Block 3 material simplified (GIT meds) Flashcards
H2 Blockers
MOA:
Clinical uses:
Adverse effects:
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)
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)
H2 Blockers
Proton Pump Inhibitors
MOA:
Clinical uses:
Adverse effects:
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)
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)
Proton Pump Inhibitors
What are the effects of overuse of Aluminum hydroxide (antacid)?
Constipation
Hypophosphatemia/Hypokalemia
Osteodystrophy
Proximal muscle weakness
Seizures
“CHOPS”
Constipation
Hypophosphatemia/Hypokalemia
Osteodystrophy
Proximal muscle weakness
Seizures
“CHOPS”
Are overuse of which antacid?
Aluminum hydroxide
What are the effects of overuse of Calcium carbonate (antacid)?
Hypercalcemia (milk-alkali syndrome)
Hypokalemia
Rebound acid increase
Hypercalcemia (milk-alkali syndrome)
Hypokalemia
Rebound acid increase
Are overuse of which antacid?
Calcium carbonate
What are the effects of overuse of Magnesium hydroxide (antacid)?
Diarrhea
Hyporeflexia
Hypokalemia
Hypotension
Cardiac arrest
Diarrhea
Hyporeflexia
Hypokalemia
Hypotension
Cardiac arrest
Are overuse of which antacid?
Magnesium hydroxide
Bismuth & Sucralfate
MOA:
Clinical uses:
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)
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 (________)
Bismuth & Sucralfate
Misoprostol
MOA:
Clinical uses:
Adverse effects:
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
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
Misoprostol
Octreotide
MOA:
Clinical uses:
Adverse effects:
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)
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)
Octreotide
Sulfasalazine
MOA:
Clinical uses:
Adverse effects:
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
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
Sulfasalazine
Loperamide
MOA:
Clinical uses:
Adverse effects:
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
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
Loperamide
Ondansetron & Granisetron
MOA:
Clinical uses:
Adverse effects:
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
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
Ondansetron & Granisetron
Aprepitant
MOA:
Clinical uses:
Adverse effects:
MOA:
Substance P antagonists that blocks NK1 (neurokinin-1) brain receptors
Clinical uses:
Antiemetic to reduce nausea/vomiting in chemo patients
MOA:
Substance P antagonists that blocks NK1 (neurokinin-1) brain receptors
Clinical uses:
Antiemetic to reduce nausea/vomiting in chemo patients
Aprepitant
Prochlorperazine & Metoclopramide
MOA:
Clinical uses:
Adverse effects:
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
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
Prochlorperazine & Metoclopramide
Orlistat
MOA:
Clinical uses:
Adverse effects:
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)
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)
Orlistat
Bulk-forming laxatives
MOA:
Clinical uses:
Adverse effects:
Psyllium & Methylcellulose
MOA:
Soluble fibers draw water into the gut’s lumen to form a viscous liquid to trigger peristalsis
Adverse effects:
Bloating
Psyllium & Methylcellulose
MOA:
Soluble fibers draw water into the gut’s lumen to form a viscous liquid to trigger peristalsis
Adverse effects:
Bloating
Bulk-forming laxatives
Osmotic laxatives
MOA:
Clinical uses:
Adverse effects:
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)
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)
Osmotic laxatives
Lactulose
MOA:
Clinical uses:
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)
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)
Lactulose
Stimulants (laxatives)
MOA:
Clinical uses:
Adverse effects:
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)
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)
Stimulants (laxatives)
Emollients (laxative)
MOA:
Clinical uses:
Adverse effects:
Docusate
MOA:
Promotes the incorporation of water & fat into poop (more pooping)
Clinical uses:
Constipation
Adverse effects:
1) Diarrhea
2) Metabolic alkalosis (overuse)
Docusate
MOA:
Promotes the incorporation of water & fat into poop (more pooping)
Clinical uses:
Constipation
Adverse effects:
1) Diarrhea
2) Metabolic alkalosis (overuse)
Emollients (laxative)
Lubiprostone
MOA:
Clinical uses:
Adverse effects:
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)
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)
Lubiprostone
infliximab, adalimumab, and certolizumab
MOA:
Clinical uses:
Adverse effects:
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
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
infliximab, adalimumab, and certolizumab
_______ IDB treatment options includes:
1) Anti-TNF antibodies like infliximab, adalimumab, and certolizumab
2) Natalizumab
3) Cyclosporine
4) IV corticosteroids
5) Surgery
Severe
______IDB treatment options includes:
1) Anti-TNF antibodies like infliximab, adalimumab, and certolizumab
2) Oral corticosteroids
3) Methotrexate
4) Azathioprine/6 Mercaptopurine
Moderate
_______IBD treatment options includes:
Budesonide (ileitis)
Topical corticosteroids
Antibiotics 5-Aminosalicylate
Mild
Liraglutide
MOA:
Clinical uses:
Adverse effects:
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
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
Liraglutide
