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Pharmacology
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🍽️ Week 11 — Gastrointestinal (GI) Drugs Study Guide

  • Assess renal & cardiac status (Na retention risk).

💢 H₂ Receptor Antagonists (-tidine)

Examples: Famotidine (Pepcid), Ranitidine (Zantac), Nizatidine (Axid), Cimetidine (Tagamet)

Adverse Effects: Headache, dizziness, diarrhea/constipation, rare blood dyscrasias.

‣
Read: rare blood dyscrasias. ⇒ this could look like anemia (fatigue, and pale color) or risk for bleeding.

Rare blood dyscrasias are conditions where the bone marrow produces an abnormal number or type of blood cells. Symptoms vary but can include fatigue, shortness of breath, easy bruising or bleeding, and an increased risk of infection or blood clots. Treatment depends on the specific condition and can involve medication, blood transfusions, or a stem cell transplant. 

In the case of rare blood dysplasias, it usually means that the bone marrow produces blood cells that are abnormal in shape, number, or function. Sometimes you can have low levels of red blood cells (like in anemia), and sometimes you might have abnormalities in all blood cell lines, including white blood cells and platelets. So it can vary, but it’s more about the abnormal development and function of those cells rather than having too many or too few.

  • Separate from antacids ≥ 1 hour. (Is not this drug fault, it’s antiacids that affect other drugs absortion)

    • ⚠️ Interaction: Cimetidine ↔ warfarin, phenytoin, theophylline, caffeine, etc.

😌 Tranquilizers (Old Therapy, we don’t use it usually)

Examples: Clidinium bromide (Quarzan)

Action: Reduce vagal stimulation & anxiety.

🟪 ANTIEMETIC / VOMITING CONTROL DRUGS

🤢 Antiemetic Classes

Class
Examples
Use
Side Effects / Notes
Antihistamines
Meclizine, Promethazine These are 1st generation antihistamines.
Motion sickness, vertigo
Drowsiness, dry mouth
Anticholinergics
Scopolamine (patch) Think ScopLamINE
Motion sickness
Dry mouth, blurred vision
Dopamine Antagonists
Metoclopramide (Reglan), Prochlorperazine (Compazine)
Chemo, post-op, toxins
EPS, hypotension
Benzodiazepines
Lorazepam (Ativan)
Chemo-related anxiety + nausea
Sedation
Serotonin (5-HT₃) Antagonists
Ondansetron (Zofran)
Chemo, post-op, radiation
Headache, constipation
Glucocorticoids
Dexamethasone
Chemo combo therapy
Hyperglycemia, insomnia
Cannabinoids
Dronabinol (Marinol)
Chemo nausea, appetite stimulus
Drowsiness, mood changes
Miscellaneous
Metoclopramide, Tigan
Post-op, GERD, toxins
Drowsiness, EPS risk ↑ in children

🟧 MOTILITY CONTROL DRUGS

💩 Laxatives & Cathartics

Type
Examples
Mechanism / Use
Key Notes
Osmotic (Saline)
Lactulose, Polyethylene glycol (MiraLax)
Pull water into colon for rapid Bowel Movement.
Risk of electrolyte imbalance

💦 Antidiarrheals

Class
Examples
Mechanism / Use
Nursing Notes
Opiates / Opiate-Related
Diphenoxylate + Atropine (Lomotil), Loperamide (Imodium)
Slow peristalsis → more water absorption
Avoid in children/elderly; risk dependence
Miscellaneous
Rifaximin, Cholestyramine, Probiotics
Treat infectious/traveler’s diarrhea
Assess hydration & electrolytes

🟩 INFLAMMATORY CONTROL DRUGS

💊 Inflammatory Bowel Disease (IBD)

Definition: Chronic inflammation of bowel:

  • Ulcerative Colitis → colon mucosa
  • Crohn’s Disease → distal small intestine

Drug Classes:

Class
Examples
Action / Use
5-Aminosalicylic Acid (5-ASA)
Sulfasalazine (Azulfidine), Mesalamine
↓ bowel inflammation
Glucocorticoids
Prednisone, Hydrocortisone
Control acute flare-ups
Immunosuppressants
Azathioprine (Imuran), Methotrexate (MTX)
Prevent recurrence
Biologic Response Modifiers
Infliximab (Remicade), Adalimumab (Humira)
Block TNF cytokines

⚖️ Irritable Bowel Syndrome (IBS)

Definition: Functional bowel disorder with alternating diarrhea/constipation, cramping, bloating.

Treatment: Supportive + symptomatic.

Subtype
Drugs
Mechanism
IBS-D (Diarrhea)
Dicyclomine (Bentyl), Loperamide (Imodium), Alosetron (Lotronex)
Reduce spasms, slow motility
IBS-C (Constipation)
Bulk laxatives, Lubiprostone (Amitiza), Linaclotide (Linzess)
↑ intestinal fluid & motility

🧾 SUMMARY — Drugs by Condition

Condition
Main Drug Classes
Peptic Ulcer Disease
PPIs, H₂ Blockers, Antacids, Antibiotics, Anticholinergics, Misoprostol, Sucralfate
GERD
PPIs, H₂ Blockers, Antacids, Anticholinergics, Sucralfate
Vomiting (Emesis)
Antiemetics (Antihistamines, Anticholinergics, Dopamine & Serotonin Antagonists, etc.)
Constipation
Laxatives (Bulk, Stimulant, Osmotic, Emollient, Chloride Activator)
Diarrhea
Antidiarrheals (Opiates, Adsorbents, Miscellaneous)
IBD
5-ASA, Glucocorticoids, Immunosuppressants, Biologic Agents
IBS
Anticholinergics, Laxatives, Antidiarrheals (by subtype)