GI Flashcards
Drugs that worsen GERD symptoms
ASA/NSAIDs
bisphosphonates
dabigatran
estrogen products
fish oil products
iron supplements
NRT
steroids
tetracyclines
GERD: initial drug tx
PPI once daily for 8 weeks
-can incr to BID if partial response or if nocturnal symptoms are present
GERD: maintenance
-PPI at the lowest effective dose
-alt: H2RA (if no erosive esophagitis)
antacids
Tums, Mylanta, Maalox, Milk of Mag, Alka-seltzers
-neutralize gastric acid by increasing gastric pH
-can accumulate with renal dysfunction
-calcium: constipation
-Aluminum: constipation
-magnesium: loose stools
-calcium containing may be preferred in pregnancy
H2RA
Famotidine (Pepcid), Ranitidine, Cimetidine
-decrease gastric acid secretion
-confusion
-cimetidine: gynecomastia, impotence (avoid)
PPI
-Esomeprazole (Nexium), Lansoprazole (Prevacid), Omeprazole (Prilosec) –> 60 min before breakfast
-Dexlansoprazole (Dexilant), Pantoprazole (Protonix)
-irreversibly bind to the gastric H/K-ATPase pump and blocking gastric acid secretion
-C.Diff associated diarrhea, hypomagnesemia, vitamin B12 deficiency with prolonged use, osteoporosis-related bone fractures with high doses or long-term use
-diminish the therapeutic effect of clopidogrel (do not use omeprazole and esomeprazole)
Metoclopramide (Reglan)
-gastroproesis
-30 min before meals and at bedtime
-CrCl < 60 mL/min decrease dose by 50%
-tardive dyskinesia, EPS
-avoid in Parkinsons disease
Drugs that require an acidic gut
-Antiretrovirals (rilpivirine, atazanavir)
-Antivirals (ledipasvir, velpatasvir/sofobuvir)
-azole antifungals (itraconazole capsules, ketoconazole, posaconazole oral solution)
-Cephalosporins (cefpodoxime, cefuroxime)
-iron products
-mesalamine
-risedronate
-TKi (dasatinib, erlotinib, pazopanib)
Drug classes that antacids bind
-antiretrovirals (INSTIs): bictegravir, dolutegravir, elvitegravir, raltegravir
-bisphosphonates
-isoniazid
-levothyroxine
-mycophenolate
-quinolones
-sotalol
-steroids
-tetracyclines
H. Pylori Treatment: bismuth quadruple therapy (first-line)
-10-14 days
-bismuth subsalicyates 300 mg QID + flagyl 250-500 mg QID + tetracycline 500 mg QID + PPI BID
-alcohol use: do not use flagyl
-pregnancy/children: do not use tetracycline
H. Pylori Treatment: concomitant therapy (if local resistance rates to clarithromycin are low and no previous macrolide exposure)
-10-14 days
-amoxicillin 1000 mg BID + clarithromycin 500 mg BID + flagyl 250-500 mg QID + PPI BID
H. Pylori treatment: clarithromycin triple therapy (if local resistance rates to clarithromycin are low and no previous macrolide exposure)
-14 days
-amoxicillin 1000 mg BID + clarithromycin 500 mg BID + PPI BID (or esomeprazole 40 mg QD)
-or 3 in 1 product Prevpac (amoxicillin + clarithromycin + lansoprazole )
NSAID induced ulcer
Sucralfate (Carafate)
-taken before meals
-constipation
-binding interactions (separate antacids by 30 in and take other drugs 2 hours before or 4 hours after)
Drugs that cause constipation
-antacids (aluminium- and calcium-containing)
-antidiarrheals
-clonidine
-colesevelam
-drugs with anticholinergic effects (antihistamines, antispasmodics, phenothiazines, TCAs, urge incontinence drugs)
-iron
-non-DHP CCB (verapamil)
-opioids
-sucralfate
OTC recommendation for constipation: most adults
fiber
OTC recommendation for constipation: iron-induced or hard stool
docusate
OTC recommendation for constipation: opioid-induced
senna or bisacodyl
OTC recommendation for constipation: pregnancy
fiber
OTC recommendation for constipation: fast relief needed
adults: bisacodyl or glycerin
Children: glycerin