Unit 6 Peptic Ulcer Disease (PUD) Gastrointestinal Drug Therapy

Gastrointestinal (GI) Tract = Digestive System

Think of it as the path food travels through your body :

🍽 Esophagus → carries food to the stomach
⬇
🥘 Stomach → breaks down food with acid
⬇
Duodenum → first part of small intestine; receives bile and enzymes
⬇
Jejunum → absorbs most nutrients
⬇
Ileum → absorbs remaining nutrients
⬇
Cecum → beginning of large intestine
⬇
Ascending colon → moves waste upward
⬇
Transverse colon → moves waste across
⬇
Descending colon → moves waste downward downward
⬇
Sigmoid colon → stores waste before leaving
⬇
Rectum → holds stool
⬇
Anus → removes stool from the body

Helper Organs (help digestion but food does not pass through them):

🟤 Liver → makes bile to help digest fats
🟢 Gallbladder → stores and releases bile
🟡 Pancreas → makes digestive enzymes

Easy Order Memory:

"Every Stomach Doctor Likes Eating Cold Apples And Tasty Desserts"

E sophagus
S tomach
D uodenum
L iver
G allbladder
P ancreas
J ejunum
I leum
C ecum
A ppendix
T ransverse colon
D escending colon
S igmoid colon
R ectum
A nus

(Think: Food goes down, gets digested, nutrients get absorbed, waste leaves. )

GI Tract Functions (Digestive System)

Think of the GI tract's job as:

Break food down → Absorb nutrients → Remove waste

1. Digestion 🍎

Digestion = breaking food into smaller pieces that the body can use.

There are 2 types:

A. Mechanical Digestion

• Physical breakdown of food.

• Example: chewing food or stomach mixing food.

Think:
➡ Breaking food apart

B. Chemical Digestion

• Uses enzymes and chemicals to break food into smaller molecules.

Think:
➡ Changing food into usable nutrients

What Does Food Break Into?

🥩 Proteins → Amino Acids

• Protein from food is broken down into amino acids .

• Amino acids are used to build and repair tissues.

Memory:
Protein → Pieces = Amino acids

🍞 Carbohydrates (CHO) → Simple Sugars (Glucose)

• Carbohydrates are broken down into glucose .

• Glucose is used for energy.

Memory:
Carbs → Glucose = Energy

🧈 Lipids (Fats/Triglycerides) → Fatty Acids

• Fats are broken down into fatty acids .

• Used for energy storage and other body functions.

Memory:
Fat → Fatty acids

2. Absorption 🩸

After digestion:

➡ Food is small enough to be absorbed.

The GI tract moves nutrients into the bloodstream so the body can use them.

Examples:

• Glucose → energy

• Amino acids → build proteins

• Fatty acids → energy/storage

Memory:
Digestion breaks it down → Absorption takes it in

3. Elimination (Defecation) 🚽

The GI tract also removes waste.

• Anything the body cannot use becomes solid waste (stool).

• Waste leaves the body through defecation .

Memory: Waste out = defecation

Super Fast Study Version

GI Tract Functions (Digestive System)

GI Tract Functions:

1. Digestion 🍽
   → Breaks food down

• Protein → amino acids

• CHO → glucose

• Lipids → fatty acids

2. Absorption 🩸
   → Moves nutrients into the body to use

3. Elimination 🚽
   → Removes solid waste

Easy Memory:

"Break it → Take it → Toss it"

🍎 Digestion = Break it
🩸 Absorption = Take it
🚽 Elimination = Toss it

GI Tract Digestion (Stomach)

Think of the stomach as a food processor :

1. It adds acid to break food down.

2. It uses enzymes to digest proteins.

3. It protects itself from the acid.

---

1. Acid Secretion (HCl)

The stomach makes HCl (hydrochloric acid) .

How does the body know to make acid?

The vagus nerve (part of the parasympathetic nervous system ) sends a signal to the stomach.

This happens when you:

👀 See food
👃 Smell food
💭 Think about food
🍽 Food enters the stomach

The brain basically tells the stomach:

➡ "Food is coming, start preparing!"

The stomach releases HCl to help digest food.

2. Pepsin

Pepsin = enzyme that breaks down proteins

When food enters the stomach:

• HCl helps activate pepsin.

• Pepsin breaks large proteins into smaller pieces.

🥩 Pepsin = Protein cutter

3. Inhibitory Enzyme (Stops HCl Secretion)

The stomach has a safety system.

When there is enough acid:

• An inhibitory enzyme sends a signal to slow/stop HCl production .

Why?

Because too much acid can damage the stomach.

🛑 Stop acid before it hurts the stomach

4. Mucus Protection

The stomach protects itself by making a mucus coating .

The mucus:

• Covers the stomach lining

• Creates a protective barrier

• Prevents HCl from damaging the stomach

Easy memory:

🛡 Mucus = stomach shield

Super Fast Study Version

GI Tract

🍽 See/smell/think food → Vagus nerve → HCl released

⬇

🧪 HCl activates pepsin

⬇

🥩 Pepsin breaks down proteins

⬇

🛑 Inhibitory enzyme slows acid

⬇

🛡 Mucus protects stomach lining

Main idea:

The stomach uses acid to digest food but uses mucus to protect itself from that same acid.

Gastroesophageal Reflux Disease (GERD)

Think of GERD as stomach acid goes the wrong way — back up into the esophagus.

🔥 What Happens?

Normally:

Stomach → keeps acid inside

But in GERD:

1. The LES (lower esophageal sphincter) relaxes when it shouldn't.

2. The stomach acid and digestive juices move back up into the esophagus.

3. This irritates the esophagus and causes a burning feeling.

🔥 Heartburn

Burning sensation behind the sternum (breastbone).

Why?

➡ Acid touches the esophagus → irritation → burning pain.

🛏Why Does It Get Worse Lying Down?

When you lie down:

• Gravity is no longer helping keep stomach contents down.

• Acid can move back up more easily.

Easy Memory:

GERD = Acid Goes the Wrong Direction

⬇ Normal:
Stomach keeps acid ✅

⬆ GERD:
Acid goes back up → burning 🔥

Super Fast Study Version:

Gastroesophageal Reflux Disease (GERD)

GERD = LES relaxes → acid backs up → esophagus irritated → heartburn

🔥 Burning behind sternum
🛏 Worse when lying down
⬆ Acid reflux into esophagus

Memory trick:
LES = "Lower Esophagus Stopper" → when it fails, acid leaks back up.

Ulcers

Think of an ulcer as an open sore or “wound” in the lining of the GI tract.

What is an ulcer?

• The mucosal lining is the protective layer inside organs like the stomach and intestines.

• An ulcer happens when this lining gets damaged , creating an open sore.

Think:

🛡 Normal lining = protected
❌ Ulcer = damaged spot/open sore

Peptic Ulcers

Peptic ulcers are ulcers caused by damage from stomach acid and digestive juices.

They mostly occur in:

1. Stomach

• It was called a gastric ulcer.

2. Duodenum

• First part of the small intestine

• Called a duodenal ulcer

Easy Way to Remember

Peptic = acid-related sore

🔥 Acid damages lining
⬇
🩹 Open sore forms
⬇
Pain/discomfort can occur

Super Fast Study Version

Ulcer = open sore in GI lining

Peptic ulcers happen mostly in:

• 🥘 Stomach

• ➡ Duodenum

Memory Trick:
"Peptic = Pain from acid eating the lining." 🩹🔥

• Open sores in the mucosal membranes/linings
  

• Peptic ulcers

  • Mostly occur in duodenum or stomach

Ulcer Causes / Risk Factors

Think of an ulcer happening when stomach acid is too strong or the stomach lining is not protected enough.

---

1. Increased HCl Production 🔥

• Too much stomach acid can damage the lining.

• More acid = more irritation.

Memory: Too much acid → sore

2. Inadequate Mucus Secretion 🛡

• The stomach normally makes mucus to protect itself.

• Less mucus = less protection from acid.

Memory: No shield → acid damage

3. Emotional & Physical Stress 😟

• Stress can increase stomach acid and affect healing.

4. Increased Vagus Nerve Stimulation 🧠

• The vagus nerve tells the stomach to make acid.

• Too much stimulation → more HCl production.

Memory: Vagus nerve = acid signal

5. Alcohol 🍺

• It can irritate and damage the stomach lining.

6. Drugs 💊

Some medications can damage the stomach lining (example: NSAIDs like ibuprofen).

7. Genetics 🧬

• Some people may be more likely to develop ulcers because of family history.

8. Gastric Bacterial Infection (H. pylori) 🦠

• H. pylori is a bacteria that damages the stomach lining.

• It makes it easier for acid to cause an ulcer.

Super Fast Study Version:

Ulcer = Too much acid + weak protection

🔥 More acid:

• ↑ HCl

• ↑ Vagus nerve stimulation

• Stress

🛡 Less protection:

• ↓ Mucus

• Alcohol

• Drugs

• H. pylori

• Genetics

Memory Trick:
"Acid up, mucus down = ulcer risk." 🩹

Ulcer Symptoms

Think of ulcer symptoms as signs that the stomach lining is irritated or damaged.

🤢 Nausea

• Feeling like you may throw up.

🍽 Loss of Appetite

• You may not feel hungry because your stomach feels uncomfortable.

🤮 Vomiting

• Stomach irritation can cause vomiting.

🔥 Periodic Stomach/Abdominal Pain

• Pain comes and goes because the ulcer gets irritated by stomach acid.

Super Fast Study Version:

Ulcer = irritated stomach lining

🤢 Nausea
🍽 Less appetite
🤮 Vomiting
🔥 On-and-off stomach pain

Memory:
"Ulcer hurts the stomach → nausea, no appetite, vomiting, pain."

Potential Mechanisms for
Disruption of Mucosal Defense

Disruption of Mucosal Defense (How Ulcers Form)

Think of the stomach lining as having a protective shield 🛡.
If that shield becomes weak, stomach acid can damage the lining and cause ulcers.

---

1. Depletion of endogenous Prostaglandins

Prostaglandins = protect the stomach lining

They help:

• Make mucus

• Protect the stomach from acid

If prostaglandins decrease:
⬇ Protection
⬆ Acid damage
➡ Higher risk of ulcers

Prostaglandins = stomach protectors

2. Helicobacter pylori (H. pylori)

H. pylori = bacteria that infects the stomach

What it does:

• Damages the mucus lining

• Weakens the stomach's protection

• Allows acid to injure the tissue

This increases:

• Risk of ulcers

• Ulcer coming back (recurrence)

Easy memory:

H. pylori = bacteria that breaks the stomach shield

Super Fast Study Version

🛡 Healthy stomach: Prostaglandins + mucus protect lining

❌ Ulcer risk

• ↓ Prostaglandins → less protection

• H. pylori → damages mucus lining

Main idea:
Weak defense + stomach acid = ulcer formation 🔥

Ulcer Formation

Think of an ulcer forming when stomach acid becomes stronger than the stomach's protection.

Step 1: HCl & Enzymes Become Concentrated 🔥

• The stomach has acid (HCl) and enzymes that help digest food.

• If they become too strong or too concentrated, they can start damaging the stomach lining.

Memory: Too much acid = damage

Step 2: Mucus Protection Is Disrupted 🛡

• The stomach normally makes mucus to protect itself from acid.

• If mucus production decreases, the stomach loses its protective shield.

Memory: Less mucus = less protection

Step 3: Erosion of Mucosa 🩹

• Without enough protection, acid damages and wears away the stomach lining.

• This creates an open sore (ulcer).

Memory: Acid breaks down lining → ulcer forms

Super Fast Study Version:

🔥 Too much acid + 🛡 weak mucus protection → 🩹 mucosal erosion → ulcer

Easy phrase:
"Acid attacks when the mucus shield is gone."

Ulcer Treatment

Think of ulcer treatment as reducing irritation + protecting the stomach + healing the sore.

1. Decrease Stress 😟⬇

• Stress can increase stomach acid.

• Less stress helps reduce irritation.

Memory: Less stress = less acid

2. Decrease Alcohol 🍺⬇

• Alcohol can damage the stomach lining.

• Reducing alcohol helps the lining heal.

Memory: Alcohol weakens the stomach shield

3. Decrease Spicy Foods 🌶⬇

• Spicy foods can irritate an already sensitive stomach.

• Avoiding them can reduce discomfort.

Memory: Avoid irritation

4. Decrease Smoking 🚭

• Smoking slows healing.

• It can increase ulcer problems.

Memory: Smoking delays healing

5. Drug Therapy 💊

Medications help by:

• Decreasing stomach acid

• Protecting the stomach lining

• Treating H. pylori infection (if present)

Memory: Meds = reduce acid + heal lining

6. Surgical Intervention 🏥

• Used only for severe ulcers or complications.

• Helps repair problems when medications are not enough.

Memory: Surgery = last option

Super Fast Study Version:

Ulcer Treatment = Protect + Heal

⬇ Reduce:

• Stress

• Alcohol

• Spicy foods

• Tuxedo

💊 Drugs → decrease acid + heal

🏥 Surgery → severe cases

Easy phrase:
"Remove the irritants, reduce acid, repair the damage." 🩹

Ulcer Drug Therapy

Think of ulcer medications as doing 3 main things:

1. Decrease stomach acid 🔥

2. Protect the stomach lining 🛡

3. Kill H. pylori bacteria 🦠

1. Antacids 💊

What they do:

• Neutralize stomach acid that is already there.

• Makes the stomach less acidic.

Memory:
Antacid = Acid neutralizer

2. Anticholinergics 🛑

What they do:

• Block signals from the vagus nerve.

• This decreases stomach acid production.

Memory:
Block the signal → less acid

3. Histamine-2 (H2) Blockers

What they do:

• Block histamine signals in the stomach.

• This decreases HCl (stomach acid) production.

Memory:
H2 blocker = blocks acid release

4. Prostaglandins 🛡

What they do:

• Increase mucus protection.

• Help protect the stomach lining from acid.

Memory:
Prostaglandins = stomach shield

5. Proton Pump Inhibitors (PPIs)

What they do:

• Strongly block the stomach's acid pump.

• Greatly decrease HCl production.

Memory:
PPI = turns off acid pump

6. Antibiotics (if H. pylori is present) 🦠

What they do:

• Kill the H. pylori bacteria.

• Multiple antibiotics are used because bacteria can become resistant.

Memory:
H. pylori = treat with antibiotics

7. Protectants 🛡

What they do:

• Coat the ulcer and create a protective barrier.

• Prevent acid from damaging the sore.

Memory:
Protectant = covers the wound

Ulcer Drug Therapy

Super Fast Study Version

Ulcer Drugs:

🔥 Decrease acid:

• Antacids → neutralize acid

• Anticholinergics → block vagus signal

• H2 blockers → block acid release

• PPIs → shut down acid pump

🛡 Protect lining:

• Prostaglandins → increase mucus

• Protectants → coat ulcer

🦠 Kill bacteria:

• Antibiotics → treat H. pylori

Easy Memory:

"Lower Acid, Protect Lining, Kill H. pylori" 🩹

Antacids

Think of antacids as acid fighters 🛡

MOA (How it works)

• Antacids neutralize stomach acid that is already present .

• They make the stomach contents less acidic , which helps relieve heartburn and ulcer pain.

Easy memory:

Antacid = Anti-acid → cancels out acid

Patient Teaching / Side Effects

🚽 Constipation

• Some antacids can slow down the movement of the intestines.

• This can make stools harder and cause constipation.

Easy memory:

Antacids can slow the gut → constipation

Super Fast Study Version:

💊 Antacids

• MOA: Neutralize acid already in the stomach

• Side effect: Constipation

Memory Trick:
"Antacid attacks acid, but can slow the stool." 🛡🚽

1. GASTROINTESTINAL SYSTEM DRUG THERAPY

2. Antacids

magnesium hydroxide        Milk of Magnesia®

aluminum hydroxide          

calcium carbonate         Tums®

H-2 Receptor Antagonists

Think of H₂ blockers as acid blockers. 🛑🔥

MOA (How it Works)

They:

• Decrease stomach acid (HCl) secretion

• Decrease pepsin secretion

Why is that helpful?

Less acid + less pepsin = less irritation to the stomach and ulcers can heal.

Easy memory:

H₂ blocker = blocks acid production

Side Effects

🚽 Constipation

• Can make it difficult to have a bowel movement.

🤕 Headache (HA)

• Some people may get headaches.

Super Fast Study Version

💊 H₂ Blockers

• ⬇ Acid secretion

• ⬇ Pepsin secretion

Side effects:

• 🚽 Constipation

• 🤕 Headache

Memory Trick:

"H₂ = Halt HCl" 🛑🔥
(HCl = stomach acid)

GASTROINTESTINAL SYSTEM DRUG THERAPY

Histamine 2 receptor blockers

cimetidine                       Tagamet®

famotidine                       Pepcid®, Zantac 360®

nizatidine  

Proton Pump Inhibitors (PPIs)

Think of PPIs as the strongest acid blockers. 💪🔥

When are they used?

• Usually used when H₂ blockers are not working well enough , even at high doses.

• Doctors move to PPIs because they are stronger.

Easy memory:

H₂ blocker not enough → use PPI

How Effective Are They?

• PPIs are more effective than H₂ blockers .

• They decrease stomach acid even more.

Easy memory:

H₂ blocker = good acid blocker
PPI = strongest acid blocker

Super Fast Study Version

💊 PPIs

• Used when H₂ blockers aren't enough

• Decrease stomach acid more than H₂ blockers

• More effective for ulcers and GERD

Memory Trick:

🔥 Acid

H₂ Blocker = turns acid down ⬇

PPI = almost turns acid off ⛔🔥

PPI = Powerful Proton Pump Inhibitor = Powerful acid blocker 💪🛑🔥

Proton Pump Inhibitors (PPIs)

Think of PPIs as drugs that turn off the stomach's acid pump. 🛑🔥

MOA (How it Works)

• Inhibits (blocks) acid production

• The stomach makes much less acid.

Easy memory:

PPI = Stops acid production

Uses 🩹 Ulcers

• Less acid = ulcers can heal.

🔥 GERD

• Less acid backing up into the esophagus = less heartburn.

Easy memory:

PPIs treat ulcers and GERD by lowering acid.

Side Effects

🚽 Constipation

• Harder to have bowel movements

🤕 Headache (HA) 🤢 Nausea

• Upset stomach

💩 Diarrhea

• Loose stools

🤕 Belly Pain

• Abdominal pain/discomfort

Super Fast Study Version

💊 PPI

• MOA: Blocks acid production

• Uses: Ulcers + GERD

Side Effects:

• 🚽 Constipation

• 🤕 Headache

• 🤢 Nausea

• 💩 Diarrhea

• 🤕 Abdominal pain

Memory Trick

PPI = Powerful acid blocker 🛑🔥

Less acid = ulcers heal + less GERD 🩹🔥

1. GASTROINTESTINAL SYSTEM DRUG THERAPY

2. Proton Pump Inhibitors drug

lansoprazole                    Prevacid®

omeprazole                     Prilosec®

pantoprazole                   Protonix®

rabeprazole                     Aciphex®

esomeprazole                  Nexium®

Prostaglandins

Think of prostaglandins as stomach protectors. 🛡

MOA (How it Works)

🛡 Promote Mucus Secretion

• Helps the stomach make more mucus.

• Mucus protects the stomach from acid.

⚪ Increase Alkaline Production

• Makes substances that help neutralize acid.

• Gives extra protection to the stomach lining.

Easy memory:

Prostaglandins = Build the stomach's protective shield

Side Effects

🤕 Cramping

• Stomach cramps

💩 Diarrhea

• Loose stools

🤕 Headache (HA) 💨 Flatulence

• Gas

🤢 Nausea

• Upset stomach

⚠ Black Box Warning Causes of Uterine Contractions

• Can make the uterus contract (squeeze).

Contraindicated in Pregnancy

• It should NOT be used during pregnancy because it may harm the pregnancy.

Easy memory:

🤰 Pregnant = NO prostaglandins

Prostaglandins

Super Fast Study Version

💊 Prostaglandins

• 🛡 Increase mucus

• ⚪ Increase alkaline protection

• MOA: promote mucus secretion and alkaline production

Side effects:

• Cramping

• Diarrhea

• Headache

• Gas

• Nausea

⚠ Can cause uterine contractions
⚠ Do not use in pregnancy

Memory Trick:

"Prostaglandins Protect the stomach, but can Produce uterine contractions." 🛡🤰

1. GASTROINTESTINAL SYSTEM DRUG THERAPY

Prostaglandin (receptor agonist) what does it do

misoprostol                     Cytotec®

GI Protectant

Think of a GI protectant as a bandage for an ulcer. 🩹

MOA (How it Works)

1. Coats the Ulcer 🩹

• Covers the ulcer with a protective layer.

• Helps protect it from stomach acid.

2. Binds to HCl and Inhibits Pepsin

• Binds to some stomach acid ( HCl ).

• Decreases the activity of pepsin (the protein-digesting enzyme).

This means:

• Less irritation

• More healing

GI Protectant = Covers and Protects the Ulcer

Use

🩹 Ulcers

• Helps ulcers heal by protecting them from acid and pepsin.

Patient Teaching

🍽Take on an Empty Stomach

• Works best when there is no food in the stomach.

• Allows the medicine to stick to the ulcer better.

Easy memory:

Empty stomach = better coating

Super Fast Study Version

💊 GI Protectant

• 🩹 Coats ulcer

• 🔥 Binds acid (HCl)

• 🥩 Pepsin Blocks

Use: Ulcers

Teaching: Take on an empty stomach

Memory Trick:

"Protectant = Protective Bandage for the Ulcer." 🩹🛡

1. GASTROINTESTINAL SYSTEM DRUG THERAPY

GI Protectant drug

sucralfate                        Carafate®

Antimicrobial Polypharmacy for Peptic Ulcer Disease

Polypharmacy just means using multiple medications together.

For ulcers caused by H. pylori bacteria , doctors usually give:

1. Proton Pump Inhibitor (PPI) 💊

• Decreases stomach acid.

• Helps the ulcer heal.

2. Antibiotic #1 🦠

• Kills H. pylori bacteria.

3. Antibiotic #2 🦠

• It also kills H. pylori.

• Two antibiotics are used because H. pylori can be hard to kill and may be resistant to one antibiotic.

Goal

✅ Heal the ulcer

✅ Get rid of H. pylori

✅ Prevent the ulcer from coming back

---

Super Fast Study Version

Ulcer + H. pylori = 3 drugs

💊 PPI → lowers acid

🦠 Antibiotic 1 → kills bacteria

🦠 Antibiotic 2 → kills bacteria

Memory Trick:

"1 PPI + 2 Antibiotics = Kill H. pylori and Heal the Ulcer." 🩹🦠

For an ulcer caused by H. pylori , the patient usually takes:

• 💊 1 Proton Pump Inhibitor (PPI) → lowers acid

• 🦠 Antibiotic #1 → kills H. pylori

• 🦠 Antibiotic #2 → kills H. pylori

All are taken during the treatment period (at the same time as part of the regimen).

Non-pharmacological Therapy

These foods are avoided because they can irritate the stomach or increase stomach acid , which can make GERD, heartburn, or ulcers feel worse.

Easy Memory:

🔥 Spicy foods/hot peppers → irritate the stomach

🍟 Fried, fatty foods → stay in the stomach longer and can increase reflux

☕ Coffee → increases stomach acid

🍅 Tomato products → naturally acidic

🧅 Onions → can trigger heartburn and reflux

Super Short Memory Trick:

"Spicy, fatty, acidic, and coffee = more irritation and more reflux." 🔥🤢

Think of COX-1 = Protects the stomach + helps with pain/inflammation

Think of COX-2 = Pain and inflammation only

Regulate NSAIDs (COX-1 and COX-2 Inhibitors)

What do they do?

They block:

✅ COX-1 → decreases pain and inflammation

✅ COX-2 → decreases pain and inflammation

The Problem

Because COX-1 also helps make the stomach's protective mucus:

❌ Blocking COX-1 = less mucus protection

🔥 Acid can damage the stomach more easily

➡ Can lead to ulcers

Side Effects

• 🤢 Stomach upset

• 🩸 Intestinal bleeding

• 🩹 Ulcers

Easy memory:

Regular NSAIDs = Less pain BUT less stomach protection

COX-2 Inhibitors What do they do?

They only block:

✅ COX-2 → decreases pain and inflammation

Benefit

They do NOT block COX-1

SW:

🛡 Stomach mucus protection stays intact

➡ Lower ulcer risk than regular NSAIDs

Side Effect

⚠ Sulfa allergy concern

Easy memory:

COX-2 = Pain relief without hurting the stomach lining as much

NSAID Induced Ulcers

Super Fast Study Version

Regular NSAIDs

❌ Block COX-1 + COX-2

😊 Less pain

🛡 Less mucus

🩹 More ulcer risk

COX-2 Inhibitors

❌ Block COX-2 only

😊 Less pain

🛡 Mucus stays protected

🩹 Lower ulcer risk

⚠ Watch for sulfa allergies

Memory Trick:

COX-1 = Stomach protector

COX-2 = Pain/inflammation

Block COX-1 → ulcer risk ↑ 🔥🩹
Block only COX-2 → safer for stomach 🛡

Antiemetics 💊

What do they do?

✅ Stop or reduce nausea (feeling sick to your stomach)

✅ Stop or reduce vomiting (throwing up)

How?

They block the CTZ (chemoreceptor trigger zone) , which is the part of the brain that helps trigger nausea and vomiting.

Easy Memory:

🤢 Nausea + 🤮 Vomiting

⬇

💊 Antiemetics stop them by blocking the brain's "vomit signal." 🧠🛑

1. GASTROINTESTINAL SYSTEM DRUG THERAPY

Antiemetics drug

prochlorperazine                  

metoclopramide        Reglan® (also gastroprokinetic)

ondansetron

Anti-diarrheals

Think of anti-diarrheals as drugs that slow down the intestines. 🚽

MOA (How it Works)

1. Decrease Muscle Contractions of the Intestine

• The intestines move more slowly.

• This gives the body more time to absorb water.

2. Bind to Irritants

• Some anti-diarrheals attach to substances that irritate the intestines.

• This helps reduce diarrhea.

Slow the gut = more water absorbed

Use 💩 Loose, Watery Stools (Diarrhea)

• Diarrhea happens when the intestines don't absorb enough water.

• Anti-diarrheals help the body absorb more water, making stools more solid.

Diarrhea = too much water in stool

Side Effect

🚽 Constipation

• If the intestines slow down too much, stools can become hard.

Stops diarrhea, but can cause constipation

Super Fast Study Version

💊 Anti-diarrheals

• ⬇ Slow intestines

• 💧 More water absorbed

• 💩 Treat diarrhea

Side effect:

• 🚽 Constipation

Memory Trick:

"Slow the poop to stop the poop." 💩➡🚽🙂

1. GASTROINTESTINAL SYSTEM DRUG THERAPY

Anti-diarrheals drug

loperamide                          Imodium®

diphenoxylate/atropine       Lomotil®  (schedule V)

Laxatives

Think of laxatives as medicines that help you poop. 🚽

MOA (How They Work)

Different laxatives work in different ways:

🚽 Stimulate Defecation

• Trigger a bowel movement.

➡Enhance Intestinal Motility

• Make the intestines move faster.

• Push stool through the intestines.

💧 Soak Up Water

• Pull water into the stool.

• Makes stool softer and easier to pass.

🧈 Emollient (Mineral Oil)

• Lubricates and softens the stool.

• Helps it slide out more easily.

⚠ Can Be Irritants

• Some laxatives irritate the intestines to make them contract and move stool out.

Use

💩 Constipation Relief

• Used when stool is hard or difficult to pass.

Super Fast Study Version

Laxatives = Help you poop

🚽 Stimulate bowel movement

➡ Move stool faster

💧 Add water to stool

🧈 Soften/lubricate stool

⚠ Some irritate intestines to push stool out

Memory Trick:

"Laxatives = Move it, soften it, or push it out." 💩🚽

1. GASTROINTESTINAL SYSTEM DRUG THERAPY

Laxatives drug

bisacodyl                         Dulcolax® (irritant)

psyllium                          Metamucil® (bulk forming)

polyethylene glycol         MiraLAX®

magnesium citrate          Citroma®

Stool Softeners

What do they do?

💧 They add water to the stool , making it softer and easier to pass .

Use:

💩 Helps with constipation (hard stools).

Side Effect:

🤕 Cramping (stomach cramps)

Easy Memory:

Stool softener = Water in stool = Softer poop = Easier to poop 🚽💧💩

• MOA: adds H2O to stool
  

• Patient teaching/Side effects: cramping

GASTROINTESTINAL SYSTEM DRUG THERAPY Stool softeners drug

docusate sodium             Colace®

docusate calcium       

Antiflatulent Agents

Think of antiflatulents as anti-gas medicines. 💨

MOA (How They Work)

💨 Prevent Gas Buildup

• Help stop gas from building up in the intestines.

🚽 Help Pass Gas

• Make it easier to pass gas (flatus/farting).

Antiflatulent = Anti-gas

Use

😖 Bloating, gas, and stomach fullness

Side Effect

🤢 GI upset

• Mild stomach discomfort or upset stomach

Super Fast Study Version

💊 Antiflatulent

• 💨 Prevents gas buildup

• 🚽 Helps pass gas

Side effect: 🤢 GI upset

Memory Trick:

"Antiflatulent = Gets rid of gas." 💨🙂

• MOA: prevents gas buildup, enables passing flatus
  

• Patient teaching/Side effects: GI upset

1. GASTROINTESTINAL SYSTEM DRUG THERAPY

2. Antiflatulent Agents

drugs

simethicone   Mylicon drops®, Gas-X®