Chp 12 Gastrointestinal drugs

  1. Gastrointestinal (GI) tract comprises the
    stomach and the intestines
  2. Peptic is an adjective that refers to any part of the body that ________. The peptic areas of the human body under normal circumstances are the ________
    • normally has an acidic lumen, or is related to or promotes digestion
    • stomach and duodenum
  3. Duodenum is the part of the _______ closest to the ________ where most ________ occurs. Large intestine is called the _______
    • small intestine
    • stomach
    • absorption into the blood
    • colon
  4. PUD is a general term describing a group of acid-peptic disorders of the ______, primarily the ____, _______, and ______. Defined as a
    • upper GI tract
    • esophagus, stomach, and duodenum
    • circumscribed loss of tissue or break that occurs in the GI mucosa extending through the smooth muscle that lines the GI tract
  5. A gastric ulcer occurs _______ and a duodenal ulcer occurs _______ and a duodenal ulcer is _____ than gastric ulcer
    • In the stomach
    • In the duodenum
    • more common
  6. Peptic Ulcer Disease Symptoms
    • Epigastric pain
    • Food or antacids usually relieve the pain
    • Feeling of being hungry
    • Heartburn, belching, and bloating
  7. In 1983 it was discovered that _____% of duodenal and ____% of gastric ulcers are caused by a bacteria called ________.
    • 90%
    • 80%
    • Helicobacter pylori (H. pylori)
  8. Where does the Helicobacter pylori (H. pylori) come from and how does it affect the stomach and duodenum?
    • Resides in the mucus overlying the gastric epithelium in infected individuals
    • Damages the GI mucosa via enzymes that degrade gastric cells and alters the inflammatory response
    • This allows acids to cause an ulcer in the mucosa in the stomach and duodenum
  9. Histamine stimulates production of _________. This is a _______ cause of ulcers.
    • gastric juices in the stomach
    • secondary
  10. _______ is the most common of the chronic conditions of the upper gastrointestinal tract and is the _______. The most common complaint is ________
    • GERD (Gastroesophageal Reflux Disease)
    • Reflux or “backing up” of gastric contents from the stomach into the esophagus
    • heartburn, but the individual may also complain of epigastric pain (pain in and around the stomach area).
  11. What is Reflux esophagitis
    • a form of GERD
    • an inflammation of the esophagus whengastric contents stay in contact for prolonged periods of time with the mucosal tissue of the esophagus
  12. Other complications from GERD
    • –Reflux into the oral cavity can cause tooth erosion. Occurs at night.
    • -GERD can lead to dysphagia (difficulty swallowing)
    • –Esophageal ulcers
  13. What are some risk factors for GERD
    • Alcohol
    • Smoking
    • Spicy foods
    • Medications
    • Calcium channel blockers
    • –Aspirin and NSAIDs
    • –Alendronate (Fosamax, for treatment of osteoporosis)
    • –Tetracycline
  14. What are some conditions that can be caused by GERD
    • Barrett's Esophagus: precancerous change in the cells lining the esophagus
    • Esophageal cancer
    • Esophageal perforation: hole in the esophagus
    • Esophageal ulcers
    • Esophagitis: inflammation of the esophagus
    • Esophageal Stricture: narrowing of the esophagus
  15. What is the Pharmacotherapy for Treating Peptic Ulcers
    • Proton pump inhibitors (PPI’s)– Quick pain relief and accelerated healing of the ulcer
    • Antibiotics –Needed to eradicate the H. pylori infection – remember……no effect on GERD, this is for peptic ulcers
    • Antihistamines (Histamine2-receptor antagonists; H2RAs) –For symptomatic relief of pain and to promote healing of the ulcer
    • Antacids– For symptomatic relief of gastric pain, especially heartburn; will not really promote healing of the ulcers
    • Mucosal defense drugs –Have no effect on gastric acid secretion
  16. What is the Pharmacotherapy for GERD
    • Antacids
    • H2-receptor antagonists
    • Proton pump inhibitors (PPI’s)
    • Gastrointestinal stimulant
  17. What are some lifestyle changes that can be made for patients with GERD
    NO Smoking, spicy food, alcohol, caffeine, NSAID’s
  18. Antacids are used in the treatment of ________ and has what effect on the body
    • dyspepsia (indigestion or heartburn)
    • Mild to moderate heartburn symptoms
    • Neutralize acids in the stomach
    • Not the primary drug of choice for treatment
    • Do not heal ulcers
  19. What is an adverse effect that can happen with antacids especially with calcium products
    “rebound” hyperacidity
  20. Sodium bicarbonate:
    • Antacid
    • (baking soda) combined in many OTC products
    • –Contains sodium
    • –Sodium is absorbed into general circulation so must minimize use in Na+ restricted diet
    • Alka-Seltzer
  21. Calcium carbonate:
    • Antacid
    • Tums
    • –Not absorbed
    • –Rebound acid secretion
  22. (Gaviscon):
    • Sodium bicarbonate/alginic acid combination
    • Alginic acid is not really an antacid – forms thick solution of sodium alginate (sound familiar?) which floats on the surface of gastric contents – prevents them from contacting the esophagus
  23. Magnesium hydroxide and aluminum hydroxide combination
    • Combining minimizes diarrhea from Mg and constipation from Al
    • –Most common antacid: Maalox, Gelusil
  24. Bismuth subsalicylate (BSS)
    • Pepto-Bismol
    • – Suppress H. pylori infection
    • – Used in combination with antibiotics
    • – Antacid of choice in the treatment and maintenance of PUD
  25. What is a drug interaction with antacids
    • Tums and Maalox, bind with the tetracyclines (tetracycline HCl, minocycline HCl and doxycycline hyclate), and with Fluoroquinolone (Cipro)
    • Do not take these antacids together with these antibiotics. Take one to two hours before or after
  26. What is the mechanism of action of Antihistamines and what is it indicated for
    • Inhibit the release of histamine-stimulated gastric acid secretion by blocking the action of histamine on the H2-receptor located on the parietal cell in the stomach
    • Effective in healing ulcers in 6 to 12 weeks
    • Indicated for the symptomatic relief and healing of ulcers and in alleviating symptoms of duodenal ulcers, gastric ulcers, and gastroesophageal reflux disease (GERD/heartburn)
    • Used in conjunction with antibiotics to eradicate H. pylori
  27. Four H2-receptor antagonists or blockers currently available by prescription and over the counter
    • –Cimetidine (Tagamet)
    • –Ranitidine (Zantac)
    • –Famotidine (Pepcid)
    • –Nizatidine (Axid)
  28. What drug was the First H2-receptor antagonist introduced and what are its drug interactions
    • –Inhibits CYP1A2 enzymes in the liver
    • Increased levels
    • –Tricyclic antidepressants (amitriptyline)
    • –Tacrine (anti-Alzheimer’s drug)
    • –Antipsychotics (clozapine)
  29. What is the mechanism of action for PPIs and what are they used for
    • Rapid symptomatic relief with accelerating healing of duodenal ulcers, H. pylori infections, and GERD
    • Provide long-term and enhanced acid suppression and show high healing rates for PUD
    • Bind irreversibly to the proton pump in the membrane of the acid-producing cells in the stomach
  30. What are the 5 PPIs
    • End in “azole”
    • Esomeprazole (Nexium)
    • Lansoprazole (Prevacid)
    • Omeprazole (Prilosec)
    • Pantoprazole (Protonix)
    • Rabeprazole (AcipHex)
  31. What are the drug interactions with PPIs and why is that the case and which PPI has the greatest effect
    • PPI’s are highly bound to plasma proteins, so there will be displacement of other highly protein-bound drugs (e.g., phenytoin, diazepam, and warfarin)
    • Don’t give PPI’s on patient’s taking clopidogrel (Plavix) and aspirin – reduces the antiplatelet effect of these medicines and therefore increases risk of a thromboembolic event
    • The above effects are more significant with omeprazole (Prilosec)
  32. To eradicate Helicobacter pylori in the treatment for PUD what is the drug regimen
    use of at least two antibiotics along with an H2 receptor antagonist or a PPI and or bismuth
  33. What are the three Antibiotic Combination Treatments:Triple therapy (Two-week course)
    Omeprazole (Prilosec) OR lansoprazole (Prevacid) + metrodiazole (Flagyl) or amoxicillin + clarithromycin (Biaxin)
  34. What is the Antibiotic Combination Treatments: Quadruple therapy (Two-week course)
    Bismuth subsalicylate (Pepto-Bismol) + metronidazole + tetracyline + H2-antagonist (ex. Zantac) or PPI (ex. Prilosec)
  35. What is irritable bowel syndrome
    • Nonspecific disease with symptoms lasting at least 12 weeks consisting of diarrhea, constipation, and abdominal pain, excessive abdominal distention (bloating)
    • Mostly affects women
    • Usually starts in adolescence or as young adult
  36. Diseases associated with IBS
    • –chronic stress and anxiety: which comes first, the IBS or the sress?
    • –Fibromyalgia or chronic fatigue syndrome, sleep disturbance, migraines
  37. Treatment of IBS
    • Diet
    • Exercise
    • Stress and anxiety management
    • Medication
    • Psychological treatment may help in reducing stress and anxiety
  38. Pharmacologic Treatment of IBS
    • Antidiarrheal agents – eg. loperamide (Immodium)
    • Antispasmodic/anticholinergic agents – treats the pain and abdominal distention, limited success–eg. Dicyclomine (Bentyl)
    • Anticonstipation agents- ex:–Osmotic laxatives – eg. Polyethylene glycol (Miralax)
  39. Emesis
  40. what medications are risk factors for constipation
    • Calcium channel blockers
    • Anticholinergics
    • Antacids
    • Iron products
    • Narcotics – opioid induced constipation
  41. Constipation treatment
    • Bulk-forming agents (fiber) that soften the stool; eg. methylcellulose (Citrucel); psyllium (Metamucil)
    • Emollients that soften the stool; eg. docusate sodium (Colace)
    • Drugs that cause a soft or semisoft stool eg. senna (Senokot)
    • Drugs that cause watery evacuation such as magnesium (Milk of magnesia)
    • Osmotic laxatives – eg. Polyethylene glycol (Miralax)
  42. What are the causes of diarrhea
    • –Sign of pathology
    • –Contaminated food or water
    • –Infection (bacterial, viral, protozoa)
    • –Disease (malabsorption syndrome, inflammatory bowel disease such as ulcerative colitis or Crohn’s disease)
    • –Immunodeficiency (eg. HIV or AIDS) –Drugs
    • –Irritable bowel syndrome
    • –Colon carcinoma
    • –Traveler’s diarrhea
  43. Most common bacteria involved in food poisoning are
    Salmonella and Escherichia coli (E. coli)
  44. What are some common antibiotic associated diarrhea
    Image Upload 1
  45. What is Inflammatory Bowel Disease- Ulcerative Colitis
    • Chronic, long-lasting disease resulting in inflammation of the mucosa of the colon (large intestine) and rectum
    • Bloody diarrhea and abdominal pain
  46. Ulcerative Colitis Treatment
    • 5-Aminosalicylates (5-ASA)
    • Corticosteroids – ex. prednisone
    • Antibiotics: ex. metronidazole (Flagyl)
  47. Patients with ulcerative colitis cannot take
    _________ an antibiotic frequently prescribed for dental infections
    clindamycin (Cleocin),
  48. _________ may be a side effect of anticholinergics, antiemetics, and proton pump inhibitors (PPIs),
  49. Diarrhea associated with antibiotic use is caused by
    Clostridium difficile
Card Set
Chp 12 Gastrointestinal drugs
Chp 12 Gastrointestinal drugs