimotility agents, adsorbents, antisecretory agents, miscellaneous
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| bacterial diarrhea (C. dif), Colitis, children <2, are contraindications for use of __ | antimotility agents
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| do not use antimotility agents more than __ in acute diarrhea | 48 hours
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| more potent at slowing GI motility than other antimotility agents, newly a generic | loperamide
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| used for symptomatic relief, not very effective for sever acute diarrhea, not systemically absorbed (Kaopectate, FiberCon) | adsorbent agents
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| examples of antisecretory agent | Bismuth subsalicylate, octreotide
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| common pathogens for traveler's diarrhea | E. coli, shigella, Campylobacter, Salmonella, viruses
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| __ is not recommended for prevention of traveler's diarrhea | prphylactic antibiotics
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| nonpharmacological management of constipation | encourage 10g crude fiber in daily diet, 1 month trial
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| pharmacologic treatment options for constipation | bulk forming laxatives, saline/hyperosmotic laxatives, emollient laxatives, lubricants, stimulants
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| bulk forming laxatives (metamucil) are best used for | prevention of constipation
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| best used for acute evacuation of the bowel, pulls water into small and large intestines | saline laxatives (Magnesium Citrate, (MOM)
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| 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))
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| 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)
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| not recommended for daily use or in the elderly for constipation | stimulants
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| anthraquinone stimulants | cascara sagrada, sennosides (Senakot), casanthrol (Peri-Colace)
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| diphenylemethane stimulants | bisacodyl (dulcolax), phenolphthalein (removed from the marked due to carcinogenic capabilities)
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