Chapter 81, 82, 83, Peptic Ulcer Dz, Laxatives, and Other GI Drugs including Infectious Dz Flashcards by Niklas Luloff

What is Peptic ulcer dz? Caused by?

Group of upper
gastrointestinal (GI) disorders
Degrees of erosion of the gut
wall
Severe erosion can be
complicated by hemorrhage
and perforation

Imbalance of mucosal and aggressive factors

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Most common infx of Peptic ulcer dz?

H. Pylori most common cause of gastric and duodenal ulcers

2nd most common - NSAIDs

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Ways anti-ulcer medications work?

Eradicate H. pylori
(antibiotics)

Reduce gastric acidity
(antisecretory agents,
misoprostol)

Enhance mucosal
defenses
(sucralfate, misoprostol)

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NSAID induced Ulcer tx considerations?

Proton pump
inhibitors (PPIs) are
preferred
Misoprostol is also
effective but can
cause diarrhea
BLACK BOX
WARNING IN
PREGNANCY
Antacids, sucralfate, &
H2 receptor blockers
are NOT
recommended

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What is the preferred tx for NSAID induced Ulcers?

H2 receptor blockers &
PPIs are preferred.

Discontinue NSAIDs if
possible.

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What is the tx for H. pylori?

Minimum of 2 antibiotics to reduce risk of resistance developing

CLARITHROMYCIN-BASED TRIPLE
THERAPY 1
CLARITHROMYCIN-BASED TRIPLE
THERAPY 2
BISMUTH-BASED QUADRUPLE
THERAPY

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Clarithromycin [Biaxin®] does what for H. pylori infx?

Suppresses growth of H.
pylori by inhibiting protein
synthesis; although rate of resistance is rising

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Why is Amoxicillin used for H. pylori?

H/ pyrlori is HIGHLY sensitive to amoxicillin, LOW rate of resistance

Amoxicillin disrupts the cell wall

Antibacterial activity is highest at a neutral pH and thus can be enhanced by reducing gastric acidity with an antisecretory agent

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What do bismuth compounds do for H. pyrloi infx?

Act topically to disrupt the cell wall of H. pylori, causing lysis and death

May inhibit urease activity and prevent H. pylori from adhering to the gastric surface

Can impart a harmless black coloration to the tongue and stool

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How are tetracyclines used against H. Pylroi?

Inhibitor of bacterial protein synthesis

Highly active against H. pylori
Resistance is rare.

Do not use in pregnant patients and young
children because tetracycline can stain developing teeth.

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What is the recommended approximate age that
you can prescribe this drug in children?

> 12 y/o

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Metronidazole
[Flagyl®]

Very effective against sensitive strains of H. pylori
Over 40% of strains are now resistant
AVOID ALCOHOL
Disulfiram-like reaction can occur if metronidazole is used with alcohol!
Avoid use during pregnancy

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What is the goal of antibiotic regimens for H. pylori? How many abx? What medications can you use with abx? When does eradication occur?

Minimize resistance.

Guidelines recommend 2 antibiotics, preferably 3.

PPI or H2 receptor antagonists

10 days, better with 14 day tx

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What is the recommended 1st line choice for treating gastric and duodenal ulcers? Examples?

Histamine 2 Receptor Antagonists by promoting healing by suppressing secretion of gastric acids

Examples:
Cimetidine [Tagamet®]
Ranitidine [Zantac®]
Famotidine [Pepcid®]
Nizatidine [Axid®]

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Cimetidine [Tagamet®] A/e? considerations for H. pylori?

Antiandrogenic effects, CNS, pneumonia…

Admin cimetidine and antacids 1 hour apart d/t antacids reducing absorption.

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Ranitidine [Zantac®] does what for H. pylori?

more potent, fewer drug a/e compared to cimetidine.

elevation of gastric pH may increase risk of pneumonia

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What is th emost effective drug for suppressing secretion of gastric acid?

A proton pump inhibitor (PPI) used for short term GERD, can increase risk of c. diff

Examples - Nexium, Dexilant, Prevacid, Aciphex, Protonix

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Omeprazole [Prilosec®] does what?

Inhibit gastric secretion or ulcer prophylaxis, short half life

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Major Omeprazole [Prilosec®] a/e?

C. diff

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Sucralfate [Carafate®] does what? Drug interactions?

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Creates a protective barrier for up to 6 hours for active ulcers and maintenance therapy

DI - antacids

Misoprostol [Cytotec®] is used for what? A/e?

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Prevention of gastric uclers caused by NSAIDs

A/e - CONTRAINDICATED DURING PREGNANCY CATEGORY X

Antacid use for gastric ulcers?

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React with gastric acid to
produce neutral salts or salts of
low acidity.

Sodium bicarbonate (antacid) does not alter systemic pH

USED WITH CAUTION WITH PATIENTS WHO HAVE RENAL IMPAIRMENT

Common antacid a/e?

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Constipation with aluminum, diarrhea with mageniusm, sodium loading

What is Magnesium Hydroxide [Milk of Magnesia] used for?

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Rapid high acid neutralizing capacity produces long lasting affects, usually taken with aluminum to promote constipation – can be used as a laxative

CAN CAUSE DIARRHEA

CAUTION W/ RENAL FALURE

Aluminum Hydroxide (Mylanta Maalox® Gaviscon®) can cause? Used with?

Magnesium hydroxide, can cause **Constipation**

Calcium Carbonate (Tums) can cause what?

Constipation, can be overcome with use of magnesium containing antacids in adjunct

Sodium Bicarbonate is used as?

Useful for treating acidosis and elevating urinary pH to promote excretion of acidic drugs after overdose **Inappropriate for treating PUD** Brief duration, high sodium content, can cause alkalosis Can exacerbate hypertension and heart failure **Can cause systemic alkalosis in patients with renal impairment**

Laxative effect vs. Catharsis?

Laxative - mild production of soft forming stool over one or several days Catharsis - prompt fluid evacuation of the bowel, fast and intense

Contraindications for laxatives?

Abd pain, N/V, cramps, appendicitis, enteritis, diverticulitis, UC, fecal impaction of bowel obstruction, habitual use, in pregnancy or lactation

What is Psyllium?

Psyllium is a fiber product produced from the husks used to increase bulk in the stool

Bulk-Forming Laxatives: psyllium [Metamucil®]

Fiber that swells with water to form a gel that soften fecal mass, used as temporary tx

Surfactant Laxatives: docusate sodium [Colace®] produces a stool when?

Several days after onset

Stimulant Laxatives: bisacodyl [Dulcolax®] ised used specifically for what?

Opioid induced constipation

Osmotic laxatives Milk of Magnesia (MOM) shows effect when?

Low doses - results in 6-12 hours High doses result in 2-6 hours

Mineral Oil does what? Major A/e?

Lubrication laxative A/e - **Anal leakage**

Glycerin suppository is used for?

Useful for reestablishing normal bowel function after termination of chronic laxative use

Purpose of bowel cleansing? Types?

To allow for good visualization of the bowel during a procedure such as a colonoscopy Sodium phophase - Polythylene glycol + elecs - NASTY TASTING!

Sodium Phosphase Products are used for what and can cause?

Osmotic laxative, Irreversible hyperphosphatemia + renal damage

What can be used as an antiemetic?

Glucocorticoids such as Methylprednisolone, Dexamethasone Commonly used to suppress chemotherapy-induced nausea and vomiting (CINV)

Serotonin receptor agenists do what? Major a/e?

Ondansetron [Zofran®] Block 3 types of serotonin receptors on afferent vagal nerves A/e.- **prolonged QT intervals, risk of torsades de pointes**

Aprepitant [Emend®] blocks what?

Blocks neurokinin1-type receptors (for substance P) in the chemoreceptor trigger zone (CTZ) to reduce CINV

Management of CINV? Give when?

Antiemetics are more effective in preventing CINV than suppressing CINV in progress Give before chemotherapy drugs

What are first line antiemetics for N/V in pregnancy?

Doxylamine [Unisom®] plus vitamin B6

What is the most effective antidiarrheal agent?

Opioids by activating the opioid receptor in the GI tract diphenoxylate (plus atropine) [Lomotil®®]] loperamide [Imodium®®]]

What causes infectious diarrhea?

C. difficile releases toxin A and toxin B tx with oral vancomycin and flagyl

How to treat IBS?

Antispasmodics Bulk-forming agents Antidiarrheals Tricyclic antidepressants OR abx and h2 blocker or PPIs

What IBS medication is approved ONLY for women?

Alosetron [Lotronex®] SEVERE IBS-D lasting > or equal to 6 months and has not responded to conventional tx

What do prokinetic agents do for the GI tract? A/e for longer term therapy?

Metoclopramide [Reglan®] Suppress emesis and increase upper GI motility! A/e - irreversible tardive dyskinesia

Chapter 81, 82, 83, Peptic Ulcer Dz, Laxatives, and Other GI Drugs including Infectious Dz Flashcards

(48 cards)