MEDS!!
GI, Biliary, & GU
(Yes! All of them!) 
The Meds!
What’s it for?
How to give?
Side Effects?
H2-Receptor BlockersExamples:
cimetidine (Tagamet)
ranitidine (Zantac)
famotidine (Pepcid)
nizatidine (Axid)
These block the action of
histamine on the H2
receptors, reducing HCl
acid secretion.
This ↓ the conversion of
pepsinogen to pepsinspeeds ulcer healing.
Famotidine also for
GERD.
Orally or
intravenously.
Give IV slowly.
Granulocytopenia,
gynecomastia, diarrhea,
fatigue, dizziness, rash.
Mental
confusion/hallucination
(cimetidine?) in the
older adult!
Proton pump inhibitorsExamples:
omeprazole (Prilosec)
lansoprazole (Prevacid)
esomeprezole (Nexium)
Pantoprazole (Protonix)
They block the ATPase
enzyme that is important
for the secretion of HCl
acid. Even more effective
than H2R blockers in
reducing acid secretion
and promoting ulcer
healing.
↓ gastric acid secretion by
slowing down the
hydrogen-potassium
adenosine triphosphatase
pump on the surface of
the parietal cells.
To eradicate H pylori.
Need to be in
protective capsule to
prevent damage.
Long term use may
cause gastric tumors and
bacterial invasion.
Adjunct therapy!
They ↑ gastric pH by
neutralizing the HCl acid.
 Kewlness!
Systemic and
nonsystemic.
Orally or via NG
tube. If there IS a
tube, monitor pH of
aspirate.
Antibiotic Therapybismuth subsalicylate
(Pepto Bismol)
bismuth combined with
H2R (Tritec).
Flagyl
Tetracycline
AntacidsAluminum
hydroxide(Amphojel)
Calcium carbonate (Tums)
dihydroxyaluminum
sodium carbonate
(Rolaids)
magaldrate (Riopan)
magnesium hydroxide
(MOM)
Limit treatment with this
for 4-8 weeks.
Causes black stools.
Can also cause black
tongue.
Long-term therapyneurological disorders.
If high in sodium, use in
caution with the elderly
and in pts with cirrhosis,
HTN, CHF, and renal
disease.
Magnesium-Not for the
person with renal
failure-Toxic-Also,
causes diarrhea.
Aluminum causes
constipation.
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AnticholinergicsBelladonna alkaloids
(Atropine sulfate)
anisotropine(Valpin)
scopolamine (Transderm
Scōp)
glycopyrrolate (Robinol)
Only occasionally used.
They ↓ cholinergic
(vagal) stimulation of
HCl acid.
Inhibits the actions of
acetylcholine at
cholinergic receptor sites,
thereby decreasing gastric
secretions.
Pepsin inhibitors.
OthersTrycyclic antidepressants
imipramine (Tofranil)
doxepin (Sinequan)
serotonin reuptake
inhibitors
Cytoprotective drug
therapyMucosal Protectantssulcralfate (Carafate)
misoprostol (Cytotec)
Some anticholinergic
properties. Reduced acid
secretion.
Overall pain relief.
Creates a protective
barrier.
Does NOT neutralize acid
and does NOT ↓ acid
secretion.
Makes a sticky gel that
adheres to the ulcer
crater. Barrier to back
diffusion of Hydrogen
ions, pepsin, and bile
salts.
Cytotec used for
prevention of ulcers
caused by NSAIDS and
aspirin. Doesn’t interfere
with their use, though.
?
Have a tendency to
decrease gastric
motility. Dry mouth and
skin, flushing, thirst,
tachycardia, dilated
pupils, blurred vision,
urine retention.
Use in caution with the
patient who has
narrow-angle
glaucoma, benign
prostatic hyperplasia,
and gastric outlet
obstruction.
Give 30 min. from
antacids.
Constipation.
Can impede absorption
of other drugs.
Drug therapy includes antacids, H2R blockers, Proton pump inhibitors, antibiotics,
anticholinergics, and cytoprotective therapy.
Patient can discontinue antacids, H2R blockers, and PPIs after the ulcer has healed.
Aspirin and nonselective NSAIDS with GI effects may be discontinued. May replace
with NSAIDS that are COX-2 inhibitors. Should use enteric-coated or co-administered
with Proton pump inhibitors or misoprostol (Cytotec). All NSAIDS, even COX-2
inhibitors, interfere with ulcer healing.
Antihistamine drugs used to treat allergies are H1R blockers and have no effect on gastric
secretion.
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Antacids may work unfavorably in combo with other drugs. They can enhance the
absorption of drugs such as dicumarol and amphetamines. Action of digitalis can be
potentiated when used in combo with calcium or magnesium antacids. Antacids may
also decrease the absorption rates of prescribed drugs like Tetracycline.
Bismuth(Example: Pepto-Bismol)-Acts to disrupt cell wall of H pylori, causing lysis &
death. May also inhibit urease activity and prevent H pylori from adhering to the gastric
surface. Can cause black tongue/black stool. Long term therapy can cause neurologic
disorders.
Metronidazole (Example:Flagyl) - anti-infectives, antiprotozoals, antiulcer agents.
Disrupts DNA and protein synthesis in susceptible organisms. In addition, is active
against H. pylori. Seizures, Headache, dizziness, abd. Pain, anorexia, nausea, leukopenia.
Increases the effects of Warfarin. Give with food or milk. Can be given with other
ABOs. First converted to chemically reactive form, then interacts with DNA causing
strand breakage and loss of helical structure. Readily absorbed from GI tract. Hepatic
metabolism.
Tetracycline (Examples: Apo-Doxy, Doryx, Doxy)-Anti-infective. Inhibits protein
synthesis. Broad spectrum. Can stain developing teeth. Rarely used DOC anymore.
Absorption decreased when given with food. Stay out of sun. No milk products, no iron
supplements, or magnesium or most antacids. Metabolized by liver and excreted in bile.
Amoxicillin (Example(s): Augmentin)-safest antibiotic. Disrupts the cell wall, letting
excessive amount of water into cell and then cell ruptures. More resistant to acid
inactivation than other penicillins. Excreted 70% urine, unchanged; 30% metabolized in
liver. Broad spectrum. Allergies, rash.
Histamine 2 receptor antagonists (ranitidine, famotidine)(Examples: Tagamet,
Pepcid, Mylanta, Zantec)-First drug of choice for ulcers. Promotes healing by
suppressing secretion of gastric acid (parietal cells of stomach), suppress basal acid
secretion and stimulation of acid secretion by gastric and acetylcholine. Most eliminated
intact in urine. Healing and prevention of ulcers.Decreased secretion of gastric acid.
Confusion, arrhythmias, agranulocytosis, aplastic anemia. Confusion, hallucination,
depression. Narrow safety margin for following drugs if given with H2 blockers:
(Coumadin, Dilantin, Theophylline, Lidocaine). Famotidine also for GERD.
Proton Pump Inhibitors (Lansoprazole, omeprazole. Example: Prevacid, Prilosec)Anti-ulcer. Treatment of erosive esophagitis. Most effective agent for suppressing
secretions of gastric acid in gastric lumen(Prilosec). Starts lowering acid within 2 hours.
Needs to be in protective capsule to prevent….Give before meals; Capsules can be
opened and sprinkled on top of applesauce, yogurt, pudding, etc. Can give with ant-acids.
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Risk of gastric cancer if used for a long time. Limit treatment to 4-8 weeks. Dizziness,
headache, diarrhea.
Mucosal protectants (sucralfate, antacids Example: Carafate)-Creates a protective
barrier. Does not neutralize acid and does not decrease acid secretion. Makes a sticky gel
that adheres to the ulcer crater creating a barrier to back diffusion of Hydrogen
ions, pepsin, and bile salts. Lasts for about 6 hours. Should be given 30 minutes from
antacids.Constipation ,most common SE. Aluminum can cause constipation,
Magnesium-diarrhea, Sodium-based can raise systemic pH. Calcium-based may cause
acid rebound, releasing CO2. (Tums)
Cytotec for NSAID induced ulcers-Suppresses the acid, the secretion of bicarb. Would
not give to pregnant patient! Diarrhea, abd. Pain, spotting, dysmennorhea. Give orally,
with meals, at bedtime. Pulmonary Fibrosis, Myocardial Fibrosis, etc.
Metamucil-Bulk-Laxative-Binds with H2O in intestine to form emollient and get
promoting peristalsis and decrease transit time.
Colace (stool softener)-Also Docusate. Keep stool soft and mobile by incorporating
water into the stool.
Anti-inflammatory(sulfasalazine, steroids)-Ulcerative colitis. Rash, anorexia,headache.
May decrease iron and folic acid absorption. Can cause crystalluria and urinary cell
calculi formation.
Bowel anti-microbials (Neomycin)-Most toxic of aminoglycosides. Can cause damage
to kidneys and hearing. If patient is going to have surgery, they may receive this then.
Immunosuppressives (Azathioprine, methotrexate)-Antimetabolites. Interferes with
folic acid metabolism. Result is inhibition of DNA synthesis and cell reproduction (cellcycle S-phase–specific). Also has immunosuppressive activity. Death of rapidly
replicating cells, particularly malignant ones, and immunosuppression. Kidney damage,
anorexia, hepatotoxicity, nausea, stomatitis, vomiting. Pulmonary Toxicity.
5FU-First drug of choice for colon cancer. Antimetabolite. Inhibits DNA and RNA
synthesis. Inhibits DNA and RNA synthesis by preventing thymidine production
(cell-cycle S-phase–specific). Kills rapidly dividing cells. Watch mucus membrane,
avoid IM injections, rectal temps, venipuncture. If infiltrated, apply ice. Wear masks,
gloves, gown. Don’t refrigerate. Don’t give if cloudy. Acute cerebeller dysfunction,
nausea and vomiting, stomatitis, diarrhea, rash, phototoxic, anemia.
Leucorvorin-Give with methotrexate (Because s-phase specific). An alkylating agent
that interferes with cellular protein synthesis (cell-cycle phase–nonspecific).
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Malignant cells not saved because the metho and the leucovorin is forced into the cells
by passive diffusion by massive doses of the drug. Failure to give the drug at the right
time and the right dose can be fatal. Hyperuricemia.
Bactrim-(Anti-infective)- Biliary tract infections, osteomyelitis, burn and wound
infections, chlamydial infections, endocarditis, gonorrhea, intra-abdominal infections,
nocardiosis, rheumatic fever prophylaxis, sinusitis, eradication of meningococcal carriers,
prophylaxis of urinary tract infections, and an alternative agent in the treatment of
chancroid. Hepatic necrosis.
Dobutamine- Death of rapidly replicating cells, particularly malignant ones.
Dopamine (Levodopa)-Contraindicated in narrow-angle glaucoma.
Epinephrine-(Anti-convulsant)-Decreases synaptic transmission in the CNS by affecting
sodium channels in neurons.
Isuprel-(Aminoglycosides, Anti-infectives)- Inhibits protein synthesis in bacteria at level
of 30S ribosome. Ototoxic (yeah, okay, hearing!), Nephrotoxic!
Levophed-(Thyroid preparations, hormones)-Treatment of some thyroid cancers.
Insomnia, irritability, nervousness, CV collapse, weight loss.
Aramine-Decreased pain/inflammation. Usually for rheumatoid arthritis. Headache,
alopecia.
Lupron-(Anti-depressants)- Inhibits the reuptake of serotonin in the CNS. Dry mouth…
Zoladex- Treatment (palliative) of prostate cancer in patients who cannot tolerate
orchiectomy or estrogen therapy. Decreased spread of cancer. CV accident, MI,
decreased libido, impotence.
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