H2RA excreted exclusively by the kidney
Nizatidine
Lanosoprazole
PPI indicated for use in pts. who have an NSAID-induced gastric ulcer BUT require the NSAID still
Omeprazole ADRs
Mild; CYP-inhibitor
*Inhibits fnxn of clopidogrel though so possibility of thrombi
Who should you avoid giving misoprostol to?
Pregnant women; it is a PGE2 analog so it can induce uterine contractions
Bismuth compounds
MOAs: Coats ulcers, increases mucous and HCO3- secretion, inhibits pepsin activity, AND antibacterial towards H. pylori
-Heals ulcers much better than H2RAs
ADRs: Darkens oral cavity due to formation of H2S
Metoclopromide
MOA: Combined cholingergic agonist and dopaminergic antagonist
=»Increased esophageal contractions and increased LES tone
-Used for symptomatic GERD but not good if ulcerative
ADRs: Tardive dyskinesia; hyperprolactinemia
3 stages of GERD tx
I: Sporadic- tx w/ lifestyle modifications and possibly H2RAs or antacids
II: Frequent- 2-3 episodes/week; tx w/ PPIs
III: Chronic: - >3 episodes/week; PPIs daily
Laxation
Evacuation of formed fecal material from the rectum
Catharsis
Evacuation of unformed, water fluid from the entire colon
Lactulose
Non-absorbable sugar that induces osmotic effects in the SI lumen to retain water
Sorbitol and mannitol can also do this
Bisacodyl
Stimulant laxative that upregulates mucosal water and electrolyte secretion
Castor oil
Surfactant laxative that decreases he surface tension of the stool causing mixing Of aqueous and fat substances in the stool to soften the stool
***Is cleaved to ricinoleic acid that decreases the net absorption of fluid/electrolytes and stimulates peristalsis (not commonly used because of this)
-Docusate works the same way
Lubiprostone
Metabolites of PGE1 that acts to open Cl- channels on the GI epithelium; accelerates the transit time of stool
-Can be used to tx opioid induced constipation
Linaclotide
Guanylate cyclase C-substrate that results in the increased activity of CFTR channels on the luminal membrane
*Black box warning =» diarrhea, abdominal pain, flatulence
Loperamide
u-receptor activity that increases stool transit time and decreases passage of stool; works like diphenoxins
DOC for moderate-severe traveler’s diarrhea in conj. w/ antimicrobial
-Poor CNS penetration
Bismuth Subsalicylate
Pepto-bismol; used for mild traveler’s diarrhea
Bismuth=antibacterial
Salicylate=anti-inflammatory
Octreotide
Used to tx. secretory diarrheas brought on by hormone secreting tumors of the pancreas and GI tract
-Also for AIDs, chemotherapy diarrhea
IBD Treatment
Mild: Topical corticosteroids, Antibiotics
Moderate: Oral corticosteroids, methotrexate (immune modulators), anti-TNF
Severe: IV-corticosteroids, anti-TNF, cyclosporine, Natalizumab (anti-alpha4 integrin)
Simethicone
Surfactant that is administered alongside antacids to decrease foaming and esophageal reflux
Candidates for weight loss medication
BMI > 30
BMI > 27 w/ risk factors (DM, HTN)
Orlistat
Gastric and pancreatic lipase inhibitor; will cause malabsorption symptoms but safer for pts. w/ HTN than amphetamines
Liraglutide
GLP-1 receptor agonist; only injectable FDA-approved non-amphetamine weight loss drug
ADRs: ***Colon cancer, nephrotoxicity, thyroid cancer (black box)
Locaserin
5-HT3 agonist used for weight loss; can cause serotonin syndrome, neuroleptic malignant syndrome, but more commonly N/V and dry mouth, possibly euphoria
Phentermine/topiramate
Increases HR, insomnia, suicidal ideation, dizziness
-Do not use in HTN, CVD
Naltrexone/buproprion
Only weight loss drug w/ black box warning for suicide, HTN, seizures, vomiting, dry mouth
-Can’t give to narcotic abusers
Candidates for gastric bypass
BMI >35 w/ comorbidities (DM, HTN, Sleep apnea)
BMI >40
-Can receive gastric sleeve, lap band, Roux en Y (in which esophagus basically diverts so SI), and biliary diversion
Vbloc Maestro
Generates electrical pulse that blocks vagal stimulation of hunger
Al(OH)3 and Mg(OH)2 effects
Al=constipation
Mg=diarrhea
- Can cause hypophosphatemia
- Can cause renal dysfnxn due to altered electrolyte levels
- Decreased bioavailability of some durgs (iron, isoniazid, ketoconazole, theophylline)
H2RAs benefit
Very good at inhibiting nocturnal gastric acid secretion
Sucralfate
Forms a sticky coat on existing peptic ulcers and forms a protective barrier; also stimulates some PGE2 prod.
***Must have a ph
Mineral Oil
Non-absorbed lubricant oil that softens the stool BUT can cause deficiency of fat-soluble vitamins
*If aspirated, can cause pneumonitis
Parasite infection often confused w/ TB
Paragonomus westermani; is contracted by eating shellfish in Japan or some shit like that (Man-snail-crab-man)
- Parasite is absorbed, coughed up, and swallowed to pass more eggs
- While in the lungs, it can form an abscess that appears similar to TB and pt. will cough up rust-colored sputum
Tx: Praziquantel
Parasite that increases risk of cholangiocarcinoma
Clinorchis sinensis; man-snail-freshwater fish-man (typically in east asia as well as paragonimus)
Clinical: Ascites, edema, cholangiocarcinoma, cirrhosis, epigastric pain
Egg has an operculum on it
Amebic liver abscess
Caused by E. histolytica; typically produces a single abscess w/ increased AP and transaminases
***Appears as an elevated diaphragm on X-ray
*CAN rupture and produce pulmonary infxn (pleuritic pain, dyspnea, rusty sputum)
If you hear something about beavers, campers, or St. Petersburg, Russia…
Giardia lamblia; you know what the poop is like and you know what the parasite looks like
Can possibly lead to reactive arthritis, lactose intolerance, diarrhea,
Tx: Metronidazole or promycin (pregnant)
Nitazoxanide
Used to tx. crytposporidium infxn in immunocompetent pts.