GASTROINTESTINAL Flashcards
Which H2 blocker is the most potent blocker of the CYP450 system?
cimetidine
What are the AE of misoprostol? In whom is it contraindicated?
diarrhea; CI in pregnant because abortifacient
What effect does metoclopromide have on colon transport time?
NONE, it only affects the stomach and LES
Cimetidine can cause the release of what anterior pituitary hormone?
prolactin i.e. causes gynecomastia
Which receptor is antagonized by PPI’s?
H/K ATPase on parietal cells
Which GI drug is a D2 receptor antagonist?
metoclopromide
Misoprostol is a PG__1 analog
E
What other disorder aside from constipation can lactulose be used to treat, why?
hepatic encephalopathy because gut flora degrade it into lactic and acetic acid which help to draw out ammonia, thus decreasing their hyperammonemia
What electrolyte imbalance may be caused by ALL antacids?
hypokalemia
3 indications for H2 blockers?
PUD, gastritis, and MILD esophageal reflux
Which osmotic laxative is also an antacid?
Magnesium hydroxide – this explains diarrhea being an AE
People on PPI’s are at increased risk of what infection?
Clostridium difficile (contrarily, these drugs are used to treat infections with H pylori)
Which osmotic laxative is also used to Tx hepatic encephalopathy?
lactulose
All H2 blockers end in _____ while all PPI’s end in ________
dine; prazole
What are 4 osmotic laxatives?
Magnesium hydroxide, magnesium citrate, polyethylene glycol, lactulose
Sulfasalazine would be contraindicated in treating a patient with an allergy to what?
sulfa drugs i.e. it contains sulfapyridine
What ist he black box warning on metoclopromide?
tardive dyskinesia
What is the toxicity of octreotide?
can cause steatorrhea, and nausea/cramping
Which antacids can chelate and decrease absorption of tetracyclines?
CaCO3 or just Ca containing antacids
Which antacids cause constipation and which cause diarrhea?
Aluminum containing ones cause constipation and Mg containing ones cause diarrhea (Mg = Must Go)
Why would metoclopromide possibly work for GERD (it isnt indicated for it, just asking about a concept)
it increases LES tone
What are 3 clinical indications for misoprostol?
prevent NSAID-induced ulcers, maintain patent ductus arteriosus, induce labor by ripening cervix
What are 4 clinical indications for octreotide?
ACUTE variceal bleeding, VIPoma, carcinoid syndrome, and acromegaly
What are the major AE of infliximab?
infection and reactivation of latent TB, fever, hypotension
A man with ulcerative colitis is receiving treatment but finds that he and his wife cannot conceive, why?
sulfasalazine causes reversible oligospermia
How do PPI’s inhibit the receptor?
IRREVERSIBLY
Which antacid is most likely to cause cardiac arrest?
Magnesium hydroxide
In which way do H2 blockers antagonize the receptor?
REVERSIBLY
Which H2 blockers decrease renal secretion of creatinine?
cimetidine and ranitidine
Which cells are affected by H2 blockers and PPI’s?
parietal cells (secrete H and IF)
Which antacids can cause a rebound increase in acid and hypercalcemia?
Calcium Carbonate
Infliximab is a monoclonal antibody against ______. What 3 diseases can it Tx?
TNF alpha; Crohn’s, UC, and Rheumatoid arthritis
What are the indications for metoclopromide?
Diabetic and Post-Surgery Gastroparesis and it is used as an anti-emetic
What is the MOA of ondansetron?
centrally acting 5-HT3 antagonist, prevents emesis in chemotherapy
What antibiotic can be used to Tx gastroparesis? MOA?
erythromycin; motilin analog
Which antacids can cause proximal muscle weakness, osteodystrophy, and seizures
Aluminum containing ones, in addition to constipation
Which drugs are used to bind to the base of ulcers and promote healing and can also be used to Tx travelers diarrhea?
Bismuth and Sucralfate
Who might abuse osmotic laxatives? And the Tx for their disorder is?
Bulimics; SSRI’s
In whom is metoclopromide contraindicated?
patients with small bowel obstruction or Parkinson’s disease
In addition to PUD, GERD and gastritis (which are indications for H2 blockers), PPI’s can additionally Tx what disease?
Zollinger Ellison Syndrome
What is sulfasalazine a combination of?
Sulfapyridine ( a sulfa drug) and 5 aminosalycylic acid
What drug is given in the treatment of acute variceal bleeding? MOA?
octreotide; long acting somatostatin analog
If a man was given a drug for “stomach problems” and developed gyncecomastia, what was he most likely given?
cimetidine it has antiandrogenic effects
