Drugs for GI Secretions

What is GERD?

loosing of the sphincter between the esophagus and stomach, causing acid to move upwards out of the stomach

What are some contributing factors to GERD?

foods, fluids, meds, smoking, and position after/during eating

What can GERD lead to if left untreated?

barrett’s esophagus (cell change in lining of esophagus) + esophageal strictures

What is PUD?

erosions in the upper GI tract

What causes PUD?

NSAIDs or h. pylori infection

How do patients describe pain caused by PUD?

gnawing + burning pain occurring several hours after eating

What are some ways to improve GERD (non-medical)?

• elevate HOB during + after eating

• avoid smoking

• eat small meals

• minimize intake of fats, sugars, alcohol, + caffiene

• avoid obesity, constipation, + other things that may increase intra-abdominal pressure

What are some ways to differentiate between PUD and GERD?

description of pain, aggravating + alleviating factors, use of drugs like steroids + NSAIDs, + lifestyle

What type of drug is cimetidine?

histamine2 receptor antagonist (H2RA)

What is cimetidine used to treat?

ulcers from PUD + heartburn/indigestion relief

How does cimetidine work?

it blocks the release of acid

When should cimetidine be given?

with or before meals AND at bedtime

What should you monitor for in a patient taking cimetidine?

renal + hepatic impairment

What are some adverse effects of cimetidine?

diarrhea, dizziness, drowsiness, HA, confusion

What would prove that cimetidine has been effective?

relief of GI symptoms, ulcer healing, + prevention of ulcer progression

What do antacids do?

increase stomach pH + neutralize acid

What is the difference between antacids and H2RAs?

H2RAs stop acid from being released, while antacids neutralize acid after it’s already been released

What is the indication for antacids?

upset stomach associated with hyperacidity

TRUE or FALSE: antacids promote ulcer healing.

false

TRUE or FALSE: antacids are available over the counter.

true

What type of drug is sodium bicarbonate?

antacid

What is sodium bicarb used for?

relief of GI symptoms due to hyperacidity

When should you take sodium bicarb?

1 and 3 hours after meals and at bedtime

What should you do if taking other medications alongside sodium bicarb?

take sodium bicarb at least 2 hours before taking the other medications

What should you educate a patient on when taking sodium bicarbonate?

• take 1-3 hours after meals and at bedtime

• take at least 2 hours before other meds

• take with a full glass of water!

What are some adverse effects of sodium bicarb?

acid rebound (stomach contents become too basic, causing the GI tract to produce even more acid)

TRUE or FALSE: antacids interact with many medications.

true

How do antacids affect other medications?

slow absorption, inactivate tetracycline meds, + increase blood levels of several drugs

What are side effects of sodium imbalances?

fluid retention, electrolyte imbalance

What are side effects of calcium imbalances?

constipation, acid rebound

What are some side effects of magnesium imbalances?

diarrhea, hypermagnesia

What are some side effects of aluminum imbalances?

constipation, hypophosphatemia

Why should you not give magnesium to patients with renal disease?

the kidneys may not excrete enough of it, causing hypermagnesium

What is an example of a PPI?

pantoprazole

What does pantoprazole do?

suppresses gastric acid secretion

What is the indication for pantoprazole?

GERD, short-term duodenal ulcer, h. pylori, etc.

When should you take pantoprazole?

30 mins before eating

Can you crush or chew pantoprazole?

no

TRUE or FALSE: antacids and pantoprazole (a PPI) cannot be taken together.

false

What are some side effects of pantoprazole?

nausea, diarrhea, HA, + increased risk of bone fractures w/ long-term use

What is the most common PPI prescribed?

pantoprazole

What should taking pantoprazole do?

relieve GI symptoms from hyperacidity + heal gastric ulcers

TRUE or FALSE: pantoprazole is low-risk.

true

What type of drug is sucralfate?

GI protectant

What does sucralfate do?

forms a barrier over a duodenal ulcer for protection

What is the indication for sucralfate?

duodenal ulcers

TRUE or FALSE: sucralfate should be taken with food.

false

When should sucralfate be taken?

1hr before or 2hrs after meals on an empty stomach

Which patients should avoid taking sucralfate?

renal failure/dialysis

Can you take sucralfate with other drugs?

take 30mins before or after other drugs

What are side effects of sucralfate?

constipation, dry mouth, + metallic taste

What should happen when taking sucralfate?

GI symptom relief + healing of ulcers

Give an example of a digestive enzyme drug.

pancrelipase

What does pancrelipase do?

aids in digestion + absorption of fats, proteins, + carbs

What is the indication for pancrelipase?

replacement therapy in patients with low pancreatic secretions

TRUE or FALSE: pancrelipase should be given with food.

true

What should you assess and monitor when giving a patient pancrelipase?

monitor pancreatic labs + nutritional status

What are side effects of pancrelipase?

nausea, abdominal cramps, diarrhea, + hyperuricosuria (high uric acid in the urine)

What should pancrelipase accomplish?

improved digestion

Which type of GI drug that we’ve studied is more commonly taken in pediatrics?

digestive enzymes (e.g. pancrelipase)

What is the goal of treating h. pylori?

complete eradication of bacteria, causing more rapid healing + remission of ulcers

TRUE or FALSE: an h. pylori infection can remain active for life if not treated.

true

What type of drugs can treat h. pylori infections?

antibiotics, PPIs, + bismuth salicylate

What are s/s of an h. pylori infection?

stomach pain, nausea, belching, heartburn, bad taste in mouth, + decreased appetite

Which GI drug can you not crush or chew?

pantoprazole