Topics

Topics
•• Peptic
Peptic Ulcer
Ulcer Disease
Disease
•• Constipation
Constipation
•• Diarrhea
Diarrhea
•• Emesis
Emesis
•• Digestion
Digestion
Peptic
Peptic Ulcer
Ulcer Disease
Disease

Factors
Factors that
that
Factors
Factors that
that Protect
Protect Against
Against
Increase
Increase Acidity
Acidity Acidity
Acidity
Peptic
Peptic Ulcer
Ulcer Disease
Disease
•• Factors
Factors Increasing
Increasing •• Factors
Factors Decreasing
Decreasing
–– H.
H.pylori
pylori –– Mucus
Mucusproduction
production
–– NSAIDs
NSAIDs –– Buffers
Buffers
–– Acidic
Acidicagents
agents –– Blood
Bloodflow
flow
–– Pepsin
Pepsin –– Prostaglandins
Prostaglandins
–– Smoking
Smoking
Regulation
Regulation of
of Gastric
Gastric Acid
Acid
Secretion
Secretion
H
H22 Receptor
Receptor Antagonists
Antagonists
•• Inhibits
Inhibits gastric
gastric acid
acid secretion
secretion
•• No
No effect
effect on
on HH11 receptors
receptors
•• cimetidine (Tagamet ®®)
cimetidine (Tagamet )
•• ranitidine (Zantac ®®)
ranitidine (Zantac )
•• famotidine (Pepcid ®®)
famotidine (Pepcid )
•• nizatidine (Axid ®®)
nizatidine (Axid )
H
H22 Receptor
Receptor Antagonists
Antagonists
•• Indications:
Indications:
–– PUD
PUD
–– GERD
GERD
–– Prevention
Prevention of
of aspiration
aspiration pneumonia
pneumonia
Proton
Proton Pump
Pump Inhibitors
Inhibitors
•• K ++H++ATPase (Proton Pump)
K H ATPase (Proton Pump)
•• Irreversible
Irreversible inhibition
inhibition
–– Must
Must synthesize
synthesize new
new enzyme
enzyme
–– Long
Long duration
duration
•• omeprazole (Prilosec ®®)
omeprazole (Prilosec )
•• lansoprazole (Prevacid ®®)
lansoprazole (Prevacid )
Anticholinergics
Anticholinergics
•• pirenzepine (Gastrozepine ®®)
pirenzepine (Gastrozepine )
•• Other
Other anticholinergics
anticholinergics have
have too
too many
many side
side
effects
effects and
and are
are not
not used
used
Prostaglandin
Prostaglandin Analog
Analog
•• misoprostol (Cytotec®®)
misoprostol (Cytotec )
–– Approved
Approved for
for treating
treating PUD
PUD due
due to
to long
long term
term
NSAID
NSAID use
use
Antacids
Antacids
•• Increase
Increase pH
pH of
of gastric
gastric environment
environment
•• Hydroxides
Hydroxides
–– Aluminum
Aluminum
–– Magnesium
Magnesium
•• Carbonates
Carbonates
–– Calcium
Calcium
Antacids
Antacids
•• Most
Most OTC
OTC drugs
drugs are
are combinations
combinations
DiGel®®
–– DiGel
Amphojel®®
–– Amphojel
Maalox®®
–– Maalox
–– Milk
Milk of Magnesia®®
of Magnesia
Mylanta®®
–– Mylanta
Antibiotics
Antibiotics
•• Aimed
Aimed atat eliminating
eliminating H.
H. pylori
pylori
•• bismuth (Pepto-Bismol ®®)
bismuth (Pepto-Bismol )
•• metronidazole (Flagyl ®®)
metronidazole (Flagyl )
•• amoxicillin (Amoxil®®)
amoxicillin (Amoxil )
•• tetracycline (Achromycin V®®)
tetracycline (Achromycin V )
Stool
Stool Formation
Formation
Water
Water absorbed
absorbed in
in colon
colon (~90%)
(~90%)
–– Excessive
Excessive absorption
absorption
•• Constipation:
Constipation:hard,
hard,dehydrated
dehydratedstool
stool
•• Increases
Increasesstrain
strainon
ondefecation
defecation
•• Harmful
Harmfulfor
forsubset
subsetof
ofpatients
patients
–– Recent
Recentepisiotomy,
episiotomy,colostomy,
colostomy,hemorrhoids,
hemorrhoids,
cardiovascular
cardiovasculardisease
disease
–– Inadequate
Inadequate absorption
absorption
•• Diarrhea:
Diarrhea:soft,
soft,non-formed,
non-formed,liquid
liquidstool
stool
Terms
Terms
Laxative
Laxative Production
Production ofof soft,
soft, formed
formed
stool
stool over
over 11 or
or more
more days
days

Cathartic
Cathartic Rapid,
Rapid, intense
intense fluid
fluid evacuation
evacuation
of
of bowel.
bowel.
Laxatives
Laxatives
•• Bulk
Bulk forming
forming
•• Surfactants
Surfactants
•• Stimulants
Stimulants
•• Osmotics
Osmotics
Bulk
Bulk Forming
Forming Laxatives
Laxatives
•• Absorb
Absorb water
water •• methylcellulose
methylcellulose
•• Soften
Soften and
and enlarge
enlarge (Citrucel®®))
(Citrucel
stool
stool •• psyllium
psyllium
(Metamucil ®®)
•• Fecal
Fecal swelling
swelling (Metamucil )
promotes
promotes peristalsis
peristalsis •• Polycarbophil
Polycarbophil
Surfanctant
Surfanctant Laxatives
Laxatives
•• Lowers
Lowers surface
surface •• Docusate
Docusate salts
salts
tension
tension –– Colace
Colace
®®

–– Facilitates ®
Facilitateswater
water –– Modane
ModaneSoft
Soft®))
penetration
penetration
Stimulant
Stimulant Laxatives
Laxatives
•• Stimulate
Stimulate peristalsis
peristalsis •• Phenylolpthalein
Phenylolpthalein
–– (Ex-Lax ®®, Feen-a-
•• Increases
Increases water
water and
and (Ex-Lax , Feen-a-
Mint ® ®
electrolytes
electrolytes secretion
secretion Mint®,,Correctol
Correctol®))
•• bisacodyl (Ducolax®®)
into
into intestinal
intestinal lumen
lumen bisacodyl (Ducolax )
•• Decreases
Decreases water
water and
and
electrolyte
electrolyte
reabsorption
reabsorption
Osmotic
Osmotic Laxatives
Laxatives
•• Poorly
Poorly absorbed
absorbed saltssalts •• Magnesium
Magnesium hydroxid
hydroxid
remain
remain in
in fecal
fecal matter
matter (Milk
(Milk of
of Magnesia®)
Magnesia®)
•• Pull
Pull water
water into
into lumen
lumen
Antidiarrheal
Antidiarrheal
•• Diarrhea
Diarrhea isis usually
usually aa compensatory
compensatory
action…
action…
–– Treatment
Treatment aimed
aimed at
at cause,
cause, no
no symptom
symptom
•• Opioid
Opioid receptors
receptors in
in GI
GI tract
tract decrease
decrease
motility
motility
–– Increase
Increase time
time for
for water
water reabsorbtion
reabsorbtion
Antidiarrheal
Antidiarrheal Agents
Agents
•• paregoric/opium
paregoric/opium tincture
tincture
•• diphenoxylate (Lomotil ®®)
diphenoxylate (Lomotil )
•• defenoxin (Motofen ®®)
defenoxin (Motofen )
•• loperamide (Imodium ®®)
loperamide (Imodium )
Vomiting
Vomiting Stimulus
Stimulus
Antiemetics
Antiemetics
•• Serotonin
Serotonin (5HT)
(5HT) Antagonists
Antagonists
•• Dopamine
Dopamine (DA)
(DA) Antagonists
Antagonists
•• Anticholinergics
Anticholinergics (muscarinic
(muscarinic blockers)
blockers)
•• Cannabinoids
Cannabinoids
Serotonin
Serotonin Antagonists
Antagonists
•• Used
Used to
to treat
treat side
side effects
effects of
of chemotherapy-
chemotherapy-
induced
induced emesis
emesis
•• condansetron (Zofran ®®)
condansetron (Zofran )
•• Doesn’t
Doesn’t affect
affect dopamine
dopamine receptors
receptors
–– ∴
∴ no
no extrapyramidal
extrapyramidal effects
effects
•• Granisetron
Granisetron (Kytril®)
(Kytril®)
Dopamine
Dopamine Antagonists
Antagonists
•• Phenothiazines
Phenothiazines
–– prochloraperazine
prochloraperazine (Compazine®)
(Compazine®)
–– promethazine
promethazine (Phenergan®)
(Phenergan®)
•• Butyrophenones
Butyrophenones
–– haloperidol (Haldol®®)
haloperidol (Haldol )
–– droperidol (Inapsine®®)
droperidol (Inapsine )
•• metoclopramide (Reglan®®)
metoclopramide (Reglan )
Cannabinoids
Cannabinoids
•• Tetrahydrocannabinol
Tetrahydrocannabinol (THC)
(THC)
–– Active
Active ingredient
ingredient in
in marijuana
marijuana
–– Dronabinol (Marinol®®))
Dronabinol (Marinol
–– Nabilone (Cesamet®®))
Nabilone (Cesamet
Digestion
Digestion Aids
Aids
•• Useful
Useful for
for inactive
inactive vagal
vagal stimulus/bypassed
stimulus/bypassed
duodenum
duodenum
•• Pancreatin (Entozyme ®®)
Pancreatin (Entozyme )
•• Pancrelipase (Viokase ®®)
Pancrelipase (Viokase )