gastro drugs

Gastro drugs can be available OTC or Rx. The GI is associated with _______ so emotions affect its activity where stress decreases digestion and relaxation increases digestion through the brain–gut connection, and strong emotions can cause nausea or fainting.

Cranial nerve X (Vagus Nerve)

Name the gastro diseases

GERD

Barrets esophagus

gastric ulcers

chronic inflammatory bowel disease

celiac disease

gastric paresis

_________ is a gastro disease where the cells of the lower esophagus are damaged due to repeated exposure to acid. Most common in patients w/ longterm GERD, symptoms can be taste changes and enamel erosion. Can lead to _____.

barret esophagus, cancer

_______ is the most prevalent gastro disease in USA, its characterized by pain from inflamed esophagus that mimics a heart attack. Symptoms may include burping, cramps, farting, fullness, and congestion in the stomach. Symptoms can be exacerabted by _______ and _______.

GERD, large meal, supine position

what are the 2 ways GERD is treated?

decrease amt of acid in stomach

constrict the cardiac sphincter (muscle between stomach and esophagus)

Gastric ulcer occurences are related to the presence of __________. However some ulcers can be secondary to long term use of NSAIDS. Typically treatment consists of antibiotics, H2 blockers, and PPI.

helicobacter pylori

_________ inhibit basal and nocturnal gastric acid secretion by competitive inhibition of the action of histamine at H2 receptiors of the parietal cells. They also inhibit acid secreted by other agents such as food and caffeine. Available OTC, used in the tx of GERD and ulcers.

H2 receptor blockers

An adverse reaction associated with H2 blockers include ________ resulting in headache and slurred speech.

CNS effects

An adverse reaction associated with H2 blockers include ________ resulting in reduced sperm count, gynecomastia, and sexual dysfunction.

antiandrogenic effects

An adverse reaction associated with H2 blockers specifically Cimetidine include ________ because its inhibits the enzyme CY-P450 from metabolizing drugs resulting in delayed elimination and an increase in serum levels, can lead to toxicity. _________ specifically takes longer to process but other drugs affected include Warfarin (Coumadin), Metronidazole (Flagyl), Phenytoin (Dilantin), Theophylline, Diazepam (Valium), and Carbamazepine (Tegretil).

liver metabolism, lidocaine (Xylocaine) metabolism

_________ and ________ may have interactions with H2 blockers because toxic levels of these antifungal agents may be produced if taken at the same time as due to delayed metabolism from H2 blocker. ________ has interactions by resulting in an increased blood level. __________ have interaction because the metabolism is slowed and recovery from using these drugs may be slower too.

Ketoconazole, Itraconazole, Alcohol, Benzodiazepines

_________ are potent inhibitors of gastric acid secretion that are effective in healing duodenal ulcers (in combo w/ antibiotics) and in monotherapy and the acute tx and maintenance of GERD. Inhibits H/K adenosine triphosphatase enzyme system at surface of gastric parietal cell.

Proton Pump Inhibitors (PPI)

_______ does not occurs with PPIs because the increase gastric mediated histamine release cannot overcome the proton pump blockade.

Tolerance

Adverse effects associated with ______ can include xerostomia, mucosal atrophy of the tongue, osteoporotic fractures, and c diff.

PPIs

Ulcers are closely related to H. Pylori. To treat uclers, a combo of ________ (tetracycline, metronidazole, clarithromycin, or amoxicillin) PLUS _______ or _______, PLUS a _______ may be used. Normally taken for 2 weeks and results in a cure for many patients.

2 anti-infective therapy, H2 blocker, PPI, bismuth subsalicylate

_________ are used to treat many gastric conditions such as acute gastritis(heartburn/upset stomach) and symptoms of ulcers, by self med and by recommendation by prescriber. These are drugs that partially neutralize HCL acid in the stomach, decreases erosive effect of acif and pepsin activity decreased.

Antacids

________ such as Sodium Bicarbonate, Magnesium Carbonate, Aluminium Hydroxide, and Calcium Carbonate neutralize HCL acid in the stomach and alter absorption of other drugs from the GI.

Antacids

__________ is miscellaneous GI drug and is a complex of aluminum hydroxide and sulfated sucrose and is used as a “bandage” for duodenal ulcers and inhibits the absorption of tetracycline

sucralfate (Carafate)

Dopamine antagonists such as __________ have dopamine blocking action whihc facilitates cholinergic effects within the GI tract, it stimulates the motility of upper GI without secretions and relaxes smooth muscle, results in accelerated _________. I used in the tx of gastric paresis.

Metoclopramide (Reglan), gastric emptying time

Synthetic prostaglandins (PGE 2 alpha) such as _________ has cholinergic-like action by increasing gastric mucus and inhibits gastric acid secretion, helping in the prevention of and management of NSAID induced ulcers.

Misoprostol (Cytotec)

Anti-flatulents such as _______ is an agent used to relieve flatulence by lowering surface tension and breaks up gas pockets so they can be expelled. Similarily, laxatives such as ________ are used to relieve constipation.

Simethicone (Mylicon, Gas-X), Metamucil

___________ such as Kaopectate, Lomotil, and Imodium are either adsorbents or have opioid-like action (bc opioids can cause constipation), used to minimize fluid and electrolyte imbalances

Antidiarrheals

__________ such as Compazines, Dramamine, and Cannabinoids (Marinol) are used to either induce or prevent vomiting.

Antiemetics

Phenothiazines such as ________ are used control severe nausea, also can be classified under antiemetics.

compazine

__________ such as dramamine (also antiemetic), bonine, and transdermal scopolamine are used to treat nause and vomiting.

anticholinergics

Antihistamines such as ________ can produce sedation but also has antiemetic properties. Hydroxyzine is used in dentisty as an antiemetic or antianxiety as well.

Benedryl

___________ has an antiemetic effect that is mediated through the chemoreceptor trigger zone.

Trimethobenzamide (Tigan)

________ such as Marinol and Casamet are used in the tx of nausea, vomiting and weight loss in pts/ w cancer and HIV.

Cannabinoids

___________ such as Anzemet and Zofran are used to control nausea and vomiting due to post operative and chemo agents, also for AIDS.

5-HT3 Receptor Antagonists

__________ is an autoimmune disease that some can be genetically predisposed to where the ingestion of gluten (wheat, rye, barley) damages the microvilli of the small intestine. Tx is a gluten free diet.

celiac disease

__________ is a type of IBD that is thought to be an autoimmune response that involves mucosa, rectum, and distal part of colon, smoking is protective against this type and cessation make exacerbate the condition.

Ulcerative colitits

___________ is a type of IBD that involves all layers of the intestinal wall, the whole intestine. Most commonly effects the colon

Crohns disease

_______ should be avoided in pts with IBD. Treatment of this disease cosnists of anti-inflammatory drugs, corticosteroids, and immunosuppressants.

Other drugs used for tx may include:

-laxatives

-colonic stimulants

-osmotic (saline) laxatives

-fiber supplementation

-antidiarrheals

-Remicade

NSAIDS

_______ is a new agent on the market approved by FDA used in tx of IBD, works by neutralizing tumor necrosis factor (TNF) in the blood stream that causes inflammation.

Inflixmab (Remicade)

________ are usually the first line of therapy in the tx of IBD, reduces symptoms by decreasing inflammation.

anti-inflammatory drugs

________ are used for tx of moderate to severe IBD that doesnt respond to other treatment.

corticosteroids

___________ are used in the tx of IBD by blocking the immune reaction that contributes to inflammation.

immunosuppressants

Dental pt management/considerations for GERD and Ulcers

-thorough med hx review to avoid drug interactions

-avoid aspirin/NSAIDS

-watch supine chair position

-monitor xerostomia (caffeine and alcohol can exacerbate)

-recommend sugarless gum and candy

-refer to physician for erosion or taste changes