Gastrointestinal Pharmacology I: Management Of Gerd

Front 1

Antacids
a)mechanism of action

Back 1

Antacids
a)mechanism of action: neutralize gastric acid; INCREASE LES PRESSURE

Front 2

Antacid
b)dosage and administration (oral therapy)

Back 2

Antacid
b)dosage and administration (oral therapy):
1. for acute mgmt of moderate to severe GERD: administer every hour; can administer every 30 min. for persistent symptoms
2. for long-term therapy: 1 to 3 hours after meals and at bedtime and whenever symptoms occur
3. for infrequent symptoms: administer as needed

Front 3

Alginic Acid-Antacid Combination (Gaviscon)
a)mechanism of action

Back 3

Alginic Acid-Antacid Combination (Gaviscon)
a)mechanism of action: mechanical BARRIER to reflux; coats esophagus thereby protecting the mucosa from irritants in the refluxed material; weak neutralizer of acid

Front 4

Alginic Acid-Antacid Combination (Gaviscon)
b)dosage

Back 4

Alginic Acid-Antacid Combination (Gaviscon)
b)dosage: oral, 1 tablet or 15 ml QID

Front 5

Bethanechol (Urecholine)
a)mechanism of action

Back 5

Bethanechol (Urecholine)
a)mechanism of action: increases LES pressure; increases esophageal clearance

Front 6

Bethanechol (Urecholine)
b)dosage and administration

Back 6

Bethanechol (Urecholine)
b)dosage and administration (oral therapy)

Front 7

Bethanechol (Urecholine)
c)adverse effects

Back 7

Bethanechol (Urecholine)
c)adverse effects: n/v/d, abdominal cramps, urinary frequency, malaise, blurred vision, orthostatic hypotension, flushing of the skin

Front 8

Bethanechol (Urecholine)
d)consideration

Back 8

Bethanechol (Urecholine)
d)consideration: bethanechol may increase gastric acid secretion, therefore, may not be considered appropriate to treat GERD in a patient with PUD

Front 9

Bethanechol (Urecholine)
e)drug interactions

Back 9

Bethanechol (Urecholine)
e)drug interactions: quinidine, procainamide

Front 10

Metoclopramide (Reglan)
a)mechanism of action

Back 10

Metoclopramide (Reglan)
a)mechanism of action: accelerates gastric emptying; increases LES pressure

Front 11

Metoclopramide (Reglan)
b)dosage and administration

Back 11

Metoclopramide (Reglan)
b)dosage and administration (oral therapy)

Front 12

Metoclopramide (Reglan)
c)adverse effects

Back 12

Metoclopramide (Reglan)
c)adverse effects:
1. CNS: drowsiness, restlessness, nervousness, fatigue, dizziness, depression, anxiety, insomnia, extrapyramidal reactions
2. GI: diarrhea
3. allergic: rash

Front 13

Metoclopramide (Reglan)
d)cautions and considerations

Back 13

Metoclopramide (Reglan)
d)cautions and considerations:
1. contraindications: EPILEPSY (severity/freq. may be increased); GI obstruction/hemorrhage (stimulation of GI motility can aggravate condition); Pheochromocytoma (may cause hypertensive crisis)
2. caution: asthma (may increase risk of bronchospasm); Parkinson's disease (may exacerbate symptoms)

Front 14

Metoclopramide (Reglan)
e)drug interactions

Back 14

Metoclopramide (Reglan)
e)drug interactions:
1. alcohol or other CNS depressants: increased CNS depressants effects
2. anticholinergics or opioid-containing medication: may antagonize effects of metoclopramide on GI motility
3. digoxin: may decrease absorption of digoxin from stomach

Front 15

Cisapride (Propulsid)
a)mechanism of action

Back 15

Cisapride (Propulsid)
a)mechanism of action: increases LES pressure; increases lower esophageal persistalsis and clearance; accelerates gastric emptying rate

Front 16

Cisapride (Propulsid)
b)clinical indication

Back 16

Cisapride (Propulsid)
b)clinical indication: symptomatic treatment of GERD; treatment of other GI motility disorders (e.g. gastroparesis)

Front 17

Cisapride (Propulsid)
e)drug interactions

Back 17

Cisapride (Propulsid)
e)drug interactions:
1. antifungals (ketoconazole, itraconazole, miconazole IV) and antibiotic (troleandomycin): concurrent administration is CONTRAINDICATED due to decreased metabolism of cisapride and potentially fatal cardiac arrhythmias
2. cimetidine: decreases metabolism of cisapride
3. anticholinergics: decreases effectiveness of cisapride
4. anticoagulants: possible decreased coagulation times

Front 18

Cisapride (Propulsid)
f)cautions

Back 18

Cisapride (Propulsid)
f)cautions: contraindicated when increased GI motility is harmful (e.g. obstruction, perforation, hemorrhage)

Front 19

Sucralfate
a)mechanism of action

Back 19

Sucralfate
a)mechanism of action: local mucosal protection- binds to inflamed tissue; forms barrier to prevent diffusion of acid and pepsin into the epithelial lining; inhibits activity of pepsin; binds bile salts.

Front 20

H2As
a)mechanism of action

Back 20

H2As
a)mechanism of action: decreases gastric acid secretion thereby decreasing the irritant properties of refluxed stomach contents

Front 21

H2As
b)dosage

Back 21

H2As
b)dosage: duration = 6 to 12 weeks; OTC H2As for relief of mild heartbur, acid indigestion, sour stomach = 1 tablet (less than or equal to 2 weeks)

Front 22

Omeprazole (Prilosec)
a)mechanism of action

Back 22

Omeprazole (Prilosec)
a)mechanism of action: inhibits the H+/K+ ATPase pump thereby inhibiting gastric acid secretion

Front 23

Omeprazole (Prilosec)
b)clinical indications

Back 23

Omeprazole (Prilosec)
b)clinical indications: short-term treatment of severe erosive esophagitis associated with GERD and for symptomatic GERD poorly responsive to usual medical treatment, including H2A therapy

Front 24

Lansoprazole (Prevacid)
a)mechanism of action

Back 24

Lansoprazole (Prevacid)
a)mechanism of action: inhibits the H+/K+ ATPase pump thereby inhibiting gastric acid secretion

Front 25

Lansoprazole (Prevacid)
b)clinical indication

Back 25

Lansoprazole (Prevacid)
b)clinical indication: short-term treatment of erosive esophagitis