Drug

Drug Class

MOA / Drug effects

Used for

SE / Contraindications

Magnesium antacids

(Phillips)

Antacids

See aluminum

See aluminum

Diarrhea

Can cause toxicity if used in pts w/ renal failure (Mg accumulates)

Not for renal / CV disease

Affects the absorption of meds given at the same time.

Sodium Bicarb

Antacids

See aluminum

See aluminum

Alkalosis

Electrolyte disturbances

*Monitor for metabolic alkalosis

Affects the absorption of meds given at the same time.

Famotidine

(Pepcid)

H2 Antagonist antacid

Competes w/ histamine for binding sites on parietal cells

*Causes decreased H+ ion production from parietal cells, which increases the stomach pH (more alkaline)

*Blocks 90%

GERD

PUD

Erosive esophagitis

GI bleed adjunct

Low incidence of SE (<3%)

May increase the secretion of prolactin

HA, lethargy, confusion

Diarrhea, cramps, jaundice

Increased BUN, liver tests

*smoking impairs absorption

Contra: Cimetidine, ketoconazole

Thrombocytopenia (low platelet)

Omeprazole

(Prilosec)

Proton Pump Inhibitor (PPI)- antacid

Irreversibly binds to H+/K+ ATPase. This prevents the movement of H+ ions out of the parietal cell into the stomach, thereby blocking ALL gastric acid secretion

Acute treatment of severe GERD unresponsive to conventional therapy

Only oral form

Treatment of H. Pylori

*require hepatic enzyme tests before & during treat.

Safe for short term, but may predispose pts to GI infections due to the reduction of the normal acid- mediated antimicrobial protection

Contra: warfarin, ketoconazole, ampicillin, digoxin

Pantoprazole

(Protonix)

Proton Pump Inhibitor (PPI)- antacid

Irreversibly binds to H+/K+ ATPase. This prevents the movement of H+ ions out of the parietal cell into the stomach, thereby blocking ALL gastric acid secretion

Short term treatment (up to 8 wks) of erosive esophagitis from GERD

H. pylori treatment

*Oral and IV form

Need hepatic enz. tests

Safe for short term, but may predispose pts to GI infections due to the reduction of the normal acid- mediated antimicrobial protection

Contra: warfarin, ketoconazole, ampicillin, digoxin

Sucralfate

(Carafate)

Mucosal Protectant

Acts locally, not systemically, binding directly to surface of ulcers

Active stress ulcers

PUD

Esophageal erosions

*Take 1hr after other meds, 2 hours before

Has little absorption into blood, so is void of systemic toxicity

Constipation, nausea, dry mouth

Take antacids .5hr  before, 1 hr after

Give on empty stomach, don’t crush

Drug

Drug Class

MOA / Drug effects

Used for

SE / Contraindications

Attapulgite

(Kaopectate)

Adsorbents-

Antidiarrheals

Coat the walls of the GI tract, bind the causative bacteria/toxin & eliminate it

Diarrhea

Can decrease the absorption of digoxin, quinidine, hypoglycemics

Oral anticoagulants (more bleeding)

Toxic w/ methotrexate

Bismuth Subsalicylate

(Pepto Bismol)

Adsorbent –

Antidiarrheal

Coat the walls of the GI tract, bind the causative bacteria/toxin & eliminate it

Diarrhea

A form of aspirin, so use w/ caution in children w/ chickenpox or flu

Temp. darkening of tongue or stool

SE: increased bleeding, constipation, confusion, tinnitus

Belladonna-alkaloid

Anticholinergic

Antidiarrheal

Decrease peristalsis & the muscular tone of the intestine, thus slowing the movement of substances through GI tract

Diarrhea

Not for pts w/ glaucoma, GI obstruction, Myastenia Gravis

~SE: urinary retention, impotence, HA, confusion, blurred vision, photophobia

It’s effects are lowered w/ antacids, MAOI’s, TCA’s and antihistamines

Diphenoxylate w/ atrophine

(Lomotil)

Opiate- antidiarrheal

Acts on smooth muscle of intestinal tract, inhibiting GI motility, decreased peristalsis in intestinal wall

Diarrhea- prescription

Drowsy, NV, constipation, resp. depression, bradycardia, palpitations, hypotension, urinary retention

Common: epigastric pain, dry mouth, anorexia

Contra: can cause additive CNS depressant effect w/ alcohol…

Don’t take if have E. Coli

Loperamide

(Imodium)

Opiate – antidiarrheal

Inhibits both peristalsis in the intestinal wall & intestinal secretion, decreasing the # of stools and water content

Diarrhea- only opiate OTC

Drowsy, NV, constipation, resp. depression, bradycardia, palpitations, hypotension, urinary retention

Common: epigastric pain, dry mouth,

Contra: can cause additive CNS depressant effect w/ alcohol…

Don’t take if have E. Coli

Psyllium

(Metamucil)

Bulk- forming laxative

Increases water absorption, resulting in greater total volume (bulk) of the intestinal contents – helps form formed stools, not liquid ones

Constipation – OTC

Can lower hyperlipidemia

*Take other meds 1 hr before, 2 hours after Metamucil

Impaction, fluid overload, electrolyte imbalances, gas, Mg. toxicity, cramp

~nutrient malabsorption, rash

*Take with lots of water

*Don’t take if abd pain, N/V

Lowers absorption of some drugs

Drug

Drug Class

MOA / Drug effects

Used for

SE / Contraindications

Docusate Sodium

(Colace)

Emollient- laxative

Prescription

Directly lubricate the stool & the intestines, and acts as stool softener

Prevent water from leaking out of the intestines

Constipation – Rx

Skin rash, decreased absorption of vitamins (KADE), lipid pneumonia, electrolyte imbalances

Glycerin

Hyperosmotic laxative

Prescription

Increase the water content of feces by increasing the osmotic pressure in the intestine, which draws in fluid, resulting in distention, peristalsis, and evacuation

Chronic constipation

Used to evacuate bowels before doctor procedures

~ prescription

SE: abd bloating, rectal irritation, electrolyte imbalances

Contra: Can cause increased CNS depression if given w/ barbiturates, opioids, and antipsychotics