DRUGS for GERD and
PUD
Key takeaways:
* Gastroesophageal reflux disease (GERD)
occurs when stomach acid enters the
esophagus. Peptic ulcers are open sores that
can form in the lining of the stomach or the
first part of the small intestine.
* Both GERD and ulcers can cause similar
symptoms, like burning upper abdominal
pain and nausea. But there are some
differences in symptoms that may help you
tell them apart.
* GERD is much more common than an ulcer,
and most people with GERD don’t have an
ulcer. But some people with an ulcer will also
have GERD, because increased stomach acid
can sometimes lead to ulcers.
What are the effects of these
drugs to peptic ulcer disease?
* Proton pump inhibitors are a
class of drugs commonly
prescribed to treat peptic ulcers.
They work by inhibiting the
proton pump in the stomach
lining, which reduces the
production of stomach acid. This
decrease in acid production helps
to promote healing and prevent
the recurrence of ulcers.
How does peptic ulcer
disease develop?
* The most common causes of
peptic ulcers are Helicobacter
pylori (H. pylori) infection and
nonsteroidal anti-inflammatory
drugs (NSAIDs). Other causes of
peptic ulcers are uncommon or
rare. People with certain risk
factors are more likely to develop
ulcers.
ANTACIDS
ANTACIDS
* Most effective antacids available are
combinations of aluminum hydroxide,
magnesium oxide or hydroxide,
magnesium trisilicate, and calcium
carbonate.
* Aluminum containing = constipation
* Magnesium c0ntaining = diarrhea
* Simethicone = a defoaming agent
that breaks up gas bubbles in the
stomach, reducing stomach
distention and heartburn.
H2 RECEPTOR
ANTAGONISTS
H2 ANTAGONISTS
* Used to treat:
* GERD
* Duodenal ulcers
* Pathological hypersecretory
conditions: Zollinger – Ellison
syndrome
* Used for the prevention and
treatment of stress ulcers in critically
ill patients
* CI in acute upper GI bleeding and
hyperparathyroidism
H2 ANTAGONISTS
* Cimetidine (Tagamet)
* Duodenal and gastric ulcers
* Administer with food.
* Gynecomastia
* Antacids may be
administered 1 or 2 hours
after administration of
cimetidine.
* Famotidine (Pepcid)
* Administer with food
* Nizatidine (Axis)
* May be given with or without
food.
* Ranitidine (Zantac)
* Administer with food.
ANTISPASMODIC AGENTS
* Anticholinergic agents
* They decrease GI motility and
reduced secretions.
* Reduced perspiration
* Reduced oral and bronchial secretions
* Mydriasis (dilation of pupils) with
blurring of vision
* Constipation
* Urinary hesitancy or retention
* Tachycardia, possibly with
palpitations
* Mild transient postural hypotension
* Mental confusion, delusions, etc.
ANTISPASMODIC
* Used to treat irritable bowel
movements, biliary spasms, mild
ulcerations, colitis, diverticulitis,
pancreatitis, infant colic, PUD
* Administered with food or milk
to minimize gastric irritation.
* Atropine sulfate
* Hyoscine (Buscopan)
GASTROINTESTINAL
PROSTAGLANDIN
* Misoprostol (Cytotec)
* Inhibits gastric acid and pepsin
secretion thereby protecting the
stomach and the duodenal lining
against ulceration.
* Used to prevent and treat aspirin or
NSAID-induced gastric ulcers.
* Induces uterine contraction = CI for
pregnant women
* With food during NSAID therapy
GASTRIC ACID PUMP
INHIBITORS (Proton Pump
Inhibitors)
* Inhibits gastric secretion by inhibiting
gastric acid pump of the parietal cells
of the stomach.
* Omeprazole
* Lanzoprazole
* Esomeprazole
* Pantoprazole
* Rabeprazole
* Administer before meals.
* Swallow whole.
* Maintain patient’s state of
hydration; include roughage in
diet.
COATING AGENT
* Sucralfate (Carafate)
* Forms a complex that adheres to
the crater of the ulcer, protecting
it from aggravators like acids,
pepsin, bile salts.
* I: duodenal ulcers
* 1 tab before each meal
* Interferes with absorption of
tetracyclines. Give tetracyclines 1
hour before or 2 hours after.
* Inhibits absorption of omeprazole and
lanzoprazole. Administer these drugs
30 minutes before sucralfate.
PROKINETIC AGENTS
* Stimulates GI motility by stimulating
cholinergic nerve fibers.
* Cisapride (Propulsid)
DRUGS for
CONSTIPATION and
DIARRHEA
Key takeaways:
* The two do not commonly occur together, but
the alternating nature of constipation and
diarrhea is a hallmark sign of irritable bowel
syndrome (IBS).
* Constipation is passing stool fewer than three
times a week. Stools are generally hard, lumpy,
or dry, which makes them difficult or painful to
pass.
* Meanwhile, diarrhea involves passing loose,
watery stools at least three times a day.
LAXATIVES / CATHARTICS
* STIMULANT LAXATIVES / CHEMICAL
STIMULANTS
* Act directly on the intestines, causing
irritation that promotes peristalsis and
evacuation.
* Oral = action lasts for 6-10 hours
* Rectal = 60 to 90 minutes
* Cascara
* Senna (Senokot)
* Castor Oil – used when thorough
evacuation of the intestine is desirable
* Blocks absorption of fats and may lead
to constipation from GI exhaustion
* Bisacodyl (Dulcolax) – the drug of choice
to empty the bowel before surgeries or
diagnostic tests
SALINE LAXATIVES
* Magnesium citrate
* Magensium hydroxide
* Sodium phosphates
LUBRICANT LAXATIVES
* They lubricate the intestinal wall and
soften the stool, allowing smooth
passage of feces.
* Onset of action is 6 to 8 hours.
* If used frequently, they may inhibit
absorption of fat-soluble vitamins.
* Mineral oil
BULK-PRODUCING
LAXATIVES
* Cause water to be retained in the
stool thereby increasing its bulk and
stimulating peristalsis.
* Must be taken with full glass of water
* Onset of action: 12 – 24 hours or
longer
* Polycarbophil
* Psyllium
FECAL SOFTENERS or
WETTING AGENTS
* Docusate sodium (Colace)
* Docusate calcium (Surfak)
* Draw water into the stool making it
softer.
ANTIDIARRHEAL
* Loperamide
* Inhibits peristalsis.
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