Drugs affecting the Gastrointestinal System

Anatomy and physiology of the digestive system

Key Points:
• Major function- Chemical and physical break down the food in the nutrients.
• Mouth- Mastication: physical breakdown of food
• Stomach- Physical and chemical mixing of food; extremely acidic environment
• Small intestine- Majority of digestion
• Large intestine- absorption of water, vitamin B, vitamin K, and sodium chloride.
DISORDERS:
1. Gastritis -“itis” inflammation
2. Gastroesophageal reflux disease (GERD)
3. Ulcers (holes and open sores)

2 categories of drugs affecting the digestive system:

1. PPI (Proton pump inhibitors)
⁃ mucosal protection
2. Antacids
⁃ H2 blockers

Peptic ulcer drugs

 Peptic ulcer drugs are aimed at either eradicating H. pylori or restoring the balance between acid and pepsin
secretions and the G.I. mucosal defense
 Presence of H. pylori: positive of peptic ulcer
o Systemic antibiotics
 H pylori is a gram-negative bacterium that’s thought to be a major causative factor. In the formation of
peptic ulcers and gastritis (inflammation of the stomach lining). Eradication of the bacteria helps to heal
ulcers and decrease their recurrence.
• Amoxicillin
• Clarithromycin
• metronidazole
• tetracycline
o H2-receptor Antagonists
 H2 receptor antagonist are commonly prescribed anti-ulcer drugs in the United States. They include:
• cimetidine
• famotidine
• nizatidine
• ranitidine
• Antacids
 Antacids are over the counter medications that are used as adjunct therapy to treat peptic ulcers. They
include:
• aluminum carbonate gel
• calcium carbonate
• magaldrate (aluminum-magnesium complex)
• magnesium hydroxide and aluminum hydroxide
• simethicone

o Proton Pump Inhibitors

  Proton pump inhibitors disrupt chemical binding in stomach cells to reduce acid production, lessening
irritation and allowing peptic ulcers to better heal. They include:
• esomeprazole- nexium (TAB)
• lansoprazole- prevacid (TAB)
• omeprazole- risec (TAB, IV)
• pantoprazole- pantoloc (TAB)
• rabeprazole-
 NOT ALLOWED TO BE CRUSHED

Adsorbent, Anti-flatulence, and digestive drugs

 adsorbent, anti-flatulent, and Digestive drugs are used to fight undesirable toxins, acids, and gases in the G.I.
tract, aiding healthy G.I. function.
o Adsorbent drugs
 Natural and synthetic adsorbents are prescribed as antidotes for the ingestion of toxins,
substances that can lead to poisoning or overdose.
 The most commonly used clinical adsorbent is activated charcoal, a black powder residue that is
obtained from the distillation of various organic materials.
o Anti-flatulent drugs
 Anti-flatulence disperse gas pockets in the G.I. tract. They are available alone or in combination
with antacids.
• simethicone
o Digestive drugs
 Digestive drugs (digestant) a digestion in the patient who is missing enzymes or other substances
needed to digest food. Digestants that function in G.I. track, liver, and pancreas include:
• pancreatin
• pancrelipase
• lipase
• protease
• amylase (pancreatic enzyme)

Obesity drugs
 Obesity drugs are used for patients who are morbidly obese and have health problems that are likely to improve
with weight loss. They are used in combination with a weight management program that includes diet, physical
activity, and behavioral modification.
 Drug therapy should be used to improve health rather than promote cosmetic weight loss.
 2 categories:
• Appetite suppressants (phentermine and sibutramine)
• fat blockers (orlistat)

Antidiarrheal drugs and laxative drugs

o Opioid-related drugs
 Decrease peristalsis (involuntary, progressive, wave like intestinal movement that pushes fecal matter
along) in intestines and include:
• Diphenoxylate with atropine

o Hyperosmolar laxatives
 Work by drawing water into the intestine, thereby promoting bowel distention and peristalsis. They
include:
• glycerin
• lactulose- liquid (common)
 • saline compounds (magnesium salts, sodium biphosphate, sodium)
• phosphate, polyethylene glycol (PEG), and electrolytes
 constipated+ heart problem= senna
o Bulk-forming laxatives
 Which resemble dietary fiber, contain natural semisynthetic polysaccharides and cellulose. These
laxatives include:
• methylcellulose
• polycarbophil
• psyllium hydrophilic mucilloid
• Emollient laxatives
 Also known as stool softener
 Include the calcium, potassium, and sodium salt of docusate
o Stimulant laxatives
 Also known as irritant cathartics, include:
• bisacodyl
• castor oil
• senna
Anti-emetic and emetic drugs
o Anti-emetic
 Given to patients who can’t stop vomiting
 The major anti-emetics are:
 Anti-histamine’s, including buclizine, cyclizine, dimenhydrinate, diphenhydramine, hydroxizine,
Hydrochloride, Hydroxyzine pamoate, meclizine, trimethobenzamide
 phenothiazines, including chlorpromazine, pherpenazine, prochlorperazine maleate,
promethazine, and thiethylperazine maleate
o Emetic
 Used to induce vomiting in a person who has ingested toxic substances.
 Ipecac syrup- used to induce vomiting in early management of oral poisoning or drug overdose.
Summary of Gastrointestinal Drugs
GI disorders drugs
1. Antacids
2. 54H2 blockers
common disorders:
• Gastritis
• GERD, acid reflux, heartburn
• ulcers
ANTACIDS
⁃ short acting
⁃ address overproduction of acid
⁃ Factors of overproduction of acid:
• coffee
• soft drinks
• tea without meal
• smoking
• stress
• chili
• peanut butter
• dairies
⁃ neutralize the stomach lining
H TWO BLOCKERS
 ⁃ “tidine” drugs
⁃ brings down volume of hydrochloric acid production
⁃ gastric parietal cells (where acid is being secreted)> increase of secretion> inflammation/irritation> peptic ulcer
⁃ factors of increase:
• NPO
• Bed rest
• no eating
• (+) pain
⁃ take 30mins before meals
⁃ wait for 2hrs after meal if already eaten
⁃ patient education:
• do not overeat
• small frequent eating
• no stress at all
• no smoking
• no to NSAID drugs
Proton Pump Inhibitors (PPI)
⁃ last drug of choice
⁃ the most effective drug in addressing gastrointestinal disorders
⁃ “prazole” drugs
• omeprazole
• ezomeprazole
• pantoprazole (3 P’s)
⁃ prevent holes: stress ulcer prophylaxis
⁃ porous bones: regular bone density test (given along calcium and VD- for absorption of calcium)
⁃ possible GI infection: Blood test (C-Diff)
⁃ MOA: inhibits gastric secretions in gastric parietal cells
⁃ Take it before meals