Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical Pharmacology I > Exam 3 - GI Part 2 > Flashcards

Exam 3 - GI Part 2 Flashcards

1
Q

Anti-Emetic Drugs

A

Anti-Emetic Drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Indications for use of Anti-Emetic Drugs:

A

Severe N/V
Motion sickness
Post-op N/V
N/V post-chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Two initiation centers of N/V:

A

Direct stimulants on GI tract

CNS - chemoreceptor trigger zone (CTZ)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What anti-muscarinic is used for motion sickness?

A

Scopolamine

MOA: Blocks Ach from binding to musc. receptors in CTZ.

Patch applied every 3 days, behind ear

ADR: Wash hands! - Can cause midriasis in one eye.

SE: dry mouth, blurred vision, urine retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What antihistamines are used as anti-emetics?

A

Dimenhydrinate (Dramamine)
Promethazine (Phenergan)

MOA: H1 receptor blockers
Antimuscarinic

Inhibit N/V, cause sedation

Phenergan comes as a suppository! YAY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are anti-seritonergic medications used to treat N/V?

A

Odansetron (Zofran)
Dolasetron (Anzemet)
Granisetron (Kytril)

Block 5HT-3 receptors (Serotonin) in stomach and brain.

Well tolerated, minus headache, diarrhea, constipation, and QT PROLONGATION, which he ALWAYS asks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What anti-serotinergic drug is used for severe N/V from chemotherapy?

A

Granisetron (Kytril)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How do you treat severe N/V due to pregnancy?

A

Doxylamine (Unison) + B12

If refractory, may use Zofran, but not enough data to know if it has teratogen effects.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Anti-dopaminergic drugs used to treat N/V?

A

Metoclopramide (Reglan)

Phenothiazines - Prochlorperazine (Compazine), Chlorpromazine, Fluphenazine, Haloperidol

Block D2 receptor antagonist in CTZ (dopamine receptors).

Parkinson’s have decreased dopamine levels, these drugs can trigger those symptoms.

Block muscarinic receptors, so might see dizziness, fatigue, seizures.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When you block dopamine receptors, what can occur?

A

Neuroleptic malignant syndrome

High potency dopamine blockers - skeletal muscle will contract and not let go leading to hyper-rigidity of the arm and legs. Produces heat and acid, leads to metabolic acidosis and rhabdomyolysis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Cannabinoids

A

Dronabinol (Marinol)

Similar to Cannabis. Derivate of delta-9-THC.

Treats N/V associated with chemotherapy when other agents have failed. Stimulates appetite.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is a substance P antagonist?

A

Aprepitant (Emend)

Antagonist at NK1 substance P receptor

A P receptor is a NT stimulated when you eat spicy foods (pain), stimulates GI tract to cause N/V. Drug inhibits P receptor to stop nausea or vomiting.
Stops N/V from cisplatin and other chemotherapy drugs.

Interacts with CYP3A4!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Treatment for acute and delayed phase of N/V?

First 24hrs?
36-72hrs?

A

Acute phase: 5HT3 receptor antagonist (Zofran)

Delayed phase: Substance P antagonists (Aprepitant)

This is why we give both drugs together.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Prokinetic Drugs

A

Metoclopramide (Reglan)

Stimulate GI tract for those with delayed gastric emptying or gastroporesis.
Common in type 2 diabetics.

Blocks D2 (dopamine) receptors to suppress release of Ach. Increases gastric emptying, GI motility, and increases LES tone to help push food along.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What prokinetic drug was removed from the market due to QT prolongation and CYP3A4 interaction?

A

Cisapride (Propulsid)

Works on 5HT4 and 5HT3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is used in addition to metoclopramide (Reglan)?

A

Erythromycin; macrolide abx that interacts with motilin receptors on GI tract to increase motility.

Used for gastroporesis and peds with delayed gastric emptying.

Toxicity may cause cramps or impair motility.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Laxatives

A

Laxatives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Laxative Mechanisms:

A

Increase motility
Increase water content of stool
Decrease colonic water and NaCl absorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Indications for laxatives

A 
Preparation for bowel surgery
Hasten bowel excretion of toxins
Post-op constipation
Minimize straining in CV disease
Relieve constipation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

CI laxatives

A

Bowel disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Long list of side effects for laxatives

A

Acute - nausea, abd cramps, diarrhea

Chronic - Cathartic colon syndrome

Leads to mucosal inflammation, atrophy of outer muscle layers, damage to nerve plexus, malabsorption, dehydration, protein loss, disruption of gut flora — b/c tract was dependent on drug.

Don’t use them chronically :)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Types of Laxatives

A

Stimulants or irritants
Bulk forming - dietary fiber
Stool softeners
Osmotic agents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Stimulant Laxatives

A

Castor oil
Bisacodyl (Dulcolax)
Senna (Senokot)

MOA: increases motility, water, and electrolyte secretion

SE: abd cramps, diarrhea, muscle weakness

Do not use a lot or patient will lose the natural urge to go. As needed basis only.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Bulk forming, non-digestable dietary fiber

A

Can be used safely every day to regulate normal defecation.

Psyllium (Metamucil)
Methylcellulose (Citrucel)

Mix with water before taking.
Increase bulk and water content of stool to increase motility.
Increased volume augments peristalsis.
Binds drugs, flatulence, and cramps.

Can bind to iron, FQ
Cause cramps/flatulence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Stool Softeners

A

Emulsify stools to make them easier to pass. Good for those with dry, hard stools.

Mineral oil
Glycerin
Docusate sodium (Colace)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Osmotic Agents

A 
Magnesium Sulfate (Causes diarrhea)
Magnesium Hydroxide (Milk of Magnesia)
Lactulose
Mannitol
Polyethylene glycol (MiraLax and GoLYTELY)

Increase water content and motility.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

MiraLax

A

occasional relief of constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

GoLYTELY

A

Flush; used for irrigation of drug packets (Cocaine smugglers)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Anti-diarrheal agents

A

Enhance water absorption and decrease GI motility locally.

Opioids:

  • Diphenoxylate (Lotomil)
  • formulated with atropine
  • Doesn’t cross BBB
  • Loperamide OTC

Common side effect of opioids is that they slow GI tract and cause constipation.

SE - constipation, cramping, flatulence, megacolon

Not for infectious diarrhea.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Why is diphenoxylate formulated with atropine?

A

Worried IVDA injecting it. Atropine causes IVDA to get sick when injecting it.

Abuse deterrent.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Megacolon

A

Blockage from overuse of antidiarrheal agents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Drug abusers and Loperamide

A

Doesn’t cross blood-brain barrier due to P-glycoprotein, which prevents absorption.

PGP inhibitor like grapefruit juice allows levels to go up of drug. Pt overdosed on cytomegaline and loperamide. by doing this, inhibit PGP for loperamide to be absorbed and cause a high.

Torsades induced coma as a result.

33
Q

Bismuth subsalicylate (Pepto-bismol)

A

Used as an antidiarrheal to inhibit intestinal secretions.

Effective in infectious diarrhea.

Can turn stools black.

34
Q

Why don’t we use Loperamide or Dyphenyloxate in infectious diarrhea?

A

Want patient to get rid of infection.

35
Q

IBS/IBD

A

IBS/IBD

36
Q

Crohn’s disease vs. Ulcerative Colitis

A

Crohn’s affects entire GI tract; UC affects colon/rectum.

test question

37
Q

Etiology of Crohn’s and UC

A

Cause unknown, thought to be polygenic on chromosome 12.

More prone when on NSAIDs.
Smoking decreases UC.

38
Q

UC

A

Inflamamtion confined to rectum and colon

Primary lesion: crypts of lieberkuhn
Pseudopolyps, collar-button ulcer

39
Q

Crohn’s

A

Inflammation of GI tract, terminal ileum is most common.

Discontinuous inflammation - sip lesions.

40
Q

UC common sxs

A

Diarrhea, Abd pain, Weight loss

Passage of mucus/pus
Blood in stool

Fever, Tachycardia, Hypotension, increased WBC and ESR

41
Q

Crohn’s common sxs

A

Diarrhea, Abd pain, Weight loss

Fatigue
Fever
Abd mass

GI bleeding, perianal/rectal lesions, and increased WBC and ESR

42
Q

What is the purpose of probiotics?

A

Help restore normal gut flora

43
Q

Are rectal suppositories better for UC or Crohn’s?

A

UC - can get away with rectally administered meds, bc they work locally.

Crohn’s - systemic tx

44
Q

Aminosalicylates

A

Sulfasalazine (Azulfidine)
-Prodrug - Broken down to form two active components: sulfapyridine and 5-ASA.

Mesalamine (5-ASA)
Asacol
Lialda
Pentasa
Canasa
Rowasa

Helps reduced inflammation by inhibiting COX and LOX.

ADR: Anorexia, diarrhea, blood dyscrasia (thrombocytopenia)

45
Q

Mesalamine

A

Less side effects than sulfasalazine; used more frequently

46
Q

Rowasa

A

Aminosalicylate

Enema can be applied

47
Q

What aminosalicylate is apropriate for UC?

A 
Lower rectum and colon
Suppository tx (Canasa)
48
Q

Why don’t suppositories work for Crohn’s?

A

They only affect lower colon and rectum; Crohn’s is all over the GI tract.

Tablets preferred for Crohn’s.

49
Q

Canasa

A

Rectal suppository; give before bedtime.

50
Q

Benefits of rectal suppossitory?

A

You bypass first pass effect
Good absorption
Good for patients who can’t take it orally

Good, locally, for UC.

51
Q

Enema

A

Liquid preparation, inserted into rectum

Patient lays on side, expel product into colon

52
Q

Drug Therapy options for IBD:

A

Olsalazine
-Dimer of mesalamine (prodrug)
Balsalazide
-Prodrug that contains 5-ASA and inert carrier molecule

53
Q

Corticosteroids for IBD

A

Topical (Anusol, Colocort)
-for UC

Oral (Budenoside, Prednisone)
-Chron’s

IV (Hydrocortisone, Prednisone)

AE: Weight gain, diarrhea, nausea, glucose intolerance, osteoperosis, Cushing’s

54
Q

Immunosuppressants: Thiopurines

A

Decrease metabolism of purines and inhibit DNA and RNA synthesis
Prevent replication of cells

Azathioprine (Imuran)
6-mercaptopurine (Purinethol)

AE: Myelosuppression, secondary infections

55
Q

Immunosuppressants: Cyclosporine

A

Inhibit release of IL-2 limiting T-cell act.

AE: nephrotoxic, HTN, hirsutism

56
Q

Immunosuppressants: Methotrexate

A

Inhibits folic acid

AE: stomatitis, myelosuppression, hepatotoxicity

57
Q

Monoclonal antibodies (MAB’s): Infliximab

A

Chimerical mab targeted at TNF-alpha

AE: infections, secondary malignancy

58
Q

Monoclonal antibodies (MAB’s): Adalimumab

A

Chimeric mab against TNF-alpha

AE: Secondary malignancy

Both are produced in bacteria, targeted against specific antigen.

59
Q

Antibiotics

A

Decrease bacteria

Used for fistulas in CD
-Cipro, Flagyl

60
Q

Treatment for UC:

A

Basically,

  1. Topical 5-ASA (Mesalamine)
  2. Topical/Oral corticosteroid
  3. Oral 5-ASA/AZA, 6-MP
  4. MAB
61
Q

Treatment for extensive UC:

A
  1. Oral 5-ASA
  2. AZA or 6-MP
  3. MAB
62
Q

Treatment for CD:

A
  1. Oral 5-ASA + Oral abx + Oral CS
  2. IV CS
  3. AZA/6-MP
  4. MAB
63
Q

Maintenance therapy:

A

UC: Sulfasalazine, 5-ASA, AZA/6-MP, MAB

CD: Same but + Methotrexate and abx

NO CS.

64
Q

IBS Non-pharm therapy:

A

Education, diet (keep dairy, avoid caffeine, dietary triggers, increase fiber)
Exercise
Psychotherapy

65
Q

Pharm therapy for IBS 3 forms:

A

IBS-C:

  • Bulk-forming laxatives
  • Osmotic laxative
  • Lubiprostone
  • TICA/SSRI
  • 5HT4 partial agonist

IBS-D:

  • Loperamide/Cholestyramine
  • 5HT3 antagonist

IBS-U:

  • Probiotics
  • Antispasmodic

Small intestine bacterial overgrowth:
Rifaximin

66
Q

IBS: Bulk Forming Laxatives

A

Absorbs water

Metamucil, Citrucel, Fiber Lax

67
Q

IBS: Osmotic Laxatives

A

Increases water retention

Milk of Magnesia
MiraLax

68
Q

IBS: Chloride channel activator

A

PGE1 derivative: Increases intestinal secretion secondary to Cl channel act.

Lubiprostone (Amitiza)

69
Q

IBS: Tricyclic antidepressants (TCA’s)

A

Effects on muscarinic receptors and serotonin reuptake

Amitriptyline
Imipramine

Not used often

70
Q

IBS: 5HT4 partial agonist

A

Hard to get, only for women

Zelnorm

Postmarket warnings about ischemic colitis and diarrhea severe

71
Q

IBS: Anti-diarrheals

A

Loperamide (Imodium)
Cholestyramine (Questran)
-For refractory pt’s

72
Q

IBS: 5-HT3 Antagonists

A

Hard to get, only for women

Lotronex

Restricted use due to ischemic colitis and DEATH!

Dangerous AF don’t take.

73
Q

IBS: Antispasmodic agents

A

Decrease GI smooth muscle and motility
Anti-Ach

Use PRN, due to tachyphylaxis

Bentyl, Robinul, Librax, Donnatal

74
Q

IBS: Antibiotics

A

Bacterial overgrowth contributes to IBS

Rifaxamin

75
Q

Tx IBS-C:

A
  1. Bulk laxative
  2. Osmotic laxative
  3. Lubiprostone
76
Q

Tx IBS-D:

A
  1. Bulk laxative
  2. Loperamide/Cholestyramine
  3. TCA/SSRI
77
Q

Tx IBS-U:

A
  1. Probiotics
  2. TCA/SSRI
  3. Antispasmodic
78
Q

Summary IBD:

A

IBD tx depends on inflammation and severity

Aminosalicyclates and CS - Mild/mod dz

IV CS, thiopurines, infliximab, adalimumab, cyclosporine, tacrolimus, MTX - Severe IBD

Clinical Pharmacology I (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions