3`1-32 GI pharmacy

Parietal Cells Regulated by…

Parietal Cells Regulated by…

Neuronal: Seeing food, thinking food, stomach starts making acidity

Paracrine: Detects stretch/content in the stomach to start making acidity

Endocrine: Gastrin (most potent activator) triggered by protein in meal

Stomach protection

Physical Barrier: Gastric mucosa

→Stimulated by prostaglandins

Chemical barrier: Bicarb

Biological barrier: Restitution of the cellular layer

Environmental barrier: Blood glow

Pancreas Exocrine vs Endocrine tissue

Exocrine tissue: Majority of pancreas, secretes bicarb and digestive enzymes

Endocrine tissue: 2% of pancreas, secrete hormones into blood

What cuases Peptic ulcers?

1. NSAIDs

2. H Pylori 

3. Acid hypersecretion

4. Cigarettes caffeine alcohol, glucocorticoids

Acid Neutralizers

Aluminum or Magnesium Hydroxide

Sodium Bicarb

Calcium carbonate

Acid neutralizer side effects

Mg: Diarrhea

Ca& Al: constipation

Sodium- caution HTN

H2 receptor antagonists

Block release of histamine from ECL cell

Cimetidine, Ranitidine, Famotidine, nizatidine

Proton pump inhibitors

omeprazole , pantoprazole

Metabolized by CYPs

Rabeprazole and Lansoprazole have a faster osnet

Class C pregnanacy

Agents that protect mucosa

1. Prostaglandin analogues 

   1. Misoprostol

   2. Good for NSAID-induced ulcers 

   3. Contraindicated in women trying to get pregnant

2. Coating agents 

   1. Sucralfate 

   2. Forms a feel that coats epithelial cells and ulcer craters 

Agents that treat H Pylori

1. Amoxicillin, tetracycline, metronidazole, clarithromycin 

2. Triple therapy: Amoxicillin, clarithromycin, PPI

3. Quadruple therapy

   1. Tetracycline, metronidazole, PPI, bismuth 

Mesalamine

Inhibits inflammatory mediators by inhibiting activity NF-KB

Treat IBD

Pharmacotherapy in IBD

1)Mesalamine

2)Glucocorticoids

3)Immunosuppressive agents

4)Biologics

5)Antibiotics & Probiotics

6)Fecal Microbiota transplant

Immunosuppressive agents for IBD

Thiopurines

Methotrexate

Cyclosporine

Thiopurines

Impair purine biosynthesis and limit cell proliferation

Ex: Azathioprine

Methotraxate

Inhibit dihydrofolate reductase and blocks synthesis of DNA

(reserved for steroid resistant ot dependent)

Cyclosporine

Cacineurin inhibitor which prevents transcription of IL2

Reserved for steroid resistant UC or fistulous CD

Anti TNF biologics

Infliximab

Adalimumab

Certolizumab

Anti integrin biologics

Natalizumab

What antibiotics for IBD

Metronidazole

Ciprofloaxacin

Clarithromycin

Meds for IBS

Alosetron- 5HT3 antagoinst for diarrhea

Tegaserod- 5HT4 agonsit for constipation