Git drugs

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

PEPTIC ULCER
DISEASE

H2
Receptor
M1
Receptor
CCK2
Histamine A-ch Gastrin
G-
Cell
Delta
cell
Gastrin
ECL
+
+
+
Somato
statin
(-)
Activates H+ /K+ ATPase
HCl
Parietal cell

PROTON PUMP
INHIBITORS
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
Proton pump
Inhibitors

PROTON PUMP
INHIBITORS
DRUG FEATURES
Lansoprazole -PPI of choice in pregnancy
- Enzyme Inhibitor
Omeprazole - Both Enzyme inducer(CYP1A2)
and Enzyme Inhibitor(CYP2C19)
Pantoprazole
Rabeprazole -most potent and fastest acting.

PROTON PUMP
INHIBITORS
-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 PUMP
INHIBITORS
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 Clopidogrel
Since it will decrease the activation of clopidogrel
And its Antiaggregant effect.

ENZYME INDUCERS
G =Griseofulvin
P = Phenytoin
R = Rifampicin
S = Smoking
Cell = Carbamazepine
Phone = Phenobarbitone

ENZYME INHIBITORS
Vitamin = Valproate
K =ketoconazole
Can = Cimetidine
Cause = Ciprofloxacin
Enzyme =Erythromycin
Inhibition =Isoniazid

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. Amoxicillin
2. Clarithromycin
3. Tetracycline
4. Metronidazole /Tinidazole
5. Bismuth subsalicylate
6. Omeprazole/ Lansoprazole
Monotherapy has failed in treatment of H. Pylori infections. Hence, multidrug regimens
given for 7-14 days are generally used.

Anti-H.pylori Agents
Triple Therapy Quadruple therapy
PPI 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 antihistaminics
Promethazine, Diphenhydramine, Meclizine,
Dimenhydrinate, Cyclizine,
Neuroleptics
Chlorpromazine, Prochlorperazine,
Haloperidol,
etc.
Prokinetic drugs
Metoclopramide, Domperidone, Ciaspride,
Mosapride
5-HT 3 antagonists Ondansetron, Granisetron
Substance-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

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.

-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.

D2 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

- 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.

-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.

Traditional 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 SYNDROME
ALKALOSIS
+
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
Domperidone
Cisapride
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:
MOA
It 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.
INDICATION
The 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.
CONTRAINDICATION
Inflammatory bowel disease
ADVERSE EFFECTS
N/V, diarrhea, abdominal cramps. It can cause bleeding and abortion in
pregnancy

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 motility
b. Potent anti secretory
c. Potent antibradycardia drug
d. Lack of central action
e. Used in preanesthetic medication

ANTICHOLINERGICS IN PEPTIC
ULCER DISEASE
1) Pirenzepine
2) 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
Quinidine
Amiodarone
Procainamide
Disopyramide
Terfenadine
Astemizole
Ketoconazole
Fluconazole
Imipramine
Amitriptyline
Erythromycin
Haloperidol
Cisapride

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)
A
Antiemetic
B
Anxiolytic
C
Analgesic
D
Antidepressant

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.Docusate
B.Dopamine
C.Loperamide
D.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.

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)
A
Aluminum hydroxide
B
Diphenoxylate
C
Magnesium hydroxide
D
Metoclopramide
E
Mineral 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
A
Aluminum hydroxide
B
Diphenoxylate
C
Magnesium hydroxide
D
Metoclopramide
E
Mineral 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.

OPIOIDS SOAMTOSTATIN
ANALOGS
BILE 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)
A
Dexamethasone
B
Dronabinol
C
Ketanserin
D
Ondansetron
E
Phenothiazines

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 antihistaminics
Promethazine, Diphenhydramine, Meclizine,
Dimenhydrinate, Cyclizine,
Neuroleptics
Chlorpromazine, Prochlorperazine,
Haloperidol, Phenothiazines
etc.
Prokinetic drugs
Metoclopramide, Domperidone, Ciaspride,
Mosapride
5-HT 3 antagonists Ondansetron, Granisetron
Substance-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)
A
Aluminum hydroxide
B
Diphenoxylate
C
Loperamide
D
Magnesium hydroxide
E
Metoclopramide

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)
A
Omeprazole
B
Rabeprazole
C
Esomeprazole
D
Pantoprazole

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)
A
Pro-drugs
B
Short acting
C
Long acting
D
High 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.

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.

Constipation Visceral painDiarrhea
Polyethylene
Glycol
Loperamide
Lubiprostone
Alosetron
Tricyclic
Antidepress
ants
No
response
No
response

Probiotics Bifidobacterium
Saccharomyces
Lactobacillus
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 oils
Chloride secretory drugs Lubiprostone, Linaclotide

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

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

STIMULANTS
Bisacodyl
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 AGENTS
Lactulose
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 SOFTENERS
1) 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)
A
Octreotide
B
Pantoprazole
C
Somatotropin
D
Dexamethasone
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-Blackmore
2. Minnesota Tube
· Variceal ligation
· Variceal sclerotherapy

-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

These 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

-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.

1) Enzyme Inhibitor
2) Anti androgenic actions
3) Gynecomastia and impotence in males
4) Hyperprolactnemia
5) Galactorrhea in females
6) Tolerance
7) hepatotoxicity

-Dronabinol
-Nabilone
-Antiemetics
-S/E : Conjunctival congestion

Anti integrin
drugs
Anti –TNF
drugs +/-
Azathioprine
Mesalamine
CyclosporineAzathioprine
ResistanceDependence
Steroids
Mesalamine
Severe
Mild/
Moderate
MaintenanceInduction
Ulcerative
colitis
NR
NR
NR

Anti integrin
drugs
Anti –TNF
drugs +/-
Azathioprine
Steroids
Severe
Mild/
Moderate
MaintenanceInduction
Crohn’s
disease
Anti
TNF@
NR
NR –No Response

ANTI-TNF @ DRUGS ANTI INTEGRIN DRUGS
Infliximab Netolizumab
Golimumab Vedolizumab
Certolizumab
Adalimumab

Condition DOC
Acute 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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