Clopidogrel + PPI Interaction
- PPIs
reduce the effectiveness of clopidogrel in preventing the recurrence of
adverse cardiac events such as heart attack and coronary artery
restenosis
Drugs increasing mucosal resistance
- Physical barriers
- Prostaglandin analogues
Antacids
- Increase rate of emptying => Short effect
- Stimulate gastrin release => Tolerance/adaptation
H. pylori eradication
- Must have a PPI
- Plus any two of:
- Amoxicillin
- Metronidazole
- Clarythromycin
- Doses vary depending on combination
- Choose the ones patient hasn't taken recently
Management of constipation
- Contraindications
- Intestinal perforation or obstruction
- Bulk-forming
- Stimulants (NB abdo. cramps)
- Anthraquinones
- Senna
- Co-danthramer (palliative only - ?carcinogenic)
- Docusate sodium (dual effect)
- Diphenylmethabe derivatives
- Softeners (NB risk of incontinence)
- Docusate sodium
- Liquid parafin
- Osmotic
- Lactulose
- PEG (Movicol)
- Magnesium salts
- Phosphate
Diarrhoea - Drug causes
- Magnesium-containing antacids
- NSAIDs
- Lithium
- PPIs
- Treatment
- Rehydration fluids MUST CONTAIN GLUCOSE for salt uptake
- Generally no Abx
- C. diff
- Treat with oral metronidazole or vancomycin
- Antimotility drugs
Nausea + vomiting pathways
- Chemoreceptor trigger zone
- Dopamine + 5-HT3 serotonin receptor
- Vestibular
- Cholinergic muscarinic receptor
- Vomiting centre pathways
- Histamine + cholinergic muscarinic receptors
- Gastric status
- Dopamine + 5-HT4 serotonin receptor
Antiemetics
- Metoclopramide
- Dopamine D2 antagnoist
- => Causes dystonia, esp. if <18 or >70
- Can treat with procyclidine (anticholinergic)
- Promethazine
- 1st generation antihistamine
- Safe in pregnancy (e.g. hyperemesis gravidarum)
- Sedative effects
Crohn's remission- Yes
- Azathioprine
- Infliximab
- Methotrexate
- No
- Aminosalicilates (but probably not harmful so often continued)
- Cyclosporin (high risk of adverse events)
- Corticosteroids (harm > benefit)
Stomach acid secretionNotes- Metronidazole tastes bad
- Beware antimotility drugs in UC
- => Paralytic ileus + megacolon
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