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drugs gi Flashcards

1
Q

buspirone

A

5HT1A receptor agonist - inhibits 5HT release and increases NO release
improves fundic and pyloric accomodation

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2
Q

metroclopramide (reglan)

A

5 HT4 agonist & dopamine antagonist
improves gastric emptying and is antiemetic

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3
Q

dicyclomine & hyoscyamine

A

anticholinergics that slow gastric empyting

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4
Q

octretoide

A

somatostatin analog that inhibits 5HT & motilin release

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5
Q

lubriprostone

A

laxactive (for constipation) that activates Cl- channelf or increased Cl- secretion & water follows

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6
Q

tagaserod

A

relieves constipation as 5HT4 partial agonist

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7
Q

ondanstron (zofran)

A

antiemetic - 5HT3 antagonist

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8
Q

dronabinol

A

antiemetic that has effects of pot

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9
Q

5PDE antagonist

A

reduce strength of esophageal contractions

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10
Q

cimetidine

A

competitive antagonist of H2 receptor
rapidly absorbed and quick onset of action
hepatic metab by p450
renal excretion
continuous dosing - keeps gastic pH > 4 –> inactivates pepsin

used for PUD
*most important one to know - GERD!!

potently binds p450 sytem –> can cause significant drug interactions (warfarin, phenytoin, thephylline and diazepam –> levels are increased)

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11
Q

ranitidine

A

competitive antagonist of H2 receptor
rapidly absorbed and quick onset of action
hepatic metab by p450
renal excretion
continuous dosing - keeps gastic pH > 4 –> inactivates pepsin
**Most important for GERD
used for PUD

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12
Q

nizatidine

A

competitive antagonist of H2 receptor
rapidly absorbed and quick onset of action
hepatic metab by p450
renal excretion
continuous dosing - keeps gastic pH > 4 –> inactivates pepsin

used for PUD

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13
Q

famotidine

A

competitive antagonist of H2 receptor
rapidly absorbed and quick onset of action
hepatic metab by p450
renal excretion
continuous dosing - keeps gastic pH > 4 –> inactivates pepsin

used for PUD

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14
Q

omeprazole, lansoprazole, rebprazole, pantoprazole, esomeprazole

A

PPIs –> irrrevesibly block the H+/K+/ ATPase final common pathway –> reduces secretion by parietal cells into the lumen
intentionally delivered as prodrugs
when delivered to parietal cell –> protonated, concentrated and sulphonated

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15
Q

tums & oscal

A

calcium carbonate that neutralize stomach acid
may cause rebound acid secretion, nephrocalcinosis or milk alkali syndrome

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16
Q

regimes used to get rid of H. pylori

A

clarithromycin, amoxicillin & PPI
clarithromycin, metronidazole, PPI
levofloxin, metronidazole and PPI

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17
Q

misoprostol

A

PGE2 anaology – prevention of GUI in pt taking NSAIDs
use limited by bloating.diarrhea
abortifacient

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18
Q

sucralfate

A

complex salt of sucrose sulfate and ALOH3–> binds to mucosa and acts within lumen
stimulates mucus and bicarb and PGE2 production
binds to areas of health mucosa and ulceration
has no effect on acid production and is NOT absorbed

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19
Q

metoclopramide & domperidone (w/drawn b/c SE)

A

dopamine antagonist used as prokinetics for gastroparesis
D2 antagonist
also antiemetic

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20
Q

erythromycin

A

motilin agoinst used for gastroparesis
interacts with CYP-3A inhibitors

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21
Q

5-aminoasalicylates

A

tx of UC
inhibit T cell proliferation, Ag presentation & adhesion & descrease TNF production
SE: diarrhead, interstitial nephritis

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22
Q

busedonide

A

non systemic glucocorticoid - ileal release - used for CD
inhibit pro-inflammatory cytokines, adhesion molecules, leuktrienes
inhibit protease
regulated NF-kapa beta
decreased phagocytosis for neutrophiles
apoptosis of lympoctes

high degree of first pass metab in liver –> lessened systemic efects
induces remission in CD

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23
Q

thiopurines - AZA & 6-MP (AZA must be converted to 6MP)

A

inhibits DNA synthesis, induction of apoptosis & inhibition of purine synthesis - immunomodulator used for CD–> Induction & maintenance of remission
must monitor if someone has TPMT mutation –> bone marrow suppresion
take months to begin to work

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24
Q

methotrexate

A

folate antagonist, inhibits interleukins
induction and maintenance of remission in CD (being evaluated for UC)

increases risk for pneumonitis - if SOB/cough –> STOP DRUG

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25
Q

anti-TNF therapy

A

inflizimab, adalimumab, certolizumab

bind solube and cell bound TNF-alpha –> induce T cell/lymphocyte apoptosis
an ddecrease IL-1,6,18 and INF gamma

all three for CD, certolizumab not for UC

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26
Q

natalizumab

A

anti-alpha 4 integrin inhibitor –> used in CD
blocks integrins and thus adhesion of leukocytes
increases risk for PML via reactivation of JC virus

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27
Q

tenofovir

A

tx hep B - polymerase inhibitor

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28
Q

entecavir

A

tx hep B - polymerase inhibitor

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29
Q

interferon

A

hep C tx
immune activation: enhances MHC I, amplification of Tc lymphocytes and NK cells, enhances macrophage activity
direct antiviral: inhibition of HCV attachment and uncoating, activation of cellular RNAses

SE: influenza-like, depression, suicide, pancytopenia, worsening of liver fx in cirrhosis (b.c systemic inflammation)

30
Q

ribavirin

A

hep C tx & hep E tx
guanosine analogue
inhibits ciral RNA-dep RNA polymerase, induction of lethal mutations in HCV RNA, GTP depletion, modulatino ot T cell response favoring tH1
increases rate of SVR when combined with interferon

SE: non=immune hemolytic anemia, teratogenic

31
Q

telaprevir

A

hep C tx - direct antiviral agent
protease inhibitor
SE: anemia, rash, dysgeusia, anorectal discomfort

drug-drug interactions with ARVs in HIV pts and calcineurin inhibitors in transplant pts

dose 3x daily

32
Q

boceprevir

A

hep C tx - direct antiviral agent
protease inhibitor
SE: anemia, rash, dysgeusia, anorectal discomfort

drug-drug interactions with ARVs in HIV pts and calcineurin inhibitors in transplant pts

dose 3x daily

33
Q

ursodiol

A

treatment of primary biliary cirrhosis

34
Q

N-acetylcysteine

A

tx of acetaminophen toxicity - acute liver failure
replenishes glutathione stores
increases metab of NAPQI

35
Q

carbamazepine

A

augments autophagy for alpha antitrypsin deficiency –> gets rid of misfolded proteins in liver that cause cholestasis
in clinical trials now in adults

36
Q

trientene

A

oral chelating agents of cu for wilson’s dz

37
Q

zinc

A

used in wilson dz –> induces metallothionein and blocks cu absorption

38
Q

stack of coin sign

A

scleroderma - small bowel

39
Q

cholestyramine

A

resin that bidns bile salts in intenstine to help with pruritis

40
Q

ursodeoxycholic acid

A

used for therapy in cholestasis
prolongs life in PBC
may protect against hydrophobic bile salts

also used in PSC

41
Q

rosiglatizone

A

insulin sensitizing agent that can be used for NAFLD

42
Q

spironolactone

A

use to tx ascites- mineralocoritcoid - potassium sparing

43
Q

furosemide

A

used to tx ascites due to portal htn

44
Q

norfloxacin or ciprofloxacin

A

used prophylactically after first episode of spontaneous bacterial peritonitis to prevent recurrence

45
Q

propanolol

A

non selective beta blockers to prevent variceal bleeding
gives 50% reduction in risk for first variceal bleed
works to constrict splanchnics

46
Q

nadolol

A

non selective beta blockers to prevent variceal bleeding
gives 50% reduction in risk for first variceal bleed
works to constrict splanchnics

47
Q

octreotide

A

given IV as splanchnic vasoconstrictor for variceal bleeding

48
Q

tx for variceal bleeding

A

octreotid, antibx, band ligation, TIPS (refractory)

49
Q

neomycin, metronidazole, rifaximin

A

tx of hepaic encephalopathy
eliminates colonic bacteria leading to decreased ammonia generation

50
Q

lactulose

A

non absorbed disaccharide –> acts as cathartic, decreasing bacterial load
hepatic encephalopathy

51
Q

sorafenib

A

mutlikinase inhibitor (Raf, VEGFR2, PDFGR) - targets VEGF so used against HCC
used for pts not candidates for other tx
increases life by 2.8 montsh (to 10.7 months)

52
Q

steroids & pentoxifylline

A

tx of severe alcohol hepatitis

53
Q

sofosbuvir

A

to be approved RNA dep RnA polymerase inhibitor for Hep C

54
Q

simeprevir

A

to be approved protease inhibitor for Hept c

55
Q

lamivudine

A

polymerase inhibitors for hep B
no longer used –> induces YMDD mutation

56
Q

telvibudine

A

polymerase inhibitors for hep B

57
Q

adefovir

A

polymerase inhibitors for hep B

58
Q

anthraquinones

A

mucosal afferent nerve fiber irritants - for constipation

59
Q

diphenylmethanes

A

mucosal afferent nerve fiber irritants - for constipation

60
Q

lubiprostone

A

increases intestinal fludi secretion and transit by activating chlorid channel for constipation

61
Q

tegaserod

A

5HT4 partial agonist for constipation - restricted b/c cardiac issues

62
Q

metronidazole

A

used to tx c dif

63
Q

gangiclovir, foscarnet

A

tx CMV colitis
diagnoses with rapid antigen, PCR or blood culture
multinucleated giant cells & viral inclusions

64
Q

meclizine

A

motion sickness (h1)

65
Q

diphenhydramine

A

motion sickness (h1)

66
Q

odansetron

A

chemotherapy (5ht3)

67
Q

metoclopramide

A

moderate (d3)

68
Q

prochlorperazine

A

severe nausea (d2)

69
Q

promethazine

A

severe nausea (d2)

70
Q

scopolamine

A

motion sickness (m1)

71
Q

dorabinol

A

refractory nausea (cr)

72
Q

lamivudine, telcibudine, entecavir, adefovir, tenofovir

A

viral polymerase inhibitor for hep B

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