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Gastrointestinal Pharmacology - Coggle Diagram

- - - - Inhibit H+/K+ ATPase proton pump that controls H+ secretion from the parietal cell
    - - Pro-drug activated in acidic env
      - Rapidly absorbed, highly protein bound
      - Metabolised by CYP450 2C19 and CYP 3A4
    - - Omeprazole
      - Lansoprazole
      - Pantoprazole 🥇
      - Rabeprazole
      - Esomeprazol
    - - CYP 2C19 genotype hav greater efficiacy and adverse effects
      - Nausea
      - Abdominal pain
      - Constipation
      - Diarrhoea
      - Risk of bone fracture
      - Susceptibility to certain infx (C.dif and HAP) 🍫⛲
      - Hypomagnesia 🧲
    - - Gastric and duodenal ulceration
      - H. pylori eradicatoin (Triple Therapy)
      - Dyspepsia
      - GORD
      - NSAID ass ulceration
      - 7. Zollinger - Ellison syndrome
        Tumors cause too much acid, resulting in peptic ulcers
    - - Esomeprazole + Omeprazole - Clopidogrel
        
        Decreased efficacy of clopidogrel
  - - - Cimetidine
      - Ranitidine
      - Famotidine
      - Nizatidine
    - - Competitive antagonism of H2 receptors
      - Prevents ↑cAMP and gastric acid secretion
    - - Gastric / duodenal ulceration
      - H. pylori eradication
      - Dyspepsia
      - GORD
      - NSAID ass ulceration
      - Zollinger-Ellison syndrome
    - - GIT disturbance
      - Headache
      - Dizziness
      - Altered LFTs
      - Bradycardia
      - Confusion
      - Depression
      - Hallucinations
      - ↑ Prolactin
      - Galactorrhoea
      - Impotence
      - CYP450 inhibiton - Cimetidine
      - Secondary hypergastrinaemia
    - - Cimetidine - Warfarin (CYP2C9), Phenytoin (CYP3A4), Theophylline (CYP1A2)
        
        Cimetidine inhibits drug metabolism
  - - - Misoprostol
    - - E1 Prostaglandin analogue
      - Antisecretory and cytoprotective properties vie EP3 receptor
      - Increases mucin and bicarbonate secretion
    - - Gastric / duodenal ulceration
      - NSAID ass ulceration
    - - Nausea and vomiting
      - Abdominal pain
      - Diarrhoea
      - Abdnormal vaginal bleeding
      - Women of childbearing age must take contraception
      - Contraindicated in pregnancy
      - Exacerbates inflammatory bowel disease (IBD)
- - - - Histamine
    - - Ach
    - - PG Prostaglandin
- - - - Gastic / duodenal ulceration
  - - - Gastric / duoudenal ulcers
      - H. pylori eradication
- - - - Amoxicillin → Lymecycline
  - - - Amoxicillin → Clarithromycin
- - - - β blockers
      - Antibiotics
      - HIV protease inhibitors
      - SSRIs
      - PPIs
      - Oestrogens
      - Methyldopa
      - Misoprostol
      - Methotrexate
  - - - Piperidine derivative
      - Opiate agonist slows GIT moltility
      - Reduces GIT secretions
    - - QT prolongation
      - Torsades de points
      - Cardiac arrest
  - - - Ion-exchange resin
    - - Diarrhoe due to ileal resection
      - Crohn's
      - Diabetic vagal neuropathy