Pharm2 4 GI Drugs pt1

Question 1

6 types of GI drugs.

Answer 1

GERD, Dyspepsia, PUD
Anti-emetics (stop you from vomiting) and Motility Agents
Anti-diarrheals, Antispasmodics
Crohn’s/Colitis, IBD
Constipation/Bowel Preps
Colorectal Agents

Question 2

4 drug classes for: GERD, Dyspepsia, PUD

Answer 2

Antacids (OTC), H2RAs, PPIs, antibiotics for PUD

Question 3

4 drug classes: antiemetics/motility agents

Answer 3

Anti-cholinergics, -dopaminergics, 5-HT3 RAs, Substance P/neurokinin-1 RAs

Question 4

2 drug classes: Anti-diarrheals, Antispasmodics

Answer 4

Opioids, anticholinergics

Question 5

2 drug classes: Crohn’s/Colitis/IBD

Answer 5

Salicylates, steroids

Question 6

4 drug classes for Constipation/bowel preps

Answer 6

Stool softeners, laxatives, bulk forming, Propylethylene glycol, etc.

Question 7

2 drug classes that are Colorectal Agents

Answer 7

Anesthetics, steroids

Question 8

H2-receptor antagonists aka H2 blockers
Mech of action?
Route of admin
How do patients get it?

Answer 8

block the action of histamine2 receptor on parietal cells in the stomach to dec acid production to treat dyspepsia
Route: PO
There are drugs that can stop people from vomiting right away, (even if they’ve been vomiting for days)
They work just as well OTC as prescription, so OTC is much more common.

Question 9

All H2RA’s end in -___. Name 4 of them.

Answer 9

-tidine

cimetidine, ranitidine, famotidine, nizatidine

Question 10

Ranitidine (H2 blockers)

Indications (4)

Answer 10

FDA-approved for the treatment of peptic ulcer disease (PUD), gastroesophageal reflux disease (GERD), dyspepsia and prevention of stress ulcers

Question 11

H2 blockers:
CI/cautions
Preg Category

Answer 11

H2RAs are generally well-tolerated (except for cimetidine which has far more cautions, contraindications and drug-drug interactions)
Preg: Category B

Question 12

__ are among the most widely-selling drugs in the world as a result of their outstanding efficacy and safety

Answer 12

PPIs

PPIs cause a pronounced and long-lasting reduction of gastric acid production completely superseding H2RAs

Question 13

Proton Pump Inhibitors (PPIs)

Mech of action

Answer 13

irreversibly blocking the H+/K+ ATP-ase pump of the gastric parietal cells
This is significantly more effective than H2RAs, dec gastric acid secretion by up to 99%

Question 14

There are 7 proton pumps in our stomachs, we are not sure which ones serve which functions.
Therefore, the best drug to inhibit acid production is:

Answer 14

the one covered by their insurance

Question 15

PPI’s are best taken when. Why?

Answer 15

They work best when taken w/ food, b/c the food activates that pump and the PPI blocks that pump pathway.

Question 16

Despite how safe and well they work, what’s the issue with these drugs?
So what will you do with these patients?

Answer 16

ppl go on them, and they never seem to go off them. They were in the hospital 5 years ago to prevent a stress ulcer, and went on that drug. Then they kept taking it. Nobody ever thought about pulling them off this drug.
So at their annual physical exams is do a medication reconciliation and see if u can reduce the # of meds they are on.

Question 17

Ex of a PPI

Answer 17

Esomeprazole

Question 18

Esomeprazole (PPI)

Indications (8)

Answer 18

dyspesica, PUD, GERD, Barrett’s esophagitis, prevention of stress gastritis, gastrinomas and other conditions that cause hypersecretion of acid and Zollinger Ellison syndrome

Question 19

What to do with a patient with Barrett’s esophagitis
(Barrett’s – lower esophageal sphincter incompetence. When they lay down they get reflux, especially if it’s w/in 2 hours of eating. The cells in lower esophagus get the inslt of the gastric secretion and begin to change and eventually one cell can become cancerous and lead to esophageal cancer.)

Answer 19

When you are writing them a prescription for Esomeprazole, concurrently talk to them about their diet, and make sure you tell them DON’T EAT within 2 hours before going to bed, and elevated the head of the bed. Doing these alone will stop most cases of GERD.

Question 20

What can you try telling the patient to do about their GERD besides just prescribing them a PPI?

Answer 20

DON’T EAT within 2 hours before going to bed, and elevated the head of the bed. Doing these alone will stop most cases of GERD.

Question 21

Esomeprazole (Nexium®)
Common adverse effects
Pregnancy

Answer 21

Common adverse effects include headache, nausea, diarrhea, abdominal pain, fatigue, dizziness
Pregnancy: Cat. B

Question 22

Long term use of Esomeprazole may cause: (2)

Answer 22

Dec in Vit B12 absorption

Inc in hip fractures (or fractures in general)

Question 23

One drug interaction of Esomeprazole. What do you do about it?

Answer 23

Clopidogrel. They have the same pathway.

We try to pull patients off the PPI, especially if they are on PCA with stenting.