GI pharm

  1. Ondansetron (Zofran)
    Serotonin (5-HT3) receptor/ antagonist
    • Therapeutic class: antiemetic
    • Preg: B
    • MOA: inhibits signals to the vomiting center of the brain.
    • Indications: prevents nausea and vomiting before chemotherapy or pre/post op work
    • Contraindications: concomitant use of apomorphine; may cause profound hypotension.
    • Alert: potential for increased risk of QT prolongation.
    • Adverse: Little to none, can cause headaches.
  2. Promethazine (Phenergan)
    H1 receptor blocker
    • Therapeutic class: Antihistamine
    • Preg: C
    • MOA: Blocks H1 receptor sites and inhibits the chemoreceptors of the brain.
    • Indications: treats and prevents motion sickness and nausea
    • Contraindications: asthma patients 
    • Adverse: Has resulted in limb amputation
    • Alert: Vesicant, prolonged QT interval, dermatitis, phototoxicity, urticaria, lowered convulsive threshold, sedation, somnolence, GI upset.
  3. omeprazole (Prilosec)
    Proton pump inhibitor
    • Therapeutic class: Antiulcer drug
    • Preg: C
    • MOA: Blocks H+, K+-ATPase, enzyme that is responsible for secreting hydrochloric acid in the stomach.
    • Indications: Peptic ulcers and GERD
    • contraindications: Few, do not give to children under 2
    • adverse: headache, nausea, diarrhea, rash and abdominal pain.
    • alert: May also decrease B12 absorption. 
    • Interactions: rare, but will increase plasma levels of clopidogrel (Plavix) and warfrain due to the inhibition of P450 enzymes. Can also increase levels of phenytoin and other CNS depressants. 

    pantoprazole (protonix) is usually the drug of choice, since it doe not affect the p450 system. 
  4. ranitidine (Zantac)
    H2 receptor antagonist
    • Therapeutic class: Antiulcer
    • Preg: B
    • MOA: Block the histamine2 receptors in the stomach, which stops the production of acid from the parietal cells
    • Indications: PUD and GERD
    • Contraindications: porphyria, pt. under age of 12
    • Adverse: High doses may result in impotence and loss of libido in men, some blood dyscrasias are possible
    • Interactions: antacid should not be given within 1 hour of H2 receptor antagonists because the effectiveness may be decreased.
  5. antacid: neutralize acid and treat heartburn
    • Magnesium: avoid in renal disease will cause hypermagnesemia 
    • Calcium: can cause hypercalcemia and renal failure in high dose.
    • Aluminum hydroxide: may interfere with phosphate absorption, mostly used in combination with other antiulcers.
    • Sodium Bicarb: Can cause metabolic alkalosis
  6. H-pylori is treated with at least?
    • 3 drugs: two antibiotics and a PPI. Treated for 7-14 days. Resistance has been noted.
    • omeprazole, clarithromycin and amoxicillin
  7. Sucralfate and Misoprostol
    • Sucralfate: coats ulcers and protect from further erosion. This drug can inhibit absorption of other drugs when used concurrently. It binds to the drugs in the stomach. 
    • Misoprostol: inhibits acid production and stimulate mucus lining of stomach.
  8. Drugs for Inflammatory bowel disease
    • First: 5-aminosalicylic acid; (5-ASA)
    • Second: oral corticosteroids (Prednisone)
    • Third: Immunosuppressive agents; azithroprine (Imuran)
  9. Sulfasalazine (Azulfidine)
    5-aminosalicylate, sulfonamide
    • Colon bacteria metabolize drug to Sulfrapyridine and 5-ASA (Aspirin)
    • Therapeutic class: anti-inflammatory bowel disease
    • Preg: B
    • MOA: inhibits mediators of inflammation in the colon, bacteria metabolizes sulfasalazine to active metabolites, one is available as an IBD drug. 
    • Indications: IBD also chrons
    • Contraindications: aspirin allergies, folate disorders, hematologic disorders, hepatic impairment, urinary obstruction, diabetes use caution.
    • Adverse: Nausea, vomiting diarrhea, dyspepsia and abdominal pain. Headache is common, blood dyscrasias  occur frequently, skin rashes are common.
    • Alert: Do not administer drug to patient who have allergies to sulfonamide antibiotics or furosemide. May increase insulin secretion and worsen hypoglycemia.
  10. IBS
    no prototype drugs for this condition treatment can be metamucil bulking agents. and lifestyle changes.
  11. Diarrhea treatments
    • opioids for severe diarrhea
    • antidiarrheals: for mild diarrhea; Bismuth compounds (pepto), psyllium(metamucil), probiotic.
  12. Diphenoxylate with atropine (Lomotil)
    • Therapeutic class: Anti Diarrheal
    • Preg: C
    • MOA: targets mu receptors in the gut, slowing peristalsis and allowing time for additional water to reabsorb in the colon allowing for more solid stool
    • Indications: Severe diarrhea.
    • Contraindications: severe liver disease, obstructive jaundice, severe dehydration, electrolyte imbalance, narrow angle glaucoma, and diarrhea associated with pseudomembranous colitis. 
    • Adverse: dizziness or drowsiness
    • interactions: CNS depressants, alcohol, when taken with MAOI may cause hypertensive crisis
  13. Laxatives
    • bulk forming agents: metamucil-absorb water and adds to size of fecal mass-If not taken with enough water may cause an obstruction. 
    • stool softeners: colace-causes more water and fat to be absorbed into stool
    • stimulants: Bisacodyl / Senna-aids in peristalsis
  14. pancrealipase (Creon, Pancrease, Zenpep)
  15. contains lipase, protease and amylase
    • given orally in capsule-taken right before, or with food.
    • Do not take with calcium supplements or magnesium antacids they may decrease the effectiveness.
  16. Clostridium Difficile
    • Number of cases have tripled and strains are becoming more and more virulent due to antibiotic resistance.
    • Difficult to kill the spores-Alcohol based cleaners are ineffective. 

    • Treated with Metronidazole or Vanco
    • Fecal transplant
  17. What antihistamine/antipsychotic is used to treat nausea?
    Promethazine (Phenergan)
  18. this dopamine antagonist can be given via oral, IV, rectal routes?
    prochlorperazine (Compazine)-this is a phenothiazine antipsychotic that is also used as an antiemetic.
  19. drug is used to treat nausea in chemo patients?
  20. This drug decreases nausea and increases GI motility?
    Reglan, metoclopramide
  21. This is a pink drug and if taken too much may cause tinnitus...
    Pepto Bismal
  22. Gloytely is considered on of these....
    Cathartic.....AKA ROCKET FUEL!
  23. Herbal treatment for constipation...?
  24. topical corticosteroid for the bowels
  25. Avoiding smoking, spicy foods, and alcohol with decrease incidences of what?
  26. H2 receptor blocker that is OTC and can also help with a Bee sting...
    (Zantac) ranitidine
  27. Timely concomitant use of these to prevent binding of other drugs....
  28. omeprazole (Prilosec) increases the effects of coumadin due to what?
    inhibition of P450 system
  29. This bacteria is found in 60-80%+ of ulcer cases?
    Helicobacter Pylori
  30. This acts as a band-aid for stomach ulcers
    sulcrafate (Carafate)
  31. This gram negative antibiotic is used to treat H-pylori...
    Metronidazole (Flagyl)
  32. This bacteria got it's name because it took long to grow in the lab....
    Clostridium diffcille
  33. How to remove C-diff from hands?
    Soap and water.....alcohol does natta
  34. This drug was once known as liquid gold, but now is just another treatment...
  35. This is an unusually treatment used to treat C-diff....
    Fecal transplant.....will most likely become the standard treatment since its 90% effective...
  36. C-diff is often triggered by this antibiotic...
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GI pharm