Integrated Science-Pharmacology-Gi Drugs

Front 1

Calcium carbonate (Tums, Rolaids)
Aluminum hydroxide (Amphojel)
Magnesium hydroxide (Milk of Magnesia)
Aluminum and magnesium salts (Maalox, Mylanta)

Class?
Indication?
MOA?
AE?
Most of these can cause constipation as an AE, which one has diarrhea as an AE?

Back 1

Class: antacids

Indication: Tx symptoms associated with hyperacidity r/t GERD, PUD, gastritis, heartburn

MOA: Decreases acidity in stomach by neutralizing acid, stomach pH increases, decrease injury to mucosal lining (stimulate prostaglandin production

AE : Systemic alkalosis, constipation, rebound hyperacidity Drug allergy, severe renal failure

Milk of Magnesia can cause diarrhea

Front 2

Cimetidine (Tagamet)
Ranitidine (Zantac)
Famotidine (Pepcid)
Nizatidine (Axid)

Class/use?
Indication?
MOA?
AE?
CI/Considerations?

Back 2

Class/use: H2 blockers used to reduce stomach acidity

Indication: Reduce acid production 80-90%, tx GERD, PUD, erosive esophagitis, control of upper GI bleeding (lst line agents)

MOA: Antagonize H2 receptors in gut (parietal cells), decrease acid production, increase stomach pH and decrease damage

AE: mental status changes like confusion esp. in elderly or pts with hepatic/renal insufficiency, gynecomastia, impotence, galactorrhea, blood dyscrasias, headache, dizziness, GI distress, N/D/C,

CI/Considerations: Drug interactions with CYP450 enzymes (cimetidine>ranitidine>famotidine, nizatidine), Fe not well absorbed b/c of low acidity

Front 3

Omeprazole (Prilosec)
Lansoprazole (Prevacid)
Rabeproazole (Aciphex)
Esomeprazole (Nexium)
Pantoprazole (Protonix)

Note -prazole ending

Class/use?
Indication?
MOA?
AE?

Back 3

Class/use: Proton pump inhibitors to reduce stomach acid

Indication: Tx GERD, erosive esophagitis, short term tc of gastric and duodenal ulcers

MOA: Irreversibly inhibits H+/K+ ATPase in parietal cells by forming a disulfide linkage to pump, decrease acid production, inactive pro-drug absorbed in intestine (concentrated in canaliculus)

AE: Decreased absorption of agents (Fe) requiring acidic environment, GI infections

Front 4

Psyllium hydrophilic colloid (Metamucil)
Calcium polycarbophil (FiberCon)
Methylcellulose (Citrucel)

Class?
Indication?
MOA?
AE?
CI/Considerations?

Back 4

Class: Bulk forming laxatives

Indication: Tx constipation, bowel preparation before surgery

MOA: 1. increases the amount of material in the gut 2. Indigestible material draw water into colon
3. Distension of colon promotes peristalsis"

AE:Bezear (indigestible mass in GI tract), gas, bloating, alter absorption of other drugs

CI/considerations: Known drug allergy, major GI condition (abdominal pain/bleeding, gastrointestinal obstruction), Pregnancy class C; OTC, takes 24hrs to act, take with full glass of water

Front 5

Bismuth subsalicylate (Pepto-Bismol)

Class/use?
MOA?
AE?
CI/Considerations?

Back 5

Class/use:Colloidal bismuth compounds; Anti-diarrheal

MOA: "1. coats ulcers and erosions 2. Stimulate mucus and bicarbonate secretion 3. Direct antimicrobial actions 4. Binds enterotoxins

AE: Encephalopathy from bismuth toxicity, Pregnancy D category, constipation, blackened stools, darkening of the tongue, tinnitus, reye’s syndrome in children

Front 6

Diphenoxylate/ atropine (Lomotil)
Loperamide HCL (Imodium)

Class?
Indication?
MOA?
AE?
Which is associated w toxic megacolon?

Back 6

Class: Opiates and opiate-like anti-diarrheal agents

Indication: Most effective drug to treat diarrhea b/c opiates cause constipation which you can’t develop tolerance for

MOA: 1. agonists at opioid receptors in gut 2. Decreased peristaltic contractions of the small and large intestines 3. Increases amount of water absorbed in gut"

AE: Pancreatitis, paralytic ileus, nervousness, restlessness, drowsiness, sedation, mental depression, dry mouth, urinary retention

Loperamide (Imodium) is associated w toxic megacolon

Front 7

Docusate sodium (Colace)
Docusate potassium (Dialose)
Docusate calcium (Surfak)

Class?
Indication?
MOA?
AE?
Time to act?
CI/Considerations?

Back 7

Class: Surfactant laxatives (stool softeners)

Indication: Gentle and safe for easy elimination and passage of stool for pts who strain or have hemorrhage

MOA:Detergent-like action reduce surface tension of water at the surface of the stool, water and lipids enter stool

AE:Diarrhea, cramp, rash

2-3 days to act

Front 8

What is a common GI use for Mineral Oil?

MOA?
AE?

Back 8

Emollient laxatives (stool softeners)
used for easy evacuation and passage of existing stools

MOA: 1. lubricates the surface of fecal material 2. Lubricates interior of colon 3. Makes passage of fecal material easier

AE: Pneumonia if aspirated, N/V/cramps, anal itching, long term use inhibits absorption of fat soluble vitamins A, D, K, E

Front 9

Magnesium hydroxide (Milk of Magnesia)
Sodium phosphate (Fleet)
Magnesium citrate

Class?
Indication?
MOA?
AE?

Back 9

Class: Osmotic laxative

Indication: Fast acting laxative, often used as preprocedure bowel prep

MOA: Non-absorbable compounds draw water into the gut, increase fecal mass and distends bowel promoting peristalsis

AE: Mg toxicity, Diarrhea, weakness, electrolyte imbalance, renal insufficiency, Pregnancy category C

Front 10

Bisacodyl (Dulcolax)
Senna (Senokot)

Class?
Indication?
MOA?
AE?

Back 10

Class: Stimulant laxatives (cathartics)

Indication:Acts on entire GI tract to relieve constipation

MOA:May directly stimulate the ENS (enteric nervous system), increase fluid and electrolyte secretion into gut

AE: Abuse potential by pts in long term use, electrolyte imbalance, dependence (cathartic colon), N/V/D, cramping

Front 11

Polyethylene glycol (PEG)
(Colyte, Golytely)

Class?
Indication?
MOA?
AE?

Back 11

Class: Bowel lavage solution

Indication: Used prior to surgery or endoscopy/colonoscopy to cleanse, overdose treatment

MOA: Ingestion of large volumes of isotonic fluid stimulates bowel evacuation

AE: Electrolyte imbalance, anaphylaxis, esophageal bleeding/tearing, bloating, cramping, N/D/V