POCKET HANDBOOK OF GI PHARMACOTHERAPEUTICS

POCKET HANDBOOK OF GI PHARMACOTHERAPEUTICS

CLINICAL GASTROENTEROLOGY GEORGE Y. WU, SERIES EDITOR For other titles published in this series, go to www.springer.com/series/7672

POCKET HANDBOOK OF GI PHARMACOTHERAPEUTICS Edited by GEORGE Y. WU, MD, PHD University of Connecticut Health Center, Farmington, CT and ACHILLES PAPPANO, PHD University of Connecticut Health Center, Farmington, CT

Editors George Y. Wu, MD, PhD Achilles Pappano, PhD Department of Gastroenterology Department of Cell Biology University of Connecticut University of Connecticut Health Center Health Center Farmington, CT 06030-1845 Farmington, CT 06032 USA USA wu@nso.uchc.edu pappano@nsol.uchc.edu ISBN: 978-1-58829-934-5 e-isbn: 978-1-59745-284-7 DOI: 10.1007/978-1-59745-284-7 Library of Congress Control Number: 2009921830 Humana Press, a part of Springer Science + Business Media, LLC 2009 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Humana Press, c/o Springer Science + Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper springer.com

PREFACE The number of agents for the treatment of digestive diseases and conditions has increased greatly, and in some cases, one is confronted with a bewildering array of brand and generic names. Although databases and reference books provide detailed information on pharmacology, toxicology, and therapeutics, obtaining commonly needed information, such as recommended first line agents, dosage, duration, side effects, and drug interactions, requires sifting through other materials. There is no text that contains just this practical pharmacological information. The purpose of this project is to remedy this deficiency with a small portable text. Because treatment questions generally begin with diagnoses, each chapter addresses therapy of a digestive disease or condition, listed in the contents. Treatment algorithms are provided where available. Agents recommended for treatment of the condition are described in detail, including brand and generic names, indications, contraindications, side effects, drug interactions, doses/ routes of administration, durations, and approximate costs. In addition, an index at the end of this handbook lists all the drugs in alphabetical order for those interested in specific agents. Although the physical characteristics enhance its portability and convenience, as with other books in this series, we believe that the practical clinical information presented in this simple format will be of greatest value. George Y. Wu Achilles Pappano Farmington, Connecticut July 22, 2008 v

CONTENTS Preface................................................... George Y. Wu, Achilles Pappano v Contributors............................................... ix I Gastroesophageal Diseases 1 Peptic Disorders........................................ 3 Lisa Rossi and Shishir Mathur 2 Gastrointestinal Bleeding................................ 13 Lisa Rossi and Shishir Mathur 3 General GI Motility Disorders............................. 19 Lisa Rossi 4 Specific GI Motility Disorders............................. 31 Lisa Rossi and Shishir Mathur 5 Inflammatory Bowel Disease.............................. 37 Shilpa Madadi and Shishir Mathur 6 General GI Infections................................... 49 Marcy Coash and Shishir Mathur 7 Specific GI Microbial Infections........................... 57 Shilpa Madadi, Vivian Teixeira, and Shishir Mathur II Liver Disease 8 Hepatitis.............................................. 85 Shilpa Madadi and Shishir Mathur 9 Cholestasis............................................ 99 Shishir Mathur 10 Hepatic Encephalopathy................................. 101 Shilpa Madadi and Shishir Mathur vii

viii Contents 11 Pruritis............................................... 105 Marcy Coash 12 Nutrition and Enzyme Deficiency.......................... 107 Shishir Mathur References................................................. 113 Index..................................................... 115

CONTRIBUTORS Marcy Coash, md Internal Medicine Residency Program, University of Connecticut Health Center, Farmington, CT Shilpa Madadi, md Gastroenterology Fellowship Program, University of Connecticut Health Center, Farmington, CT Shishir Mathur, mbbs Internal Medicine Residency Program, University of Connecticut Health Center, Farmington, CT Achilles Pappano, phd Department of Cell Biology, University of Connecticut Health Center, Farmington, CT Vivian Teixeira, md Primary Care Residency Program, University of Connecticut Health Center, Farmington, CT Lisa Rossi, md Department of Gastroenterology, Saint Francis Hospital and Medical Center, Hartford, CT George Wu, md, phd Department of Gastroenterology, University of Connecticut Health Center, Farmington, CT ix

I Gastroesophageal Diseases

1 Peptic Disorders Lisa Rossi, MD and Shishir Mathur, MBBS CONTENTS Gastroesophageal Reflux Disorder (GERD) and Peptic Ulcer Disease (PUD) Proton Pump Inhibitors Histamine H2 Antagonists Other Agents Helicobacter Pylori From: Clinical Gastroenterology: Pocket HandBook of GI Pharmacotherapeutics Edited by: G.Y. Wu and A. Pappano, DOI: 10.1007/978-1-59745-284-7_1, Humana Press, a part of Springer Science + Business Media, LLC 2009 3

4 Rossi and Mathur GASTROESOPHAGEAL REFLUX DISORDER (GERD) AND PEPTIC ULCER DISEASE (PUD) Patient with GERD Lifestyle modifications Treatment with proton pump inhibitor for 2 weeks Symptoms resolve consider stopping therapy No Improvement Long term therapy Consider motility agents Consider ph monitoring Recurrence of symptoms Consider surgery, endoscopic therapy in select patients PROTON PUMP INHIBITORS Omeprazole Trade name: Prilosec, Prilosec OTC Manufacturer: AstraZeneca, Proctor and Gamble, generic Dosage: GERD/erosive esophagitis: 20 mg p.o. q.d. for 4 weeks Gastric ulcer: 40 mg p.o. q.d. for up to 4 8 weeks Duodenal ulcer: 20 40 mg p.o. q.d. for 4 8 weeks Helicobacter pylori infection: 20 mg p.o. b.i.d. in conjunction with triple therapy Stress ulcer prophylaxis: 40 mg p.o. q.d. initially, then 20 40 mg daily Gastric hypersecretion: 60 mg p.o. q.d. initial dose, increase up to 120 mg p.o. t.i.d.

Chapter 1 / Peptic Disorders 5 Contraindications/cautions: Hypersensitivity to omeprazole Caution in hypocalcemia, hypokalemia, metabolic alkalosis, respiratory alkalosis, Bartter s syndrome (powder for oral suspension contains 1,680 mg or 20 meq of sodium bicarbonate) Adverse effects: Gastrointestinal: Abdominal pain, diarrhea, pancreatitis, hepatotoxicity Neurologic: Headache Renal: Interstitial nephritis Musculoskeletal: Hip fracture, rhabdomyolysis Drug interactions: Increases levels of warfarin, cyclosporine, digoxin, phenytoin Decreases levels of atazanavir, ketoconazole, itraconazole, cefuroxime Pregnancy category: C Lactation: Probably safe Relative cost: ($$) Esomeprazole Magnesium (Oral) Esomeprazole Sodium (IV) Brand name: Nexium Manufacturer: AstraZeneca Dosages: GERD/erosive esophagitis: 20 40 mg p.o. q.d. for treatment Maintenance therapy in GERD/erosive esophagitis: 20 mg p.o. q.d. Gastric ulcer: 20 40 mg p.o. q.d. for up to 6 months Acute non-variceal upper gastrointestinal (GI) bleed: 80 mg i.v. bolus followed by continuous infusion at 8 mg/h. for 72 h. after endoscopic therapy H. pylori infection: 40 mg p.o. q.d. in conjunction with triple therapy Zollinger-Ellison syndrome: 40 mg b.i.d. increase up to 240 mg per day based on symptoms Contraindications/cautions: Hypersensitivity to esomeprazole or benzimidazoles Caution with liver disease Adverse effects: Gastrointestinal: Abdominal pain, constipation, diarrhea, flatulence, nausea, pancreatitis (rare) Neurologic: Headache Dermatologic: Erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis Musculoskeletal: Hip fracture, rhabdomyolysis