Pharm2 4 GI Drugs pt1 Flashcards Preview

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Flashcards in Pharm2 4 GI Drugs pt1 Deck (23)
1

6 types of GI drugs.

GERD, Dyspepsia, PUD
Anti-emetics (stop you from vomiting) and Motility Agents
Anti-diarrheals, Antispasmodics
Crohn’s/Colitis, IBD
Constipation/Bowel Preps
Colorectal Agents

2

4 drug classes for: GERD, Dyspepsia, PUD

Antacids (OTC), H2RAs, PPIs, antibiotics for PUD

3

4 drug classes: antiemetics/motility agents

Anti-cholinergics, -dopaminergics, 5-HT3 RAs, Substance P/neurokinin-1 RAs

4

2 drug classes: Anti-diarrheals, Antispasmodics

Opioids, anticholinergics

5

2 drug classes: Crohn's/Colitis/IBD

Salicylates, steroids

6

4 drug classes for Constipation/bowel preps

Stool softeners, laxatives, bulk forming, Propylethylene glycol, etc.

7

2 drug classes that are Colorectal Agents

Anesthetics, steroids

8

H2-receptor antagonists aka H2 blockers
Mech of action?
Route of admin
How do patients get it?

block the action of histamine2 receptor on parietal cells in the stomach to dec acid production to treat dyspepsia
Route: PO
There are drugs that can stop people from vomiting right away, (even if they’ve been vomiting for days)
They work just as well OTC as prescription, so OTC is much more common.

9

All H2RA's end in -___. Name 4 of them.

-tidine
cimetidine, ranitidine, famotidine, nizatidine

10

Ranitidine (H2 blockers)
Indications (4)

FDA-approved for the treatment of peptic ulcer disease (PUD), gastroesophageal reflux disease (GERD), dyspepsia and prevention of stress ulcers

11

H2 blockers:
CI/cautions
Preg Category

H2RAs are generally well-tolerated (except for cimetidine which has far more cautions, contraindications and drug-drug interactions)
Preg: Category B

12

__ are among the most widely-selling drugs in the world as a result of their outstanding efficacy and safety

PPIs
PPIs cause a pronounced and long-lasting reduction of gastric acid production completely superseding H2RAs

13

Proton Pump Inhibitors (PPIs)
Mech of action

irreversibly blocking the H+/K+ ATP-ase pump of the gastric parietal cells
This is significantly more effective than H2RAs, dec gastric acid secretion by up to 99%

14

There are 7 proton pumps in our stomachs, we are not sure which ones serve which functions.
Therefore, the best drug to inhibit acid production is:

the one covered by their insurance

15

PPI's are best taken when. Why?

They work best when taken w/ food, b/c the food activates that pump and the PPI blocks that pump pathway.

16

Despite how safe and well they work, what's the issue with these drugs?
So what will you do with these patients?

ppl go on them, and they never seem to go off them. They were in the hospital 5 years ago to prevent a stress ulcer, and went on that drug. Then they kept taking it. Nobody ever thought about pulling them off this drug.
So at their annual physical exams is do a medication reconciliation and see if u can reduce the # of meds they are on.

17

Ex of a PPI

Esomeprazole

18

Esomeprazole (PPI)
Indications (8)

dyspesica, PUD, GERD, Barrett’s esophagitis, prevention of stress gastritis, gastrinomas and other conditions that cause hypersecretion of acid and Zollinger Ellison syndrome

19

What to do with a patient with Barrett's esophagitis
(Barrett’s – lower esophageal sphincter incompetence. When they lay down they get reflux, especially if it’s w/in 2 hours of eating. The cells in lower esophagus get the inslt of the gastric secretion and begin to change and eventually one cell can become cancerous and lead to esophageal cancer.)

When you are writing them a prescription for Esomeprazole, concurrently talk to them about their diet, and make sure you tell them DON’T EAT within 2 hours before going to bed, and elevated the head of the bed. Doing these alone will stop most cases of GERD.

20

What can you try telling the patient to do about their GERD besides just prescribing them a PPI?

DON’T EAT within 2 hours before going to bed, and elevated the head of the bed. Doing these alone will stop most cases of GERD.

21

Esomeprazole (Nexium®)
Common adverse effects
Pregnancy

Common adverse effects include headache, nausea, diarrhea, abdominal pain, fatigue, dizziness
Pregnancy: Cat. B

22

Long term use of Esomeprazole may cause: (2)

Dec in Vit B12 absorption
Inc in hip fractures (or fractures in general)

23

One drug interaction of Esomeprazole. What do you do about it?

Clopidogrel. They have the same pathway.
We try to pull patients off the PPI, especially if they are on PCA with stenting.