git drugs

GIT DRUGS-DR.AKIF A.B

STEP TO PG-MD/MS DR.AKIF A.B

PEPTIC ULCERDISEASE


H2 Receptor

M1Receptor

CCK2

Histamine A-ch Gastrin

G-Cell

Delta cell

Gastrin

ECL

+

+

+

Somatostatin

(-)

Activates H+ /K+ ATPase

HCl

Parietal cell


PROTON PUMPINHIBITORS

1) Most effective Antisecretory drug

2) Half life =30-120min

3) Duration of action = >24hrs

4) Even though PPIs have a short half life but their duration of action is more since they binds with receptors irreversibly and takes around 24hrs for new receptors to form. Thus these are known as Hit and Run Drugs

5) Should be given 30 minutes prior to taking food so that when food is ingested they should be available at the site of action.



Proton pump Inhibitors


DRUG FEATURESLansoprazole -PPI of choice in pregnancy

- Enzyme Inhibitor

Omeprazole - Both Enzyme inducer(CYP1A2) and Enzyme Inhibitor(CYP2C19)

PantoprazoleRabeprazole -most potent and fastest

acting.



-DOC in : 1) Peptic ulcer disease

2) Zollinger ELLison Sx

3) NSAIDs induced Ulcer

4) GERD


NSAIDs induced Ulcer-DOC = PPIs

-Most specific drug =Misoprostol


S/E of PROTON PUMPINHIBITORS

1) Acid is required for proper digestion of food. So when acid is decreased food is not digested properly and leads to:

1) Nausea

2) Flatulence

3) Constipation/ Diarrhoea

2) Pseudomembranous colitis :Decrease in acid leads to survival of bacterias and leads to infection.

3) Hypergastrinemia


Chronic S/E of PROTON PUMP INHIBITORS

-Decrease acid impairs absorption of calcium , Iron, Magnesium and Vitamin B12.

1)Osteoporosis

2)Anemia

3)Hypomagnesemia


DRUG INTERACTIONS OF PPIs

CYP2C9 enzyme activates clopidogrel

PPIs inhibits CYP2C9

Thus PPIs shouldn’t be combined with ClopidogrelSince it will decrease the activation of clopidogrelAnd its Antiaggregant effect.

PPIs + Clopidogrel


ENZYME INDUCERSG =Griseofulvin

P = Phenytoin

R = Rifampicin

S = Smoking

Cell = Carbamazepine

Phone = PhenobarbitoneSTEP TO PG-MD/MS DR.AKIF A.B

ENZYME INHIBITORSVitamin = Valproate

K =ketoconazole

Can = Cimetidine

Cause = Ciprofloxacin

Enzyme =Erythromycin

Inhibition =IsoniazidSTEP TO PG-MD/MS DR.AKIF A.B

1. Which of the following drugs is not used for H. pylori treatment? (LQ)

A Oxytetracycline

B Bismuth compounds

C Amoxicillin

D Mosapride


Ans. D Mosapride

Mosapride is a 5-HT4 agonist used in GERD. Rest of all drugs are used in H.Pylori

Drugs used against H. Pylori are:

1. Amoxicillin2. Clarithromycin3. Tetracycline4. Metronidazole /Tinidazole5. Bismuth subsalicylate6. Omeprazole/ LansoprazoleMonotherapy has failed in treatment of H. Pylori infections. Hence, multidrug regimens given for 7 -14 days are generally used.


Anti-H.pylori AgentsTriple Therapy Quadruple

therapyPPI OD PPI BD

Clarithromycin Metronidazole

Metronidazole or Amoxicillin or Tetracycline

Tetracycline

Bismuth Subsalicylate

- Given for 14days


2. All are antiemetic except (DNB Dec 2009)

A Domperidone

B Metoclopramide

C Cinnarizine

D Ondansetron


Ans. C Cinnarizine

Cinnarizine is used for treatment of vertigo.


Class of emetics Example

Anticholinergics Hyoscine, Dicyclomine

H1 antihistaminicsPromethazine, Diphenhydramine, Meclizine,Dimenhydrinate, Cyclizine,

Neuroleptics

Chlorpromazine, Prochlorperazine, Haloperidol,etc.

Prokinetic drugsMetoclopramide, Domperidone, Ciaspride, Mosapride

5-HT 3 antagonists Ondansetron, GranisetronSubstance-P/Neurokinin Receptor Antagonist (used inchemotherapy induced vomitting)

Aprepitant

Adjuvant antiemetics Dexamethasone, Benzodiazepines, Cannabinoids


3. Most potent anti-emetic is: (DNB June 2010)

A Ondansetron

B Granisetron

C Dolasetron

D Palonosetron


Ans. D Palonosetron

5HT3 antagonist potency sequence {Mnemonics: PGOD}: Palonosetron>Granisetron>Odansetron>Dolasetron

-5HT3 Receptor is present at CTZ area and its inhibition prevents vomiting


ANTI-EMETICS DOC

Type of vomiting DOC

Early onset chemotherapy Induced vomiting

Ondansetron

Late onset chemotherapy Induced vomiting

Aprepitant

Motion sickness Scopalamine >Hyoscine/Dicyclomine

Morning Sickness Pyridoxine + Doxylamine


4. We have two patients. One requires suppression of emesis caused by an anticancer drug that causes a high incidence and severity of vomiting (highly emetogenic drug). Another patient has severe diabetic gastroparesis and gastroesophageal reflux, which requires relief. Which one drug would be suitable for both indications (assuming no specific contraindications)? (LQ)

A Diphenoxylate

B Dronabinol

C Loperamide

D Metoclopramide


Ans. D Metoclopramide

a. Metoclopramide has clinically useful antiemetic and prokinetic actions and would be suitable for either of the patients described in the question.

b. The antiemetic effect arises from blockade of dopamine (and, probably, serotonin) receptors in the brain’s chemoreceptor trigger zone (CTZ).

c. The enhanced gastric and upper intestinal motility probably reflects an enhancement of the expected effects of ACh on muscarinic receptors found on longitudinal smooth muscle in the GI tract.

d. Metoclopramide raises the lower esophageal sphincter tone and relaxes the pyloric sphincter, which hastens gastric emptying.

e. This helps explain its beneficial effects in both gastroparesis and GERD. Importantly, the drug should not be given along with atropine because of its cholinergic properties.


PROKINETICS-Acts by stimulating A-ch which increases motility and peristalsis of GIT

-A-ch stimulates GI Motility

-Dopaminergic(D2) and serotonergic (5HT4) neurons acts by forming synapse with cholinergic neurons

-D2 is an Inhibitory neuron

-5HT4 is an stimulatory neuron.

-CCK and motilin are other receptors which increases GI motility

-Prokinetics acts by inhibiting D2 receptor and stimulating 5HT4, Motilin and CCK.


PROKINETICSD2 Antagonists 5HT4 agonists MotilinReceptor

Agonists

Metoclopromide Cispride Erythromycin

Domperidone Tegaserod

Levosulpiride Mosapride

Itopride


D2 Antagonists-Prokinetic effect

-Extra effects : 1) Antiemetic : Due to D2 antagonist effect at CTZ area

2) Increases Lower Esophageal Sphincter

3) Increases Gastric motility and emptying

4) Increases small intestinal motility

5) No effect on Large Intestine


METOCLOPROMIDE- Prokinetic agent

-D2 Antagonist

-Also 5HT3 antagonist and 5HT4 agonist

-Uses : 1) Gastroparesis : Since it increases Gastric motility

2) GERD : Since it increases LES pressure

3) Post op Ileus : Since it increases motility of small intestine

4) Hiccups

-It is lipid soluble drug. Hence easily crosses BBB and due to D2 Antagonism it causes Hyperprolactinemia, Extrapyramidal S/E.


DOMPERIDONE-Exclusively D2 receptor Antagonism

-Lipid insoluble drug. Hence doesn’t crosses BBB

-Doesn’t cause Hyperprolactinemia, Extrapyramidal S/E.

-Uses similar to Metoclopromide


5. A patient presents with severe abdominal pain. Endoscopy reveals several benign ulcers in the antral mucosa of the stomach. When therapy is started, which will provide the fastest relief of the discomfort with just a single dose? (AIPG 2010)

A Antacids

B Ranitidine

C Misoprostol

D Omeprazole


Ans. A Antacids

a. The typical symptoms of acid-peptic disease are caused by acid.

b. Although antacids seem to have no ability to accelerate ulcer healing, they act almost instantaneously to neutralize acid (provided adequate dosages are given), thereby relieving pain and other discomforts that are due to the acid in a matter of a minute or so.

c. All the other drugs can, to varying degrees, suppress gastric acid secretion and ultimately get the patient near or to a “no acid, no pain” state. However, it takes some time (variable, but clearly longer than it takes for an antacid to work) for other medications to be absorbed and reach blood levels sufficient to suppress acid production and then reduce symptoms.


ANTACIDSTraditional and obsolete Now being used

Calcium carbonate Combination of Aluminium and Magnesium salt

Sodium bicarbonate

- Calcium carbonate and Sodium bicarbonate is not being used due to risk of MILK-ALKALI Syndrome.

-Aluminium salts causes Constipation and Magnesium salts causes Diarrhoea. Hence both are combined to counteract their extra effects.

-Aluminium hydroxide is absolutely C.I in Renal failure

-Magnesium hydroxide can decrease absorption of fat soluble vitamins. Hence should be avoided in elderly patients.


MILK-ALKALI SYNDROMEALKALOSIS

+

HYPOCALCEMIA

+

RENAL FAILURE


6. Which of the following drug is not a gastrokinetic drug:

A Erythromycin

B Domperidone

C Cisapride

D Ampicillin


Ans. D Ampicillin

GASTROKINETIC DRUGS:Metoclopramide DomperidoneCisapride Erythromycin (via motilin receptors)

*Prokinetic drugs act by promoting gastric motility, increase gastric emptying, prevent the retention and reflux of gastric contents and thus provide symptomatic relief.


7. Misoprostol is a: (DNB June 2012)

A Prostaglandin E1 analogue B Prostaglandin E2 analogue C Prostaglandin antagonist D Antiprogestin


Ans. A Prostaglandin E1 analogue

Prostaglandin Analogues:MOAIt is a synthetic analogue of PGE1. It produces significant reduction of basal and food stimulated acid secretion. It is rapidly absorbed undergoes extensive first pass metabolism. Peak effect seen in 60 min and lasts for 3 hours.

INDICATIONThe primary use of PG analogue is in the prevention of NSAID associated gastrointestinal injury and blood loss. Especially in patients in which NSAIDS can not be stopped.

CONTRAINDICATIONInflammatory bowel disease

ADVERSE EFFECTSN/V, diarrhea, abdominal cramps. It can cause bleeding and abortion in pregnancy


NSAIDs induced Ulcer-DOC = PPIs

-Most specific drug =Misoprostol


8. Which one of the following drugs increases gastrointestinal motility? (LQ)

A Glycopyrrolate

B Atropine

C Neostigmine

D Fentanyl


Ans. C Neostigmine

Anticholinesterase drugs increase the level of ACh by protecting it from hydrolysis.Neostigmine is an anticholinesterase drug.

Fentanyl:a. It is an opioid analgesic which leads to constipation by:b. Direct action on GIT/CNS increases tone and segmentation but decreases propulsive movement.c. Spasm of pyloric / ileo-caecal and anal sphincters.d. Decrease in all GIT secretions.f. Central action causing inattention to defecation reflex.

Glycopyrrolate :a. Anticholinergic drug. Hence decreases Gastric motilityb. Potent anti secretoryc. Potent antibradycardia drugd. Lack of central actione. Used in preanesthetic medication


ANTICHOLINERGICSANTICHOLINERGICS IN PEPTIC ULCER DISEASE1) Pirenzepine2) Telenzepine

-Decreases Acid secretion by Inhibiting M1 Receptors

-Not being used much because of other better drugs.


9. Drug implicated for prolonging QT interval in a premature baby is: (AIIMS Nov 2010)

A Domperidone

B Metoclopramide

C Cisapride

D Omeprazole


Ans. C Cisapride

Drugs causing prolonged QT interval / Torsades de pointes

Antiarrhythmic

Antihistaminics

CYP 3A4 inhibitors

Others

QuinidineAmiodaroneProcainamideDisopyramide

TerfenadineAstemizole

KetoconazoleFluconazole

ImipramineAmitriptylineErythromycinHaloperidolCisapride


10. Which of the following is false regarding metoclopramide: (AIIMS May 2009)

A Extrapyramidal side effects

B Promotes gastric motility

C Milk secretion

D Stimulates chemo trigger zone


Ans. D Stimulates chemo trigger zone

b. It speeds gastric emptying by increasing gastric peristalsis and relaxing pylorus and first part of duodenum. It directly acts on CTZ and blocks it.

c. It is a dopamine (D2) receptor blocker and produces extrapyramidal side effects and hyperprolactinemia.


11) Dimethyl polysiloxane acts as: (LQ)

A Defoaming agent

B Local antacids

C Systemic antacids

D Ulcer healing agents


Ans. A Defoaming agent

Dimethyl Polysiloxane (Simethicone) is a silicon polymer, which reduces surface tension and collapses the froth (antifoaming agent).

It is not absorbed from intestine and is pharmacologically inert.

It reduces flatulence.


12) Proton pump inhibitors are most effective when: (LQ)

A Given after prolonged fasting B Along with an H2 blocker C Given with meals D Given before meals


Ans. D Given before meals ‘

Proton pump inhibitors are most effective when taken immediately before a meal, preferably with the morning meal.


13. Ondansetron is a potent: (DNB Dec 2012) AAntiemeticBAnxiolytic CAnalgesicDAntidepressant


Ans. A Antiemetic

a. Ondansetron is a competitive, highly selective antagonist of 5-hydroxy tryptamine (serotonin) subtype-3 (5HT3) receptors.

b. Ondansetron is indicated for the prevention of nausea and vomiting associated with initial and repeat courses of moderately of highly emetogenic cancer chemotherapy, including high-dose cisplatin.


14. Which one of the following drugs has been shown to offer protection from gastric aspiration syndrome in a patient with symptoms of reflux? (LQ) A Ondansetron

B Metoclopramide

C Sodium citrate

D Atropine


Ans. B Metoclopramide

a. Metoclopramide has been used in patients with gastroesophageal reflux disease (GERD); it can produce symptomatic relief without necessarily promoting healing of associated esophagitis.

b. Metoclopramide is indicated more often in symptomatic patients with gastroparesis, in whom it may cause mild to moderate improvement in gastric emptying.


15. The two most common ingredients in over-the-counter antacid combination products are a magnesium salt and an aluminum salt. The rationale for this particular combination is that: (LQ) A. Al salts counteract the gastric mucosal-irritating effects of Mg salts

B. Al salts require activation by an Mg-dependent enzyme

C. Mg salts cause a diuresis that helps reduce systemic accumulation of the Al salt by increasing renal Al excretion

D. Mg salts tend to cause a laxative effect that counteracts the tendency of an Al salt to cause constipation


Ans. D Mg salts tend to cause a laxative effect that counteracts the tendency of an Al salt to cause constipation.

a. Magnesium salts used alone tend to cause a laxative effect. (Indeed, at dosages higher than those used for acid neutralization, magnesium salts are used for their laxative or cathartic effects.) Aluminum (and calcium) antacids, given alone, tend to cause constipation. Combining a magnesium salt with an aluminum (and/or calcium antacid) is an often successful approach to minimizing antacid-induced changes of net gut motility


16. A 55-year-old woman with insulin-dependent diabetes of 40 years' duration complains of severe bloating and abdominal distress, especially after meals. Evaluation is consistent with diabetic gastroparesis. The drug you would be most likely to recommend is (AIPG 2011) A.DocusateB.Dopamine C.LoperamideD.Metoclopramide E.Sucralfate


Ans. D Metoclopramide

Of the drugs listed, only metoclopramide is considered a prokinetic agent, i.e. one that increases propulsive motility in the gut.


METOCLOPROMIDE- Prokinetic agent

-D2 Antagonist

-Also 5HT3 antagonist and 5HT4 agonist

-Uses : 1) Gastroparesis : Since it increases Gastric motility

2) GERD : Since it increases LES pressure

3) Post op Ileus : Since it increases motility of small intestine

4) Hiccups

-It is lipid soluble drug. Hence easily crosses BBB and due to D2 Antagonism it causes Hyperprolactinemia, Extrapyramidal S/E.


17.A patient who must take verapamil for hypertension and angina has become severely constipated. Which of the following drugs would be most suitable as a cathartic? (LQ) AAluminum hydroxideBDiphenoxylate CMagnesium hydroxideDMetoclopramide EMineral oil


Ans. C) Magnesium hydroxide

A cathartic that mildly stimulates the gut would be most suitable in a patient taking a smooth muscle relaxant drug such as verapamil.

Magnesium hydroxide, by holding water in the intestine, provides additional bulk and stimulates increased contractions.


18. Your cousin is planning a three-week trip overseas and asks your advice regarding medications for traveler's diarrhea. A drug suitable for noninfectious diarrhea is AAluminum hydroxideBDiphenoxylate CMagnesium hydroxideDMetoclopramide EMineral oil


Ans. B Diphenoxylate Diphenoxylate and Ioperamide are the traditional traveler's antidiarrheal drugs.

Diphenoxylate requires a prescription in the USA but is less expensive than loperamide.


ANTI-DIARRHEA DRUGSOPIOIDS SOAMTOSTATIN

ANALOGSBILE ACID BINDING RESINS

Loperamide Octreotide Cholestyramine

Diphenoxylate Colesevalam

Colestipol


LOPERAMIDE-Opioid

-Mu receptor antagonist

-Decreases intestinal motility

-Increases anal sphincter pressure

-DOC in : 1) Irritable Bowel Sx

2) Ironitecan induced Diarrhea

-Also used in Traveller’s Diarrhea

-C.I : 1) Children <2yrs

2) Inflammatory Bowel Sx


OCTREOTIDE-Somatostatin analog

-Inhibits secretion of various hormones in GIT like Serotonin, Gastrin ,VIP etc. which leads to decrease GI Secretion and Motility.

-DOC in: HIV associated Diarrhea

-Other uses : 1) Secretory diarrhea

2) chemotherapy induced diarrhea


19. Which of the following drugs or drug groups is not useful in the prevention of nausea and vomiting induced by cancer chemotherapy (LQ) ADexamethasone BDronabinol CKetanserin DOndansetron EPhenothiazines


Ans. C Ketanserin

Ketanserin is an inhibitor of 5-HT 2 receptors and has no antiemetic action. All of the other drugs listed are useful in preventing chemotherapy-induced nausea and vomiting.


Class of emetics Example

Anticholinergics Hyoscine, Dicyclomine

H1 antihistaminicsPromethazine, Diphenhydramine, Meclizine,Dimenhydrinate, Cyclizine,

Neuroleptics

Chlorpromazine, Prochlorperazine, Haloperidol, Phenothiazinesetc.

Prokinetic drugsMetoclopramide, Domperidone, Ciaspride, Mosapride

5-HT 3 antagonists Ondansetron, GranisetronSubstance-P/Neurokinin Receptor Antagonist (used inchemotherapy induced vomitting)

Aprepitant

Adjuvant antiemetics Dexamethasone, Benzodiazepines,

Cannabinoids Dronabinol , Nabilone

20. On your way to an examination you experience that vulnerable feeling that an attack of diarrhea is imminent. If you stopped at a drugstore, you could buy this antidiarrheal drug without a prescription even though it is related chemically to the strong opioid-analgesic meperidine (AIPG 2009) AAluminum hydroxideBDiphenoxylate CLoperamideDMagnesium hydroxide EMetoclopramide


Ans. C Loperamide

a. Aluminum hydroxide is constipating but is not related chemically to meperidine; magnesium hydroxide is a strong laxative.

b. The two antidiarrheal drugs that are structurally related to opioids are diphenoxylate and loperamide.

c. Loperamide is available over-the-counter; diphenoxylate is mixed with atropine alkaloids, and the product (Lomotil, others) requires a prescription.


21. PPI with CYPP450 enzyme inhibiting activity (LQ) AOmeprazoleBRabeprazole CEsomeprazoleDPantoprazole


Ans. A Omeprazole

a. Omeprazole has maximum enzyme inhibiting action on CYPP450 among PPI. The drug can inhibit metabolism of warfarin and therefore can lead to bleeding. Pantoprazole is claimed to have lesser possibility of drug interactions and stable pharmacokinetics.

b. Rabeprazole has best 24 hours pain relief and the drug has marginally better efficacy than other proton pump inhibitors. Esomeprazole is an optical isomer of omeprazole


22) Which of the following drug is wrong about proton pump inhibitors (AIIMS Nov 2010)

APro-drugs BShort acting CLong acting DHigh first pass metabolism


Ans. B Short acting

a. These act by blocking the enzyme Na+K+ ATPase.

b. The drugs are well absorbed orally and in the apex of parietal canaliculi; these drugs get converted into their active moiety.

b. The drugs have high first pass metabolism. They form a covalent bond with their target. Perhaps, that is the reason of their long duration of action.


S/E of PROTON PUMPINHIBITORS

1) Acid is required for proper digestion of food. So when acid is decreased food is not digested properly and leads to:

1) Nausea

2) Flatulence

3) Constipation/ Diarrhoea

2) Pseudomembranous colitis :Decrease in acid leads to survival of bacterias and leads to infection.

3) Hypergastrinemia


Chronic S/E of PROTON PUMP INHIBITORS

-Decrease acid impairs absorption of calcium , Iron, Magnesium and Vitamin B12.

1)Osteoporosis

2)Anemia

3)Hypomagnesemia


23. Drug used in irritable bowel syndrome with constipation is (AI 2012)

A Lubiprostone

B Loperamide

C Alosetron

D Clonidine


Ans. A Lubiprostone Lubiprostone acts by stimulating Cl channel opening in the intestine, increasing liquid secretion in gut and decreasing transit time, therefore used for chronic constipation.

It has also been approved for constipation dominant irritable bowel syndrome in women.


IRRITABLE BOWEL SYNDROME

Constipation Visceral painDiarrhea

Polyethylene Glycol

Loperamide

LubiprostoneAlosetron

Tricyclic Antidepressants

No response

No response


LAXATIVESProbiotics Bifidobacterium

SaccharomycesLactobacillus

Prebiotics Psyllium husk, bran, methyl cellulose

Symbiotics Combination of Pro and Prebiotics

Stimulants Bisacodyl, cascara , senna

Osmotic agents Lactulose, sorbitol, mannitol

Stool softeners Docusate sodium and calcium

Mineral oilsChloride secretory drugs Lubiprostone, Linaclotide


PROBIOTICS-Live organisms that provides benefit to health when taken in adequate amounts.

BifidobacteriumSaccharomycesLactobacillus


PREBIOTICS-Food ingredients that is composed of oligosaccharides, not digestable by humans, but has a beneficial effect on growth of organisms.

Psyllium husk

Bran

methyl cellulose


BRAN


STIMULANTSBisacodyl

cascara

senna

-These irritates colon by inducing inflammation and thus leads to water and solute accumulation.

-Takes 5-6hrs to act

-Absolutely C.I in Intestinal Obstruction

-Cascara and senna can cause Melanosis coli


OSMOTIC AGENTSLactulose

Sorbitol

mannitol

-These are non digestible sugars metabolised into short chain fatty acids which are Osmotic and draws water into intestinal lumen.

-Lactulose when metabolised into Short chain fatty acids makes intestinal pH acidic which turns ammonia into polar ammonium and facilitates its excretion. Hence used in Hepatic Encephalopathy.


STOOL SOFTENERS1) Docusate sodium and calcium ; These are surfactants and softens stools by decreasing Surface tension

2)Mineral oils : They directly enters stools and softens them.


26) Which of the following agents are useful in medical treatment of variceal bleeding? (AI 2011) AOctreotideBPantoprazole CSomatotropinDDexamethasone Flip


Ans. A Octreotide

Management of Variceal Bleeding

A. Prevention of re-bleeding· Non-selective beta blockers (e.g. propanolol)· Variceal band ligation

B. Management of acute bleed· Stabilize with fluids and blood· Octreotide· Vasopressin (Not preferred now)· Balioon tamponade:1. Sengstaken-Blackmore2. Minnesota Tube· Variceal ligation· Variceal sclerotherapy


SUCRALFATE-Made of Sucrose + Aluminium Hydroxide

-acid stimulates its cross linking which produces a polymer which covers the ulcer site

-Given on empty stomach before meals

-Antacids shouldn’t be given along with it since acid is required for its function. Thus a minimum of 30 minutes gap should be maintained between antacids and sucralfate.

-S/E : MC: Constipation


BISMUTH COMPOUNDSThese physically binds with ulcer and promotes mucin and bicarbonate production.

-Uses : 1) Anti H.pylori agent

2) Anti secretory hence used in Traveller’s diarrhea

-S/E : constipation and black discolration of tongue and stools


H2 BLOCKERS-Ranitidine

-Cimetidine = Shortest acting

-Famotidine = Longest acting

-DOC for Prophylaxis of Aspiration Pneumonia in patients undergoing Surgery.

- Maximum ulcer healing effect is seen after 8 weeks.


CIMETIDINE S/E1) Enzyme Inhibitor

2) Anti androgenic actions

3) Gynecomastia and impotence in males

4) Hyperprolactnemia

5) Galactorrhea in females

6) Tolerance

7) hepatotoxicity


CANNABINOID RECEPTORAGONISTS

-Dronabinol

-Nabilone

-Antiemetics

-S/E : Conjunctival congestion


Anti integrin drugs

Anti –TNF drugs +/-

Azathioprine

Mesalamine

Cyclosporine Azathioprine

Resistance Dependence

Steroids

MesalamineSevereMild/

Moderate

MaintenanceInduction

Ulcerative colitis

NR

NR

NR


Anti integrin drugs

Anti –TNF drugs +/-

AzathioprineSteroids

SevereMild/

Moderate

MaintenanceInduction

Crohn’s disease

Anti TNF@

NR

NR –No Response


ANTI-TNF @ DRUGS ANTI INTEGRIN DRUGS

Infliximab Netolizumab

Golimumab Vedolizumab

Certolizumab

Adalimumab


Condition DOCAcute bleeding gastric ulcer PPIs

Acute colonic pseudoobstruction (Ogilvie Sx)

Neostigmine

Aspiration pneumonia prophylaxis in surgical patients

H2 blockers

Dyspepsia PPIs

Gastrinoma PPIs

GERD PPIs

NSAID induced ulcer PPIs

Peptic ulcer disease PPIs

Zollinger ellison Sx PPIs

Stress ulcer PPIs


CONDITION DOC

GERD in pregnancy Antacids or sucralfate

Hemochromatosis Deferoxamine

Hiccups Chlorpromazine

HIV associated secretory diarrhea Octreotide

Irritable bowel Sx diarrhea Loperamide

Irritable bowel Sx constipation Polyethylene glycol

Whipples disease Cotrimoxazole

Xerostomia Cevimeline >pilocarpine

Wilson disease without heaptic decompensation or neuropsychiatric features

Zinc

With hepatic decompensation Zinc +Trientene

With neuropsychiatric features tetrathiomolybdate


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