Chapter 28 Gastrointestinal Flashcards
1
Q
Cimeditine (Tagamet)
A
- H2 receptor antagonist
- compete with histamine for H2 receptors on gastric parietal cells
- inhibit meal stimulated and basal secretion
- treat dyspepsia, PUD, GERD
- less preferred to PPI due to slow healing rates
- ADE: gynecomastia, inhibit many CYP
2
Q
Famotidine (Pepcid)
A
- H2 receptor antagonist
- compete with histamine for H2 receptors on gastric parietal cells
- inhibit meal stimulated and basal secretion
- treat dyspepsia, PUD, GERD
- less preferred to PPI due to slow healing rates
- ADE: remarkably nontoxic
3
Q
Nizatidine (Axid)
A
- H2 receptor antagonist
- compete with histamine for H2 receptors on gastric parietal cells
- inhibit meal stimulated and basal secretion
- treat dyspepsia, PUD, GERD
- less preferred to PPI due to slow healing rates
- ADE: remarkably nontoxic
4
Q
Esomeprazole (Nexium)
A
- proton pump inhibitor
- bind to and antagonize proton pump (H+ K+ ATPase)
- dose dependent inhibition of 95% acid secretion for 1-2 days
- heal 80-90% of PUD in 2 wks with antibiotic combo
- treat zollinger-ellison syndrome (gastrinoma), GERD, dyspepsia
- ADE: minor GI/CNS, skin rash, increase LFT, hypomagnesemia
5
Q
Omeprazole (Prilosec)
A
- proton pump inhibitor
- bind to and antagonize proton pump (H+ K+ ATPase)
- dose dependent inhibition of 95% acid secretion for 1-2 days
- heal 80-90% of PUD in 2 wks with antibiotic combo
- treat zollinger-ellison syndrome (gastrinoma), GERD, dyspepsia
- ADE: minor GI/CNS, skin rash, increase LFT, hypomagnesemia
6
Q
Pantoprazole (Protonix)
A
- proton pump inhibitor
- bind to and antagonize proton pump (H+ K+ ATPase)
- dose dependent inhibition of 95% acid secretion for 1-2 days
- heal 80-90% of PUD in 2 wks with antibiotic combo
- treat zollinger-ellison syndrome (gastrinoma), GERD, dyspepsia
- ADE: minor GI/CNS, skin rash, increase LFT, hypomagnesemia
7
Q
Rabeprazole (Aciphex)
A
- proton pump inhibitor
- bind to and antagonize proton pump (H+ K+ ATPase)
- dose dependent inhibition of 95% acid secretion for 1-2 days
- heal 80-90% of PUD in 2 wks with antibiotic combo
- treat zollinger-ellison syndrome (gastrinoma), GERD, dyspepsia
- ADE: minor GI/CNS, skin rash, increase LFT, hypomagnesemia
8
Q
Lansoprazole (Prevacid)
A
- proton pump inhibitor
- bind to and antagonize proton pump (H+ K+ ATPase)
- dose dependent inhibition of 95% acid secretion for 1-2 days
- heal 80-90% of PUD in 2 wks with antibiotic combo
- treat zollinger-ellison syndrome (gastrinoma), GERD, dyspepsia
- ADE: minor GI/CNS, skin rash, increase LFT, hypomagnesemia
9
Q
Dexlansoprazole (Dexvant)
A
- proton pump inhibitor
- bind to and antagonize proton pump (H+ K+ ATPase)
- dose dependent inhibition of 95% acid secretion for 1-2 days
- heal 80-90% of PUD in 2 wks with antibiotic combo
- treat zollinger-ellison syndrome (gastrinoma), GERD, dyspepsia
- ADE: minor GI/CNS, skin rash, increase LFT, hypomagnesemia
10
Q
Sucralfate (Carafate)
A
- cytoprotective for PUD
- adheres to ulcer crater and creates protective barrier
- stimulates PG synthesis in mucosal cells
- caution in renal insufficiency
- ADE: impair absorption other drugs (separate by 2 hours)
11
Q
Misoprostol (Cytotec)
A
- cytoprotective for PUD
- inhibits gastric acid secretion
- promotes secretion of mucus and bicarbonate
- prevents NSAID induced ulcers
- reserved for high risk (elderly or PUD Hx)
12
Q
H. Pylori Regimen
A
- PPI and 2 or more antimicrobials
- amoxicillin, clarithromycin, bismuth subsalicylate, metronidazole, tetracycline
13
Q
Hydrocortisone / Prednisone
A
- glucocorticoids
- treat both UC and Crohn’s
- induce remission but less effective in retaining
- systemic ADE
14
Q
Sulfasalazine / Mesalamine
A
- aminosalicylates
- induce remission in UC
- less effective in Crohn’s
15
Q
Infliximab / Azathioprine / Cyclosporine
A
- immunomodulators
- UC / Crohn’s
16
Q
Metoclopramide (Reglan)
A
- Prokinetic and blocks D2 / 5-HT3 receptors
- accelerates gastric emptying
- treats GERD, diabetic gastroparesis, intractable hiccups, constipation, antiemetic
- ADE: drowsiness, EPSE, seizure, diarrhea, hematologic toxicity, hyperprolactinemia
17
Q
Metamucil
A
- bulk forming laxative
- mechanically distends intestinal wall to stimulate peristalsis
- must be taken with full glass of water
- safest and preferred for chronic constipation
- can mitigate diarrhea
18
Q
Docusate Sodium (Colace)
A
- surfactant laxative (stool softener)
- few adverse effects
- reduce straining
19
Q
Docusate calcium (Surfak)
A
- surfactant laxative (stool softener)
- few adverse effects
- reduce straining
20
Q
Magnesium oxide
A
- osmotic laxative
- increases water retainment to increase peristalsis
- excessive use causes fluid and electrolyte loss
- systemic absorption dangerous in renal failure
21
Q
Saline laxative
A
- osmotic laxative
- acts rapidly
- increases water retainment to increase peristalsis
- excessive use causes fluid and electrolyte loss
- systemic absorption dangerous in renal failure
22
Q
Sodium Phosphate (Fleet’s Phospa-soda)
A
- osmotic laxative
- used to evacuate bowel for surgery or diagnostic study
- increases water retainment to increase peristalsis
- excessive use causes fluid and electrolyte loss
- systemic absorption dangerous in renal failure
23
Q
Magnesium Citrate
A
- osmotic laxative
- increases water retainment to increase peristalsis
- excessive use causes fluid and electrolyte loss
- systemic absorption dangerous in renal failure
24
Q
Bisacodyl / Senna / Cascara
A
- stimulant laxative
- can cause significant cramping, electrolyte and fluid depletion
25
Linaclotide (Linzess)
- Guanylate Cyclase-C Receptor Agonists
- Rx only for severe chronic idiopathic constipation
- once daily dosing
26
Plecanatide (Trulance)
- Guanylate Cyclase-C Receptor Agonists
- Rx only for severe chronic idiopathic constipation
- once daily dosing
27
Lubiprostone (Amitiza)
- locally acting chloride channel activator
- indicated for opioid induced constipation
- twice daily dosing
28
Prucalopride (Motegrity)
- 5-HT4 receptor agonist
- stimulates peristaltic reflex
- may be teratogenic
- label warns worsening depression and SI
29
Atropine / Hycoscyamine / Dicyclomine / Scopolamine
-antispasmodic (anticholinergic) for diarrhea
30
Alosetron (Lotrenex)
- 5-HT3 receptor antagonist
- used in IBS for women with predominant symptom of diarrhea
- can cause ischemic colitis which may require transfusion/surgery
- restricted to failure of conventional antidiarrheal
31
Diphenoxylate (Lomotil)
- opioid
- schedule V
- control diarrhea of almost any cause
32
Loperamide (Imodium)
- opioid
- OTC
- control diarrhea of almost any cause
33
Ondansetron (Zofran)
- 5-HT3 receptor antagonist
- blocks receptors on visceral afferent nerves of GI tract, solitary nucleus, and CTZ
- ADE: QT prolong and chemotherapy doses, headache, constipation, diarrhea, anaphylaxis, increase LFT
34
Granisetron (Kytril)
- 5-HT3 receptor antagonist
- blocks receptors on visceral afferent nerves of GI tract, solitary nucleus, and CTZ
- ADE: headache, constipation, diarrhea, anaphylaxis, increase LFT
35
Palonesetron (Aloxi)
- 5-HT3 receptor antagonist
- blocks receptors on visceral afferent nerves of GI tract, solitary nucleus, and CTZ
- ADE: headache, constipation, diarrhea, anaphylaxis, increase LFT
36
Dolasetron (Anzemet)
- 5-HT3 receptor antagonist
- blocks receptors on visceral afferent nerves of GI tract, solitary nucleus, and CTZ
- common in cancer centers
- ADE: headache, constipation, diarrhea, anaphylaxis, increase LFT
37
Metoclopramide (Reglan)
- D2 receptor antagonist
- acts primarily at the CTZ
- antiemetic, antipsychotic, anticholinergic, antihistamine, sedative
38
Prochlorperazine (Compazine)
- D2 receptor antagonist
- acts primarily at the CTZ
- antiemetic, antipsychotic, anticholinergic, antihistamine, sedative
39
Promethazine (Phenergan)
- D2 receptor antagonist
- acts primarily at the CTZ
- antiemetic, antipsychotic, anticholinergic, antihistamine, sedative
40
Aprepitant (Emend)
- Neurokinin-1 receptor antagonist
| - Combined with 5-HT3 antagonists and dexamethasone for highly emetogenic chemotherapy
41
Dimenhydrinate / Meclizine
-antiemetic for motion sickness
