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Pharmacology -AM > GERD/PUD/IBD > Flashcards

GERD/PUD/IBD Flashcards

1
Q

Combo pack options for H.pylori-associated ulcers

A

Pylori, Helidac, PrevPac
Abx + PPI
$$$

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2
Q

MOA= anti-inflammatory effects to areas of inflammation in the GI tract

A

Aminosalicylates (-salazine)

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3
Q

This can form when there is an imbalance of Gastric acid/pepsin vs Bicarbonate/mucous secretion/prostaglandins

A

PUD

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4
Q

What do you need to test for when using Azathioprine & 6-MPs to avoid the possibility of Azathioprine toxicity?

A

TPMT, it metabolizes Azathioprine to 6-MP. If not present, then need to reduce the dose

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5
Q

Anti-TNF-alpha Biologic drugs used for IBD:

A

Infliximab
Certolizumab
Adalimumab
Golimumab

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6
Q

H2 blockers drugs

A

Cimetidine
Famotidine
Nizatidine
Ranitidine

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7
Q

What is the 4th drug you add if 3 drug treatment for H.pylori fails?

A

Bismuth

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8
Q

AE: Hypersensitivity

A

Azathioprine & 6-MP

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9
Q

Misoprostol (synthetic prostaglandin) MOA

A

inhibits secretion of acid and stimulates secretion of mucous and bicarbonate

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10
Q

Aminosalicylates or sulfasalazine or budesonide (a PO corticosteroid) are often used to treat _______ especially in cases that are less severe (but can be used then, too). These all could be used for acute flares or maintenence.

A

UC or CD

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11
Q

Why would you want to use Cyclosporine for IBD?

A

Used for patients with fulminant or refractory Sx (serious cases)

Also used to prevent organ rejection in transplant patients

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12
Q

What IBD drugs include the possible AE of increased risk of Progressive Multifocal Leukoencephalopathy?

A

Natalizumab
Vedolizumab

(other biologics)

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13
Q

How long could it take for Azathioprine & 6-MP to work with IBD?

A

3-12 months

PO

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14
Q

Bismuth Subsalicylate (Pepto Bismol) use

A

sometimes used in quadruple therapy for treating peptic ulcers

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15
Q

Bismuth Subsalicylate AE

A

black tongue & stools

salicylism (w/ high doses)

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16
Q

Sucralfate MOA

A

non-absorbed, forms paste-like adhesive over ulcer and protects from acids/bile salts/pepsin

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17
Q

Sucralfate administration

A

multiple times daily, large pills- inconvenient

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18
Q

Defect in the gastric or duodenal mucosal wall that extends into the deeper layers of submucosa

A

Peptic Ulcer Disease

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19
Q

gastric acid secretion is inhibited by

A

prostaglandins

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20
Q

One of the Aminosalicylates has worse AE than the others. Which one, and what are the AE?

A

Sulfasalazine

headache, GI fx, fatigue, bone marrow suppression, lowered sperm counts, hepatitis

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21
Q

PPI MOA

A

inhibits gastric H+ pump
(H+=acid=proton, proton pump inhibitor)
reduces secretion of gastric acid

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22
Q

Why would you use Methotrexate for IBD?

A

maintain remission of CD and decrease steroid use

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23
Q

PPI AE

A

headache, diarrhea, constipation, ab pain

increased risk of community acquired pneumonia & c diff

reduced calcium absorption (take calcium citrate for supplementation)

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24
Q

Risk factors for NSAID-induced PUD

A
  • > 60
  • concomitant anticoagulant use
  • preexisting coagulopathy
  • concomitant corticosteroid or SSRI use
  • CV disease
  • Multiple NSAID use
  • High dose NSAID use
  • > 1 month NSAID use
  • NSAID related dyspepsia
  • smoking
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25
MOA of this IBD Tx: host flora may alter inflammatory response
Probiotics: L. acidophilus, Bifidobacterium
26
Antacid drugs
- magnesium hydroxide - magnesium hydroxide/aluminum hydroxide - calcium carbonate - sodium bicarbonate
27
Antacid use
immediate, short acting
28
gastric acid secretion is stimulated by
acetylcholine, gastrin, histamine
29
The biggest difference between Ulcerative Colitis and Crohn's disease?
Depth and location- UC: colon & rectum and continuous, does not extend beyond submucosal layer CD: anywhere mouth to anus and discontinuous, ulcerates deeply- transmural
30
Benefit of using Anti-TNF-alpha Biologics for IBD (-umab):
Decrease in TNF-alpha = reduction of inflammation
31
Inflammatory response includes atypical type 2 T helper cells that produce pro-inflammatory cytokines: IL-1, IL-6, TNF-alpha
Ulcerative Colitis
32
Tx approach to GERD
Lifestyle changes Patient-directe therapy (OTC meds) Acid suppressing therapy (Rx meds) Anti-reflux surgery
33
Corticosteroids that are not considered systemic corticosteroids:
oral budesonide, nasal corticosteroids, inhaled cortiocosteroids. nasal corticosteroids and inhaled corticosteroids would not help a patient maintain remission of UC or CD because these routes do not affect the GI tract significantly/at all.
34
Which Aminosalicylates are linked to molecules or formulated for different areas of effect, or # doses/day?
Sulfasalzine Olsalazine Balsalazine
35
Inhaled corticosteroids
``` Beclomethasone Budesonide Ciclesonide Flunisolide Fluticasone Mometasone ```
36
Benefits of using Natalizumab & Vedolizumab for IBD?
reduced inflammation
37
Sucralfate use
specific situations, to reduce the risk of NSAID-induced gastric ulcers *must stop the NSAID
38
How do you choose what IBD drugs to use?
Based on location and severity of disease Route of administration that is chosen is also determined based on the location and sometimes severity of the disease.
39
H2 blockers administration
Rx or OTC, PO and some IV
40
Other medications used in the Tx of IBD
Antibiotics (CD) Smoking (transdermal nicotine)- (UC) Probiotics (mostly UC)
41
If a patient has an active TB or Hep B infection, what meds would you want to avoid using?
Anti-TNF-alpha Biologics: infliximab, certolizumab, adalimumab, golimumab
42
Patients with _______ are at a high risk of relapse--50-80% of patients may relapse within a year or two. In contrast, some patients can achieve remission for many years. Expect that most (if not all) patients will be on maintenance therapy indefinitely.
UC and CD
43
Antacids *
absorption of cations (Mg, Al, Ca) can occur with renal impaired
44
Misoprostol AE
GI AE's are common - ab pain - flatulence - diarrhea & nausea (dose related)
45
Immunosuppressant drugs for IBD
``` Azathioprine 6-mercaptopurine (6-MP) Methotrexate Cyclosporine Biologics ```
46
Goals and cautions of IBD Tx
Goals: maximize efficacy & minimize toxicity Cautions: - avoid antidiarrheal meds (reduce motility) - avoid anticholinergic drugs (reduce motility) - avoid NSAIDs (worsen Sx) - caution w/ opioids (reduce motility)
47
PPI interactions
reduce absorption of drugs that need an acidic environment CYP450 CYP2C19 - Omeprazole (worst w/ slow metabolism)
48
With this IBD Tx, CD has a minimal response while VSL#3 may reduce pouchitis in patients with ileal pouch anal anastomosis, and it may also prevent relapse in mild-mod UC disease
Probiotics: L. acidophilus, Bifidobacterium
49
Antacids MOA
React with gastric acid to produce water+ a salt (more neutral). Reduce acidity
50
What do you consider when choosing Tx for IBD?
``` Patients Sx Medical Hx Current medication use Drug allergies Extent, location, and severity ```
51
PPI drugs
``` Esomeprazole Lansoprazole Omeprazole Pantoprazole Rabeprazole Dexlansoprazole ```
52
Goals of GERD Tx
Alleviate Sx Decrease frequency of recurrent disease Promote healing of mucosal injury Prevent complications
53
Misoprostol administration
4x day
54
The long term AE effects of this IBD drug include hepatotoxicity, pulmonary fibrosis, and bone marrow suppression
Methotrexate
55
Sucralfate interactions
prevents absorption of many drugs (digoxin, fluoroquinolone) concern with low TI
56
What are the cons of using Anti-TNF-alpha Biologics for IBD?
- Only available as SubQ or IV - expensive - serious AE Infliximab has IV infusion related rxn risks: fever, chest pain, hypoTN, dyspnea
57
Systemic (oral) corticosteroids
Prednisone Prednisolone Methyprednisolone
58
Non-pharmacologic therapy for PUD
- reduce psychological stress - stop smoking - avoid alcohol - avoid NSAID/ASA use
59
Antacid AE
- Constipation w/ calcium & aluminum - Diarrhea w/ magnesium - Acid/base imbalance w/ sodium bicarb
60
This IBD drug's MOA is as a folate antagonist
Methotrexate
61
Other biologic immunosuppressant drugs used for IBD (not anti-TNF-alpha):
Natalizumab | Vedolizumab
62
GERD lifestyle changes
- eat smaller meals - avoid eating in 3 hours prior to bed - avoid irritating foods - avoid irritating meds (NSAIDs) - smoking cessation - avoid alcohol - wt loss - elevate head of the bed
63
This IBD Tx has AE of significant toxicity risks including: nephrotoxicity, risks of infection, seizures, hypertension, LFT abnormalities
Cyclosporine
64
Which Aminosalicylate affects different areas based on the route of administration?
Mesalamine PO-> ileum, cecum Enema -> colon, rectum Suppository -> rectum
65
Why would you want to use Azathioprine & 6-MP for IBD?
maintaining remission and reducing the need for long term corticosteroid use
66
AE include: possible reactivation of serious infx including TB, Hep B, HF, lymphoma
Anti-TNF-alpha Biologics: infliximab, certolizumab, adalimumab, golimumab
67
PPI administration
PO (can open & mix in) 30-60 minutes before meals Lasts 18 hours
68
MOA: target immune response or cytokines involved with IBD
Immunosuppressants
69
How do you treat NSAID-associated ulcers?
discontinue NSAID if possible. | If not, PPI, H2RAs, Sucralfate
70
How do you treat H.pylori-associated ulcers?
3 drug combo: PPI (or H2RA) Antibiotics- Clarithromycin, Amoxicillin or metronidazole 10-14 days
71
Sucralfate AE
constipation, nausea, metallic taste aluminum toxicity MC with renal failure
72
How do you prevent NSAID-associated ulcers?
Use gastroprotection if must use: - Misoprostol >> H2RAs - PPIs >> H2RAs - Misoprostol = PPIs - COX2 selective NSAID = PPI + nonselective NSAID (latter is preferred) - PPIs better tolerated than Misoprostol
73
Reasons for H.pylori Tx failure
Reinfection Non-adherance Antimicrobial resistance (70%)
74
H2 blockers *
Dose adjust for renal impaired Will enter breast milk, cross placenta
75
Misoprostol use
in specific situations, to reduce the risk of NSAID-induced gastric ulcers
76
Antacid administration
best to take after meals
77
Non-pharmacologic therapy for IBD
- avoid irritating foods - B12, folic acid, fat soluble vitamins, iron, etc supplementation if needed - Assess for risk of bone loss - surgery
78
Antacid interactions
Blocks absorption of many drugs, take other drugs 1-2 hrs before and/or 4-6 hrs after - ferrous sulfate - isoniazid - sulfonylureas - flouroquinolones
79
Why would you choose to use Aminosalicylates?
To induce and maintain remission in mild-moderate IBD
80
Aminosalicylate *
Contraindicated in sulfamide allergy Must supplement with folic acid during pregnancy
81
PPI *
Do not stop abruptly, must taper off
82
AE with long term use: cataracts, skin atrophy, HTN, hyperglycemia, adrenal suppression, osteoporosis, increased risk of infection, delayed growth in children
corticosteroids best not to use long term
83
What meds are the last resort choice for IBD Tx?
Natalizumab Vedolizumab (other biologics)
84
Aminosalicylate drugs
- Mesalamine - Sulfasalazine - Olsalazine - Balsalazine
85
MC causes of PUD
H. pylori infection (esp DU) NSAIDs (esp GU) Stress-related mucosal damage
86
H2 blockers interactions
Reduce efficacy of drugs that require an acidic environment. | Cimetidine reacts w/ CYP450 and interferes with the metabolism of other drugs (warfarin, phenytoin)
87
Bismuth Subsalicylate MOA
antimicrobial, inhibits pepsin, increase mucous secretion, works w/ glycoproteins to coat & protect ulcers
88
This IBD drug is Pregnancy Category X
Methotrexate
89
H2 blockers MOA
inhibits H2 receptors from binding to Histimine (which stimulates gastric secretion) to reduce secretion of gastric acid
90
Inflammatory response includes T-helper type 1 cells that produce pro-inflammatory cytokines: Interferon-gama, TNF-alpha*, IL-1, IL-6, IL-8, IL-12
Crohn's disease
91
H2 blockers AE
mostly well tolerated Confusion w/ elderly & IV Cimetidine may cause endocrine fx (gynecomastia/galactorrhea)
92
Patient directed GERD therapy options (OTC)
- Antacids- quick, cheap, prn - OTC H2 blockers- work in 30 min, prn, less $ than PPIs - PPIs- effective, not for prn, use for 2 wks then stop
93
Antibiotics used in IBD Tx
Metronidazole -> pouchitis, CD with resection or perianal fistulas Ciprofloxacin -> refractory active CD Can also use in combination
94
Misoprostol *
Avoid in pregnancy
95
MOA: inhibits purine synthesis, reduction of IBD associated GI inflammation
Azathioprine & 6-MP

Pharmacology -AM (4 decks)

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