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Pharm SJSM > Block 3 material simplified (GIT meds) > Flashcards

Block 3 material simplified (GIT meds) Flashcards

1
Q

H2 Blockers

MOA:

Clinical uses:

Adverse effects:

A

Cimetidine, Famotidine, & Nizatidine

MOA:
Inhibit H2 receptors to reduce H+ secretion from gastric parietal cells

Clinical uses:
Peptic ulcers
Gastritis
Mild esophageal reflux

Adverse effects: mostly Cimetidine
1) Inhibits CYP450 (drug interactions)

2) Antiandrogenic
(prolactin release, gynecomastia, impotence, low libido)

3) Cross BBB & placenta
(confusion, headaches, & dizziness)

4) Elevated CK (reduced renal clearance)

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2
Q

Cimetidine, Famotidine, & Nizatidine

MOA:
Inhibit H2 receptors to reduce H+ secretion from gastric parietal cells

Clinical uses:
Peptic ulcers
Gastritis
Mild esophageal reflux

Adverse effects: mostly Cimetidine
1) Inhibits CYP450 (drug interactions)

2) Antiandrogenic
(prolactin release, gynecomastia, impotence, low libido)

3) Cross BBB & placenta
(confusion, headaches, & dizziness)

4) Elevated CK (reduced renal clearance)

A

H2 Blockers

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3
Q

Proton Pump Inhibitors

MOA:

Clinical uses:

Adverse effects:

A

Omeprazole, Lansoprazole, Esomeprazole, Pantoprazole, & Dexlansoprazole

MOA:
Irreversibly inhibits H+/K+ ATPase in gastric parietal cells
(needs acidic pH take before food)

Clinical uses:
Peptic ulcers
Gastritis
GERD
Zollinger Ellison syndrome
H. pylori
Prophylaxis for stress-induced ulcers

Adverse effects:
1) High risk of C.diff infection
2) Pneumonia
3) Acute interstitial nephritis
4) Vit B12, Mg2+, & Ca2+ malabsorption (higher fracture risk in elderly)

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4
Q

Omeprazole, Lansoprazole, Esomeprazole, Pantoprazole, & Dexlansoprazole

MOA:
Irreversibly inhibits H+/K+ ATPase in gastric parietal cells
(needs acidic pH take before food)

Clinical uses:
Peptic ulcers
Gastritis
GERD
Zollinger Ellison syndrome
H. pylori
Prophylaxis for stress-induced ulcers

Adverse effects:
1) High risk of C.diff infection
2) Pneumonia
3) Acute interstitial nephritis
4) Vit B12, Mg2+, & Ca2+ malabsorption (higher fracture risk in elderly)

A

Proton Pump Inhibitors

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5
Q

What are the effects of overuse of Aluminum hydroxide (antacid)?

A

Constipation
Hypophosphatemia/Hypokalemia
Osteodystrophy
Proximal muscle weakness
Seizures

“CHOPS”

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6
Q

Constipation
Hypophosphatemia/Hypokalemia
Osteodystrophy
Proximal muscle weakness
Seizures

“CHOPS”

Are overuse of which antacid?

A

Aluminum hydroxide

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7
Q

What are the effects of overuse of Calcium carbonate (antacid)?

A

Hypercalcemia (milk-alkali syndrome)
Hypokalemia
Rebound acid increase

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8
Q

Hypercalcemia (milk-alkali syndrome)
Hypokalemia
Rebound acid increase

Are overuse of which antacid?

A

Calcium carbonate

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9
Q

What are the effects of overuse of Magnesium hydroxide (antacid)?

A

Diarrhea
Hyporeflexia
Hypokalemia
Hypotension
Cardiac arrest

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10
Q

Diarrhea
Hyporeflexia
Hypokalemia
Hypotension
Cardiac arrest

Are overuse of which antacid?

A

Magnesium hydroxide

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11
Q

Bismuth & Sucralfate

MOA:

Clinical uses:

A

MOA:
They bind to the ulcers base to protect it from further damage & they allow HC0-3 secretion to reestablish the pH gradient in the mucous layer

Note:
Sucralfate needs acidic pH (give before meals) & AVOID PPI’S & H2 inhibitors

Clinical uses:
1) Improve ulcer healing
2) Travelers diarrhea (Bismuth)
3) H.pylori-induced gastritis (Bismuth)

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12
Q

MOA:
They bind to the ulcers base to protect it from further damage & they allow HC0-3 secretion to reestablish the pH gradient in the mucous layer

Note:
_______ needs acidic pH (give before meals) & AVOID PPI’S & H2 inhibitors

Clinical uses:
1) Improve ulcer healing
2) Travelers diarrhea (_______)
3) H.pylori-induced gastritis (________)

A

Bismuth & Sucralfate

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13
Q

Misoprostol

MOA:

Clinical uses:

Adverse effects:

A

MOA:
PGE1 analog that increases the production/secretion of bicarbonate from the gastric mucosa & reduces the secretion of acid to protect the lining

Clinical uses:
1) Prevent NSAID-induced peptic ulcers
2) Off label labor inducer (ripens the cervix)

Adverse effects:
Diarrhea

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14
Q

MOA:
PGE1 analog that increases the production/secretion of bicarbonate from the gastric mucosa & reduces the secretion of acid to protect the lining

Clinical uses:
1) Prevent NSAID-induced peptic ulcers
2) Off label labor inducer (ripens the cervix)

Adverse effects:
Diarrhea

A

Misoprostol

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15
Q

Octreotide

MOA:

Clinical uses:

Adverse effects:

A

MOA:
Long-acting somatostatin analog that inhibits the release of various splanchnic vasodilatory hormones

Clinical uses:
1) Acute varicocele bleeds
2) Acromegaly
3) VIPoma
4) Carcinoid tumor

Adverse effects:
1) Nausea/Cramps
2) Steatorrhea
3) Higher risk of cholelithiasis (due to CCK inhibition)

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16
Q

MOA:
Long-acting somatostatin analog that inhibits the release of various splanchnic vasodilatory hormones

Clinical uses:
1) Acute varicocele bleeds
2) Acromegaly
3) VIPoma
4) Carcinoid tumor

Adverse effects:
1) Nausea/Cramps
2) Steatorrhea
3) Higher risk of cholelithiasis (due to CCK inhibition)

A

Octreotide

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17
Q

Sulfasalazine

MOA:

Clinical uses:

Adverse effects:

A

MOA:
A combination of sulfapyridine (antibacterial) & 5-aminosalicylic acid (anti-inflammatory) that is activated by colonic bacteria

Clinical uses:
Ulcerative colitis
The ulcerative component of Chron’s

Adverse effects:
1) Malaise/Nausea
2) Sulfonamides toxicity
3) Reversible oligospermia

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18
Q

MOA:
A combination of sulfapyridine (antibacterial) & 5-aminosalicylic acid (anti-inflammatory) that is activated by colonic bacteria

Clinical uses:
Ulcerative colitis
The ulcerative component of Chron’s

Adverse effects:
1) Malaise/Nausea
2) Sulfonamides toxicity
3) Reversible oligospermia

A

Sulfasalazine

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19
Q

Loperamide

MOA:

Clinical uses:

Adverse effects:

A

MOA:
An agonist at μ-opioid receptors in the myenteric plexus to slow gut motility & increase electrolyte resorption (hardens poop & reduces frequency)

Clinical uses:
Diarrhea

Adverse effects:
Constipation
Nausea/Cramping

20
Q

MOA:
An agonist at μ-opioid receptors in the myenteric plexus to slow gut motility & increase electrolyte resorption (hardens poop & reduces frequency)

Clinical uses:
Diarrhea

Adverse effects:
Constipation
Nausea

A

Loperamide

21
Q

Ondansetron & Granisetron

MOA:

Clinical uses:

Adverse effects:

A

MOA:
5-HT3 antagonist that acts peripherally to reduce vagal stimulation & centrally as an antiemetic

Clinical uses:
Control post-op vomiting in chemo patients

Adverse effects:
1) Headache
2) Constipation
3) QT prolongation
4) Serotonin syndrome

22
Q

MOA:
5-HT3 antagonist that acts peripherally to reduce vagal stimulation & centrally as an antiemetic

Clinical uses:
Control post-op vomiting in chemo patients

Adverse effects:
1) Headache
2) Constipation
3) QT prolongation
4) Serotonin syndrome

A

Ondansetron & Granisetron

23
Q

Aprepitant

MOA:

Clinical uses:

Adverse effects:

A

MOA:
Substance P antagonists that blocks NK1 (neurokinin-1) brain receptors

Clinical uses:
Antiemetic to reduce nausea/vomiting in chemo patients

24
Q

MOA:
Substance P antagonists that blocks NK1 (neurokinin-1) brain receptors

Clinical uses:
Antiemetic to reduce nausea/vomiting in chemo patients

A

Aprepitant

25
Q

Prochlorperazine & Metoclopramide

MOA:

Clinical uses:

Adverse effects:

A

MOA:
D2 receptor antagonist that increase acetylcholine’s response in the upper Gi tract to promote gastric emptying (prokinetic effect) and reducing nausea and vomiting (antiemetic effect).

AVOID in patients with a small bowel obstruction

Clinical uses:
Diabetic & post op gastroparesis
Antiemetic

Adverse effects:
1) Extrapyramidal symptoms (tardive dyskinesia & lower seizure threshold)
2) Drowsiness/Fatigue
3) Depression
4) Diarrhea
5) Drug interactions with digoxin & diabetic drugs

26
Q

MOA:
D2 receptor antagonist that increase acetylcholine’s response in the upper Gi tract to promote gastric emptying (prokinetic effect) and reducing nausea and vomiting (antiemetic effect).

AVOID in patients with a small bowel obstruction

Clinical uses:
Diabetic & post op gastroparesis
Antiemetic

Adverse effects:
1) Extrapyramidal symptoms (tardive dyskinesia & lower seizure threshold)
2) Drowsiness/Fatigue
3) Depression
4) Diarrhea
5) Drug interactions with digoxin & diabetic drugs

A

Prochlorperazine & Metoclopramide

27
Q

Orlistat

MOA:

Clinical uses:

Adverse effects:

A

Lipid lowering agent

MOA:
Inhibits gastric & pancreatic lipase to reduce breakdown & absorption of dietary fats (take with a fatty meal)

Clinical use:
Weight loss

Adverse effects:
1) Abdominal pain
2) Flatulence
3) Bowel urgency/frequency
4) Steatorrhea (fat-soluble vitamin def)

28
Q

MOA:
Inhibits gastric & pancreatic lipase to reduce breakdown & absorption of dietary fats (take with a fatty meal)

Clinical use:
Weight loss

Adverse effects:
1) Abdominal pain
2) Flatulence
3) Bowel urgency/frequency
4) Steatorrhea (fat-soluble vitamin def)

A

Orlistat

29
Q

Bulk-forming laxatives

MOA:

Clinical uses:

Adverse effects:

A

Psyllium & Methylcellulose

MOA:
Soluble fibers draw water into the gut’s lumen to form a viscous liquid to trigger peristalsis

Adverse effects:
Bloating

30
Q

Psyllium & Methylcellulose

MOA:
Soluble fibers draw water into the gut’s lumen to form a viscous liquid to trigger peristalsis

Adverse effects:
Bloating

A

Bulk-forming laxatives

31
Q

Osmotic laxatives

MOA:

Clinical uses:

Adverse effects:

A

Magnesium hydroxide, Magnesium citrate, Polyethylene glycol, & Lactulose

MOA:
They are osmotic loads that draw water into the Gi lumen to trigger peristalsis

Clinical uses:
Constipation (all)
Hepatic encephalopathy (Lactulose)

Adverse effects:
1) Diarrhea
2) Dehydration
3) Metabolic alkalosis (overuse)

32
Q

Magnesium hydroxide, Magnesium citrate, Polyethylene glycol, & Lactulose

MOA:
They are osmotic loads that draw water into the Gi lumen to trigger peristalsis

Clinical uses:
Constipation (all)
Hepatic encephalopathy (Lactulose)

Adverse effects:
1) Diarrhea
2) Dehydration
3) Metabolic alkalosis (overuse)

A

Osmotic laxatives

33
Q

Lactulose

MOA:

Clinical uses:

A

MOA:
A synthetic disaccharide that’s not absorbed in the gut that is metabolized by gut flora to activate an osmotic effect to soften stool and promote bowel movements

Clinical uses:
1) Constipation
2) Hepatic encephalopathy
(It reduces ammonia absorption)

34
Q

MOA:
A synthetic disaccharide that’s not absorbed in the gut that is metabolized by gut flora to activate an osmotic effect to soften stool and promote bowel movements

Clinical uses:
1) Constipation
2) Hepatic encephalopathy
(It reduces ammonia absorption)

A

Lactulose

35
Q

Stimulants (laxatives)

MOA:

Clinical uses:

Adverse effects:

A

Senna & Bisacodyl

MOA:
Stimulate the enteric nerves to contract the colon (induce pooping)

Clinical uses:
Constipation

Adverse effects:
1) Diarrhea
2) Melanosis coli
3) Metabolic alkalosis (overuse)

36
Q

Senna & Bisacodyl

MOA:
Stimulate the enteric nerves to contract the colon (induce pooping)

Clinical uses:
Constipation

Adverse effects:
1) Diarrhea
2) Melanosis coli
3) Metabolic alkalosis (overuse)

A

Stimulants (laxatives)

37
Q

Emollients (laxative)

MOA:

Clinical uses:

Adverse effects:

A

Docusate

MOA:
Promotes the incorporation of water & fat into poop (more pooping)

Clinical uses:
Constipation

Adverse effects:
1) Diarrhea
2) Metabolic alkalosis (overuse)

38
Q

Docusate

MOA:
Promotes the incorporation of water & fat into poop (more pooping)

Clinical uses:
Constipation

Adverse effects:
1) Diarrhea
2) Metabolic alkalosis (overuse)

A

Emollients (laxative)

39
Q

Lubiprostone

MOA:

Clinical uses:

Adverse effects:

A

Cl- channel activator

MOA:
It activates the type 2 Cl- channels in the small intestine to increase the amount of Cl- rich fluid into the intestine to stimulate intestinal motility and shortens intestinal transit time

Clinical uses:
women with IBS (predominantly constipation)

Adverse effects:
Category C (pregnancy)

40
Q

Cl- channel activator

MOA:
It activates the type 2 Cl- channels in the small intestine to increase the amount of Cl- rich fluid into the intestine to stimulate intestinal motility and shortens intestinal transit time

Clinical uses:
women with IBS (predominantly constipation)

Adverse effects:
Category C (pregnancy)

A

Lubiprostone

41
Q

infliximab, adalimumab, and certolizumab

MOA:

Clinical uses:

Adverse effects:

A

MOA:
anti-TNF monoclonal antibody

Clinical uses:
1) IBD
2) Rheumatoid arthritis
3) Ankylosing spondylitis
4) Psoriasis

Adverse effects:
1) predisposing to infection (reactivation of latent TB)
2) drug-induced lupus

42
Q

MOA:
anti-TNF monoclonal antibody

Clinical uses:
1) IBD
2) Rheumatoid arthritis
3) Ankylosing spondylitis
4) Psoriasis

Adverse effects:
1) predisposing to infection (reactivation of latent TB)
2) drug-induced lupus

A

infliximab, adalimumab, and certolizumab

43
Q

_______ IDB treatment options includes:
1) Anti-TNF antibodies like infliximab, adalimumab, and certolizumab
2) Natalizumab
3) Cyclosporine
4) IV corticosteroids
5) Surgery

A

Severe

44
Q

______IDB treatment options includes:
1) Anti-TNF antibodies like infliximab, adalimumab, and certolizumab
2) Oral corticosteroids
3) Methotrexate
4) Azathioprine/6 Mercaptopurine

A

Moderate

45
Q

_______IBD treatment options includes:
Budesonide (ileitis)
Topical corticosteroids
Antibiotics 5-Aminosalicylate

A

Mild

46
Q

Liraglutide

MOA:

Clinical uses:

Adverse effects:

A

GLP-1 agonist

MOA:
decrease glucagon release, decrease gastric emptying, increase glucose-dependent insulin release

Clinical uses:
Weight loss

Adverse effects:
1) N/V
2) headache
3) nasopharyngitis
4) increase satiety

47
Q

GLP-1 agonist

MOA:
decrease glucagon release, decrease gastric emptying, increase glucose-dependent insulin release

Clinical uses:
Weight loss

Adverse effects:
1) N/V
2) headache
3) nasopharyngitis
4) increase satiety

A

Liraglutide

Pharm SJSM (23 decks)

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