Gastrointestinal System Flashcards
Amoxicillin
Antimicrobial Agent: mainly used for a H.pylori infection that causes a peptic ulcer
- not used alone because of resistance so combination with PPI is common
H. Pylori Infection Dx
urea breath or biopsy
Bismuth Compounds (Peptobismol)
Antimicrobial Agent: mainly used for a H.pylori infection that causes a peptic ulcer
- not used alone because of resistance so combination with PPI is common
Clarithromycin
Antimicrobial Agent: mainly used for a H.pylori infection that causes a peptic ulcer
- not used alone because of resistance so combination with PPI is common
Metronidazole
Antimicrobial Agent: mainly used for a H.pylori infection that causes a peptic ulcer
- not used alone because of resistance so combination with PPI is common
Tetracycline
Antimicrobial Agent: mainly used for a H.pylori infection that causes a peptic ulcer
- not used alone because of resistance so combination with PPI is common
Cimetidine
H2 Blocker: blocks the binding of histamine to decrease gastric acid secretion
- Peptic Ulcers, Acute Stress Ulcers, GERD
- AE: HA, dizzy, muscular pain
inhibits CP450 - increases warfarin
Famotidine
H2 Blocker: blocks the binding of histamine to decrease gastric acid secretion
- Peptic Ulcers, Acute Stress Ulcers, GERD
- AE: HA, dizzy, muscular pain
- most potent
Nizatidine
H2 Blocker: blocks the binding of histamine to decrease gastric acid secretion
- Peptic Ulcers, Acute Stress Ulcers, GERD
- AE: HA, dizzy, muscular pain
- no liver metabolism so 100% bioavailable
Ranitidine
H2 Blocker: blocks the binding of histamine to decrease gastric acid secretion
- Peptic Ulcers, Acute Stress Ulcers, GERD
- AE: HA, dizzy, muscular pain
- longer acting, more potent than cimetidine and current FDA voluntary recall (found NMDA)
Dicyclomine
antimuscarinic agent
- PRAZOLE
- class?
- used for?
- AE?
- what are they?
Proton Pump Inhibitor: bind to proton pump to inhibit H+ secretion and decreases gastric acid
- if no h. pylori infection, use these drugs!!
- # 1 choice for stress ulcers and prophylaxis of heartburn
- Tx: erosive esophagitis, active duodenal ulcer, hypersecretory conditions (chronically), and GERD
AE: HA, N, D, long term use may lead to fractures
Prodrugs: have acid-resistant enteric coat, absorbed in duodenum and transported to parietal cells to active form
- CANNOT take with drugs that decrease acid because it will decrease the conversion to active drug metabolites
Misoprostol
Prostaglandin E Analog that will treat ulcers produced by NSAID use
- Contraindicated in pregnancy because it causes uterine contractions and dislodging in fetus
PGE
produced by the gastric mucosa to inhibit HCI secretion and stimulate mucus/bicarbonate production
Omeprazole
interferes with warfarin
Antacids
weak bases that react with gastric acid to form water and salts and decreases pepsin activity (inactivates when pH is less than 4)
better on full stomach
symptomatic relief of peptic ulcer disease + GERD
Aluminum Hydroxide
antacid
AE: constipation
Calcium Carbonate
Antacid
Magnesium Hydroxide
Antacid
AE: diarrhea
Sodium Bicarbonate
Antacid
AE: systemic alkalosis
Mucusal Protective Agent (MPA)
prevent mucosal injury, decrease inflammation and help heal ulcers
Bismuth Subsalicylate
Antimicrobial actions (inhibit growth), inhibit pepsin, increase mucus secretion, coat and protect ulcer crater
MPA
Sucralfate
- what does it do
- tx?
- need?
MPA
complex of aluminum hydroxide and sulfated sucrose that forms gel with epithelial cells to cover injury and impairs HCI diffusion
stimulates prostaglandin secretion
NOT GIVEN WITH PPI, H2 BLOCKER, ANTACIDS because it needs an acidic environment to work with
Tx: stress-related gastritis
5 Primary Inputs of Nausea/Vomit
Chemoreceptor Trigger Zone (CTZ): in area postrema outside of BBB
- DA/5HT/Neurokinin-1/Opioid Receptors
Pharynx: Vagus Nerve (gag reflex)
Vestibular Apparatus (inner ear): Motion Sickness - Histamine and Muscarinic Receptors
GI Tract
- 5HT Receptors
Cerebral Cortex: Psychological
- reaction from stress, anticipation, psychiatric disorders
Prochlorperazine
Anti-psychotic
DA Antagonist that blocks DA/Histamine/Muscarinic at CTZ
- effective against mild/low emetogenic agents
AE: sedation, hypotension, EPS
Promethazine
Anti-Histamine
DA Antagonist that blocks DA/Histamine/Muscarinic at CTZ
- effective against mild/low emetogenic agents
AE: sedation, hypotension, EPS
Haloperidol
DA Antagonist
AE: prolongs QT interval which leads to arrhythmias
last choice drug
Droperidol
DA Antagonist
AE: prolongs QT interval which leads to arrhythmias
last choice drug
Metoclopramide
DA Antagonist
AE: sedation, Diarrhea, EPS
-SETRON
5-HT3 (5HT Antagonists)
effective against all agents + from GI but NOT motion sickness
AE: HA and prolongs QT interval
Aprepitant
Substance P / Neurokinin-1 Blocker
can work alone but usually with dexmethasone and palonesetron
AE: constipation and fatigue
very effective with high emetogenic agents
Dexamethasone
corticosteroid
combos are common and may involve blockage of prostaglandin
Methylprednisolone
Corticosteroid
Dronabinol
THC derivative
binds to CNS cannabinoids receptors
Aprazolam
BZD
- has low antiemetic potency and effectiveness mainly from sedative properties
- good for anticipatory vomit
Lorazepam
BZD
- has low antiemetic potency and effectiveness mainly from sedative properties
- good for anticipatory vomit
Diarrhea
caused by increase in motility in GI and decreased absorption of fluid
Diphenoxylate
Anti-motility agent
- opioid-like actions in gut that decrease Ach release and peristalsis
- lacks analgesic effect
prolonged use can lead to dependence
Loperamide
Anti-motility agent
- opioid-like actions in gut that decrease Ach release and peristalsis
- lacks analgesic effect
prolonged use can lead to dependence
Aluminum Hydroxide
Adsorbent: molecules adhere to surface to treat diarrhea
- adsorb intestinal toxins and or coating the intestinal mucosa
- can interfere with absorption of other drugs
AND
Antacid: causes constipation
Methylcellulose
Adsorbent: molecules adhere to surface
- adsorb intestinal toxins and or coating the intestinal mucosa
- can interfere with absorption of other drugs
AND
Bulk Laxative: form gel with intestine to increase water retention and peristalsis
Bismuth Subsalicylate
Fluid/Electrolyte Transport
- decreases fluid secretion to treat diarrhea
Antimicrobial Agent (h.pylori infection)
MPA: inhibit pepsin activity and increase mucus secretion
Laxative
increases movement of food through GI which can decrease effect of drugs
- cause electrolyte imbalance and potential for dependency (except lubipristone)
Bisacodyl
stimulates colon and can cause cramping
- do not use with meds that increase gastric pH because if it dissolves in stomach = pain
Castor Oil
irritates stomach and increases peristalsis
- avoid in pregnancy because it stimulates pregnancy
Senna
stimulant that causes bowel evacuation and electrolyte secretion to treat constipation
Docusate
stool softener mainly for prevention of constipation
Glycerin Suppositories
lubricant laxative for constipation
Mineral Oil
lubricant laxative for constipation
Methylcellulose
Bulk Laxative that forms gel in large intestines to cause water retention and intestinal distention
- increases peristalsis
Psyllium
Bulk Laxative that forms gel in large intestines to cause water retention and intestinal distention
- increases peristalsis
Magnesium Citrate
Nonabsorbable salts/electrolytes to hold water in intestine via osmosis
Saline and Osmotic Laxative
Magnesium Hydroxide
Saline and Osmotic Laxative - Treat Constipation
-Nonabsorbable salts/electrolytes to hold water in intestine via osmosis
AND
Antacid: causes diarrhea
Polyethylene Glycol
Nonabsorbable salts/electrolytes to hold water in intestine via osmosis
Saline and Osmotic Laxative
Lactulose
Nonabsorbable salts/electrolytes to hold water in intestine via osmosis
Saline and Osmotic Laxative
Lubiprostone
Chloride Channel Activator - increase fluid secretion in intestinal lumen - less change in electrolytes - used chronically bc no dependence - minimal drug interactions AE: nausea