Drug MOA Indication CI/ADR Others

Rifaximin -Blocks absorption and Hepatic encephalopathy Diarrhea and Used with lactulose for hep
production of ammonia dehydration encephalopathy.
-eradicates ammonia -Poorly absorbed abx
producing bacteria
Osmotic laxatives (Mg Non-absorbable sub Mg- Acute constipation, -Mg- prolonged use Mg (OH)3 AKA milk of magn
(OH)3 and Mg citrate cpds, that draw water into prevention of chronic hypermagnesemia in -hemolysis and GI bleed ind
lactulose, polyethylene intestinal lumen constipation renal insufficiency hyperammonemia
glycol PEG) distention peristalsis -PEG- for complete -diarrhea -laxatives increase stool vol
GI cleansing before -misused by Bulimia pts luminal water content, and
Lactulose- used by colon endoscopy -overusemet alkalosis directly stimulate motility
bacteria  produces Lactulose- for chronic &secretions.
FA acidifies constipation and hep They do not increase phas
ammonia gets trapped encephalopathy segmental contractions
and excreted
Surfactant agents (stool Facilitate penetration Oral or rectal
softeners) of stool by water and
-docusate lipids
-enema
-glycerin suppository
Senna and bisacodyl Stimulates enteric constipation -Chronic use- melanosis Stimulant laxative (catharti
(stimulants) nervous system and coli (brown pigmentation) stimulation)
colonic secretions -overusemet alkalosis
Loperamide, Diphenoxylate Bind mu opiate Diarrhea -Constipation- can be Loperamide- High first pass
receptors in colonic avoided by titration of Does not cross BBB
myenteric plexus-> the drug. No respiration, sedation, no
inhibit Ach release-> -Don’t use in patients Diphenoxylate-
slow peristalsis-> with bloody diarrhea or Crosses BBB, less extensive
increased transit time-> fever. met; give with atropine to
increased H2O discourage abuse
absorption.
-increase colonic phasic
segmenting activity
Psyllium, Pectin, Bulk forming agents- constipation bloating Psyllium- indigestible hydrop
methylcellulose absorb water and colloid
intraluminal contents to
form stools
distention peristalsis
Bismuth subsalicylate -Stimulates intestinal Antispasmodic-
fluid absorption->reduce diarrhea
diarrhea Travelers diarrhea
-Inhibits PG synthesis->
reduce hypermotility
Bile acid sequestrants Bind bile acids-> bile acid diarrhea
-cholestyramine
Aprepitant Neurokinin-1 receptor Chemo induced N+V No ADR Substance P binds NK1 in ar
antagonist posterema
Substance P antagonist -crosses BBB
-often combined with 5HT3
antagonist to prevent N, V
Octreotide Somatostatin analog -Chemo induced Cholelithiasis due to CCK Inhibits splanchnic vasodilat
Inhibits ECL, G cells diarrhea inhibition hormones
-ZE Cramps
-Secretory diarrhea Steatorrhea
due to VIPoma and
carcinoid
-variceal bleeding
Misoprostol PGE1 analog NSAID induced ulcers Diarrhea
abortifacient
Methylnaltrexone Peripheral Mu opioid Constipation Does not cause withdrawal s
receptor Treat constipation in because it acts peripherally
antagonistcounteract pts taking opioids
s inhibitory effect of
opioids on peristalsis
Lubiprostone Chloride channel constipation Nausea and HA
agonist chloride
efflux into intestinal
lumen, followed by
water and sodium,
 increases intestinal
secretions
Sofosbuvir RNA dependent RNA pol HCV Direct acting antiviral (DAA
inhibitor prevents
viral replication and
assembly
Simeprevir HCV protease inhibitor HCV DAA
Ledispavir Ns5A inhibitionno HCV DAA
replication and assembly
sucralfate Binds the base of Heals ulcers Does not prevent reoccurr
mucosal ulcers and of ulcers
protects against acid
Metoclopramide Dopamine (D2) -Upper GI Prokinetic -CI-small bowel Does not treat PUD
antagonist in area --antiemetic- chemo obstruction (upper GI -increases esophageal perist
postrema and GIT induced vomiting prokinetic effect of the increases LES, enhances gas
D2 in GI- increases -Tx GI motility drug increased emptying
eso peristalsis, disorders, delayed pressure against a -Drug interaction with digox
increases LES emptying due to post-op downstream diabetic drugs
pressure> enhances surgeries, -diabetic obstruction
gastric emptying gastroparesis, nausea perforation
( prokinetic) and vomiting ADR- diarrhea
D2 in area posterema- (prokinetic effect)
antiemetic -drowsiness
-depression
-extrapyramidal effects-
dystonia , akathisia,
tardive dyskinesia with
chronic use due to D2
blockade
-NMS(fever, rigidity,
AMS, autonomic
instability,
rhabdomyolysis-
increased CK))
-increased prolactin
-galactorrhea,
impotence, menstrual
disorders, gynecomastia
-Torsade’s
Ondansetron 5HT3 R antagonist on Chemo induced or post- 1. Constipation Prevent nausea and vomiting
vagal afferent on the op vomiting (when 2. HA to GI upset
GI tract Vagus stimulated) 3. Dizziness
4. Prolong QT
interval-
torsade’s (all
5HT3 blockers)
5. Serotonin
syndrome(rigidity,
hyperthermia,
confusion)

1st gen H1 blockers Cross BBB and Block H1 Vestibular nausea Sedation H1 is Gq, H2 is Gs
(diphenhydramine, (Gq) in vestibular Antimuscarinic
meclizine, hydroxyzine) system
scopolamine Muscarinic antagonist Vestibular nausea
(motion sickness)
Cimetidine, ranitidine, Reversible H2 R -First line for Cimetidine- H2 are Gs.
famotidine, nizatidine blockers inhibit acid nocturnal acid anticholinergic effects, H2 are located in basolatera
secretion by parietal secretion inhibits cyp 450-prolongs parietal cells
cells -GERD half-lives of warfarin Cimetidine is antiandrogenic
-Gastric and duodenal Also inhibits DHT to
ulcers androgen receptor
-Fq heartburn and daily binding and inhibits met
regimen of estradiol-
gynecomastia, impotence,
elevated prolactin
(galactorrhea)
Decreases creatnine
clearance
Omeprazole Irreversibly inactivate Night-time as well as -increased risk for Rapid sx relief and faster
(PPIs) K/H ATPase. Inhibits meal stimulated acid c.diff. healing
acid secretion in secretion -increased risk for resp Gastrinoma is due to over
response to all three Erosive and non-erosive infection and nosocomial stimulation of ECL, and
(histamine, gastrin and GERD pneumonia pariental cells
vagal stimulation -preferred in -decrease absorption of Triple therapy: PPI,
treatment of NSAID calcium, magnesium and clarithromycin, and amoxicil
induced ulcers iron (all require acid metronidazole
-gastrinoma (zE) for absorption) -PPIs block the common pat
- H.pylori erradication Increased risk of op hip
fx