GI Drugs

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GI Drugs by Mind Map: GI Drugs

1. Ipecac

2. Antimuscarinics

3. H1-Receptor Antagonists

4. 5-HT3 Receptor Antagonists

5. NK1 Antagonist

6. Treatment of Heartburn, GERD, and PUD

6.1. Mucosal Protective Agents

6.1.1. Sucralfate Treat and Prevent PUD Forms sticky polymer in acidic environment and adheres to ulcer site, forming a barrier Can interfere with other drug absorption

6.1.2. Chelated Bismuth Protects ulcer crater and allows healing Some activity against H. pylori :bangbang: Black Stools, Constipation :bangbang:

6.2. Antibiotics

6.3. Acid-reducing therapeutics

6.3.1. Proton Pump Inhibitors Omeprazole **24 hour** prevention of gastric acid release **48 hours** of decreased acid secretion

6.3.2. H2-Receptor Antagonists Slide Cimetidine Famotidine Ranitidine Nizatidine

6.3.3. Antacids Mechanism of Action Antacid Neutralizing Capacity (**ANC**) Systemic Antacid Sodium Bicarbonate Nonsystemic Antacid (**Maalox**) Aluminum Hydroxide + (**Mylanta**) Magnesium Hydroxide Combinations (**Tums**) Calcium Carbonate Contraindications **Tums** May cause constipation **Maalox / Mylanta** are contraindicated in patients with **impaired renal function**

6.3.4. Anticholinergics Pirenzipine Muscarinic M1 ACh-R Antagonist Blocks gastric acid secretions Anticholinergic Side Effects

6.3.5. Prostaglandins Misoprostol Decreased gastric acid release Stimulates prostaglandin GPCR-inhibitory pathway NSAID-induced injury Contraindications Side Effects

6.4. Anti-H.pylori Therapy Antibiotic Ulcer Therapy

6.4.1. Disrupt bacterial cell wall Bismuth Amoxicillin Metronidazole in place of Amoxicillin resistance or intolerance

6.4.2. Inihibit protein synthesis Clarithromycin Tetracycline

6.4.3. **Triple Therapy**: 7-14 days 80-85% effective 1. PPI 2. Amoxicillin/Tetracycline 3. Metronidazole/Clarithromycin

6.4.4. **Quadruple Therapy**: Add Bismuth to Triple Therapy

7. Canabinoids

8. Phenothiozines

9. Upper GI Disorders

9.1. GERD

9.2. PUD

9.3. Duodenal Ulcer

9.4. Nausea

9.5. Emesis

10. Emesis

10.1. Inducing Emesis: Syrup of Ipecac

10.1.1. Syrup of Ipecac Stimulates serotonin release from EC cells :arrow_right: activates afferent vagus

10.1.2. Indications / Acceptable Use No alternative therapy to decrease GI absorption Can be administered within 30-90 minutes of ingestion

10.2. Vestibular Anti-Emetics

10.2.1. Histamine - H1 Diphenhydramine Motion-induced nausea mediated by vestibular apparatus

10.2.2. Muscarinic - M1 Scopolamine Surgeries affecting Vestibular systeem Vestibular sensitivty with opioid administration Movement after surgery

10.3. PONV Antiemetics

10.3.1. Neuroleptics / Typical Antipschotics Phenothiazines Metoclopramide Given with IV dexamethasone for PONV Prokinetic Properties :arrow_right: esophageal clearance and gastric emptying Droperidol FDA BLACK BOX WARNING

10.3.2. Serotonin 5HT3-R antagonists Contraindications: 1. Congenital Long QT Syndrome 2. SSRI/SNRI - risk of Serotonin Syndrome Dolasetron Ondansetron

10.3.3. Corticosteroids Dexamethasone

10.3.4. Aprepitant 24 Hour Duration Combines with 5HT3 antagonist and dexamethasone if necessary

10.3.5. Dronabinol Medical Marijuana, for refractory chemo NV

10.4. Emesis Mechanisms

10.4.1. Emesis: Key Neurotransmitter Systems Serotonin Neurokinin Histamine - H1 Diphenhydramine Dopamine - D2 Muscarinic - M1 Scopolamine Opioid - Mu GABA Cannabinoid Receptors

10.4.2. Antiemetics Graphic Antiemetic Therapeutic Sites

10.4.3. Vomiting Center Vomiting Center