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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
Q

Adverse effects of bismuth compounds (4)

A

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

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26
Q

3 classes of prokinetic drugs

A

1 - cholinomimetics (bethanechol, neostigmine)
2 - D2 antagonists (metoclopramide, domperidone)
3 - Macrolides (erythromycin)

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27
Q

Prokinetics: stimulates M3 receptors; used in the past to tx gastroparesis

A

bethanecol

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28
Q

Prokinetics: AChE inhibitor; Given IV to hospitalized pts with acute large bowel distention

A

neostigmine

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29
Q

Prokinetic class with SE of excessive salivation, nausea, vomiting, diarrhea, bradycardia

A

cholinomimetics (bethanecol, neostigmine)

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30
Q

Prokinetic class with SE of restlessness, drowsiness, insomnia, anciety, agitation, extrapyramidal effects, tardive dyskinesia, elevated prolactin

A

D2 receptor antagonist (metoclopramide, domperidone)

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31
Q

Prokinetic that can cause galactorrhea, gynecomastia, impotence, and menstrual disorders

A

D2 receptor antagonist (metoclopramide, domperidone)

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32
Q

D2 receptor antagonist that does not readily cross the bbb and .:. has fewer neuropsyciatric and extrapyramidal SE

A

domperidone

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33
Q

Prokinetic that directly stimulates motilin receptors on GI smooth muscle and promotes the onset of an MMC

A

erythromycin

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34
Q

prokinetic that is given IV for gastroparesis OR prior to endoscopy after an acute upper GI bleed

A

erythromycin

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35
Q

Action/Class: Psyllium

A

Laxative

Bulk-forming

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36
Q

Action/Class: methylcellulose

A

Laxative

Bulk-forming

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37
Q

Action/Class: polycarbophil

A

Laxative

Bulk-forming

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38
Q

Action/Class: docusate

A

Laxative

stool surfactant agents

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39
Q

Action/Class: glycerine suppository

A

Laxative

stool surfactant agents

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40
Q

Action/Class: magnesium hydroxide

A

Osmotic Laxative

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41
Q

Action/Class: sorbitol

A

Osmotic Laxative

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42
Q

Action/Class: lactulose

A

Osmotic Laxative

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43
Q

Action/Class: magnesium citrate

A

Osmotic Laxative

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44
Q

Action/Class: sodium phosphate

A

Osmotic Laxative

45
Q

Action/Class: balanced polyethylene glycol

A

Osmotic Laxative

46
Q

Action/Class: Aloe

A

Laxative

Stimulant

47
Q

Action/Class: Senna

A

Laxative

Stimulant

48
Q

Action/Class: Cascara

A

Laxative

Stimulant

49
Q

Action/Class: bisacodyl

A

Laxative

Stimulant

50
Q

Action/Class: Lubiprostone

A

Laxative

Chloride channel activator

51
Q

Action/Class: Methylnaltrexone

A

Laxative
opioid receptor antagonist
** highlighted in PPT

52
Q

Action/Class: alvimopan

A

Laxative
opioid receptor antagonist
** highlighted in PPT

53
Q

Action/Class: Tegaserod

A

Laxative

5 HT4 agonist

54
Q

Action/Class: Cisapride

A

Laxative
5 HT4 agonist
** highlighted in PPT

55
Q

Action/Class: Prucalopride

A

Laxative

5 HT4 agonist

56
Q

Action/Class: Linaclotide

A

Laxative

Guanylate cyclase C agonist (i.e. CFTR activator)

57
Q

Laxative with potential side effect of long QT

58
Q

To treat opiod induced constipation

A

methylnaltrexone

59
Q

Action/Class: Loperamide

A

Anti-diarrheal

Opioid agonist

60
Q

Action/Class: Diphenoxylate

A

Antidiarrheal

Opioid agonist

61
Q

Non-Rx Opioid Agnoist for tx of diarrhea

A

loperamide

62
Q

What do you mix with Diphenoxylate to minimize dependence?

63
Q

To treat diarrhea caused by excess fecal bile acids

A

Bile salt-binding resins (cholestyramine, colestipol, colesevelam)

64
Q

To treat effects of endcrine tumor (carcinoid, VIPoma)

A

Octreotide

65
Q

synthetic somatostatin

A

octreotide

66
Q

To tx IBS with constipation

A

Lubiprostone (Cl channel activator)

67
Q

To tx IBS with diarrhea

A

Alosertron (5HT3 antagonist)

68
Q

How often are anticholinergics used for IBS? MOA? Give two examples

A

infrequently

antispasmodic

dicyclomine
Hyoscyamine

69
Q

Action/Class: ONdansetron; granisetron; dolasetron; palonosetron

A

Antiemetic

5HT3 blocker

70
Q

Action/Class: dexamethasone

A

Antiemetic

corticosteroid

71
Q

Action/Class: aprepitant; fosaprepitant

A

Antiemetic

neurokinin receptor antagonist

72
Q

Action/Class: metoclopramide

A

Antiemetic (also prokinetic)

D2 blocker

73
Q

Action/Class: droperidol

A

Antiemetic

D2 blocker

74
Q

Action/Class: promethazine

A

Antiemetic

D2 blocker

75
Q

Action/Class: diphenhydramine

A

Antiemetic (esp for motion sickness)

H1 blocker

76
Q

Action/Class: meclizine

A

Antiemetic

H1 blocker

77
Q

Action/Class: Dronabinol

A

Antiemetic

cannabinoid

78
Q

Action/Class: nabilone

A

Antiemetic

cannabinoid

79
Q

Class profile

Indication: chemotherapy induced nausea and vomiting, postop and post radiation nausea and vomiting
AE: headache, dizziness, constipation, prolongation of QT

A

5 HT3 blockers

ONdansetron; granisetron; dolasetron; palonosetron

80
Q

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

A

corticosteroids

81
Q

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

A

Neurokinin receptor antagonist (Aprepitant)

82
Q

Action/Class: aprepitant

A

anti-emetic

Neurikinin receptor antagonist

83
Q

Class Profile: Potent antiemetic and sedative properties
Inhibition of dopamine and muscarinic receptors (antiemetic)
Antihistamine (sedation)

A

Phenothiazines

(Prochlorperazine, thethylperazine, Promethazine**)

**highlighted in PPT

84
Q

Action/Class:Promethazine

A

antiemetic
phenothiazine

**highlighted in PPT

85
Q

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

A

Butyrophenone

Droperidol

86
Q

Action/Class: Droperidol

A

Antiemetic

Butyrophenone

87
Q

Action/Class:Metoclopramide, trimethobenzamide

A

antiemetic

substituted benzamide

88
Q

Action/Class: Prochlorperazine, thethylperazine

A

antiemetic

phenothiazine

89
Q

Class Profile:Central dopaminergic blockade
nausea and vomiting from highly emetogenic chemotherapeutic regimen
AE - extrapyramidal effects (restlessness, dystonias, parkinsonian symptoms)

A

substituted benzamide

Metoclopramide, trimethobenzamide

90
Q

Class Profile: Weak antiemetic activity
Particularly useful for the prevention or treatment of motion sickness
AE – sedation, dizziness, confusion, dry mouth, cycloplegia, urinary retention

A

H1 antihistamines and anticholinergic drugs

Diphenhydramine, dimenhydrinate, Meclizine, Hyoscine (aka scopolamine)

91
Q

Antiemetic: antihistamine with minimal anticholinergic, less sedation, prevention of motion sickness and treatment of vertigo due to labyrinth dysfunction

92
Q

Antiemetic: antimuscarinic to prevent motion sickness

A

Hyoscine (aka scopolamine)

93
Q

antihistamine and anticholinergic, used in conjunction with other antiemetics for treatment of emesis due to chemotherapy

A

diphenhydramine, dimenhydrinate

94
Q

Antiemetic: Before the initiation of chemotherapy to reduce anticipatory vomiting or vomiting caused by anxiety

A

Benzodiazepines

Lorazepam, diazepam

95
Q

Action/Class: Dronabinol

A

Anti-emetic and appetite stimulant

Cannabinoid

96
Q

Action/Class: Nabilone

A

Anti-emetic

Cannabinoid

97
Q

Therapy for severe IBD

A

TNF antagonists (Infliximab, Adalimumab, Certolizumab)

IV corticosteroids

98
Q

Therapy for moderate IBD

A

TNF antagonists (Infliximab, Adalimumab, Certolizumab)

oral corticosteroids

Methotrexate

Azathioprine/6 MP

99
Q

Therapy for mold IBD

A

Budesonide

Topical corticosteroids

Antibiotics

5-Aminosalicylates

100
Q

Action/Class: Sulfasalazine, balsalazide, olsalazine

A 
IBD Therapy (mild)
Aminosalicylates
101
Q

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)
A

Sulfasalazine

102
Q

Name 3 anti-TNF antibodies for IBD

A

Infliximab
Adalimumab
Certolizumab

103
Q

Which anti-TNF Ab is fully humanized?

A

Adalimumab

Certolizumab (s chimeric, so… whatever. Note the U before the MAB, and that means humanized apparently)

104
Q

Which anti-TNF Ab is chimeric?

A

Infliximab

the I before the MAB signifies chimeric.

105
Q

Blocks alcohol dehydrogenase for

  • excess alcohol consumption
  • tx of ethylene glycol ingestion
  • tx of methanol ingestion
A

fomepizole

106
Q

Blocks aldehyde dehydrogenase to act as a deterrent for alcohol consumption. Poor rates of compliance.

A

Disulfiram

107
Q

For alcohol dependence
Nonselective competitive antagonist of opioid receptors
Reduced risk of relapse

A

Naltrexone

108
Q

For alcohol dependence
NMDA antagonist & GABAA agonist
Reduced risk of relapse

A

Acamprosate

Maria's GI Cards (4 decks)

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