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Questions and Answers
What is the most common side effect of sucralfate?
What is the most common side effect of sucralfate?
When is sucralfate pregnancy use considered acceptable?
When is sucralfate pregnancy use considered acceptable?
Which drug interaction can occur with sucralfate and Digoxin?
Which drug interaction can occur with sucralfate and Digoxin?
What is a possible indication for Misoprostol (Cytotec) use?
What is a possible indication for Misoprostol (Cytotec) use?
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In patients with renal impairment, what is the dosing adjustment for Misoprostol?
In patients with renal impairment, what is the dosing adjustment for Misoprostol?
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What potential effect can sucralfate have on the serum concentration of quinolones?
What potential effect can sucralfate have on the serum concentration of quinolones?
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What is the main reason why sucralfate is preferred for initial treatment of GERD in pregnancy?
What is the main reason why sucralfate is preferred for initial treatment of GERD in pregnancy?
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Which of the following medications should be avoided within 30 minutes of taking a dose of sucralfate?
Which of the following medications should be avoided within 30 minutes of taking a dose of sucralfate?
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What is the primary mechanism of action of sucralfate in treating GI irritations?
What is the primary mechanism of action of sucralfate in treating GI irritations?
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For which condition is sucralfate considered an off-label treatment during pregnancy?
For which condition is sucralfate considered an off-label treatment during pregnancy?
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What is the recommended dosing adjustment for sucralfate in cases of renal impairment?
What is the recommended dosing adjustment for sucralfate in cases of renal impairment?
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Which of the following drugs can have its absorption inhibited by sucralfate when taken together?
Which of the following drugs can have its absorption inhibited by sucralfate when taken together?
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Which adverse effect is most commonly associated with the use of Bismuth Subsalicylate?
Which adverse effect is most commonly associated with the use of Bismuth Subsalicylate?
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What is a significant drug interaction to be cautious about when using Bismuth Subsalicylate?
What is a significant drug interaction to be cautious about when using Bismuth Subsalicylate?
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In which trimester of pregnancy should Bismuth Subsalicylate be avoided due to safety concerns?
In which trimester of pregnancy should Bismuth Subsalicylate be avoided due to safety concerns?
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What diagnostic procedure can be interfered with by the use of Bismuth Subsalicylate?
What diagnostic procedure can be interfered with by the use of Bismuth Subsalicylate?
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Which population should avoid using Bismuth Subsalicylate due to the risk of Reye syndrome?
Which population should avoid using Bismuth Subsalicylate due to the risk of Reye syndrome?
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What is a contraindication for the use of Bismuth Subsalicylate?
What is a contraindication for the use of Bismuth Subsalicylate?
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Study Notes
Mucosal Protective Agents
- Sucralfate (Carafate) is a complex of sucrose and aluminum hydroxide, used to treat GI irritations, including reflux esophagitis and peptic ulceration.
Sucralfate
- Beneficial in combination with 2 antibiotics for healing of duodenal ulcers and eradication of H pylori.
- Initial treatment of GERD in pregnancy, with low systemic effects and toxicity due to poor absorption.
- Should be taken on an empty stomach, 1 hour before meals, and avoid antacids within 30 minutes of dose.
- Contraindicated in patients with renal failure, as it may cause aluminum overload.
- Inhibits absorption of other drugs, such as digoxin, phenytoin, ketoconazole, and fluoroquinolones.
Sucralfate Indications and Dosing
- Short-term treatment (< 8 weeks) of active duodenal ulcers.
- Maintenance therapy for duodenal ulcers (tablets).
- Off-label use for GERD in pregnancy.
- Dosing: adult, pediatric, and no dose adjustment for renal or hepatic impairment.
Sucralfate Mechanism of Action and Pharmacokinetics
- Forms a cytoprotective gel covering gastric mucosa, protecting against peptic acid, pepsin, and bile salts for up to 6 hours.
- Promotes tissue growth and repair.
- Onset of action: 1-2 hours, with minimal absorption from the GI tract.
- Works locally at sites of ulcer, with no systemic activity, and no hepatic metabolism.
- Excreted primarily in the urine.
Sucralfate Adverse Effects and Warnings
- Constipation is the most common side effect.
- Hyperglycemia reported with sucralfate suspension in patients with diabetes.
- Use cautiously with advanced kidney impairment, due to potential accumulation of aluminum.
- Use tablets with caution in patients with impaired swallowing, as aspiration has been reported.
Sucralfate Drug Interactions
- Reduces blood levels of digoxin, furosemide, ketoconazole, and quinolones.
- Increases concentration of sucralfate when used with multivitamins with minerals.
- Decreases level of quinidine.
Sucralfate Pregnancy and Breastfeeding
- Acceptable for use in pregnancy, with minimal absorption.
- Use with caution in breastfeeding, as recommended by the manufacturer.
Prostaglandin Analogs
- Misoprostol (Cytotec) is used to reduce the risk of NSAID-induced gastric ulcers and for termination of pregnancy.
Misoprostol
- Dosing: adult, pediatric, and no dose adjustment for renal impairment.
- Excretion primarily in urine, with a half-life of 2-5 hours.
Bismuth Subsalicylate
- Adverse effects include esophagitis, melena, anaphylaxis, encephalopathy, and tinnitus.
- Warnings: can be neurotoxic in large doses, absorbs x-rays, and can interfere with diagnostic procedures of the GI tract.
- Avoid use in pediatrics with chickenpox or flu-like symptoms to reduce the risk of Reye syndrome.
Bismuth Subsalicylate Contraindications and Drug Interactions
- Contraindicated in patients with allergy to salicylates, taking other salicylates, those with an ulcer or bleeding problem.
- Interacts with aspirin, NSAIDs, SSRIs, antidiabetic agents, ACE inhibitors, and corticosteroids.
Bismuth Subsalicylate Pregnancy and Breastfeeding
- Avoid use for treatment of dyspepsia, acute diarrhea, or treatment or prevention of traveler's diarrhea.
- Pregnancy category C; category D in 3rd trimester.
- Salicylate enters breast milk, use with caution.
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Description
Learn about mucosal protective agents like Sucralfate (Carafate) used in treating GI irritations, peptic ulceration, GERD, and duodenal ulcers. This medication is beneficial for various GI conditions with low systemic effects and toxicity.
