• Peptic ulcer durgs (Most common)
• Adsorbent (only goes into 1st few layers of the GI lining)
• Antiflatulent
• Digestive Drugs
• Antidiarrheal and laxative durgs
• Antiemetic and emetic drugs

• Pain or disxomport in upper abdomen
• common causes include:
  • non-ulcer dyspepsia
  • Gastroesophageal reflux disease
  • Duodenal ulcer
  • Gastric ulcer

• Duodenal + Gastric Ulcers
• a chronic disease
• Group of ulcerative disorders of the GI tract that require acid and pepsin for their formation:
  • Helicobacter pylori-associated ulcers
  • NSAID-induced ulcers (PG inhibition)
  • Stress related mucosal damage (stress ulcers, ie pregnancy)

• Dysphagia
• Weight loss > 3 Kg over 6 months
• persistent vomitting
• Bleeding, Hematemesis, Melena
• anemia
• Fever, Chills

Vomitting blood

• Once ulcer has eaten through blood vessel.
• Now only a very small layer preventing a perferation of the mucosa
• Medical emergency

• PGE, PGI
• inhibited by NSAIDs, therefore their use can lead to ulcers

• Bland diets no longer prescribed
• Moderation if a food/bev makes dyspepsia worse
• Common offenders: coffee, alcohol, orange juice, spicy foods, fatty foods, large meals or eating on the run
• Smoking

Histamine

gastrin

ACh

Act at the proton pump

• Either eradicate H. pylori or restore balance between acid and pepsin secretions
• Systemic antibiotics
• antacids
• Histamine-2(H2) receptor antagonists
• proton pump inhibitors
• peptic durgs (ie Misoprostol, Sucralfate)

• used for ulcers caused by H. pylori
• Use at least 2 antibicrobial durgs and an antacid for 2 weeks
• Antibiotics used include:

metronidazole

tetracycline

clarithromycin

amoxicillin

• combined with an H2 receptor antagonist or proton pump inhibitor to ↓ stomach acid and promote healing

Over the counter medications

Include:

• Magnesium hydroxide and alluminum hydroxide (end result = H₂O)
• Calcium Carbonate (end result = ↑ CO₂)

• work locally in stomach by neutralizing gastric acid
• distributed throughout the GI tract
• Eliminated 1° in feces

• Prescribed to relieve pain and promote healing in PUD
• also used to relieve sympotms of acid indigestion, heart-burn, dyspepsia or GERD
• also used to prevent stress ulcers, GI bleeding, and hyperphosphatemia in kidney failure

• antacids can interfere with the absorption of oral durgs given at the same time
• Thyroxin: antacid prevents absorption, can lead to hypothyroidism again
• Ciprofloxacin: antacid bonds with it and prevents it from working, infection will progress

• commonly prescribed anti-ulcer drugs, including:
• Cimetidine (Tagament)
• Nizatidine (Axid)
• Ranitidine (Zantac)
• Famotidine (Pepcid)

• Block histamine from stimulating the acid-secreting parietal cells of the stomach
• Chemical structure similar to histamine
• compete with histamine for binding in H2 receptors on gastric parietal cells
• Inhibit both meal-stimulated secretion and basal secretion of gastric acid
• promote healing of duodenal and gastric ulcers
• reduce gastric acid production and provent stress ulcers

• interfere with binding thus block acid secretion (reversible competitive inhibitors)

• 90% reductionin basal and food stimulating secretion of gastric acid after a single dose

1. GERD
2. Duodenal ulcers
3. Gastric ulcers

2+3 = Peptic ulcers

Used in treatment of Zollinger-Ellison Syndrome

• require high doses for long periods of time
• Caues impotence and Gynecomastia, due to    anti-antiadronergic effects
• Therefore not used, especially in men, fo treatment of ulcers or GERD

• Treatment of Gastric ulcers
• Active duodenal ulcers and peptic ulcers (H. Pylori)
• Erosive Esophagitis
• GERD

Given orally in Interic-coated form to bypass the stomach and are dissolved and absorbed in the small intestine

• DO NOT CRUSH
• Given Once a day

• Block the last step in secretionof gastric acid by combining with hydorgen, potassium, and ATP in the parietal cells
• Irreversibly inhibit the proton pump (H+K+ATPase) located in the luminal membrane of the gastric parietal cells  

Rapeprazole (Pariet)

Pantoprazole (Rantoloc)

Omeprazole (losec)

 Lansoprazole (Prevacid)

Misoprostol (analog of PGE1)

• stimulates mucous flow and bicarbonate secretion in the stomach
• binds the prostaglandin receptor onthe parietal cell and inhibits HCl secretion
• Very effectiv in NSAID induced ulcers
• (Good for arthritis and POTS disease)

analog of the  gastroprotective prostaglandin PGE1

Protects against NASID induced ulcers, by boosting productionof gastric mucus

DO NOT USE during Pregnancy (prostoglandins important for uterine development, can lead to early uterine ripening) 

There are 3 different COX molecules Cox 1, 2, and 3

• NSAIDs inhibit all of them and therefore all prostaglandins (PGA, PGB, PGG, PGE and PGI)
• PGE and PGI are gastro protective
• Therefore inhibition of these PG may effect GI

Celebrix only inhibits Cox 2, which only inhibits PGA, B and G, therefore does not effect GI and cause ulcers

Peptic ulcer durg

• works locally in stomach by rapidly reacting with HCl to form a thick, paste-like substance that adheres to the gastric mucose.
• "Liquid band-aid"

• synthetic polypeptide, which resembles Somatostatin
• Longer half life than somatostatin

• a peptide released into the GIT by Paracrine cells and D cells
• reduces intestinal fluid secretion
• slows gastrointestinal motility
• inhibits secretion of hormones such as GH, insulin, and Gastrin
• Half life = 3 minutes
• DO NOT give to diabetics, children... anyone b/c of effects on GH & insulin

• aid digestion in pts who are missing enzymes or other substances needed to digest food
• NOT Absorbed, act locally in GIT, excreted in feces
• action resembles the action of the substances they replace

• Dehydrocholic acid - replaces bile
• Pancreatin and Pancrealipase - replace pancreatic enzymes

• Trypsin to digest proteins
• Amylase to digest carbohydrates
• Lipase to digest fats

Pancreatic enzymes given to patientw with pancreatitis and cystic fibrosis

• usually due to alcholism, may also be virally induced
• symptoms: radiating pain in lower right abdomen that moves to back

Include: 

Opioid-related drugs

Kaolin

Pectin

Include:

Hyperosmolar drugs

dietary fiber & related bulk-forming substances

emollients

stimulants

lubricants

Antidiarrheal effect

↓ peristalsis in the intestines 

Include:

Diphenoxylate (Lomotil)

Loperamide (Imodium)

Loperamide:

Not well absorbed

distributed in serum

metabolized in liver

excreted in feces

• Used to treat acute, nonspecific diarrhea
• Loperamide also used to treat chronic diarrhea

• Locally acting OTC antidiarrheals 
• work by adsorbing irritants and soothing intestinal mucosa (irritant is maintained on surface until it's denatured and eliminated)

Not absorbed or distributed

excreted in feces

• Blind with bacteria, toxins, and other irritants of intestinal mucosa
• Pectin ↓ pH in intestinal lumen; provides a soothing effect on irritated mucosa
• Used to relieve milt to moderate diarrhea

• work by drawing water into intestine promoting bowel distention and peristalsis (BM promoted by drawing H₂O into intestine)

Include:

Glycerin

Lactulose

Milk of magnesia

Hyperosmolar laxative used to treat:

• constipation 
• decrease ammonia production and absorption form the intestines in liver disease (due to improper protein metabolism, can lead to hepatic encephally

• high fiber diet = most natural way to prevent or treat constipation
• caused distention of GIT
• not absorbed systemically
• polysaccharides of these drugs are converted into osmotically active metabolites that draw water into colon
• excreted in feces
• increase stool mass and water content promoting peristalsis

Methylcellulose (Citrucel)

Polycarbophil (Fiberall)

Psyllium hydrophilic mucilloid (Metamucil)

Decrease absorption of Digoxin, warfin, and salicylates if given within 2 hrs of these laxatives

(give active drug 1st, then wait 2 hrs)

• also called stool softeners
• Include: Calcium, Potassium, sodium salts of Docusate
• Soften stool and make bm easier by allowing water and fats to penetrate the stool

• also known as irritant cathartics

Include:

Bisacodly (Dulcolax)

Cascara sarada

caster oil

phenolphthalein (ex-lax)

senna (senokot)

• Minimally absorbed
• metabolized in liver
• excreted in urine and feces

• Stimulate peristalsis and produce a bm by irritating the intestinal mucosa or stimulating nerve endings of the intestinal smooth muscle

• prevent vomiting (Emesis)

Types: 

antihistamines

phenothiazines

serotonin receptor antagonists

• Prevent or treat notion sickness and narcotic induced nausea
• Dimenhydrinate (Gravol), 
• meclizine hydrochloride (antivert)

• control severe nausea and vomiting post surgery, viral related, during chemotherapy and radiation treatment
• Block vomiting center in the brain
• Prochlorperazine (Stemetil)
• Promethazine hydrochloride (Phenergan)

• control severe nausea and vomiting post surgery, viral related, during chemotherapy and radiation treatment
• Ondansetron (Zofran)
• Expensive drug
• Used in chemotherapy
• block serotonin stimulation centrally in the chemoreceptor trigger zone (CTZ) and peripherally in the Vagal nerve terminals, both of which stimulate vomiting

Phenteramine (Ionamin)

Sibutramine (Meridia)

Orlistat (Xenical)

• Adrenergic appetite suppressant
• can raise bp
• use for 3-6 months only. 2-5 Kg weight loss

• Blocks serotonin and NE reuptake in the brain
• can raise bp
• use for 3-6 months only. 2-5 Kg weight loss

• essential nutrients needed for normal functioning, growth, and maintenance of body tissues
• DO NOT provide calories (energy)
• needed in very small amounts

• cell synthesis
• especially epithelial tissues
• deficiency leads to keratinization, skin breakdown
• production immune cells (B cells, T cells, etc)
• Vision/xerophthalmia (dry eyes)
• bone growth

• adults: Osteomalacia
• arab women who cover skin
• soft bones

• Children: Rickets
• little sunlight exposure
• bowed legs
• beaded ribs

• Hospitalized alcoholics are routinely given Thiamine on admission for Encephalopathy
• folic acid 1-5 mg daily should always be taken when pregnant to prevent neural tube defects
• Spina bifida

• newborns given dose of vit. K until vit. K producing bacteria establish themselves in their intestinal tract