GI pharm

• 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.

• 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.

• 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. 

• 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.

• 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

• 3 drugs: two antibiotics and a PPI. Treated for 7-14 days. Resistance has been noted.
• omeprazole, clarithromycin and amoxicillin

• 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.

• First: 5-aminosalicylic acid; (5-ASA)
• Second: oral corticosteroids (Prednisone)
• Third: Immunosuppressive agents; azithroprine (Imuran)

• 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.

no prototype drugs for this condition treatment can be metamucil bulking agents. and lifestyle changes.

• opioids for severe diarrhea
• antidiarrheals: for mild diarrhea; Bismuth compounds (pepto), psyllium(metamucil), probiotic.

• 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

• 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

• given orally in capsule-taken right before, or with food.
• Do not take with calcium supplements or magnesium antacids they may decrease the effectiveness.

• 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

Promethazine (Phenergan)

prochlorperazine (Compazine)-this is a phenothiazine antipsychotic that is also used as an antiemetic.

Zofran

Reglan, metoclopramide

Pepto Bismal

Cathartic.....AKA ROCKET FUEL!

Senna

Budesonide

GERD

(Zantac) ranitidine

Antacids

inhibition of P450 system

Helicobacter Pylori

sulcrafate (Carafate)

Metronidazole (Flagyl)

Clostridium diffcille

Soap and water.....alcohol does natta

Vancomycin

Fecal transplant.....will most likely become the standard treatment since its 90% effective...

Clindimycin