1. Drugs for Gastrointestinal and Related Diseases
Chapter 10
Drugs for Gastrointestinal and Related Diseases

2. Chapter 10 Definitions Gastrointestinal (GI) tract GI transit time
GERD
Peptic Disease
Ulcer

3. The Gastrointestinal System
Gastrointestinal (GI) tract is a continuous tube
Starts at mouth  pharynx  esophagus  stomach  small intestine  large intestine  ends at anus
Digestive and absorptive process take place in the GI tract

4. GI Transit Time Speeding up transit time = less absorption
Slowing transit time = more absorption

5. Gastroesophageal Reflux Disease (GERD)
Symptoms
Radiating burning or pain in chest
Acid taste
Recurrent abdominal pain
Meal-related esophagitis due to reflux (backflow) of acidic stomach contents through incompetent esophageal sphincter

7. H2 Histamine Receptor Antagonists
Block gastric acid and pepsin secretion
Blocks action of histamine in the stomach- decreasing the production of acid
All available OTC in some strengths
Bedtime dose is most important

8. Therapeutic Uses of ranitidine (Zantac, Zantac 75)
Active duodenal ulcers and benign gastric ulcers
Long-term prevention of duodenal ulcers
Gastric hypersecretory states
GERD
Postoperative ulcers
Preventing stress ulcers
Upper GI bleeding

9. Therapeutic Uses of ranitidine (Zantac, Zantac 75)
Precautions:
Pregnancy-B
Do not crush, chew or break
Side-Effects:
Increase risk of Pneumonia
HA, dizziness, insomnia, decreased sex drive, swollen breast-men, nausea, vomiting, diarrhea, constipation

10. Dispensing Issues of Ranitidine
Look-alike and sound-alike
Ranitidine (H2 antagonist)
Amantadine (for flu)
Rimantadine (antiviral)

11. Dispensing Issues of Zantac
Look-alike and sound-alike
Zantac
Xanax (antianxiety)

12. Proton Pump Inhibitors
An enzyme maintains acidity in gastric secretions by pumping
Acidic hydrogen ions (protons) into stomach
Nonacidic potassium ions out
Proton pump inhibitors (PPIs) block this enzyme, reducing stomach acidity
PPIs must be taken daily

13. omeprazole (Prilosec)
Indicated for short-term treatment of esophagitis, GERD, and hypersecretory conditions
Take before meals
Also indicated for peptic disease caused by bacterium Helicobacter pylori (H. pylori)

14. omeprazole (Prilosec)
Precautions:
Pregnancy Cat C
Do not crush, chew or break
Side Effects:
Fever
Cold symptoms
Stomach pain
Nausea, vomiting, diarrhea
headache

15. lansoprazole (Prevacid)
Indicated for short-term therapy of ulcers and esophagitis
Indicated for long-term treatment of hypersecretory disorders and Zollinger-Ellison syndrome (hypersecretion from a tumor)

16. lansoprazole (Prevacid)
Not for immediate relief of heartburn
Precautions:
1Q24H for 14days, 4 months between treatments
Pregnancy Cat. B
Do not crush, chew or break
Side Effects:
Headache, nausea, stomach pain, diarrhea, constipation

17. esomeprazole (Nexium)
Very similar to Prilosec, but metabolized slower which increases duration of acid suppression
Take on an empty stomach

18. esomeprazole (Nexium)
Not for immediate relief of heartburn
4-8 weeks full glass of water, 1 hr before food
Precautions:
Severe liver disease, low levels of magnesium
Pregnancy Cat B
Side Effects:
Headache, drowsiness, diarrhea, nausea, stomach pain, constipation, dry mouth

19. Agents for GERD Combinations
calcium carbonate-famotidine-magnesium hydroxide (Pepcid Complete)
lansoprazole-naproxen (Prevacid NapraPAC)