For surface agents, how long should you avoid taking med if you take a different med?
Avoid giving w.in 2 hrs of other meds
What are the 2 surface agents?
Alginic acid (Gaviscon)
Sucralfate (Carafate)
What is Sucralfate (Carafate) safe in? Why?
pregnancy
Largely unabsorbed & no systemic toxicity
What does Alginic acid (Gaviscon) form and reduce?
Forms a viscous layer that serves as a protective barrier → reduction of reflux episodes
What is the duration and efficacy of Sucralfate?
Short duration of action, limited efficacy vs. PPIs
Is Sucralfate systemic or local? What does it form and do?
Local → forms protective barrier → binds to protein in damaged tissue → create barrier b/w mucosa & gastric acid
Dosing of metoclopramid? When to reduce dose?
10mg po/IV every 6 hours; 30 minutes before each meal → Reduce dose 50% if Crcl < 60ml/min
Dosing of sucralfate
Dose → 1 gram 2-4x/day on empty stomach → take 1 hour before or 2 hours after meals
What drugs does sucralfate decrease the absorption of by binding to them in the GI tract?
Fluoroquinolones, levothyroxine, digoxin, warfarin, bisphosphonates
How long should you wait after taking an antacid to take sucralfate?
30 min
What does Metoclopramide (Reglan) do? What is it reserved for? Is it recommended for general use in GERD?
↑ LES pressure & accelerates gastric emptying → Reserved for delayed gastric emptying → Not rec for general use in GERD
What is a specific prokinetic agent?
Metoclopramide (Reglan)
Caution of metoclopramide
Caution → elders & those w/ renal dysfunction
Side effects of metoclopramide
Side effects → extrapyramidal effects, tardive dyskinesia, QTc prolongation, CNS: drowsiness, agitation, irritability, depression
Contradindications of metoclopramide
Contraindications → Parkinson’s disease, mechanical obstruction, concomitant use of other dopamine agonists
