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Pharm 3 > E2: GI Drugs > Flashcards

E2: GI Drugs Flashcards

1
Q

What are the antibiotics effective for treating for H. Pylori?

A

Metronidazole, amoxicillin, tetracyclines, and clarithromycin

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2
Q

What 3 things stimulate gastric acid secretion?

A

Gastrin, ACh, and histamine

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3
Q

How do NSAIDS increase risk of gastric ulcers?

A

They interfere with formation of prostaglandins (which reduce acid secretion and increase mucous production)

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4
Q

What kind of drugs are magnesium hydroxide and aluminum hydroxide?

A

Antacids

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5
Q

What are the side effects of magnesium hydroxide?

A

It increases gastric motility and may cause diarrhea

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6
Q

What are the side effects of aluminum hydroxide?

A

Relaxes smooth muscle, decreases gastric motility, and may cause constipation

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7
Q

Magnesium hydroxide should be avoided in what patients?

A

Patient with impaired renal function

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8
Q

What kind of drugs are cimetidine, randitidine, famotidine, and Nizatidine?

A

H2 blockers

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9
Q

What are the uses of H2 blockers?

A
  • decreasing nocturnal acid formulation
  • treatment of duodenal and gastric ulcers, adjuncts for GERD and ZES
  • Per-operatively to decrease acid content
  • prevent development of ulcers from stress
  • used in severe allergic reactions to decrease H2 mediated vasodilation
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10
Q

What are the side effects of chronic cimetidine use?

A

At high doses, has an anti androgen effect, loss of libido, impotence, gynecomastia, but can be used to treat masculinization in females

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11
Q

What are the drug interactions with cimetidine?

A

Cimetidine inhibits CYP3A4 so this is important for drugs with low therapeutic range, like warfarin, phenytoin, theophylline, phenobarbitals, some benzos, propanol, digoxin, and TCAs
** other H2 blockers do no inhibit CYP3A4

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12
Q

What is the MOA of PPIs?

A
  • Irreversibly inhibit the proton pump that is the final stage in production of gastric acid.
  • Prodrugs that become activated in gastric parietal cells and then bind irreversibly to H+, K+ ATPase
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13
Q

What is the DOC for GERD with esophagitis?

A

PPIs

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14
Q

What kind of drugs are omeprazole and Esomeprazole?

A

PPIs

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15
Q

What are the adverse effects of PPIs?

A
  • nausea, diarrhea, abdominal pain
  • cough, URI
  • Decrease absorption of Ca+, increasing risk of osteoporosis
  • magnesium and B12 deficiency
  • Long term use have slightly increased risk of CKD
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16
Q

What are the drug interaction with omeprazole?

A

Omeprazole inhibits CYP2C19, decreasing metabolism of phenytoin, diazepam, and warfarin
-conversion of clopidogrel to the active component may be inhibited

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17
Q

What is the DOC for initial and maintenance treatment of GERD?

A

PPIs

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18
Q

What kind of drug is Misoprostol?

A

A Prostglandin E1 analogue that increases secretion of mucous and decreases acid secretion

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19
Q

What is the use of Misoprostol?

A

Approved for prevention of NSAID induced ulcers, but rarely used due to availability of more convenient and safer drugs

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20
Q

What are the contraindications to Misoprostol?

A

Since it is a PG analogue, it can induce uterine contractions and abortion is pregnant women. Contraindications in women who are pregnant or may become pregnant while taking the drug

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21
Q

What are the 3 prokinetic drugs for the GI tract?

A

Erythromycin, Metoclopramide, and bethanechol

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22
Q

How does erythromycin stimulate GI activity?

A

The neural regulation of gastric motility involves stimulation of cholinergic neurons, inhibition of adrenergic neurons, and modulation of DA and serotonin. Erythromycin stimulates these receptors

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23
Q

How does Metoclopramide increase GI activity?

A

It is a Dopamine D2 receptor antagonists and since DA in the GI tract acts to decrease motility, inhibiting DA will increase activity

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24
Q

What are the uses of Metoclopramide?

A
  • enhances motility and tone of smooth muscle in the GI tract likely by increases ACh
  • Antiemetic
  • Use for Post surgical gastric hypomotility
  • EPS, GI cramping, and diarrhea side effects
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25
Q

Is Metoclopramide safe is pregnancy?

A

No

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26
Q

What is the MOA of bethanechol?

A

-Mucarinic agonist that increases tone and motility of the GI tract

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27
Q

What are the uses of bethanechol?

A

Used to treat postoperative ileus or to increase lower esophageal sphincter tone

28
Q

What drug is frequentl used as a prokinetic agent in patients with diabetic gastroparesis or small bowel dysmotility? Why?

A

Erythromycin or other macrolides because they stimulate receptors for motilin, a peptide which causes potent contraction of the GI tract

29
Q

What are the two antispasmodics used for irritable bowel syndrome?

A

Dicyclomine and Amitripyline

30
Q

How does Dicyclomine treat IBS?

A

Muscarinic antagonist use to decrease intestinal over activity and reducing cramping/spasms

** anticholinergics side effects: dry mouth, constipation, sedation, etc

31
Q

How does Amitripyline treat IBS?

A

Blockade of muscarinic receptors decreases spasticity and increases central NE release, which stimulates alpha 2 receptors to reduce chronic pain

32
Q

How is the vomiting center in the brain stimulated?

A

Chemoreceptor trigger zone (CTZ)which is rich in 5HT3 receptors, D2 receptors, neurokinin and opioid receptors

33
Q

What is the MOA of Zofran?

A

-selectively blocks 5HT3 receptors in the CTZ and in the GI tract

34
Q

What is the use of Zofran?

A
  • treatment of nausea and vomiting due to chemotherapy and vagal stimulation
  • Not effective for motion sickness

**no significant side effects and not sedating

35
Q

What is the MOA of Prochloperazine and Promethazine?

A

Blocks D2, muscarinic, and H1 histamine receptors.

36
Q

What is the use of Prochlorperazine and Promethazine?

A

Used for post operative nausea and vomiting, as well as nausea and vomiting due to other causes

**signifcant sedation due to blockade of histamine and muscarinic receptors

37
Q

What kind of drug is Dronabinol and what is it used for?

A

a form of THC, the active compound in marijuana.

-Effective antiemetic and appetite stimulant and used for chemotherapy induced nausea and vomiting

38
Q

What is the MOA of Aprepitant?

A

-Blocks NK1 receptors and are combined with a 5HT3 antagonist and corticosteroid for severe chemotherapy induced nausea and vomiting

39
Q

What are the contraindications to laxative use?

A

Intestinal blockage, perforation, or toxic megacolon

40
Q

Why is chronic use of laxatives harmful?

A

May cause electrolyte imbalance, dependence, and serious alterations in bowel function

41
Q

How do bulk forming laxatives work?

A

Increase bulk of the feces by attracting water, forming a soft mass that stimulates the wall of the GI tract and induces peristalsis

42
Q

What is the best way to prevent constipation and diverticulitis?

A

High fiber diet

43
Q

What kind of drugs are dietary fiber ad Psyllium?

A

Bulk forming laxatives

44
Q

Which bulk forming laxative contains fibrous material from plantago seeds?

A

Psyllium

45
Q

What are the common sid effects of bulk forming laxatives?

A

Bloating and flatulence

-Imporant to consume enough water with these because fecal impact ion may occur with inadequate water

46
Q

What kind of drugs are magnesium hydroxide, lactulose, and polyethylene glycol?

A

Osmotic laxatives

47
Q

Although lactulose is used as an osmotic laxative, what else is it commonly used for?

A

To decrease ammonia buildup in patients with cirrhosis and other hepatic diseases

48
Q

What is the MOA of osmotic laxatives?

A

-Poorly absorbed salts or sugars that hold water in the intestine, speed transfer through the intestine and usually cause fluid evacuation in 1-6 hours

49
Q

How is polyethylene glycol administered?

A

Nasogastric tube or orally, often in prep for colonoscopy

-Now available OTC as Miralax for treatment of occasional constipation

50
Q

Are osmotic laxatives safe for chronic use?

A

With the exception of lactulose for liver disease, they should not be used chronically. They can produce intense effects

51
Q

What kind of drugs are Biscodyl and Senna?

A

Irritants which stimulate peristalsis by action on the mucosa, either by irritation or excitation of the reflexes, enhance secretion and inhibit water reabsorption

52
Q

What are the uses of laxatives in general?

A
  • Reduce straining
  • maintain soft stools in patients with abscesses, hemorrhoids, etc
  • Empty out the bowel to prepare for surgery
  • acute functional constipation
53
Q

What are the contraindications to laxative use?

A

Nausea, vomiting, abdominal cramping ,undiagnosed abdominal pain, appendicitis, or intestinal obstruction

54
Q

What are the adverse effects of chronic laxative use?

A

Laxative dependence, fluid and electrolyte imbalance, spastic colitis, and increased risk of UC

55
Q

What is the MOA of Lubiprostone?

A

-PG E1 derivative, which increases intestinal fluid secretion by activating specific CIC-3 chloride channels in the luminal cells of the intestinal epithelium

56
Q

What are the uses of Lubiprostone?

A
  • Softens stools, increase intestinal motility, promotes spontanous bowel movements within 24 hours
  • reduces symptoms of chronic constipation
  • approved for women with IBS and constipation
57
Q

What is the MOA of Linaclotide?

A

-Stimulates intestinal chloride secretion by activating guanylate cyclase C on the luminal surface, this activates cystic fibrosis transmembrane conductor (CFTR), increasing Cl- secretion.

58
Q

What are the uses of Linaclotide?

A

-Approved for treatment of chronic constipation and forIBS with constipation

59
Q

What is the MOA of Loperamide?

A

Opioid analogue that decreases peristalsis.

-Used for diarrhea

60
Q

What are the adverse effects of Loperamide?

A
  • At therapeutic doses, has not CNS effects and this low abuse potential.
  • Abdominal pain/distention, constipation, dry mouth, hypersensitivity, nausea, and vomiting
61
Q

What are the contraindications to opioid use for diarrjea?

A
  • Should not be used in diarrhea caused by organisms that penetrate the intestinal mucosa
  • UC, may cause toxic megacolon
  • Abuse potential, so dont use if hx of drug abuse
62
Q

What is the MOA of colloidal bismuth compounds (Pepto)?

A
  • Absorbs excess water and possible some microbial toxins and destroy some pathogens
  • Inhibits PG synthesis, decreasing secretion and exerting an anti-inflammatory effect
63
Q

What are the contraindications to Salicylate?

A

Patient who are allergic o aspirin and in children due to risk of Reye’s syndrome

64
Q

Sulfasalazine is often used to for what condition?

A

UC, less often for Crohns

65
Q

What is the MOA of Simethicone?

A

Antiflatulent that coats and dissipates gas to make it pass with less of a notice

Pharm 3 (20 decks)

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