GI drugs

Antidiarrheals

Adsorbents, Anticholenergics, Opiates

Adsorbents

Action: coat mucosa
SE: inc bleeding time, tinnitus, constipation, blue gums, metallic taste
Drugs: Bismuth subsalicylate (Pepto), Attapulgite ( Keopectate)

Opiates

Action: decrease motility
SE: urinary retention, NVAC, flushing, urticaria, dizziness, drowsiness

Antidiarrheal drugs

Diphenoxylate & atropine [Lomotil]
Difenoxin & atropine [Motofen]
Loperamide [Imodium]
Octreotide [Sandostatin]
Paregoric & tincture of opium

Laxatives

Bulk forming, surfactant, emollient, saline, stimulants, hyperosmotics
Methylnaltrexone [Relistor] - block opioid effects

Bulk-Forming lax.

act: absorb water, distend bowel
SE: impaction, fluid overload
Drugs: methylcellulose [Citrucel]
psyllium [Metamucil]

Emollient/surfactant lax.

act: lubricate, lower surface tension
SE: rash, dec vitamin absorb, lipid pneumonia
Drugs: mineral oil, docusate [Colace]

Saline lax.

Act: inc osmotic pressure
SE: Mg toxicity in renal pt
Drugs:. MOM, fleets [mag salts]

Stimulant lax.

Act: inc peristalsis
SE: rash, gastric irritation, malabsorption
Drugs: bisacodyl [Dulcolax]

Hyperosmotic lax.

act: inc fecal water
SE: abd bloating
Drugs: polyethylene [GoLytely], lactulose [Cephulac]

Antacids

act: combine c H+ to form water, inc pH of stomach
SE: Mg>diarrhea
Ca++, Al>constipation
Na+> fluid retention
NaHCO3> alkalosis
rebound hyperacidity
systemic alkalosis with overuse

Antacids cont.

interactions: chelation, alter pH, alter urine pH
Drugs:
Mg- MOM
Al & Mg- Mylanta, Riopan, Maalox
Ca++ - Tums

H2 antagonists

act: bing to h2 receptors, block ACH and gastrin
SE: HA, dizziness, fatigue, NVC, Myalgia, rash, impotence, dec libido, inc BUN, blood dyscrasia

H2 antagonist drugs

Cimetidine [Tagamet]
Famotidine [Pepcid]
Nizatidine [Axid]
Ranitidine [Zantac]

Proton Pump Inhibitors

Act: bind irreversibly to HKATPase pump, block acid secretion
Uses: GERD, PUD, NSAID ulcer, hypersecretion states
SE: alopecia, back pain, fatigue, NVDA, blood dyscrasia
Drugs: -azole
interactions: vallium, coumadin, dilantin

Sucralfate [Carafate]

pastelike
SE: nausea, constipation
interactions: imede dilantin/coumadin abs
needs acidic environment (2 hour separation from antacids, h2, PPI)

Misoprostol [cytotec]

prostaglandin e1
prevent NSAID ulcers
SE: NVD, cramps, spotting
category X

IBD drugs

Mesalamine [Asacol, 5-ASA]
SE: NVD, cramps, rhinitis

IBD drugs

Aminosalicylates:
sulfasalazine [Azulfidine]- GI, HA, impaired M fert,
-cont: ASA or sulfa allergy
intax: coumadin, dig, dilantin, hypoglycemic

IBS drugs:

antispasmodics: dicyclomine [Bentyl]
serotonin antagonist: alosetron [Lotronex]- many restrictions

BRMs

inflixib [Remicade] - monoclonal antibody
given IV
SE: immunosuppression, liver dmg, stomach pain