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424 Pharmacology > GI > Flashcards

GI Flashcards

1
Q

Antacids

  1. What are the different formulations?
  2. Which ones have the highest reduction in stomach acid?
  3. What time period should antacids be separated from other medications?
A
  1. Formulations: aluminum hydroxide, magnesium hydroxide, calcium carbonate
  2. Magnesium and calcium carbonate have the highest reduction in stomach acid
  3. At least 2 hours
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2
Q

Antacids

Indications & Pharmacodynamics

A
  • Indications: hyperacidity, PUD, GERD
  • Pharmacodynamics: weak bases that interact with HCl in your stomach to reduce gastric acidity and increase pH
    • If ingested in a fasting state antacids will reduce acidity for 20-40 minutes
    • If administered one hour post-meal, will last about 2-3 hours
    • Minimally absorbed - calcium based will have increased absorption when taken with Vit D
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3
Q

Antacids

Caution/contraindications: when to avoid, caution, pregnancy & adverse fx (2)

A
  • Avoid: aluminum and magnesium based in renal impairment or renal insufficiency;calcium based in hypercalcemia or renal calculi; abdominal pain of unknown etiology
  • Caution: sodium restriction
  • Compatible with pregnancy and lactation
  • Adverse fx: aluminum and calcium based can cause constipation; magnesium based can cause diarrhea
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4
Q

Cytoprotective agents

Sucralfate

Indications & Pharmacodynamics

A

Indications: prophylaxis and tx of duodenal ulcers associated with NSAID use and tx for duodenal ulcers from other causes

Pharmacodynamics: selectively binds to necrotic ulcer tissue, covering it and acting as a barrier for outside stimuli such as acids

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5
Q

Cytoprotective agents

Sucralfate

Caution/contraindications: catuion, pregnancy, peds, other considerations & adverse fx (3)

A
  • Caution: geriatric patients with CrCl less than 30ml/min
  • Pregnancy/lactation: OK
  • Peds: avoid - limited data
  • Other considerations: Take on an empty stomach; separate from other meds by 2 hours
  • Adverse fx: constipation, dizziness, gastric discomfort
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6
Q

Cytoprotective agents

Misoprostol

Indications & Pharmacodynamics

A
  • Indications: prophylaxis and tx of duodenal ulcers associated with NSAID use
  • Pharmacodynamics
    • Inhibition of gastric secretion through inhibition of histamine stimulated by cAMP
    • Mucosal protective qualities by increasing mucus and bicarbonate
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7
Q

Cytoprotective agents

Misoprostol

Caution/contraindications: caution, pregnancy, peds, other & adverse fx (5)

A
  • Caution: renal impairment
  • Pregnancy/lactation: Avoid
  • Peds: avoid - limited data
  • Other: Take with food
  • Adverse fx: diarrhea, abdominal pain, nausea, postmenopausal bleeding, headache
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8
Q

Histamine 2 Agonists

Ranitidine, Famotidine, Cimetidine

Indications & Pharmacodynamics

A
  • Indications: mild intermittent GERD, PUD, heartburn
  • Pharmacodynamics: reversible competitive inhibition of histamine at H2 receptors of the gastric parietal cells, thus inhibiting gastric acid secretion; gastric acid secretion reduced by 35-50%
    • Onset 30 minutes
    • Can be taken PRN
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9
Q

Histamine 2 Agonists

Ranitidine, Famotidine, Cimetidine

Which medication of the three is most commonly used and why?

A
  • Famotidine: considered the safest so used most commonly
  • Ranitidine has been removed from the market due to occurrence of hepatitis
  • Cimetidine has excess adverse fx and risks do not typically outweigh benefits
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10
Q

Histamine 2 Agonists

Famotidine

Caution/contraindications: caution, pregnancy, peds & adverse fx (7)

A
  • Caution: renal impairment
  • Pregnancy/lactation: OK
  • Peds: OK
  • Adverse fx: headache, dizziness, confusion, agranulocytosis, granulocytopenia, thrombocytopenia, aplastic anemia
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11
Q

Proton pump inhibitors

Omeprazole, pantoprazole, esomeprazole

Indications & Pharmacodynamics

A
  • Indications: duodenal and gastric ulcers, erosive gastritis, Zollinger-Ellison syndrome, GERD (when sx no longer mild and intermittent)
  • Pharmacodynamics: reduce acid secretion by more than 90%; inhibit gastric proton pumps - H/K-ATPase pump, located on the parietal cells to suppress acid secretion
    • Take 30-60 minutes before meal, preferably before breakfast
    • Last 72 hours, but slow onset
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12
Q

Proton pump inhibitors

Omeprazole, pantoprazole, esomeprazole, lansoprazole, rabeprazole

Caution/contraindications: black box warning, caution, pregnancy, peds (different ages for each medication)

A
  • Black box warning for omeprazole and clopidogrel - reduces effectiveness of clopidogrel
  • Caution: elderly and those with hepatic dysfunction
  • Pregnancy/lactation: OK
  • Approved in peds
    • esomeprazole, omeprazole, lansoprazole - short term use for children 1+
    • pantoprazole ok for 5+
    • rabeprazole ok for 12+
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13
Q

Proton pump inhibitors

Omeprazole, pantoprazole, esomeprazole

Adverse fx (4)

What does long term use predispose a person to? (4)

A

Adverse fx: nausea, diarrhea, HA, abdominal pain

long term use: risk for bone fractures, C.diff infections, hypomagnesemia, Vit B12 deficiency

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14
Q

Antimotility agents

Diphenoxylate/atropine

Pharmacodynamics & adverse fx (6)

A

pharmacodynamics: inhibits excessive GI motility and GI propulsion; atropine added, provides anticholinergic fx that decrease secretion in the bowel and slow peristalsis

Adverse fx: dry mouth, dry eyes, urinary retention, blurred vision, drowsiness, dizziness

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15
Q

Antimotility agents

Diphenoxylate/atropine

Caution/contraindications: caution, contraindication, pregnancy, peds, other

A
  • Caution: liver/kidney disease, pts with bowel infection- fever, bloody stool, fecal leukocytes, BPH, elderly
  • Contraindicated: narrow-angle glaucoma
  • Pregnancy: caution
  • Peds: 12+ ok
  • Other considerations: Class V controlled substance, high doses can cause euphoria and physical dependence
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16
Q

Antimotility agents

Loperamide

Pharmacodynamics & adverse fx (4)

A
  • Pharmacodynamics: acts through opioids receptors to inhibit peristalsis and prolong gastric time; reduces fecal volume and diminishes loss of fluid and electrolytes
  • Adverse fx: abdominal discomfort, constipation, drowsiness, dry mouth
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17
Q

Antimotility agents: indication

A

acute diarrhea of IBS with diarrhea predominance

18
Q

Antimotility agents

Loperamide

Caution/contraindications: caution, pregnancy, peds, other considerations

A
  • Caution: bacterial bowel infection- fever, bloody stools or fecal leukocytes
  • Pregnancy: caution
  • Peds: 2+ ok
  • Other considerations: May induce drowsiness, do not operate heavy machinery
19
Q

Antimotility agents

Kaolin & Pectin

Pharmacodynamics, adverse fx (4), caution/contraindications (2)

A
  • Pharmacodynamics
    • kaolin is a clay-like powder that attracts and holds bacteria
    • pectin thickens the stool by absorbing moisture
  • Adverse fx: constipation, feeling of fullness, stomach bloating, gas
  • Caution/Contraindications
    • Do not use with children d/t salicylate component
    • May absorb nutrients and medications; separate from adsorbents and other medications
20
Q

Antimotility agents

Polycarbophil

Pharmacodynamics, adverse fx (2), caution/contraindications: pregnancy, peds, other considerations

A
  • Pharmacodynamics: can provide bulk to stools by absorbing water in the GI tract
  • Adverse fx: stomach upset, bloating gas
  • Caution/Contraindications
    • Pregnancy/lactation: OK
    • Peds: 6+ ok
    • Other considerations: Risk for rebound constipation, increase fluid intake
    • Interactions: tetracycline or quinolones
21
Q

Antiemetics - treatment is dependent on stimuli, indicate which drugs are recommended for the following causes of nausea/vomiting:

  1. Drugs, ketoacidosis, uremia
  2. obstruction, gastroparesis
  3. visceral pain
  4. motion sickness, vestibular inflammation
  5. higher brain stem, emotions, sensory disturbance
A
  1. phenothiazines, metoclopramide
  2. metoclopramide
  3. analgesics
  4. antihistamines, anticholinergics
  5. benzodiazepines, dronabinol, corticosteroids
22
Q

5HT3 receptor antagonists

Ondansetron

Pharmacodynamics, caution/contraindications: caution, interactions, pregnancy & adverse fx (3)

A
  • Pharmacodynamics: blocks serotonin peripherally on vagal nerve terminals and centrally in the CTZ
  • Caution/contra
    • Caution: QT prolongation
    • Interactions: serotonin medications
    • Pregnancy/lactation: caution
  • Adverse fx: HA, constipation, fatigue
23
Q

Antihistamines

Dramamine, meclizine

Indications & pharmacodynamics

A

Indications: nausea/vomiting related to motion sickness or vestibular inflammation

Pharmacodynamics: competes with histamine for H1 receptor sites, block the CTZ, diminish vestibular stimulation, depress labyrinthine function through central anticholinergic activity

24
Q

Antihistamines

Dramamine, meclizine

Caution/contraindications: avoid, interactions, pregnancy, peds & adverse fx (5)

A
  • Caution/contra
    • Avoid: narrow-angle glaucoma, BPH, thickened respiratory secretions, elderly patients (BEERS list)
    • Interaction: CNS depressants
    • Pregnancy: OK, lactation: avoid
    • Peds
      • Dramamine: 2+
      • meclizine: 12+
  • Adverse fx: drowsiness, dry mouth, blurred vision, urinary retention, paradoxical excitation in children
25
Q

Anticholinergics

Scopolamine

Indications & Pharmacodynamics

A
  • Indications: nausea/vomiting related to motion sickness or vestibular inflammation
  • Pharmacodynamics: blocks action of acetylcholine at the parasympathetic sites in smooth muscle, CNS and secretory glands
    • Placed behind one ear - used for prolonged period of time, takes 4 hours to take effect, can stay in place 72 hours
26
Q

Anticholinergics

Scopolamine

Caution/contraindications: avoid, caution, pregnnacy, peds & adverse fx (5)

A
  • Caution/contra
    • Avoid: narrow-angle glaucoma, BPH, thickened respiratory secretions, elderly patients (BEERS)
    • Caution: renal impairment
    • Pregnancy/lactation: avoid
    • Peds: avoid
    • Adverse fx: drowsiness, dry mouth, blurred vision, urinary retention, dilated pupils
27
Q

Phenothiazines

Promethazine, prochlorperazine

Indication & Pharmacodynamics

A

Indication: nausea/vomiting d/t drugs, ketoacidosis, uremia

Pharmacodynamics: block dopamine receptors in the CTZ as well as cholinergic, alpha 1 adrenergic and histamine 1 receptors

28
Q

Phenothiazines

Promethazine, prochlorperazine

Caution/contraindications: avoid, interactions, pregnancy, specific consideration for prochlorperazine & adverse fx (9)

A
  • Caution/contra
    • Avoid in patients with narrow-angle glaucoma, BPH, thickened respiratory secretions, elderly (BEERS)
    • Interaction: CNS depressants
    • Pregnancy: other agents preferred, lactation: avoid
    • Prochlorperazine: 1st generation antipsychotic; can cause blood dyscrasias - leukopenia, neutropenia, agranulocytosis
  • Adverse fx: sedation, extrapyramidal reactions, agranulocytosis, dry mouth, blurred vision, constipation, bradycardia, hypotension
    • Promethazine: fatal respiratory depression in children younger than 2 years
29
Q

Cannabinoids

Dronabinol

Indication & Pharmacodynamics

A

Indication: nausea/vomiting d/t stimuli from higher brain stem, emotions, senses

Pharmacodynamics: activates CB1 receptors in the brain, preventing the pro-emetic fx of endogenous compounds such as dopamine and serotonin

30
Q

Cannabinoids

Dronabinol

Caution/contraindications: caution, pregnancy, peds, other considerations & adverse fx (7)

A
  • Caution/contra
    • Caution: seizure disorder, cardiac disorders
    • Pregnancy/lactation: avoid
    • Peds: Avoid less than 6, caution less than 12
    • Other consideration: Drug test will show positive for marijuana, high potential for abuse
  • Adverse fx: depression, dizziness, paranoid thoughts, somnolence, palpitations, tachycardia, hypotension
31
Q

Prokinetic

Metoclopramide

Indications & Pharmacodynamics

A

Indications: diabetic gastroparesis, GERD not responsive to H2 blocker, PPI

Pharmacodynamics: dopamine receptor antagonist in CNS, leading to prevention of nausea; also stimulates motility in the upper GI tract

32
Q

Prokinetic

Metoclopramide

Caution/contraindications: avoid, caution, pregnancy, peds, other considerations & adverse fx (6)

A
  • Caution/contra
    • Avoid: suspected or active bowel obstruction, parkinson disease
    • Caution: renal impairment
    • Pregnancy: OK, lactation: caution
    • Peds: OK
    • Other consideration: high potential for abuse, can prolong QT
  • Adverse fx: black box warning for extrapyramidal side fx, depression, drowsiness, dizziness, diarrhea, hypoglycemia
33
Q

Senna

Pharmacodynamics, caution/contraindications: avoid, caution, pregnancy, peds, adverse fx (5)

A
  • Pharmacodynamics: stimulate myenteric plexus, resulting in prostaglandin release and increase cAMP concentration
  • Caution/contra
    • Avoid: bowel obstruction suspected or active
    • Caution: severe CVD
    • May be used in pregnancy and lactation (except for castor oil)
    • Peds
      • Bisacodyl: 76+
      • Senna and castor oil: 2+
  • Adverse fx: abdominal cramping, electrolyte imbalance, diarrhea, nausea, vomiting
34
Q

Bulk laxatives

Psyllium

Pharmacodynamics, caution/contraindications: caution, pregnancy, peds & adverse fx (3)

A
  • Pharmacodynamics: soluble fiber that absorbs water in the intestine to form a viscous liquid that promotes peristalsis and reduces transit time
  • Caution/contra
    • caution in narrowed esophageal or intestinal lumen
    • Compatible in pregnancy/lactation
    • Ok for peds 6+
  • Adverse drug fx: abdominal cramping, bloating, esophageal or intestinal obstruction
35
Q

Osmotic laxatives

Magnesium hydroxide, polyethylene glycol

Pharmacodynamics, caution/contraindications: caution (lactulose & magnesium), pregnancy, peds & adverse fx (4)

A
  • Pharmacodynamics: draw water into the intestinal lumen to increase intraluminal pressure which distends the colon and increases peristalsis
  • Caution/contra
    • Lactulose: caution in diabetic pts
    • Magnesium: caution in renal impairment
    • All may be used in pregnancy and lactation
    • Approved in peds 2+
  • Adverse fx: abdominal cramping, nausea, diarrhea, bloating
36
Q

Stool softener

Docusate sodium

Pharmacodynamics, caution/contraindications: pregnancy, peds & adverse fx (1)

A
  • Pharmacodynamics: reduces surface tension of oil-water interface on the stool, facilitates admixture of fat and water into the stool, producing an emollient action
  • Caution/contra
    • Compatible with pregnancy and lactation
    • Peds older than 2
  • Adverse fx: overly loose stools
37
Q

Lubricants

Mineral oil

Pharmacodynamics, caution/contraindications: pregnancy, avoid & adverse fx (5)

A
  • Pharmacodynamics: eases passage of stool by decreasing water absorption and lubricating the intestine
  • Caution/contra
    • Avoid in pregnancy and lactation
    • Avoid in elderly
  • Adverse fx: abdominal cramping, diarrhea, nausea, oily rectal leakage, vomiting
38
Q

Chloride channel activators

Lubiprostone

Pharmacodynamics, caution/contraindications: avoid, pregnancy, peds & adverse fx (5)

A
  • Pharmacodynamics: activates Cl channels in the GI epithelial lining, producing chloride-rich secretions that soften the stool and increase motility
  • Caution/contra
    • Avoid: Known or suspected bowel obstruction
    • Not recommended in peds or pregnancy
  • Adverse fx: HA, nausea, diarrhea, abdominal pain, bloating
39
Q

Opioid receptor antagonists

Methylnaltrexone

Pharmacodynamics, caution/contraindications: avoid, pregnancy, peds, other considerations & adverse fx (5)

A
  • Pharmacodynamics: antagonist at mu receptors in the GI tract
  • Caution/contra
    • Avoid: Known or suspected bowel obstruction
    • Caution in pregnancy
    • Not recommended in peds
    • other considerations: Dosing is weight based, expensive
  • Adverse fx: flatulence, nausea, diarrhea, abdominal pain, bloating

424 Pharmacology (12 decks)

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