GI Drugs

Question 1

Not well-studied; especially true of “off-patent drugs”

Answer 1

Significant knowledge gaps remain esp

in children < 1

Question 2

Antiemetic Agents: not really a class of drugs used much in NICU

Answer 2

(used more freq in surgical populations)

Question 3

Vomiting is controlled by the vomiting center of the medulla and has input from at least what four sources?

Answer 3

1-chemoreceptor trigger zone,
2-Cortex
3-vestibular apparatus
4-gi tract

Question 4

Promethazine

Phenergan

Answer 4

long hx of use as an anti-emetic; most commonly prescibed antiemetic in US; Side effects: Sedation, extrapyramidal effects, seizures, tachy, and hypotension

Question 5

Reglan or Metoclopramide

Answer 5

Antiemetic with side effects: sedation, anticholinergic, and EPS symptoms

Question 6

Antacids: not used as much due to safety concerns and dosing irregularities

Answer 6

May be used for tx of:
Gastritis, esophagitis, Peptic Ulcer Disease,
GERD

Question 7

Antacids were also used for prophylaxis for stress in the past

Answer 7

replaced by otherr acid-modifying drugs (H2 receptor antagonist, proton pump inhibitors)

Question 8

4 types of antacids

Answer 8

Sodium bicarbonate
calcium carbonate
Magnesium-containing
Aluminum-containing

Question 9

Sodium Bicarbonate and Calcium carbonate are the most potent and most fast acting

Answer 9

Chronic use of Sodium bicarbonate is associated with fluid retention, systemic alkalosis and milk alkali syndrome

Question 10

Calcim Carbonate

Answer 10

has a longerr duration of action than sodium bicarbonate, but s associated with hypercalcemia, hypercaciurea, renal calcium deposits, compromised renal function and gastric acid hypersecretion

Question 11

Magnesium-containing

Answer 11

diarrhea, hypermagnemia (esp in thise with copromised renal fx);

Question 12

Aluminum-containing

Answer 12

side-effects; constipation, hypocalcemia and hypophosphatemia

Question 13

if antiactids are used with other meds, it might decrease drug absorption due to an alteration in the gastric pH

Answer 13

administer 2 hours after other drugs may help avoiding this interaction

Question 14

administering Antacids 1 hour after meals is effective in reducing gastric acidity

Answer 14

pediatric patients require long-term therapy should be closely monitored for adverse side effects

Question 15

Prokinetic Agents: Used to improve gastric motility

Answer 15

Metoclopramide, Cisapride, Erythromycin

Question 16

Metoclopramide is the most common prokinetic agent in NICU

Answer 16

combination of central and peripheral dopamine antagonism;
augmentation of acetylcholine release from postganglionic nerve terminals is likely responsible for the drugs effect on the GI muscle

Question 17

Metoclopramide does NOT increase gastric acid secretion, endogenous gastric release or salivation

Answer 17

it DOES promote the coordination of gastric, pyloric and duodenal motor function and accelerated gastric emptying by increasing gastric tone

Question 18

Metoclopramide: studies reveal some improvement in reflux and GER in SMALLLLLLL studies in infants with GER;

Answer 18

need larger trials/studies

Question 19

metoclopramide side effects

Answer 19

drowsiness, restlessness, dry mouth, light headedness, diarrhea, EPE;
side effects are dose related and associated with 20% of pts

Question 20

Prokinetic: Cicapride: Propulsid

Answer 20

Removed fromt eh market in US and canada for safety concerns; widely available in the rest of the world; caused prolonged QTC interval associated with vent. arrythmias, underlying cardiac disease, renal insufficiency, electrolyte disturbances, hepatic dysfx, and concurrent use with other cardiac meds known to alter cardiac conduction

Question 21

Prokinetic: Erythromycin: dose used for prokinetic benefits is much smaller than antimicrobal therapy

Answer 21

effect of EES is similar to the polypeptide hormone Motilin-stimulated migrating motor complexes in the GI tract and promotes the movement of nutrients

Question 22

EES and pyloric stenosis

Answer 22

increase in pyloric stenosis with pertusis outbreak

Question 23

EES: increases esophageal sphinccter tone, but NOT the amplitude of contractions of the distal esophgus

Answer 23

(in adults with GE reflux)

Question 24

H2-Receptor Antagonists

2 used in Children: Zantac & Pepcid

Answer 24

some of the most commonly used drugs for treatment of

reflux, gastric/duodenal ulcers, tx/prophylaxix against GI hemorrhage

Question 25

H2 receptor antagonist

Answer 25

reduced gastric acidity by acting as a competitive, reversibe inhibitor of histamine at the Histamine H@ receptor site

Question 26

H2 receptor antagonsits

Answer 26

decreases the acid-secretory response of the parietal cells to stimulated acid secretion from cholinergic agents

Question 27

H2 receptor antagonists

Answer 27

are particularly effective supressing nocturnal acid production (important for those with duodenal ulcers)

Question 28

H2 antagonists are frequently used in NICU/PICU as prophylaxix for stress ulcers

Answer 28

side-effects: Gi symptoms, rash, dizziness (most common), mania, seizures, gynecomastia, galactorrhea, impotence, decrease in spermatogenesis, thrombocytopenia, agranulocytosis

Question 29

H2 receptor Antagonists

Answer 29

routine use is questioned due to the pH might allow for the overgrowth in bacteria; may increase the risk for NEC in VLBW; need larger scale studies

Question 30

Proton Pump Inhibitors: PPI’s—Prevacid is the most common used

Answer 30

4 approved in the US; none approved for children < 1 yr

Question 31

Lansoprazole (prevacid)

Answer 31

tx for reflux esophagitis; inhibits gastric acid secretion; onset within one hour, maximal effect at 1.5 hours

Question 32

Prevacid

Answer 32

inhibition of HK+ATPase=the enzyme responsible for the final step in secretion of HCL acid in the parietal cells-proton pump extinsively metabolized in the liver;4average elimination/1/2 life is 1.5 hours; inhibition of acid secretion is about 50% of maximum at 24 hr of age with a durtion of action being approx 72 hrs

Question 33

side effects or PPI’s:

Answer 33

headache, nausea and diarrhea

Question 34

PPI questional onset of gram negative sepsis in….

Answer 34

VLBW