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PC707 ADV PHARMACOLOGY MODULE 3 GI
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PC707 ADV PHARMACOLOGY MODULE 3 GI
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PC707 ADV PHARMACOLOGY MODULE 3 GIAntacids - Answers- First line tx for GERD/PUD, neutralizes stomach acidity
Types of antacids - Answers- Milk of Mg, Ca Carbonate (TUMS), Na Bicarb (Alka
Seltzer), Al Hydroxide/Al Salts
Antacids: MOA - Answers- Chemically combines with acids to lower the stomach's pH.
Works faster than MOA of H2RA's because they work on gastric acids already secreted.
Works best for acute stress.
Antacids: Side effects - Answers- Diarhea and renal insufficiency (Milk of Mg),
constipation (Ca Carbonate/TUMS),
HTN and GI distress and contains aspirin (Na Bicarb/Alka Seltzer),
Drug to drug interaction of antacid Al Hydroxide - Answers- Decreases warfarin
absorption
Antacids: Pregnancy - Answers- Na Bicarb contains ASA avoid in pregnancy d/t
fetal/maternal alkalosis/fluid overload/↑ BP
Antacids: Patient education - Answers- Antacids block the MAO of enteric coated
drugs. Space out by 2 hours b4 or after.
Do not take with iron or prenatals.
With Ca Carb drink with plenty of water to keep disolved.
Antacids: Stepwise approach with pregnancy - Answers- 1. Lifestyle changes
2. Mg based antacids Milk of Mg (CAT B) relieve constipation
3. Ca based antacids TUMS/Rolaids (CAT C)- cause constipation
H2RAs (Histamine Receptor Antagonists): MOA - Answers- Histamine inhibits the
secretion of gastric acid by blocking H2 receptors on the parietal cell
H2RAs (Histamine Receptor Antagonists): Potential Side Effects - Answers-
Competitively binds to histamine receptors in parietal cells to stop secretion; causes
drowsiness, dizziness
H2RAs (Histamine Receptor Antagonists): Adverse Effects - Answers- Antiandrogenic
reactions (gynecomastia, impotence), CNS effects (confusion, agitation, depression),
agranulocytosis, granulocytopenia, thrombocytopenia, plastic anemia, GI: less common:
C, D, N
H2RAs (Histamine Receptor Antagonists): Potential Drug to drug interactions -
Answers- Many drug-to-drug interactions b/c uses several of the enzymatic pathways &
should be avoided. Ranitidine and Famotidine are safer. May ↓ liver metabolism of
Warfarin, phenytoin, propranolol, nifedipine, chlordiazepoxide, diazepam, certain
, tricyclic antidepressants, lidocaine, theophylline, & metronidazole → toxic levels of
these drugs
H2RAs (Histamine Receptor Antagonists): Contraindications - Answers- Use caution in
patients with renal impairment → more risk for CNS adverse reactions. Hepatocellular
injury may occur w/ nizatidine→↑ liver enzymes. Do not give Ranitidine & Nizatidine to
patients w/ liver disease.
H2RAs (Histamine Receptor Antagonists): Patient Education - Answers- Take the full
course of therapy even if feeling better. Take missed doses ASAP & do not double dose
if time for next dose. Take w/ meals or just after & @ bedtime to achieve best effect. If
taking antacids, administration should be spaced by 30 mins to 1 hr. Take with meals
and at bedtime
H2RAs (Histamine Receptor Antagonists): Use in Pregnancy - Answers- Pregnancy:
Category B, Ranitidine (Zantac) is first-line H2 Antagonist for pregnancy. Avoid
Cimetidine (Tagamet)
H2RAs (Histamine Receptor Antagonists): Lactation - Answers- Excreted in breastmilk,
Decision to discontinue medication is based on maternal need when the pregnancy has
ended.
H2RAs (Histamine Receptor Antagonists): Children & Elderly - Answers- Infants &
children have been successfully treated w/H2Ra blockers w/ good response and few
adverse reactions. Empiric treatment w/ H2RA's in infants no longer recommended.
Dosing for infants & children is available. Twice daily dosing is required. Use cautiously,
due to ↓ renal function. Cimetidine has most problems w/ ↓ renal clearance & ranitidine
the fewest.
IBS Management Goals - Answers- Symptom relief and improved quality of life
IBS Food Diary/Food Avoidance - Answers- Food diary may be useful to determine an
association between certain foods and IBS symptoms in individual patients
IBS Effects of Antidepressants - Answers- Improve abdominal pain, global assessment
scores, and overall symptom scores. Benefits seen with selective serotonin reuptake
inhibitors (SSRIs) and with tricycle antidepressants (TCAs)
IBS Effects of Probiotics - Answers- Reduce IBS symptoms, decrease pain and
flatulence
IBS Effects of Therapeutic Provider/Patient Partnership - Answers- Associated with
improved outcomes and with fewer return visits
Proton Pump Inhibitors: MOA - Answers- Gastric acid is pumped out of the parietal cells
in the stomach. Proton pump inhibitors [e.g. omeprazole (Prilosec®)] stop the
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