RP

Gastrointestinal Pharmacology and Related Topics (Video Notes) - 150 VOCABULARY flashcards

Antacids

  • Mechanism: neutralize excess stomach acid to provide fast relief from heartburn and indigestion; act within gastric contents to raise pH.
  • Common compounds: aluminum hydroxide, magnesium hydroxide, calcium carbonate.
  • Brand examples: Mylanta, Maalox.
  • Usage: for mild, occasional stomach discomfort and acid-related symptoms.

H2 Receptor Antagonists (H2 Blockers)

  • Description: histamine-2 receptor antagonists; decrease stomach acid production.
  • Examples mentioned: Bramadine, Ripexin (note: names from transcript may be misspelled).
  • Effects: effective in treating GERD and used prophylactically to prevent acid-related issues.

Proton Pump Inhibitors (PPIs)

  • Mechanism: suppress gastric acid by irreversibly inhibiting proton pumps in stomach lining cells, reducing acid secretion.
  • Examples listed: Omeprazole, Esomeprazole (Nexium), Bentoprazole (likely Pantoprazole; transcript includes Bendoprazole).
  • Key points:
    • Omeprazole is widely used.
    • Esomeprazole is Nexium.
    • PPIs are first-line treatments for GERD and help promote healing of the gastric mucosa.
    • PPIs start to help heal gastric mucosa with continued use.

Protective Agents

  • Agents mentioned: sucralfate; paraffin (paraffin is a liqui d or solid used historically).
  • Notes:
    • Sucralfate acts as a protective coating over ulcers and erosions.
    • Paraffin (paraffin) is less commonly used nowadays; described as a large horse-pill in nursing homes.

NSAIDs and Ulcer Prevention

  • Point: NSAIDs are associated with ulcer risk; when NSAIDs are necessary, protective agents are given to prevent ulcer disease.
  • Implication: co-prescription or concomitant acid-suppressive or protective therapy may be used to mitigate NSAID-related gastric injury.

Helicobacter pylori Infection

  • H. pylori: common stomach bacteria.
  • Treatment approach: requires multiple antibiotics (e.g., clarithromycin) along with acid suppression to enhance healing.
  • Acid suppression role: used alongside antibiotics to improve treatment efficacy for H. pylori.
  • Diagnostic tests mentioned:
    • Breath test (urea breath test) or spit test.
    • Endoscopy with biopsy for testing.
  • Notes: therapy aims to eradicate infection and promote healing of gastric mucosa.

Bismuth Compounds

  • Example: Pepto-Bismol.
  • Use: over-the-counter relief for diarrhea, nausea, upset stomach; commonly used for gastrointestinal upset.

Lifestyle Modifications

  • Emphasis: lifestyle changes are a major component of management.
  • Common triggers to modify or avoid:
    • Stress
    • Smoking
    • Spicy foods
    • Alcohol
  • Additional point: excessive use of certain medications can contribute to ulcers; lifestyle changes can reduce dependence on medications.

Supportive Care and Anti-emetics

  • Aim: relieve symptoms, improve quality of life during treatment, monitor for complications.
  • Focus area: nausea and vomiting management (antiemetics).
  • Categories:
    • Serotonin antagonists: block serotonin receptors in the chemoreceptor trigger zones to prevent nausea (e.g., associated with chemotherapy).
    • Dopamine antagonists: act centrally as antiemetics.
  • Practical notes on antiemetics:
    • Nausea management can be challenging; personal perspective included in transcript.
    • Extrapyramidal symptoms (EPS) can occur with certain dopamine antagonists; risk factors include acute dystonia, akathisia, and parkinsonian symptoms.
    • Metoclopramide (Reglan) is mentioned with a caution about EPS; dose reference given as "ten" (transcript notes: dose is $10$, units not specified in transcript).
    • Headaches frequently occur during antibiotic therapy (additional aside from antiemetics).

Laxatives and Bowel Management

  • Mention: continuous monitoring is crucial.
  • Laxatives discussed:
    • Bulk-forming laxatives: increase stool mass by absorbing water and expanding in the intestine.
    • Osmotic laxatives: also contribute to stool mass and water retention to facilitate bowel movements.
  • Practical note: part of supportive care to manage constipation or bowel regimen during treatment.

Summary of Key Concepts and Connections

  • Antacids provide immediate symptomatic relief by neutralizing acid; PPIs provide longer-term control by inhibiting acid production, with protective agents and H2 blockers serving complementary roles.
  • GERD management often involves PPIs as first-line therapy, with H2 blockers and antacids providing additional options depending on severity and response.
  • NSAID-induced ulcers are a significant risk where protective strategies are used to mitigate damage when NSAIDs are necessary.
  • H. pylori infection requires a combination of antibiotics and acid suppression to eradicate the bacteria and promote mucosal healing; diagnostic testing includes breath/spit tests and endoscopy with biopsy.
  • Bismuth compounds offer symptomatic relief for gastrointestinal upset and are widely available OTC.
  • Lifestyle factors (stress, smoking, spicy foods, alcohol) significantly influence gastric ulcer risk and treatment outcomes; behavioral changes can reduce reliance on medications.
  • Anti-emetic therapy includes serotonin and dopamine antagonists; awareness of EPS is important when using dopamine antagonists such as metoclopramide (Reglan); dosing considerations may appear in clinical notes as $10$ (unit unspecified) in the transcript context.
  • Supportive care emphasizes symptom relief, quality of life, and monitoring for complications, with laxatives playing a role in maintaining bowel function during treatment.