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Maria's GI Cards > Choi > Flashcards

Choi Flashcards

1
Q

Antacid that causes CO2 gas, metabolic alkalosis, and Na-fluid retention

A

sodium bicarbonate

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2
Q

antacid that causes CO2 gas, metabolic alkalosis, and milk-alkali syndrome

A

calcium carbonate

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3
Q

antacid that causes osmotic diarrhea

A

magnesium hydroxide

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4
Q

antacid that causes constipation

A

aluminum hydroxide

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5
Q

Pts with *** insufficiency should not take antacids long term

A

renal

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6
Q

Antacids should not be given within 2 hours of doses of tetracyclines, fluoroquinolones, itraconazole, and iron because

A
  • reduced absorption

- affected dissolution or solubility

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7
Q

inhibits both meal stimulated and nocturnal secretion of acid

A

PPI

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8
Q

inhibits nocturnal acid secretion only

A

H2 blocker

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9
Q

Explain why you should take PPIs 1 hour before meals (2)

A

1 - PPI is an uncharged prodrug which is capable of crossing the plasma membrane of parietal cells. It is activated by H+, which adds a charge to the PPI. If you take it after a meal, it is activated in the stomach lumen, and will A) not be effective and B) be unable to cross PM.
2 - Parietal cell needs to be in active (stimulated) form in order for PPI to inhibit PP. PPIs have short half life, so it is important to activate parietal cell while PPI is IN the cell and capable of action.

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10
Q

PPIs have a very short half life but a long duration of action. Why?

A

Irreversible inhibitor, .:. in order to regain H+ secretion, you need to produce and insert a new PP into the PM

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11
Q

PPIs take a few days to produce full effect. Why?

A

Because not all proton pumps are available to be inhibited. Takes multiple cycles to hit hte critical # of PPs

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12
Q

H. pylori triple therapy

A
  • PPI (omexazaprole, lansoprazole, etc)
  • Clarythromycin
  • Metronidazole OR amoxicilline OR tetracycline
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13
Q

H. pylori quadruple therapy

A
  • PPI OR H2 antagonist
  • metronidazole
  • tetracycline
  • bismuth
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14
Q

H2 antagonist that can cause gynecomastia, impotence, galactorrhea

A

Cimetidine

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15
Q

Black box warning on PPIs

A

Life-threatening hypomagnesia with secondary hypocalcemia

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16
Q

For Acid - Peptic DZ: salt of sucrose complexed to sulfated aluminum hydroxide

A

Sucralfate

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17
Q

For Acid - Peptic DZ: MOA of sucralfate

A

polymerizes in stomach and forms a wall; stimulates mucosal protaglandin and bicarb secretion

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18
Q

For Acid - Peptic DZ: Used for prevention of stress related bleeding in critically ill pts

A

sucralfate

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19
Q

Adverse effects of sucralfate

A

constipation (aluminum)

Do not use for prolonged periods with renal insufficiency

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20
Q

For Acid - Peptic DZ: methyl analog of PGE1

A

Misoprostol

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21
Q

For Acid - Peptic DZ: Pros and Cons of misoprostol

A

Pro: better bioavailability than PGE1
Con: need to take qid (4Xday)

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22
Q

For Acid - Peptic DZ: Con of PGE1

A

v. unstable. only lasts for minutes

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23
Q

C/I for misoprostol; Why?

A

pregnant or fertile female; stimulate uterine contractions.

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24
Q

For Acid - Peptic DZ: Creates a protective layer, may stimulate PG, mucus, bicarb secretion; has direct antimicrobial effects and binds enterotoxins

A

Bismuth compounds

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25
Adverse effects of bismuth compounds (4)
1 - Weird blackness everywhere (stool, tongue) 2 - Avoid with renal insufficiency 3 - Prolonged use can lead to bismuth tox .:. encephalopathy 4 - High dose can lead to salicylate tox
26
3 classes of prokinetic drugs
1 - cholinomimetics (bethanechol, neostigmine) 2 - D2 antagonists (metoclopramide, domperidone) 3 - Macrolides (erythromycin)
27
Prokinetics: stimulates M3 receptors; used in the past to tx gastroparesis
bethanecol
28
Prokinetics: AChE inhibitor; Given IV to hospitalized pts with acute large bowel distention
neostigmine
29
Prokinetic class with SE of excessive salivation, nausea, vomiting, diarrhea, bradycardia
cholinomimetics (bethanecol, neostigmine)
30
Prokinetic class with SE of restlessness, drowsiness, insomnia, anciety, agitation, extrapyramidal effects, tardive dyskinesia, elevated prolactin
D2 receptor antagonist (metoclopramide, domperidone)
31
Prokinetic that can cause galactorrhea, gynecomastia, impotence, and menstrual disorders
D2 receptor antagonist (metoclopramide, domperidone)
32
D2 receptor antagonist that does not readily cross the bbb and .:. has fewer neuropsyciatric and extrapyramidal SE
domperidone
33
Prokinetic that directly stimulates motilin receptors on GI smooth muscle and promotes the onset of an MMC
erythromycin
34
prokinetic that is given IV for gastroparesis OR prior to endoscopy after an acute upper GI bleed
erythromycin
35
Action/Class: Psyllium
Laxative | Bulk-forming
36
Action/Class: methylcellulose
Laxative | Bulk-forming
37
Action/Class: polycarbophil
Laxative Bulk-forming
38
Action/Class: docusate
Laxative | stool surfactant agents
39
Action/Class: glycerine suppository
Laxative | stool surfactant agents
40
Action/Class: magnesium hydroxide
Osmotic Laxative
41
Action/Class: sorbitol
Osmotic Laxative
42
Action/Class: lactulose
Osmotic Laxative
43
Action/Class: magnesium citrate
Osmotic Laxative
44
Action/Class: sodium phosphate
Osmotic Laxative
45
Action/Class: balanced polyethylene glycol
Osmotic Laxative
46
Action/Class: Aloe
Laxative | Stimulant
47
Action/Class: Senna
Laxative | Stimulant
48
Action/Class: Cascara
Laxative | Stimulant
49
Action/Class: bisacodyl
Laxative | Stimulant
50
Action/Class: Lubiprostone
Laxative | Chloride channel activator
51
Action/Class: Methylnaltrexone
Laxative opioid receptor antagonist ** highlighted in PPT
52
Action/Class: alvimopan
Laxative opioid receptor antagonist ** highlighted in PPT
53
Action/Class: Tegaserod
Laxative | 5 HT4 agonist
54
Action/Class: Cisapride
Laxative 5 HT4 agonist ** highlighted in PPT
55
Action/Class: Prucalopride
Laxative | 5 HT4 agonist
56
Action/Class: Linaclotide
Laxative | Guanylate cyclase C agonist (i.e. CFTR activator)
57
Laxative with potential side effect of long QT
cisapride
58
To treat opiod induced constipation
methylnaltrexone
59
Action/Class: Loperamide
Anti-diarrheal | Opioid agonist
60
Action/Class: Diphenoxylate
Antidiarrheal | Opioid agonist
61
Non-Rx Opioid Agnoist for tx of diarrhea
loperamide
62
What do you mix with Diphenoxylate to minimize dependence?
atropine
63
To treat diarrhea caused by excess fecal bile acids
Bile salt-binding resins (cholestyramine, colestipol, colesevelam)
64
To treat effects of endcrine tumor (carcinoid, VIPoma)
Octreotide
65
synthetic somatostatin
octreotide
66
To tx IBS with constipation
Lubiprostone (Cl channel activator)
67
To tx IBS with diarrhea
Alosertron (5HT3 antagonist)
68
How often are anticholinergics used for IBS? MOA? Give two examples
infrequently antispasmodic dicyclomine Hyoscyamine
69
Action/Class: ONdansetron; granisetron; dolasetron; palonosetron
Antiemetic | 5HT3 blocker
70
Action/Class: dexamethasone
Antiemetic | corticosteroid
71
Action/Class: aprepitant; fosaprepitant
Antiemetic | neurokinin receptor antagonist
72
Action/Class: metoclopramide
Antiemetic (also prokinetic) | D2 blocker
73
Action/Class: droperidol
Antiemetic | D2 blocker
74
Action/Class: promethazine
Antiemetic | D2 blocker
75
Action/Class: diphenhydramine
Antiemetic (esp for motion sickness) | H1 blocker
76
Action/Class: meclizine
Antiemetic | H1 blocker
77
Action/Class: Dronabinol
Antiemetic | cannabinoid
78
Action/Class: nabilone
Antiemetic | cannabinoid
79
Class profile Indication: chemotherapy induced nausea and vomiting, postop and post radiation nausea and vomiting AE: headache, dizziness, constipation, prolongation of QT
5 HT3 blockers | ONdansetron; granisetron; dolasetron; palonosetron
80
Class Profile antiemetic with unknown MOA Enhances 5HT3 receptor antagonists prevention of acute and delayed nausea and vomiting in pts receiving moderate to high emetogenic chemotherapy regimens
corticosteroids
81
Class profile antiemetic; May inhibit the metabolism of other drugs metabolized by the CYP3A4 (docetaxel, paclitaxel, etoposide, irinotecan, imatinib, vinblastine, vincristine) Decreases the INR in patients taking warfarin
Neurokinin receptor antagonist (Aprepitant)
82
Action/Class: aprepitant
anti-emetic | Neurikinin receptor antagonist
83
Class Profile: Potent antiemetic and sedative properties Inhibition of dopamine and muscarinic receptors (antiemetic) Antihistamine (sedation)
Phenothiazines (Prochlorperazine, thethylperazine, Promethazine**) **highlighted in PPT
84
Action/Class:Promethazine
antiemetic phenothiazine **highlighted in PPT
85
Class Profile: Central dopaminergic blockade Post-operative nausea and vomiting, in conjunction with opiates and benzodiazepines for sedation for surgical and endoscopic procedures, for neuroleptanalgesia, for induction and maintenance of general anesthesia AE - extrapyramidal effects, hypotension, may prolong QT interval
Butyrophenone | Droperidol
86
Action/Class: Droperidol
Antiemetic | Butyrophenone
87
Action/Class:Metoclopramide, trimethobenzamide
antiemetic | substituted benzamide
88
Action/Class: Prochlorperazine, thethylperazine
antiemetic | phenothiazine
89
Class Profile:Central dopaminergic blockade nausea and vomiting from highly emetogenic chemotherapeutic regimen AE - extrapyramidal effects (restlessness, dystonias, parkinsonian symptoms)
substituted benzamide | Metoclopramide, trimethobenzamide
90
Class Profile: Weak antiemetic activity Particularly useful for the prevention or treatment of motion sickness AE – sedation, dizziness, confusion, dry mouth, cycloplegia, urinary retention
H1 antihistamines and anticholinergic drugs Diphenhydramine, dimenhydrinate, Meclizine, Hyoscine (aka scopolamine)
91
Antiemetic: antihistamine with minimal anticholinergic, less sedation, prevention of motion sickness and treatment of vertigo due to labyrinth dysfunction
Meclizine
92
Antiemetic: antimuscarinic to prevent motion sickness
Hyoscine (aka scopolamine)
93
antihistamine and anticholinergic, used in conjunction with other antiemetics for treatment of emesis due to chemotherapy
diphenhydramine, dimenhydrinate
94
Antiemetic: Before the initiation of chemotherapy to reduce anticipatory vomiting or vomiting caused by anxiety
Benzodiazepines Lorazepam, diazepam
95
Action/Class: Dronabinol
Anti-emetic and appetite stimulant | Cannabinoid
96
Action/Class: Nabilone
Anti-emetic | Cannabinoid
97
Therapy for severe IBD
TNF antagonists (Infliximab, Adalimumab, Certolizumab) IV corticosteroids
98
Therapy for moderate IBD
TNF antagonists (Infliximab, Adalimumab, Certolizumab) oral corticosteroids Methotrexate Azathioprine/6 MP
99
Therapy for mold IBD
Budesonide Topical corticosteroids Antibiotics 5-Aminosalicylates
100
Action/Class: Sulfasalazine, balsalazide, olsalazine
``` IBD Therapy (mild) Aminosalicylates ```
101
Class Profile: - First-line agent for treatment of mild to moderate active ulcerative colitis and Crohn’s disease - Slow acetylators have more frequent and more severe adverse effects - Oligospermia - Impairs folate absorption and processing (dietary supplementation is recommended)
Sulfasalazine
102
Name 3 anti-TNF antibodies for IBD
Infliximab Adalimumab Certolizumab
103
Which anti-TNF Ab is fully humanized?
Adalimumab | Certolizumab (s chimeric, so... whatever. Note the U before the MAB, and that means humanized apparently)
104
Which anti-TNF Ab is chimeric?
Infliximab | the I before the MAB signifies chimeric.
105
Blocks alcohol dehydrogenase for - excess alcohol consumption - tx of ethylene glycol ingestion - tx of methanol ingestion
fomepizole
106
Blocks aldehyde dehydrogenase to act as a deterrent for alcohol consumption. Poor rates of compliance.
Disulfiram
107
For alcohol dependence Nonselective competitive antagonist of opioid receptors Reduced risk of relapse
Naltrexone
108
For alcohol dependence NMDA antagonist & GABAA agonist Reduced risk of relapse
Acamprosate

Maria's GI Cards (4 decks)

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