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4. Pharm III > 2- GI Drugs > Flashcards

2- GI Drugs Flashcards

1
Q

What antacids are fast acting, not useful for ulcers, and should be used with caution in pts with CHF?

A

Sodium bicarbonate

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2
Q

Pt taking a calcium carbonate antacid should be cautioned on what 2 side effects?

A

“Milk alkali” syndrome- high blood calcium + metabolic alkalosis

Acid rebound

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3
Q

What are the SEs of magnesium hydroxide and aluminum hydroxide? (antacids)

A

Magnesium hydroxide- diarrhea (also used at laxative)

Aluminum hydroxide- constipation

Combined to decrease SEs

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4
Q

Magnesium hydroxide and aluminum hydroxide (antacids) should be used with caution in patients with what?

A

Renal function (accumulation)

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5
Q

What drug interaction between magnesium hydroxide and aluminum hydroxide is of importance when they are combined?

A

Decreased absorption

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6
Q

What is the use of antacids?

A

Temporary relief of heartburn, gastritis

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7
Q

Drug interactions

Theophylline, ketoconazole, quinolone abx, and tetracycline form complexes with what meds?

A

Antacids

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8
Q

Drug interactions

What meds will decrease the absorption of digoxin, phenytoin, and propranolol?

A

Antacids

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9
Q

Drug interactions

What meds will increase the elimination of phenobarbital and salicylates leading to alkalinization of urine?

A

Antacids

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10
Q

What drugs are H2 antagonists?

(decrease GI acid formation through H2 receptor blockade, all OTC)

A

Cimetidine (Tagamet)

Ranitidine (Zantac)

Famotidine (Pepcid)

Nizatidine (Axid)

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11
Q

What is the use of H2 blockers?

A

Ulcers (used at night)

GERD (adjunct)

Pre-anesthesia

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12
Q

How are H2 blockers given for severe allergic reaction?

A

In combo with H1 antagonists

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13
Q

How are H2 blockers metabolized and excreted?

A

Metabolized by liver

Excreted by kidney

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14
Q

What are the SEs of H2 blockers?

A

HA, dizziness, nausea, rash/ itch

(worse in elderly)

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15
Q

What drug has an anti-testosterone effect and can therefore be beneficial in women, but cause gynecomastia/ loss of libido/ impotence in men?

A

Cimetidine

(H2 blocker)

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16
Q

Drug interactions

What drug inhibits metabolism of warfarin, phenytoin, theophylline, and digoxin?

A

Cimetidine

(H2 blocker)

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17
Q

What drugs end in “prazole”?

A

PPIs

(Omeprazole, Esomeprazole, Lansoprazole, Rabeprazole, Pantoprazole)

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18
Q

What is the DOC for GERD?

A

PPIs (“prazoles”)

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19
Q

What drugs irreversibly block acid formation and have a duration of action of 2-3 days as new pumps are formed?

A

PPIs (take on empty stomach, in a.m.)

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20
Q

What are the SEs of PPIs?

A

Nausea, diarrhea, colic, osteoporosis, decrease Mg++ absorption

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21
Q

What are the uses for PPIs (aside from GERD = DOC)? (3)

A

Ulcers refractory to tx w/ H2 antagonists

Pts on NSAIDS

Zollinger-Ellison syndrome

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22
Q

What is the MOA of Misoprostol (Cytotec)?

A

PGE1 analogue

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23
Q

What drug is used to prevent or reduce NSAID-induced damage?

A

Misoprostol (Cytotec)

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24
Q

What are the SEs and contraindication of Misoprostol (Cytotec)?

A

SEs: diarrhea, nausea, HA, dizziness

C/i: pregnancy (can induce abortion)

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25
Q

What drugs are prokinetic agents? (3)

A

Metoclopramide

Bethanechol

Erythromycin

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26
Q

What is the use of Metoclopramide?

A

Antiemetic

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27
Q

What are the SEs of Metoclopramide?

A

Parkinson’s-like sxs, antiemetic, GI cramping, diarrhea

28
Q

Contraindication to use of Metoclopramide?

A

Pregnancy (methemoglobinemia in infants)

29
Q

What prokinetic agent is used to tx diabetic gastroparesis?

A

Erythromycin

30
Q

MOA/ SEs for Bethanechol? (prokinetic agent)

A

MOA: muscarinic agonist

SEs: diarrhea, abd cramps

31
Q

What are the most commonly used muscarinic antagonists, used to decrease GI spasms?

A

Glycopyrrolate and dicyclomine

32
Q

What are the SEs of Glycopyrrolate and Dicyclomine? (antispasmodics- muscarinic antagonists)

A

Dry mouth, sedation, constipation

33
Q

Pt presents with IBS. What GI drug should you prescribe to decrease GI effects and decrease pain transmission?

A

Amitriptyline

34
Q

Pt presents with IBS WITH diarrhea. What antispasmodic agent should be prescribed and what is its SE?

A

Eluxadoline (opioid agonist)

SE: severe constipation

35
Q

What drugs are very effective for N/V induced chemotherapy, radiation, and gastric diseases, but NOT used for motion sickness?

A

5HT3 antagonists; “setrons”

Ondansetron (Zofran)

Granisetron (Kytril)

Dolasetron (Anzemet)

Palonosetron (Aloxi)

36
Q

What are the SEs for the 5HT3 antagonists? (“setron”)

A

HA, constipation, dizziness

37
Q

What antiemetic drugs can be used post-op, for gastroenteritis, or chemo SEs, AS WELL AS motion sickness (but not DOC)?

A

Prochlorperazine, Promethazine

(block DA, muscarinic, histamine receptors)

38
Q

What are the SEs of Prochlorperazine and Promethazine?

A

Highly sedating

39
Q

You are treating a pt with chemo-induced N/V with Dronabinol/ medical marijuana (THC). What SE should they be aware of?

A

Stimulates appetite

40
Q

What drug might you combine a 5HT3 antagonist for increased antiemetic effects?

A

Aprepitant- NK1 antagonist

41
Q

What is the best bulk-forming laxative and what are common SEs?

A

High-fiber diet (+ water)

SEs: bloating, flatulence

(other fiber sources: Methylcellulose, Psyllium, Polycarbophil)

42
Q

What are the types of osmotic laxatives (NOT absorbed, pulls water w/ them)?

A

Magnesium hydroxide- stimulates GI tract, increases peristalsis

Sodium salts- oral/ enema, caution w/ overuse

Artificial sweeteners (Sorbitol, Mannitol, Sucralose)

43
Q

Pt undergoing prep for colonoscopy will likely be taking what laxative?

(large volume consumed + electrolytes)

A

Polyethylene glycol

44
Q

What OTC laxative may be used for occasional constipation (up to 7 days) and what pt edu should be provided?

A

Miralax (polyethylene glycol)
LOTS OF WATER

45
Q

What laxative is used to decrease blood ammonia levels in pts with cirrhosis or liver disease and what are its SEs?

A

Lactulose

SEs: flatulence and diarrhea

46
Q

Female pt who is pregnant presents to your office with GI complaints. What laxative can be prescribed in order to stimulate peristalsis and enhance secretion/ inhibit absorption of H2O?

A

Bisacodyl, Senna

(mucosal agents)

47
Q

What mucosal agent is used for diagnostic surgery procedures (colonoscopy) and what is its c/i?

A

Castor oil

C/i: pregnancy (stimulates uterus)

48
Q

Although generally not very effective and not recommended, what laxatives are used as lubricants/ stool softeners?

A

Mineral oil

Docusate

Glycerin

49
Q

What are the cautions with mineral oil use? (lubricant/ softener)

A

Inhibits absorption of fat soluble vitamins, oral inhalation (pneumonia), leaking (need diaper)

50
Q

What stool softeners are safe to be used long-term/ chronically?

A

Lubiprostone, Linaclotide

51
Q

What is the use of Lubiprostone?

A

Increase fluid secretion, softer stool

(PGE1 analogue, activations Cl channels)

52
Q

Pt presents with IBS WITH constipation. What laxative can be used and what is a SE?

A

Linaclotide

SE: diarrhea

53
Q

Contraindication to Linaclotide?

A

Children and teens < 18 yo (risk of dehydration)

54
Q

What is considered first line for tx of constipation?

A

Diet, water, exercise

(THEN drugs)

55
Q

What are the contraindications to laxative use?

A
  • N/V/ abd cramps
  • Undiagnosed abd pain
  • Appendicitis
  • Intestinal obstruction
56
Q

What are the concerns with overuse of laxatives?

A

Fluid/ electrolyte imbalance

Spastic colitis

UC

(can only use Lubiprostone and Linaclotide chronically)

57
Q

What anti-diarrheal agents may benefit watery diarrhea by increasing bulk?

A

Adsorbents

(absorb water, form gel-like mass)

(dietary approach = bananas, applesauce, rice)

58
Q

What opioid may be used in the tx of diarrhea, has low abuse potential because it does not enter the CNS and has SEs of abd pain and constipation?

A

Loperamide (Imodium)

59
Q

Pt presents with sxs of atropine poisoning. What anti-diarrheal have they likely overdosed on?

A

Diphenoxylate/ atropine (Lomotil)

60
Q

What opioid may be used in the tx of diarrhea, is combined w/ atropine to reduce abuse potential and increase effectiveness?

A

Diphenoxylate/ atropine (Lomotil)

61
Q

What anti-diarrheal is most commonly used in the tx of “traveller’s diarrhea” to absorb water and pathogens?

A

Bismuth subsalicylate

(salicylate = anti-inflammatory)

62
Q

SE of bismuth subsalicylate? (Pepto-Bismol)

A

Black tongue, mouth, stool

63
Q

Contraindications to bismuth subsalicylate (Pepto-Bismol)?

A

Pts allergic to aspirin

Children (risk of Reyes)

Asthmatics (caution)

64
Q

What GI drug should be considered for tx of IBD (best for UC) and what is its c/i?

A

Sulfasalazine (5-ASA + sulfapyridine)

C/i: children (Reyes)

65
Q

Pt presents with severe UC or Crohn’s that is refractory to other drug treatments. What drugs can be used?

A

Infliximab, Adalimumab

(TNF alpha blocking agents, anti-inflammatory effects)

66
Q

What is the major adverse effect of Infliximab and Adalimumab?

(TNF alpha blocking agents used for refractory IBD)

A

Immunosuppression (TB test required)

67
Q

What drug coats and dissipates gas to decrease bloating and flatulence and can be used in combo with antacids?

A

Simethicone

4. Pharm III (16 decks)

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