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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
Q

Histamine (H2) Receptor Antagonists (RA) - H2RA - MOA:

A

Competitively blocks the binding of histamine to H2 receptors of the parietal cell, inhibiting gastric acid secretion induced by histamine

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26
Q

H2RA’s - clinical use:

A

PUD
GERD
Dyspepsia
ZES

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27
Q

H2RA’s - AE’s?

A

CNS effects - HA, dizziness, fatigue, somnolence, confusion

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28
Q

Rare side effect of prolonged use of Cimetidine?

A

Gynecomastia

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29
Q

Common H2RA’s:

A
  1. Cimetidine (Tagamet)
  2. Ranitidine (Zantac)
  3. Famotidine (Pepcid)
  4. Nizatidine (Axid)
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30
Q

What is the preferred H2RA for IV use?

A

Ranitidine (Zantac) (remember RANitidine - RAN the fluid through the IV)

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31
Q

What are the most effective agents for management of GERD?

A

PPI’s

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32
Q

All the PPI drug names end in:

A

Prazole

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33
Q

PPI - MOA:

A

PRODRUG

Irreversibly binds to the H+/K+ ATPase enzyme system (proton pump) of the cells suppressing secretion of hydrogen ions

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34
Q

PPI - clinical use:

A

PUD
ZES
GERD

Better than H2RA’s across the board

Should be given 30-60 mins before meals

35
Q

Adverse effects of PPI’s:

A

Hypomagnesaemia

C-diff

Risk of fracture

36
Q

Sucralfate - MOA:

A

Covers the ulcer site and protects it from acid

Stimulates prostaglandin release

37
Q

Sucralfate - clinical use:

A

Heals peptic ulcers, but not seen a lot bc H2RA and PPI are more effective

38
Q

Misoprostol - MOA:

A

Prostaglandin analog

Antisecretory and mucosal protective properties

39
Q

Misoprostol - clinical use:

A

NSAID-induced ulcers

Not widely used bc of high AE profile and multiple daily dosing

40
Q

Misoprostol - pregnancy cat:

A

X

41
Q

Bismuth Subcitrate Potassium is only available as a combination rx product that contains:

A

Metronidazole
Tetracycline

(Tx of h. Pylori)

42
Q

AE’s of Bismouth subsalicylate:

A

Harmless blackening of stool
Darkening of tongue
High doses can lead to salicylate toxicity

43
Q

Metoclopramide (Reglan) - MOA:

A

Dopamine antagonist

Stimulates gastric motility

Block serotonin receptors in the trigger zone, resulting in anti-emetic action

44
Q

Metoclopramide (Reglan) - clinical use:

A

GERD

N/V from chemotherapy

Diabetic gastroparesis

45
Q

Metoclopramide (Reglan) - AE’s:

A

Extrapyramidal effects (dystonias, akathisia, parkinsonian features

46
Q

Eryhthromycin - MOA:

A

Stimulates motilin receptors on GI smooth muscle

47
Q

Erythromycin - clinical use:

A

IV - gastroparesis

48
Q

5HT3 antagonists - MOA:

A

Block presynaptic serotonin receptors on sensory vagal fibers in gut wall as well as block central blockade in the vomiting center and CTZ

49
Q

5HT3 antagonists - clinical use:

A

Post-operative n/v
Chemo and radiation induced n/v
General medical use

50
Q

5HT3 antagonists - AE’s:

A

MC is dizziness, HA, constipation

QTc prolongation (uncommon)

51
Q

5HT3 antagonist drugs:

A

Odansetron (Zofran)
Granisetron (Kytril)
Dolasetron (Anzemet)
Polanosetron (Aloxi)

52
Q

Antihistamines - MOA (nausea/vomiting):

A

Block H1, prevent vomiting due to motion sickness

Causes drowsiness and anticholinergic effcts

53
Q

Antihistamine meds:

A

Meclizine
Diphenhydramine
Dimenhydrinate
Doxylamine

54
Q

Antihistamine - pregnancy cat:

A

A

55
Q

Phenothiazines - MOA:

A

Block dopamine, muscarinic, and histamine receptors in CTZ

56
Q

Phenothiazines - clinical use:

A

Effective oral, injectable, and rectal anti-emetics

57
Q

Phenothiazines - AE’s:

A

HOTN, extrapyramidal, drowsiness

58
Q

Prochlorperazine (Compazine) used to be used for:

A

Typical antipsychotic

59
Q

Promethazine (Phenergan), although categorically a Phenothiazine, is also a:

A

1st generation anti-histamine

60
Q

Scopolamine - MOA:

A

Cholinergic antagonist - blocks the muscarinic receptors in the vestibular system

61
Q

Droperidol - MOA:

A

Blocks dopamine receptors in CTZ

62
Q

Droperidol - clinical use:

A

Post-operative n/v

Sedation in endoscopy (in combination with benzos)

63
Q

What are the two corticosteroids used in tx of n/v?

A

Dexamethasone

Methylprednisolone

64
Q

Benzodiazepines - clinical use in n/v?

A

Reduce anticipatory nausea and vomiting caused by anxiety

65
Q

Tx for mild diarrhea:

A

Rehydration fluids
Lactose-free diet
Avoid caffeine

66
Q

Tx for moderate diarrhea:

A

Anti-motility agents

Rehydration fluids

67
Q

Tx for traveler’s diarrhea:

A

Fluoroquinolones
Azithromycin
Rifaximin

68
Q

Loperamide - MOA:

A

Mu opioid agonist

Does not cross BBB

Meperidine derivative

69
Q

Osmotic laxatives - MOA:

A

Rapid movement of water into distal small bowel and colon

Leads to bowel distention and passage of stool

70
Q

Osmotic laxatives - AE’s:

A

Black box: nephropathy potential (sodium phosphate “fleets”)

Mag-sulfate -> caution in renal patients

71
Q

Lactulose is preferred as laxative in which pt’s:

A

Liver disease

72
Q

What is polyethylene glycol used for?

A

Colonoscopy prep

73
Q

Peg 3350 (Miralax) is approved for:

A

IBS-C

Safe in renal and hepatic disease

Safe in pregnancy

74
Q

What are the two natural plant fibers used in bulk-forming laxatives?

A

Psyllium

Wheat dextrin

75
Q

What are the two synthetic plant fibers used in bulk-forming laxatives?

A

Calcium polycarbophil

Methylcellulose

76
Q

Senna - MOA:

A

Active ingredient = sennosides

Causes water and electrolyte secretion into the bowel

77
Q

Bisacodyl (Dulcolax) - MOA:

A

Directly acts on nerves in the mucosa of the colon

78
Q

Castor Oil - pregnancy?

A

Contraindicated - will stimulate uterine contractions

79
Q

Docusate - MOA:

A

Softens the stool permitting water and lipids to penetrate

80
Q

Docusate - clinical use

A

Preferred as prophylaxis rather than acute tx for constipation

81
Q

Lubiprostone - MOA:

A

Stimulates secretion of chloride-rich fluid into the lumen

82
Q

Lubiprostone - clinical use:

A

IBS-C

Opioid-induced constipation

83
Q

What color are fire trucks?

A

“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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