what are the causes of peptic ulcer disease?
- H. pylori
- NSAID
- Zollinger-Ellison syndrome
- stress ulcers
- smoking - increases pepsin production
- increased age
what is the stomach’s natural defense against peptic ulcer disease?
mucus, bicarbonate, blood flow, and prostaglandins
what are the causes of GERD?
- smoking
- increased age
- FOODS (chocolate and fat)
- medications (B-blockers, calcium channel blockers, nitrates)
- pregnancy
how should h. pylori be treated?
use a combination of antibiotics (2-3) with an acid reduction agent
- bismuth (Pepto-Bismol)
- clarithromycin - resistance
- amoxicillin
- tetracycline
- metronidazole (Flagyl) - resistance
does a bland food and avoidance of caffeine best treat for PUD?
no, it doesn’t work for everyone since everyone is different
- eat smaller meals
what is the action of H2 blockers (-tidine)?
inhibition of gastric acid secretion by blocking H2 receptors
what are the benefits of H2 blockers (-tidine)?
- easy to swallow
- often a better choice than antacids
- little-no effect from food
when does the dose of H2 blockers (-tidine) need to reduced?
in patients with renal impairment
what are the approved uses for H2 blockers (-tidine)?
- PUD
- esophagitis
- acute stress ulcer - GI bleeding
- Zollinger-Ellison syndrome
- GERD
what are the side effects of cimetidine (H2 Blocker)?
headache, drowsiness, confusion (ESPECIALLY IV DOSE IN ELDERLY)
- seems to be dose-related
- fewer CNS problems with other H2 blockers
antiandrogenic effects
- gynecomastia and decrease libido in males
many drug interaction r/t CP450 inhibition
what other examples of other H2 blockers besides cimetidine?
ranitidine (Zantac) and famotidine (Pepcid)
how do ranitidine (Zantac) and famotidine (Pepcid) work?
generally act the same as cimetidine but more potent, fewer side-effects, fewer drug interactions
what are the actions of proton-pump inhibitors (PPIs) (-prazole)?
binds to and inhibits enzymes on the parietal cell membrane and moderates acid secretion
what are the benefits of proton-pump inhibitors (PPIs) (-prazole)?
- more effective because they last longer
- last 2 weeks after the last dose - taper off to rebound hypersecretion
what are examples of proton-pump inhibitors (PPIs)?
- omeprazole (Prilosec)
- lansoprazole (Prevacid)
- Pantoprazole - most common because it can be given PO and IV
what is omeprazole (Prilosec) used for?
PPI - PUD - GERD - erosive esophagitis - Zollinger-Ellison syndrome NOT STRESS
what are the side effects of omeprazole (Prilosec)?
- N/V
- diarrhea
- headache
what are the consequences of long-term use of omeprazole (Prilosec)?
- association with C.diff
- maybe stomach ulcers and STOMACH CANCER
what are drug interactions with omeprazole (Prilosec)?
- clopidogrel - antiplatelet
- phenytoin - anti seizure
- warfarin
- benzodiazepines
do critically ill patients need to be treated prophylactically to prevent stomach ulcers?
probably not
what is the action of sucralfate (Carafate)?
ulcer coating drug - NO MORE THAN 8 WEEKS
- combines with chemicals from damaged cells in ulcer craters and forms a coating over the ulcer
- when there is a pH less than 4 it results in a product that is viscous and sticky and adheres to an ulcer crater
- doesn’t decrease acid production but creates a protective barrier
what is the negative about administration with sucralfate (Carafate)?
- taken 1 hour before meals without other drugs
- 2-4 times per day before meals and bed
what form does sucralfate (Carafate) come in?
pill or liquid
what is the main side effect of sucralfate (Carafate)?
constipation
what is the action of misoprostol (Cytotec)?
analog of prostaglandin E1 which increases protective mucous
what is the only approved use of misoprostol (Cytotec) in the US?
gastric ulcers caused by long term NSAIDs
what are the side effects of misoprostol (Cytotec)?
- diarrhea
- miscarriage - category X for women of childbearing age, can be used improperly for abortion or stimulate labor
what are most antacids made of?
a combination of aluminum and magnesium salts
where do antacids work?
locally in the gut to neutralize acid and reduce pain
how long does it take for antacids to work?
- relief of pain in 1-2 days
- complete ulcer healing 8-10 weeks if taken 8-10 times a day
what is an example of antacids?
magnesium hydroxide (Mylanta)
what is the benefit of hydroxide (Mylanta)?
- potent and rapid-acting
- Mg is absorbed quickly into the blood
what is the negative of hydroxide (Mylanta)?
- can reduce the absorption of other drugs
- contraindicated in renal patients
increased gut motility - less time for other PO meds to be absorbed
how does hydroxide (Mylanta) work?
increased gut motility - less time for other PO meds to be absorbed
what kind of patient is hydroxide (Mylanta) contraindicated in?
patients with renal disease
how does bismuth subsalicylate (Pepto-Bismol) work?
- disrupts cell wall of H. pylori
- inhibits prostaglandin synthesis to decrease GI motility
what does bismuth subsalicylate (Pepto-Bismol) treat?
diarrhea
what allergy contraindication is there with bismuth subsalicylate (Pepto-Bismol)?
sulfa
what side effects are there of bismuth subsalicylate (Pepto-Bismol)?
black discoloration of tongue and stool
what do laxatives do?
produces soft stool
what do cathartics do?
evacuate the stool
what can cause constipation?
- anesthesia/surgery, lack of mobility
- dehydration
- opioids
- iron
- calcium channel blockers
what are the different types of laxatives/cathartics?
- bulk-forming agents
- saline laxative-cathartic
- hyperosmotic agents
- stimulant/irritants
- stool softeners
- lubricants
what are bulk-forming laxatives used for?
used for diarrhea to absorb water
how do bulk-forming laxatives work?
forms mass by absorbing water then gravity helps
- produces stool in 1-3 days
what are examples of bulk-forming laxatives?
- methylcellulose (Citrucel)
- psyllium (Metamucil)
what education is needed with psyllium (Metamucil)?
the powder needs to be mixed in 8oz of water and followed by 8oz of water
- if it sits around it turns clumpy in the esophagus or a cup
what is an example of surfactant laxatives?
docusate sodium (Colace)
how does docusate sodium (Colace)?
softens stool by facilitating the penetration of water
- not for true constipation
what are examples of stimulant laxatives?
- bisacodyl
- senna
- castor oil
how do stimulant laxatives work?
stimulate peristalsis and soften feces
- increases H2O and electrolyte secretion into the stool
what is a side effect of senna?
cayuse a yellow/orange stool and urine
how does saline cathartics work?
retains water and soften stools
- poorly absorbed
what are examples of saline cathartics?
- magnesium hydroxide (milk of magnesia)
- polyethylene glycol (Miralax)
- polyethylene glycol solution (CoLyte, Golytely)
what is lactulose?
poorly absorbed and is more expensive with more side effects
- flatulence and cramping - more than bulk-forming laxatives
- also used to lower ammonia levels
what are antimuscarinics used for?
motion sickness
what are examples of antimuscarinics used for motion sickness?
- scopolamine - related to atropine
- Transderm-scop
- topical prep
what are the side effects of antimuscarinics topical prep?
- dry mouth
- blurred vision
- contraindications to Atropine
- more CNS depression
what antihistamine is also used as an antiemetic?
hydroxyzine
how does hydroxyzine work?
- H1 receptor blocking agent
- blocks the action of acetylcholine in the brain
what is a side effect of hydroxyzine?
drowsiness, caution with operating machinery
what are 2 examples of 5-HT3 Receptor Antagonist?
- hydroxytryptamine
- ondansetron (zofran)
when is ondansetron (zofran) commonly used?
post-op
what route does ondansetron (zofran) come?
IV or PO
what is the action of ondansetron (zofran)?
inhibit the activation of serotonin receptors?
what are the side effects of ondansetron (zofran)?
headache, dizziness, diarrhea, QT interval
