Big picture pharm

Question 1

antacids

Answer 1

buffer

local neutralization of acids

Question 2

sucralfate

Answer 2

physical barrier that coats stomach

constipation bc Al3+

Question 3

bismuth

Answer 3

promote mucin & bicarb production

antibacterial fx

Question 4

misoprostol

Answer 4

PGE2 analog:

• stim mucin/bicarb
• suppress acid
• incr mucosal blood flow

UTERINE CONTRACTIONS

Question 5

why use misoprostol

Answer 5

protect from NSAID use

Question 6

H2 receptor antagonists

Answer 6

-competitively bind H2 receptor on parietal cell

CHANGE pH
renal insufficiency

Question 7

cimetidine AE

Answer 7

gynecomastia, galactorrhea

Question 8

PPIs

Answer 8

-prazoles

• inactivate H+,K+ ATPase
• reduced vitamin/mineral absorption
• skin rash, myopathy, arthralgia

Question 9

Tx for Barrett’s, Z-E

Answer 9

PPIs

Question 10

bethanechol

Answer 10

• cholinergic agent
• direct muscarinic agent stimulates parasymp
• rarely used

Question 11

metoclopramide

Answer 11

• serotonin receptor agonist
• dopamine antagonist

TARDIVE DYSKINESIA
Serotonin syndrome

Question 12

cisapride

Answer 12

serotonin receptor agonist

Question 13

domperidone

Answer 13

dopamine receptor antagonist

Question 14

erythromycin

Answer 14

motilin like agent

-macrolide Abx

Question 15

fiber/bulk forming agents

Answer 15

• absorb water to slow diarrhea
• distend colon to promote motility with constipation

binds other meds
bloating

Question 16

docusate, mineral oil

Answer 16

softens stool by lowering surface tension (for constipation)

impaired absorption of fat soluble agents

Question 17

saline based osmotic agents

Answer 17

• magnesium citrate
• phosphate salts

draw water in, expands stool, presses on wall, stimulates motility

caution if renal/cardio

Question 18

lactulose, sorbitol, glycerin enema

Answer 18

sugar/alcohol based osmotic agents

draw water in, expands stool, presses on wall, stimulates motility

Question 19

bisacodyl

Answer 19

stimulates intestinal wall –> contractions

avoid overuse/dependence

Question 20

senna,

cascara

Answer 20

stimulates intestinal wall –> contractions

avoid overuse/dependence

Senna not approved by FDA for laxative - marketed as weight loss

Question 21

lubiprostone

Answer 21

chloride channel agonist –> increase secretions/motility

concerns if pregnant

Question 22

tegaserod

Answer 22

serotonin receptor agonist

IBS-C in women <65 yrs

Question 23

linaclotide,

plecanatide

Answer 23

guanylate cyclase agonists

also suppress afferent nerve fibers

Question 24

prucalopride

Answer 24

serotonin receptor agonist

Question 25

methylnaltrexone

Answer 25

PAMORA (for constipation)

Question 26

naloxegol

Answer 26

PAMORA (for constipation)

Question 27

alvimopan

Answer 27

PAMORA (for constipation)

Question 28

nalemedine

Answer 28

PAMORA (for constipation)

Question 29

bismuth

Answer 29

absorbs extra fluid, slows things down, antimicrobial, cytoprotectant

Question 30

cholecystyramine

Answer 30

binds bile acids

Tx for secretory diarrhea

Question 31

morphine

Answer 31

activates mu receptors, slows motility

Question 32

loperamide

Answer 32

activates mu receptors, slows motility

CARDIOTOXIC if overdose

Question 33

diphenoxylate + atropine

Answer 33

activates mu receptors, slows motility

atropine built in deterrant

Question 34

eluxadoline

Answer 34

GI selective mu receptor agonist
-binds sphincter of Oddi

avoid if bile duct obstruction, pancreatitis

Question 35

octreotide

Answer 35

somatostatin analog –> decr secretions

tx for diarrhea

Question 36

clonidine

Answer 36

alpha-2 receptor agonist

tx for diarrhea

Question 37

alosetron

Answer 37

serotonin receptor antagonist

tx for diarrhea

Question 38

rifaximin

Answer 38

antibiotic
changes bacterial flora

good for travelers diarrhea, IBS, hepatic encephalopathy

Question 39

corfelemer

Answer 39

blocks secretion of CFTR, calcium channel –> decrease secretions

Tx for HIV pts w/ severe watery diarrhea