GI DISORDERS

CLASS/ DRUG
ANTACIDS
Adjuncts w/ H2 Antagonists Take 1-3h after meal

MECHANISM
MG OXIDE ALOH + MGOH
Mg salts motility Al salts motility Neutralize HCl gastric secretions Used for heart burn Blocks parietal cell H2 receptors inhibiting basal acid secretion as well as secretion induced by meals Taken at bedtime Healing takes 1-2m but not a long term cure Take intermittently Blocks H+/K+ ATPase in parietal cell to transport H+ into stomach lumen pH of GI tract S-enantiomer of Omeprazole Mg salt Tx GERD

ADVERSE EFFECTS
Diarrhea Constipation Blood urine pH (metabolic alkalosis) Bloated feeling (CO2 release)

OTHER
Simethicone bloating & foam/bubbles -Added to preparations

H2 RECEPTOR ANTAGONISTS
Available OTC Heals ulcer temporarily

CIMETIDINE, RANITIDINE NIZATIDINE, FAMOTIDINE

Safe

Relapses are high thus maintenance therapy is needed

PROTON PUMP INHIBITORS

Very effective (1x blocks 90% of gastric acid secretion)

OMEPRAZOLE

Ulcer recurrence can occur

Coadministered w/: a. Clarithromycin + Amoxicillin b. Clarithromycin + Metrondiazole Absorbed more rapidly Healing time Coadministered w/ Clarithromycin & Amoxicillin

ESOMEPRAZOLE LANSOPRAZOLE

MUCOSAL PROTECTIVE AGENTS

Forms a protective barrier over ulcer

SULCRALFATE AL SUCROSE SULFATE BISMUTH SUBSALICYLATE (PEPTOBISMOL) MISOPROSTOL

Protects the gastric & duodenum mucosa from acid by forming a viscous, gel-like substance (pepsin attacks) Insoluble in H2O Binds selectively to ulcer tissues Bactericidal effects against H pylori Prevent ulcers induced by NSAIDs Methyl analog of PGEI PO

Interferes w/ absorption of other PO drugs & food

4-8w to heal

Coadministered w/ Cimetidine/ Erythromycin & anti-histamines (Tritec) -Take 4x a day -Bloating, Diarrhea -Uterine contactions abortions Resistant to metabolism take PO

Peptic Ulcers lesion of gastric or duodenal mucosa occurring where the mucosal epithelium has been compromised & is exposed to acid and pepsin H. pylori causes ~60% of duodenal ulcers & ~50% of gastric ulcers Risk Factors NSAIDs (inhibit PG synthesis), Coffee ( gastric acid secretion), Alcohol, Hereditary, Age, H. pylori, Smoking, Gastroparesis Gastroparesis GI tract stasis delayed gastric emptying; mild or severe; associated w/ N&V hospitalization; common after surgery - Tx: Prokinetic medications that facilitate passage down the GI tract: o Metoclopamide D2 antagonist, facilitates gastric emptying o Erythromycin antibiotic that provides antral contractions; acts on motlilin o Serotonin, Histamine, ACh used as drug templates for GI tract receptors to induce motility