GI

GI drug classes

Antacids [Calcium or magnesium based, TUMS] Antacids • Aluminum/Magnesium/Calcium based • Often also have simethicone (for anti-gas properties) • Acute relief only, doesn't change amount of acid produced Concern for metabolic issues, rebound hyperacidity and excess calcium {stone formation!} *Don't take within 1-2 hours of other drugs *Don't take with quinolone antibiotics

Proton pump inhibitors [Pantoprazole, Omeprazole] PPI Reduce production of acid in the stomach (about 70%) by blocking an enzyme that controls the proton (acid) pump Enzymes that control the proton pump are found in the parietal cells of the smooth muscle wall Metabolized by the liver [so caution with these patients..] Will cause vitamin deficiency (especially the B vitamins!) Will inhibit clopidogrel effect Try not to use long term (may mask GI cancers) Treats: Examples Pantoprazole (Protonix) Omeprazole (Prilosec) LESS Absorption of: Calcium, B vits/ Folic acid, magnesium Often used as stress ulcer prevention in hospitalized patients Used in the treatment of H-pylori Helpful in GERD/Ulcers too

H2 Antagonist (Histamine blockers) [Famotidine] H2 Antagonists: Famotidine (Pepcid) BLOCK histamine induced gastric acid secretion (also in the parietal cells) [up to 90% of acid secretion is blocked] Give with food to prolong effects *Assess patients for blood in their stool! Body gets used to these over time.

Amino-salicylates [Sulfasalazine] Amino- salicylates: Sulfasalazine • Anti-inflammatory- inhibit production of inflammatory response • Could become nephrotoxic (drink plenty of water) • May cause skin/bodily fluids to turn orange • May be helpful in RA (auto-immune) • Wil cause issues with folic acid absorption (which will lower the immune system function!) Could be used to treat: Chrons Ulcerative colitis RA

Other: Metoclopramide [Reglan] Metoclopramide (Reglan) GI stimulant (move food through faster) by increasing contractility of smooth muscle Helps with nausea and gastroparesis (nausea because it blocks dopamine and serotonin receptors where vomiting receptors are located) Avoid alcohol- will increase side effects Risk for neuro problems (Seizures, tardive dyskinesia, suicidal thoughts, anxiety, hallucinations) (BLACK BOX WARNING!)