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Flashcards in Gastrointestinal Drugs Deck (41)
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gastric problems caused by excessive gastric acid stripipng away the protective mucus barrier

ARD-Acid-related disorders





usually a combo of acid, pls gastrointestinal reflux (GERD)



inflammation/ulceration of the stomach lining by the proteolytic enzyme pepsin

PUD-peptic ulcer disease


use of aspirin and other NSAIDS, alcohol, cigarettes and caffeine, H. pylori infection, as well severe psychological and traumatic (physical) stress

other factors contributing to ARD


drugs for ARD decrease or neutralize

HCl-hydrocholoric acid in the stomach


They were the mainstay of treatment for many years and are still used a lot; they all neutralize HCl to some degree
*some have calcium too for that extra benefit
i.e. aluminum and calcium salts (Tums) and magnesium salts (Milk of Magnesia)

Oral antacids (as tablets or liquids)


Combined antacids:
(To limit the tendency of single formulations to produce loose stools or constipation)

Maalox (Magnesium And Aluminum hydrOXides)
Riopan (aluminum and simethicone)
Rolaids (calcium and magnesium)


effective home remedy for indigestion (but it contains high amounts of sodium and causes acid rebound within a few hours)

Baking soda


used for "gas" (it reduces surface tension of liquids to keep bubbles from forming)



Antihistamines which work at the histamine2 receptor (not the H1 rc like Benadryl for allergies); they were originally Rx-only and made a lot of $$ but can now be bought OTC;
I.e. Tagamet (cimetidine) intro'd in 1977 (1st superstar drug of this class), ranitidine (Zantac by Glaxo) and famotidine (Pepcid by Merck)

H2 blockers


Drugs that replaced dependence on antacids (which saw a lot of recurrence and relapse, scarring which caused obstruction, hemorrhage and perforation life-threatening events),
revolutionized treatment of ARD, peptic ulcers, complications,
and dramatically reduced the # of ulcer surgeries

H2 blockers and PPIs--proton pump inhibitors
*good idea to take antacids with H2 blockers but but don't combine H2 blockers and PPIs--results in atrophic gastritis


Another drug method to decrease stomach acid--by shutting down the proton (H+) pump in the stomach's parietal cells responsible for the hydrogen in HCl
-Rx Prilosec (lansoprazole) was 1st and then Nexium (esomeprazole--the 'purple pill')
*Prilosec was the 1st one to go OTC as the same dose as its Rx strength

PPIs--proton pump inhibitors


A gram (-) bacteria that survives well in a highly acidic environment--infects the gastric mucosa--and is very associated with the development of Peptic Ulcers;
-treated by multiple antibiotics combined with a PPI or H2 blocker or Pepto-Bismol (bismuth subsalicylate)
-treatment is often curative but the infection is hard to completely get rid of

Helicobacter Pylori


H. pylori antibody
H. pylori antigen
H. pylori breath test
CLO test
RUT-Rapid urease test

diagnostic tests for H. Pylori


Amoxicillin or clarithromycin (the macrolide Biaxin) combined with a PPI
(simplified by the recent approval of a blister pack combo of all3 drugs--'PrevPac')

treatment for H. Pylori


Many things ranging from infections to malabsorption to bowel irritability can cause food/secretions to move too quickly through the GI tract = ________



opioid drugs like codeine (anticholinergic effects to slow down the bowel); molecule structure similar to Demerol but don't cause euphoria or really have potential for addiction
'Lomotil' = diphenoxylate + atropine
'Imodium' = loperamide

effective treatment for diahrrea


bulk agents (binding agents) which are inert, non-digestible fiber:
'Kaopectate' (kaolin and pectin)--binds excess water in the case of bacterial toxins
-this type of fiber binds free water in the gut
*can also be used to treat constipation (softens stools)

other antidiarrhea drugs/treatments


types of fiber that absorb excess water in the gut

Binding Agents


Indicated for heartburn treatment but is actually a very weak antacid (Mylanta and Maalox work much better)
-has antisecretory activity in the gut (decreases water excretion in stools) and bismuth absorbs toxins caused by E. coli
*a good choice to augment therapy for travelers diarrhea

Pepto-Bismol (bismuth subsalicylate)


Antibiotics along with fluid/electrolyte replacement:
I.e. TMP-SMX (Septra), ciprofloxacin (Cipro), and doxycycline (Vibramycin)

treatment for certain types of Infectious Diarrhea


Opioids like codeine & Lomotil (diphenoxylate + atropine) with anticholinergic effects;
OTC opioid-like drugs like Imodium (loperamide) with anticholinergic effects (less effective)
Binding agents to soak up excess water, inluding any dietary fiber (i.e. oatmeal), Kaopectate (kaolin/pectin) or Konsyl
Pepto-Bismol with antisecretory effects

Summary of antidiarrhea drugs/treatments


Bulk agents to retain water in the stool
Stool softeners and lubricants
Irritants and stimulants to increase bowel peristalsis
Salt (saline) solutions (like Epson's salts and hypertonic magnesium salts) to draw water into the bowel lumen and cause a "flush" effect
*these are mostly saline enemas

Laxatives/treatments for constipation
*they work by many different mechanisms


Contain cellulose fibers similar to Kaolin-Pectin fiber for diarrhea; they hold onto water and increase bulk through natural process
I.e. 'Metamucil' or psyllium (found in 'Konsyl')

Bulk agents


They don't stimulate bowel movements but slowly create a film around the stool which allows moisture retention
*usually contain the drug docusate (like in 'Colace')
*best example: pure mineral oil--but should only be used temporarily to avoid significant body absorption

Stool softeners and lubricants


they work as purgatives: stimulate vigorous bowel peristalsis; shouldn't be taken daily/too often
*high potential for abuse--especially in elderly
I.e. casor oil and sennoside compounds

Irritant/Stimulant drugs


A large group of flowering plants native to the middle east and Asia; major components of heral and folk medicine;
they are the active ingredient in Ex-lax and similar OTC irritant/stimulant axatives

the Sennas


they range from normal-tonic mixtures of NaCl (saline/Fleets enema) to hypertonic magnesium citrate solutions used as 'bowel preps' before colonoscopies or surgery.
*mag salts by osmosis draw water into the bowel lumen to promote emptying- "flush from above"
(I.e. Epson's salts, Mag Citrate and other hypertonic Mg salts)

Salt solutions


pre-prepared enemas

Fleet enemas