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  /Title (pharm250-gastrointestinal-system.pdf)
  /Creator (Cheatography)
  /Author (kjaniskevich)
  /Subject (PHARM250 Gastrointestinal System Cheat Sheet)
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    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{PHARM250 Gastrointestinal System Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{kjaniskevich} via \textcolor{DarkBackground}{\uline{cheatography.com/132444/cs/27518/}}}
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  \vspace{-2pt}kjaniskevich \\
  \uline{cheatography.com/kjaniskevich} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 13th April, 2021.\\
   Updated 13th April, 2021.\\
   Page {\thepage} of \pageref{LastPage}.
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\begin{tabularx}{8.4cm}{x{4 cm} x{4 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Constipation + Diarrhea - Classes of medication}}  \tn
% Row 0
\SetRowColor{LightBackground}
Bulk-forming agents \{\{nl\}\} {\emph{Psyllium, polycarbophil}} & Ferment in the colon → gas formation, increased osmotic load, water retention and wall stress → stimulates motility \{\{nl\}\} Swell in intestinal fluid → creates gel → facilitate passage \tn 
% Row Count 10 (+ 10)
% Row 1
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Osmotic agents \{\{nl\}\}{\emph{glycerin (suppository), lactulose, polyethylene glycol (PEG) 3350, magnesium citrate, sodium phosphate, magnesium hydroxide (milk of magnesia), sorbitol}} & Contain poorly absorbed ions or molecules that create an osmotic gradient to retain water within the intestinal lumen – the ↑ pressure on the intestinal wall induces gastric motility \{\{nl\}\}  Used for bowel evacuations before procedures (if high, frequent dosing) or for daily \seqsplit{maintenance/prevention} (if low, daily dosing)\{\{nl\}\}BM within 30 mins (high, frequent doses) -\textgreater{} 3 days (low daily doses) \tn 
% Row Count 30 (+ 20)
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Constipation + Diarrhea - Classes of medication (cont)}}  \tn
% Row 2
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Stimulants \{\{nl\}\}{\emph{Senna/sennosides (Senokot®, Senokot-S®) Bisacodyl (Dulcolax®) Sodium picosulfate (Pico-Salex®) Castor oil}} & Stimulate the smooth muscle to produce rhythmic contractions\{\{nl\}\} May be recommended if osmotic laxatives fail or not tolerated\{\{nl\}\} Sometimes referred to as a "rescue agent"\{\{nl\}\} A dose effective in one individual may cause painful cramping in the next\{\{nl\}\}BM within 6-12 hours (often overnight use) \tn 
% Row Count 16 (+ 16)
% Row 3
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Stool softeners \{\{nl\}\}{\emph{Docusate sodium or docusate calcium}} & Act as a surfactant → better mixing of aqueous and fatty substances to soften the fecal mass\{\{nl\}\} A preventative measure rather than a "rescue"\{\{nl\}\} Sometimes added to other laxatives (for the "gentle" touch)\{\{nl\}\} Most recent evidence suggests not better than placebo\{\{nl\}\} What to expect: BM in 1 - 5 days \tn 
% Row Count 32 (+ 16)
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\begin{tabularx}{8.4cm}{x{4 cm} x{4 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Constipation + Diarrhea - Classes of medication (cont)}}  \tn
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Lubricants & Lubricates contents of GI tract and keeps water in GI tract\{\{nl\}\} Limited use -\textgreater{} after myocardial infarction or rectal surgery\{\{nl\}\} Mineral oil (heavy) – only one suitable for consumption\{\{nl\}\} Not recommended due to risk of aspiration → lipid pneumonia, binding of fat soluble vitamins/meds, and anal seepage\{\{nl\}\}What to expect: BM in 6-8 hours – avoid lying down or bedtime dosing \tn 
% Row Count 20 (+ 20)
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Suppositories \& Enemas\{\{nl\}\}{\emph{Mineral oil retention enema, Phosphate enema, Tap water enema}}{\emph{Microlax® Enema (sodium citrate, sodium laurel sulfoacetate)}} & For acute relief or bowel prep for procedure \{\{nl\}\} Not for management of chronic constipation \{\{nl\}\} Presence of object in rectum stimulates defecation reflex \{\{nl\}\} This is in addition to any benefits provided by specific ingredient (i.e. glycerin – osmotic; mineral oil – lubricant)\{\{nl\}\} Patient should try to retain (hold in) product as long as possible (generally a few minutes) \{\{nl\}\}  What to Expect: Cleansing of bowel within 1 hour; if no BM – call physician Not pleasant, therefore not the preferred route \tn 
% Row Count 47 (+ 27)
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\begin{tabularx}{8.4cm}{x{4 cm} x{4 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Constipation + Diarrhea - Classes of medication (cont)}}  \tn
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\mymulticolumn{2}{x{8.4cm}}{{\bf{Antidiarrheals}}} \tn 
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Adsorbant agents \{\{nl\}\}{\emph{attapulgite (Kaopectate®, Fowler's®)}} & Adsorbs fluid in intestine, reducing stool liquidity \{\{nl\}\}  May give some relief, very safe (can use in kids) \tn 
% Row Count 7 (+ 6)
% Row 8
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Antimotility agents \{\{nl\}\}{\emph{loperamide (Imodium®), belladonna, diphenoxylate}} & Opioid agonists that do not cross blood-brain barrier \{\{nl\}\} Dependence and tolerance with long-term use? NOPE \tn 
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Antisecretory agents \{\{nl\}\}{\emph{bismuth subsalicylate (Pepto-Bismol®)}} & Stimulates absorption of fluid and electrolytes across intestinal wall; also bactericidal (e. coli)and anti-inflammatory \{\{nl\}\} Not for children (related to ASA  Reye's)\{\{nl\}\} Good option for traveller's diarrhea \tn 
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Bulk-Forming agents \{\{nl\}\} {\emph{psyllium (Metamucil®)}} & Identical mechanism as with constipation\{\{nl\}\} Creates "gel" using excess fluid in GI tract \tn 
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{\emph{Loperamide (Imodium®)}} & Slows intestinal motility by stimulating opioid receptor, which reduces fecal volume and increases viscosity \{\{nl\}\} Very high first-pass effect and poor penetration of blood-brain barrier\{\{nl\}\} No dependence or tolerance with long-term use\{\{nl\}\}Also useful for radio- or chemo-induced diarrhea \tn 
% Row Count 44 (+ 15)
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Adverse effects of medication for the GI tract}}  \tn
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Bulk-forming Agents & flatulence, bloating are common \tn 
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Osmotic Agents & nausea, abdominal bloating, cramping, diarrhea, flatulence, skin rashes/hives \tn 
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Stimulants & : bloating, abdominal discomfort, flatulence, diarrhea\{\{nl\}\} Highest incidence of cramping/pain (due to muscle contractions) \{\{nl\}\}  Caution: \{\{nl\}\} Avoid in pregnancy if possible (do not stimulate!) \{\{nl\}\} Avoid if sensitive to electrolyte or fluid abnormalities \tn 
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Stool softeners & bloating, abdominal discomfort, flatulence \tn 
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Lubricants & allergic reactions, anal seepage, alteration of \seqsplit{vitamins/minerals/drugs} \tn 
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Suppositories \& Enemas & discomfort, bloating, cramping, allergic reactions \tn 
% Row Count 30 (+ 3)
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Adverse effects of medication for the GI tract (cont)}}  \tn
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Loperamide (Imodium®) & cramping, discomfort, skin rash, dry mouth; Possible CNS usually only if compromised BBB = drowsiness, dizziness, confusion (rare) \tn 
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Dimenhydrinate (Gravol®) & drowsiness + anticholinergic effects \tn 
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Doxylamine + Pyridoxine (Diclectin®) & drowsiness, fatigue \tn 
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Domperidone & headache, menstrual irregularities, dry mouth, diarrhea, abdominal discomfort \tn 
% Row Count 15 (+ 4)
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Ondansetron (Zofran®) & headache, dizziness, drowsiness, constipation, diarrhea (all rare) \tn 
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% Row 11
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H2-Antagonists & headache, dizziness, drowsiness Difficult to differentiate between heartburn symptoms and some adverse effects (nausea, vomiting, constipation, diarrhea)\{\{nl\}\} Very rare – reduction in RBC, WBC, and platelets; bradycardia, allergic reactions \{\{nl\}\}Because of reduction in acidity, it can potentially interact with absorption of drugs or vitamins (like B12) that need an acidic environment to absorb \{\{nl\}\} Separate as much as possible, while also understanding that we want prolonged reduction in acidity \tn 
% Row Count 45 (+ 26)
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Adverse effects of medication for the GI tract (cont)}}  \tn
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Proton Pump Inhibitors (PPIs) & very well tolerated; limited to headache, diarrhea, flatulence, nausea, abdominal pain \{\{nl\}\} Long-term (years): decrease in bone mineral density + others via post-marketing surveillance \tn 
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Sucralfate & constipation or diarrhea, nausea, headache, indigestion, dry mouth \{\{nl\}\} Bezoars have been reported in people treated with sucralfate (most had comorbidities that contributed such as low gastric motility) \{\{nl\}\} May increase blood glucose due to high carbohydrate content \tn 
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Antacids & Calcium – constipating \{\{nl\}\} Magnesium \& aluminum – diarrhea, and can make stool a whiter colour \tn 
% Row Count 30 (+ 6)
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Adverse effects of medication for the GI tract (cont)}}  \tn
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Misoprostol & headache, abdominal cramps, diarrhea, vaginal bleeding, uterine cramping \tn 
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% Row 16
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Aminosalicylates \{\{nl\}\} {\emph{5-ASA (Asacol®)}} & nausea, diarrhea, abdominal pain, headache, rash, rhinitis, photosensitivity \{\{nl\}\} Meds are well tolerated; can be difficult to discern adverse effects from condition \tn 
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% Row 17
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Immuno-suppressants \{\{nl\}\}{\emph{Methotrexate (MTX)}} & ulcerative stomatitis, leukopenia, nausea, abdominal distress, malaise, fatigue, chills \& fever, dizziness, decreased resistance to infection \tn 
% Row Count 21 (+ 8)
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Pancreatin (Creon®) & Rare - nausea, vomiting, diarrhea \tn 
% Row Count 23 (+ 2)
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Local anesthetics (dibucaine, pramoxine) & Use \textgreater{} 7 days: possible CNS effects (restlessness, excitement, nervousness, paresthesias, dizziness, tinnitus, blurred vision, nausea and vomiting, muscle twitching and tremors, convulsions) and cardiovascular effects (hypotension, bradycardia) \tn 
% Row Count 36 (+ 13)
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Adverse effects of medication for the GI tract (cont)}}  \tn
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Corticosteroids (hydrocortisone) & Use \textgreater{} 14 days, mucosal atrophy \tn 
% Row Count 2 (+ 2)
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Nausea, \& Vomiting - Classes of medication}}  \tn
% Row 0
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{\emph{Dimenhydrinate (Gravol®)}} & An antihistamine (with anticholinergic activity)\{\{nl\{\{ Only effective for nausea \& vomiting caused by motion sickness (vestibular apparatus)\{\{nl\}\} Used for all types of nausea (like a virus…..) inappropriately (sedation may provide benefit) \tn 
% Row Count 13 (+ 13)
% Row 1
\SetRowColor{white}
{\emph{Doxylamine + Pyridoxine (Diclectin®)}} & Prescription product specifically for nausea and vomiting during pregnancy \{\{nl\}\} Mechanism of action largely unknown \{\{nl\}\} Doxylamine = antihistamine; pyridoxine = vitamin B6\{\{nl\}\} Safe for baby\{\{nl\}\} Used when concerned about proper nutrition \{\{nl\}\} Effect \textasciitilde{} 8 hours after dose \tn 
% Row Count 27 (+ 14)
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{\emph{Domperidone}} & Mechanism of action: a peripheral dopamine antagonist, that blocks dopamine receptors in the GI tract; also has pro-kinetic properties, which increases peristalsis to improve gastric emptying rates\{\{nl\}\} Also stimulates release of prolactin – used to enhance milk production while breastfeeding (see Module 8)\{\{nl\}\} Primary use: antiemetic for multiple GI conditions, prevention of nausea \& vomiting with concurrent medications (chemo), enhance milk production, GERD \tn 
% Row Count 51 (+ 24)
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Nausea, \& Vomiting - Classes of medication (cont)}}  \tn
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{\emph{Ondansetron (Zofran®)}} & Mechanism of action: serotonin receptor antagonist in chemoreceptor trigger zone and along GI tract (CTZ)\{\{nl\}\} Primary use: chemotherapy induced nausea \& vomiting\{\{nl\}\} Occasionally used in severe nausea \& vomiting in pregnancy (concerned about baby nutrition) \tn 
% Row Count 14 (+ 14)
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{PUD + GERD - classes of medication}}  \tn
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{\bf{H2-Antagonists }} \{\{nl\}\}{\emph{-tidine}} & Blocks H2 receptors which prevents acid secretion; reduces the volume and acidity of secretions  allowing a lesion to heal \{\{nl\}\} Can take up to 3 months to heal a lesion \{\{nl\}\} Cimetidine was first drug  lots of significant drug interactions via CYP450 enzymes and significant adverse effects (gynecomastia) not widely used anymore but still available \tn 
% Row Count 18 (+ 18)
% Row 1
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{\emph{Ranitidine (Zantac®), famotidine, nizatidine}} & Most effective if taken regularly (every day) to consistently reduce acid and allow lesion to heal \{\{nl\}\} Can also be used as needed (PRN) for heartburn by anyone\{\{nl\}\} Very safe, Smoking decreases the effectiveness of H2-antagonists (encourage smoking cessation) \tn 
% Row Count 32 (+ 14)
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{\bf{Proton pump inhibitors (PPIs) }} \{\{nl\}\}{\emph{-prazole}} & Proton pumps = cells that are present in the lining of the stomach; their job is to 'pump' protons (H+) into the stomach for acid secretion \{\{nl\}\} PPIs inhibit this, preventing acid secretion, creating a less acidic environment for a lesion to heal \{\{nl\}\} ↓ acidity more than H2-antagonists (more effective) \{\{nl\}\} Also very safe; recently OTC \{\{nl\}\} A longer duration of action than H2-antagonists = less frequent dosing \tn 
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{\emph{Omeprazole, esomeprazole, lansoprazole, pantoprazole, rabeprazole}} & Have a longer onset of action than H2-antagonists (don't work as quickly) – would not be effective to use PRN (as needed) for heartburn \tn 
% Row Count 29 (+ 7)
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{\bf{Sucralfate }} & A cytoprotective agent that adheres to and then protects ulcerated gastric or duodenal mucosa\{\{nl\}\}  Product also contains aluminum, which lowers acidity of gastric contents \tn 
% Row Count 38 (+ 9)
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{\bf{Antibiotics }} & Must be specific for h. pylori – breath tests confirm presence \{\{nl\}\} We attempt to completely eradicate the bacteria, due to extremely high rate of recurrence \{\{nl\}\} Eradication of h. pylori allows ulcers to heal more rapidly and remain in remission longer, often permanently \{\{nl\}\} Otherwise, organism may survive for life \{\{nl\}\} We always give at least 2 antibiotics to:\{\{nl\}\} Increase effectiveness of therapy\{\{nl\}\} Reduce chance of resistance \{\{nl\}\} Also give with H2-antagonist or a PPI to allow for healing \tn 
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{\emph{amoxicillin, clarithromycin, metronidazole, tetracycline}} & Specific for h. pylori \{\{nl\}\} As with all antibiotic therapy, complete course must be finished – at least 1 week \tn 
% Row Count 32 (+ 6)
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{\bf{Antacids}} & Neutralize acid that is already present – do NOT have an effect on future acid secretion – supportive role only \{\{nl\}\} Most appropriately used as needed (PRN) \{\{nl\}\} Very safe and can be used for long periods of time (years) with few consequences – Tums® are also used as a calcium supplement! – but long term use for recurring heartburn indicates underlying problem \{\{nl\}\} Can interfere with absorption of many medications – separate by 2 hours \tn 
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{\bf{Misoprostol}} \{\{nl\}\} {\emph{Arthrotec® = diclofenac + misoprostol}} & A mucosal protective agent, occasionally used to prevent GI adverse effects of long-term NSAID use \{\{nl\}\} A synthetic prostaglandin E analogue, increasing mucous production \{\{nl\}\} ALSO used for medically-induced abortions, and to evacuate uterus after miscarriage\{\{nl\}\} DO NOT USE FOR PREGNANT PATIENTS \tn 
% Row Count 39 (+ 16)
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\begin{tabularx}{8.4cm}{x{4 cm} x{4 cm} }
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{IBD, IBS, pancreatitis + Hemorrhoids - Meds}}  \tn
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{\bf{Inflammatory Bowel Disease (IBD)}} & key treatment includes anti-inflammatories + also an auto-immune component \tn 
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% Row 1
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Aminosalicylates \{\{nl\}\} {\emph{5-aminosalicylic acid (5-ASA), sulfasalazine, mesalamine}} & Anti-inflammatories (a GI topical effect) \{\{nl\}\} Inhibit production of inflammatory mediators prostaglandins and leukotrienes \{\{nl\}\} For mild symptoms, would not treat an exacerbation \{\{nl\}\} Used to lengthen times between exacerbations \{\{nl\}\} Can be given orally (formulated for minimal systemic absorption) or rectally (if lesions are more present in lower tract) – all work topically \tn 
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Corticosteroids & Useful because of both anti-inflammatory and immunosuppressant activity \{\{nl\}\} Auto-immune \& inflammatory components to IBD \{\{nl\}\} Used to treat exacerbations to send disease into remission\{\{nl\}\} Short term therapy, at high doses (pulse therapy) To minimize adverse effects \tn 
% Row Count 38 (+ 14)
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\begin{tabularx}{8.4cm}{x{4 cm} x{4 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{IBD, IBS, pancreatitis + Hemorrhoids - Meds (cont)}}  \tn
% Row 3
\SetRowColor{LightBackground}
{\emph{Budesonide (Entocort®)}} & A unique corticosteroid used specifically for IBD\{\{nl\}\} Encapsulated to avoid significant absorption in stomach or duodenum, then released slowly in lower tract \{\{nl\}\} In direct (topical) contact with lesions (ulcers)\{\{nl\}\} Any absorption that does occur is almost entirely removed by first-pass metabolism \{\{nl\}\} Avoids most long-term corticosteroid adverse effects (would still monitor) \tn 
% Row Count 20 (+ 20)
% Row 4
\SetRowColor{white}
Immuno-suppressants \{\{nl\}\} {\emph{Methotrexate, azathioprine, mercaptopurine}} & Suppresses auto-immune component of disease only \{\{nl\}\} For more severe disease, where aminosalicylates are not enough to prevent exacerbations \{\{nl\}\} Takes \textasciitilde{}3 months for onset of action \{\{nl\}\} Can increase time between exacerbations \tn 
% Row Count 32 (+ 12)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{8.4cm}{x{4 cm} x{4 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{IBD, IBS, pancreatitis + Hemorrhoids - Meds (cont)}}  \tn
% Row 5
\SetRowColor{LightBackground}
{\emph{Methotrexate (MTX)}} & Folate antagonist, interfering with DNA synthesis, repair, and cellular replication – most active against rapidly dividing cells \{\{nl\}\} Used in many auto-immune diseases (rheumatoid arthritis, IBD)\{\{nl\}\}Due to the mechanism of action, we must replace folic acid that is being inhibited \tn 
% Row Count 15 (+ 15)
% Row 6
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Biologics} \tn 
% Row Count 16 (+ 1)
% Row 7
\SetRowColor{LightBackground}
{\emph{Infliximab (Remicade®)}} & tumour necrosis factor (TNF)-α inhibitor (a cell signaling protein involved in inflammation and immune response) \tn 
% Row Count 22 (+ 6)
% Row 8
\SetRowColor{white}
{\emph{Adalimumab (Humira®)}} & also TNF-inhibitor \tn 
% Row Count 24 (+ 2)
% Row 9
\SetRowColor{LightBackground}
{\bf{Irritable Bowel Syndrome}} & Abdominal pain or discomfort with altered bowel habits which occur over a period of at least 3 months \{\{nl\}\} "Altered bowel habits" = bloating, cramping, mucous in stool, constipation, diarrhea \tn 
% Row Count 34 (+ 10)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{8.4cm}{x{4 cm} x{4 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{IBD, IBS, pancreatitis + Hemorrhoids - Meds (cont)}}  \tn
% Row 10
\SetRowColor{LightBackground}
Antispasmodics \{\{nl\}\}{\emph{dicyclomine \& hyoscine}} & reduce muscle spasms of GI tract by blocking muscarinic receptors (anticholinergic effects!) \tn 
% Row Count 5 (+ 5)
% Row 11
\SetRowColor{white}
Calcium channel blockers (CCB) \{\{nl\}\}{\emph{pinaverium}} & very specific for GI smooth muscle, reduces muscle contractions by inhibiting calcium influx (hypotension!) \tn 
% Row Count 11 (+ 6)
% Row 12
\SetRowColor{LightBackground}
Opioid agonists  \{\{nl\}\}{\emph{loperamide}} & doesn't cross blood-brain barrier; trimebutine – also has anti-serotonin activity \tn 
% Row Count 16 (+ 5)
% Row 13
\SetRowColor{white}
Antidepressants \{\{nl\}\} {\emph{TCAs \& SSRIs}} & address neurological connection (serotonin receptors in CNS and GI) and overlap of neurological conditions with IBS \{\{nl\}\} \textasciitilde{}55\% patients given TCA or SSRI saw benefit compared to \textasciitilde{}35\% placebo \tn 
% Row Count 26 (+ 10)
% Row 14
\SetRowColor{LightBackground}
Osmotics \& stool softeners & used for prevention or as needed \tn 
% Row Count 28 (+ 2)
% Row 15
\SetRowColor{white}
{\bf{Pancreatitis}} & Acute or chronic inflammation of the pancreas (very painful) \{\{nl\}\} Usually caused by gallstones, heavy alcohol use, or cystic fibrosis (CF) \tn 
% Row Count 35 (+ 7)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{8.4cm}{x{4 cm} x{4 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{IBD, IBS, pancreatitis + Hemorrhoids - Meds (cont)}}  \tn
% Row 16
\SetRowColor{LightBackground}
{\emph{Pancreatin (Creon®)}} & Enzymes are not absorbed \{\{nl\}\} Capsules formulated to release in duodenum \tn 
% Row Count 4 (+ 4)
% Row 17
\SetRowColor{white}
{\bf{Hemorrhoids}} & Commonly seen with constipation, diarrhea, pregnancy, advancing age and possibly physical exertion \{\{nl\}\} Symptom relief only – no meds are curative \{\{nl\}\} Products can provide short-term relief of pain, burning, itch, discomfort and irritation while swelling subsides and healing occurs \tn 
% Row Count 19 (+ 15)
% Row 18
\SetRowColor{LightBackground}
Local anesthetics \{\{nl\}\}{\emph{dibucaine, pramoxine}} & to relieve pain \{\{nl\}\} Safe if \textless{} 7 days of continued use \tn 
% Row Count 22 (+ 3)
% Row 19
\SetRowColor{white}
Corticosteroids \{\{nl\}\}{\emph{hydrocortisone}} & to reduce itch and inflammation \{\{nl\}\} Safe if \textless{} 14 days of continued use \tn 
% Row Count 26 (+ 4)
% Row 20
\SetRowColor{LightBackground}
Astringents \{\{nl\}\}{\emph{hamamelis}} & dries out skin to relieve burning, itching, and pain \tn 
% Row Count 29 (+ 3)
% Row 21
\SetRowColor{white}
Anti-infectives \{\{nl\}\}{\emph{framycetin}} & if concerned about infection \tn 
% Row Count 31 (+ 2)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{8.4cm}{x{4 cm} x{4 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{IBD, IBS, pancreatitis + Hemorrhoids - Meds (cont)}}  \tn
% Row 22
\SetRowColor{LightBackground}
Protectants \{\{nl\}\}{\emph{glycerin, petrolatum}} & to provide barrier for healing \tn 
% Row Count 2 (+ 2)
% Row 23
\SetRowColor{white}
Vasoconstrictors \{\{nl\}\}{\emph{phenylephrine}} & to relieve inflammation and limit bleeding; short term only \tn 
% Row Count 5 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}