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Gastrointestinal Pharmacology (misoprostol (analog of prostaglandin E1. in…
Gastrointestinal Pharmacology
GERD
antacids
H-2 blockers
cimetidine, famotidine, ranitidine
4-8 weeks to get healing, tolerance is developed, better more long term data than PPI's
proton pump inhibitors,(PPI's)
omeprazole, esomeprazole
OTC limit 14 days, can take up to 14 days for full effect, some patient find complete relief within 24 hours the 14 day course may be repeated every 4 months
no tolerance is developed
long term use associated with
pneumonia, fractures,theoretical increase in gastric cancer risk, hypomagnesemia,C. DIff infection, zollinger-ellison syndrome,
sucralfate
promotes ulcer healing by creating a protective barrier against acid and pepsin.
no acid neutralizing capacity and does not decrease acid secretion
MOA: composed of sulfated sucrose and aluminum hydroxide. under mildly acidic condition (pH4) sucralfate undergoes polymerization and cross-linking reaction
product is a viscous and very sticky gel that adheres to the ulcer crater creating a barrier to back-diffusion of hydrogen ions, pepsin, and bile salts
lasts upto 6 hours
misoprostol
analog of prostaglandin E1. in the US only approved GI indication prevention of GI ulcers caused by long term therapy with NSAIDs.
prostaglandins help protect the stomach by suppressin secretion of gastric acid, promoting secretion of bicarbonate and cytoprotective mucus, and maintaing submucosal blood flow
NSAIDs cause gastric ulcers by inhibiting prostaglandin biosynthesis
MOA: serves as a replacement for endogenous prostaglandins
bismuth salts
pepto bismol
topically to coat and protect the GI
stimulate absorption of fluids and electrolytes by the intestinal wall
as a salicylate, reduces inflammation/irritation of the stomach and intestinal lining through inhibition of prostaglandin
stool discoloration
NSAID induced ulcers
switch pain med class
COX-1 and COX-2 selectivity of NSAIDS has driven the concept that inhibition of COX-1 leads to the predominant reduction in synthesis of mucosal protective prostaglandin leading to gastrointestinal toxicity of NSAIDs relative to COX-2 inhibition which plays a ole in ulcer healing
lower GI disorders
diarrhea and constipation
fiber
Daily 25-30 grams
bulk forming agent (metamucil)
soluble fiber may be beneficial in reducing IBS symptoms. soluble fiber stays in the gut longer, adding bulk to the colon, which helps the colon work normally
foods include, peas, oats, barley, brown rice,dried fruits
laxatives
bulk laxative (metamucil
lubricants include mineral ois
disadvantage: interfere with absorption of fat-soluble vitamins
stimulants
bisacodyl
disadvantage: intestinal cramping
stool softeners
docusate
advantage: non toxic
osmotic laxative
lactulose, glycerine
use with caution in patients with renal impairment
loperamide (imodium)
anti-diarrheal that delays intestinal transit, increases sphincter tone through opioid receptor
opioid that does not cross BBB
episodic management of diarrhea, reduces stool frequency, improves stool consistency, not effective for pain, bloating or global symptoms of INS
adverse effects include: constipation, abdominal cramping, nausea