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Junior - Pharm II - 1 > 6 - GI > Flashcards

6 - GI Flashcards

1
Q

Three factors that stimulate production of HCl at the parietal cell:

A
  1. Acetylcholine (parasympathetic)
  2. Histamine
  3. Gastrin
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2
Q

What is the protective substance for the lumen of the stomach:

A

Prostaglandin E1, E2, and I2 (Prostacyclin)

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3
Q

Meds for mild GERD (<1 episode per week):

A

Start with H2 inhibitors in addition to antacids for breakthrough symptoms

If not controlled after 4 weeks, switch to PPI

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4
Q

Meds for frequent GERD (> 1 episode per week):

A

Start with PPI (30-60 mins before meal)

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5
Q

Causes of PUD:

A
  1. H. Pylori
  2. NSAID’s
  3. Stress Ulcers
  4. ZES
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6
Q

S/S of gastric ulcer:

A

Epigastric pain exacerbated by eating

Heartburn, belching, nausea

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7
Q

S/S of duodenal ulcer:

A

Epigastric pain, usually worse at night, occurs 1-3 hrs post-prandial (pain may actually be relieved by eating)

Heartburn, belching, nausea

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8
Q

All patients with PUD should be tested for:

A

H pylori

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9
Q

Tx for h pylori:

A
  1. Anti-secretory (PPI)

2. ABX (see next card)

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10
Q

1st line triple therapy for H pylori:

A
  1. Clarithromycin
  2. Amoxicillin
  3. PPI
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11
Q

2nd line quadruple therapy for h pylori:

A
  1. Tetracycline
  2. Metronidazole
  3. Bismuth subsalicylate
  4. PPI
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12
Q

How long does for h pylori abx?

A

14 days

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13
Q

If PUD is present, continue PPI for ___ weeks so ulcers have time to heal (h pylori tx)

A

4 to 8 duodenal

8 to 12 gastric

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14
Q

Must be off PPI for how many weeks prior to confirmation of eradication test for h pylori?

A

1 to 2 weeks

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15
Q

Which COX is more important for GI health?

A

COX-1

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16
Q

If your pt has an NSAID-induced peptic ulcer and they just HAVE to be on an NSAID, consider putting them on:

A

Celecoxib (Celebrex) - it’s COX-2 selective, so less GI effect (but it DOES come with CV risk)

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17
Q

Prevention of stress ulcers for ICU pt’s:

A

PPI

H2RA

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18
Q

Clinical indication for antacids:

A

1st line therapy for intermittent symptoms (less than twice weekly)

Breakthrough therapy for those on PPI or H2RA therapy

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19
Q

Sodium bicarbonate - MOA:

A

Reacts with HCl to produce carbon dioxide and sodium chloride

CO2 results in gastric distention and belching, but relieved acidity-symptoms

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20
Q

Calcium carbonate - MOA:

A

Less effective but same MOA as bicarb

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21
Q

Magnesium Hydroxide - MOA:

A

Reacts slowly with HCl to form magnesium chloride and water

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22
Q

Magnesium hydroxide - clinical use:

A

Antacid

Laxative

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23
Q

Magnesium hydroxide - AE’s:

A

Osmotic diarrhea

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24
Q

Magnesium hydroxide is commonly combined with what two drugs to normalize bowel function?

A

Aluminum hydroxide and simethicone

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25
Histamine (H2) Receptor Antagonists (RA) - H2RA - MOA:
Competitively blocks the binding of histamine to H2 receptors of the parietal cell, inhibiting gastric acid secretion induced by histamine
26
H2RA’s - clinical use:
PUD GERD Dyspepsia ZES
27
H2RA’s - AE’s?
CNS effects - HA, dizziness, fatigue, somnolence, confusion
28
Rare side effect of prolonged use of Cimetidine?
Gynecomastia
29
Common H2RA’s:
1. Cimetidine (Tagamet) 2. Ranitidine (Zantac) 3. Famotidine (Pepcid) 4. Nizatidine (Axid)
30
What is the preferred H2RA for IV use?
Ranitidine (Zantac) (remember RANitidine - RAN the fluid through the IV)
31
What are the most effective agents for management of GERD?
PPI’s
32
All the PPI drug names end in:
Prazole
33
PPI - MOA:
PRODRUG Irreversibly binds to the H+/K+ ATPase enzyme system (proton pump) of the cells suppressing secretion of hydrogen ions
34
PPI - clinical use:
PUD ZES GERD Better than H2RA’s across the board Should be given 30-60 mins before meals
35
Adverse effects of PPI’s:
Hypomagnesaemia C-diff Risk of fracture
36
Sucralfate - MOA:
Covers the ulcer site and protects it from acid Stimulates prostaglandin release
37
Sucralfate - clinical use:
Heals peptic ulcers, but not seen a lot bc H2RA and PPI are more effective
38
Misoprostol - MOA:
Prostaglandin analog Antisecretory and mucosal protective properties
39
Misoprostol - clinical use:
NSAID-induced ulcers Not widely used bc of high AE profile and multiple daily dosing
40
Misoprostol - pregnancy cat:
X
41
Bismuth Subcitrate Potassium is only available as a combination rx product that contains:
Metronidazole Tetracycline (Tx of h. Pylori)
42
AE’s of Bismouth subsalicylate:
Harmless blackening of stool Darkening of tongue High doses can lead to salicylate toxicity
43
Metoclopramide (Reglan) - MOA:
Dopamine antagonist Stimulates gastric motility Block serotonin receptors in the trigger zone, resulting in anti-emetic action
44
Metoclopramide (Reglan) - clinical use:
GERD N/V from chemotherapy Diabetic gastroparesis
45
Metoclopramide (Reglan) - AE’s:
Extrapyramidal effects (dystonias, akathisia, parkinsonian features
46
Eryhthromycin - MOA:
Stimulates motilin receptors on GI smooth muscle
47
Erythromycin - clinical use:
IV - gastroparesis
48
5HT3 antagonists - MOA:
Block presynaptic serotonin receptors on sensory vagal fibers in gut wall as well as block central blockade in the vomiting center and CTZ
49
5HT3 antagonists - clinical use:
Post-operative n/v Chemo and radiation induced n/v General medical use
50
5HT3 antagonists - AE’s:
MC is dizziness, HA, constipation QTc prolongation (uncommon)
51
5HT3 antagonist drugs:
Odansetron (Zofran) Granisetron (Kytril) Dolasetron (Anzemet) Polanosetron (Aloxi)
52
Antihistamines - MOA (nausea/vomiting):
Block H1, prevent vomiting due to motion sickness Causes drowsiness and anticholinergic effcts
53
Antihistamine meds:
Meclizine Diphenhydramine Dimenhydrinate Doxylamine
54
Antihistamine - pregnancy cat:
A
55
Phenothiazines - MOA:
Block dopamine, muscarinic, and histamine receptors in CTZ
56
Phenothiazines - clinical use:
Effective oral, injectable, and rectal anti-emetics
57
Phenothiazines - AE’s:
HOTN, extrapyramidal, drowsiness
58
Prochlorperazine (Compazine) used to be used for:
Typical antipsychotic
59
Promethazine (Phenergan), although categorically a Phenothiazine, is also a:
1st generation anti-histamine
60
Scopolamine - MOA:
Cholinergic antagonist - blocks the muscarinic receptors in the vestibular system
61
Droperidol - MOA:
Blocks dopamine receptors in CTZ
62
Droperidol - clinical use:
Post-operative n/v Sedation in endoscopy (in combination with benzos)
63
What are the two corticosteroids used in tx of n/v?
Dexamethasone | Methylprednisolone
64
Benzodiazepines - clinical use in n/v?
Reduce anticipatory nausea and vomiting caused by anxiety
65
Tx for mild diarrhea:
Rehydration fluids Lactose-free diet Avoid caffeine
66
Tx for moderate diarrhea:
Anti-motility agents | Rehydration fluids
67
Tx for traveler’s diarrhea:
Fluoroquinolones Azithromycin Rifaximin
68
Loperamide - MOA:
Mu opioid agonist Does not cross BBB Meperidine derivative
69
Osmotic laxatives - MOA:
Rapid movement of water into distal small bowel and colon Leads to bowel distention and passage of stool
70
Osmotic laxatives - AE’s:
Black box: nephropathy potential (sodium phosphate “fleets”) Mag-sulfate -> caution in renal patients
71
Lactulose is preferred as laxative in which pt’s:
Liver disease
72
What is polyethylene glycol used for?
Colonoscopy prep
73
Peg 3350 (Miralax) is approved for:
IBS-C Safe in renal and hepatic disease Safe in pregnancy
74
What are the two natural plant fibers used in bulk-forming laxatives?
Psyllium | Wheat dextrin
75
What are the two synthetic plant fibers used in bulk-forming laxatives?
Calcium polycarbophil Methylcellulose
76
Senna - MOA:
Active ingredient = sennosides Causes water and electrolyte secretion into the bowel
77
Bisacodyl (Dulcolax) - MOA:
Directly acts on nerves in the mucosa of the colon
78
Castor Oil - pregnancy?
Contraindicated - will stimulate uterine contractions
79
Docusate - MOA:
Softens the stool permitting water and lipids to penetrate
80
Docusate - clinical use
Preferred as prophylaxis rather than acute tx for constipation
81
Lubiprostone - MOA:
Stimulates secretion of chloride-rich fluid into the lumen
82
Lubiprostone - clinical use:
IBS-C Opioid-induced constipation
83
What color are fire trucks?
“I’ve seen ‘em yellow, blue, red, orange, pink, teal, salmon, and white. Every color of the rainbow.” -Know it all fire fighter

Junior - Pharm II - 1 (6 decks)

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