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Pharmacology (Dale Turley) > GastroIntestinal > Flashcards

GastroIntestinal Flashcards

1
Q

Idiopathic disease involving an immune reaction of the body to its own intestinal tract

A

Inflammatory Bowel Disease (IBS)

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2
Q

IBS major types?

A

UC

Crohns

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3
Q

UC is limited to the ?

A

colon

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4
Q

Crohns disease can involve ________ of the gastrointestinal tract

A

any part

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5
Q

IBS: goal of therapy?

A

Goal of therapy: Reduce inflammation and control flare-ups

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6
Q

IBS tx step wide approach ?

A

Benign drugs first

5-ASA’s first

Crohns, peri-anal disease and inflammatory mass

Corticosteroids 2nd

Immune modifying agents 3rd

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7
Q

______ oral aminosalicylate agents in the United States

A

Six

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8
Q

Two most common 5-ASAs?

A

Sulfasalazine (Azulfidine)

Mesalamine ( Asacol, Pentasa, Lialda)

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9
Q

_________ was originally proposed as a treatment for rheumatoid arthritis.

A

Sulfasalazine

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10
Q

It was subsequently discovered that sulfasalazine was also efficacious in treating ?

A

inflammatory bowel disease, particularly ulcerative colitis.

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11
Q

The 5-aminosalicylic acid (5-ASA) medications were developed because many patients were intolerant of or allergic to _________.

A

sulfasalazine

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12
Q

____________ is a prodrug composed of 5-aminosalicylic acid (5-ASA) linked to __________.

A

Sulfasalazine

sulfapyridine

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13
Q

___________ accounts for many of its side effects

A

Sulfapyridine

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14
Q

5-ASA MOA?

A

exact mechanism of action unknown

blocks cyclooxygenase and inhibits prostaglandin
production

producing anti-inflammatory effects

ASA also black cyclooxygenase

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15
Q

Also known as “DMARDS” (disease-modifying antirheumatic drugs)?

A

5-ASA

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16
Q

Compounds are broken up by ____________ releasing active compound 5-ASA

A

colonic bactreria

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17
Q

Indications for Sulfasalazine (Azulfidine)?

A

Ulcerative Colitis
Crohn’s Disease
Rheumatoid Arthritis

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18
Q

Sulfasalazine trade?

A

Azulfidine

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19
Q

Side effects can occur with both sulfasalazine and 5-ASA, but are more common with ____________

A

sulfasalazine

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20
Q

Approximately ______ percent of patients discontinue sulfasalazine due to side effects.

A

20 to 25

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21
Q

Adverse reactions and interactions to Sulfasalazine (Azulfidine)?

A

Pruritus

abnormal LFTs

leukopenia

urticaria, anemia

hemolytic anemia

TTP

cyanosis

anorexia

N/V, HA and dizziness

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22
Q

Sulfasalazine (Azulfidine) monitoring?

A

CBC w/ diff, LFTs at baseline, then q2wk x3mo, then

BUN/Cr, urinalysis w/ microscopic exam

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23
Q

Sulfasalazine (Azulfidine) decreases?

A

Decreases the effects of

Iron supplement, Digoxin and Folic Acid

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24
Q

Sulfasalazine (Azulfidine) increases the effects of?

A

oral anticoagulants,

hypoglycemic agents

methotrexate

**check INR and glucose*

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25
Q

Contraindications to Sulfasalazine (Azulfidine)?

A

Hypersensitivities to sulfonamides and salicylates (ASA, Bactrim)

GI obstruction

caution if renal impairment
caution if hepatic impairment

**it will slow motility so you get GI obstruction *

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26
Q

Sulfasalazine (Azulfidine) is Preg. Cat?

A

Pregnancy Cat B (trimester specific due to folate metabolism)

** cause what it does to the folic acid synthesis *

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27
Q

Sulfasalazine (Azulfidine) dosing?

A

Dosing

Crohns: Dz 500 mg PO q 6hr - give with food

RA: 1 Gm PO q 12 hr

UC: 500 mg q 6 hr

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28
Q

mesalamine three trade name?

A

Asacol

Pentasa

Lialda

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29
Q

Mesalamine indications?

A

Indicated for Crohns Disease and Ulcerative Colitis

30
Q

Mesalamine is a derivative of?

A

derivative of salicylic acid (anti-inflammatory effects)

31
Q

The release of 5-ASA is ____________

A

pH-dependent

** pH dependent is the key to the drug especially when it comes to prescribing it *

32
Q

Oesophagus pH?

A

7.0

33
Q

Stomach pH?

A

1-2.5 (5 when fed)

34
Q

Proximal small intestine pH?

A

6.16-7.35

35
Q

Distal small intestine pH?

A

6.8-7.88

36
Q

Ascending colon pH?

A

5.26-6.72

37
Q

Descending colon pH?

A

5.02-7.02

38
Q

Mesalamine targets location depending on ?

A

pH

39
Q

_______- drug released at a pH of 7 (typically at the terminal ileum)

A

Asacol

**more for UC*

40
Q

_______ – time release coating begins at pylorus (pH 4), used proximal colonic disease ( more acidic)

A

Pentasa

**more for crohns*

41
Q

______ indicated to induce remission of active UC

A

Lialida

42
Q

_________ of release mechanism of Asacol and Pentasa

A

Combination

43
Q

Mesalamine has a ____ relapse

A

high

44
Q

__________ high concentration of mesalamine to descending colon (enema or suppository for proctitis)

A

Rectal dosage

45
Q

Mesalamine: UC tx?

A

Oral: Usual course of therapy is 6 to 8 weeks:

Asacol HD: 1.6 g 3 times daily for 6 weeks

Delzicol: 800 mg 3 times daily for 6 weeks

Lialda: 2.4 or 4.8 g once daily

Pentasa: 1 g 4 times daily

46
Q

Mesalamine: UC remission maintenance?

A

Oral:

Apriso: 1.5 g once daily in the morning

Delzicol: 1.6 g in 2 to 4 divided doses

Lialda: 2.4 g once daily

Pentasa: 1 g 4 times daily

**GOUT people get an additional high dose and then a maintenance dose *

47
Q

Anti-diarrhea Meds: Absorbent preparations

?

A

Bismuth subsalicylate (Pepto-Bismal, Kaopectate)

48
Q

Anti-diarrhea Meds: Opiates?

A

Diphenoxylate with atropine (Lomotil)

49
Q

Anti-diarrhea Meds: Anticholinergics (IBS)?

A

Belladonna
Scopalamine

remember glaucoma effects of anticholenigerics - closed canal of schlemm which would increase IOP.

50
Q

Biological Therapies are ?

A

Immune Modifying Agents or Biologicals

51
Q

When are Biological Therapies indicated?

A

When corticosteroids fail or require long term therapy

Biologicals not used in acute flare-ups - cause onset of action is not until 2-3 months

52
Q

BT: Class: Tumor Necrosis Factor (TNF) Inhibitors

examples?

A

Infliximab (Remicade)
Etanercept (Embrel)
Adalimumab (Humira)

53
Q

TNF Inhibitors BBW?

A

Chronic or recurrent infection

Pulmonary and extrapulmonary tuberculosis (TB)

Invasive fungal infections and other opportunistic infections incl. Legionella and Listeria ( especially w/ PNA)

**these really suppress immune system and open you up for opportunistic infections, CXR and basic lab work for monitoring and before you give them treatment with these guys *

54
Q

TNF Inhibitors indications?

A 
Crohns
Ulcerative Colitis
Rheumatoid Arthritis
Ankylosing Spondylitis
Psoriasis
55
Q

TNF inhibitors contrindications?

A

Contraindicated in co-morbid active infections and disease:

DM
hepatitis
restrictive lung disease

56
Q

TNF Inhibitor facts?

A

Peds under >6 yo

Many drug-drug interactions

57
Q

TNF inhibitor reactions?

A

serum sickness

anaphylactoid rxn

hypersensitivity rxn ( rashes
preload with prednisone and benadryl ( premedicate))

Opportunistic infections, sepsis, pneumonia, opportunistic infection, tuberculosis, malignancy, lymphoma, hepatosplenic T-cell lymphoma (peds pts), leukemia, HBV reactivation, hepatotoxicity, CHF

58
Q

TNFI are administered _________ and repeated at _ week and _ week intervals

A

Administered IV infusion and repeated at 2 week and 6 week intervals

59
Q

How long do you observe for post infusion signs of infections when taking TNFI?

A

Observed for post infusion signs of infections (3-12 days)

60
Q

Lipase Inhibitor?

A

Orlistat

61
Q

Orlistat is the only drug in class?

A

Lipase Inhibitors

FDA approval in 1999

62
Q

What is commonly used for obesity management?

A

Orlistat:

Commonly used for obesity management
Weight loss
Weight maintenance
Reduce the risk of weight gain following weight loss

**reduces absorbing of fat , potato chip*

63
Q

What is Orlistat used with ?

A

calorie diet

64
Q

Orlistat trade name?

A

Orlistat (Alli, Xenical)

65
Q

Orlistat indications Obesity?

A

BMI greater than 30

BMI greater than 27 with co-morbidities (HTN, DM, HLP)

66
Q

Orlistat MOA?

A

reversible inhibitor of gastric and pancreatic lipases, thus inhibiting absorption of dietary fats by 30%

Binds sites stomach and small intestines

Does not break down dietary fat

Undigested triglycerides not absorbed causing reduced caloric intake

67
Q

Orlistat availability?

A

OTC 60 mg capsule PO tid

Reduced calorie diet and exercise

68
Q

Orlistat adverse reactions?

A

Fatty / oily stools

Fecal urgency, flatulence, increased stools

69
Q

Contraindications to Orlistat?

A

Malabsorption disorders, vitamin deficiency and cholestasis

**short gut sycnrome or gastroparesis or GB disease - avoid this medication in these people *

70
Q

Zofran is Preg. Cat ?

A

C

it used to be B

71
Q

What is a Reverse Lipase Inhibitor?

A

Binds sites stomach and small intestines

Does not break down dietary fat

Undigested triglycerides not absorbed causing reduced caloric intake

Pharmacology (Dale Turley) (31 decks)

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