Gastrointestinal Pharmacology

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Gastrointestinal Pharmacology by Mind Map: Gastrointestinal Pharmacology

1. Control of Gastric Acidity

1.1. Antacids - Gastric Acid Neutralizers

1.1.1. Carbonates or Hydroxides of: AL Al(OH), Mg Mg(OH)2 Ca CaCO3 Na NaHCO3

1.1.2. Combination Drugs Mylanta Maalox

1.2. Gastric Cytoprotectants

1.2.1. Sucralfate

1.2.2. Misoprostol

1.2.3. Bismuth Compounds

1.3. H2 Receptor Blockers

1.3.1. Cimetidine

1.3.2. Famotidine

1.3.3. Ranitidine

1.4. Proton Pump Inhibitors (PPIs) - "azoles"

1.4.1. Omeprazole

1.4.2. Esomeprazole

1.4.3. Pantoprazole

1.4.4. Lansoprasole

1.4.5. Rabeprazole

1.4.6. Dexrabeprazole

1.5. Antibiotics - H. Pylori eradication

1.5.1. Amoxicillin

1.5.2. Clarithromycin

1.5.3. Metronidazole

1.5.4. Tinidazole

1.5.5. Tetracycline

2. Anti-Diarrheals

2.1. Nonspecific

2.1.1. Absorbants Isaphgula Methylcellulose Kaolin Pectin

2.1.2. Anti-secretory drugs Rasecadotril Bismuth subsalicylate (Pepto-Bismol) Anticholinergics Ocreotide

2.1.3. Antimotility Opioids (link goes to Opioid Mind-map) Codeine Loperamide (does not X BBB) Diphenoxylate

2.2. Probiotics (help with replacing bacterial flora lost in diarrhea) - (you can skip for PT 747)

2.2.1. Lactobacillus sp

2.2.2. Strep. faecalis

2.2.3. Bifidobacterium bifidum

2.2.4. Enterococcus sp.

2.2.5. Others

2.3. Drugs for Inflammatory Bowel Disease (you can skip for PT 747)

2.3.1. 5-ASA compounds Sulfasalazine Mesalazine Balsalazide Olsalazine

2.3.2. Glucocorticoids Prednisolone Hydrocortisone (enema)

2.4. Antibiotics are used for infective diarrhea - See chemotherapy of microbials

3. Laxatives (a.k.a. Purgatives, Cathartics)

3.1. Bulk forming (Dietary fiber)

3.1.1. Bran

3.1.2. Psyllium

3.1.3. Isapghula

3.1.4. Methylcellulose

3.2. Stool Softener

3.2.1. Docusates

3.2.2. Liquid Paraffin

3.3. Stimulant Purgatives

3.3.1. Diphenylmethanes Bisacodyl Sod. picosulfate Phenolphthalein - used over 100 yrs as laxative but now discontinued over concerns of Carcinogenicity - replaced by Bisacodyl & Senna Extracts in OTC preparations

3.3.2. Anthraquinones Senna Cascara sagrada

3.3.3. 5-HT4 Agonist (Chronic Constipation) Prucalopride

3.3.4. Fixed Oil Castor Oil

3.4. Osmotic Purgatives

3.4.1. Mag. sulfate (Epson Salts)

3.4.2. Mag. hydroxide (Milk of Magnesia)

3.4.3. Lactulose

3.4.4. Sod. sulfate

3.4.5. Sod. phosphate

3.4.6. Sod. potassium tartarate

4. Important Side-Effects of Gastric Acid Regulators

4.1. Antacids

4.1.1. Constipation w/Aluminum Hydroxide Sometimes people will take these drugs for diarrhea because they incidentally find Aluminum based Drugs to help the diarrhea.

4.1.2. Diarrhea w/Magnesium hydorxide

4.1.3. Abdominal Distension with Calcium Carbonate

4.1.4. Acid Rebound with CaCO3 when stopped

4.1.5. Milk-Alkali Syndrome

4.2. Cytoprotectants

4.2.1. Misoprostol can cause Diarrhea & is contraindicated in Pregnancy

4.2.2. Bismuth Compounds contraindicated in Aspirin Allergy

4.3. H2-Receptor Antagonists

4.3.1. Ranitidine is recalled by FDA due to NDMA concerns - if you find old stock with patient, it needs to be discarded.

4.3.2. Blocks absorption of other drugs that require an acid-environment to get absorbed in the stomach. Examples - antifungals e.g. Ketoconazole.

4.3.3. At prescription Strength - may cause confusion, hallucinations, delirium, & slurring

4.3.4. Cimetidine Gynaecomastia Galactorrhea

4.4. PPIs

4.4.1. C-diff Infections

4.4.2. Bone Fractures

4.4.3. Stevens-Johnson syndrome/Toxic epidermal necrolysis (TEN/SJS) - Rare Cases

5. Relevance to Rehabilitation Practice

5.1. Relieves Gastrointestinal Problems

5.1.1. Enhances participation

5.2. May cause Fractures even in long run

5.3. Critical Role in Certain Patients

5.3.1. Treatment of Severe Diarrhea in Newborns is life-saving - Wokring with this population, it is important to notify physicians when such diarrhea is noticed

5.3.2. Treatment of Gastric Ulcer in severe trauma & Burns

5.3.3. Patient Education Avoid overuse of laxatives, Antacids Risk of fecal impaction in Spinal Cord Injured patients if opioids are especially used. Avoid Overuse or indiscriminate use of opioids - it can lead to severe consiptation Risk of Fractures with long-term PPI use Risk of C-Difficule with Indiscrimate of use of Antibiotics Other risks and side-effects as noted.

5.4. Precautions in Antacid Usage

5.4.1. Antacids Renal Insufficiency Drug Interactions Milk-Alkali Syndrome

5.4.2. Watch for non-specific but uncharacteristic symptoms & signs during your care

5.5. Educating the client on overuse or underuse (expand other nodes to see connections)

6. Important Side-effects of Anti-Diarrheals

6.1. Overuse leads to constipation

6.2. Opioid drugs except Loperamide will X the BBB & cause CNS depression effects if abused (see Opioid Drug Side-effects at the link)

7. Important Side-effects of Laxatives

7.1. Overuse (Habit Forming) - leads to inability to "poop" without use.

7.2. Can also lead to diarrhea-like situation if used indiscriminately