Nu 578, Unit 4 - GI Drugs
Treatment Goal for PUD/ GERD - answer Main treatment goal: neutralization of
stomach acid
•Oxyntic glands in stomach secrete acid (parietal cells)
•To get maximum acid secretion, these cells need to be stimulated by gastrin + ACh +
histamine
•If any one of these 3 is ↓, acid secretion will be markedly ↓
acid secretion - answer- ↑ ACH ↑ gastrin in gut
-Histamine is always available in gut
- when the 3 work together, They stimulate the parietal cells to ↑ HCI secretion.
Cimetidine (Tagamet) - answerH2 receptor antagonist
- PUD or GERD tx
- Inhibits P450 enzymes.
- Well tolerated, but watch for renal/hepatic tox in older patients.
Ranitidine (Zantac) - answerH2 receptor antagonist
- PUD or GERD tx
-Less P450 inhibition—on recall due to contaminant that may cause cancer
Famotidine (Pepcid) - answerH2 receptor antagonist
- PUD or GERD tx
- No P450 inhibition
Nizatidine (Axid) - answerH2 receptor antagonist
- PUD or GERD tx
- No P450 inhibition—recalled drug
Aluminium salts(Remegel) - answer- Antacid
- PUD or GERD tx
- Constipation, hypercalcemia
Ca carbonate(Tums) - answer- Antacid
- PUD or GERD tx
- Constipation, hypercalcemia
Mg salts(Milk of Magnesia) - answer- Antacid
- PUD or GERD tx
- diarrhea
Na citrate (Bicitra) - answerPrep-op antacid
, Sucralfate (Carafate) - answerForms protective coat over ulcer, causes constipation
Metoclopramide (Reglan) - answer- ↑ rate of gastric emptying
- extrapyramidal effect, possible
- do NOT use w/MAOIs or antipsychotics
Cisapride (Propulsid) - answer↑ GI motility by ↑ ACh release. Used for GERD
Omeprazole (Prilosec)
Esomeprazole (Nexium)
Lansoprazole (Prevacid)
Pantoprazole (Protonix)
Rabeprazole (Aciphex) - answer- Inhibits H+ secretion by blocking H+/K+ ATPase.
- Also inhibits P450.
- PPIs—Proton Pump Inhibitors.
- Linked to chronic kidney disease with long term use; difficult to deprescribe without a
lot of acid reflux
Misoprostol (Cytotec) - answer- PG derivative.
- Protects stomach by ↑ HCO3 + mucus secretion.
- Do NOT use in pregnancy!
Treatment of Ulcers - answer• Ulcers are usually colonized by H pylori which delay the
healing process. Strategies for PUD combine an H2 antagonist or PPI+ an antacid + an
antibiotic
• Most H2 blockers have best efficacy if given 30-60 min before meal
• Watch coadministration of other drugs with antacids!
Combination treatment for Ulcers - answer• Helidac—Bismuth subsalicylate,
metronidazole, tetracycline. Tell patient to also take a PPI or H2 blocker
• Pylera—Bismuth subcitrate, metronidazole, tetracylcine. Tell patient to take a PPI or
H2 blocker.
• Prevpac—Lansoprazole, amoxicillin, clarithromycin.
Diphenoxylate + Atropine (Lomotil) - answer- Diarrhea tx
- Binds both opiate and ACh receptors in GI
- Do NOT use in parasitic/bacterial infections
- Do NOT use w/MAOIs
Loperamide (Imodium) - answer-Opiates
-Tx for diarrhea
- do not use w/ MAOIs
Opium tincture - answer- Opiates
-Tx for diarrhea
Treatment Goal for PUD/ GERD - answer Main treatment goal: neutralization of
stomach acid
•Oxyntic glands in stomach secrete acid (parietal cells)
•To get maximum acid secretion, these cells need to be stimulated by gastrin + ACh +
histamine
•If any one of these 3 is ↓, acid secretion will be markedly ↓
acid secretion - answer- ↑ ACH ↑ gastrin in gut
-Histamine is always available in gut
- when the 3 work together, They stimulate the parietal cells to ↑ HCI secretion.
Cimetidine (Tagamet) - answerH2 receptor antagonist
- PUD or GERD tx
- Inhibits P450 enzymes.
- Well tolerated, but watch for renal/hepatic tox in older patients.
Ranitidine (Zantac) - answerH2 receptor antagonist
- PUD or GERD tx
-Less P450 inhibition—on recall due to contaminant that may cause cancer
Famotidine (Pepcid) - answerH2 receptor antagonist
- PUD or GERD tx
- No P450 inhibition
Nizatidine (Axid) - answerH2 receptor antagonist
- PUD or GERD tx
- No P450 inhibition—recalled drug
Aluminium salts(Remegel) - answer- Antacid
- PUD or GERD tx
- Constipation, hypercalcemia
Ca carbonate(Tums) - answer- Antacid
- PUD or GERD tx
- Constipation, hypercalcemia
Mg salts(Milk of Magnesia) - answer- Antacid
- PUD or GERD tx
- diarrhea
Na citrate (Bicitra) - answerPrep-op antacid
, Sucralfate (Carafate) - answerForms protective coat over ulcer, causes constipation
Metoclopramide (Reglan) - answer- ↑ rate of gastric emptying
- extrapyramidal effect, possible
- do NOT use w/MAOIs or antipsychotics
Cisapride (Propulsid) - answer↑ GI motility by ↑ ACh release. Used for GERD
Omeprazole (Prilosec)
Esomeprazole (Nexium)
Lansoprazole (Prevacid)
Pantoprazole (Protonix)
Rabeprazole (Aciphex) - answer- Inhibits H+ secretion by blocking H+/K+ ATPase.
- Also inhibits P450.
- PPIs—Proton Pump Inhibitors.
- Linked to chronic kidney disease with long term use; difficult to deprescribe without a
lot of acid reflux
Misoprostol (Cytotec) - answer- PG derivative.
- Protects stomach by ↑ HCO3 + mucus secretion.
- Do NOT use in pregnancy!
Treatment of Ulcers - answer• Ulcers are usually colonized by H pylori which delay the
healing process. Strategies for PUD combine an H2 antagonist or PPI+ an antacid + an
antibiotic
• Most H2 blockers have best efficacy if given 30-60 min before meal
• Watch coadministration of other drugs with antacids!
Combination treatment for Ulcers - answer• Helidac—Bismuth subsalicylate,
metronidazole, tetracycline. Tell patient to also take a PPI or H2 blocker
• Pylera—Bismuth subcitrate, metronidazole, tetracylcine. Tell patient to take a PPI or
H2 blocker.
• Prevpac—Lansoprazole, amoxicillin, clarithromycin.
Diphenoxylate + Atropine (Lomotil) - answer- Diarrhea tx
- Binds both opiate and ACh receptors in GI
- Do NOT use in parasitic/bacterial infections
- Do NOT use w/MAOIs
Loperamide (Imodium) - answer-Opiates
-Tx for diarrhea
- do not use w/ MAOIs
Opium tincture - answer- Opiates
-Tx for diarrhea
