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2022 Adv Pharm Faculty Landing Page > GI > Flashcards

GI Flashcards

1
Q

Probiotics vs Prebiotics

A
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2
Q

Probiotic contraindications

A

Immunocompromised

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3
Q

Goals for anti-diarrheal therapy

A
  1. Eliminate causes
  2. Decrease fluid in lumen
  3. Decrease propulsive contractions
  4. Increase mixing contractions
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4
Q

Opioids as anti-diarrheals

Examples and Mechanism of Action

A

Eg. morphine and codeine

MOA: Mu receptor agonist, work by increasing fluid absorption and decreasing fluid secretion, decreasing propulsive contractions and increasing segmental contractions to delay gastric emptying

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5
Q

Loperamide

A

Mu opioid agonist with low risk for addiction

Less CNS effects, more PNS

Side effect: fatigue, n/v, dizziness, dry mouth, cramping, paralytic ileus, urinary retention, rash

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6
Q

Bismuth Subsalicylate

Mechanism of Action and Side Effects

A

Stimulates fluid absorption in GI tract, reduces inflammation by inhibiting prostaglandins, binds to toxins, and bactericidal action

Can cause black stool

Toxicity can lead to tinnitus

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7
Q

Pharmalogical constipation options

A
  • Bulk laxatives
  • Emollients
  • Stimulants
  • Saline laxatives
  • Hyperosmolar laxatives
  • Enemas
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8
Q

Bulk laxative

Examples and Mechanism of Action

A

Not systemically absorbed, work by pulling fluid into the GI to form a soft, bulky stool

Eg. Psyllium, methycellulose, calcium polycarbophil, bran

*Must take with plenty of water

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9
Q

Emollient examples and mechanisim of action

A

Docusate sodium (Colace) and Docusate calcium (Surfak)

Not systemically absorped, work by enabling stool to be penetrated by water and become soft

First line for hard/dry stool

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10
Q

Stimulant laxatives

Examples and mechanism of action

A

Bisacodyl, Senna, Castor oil

Act on GI mucosa to stimulate peristalsis

Not for long term use, can cause dependence

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11
Q

Saline laxatives

Examples and mechanism of action

A

Magnesium hydroxide, magnesium sulfate, magnesium citrate, sodium phosphate

Work by drawing water into the intestinal lumen

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12
Q

Hyperosmolar laxatives

Examples and mechanism of action

A

Lactulose, sorbitol, glycerol, polyethylene glycol

Draws water into the intestinal lumen, doesn’t have electrolytes like saline laxatives do.

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13
Q

Enema examples and mechanism of action

A

Sodium phosphate (Fleet enema), soap suds, tap water, olive oil, saline

Induce bowel evacuation by stimulating distention

*Risk for electrolyte imbalances with all enema types

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14
Q

Pharmalogical Options for GERD/PUD

A
  • Antacids
  • H2RB
  • PPI
  • Probiotics
  • Bismuth
  • Antimicrobials
  • Cytoprotective agents
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15
Q

Antacids Mechanism of Action and Patient Education

A

Work by neutralizing gastric acid, thereby increases pH of stomach and duodenum.

Take 1 hour after meal, drink full glass of water with tablet

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16
Q

Antacid adverse effects

A

Calcium carbonate and aluminums: constipation

Magnesium hydroxide: diarrhea

Sodium bicarbonate: elevated Na+ and fluid retention

17
Q

Histamine 2 Receptor Blockers

Examples and Mechanism of Action

A

Ranitidine, Cimetidine, Famotidine, Nizatidine

Binds H2 receptors of gastric parietal cell reducing secretion of gastric acid.

**Considered first line for patients with more than ocassional symptoms

18
Q

H2 Receptor Blockers Cautions

A

Generally well tolerated

Use caution in elderly (Beers criteria)

19
Q

Proton Pump Inhibitors

Mechanism of Action and Examples

A

Irreversibly bind to hydrogen-potassium ATPase pump of parietal cell to block acid secretion.

Esomeprazole, lansoprazole, omeprazole, pantoprazole, rabeprazole

20
Q

PPI adverse effects and education

A

Can have nutrient malabsorption, rebound heartburn with prolonged use

Increased risk for bacterial infection, pneumonia, fracture, CKD, possible increase MI risk

Beers criteria (avoid in elderly >8 weeks)

Take before breakfast, do not take at same time as H2 receptor blocker

21
Q

PUD Management

A
  1. Decrease acid secretion with PPI
  2. Treat infection if present (H. pylori)
  3. Cytoprotective agents to protect gastric mucosa
  4. Remove contributing factors (NSAIDs)
22
Q

Sucralfate

Mechanism of Action, Patient Education, Side Effects

A

Creates protective barrier which allows healing of gastric mucosa

Take 2 hours apart from other medications on an empty stomach

Constipation most common s/e

Avoid in renal failure

23
Q

Misoprostol

Indications, Side Effects, Education

A

Used for NSAID induced PUD

Side effects: diarrhea, cramping, pain

**Abortifactant: must document effective birth control in persons of childbearing years with uterus. May also cause birth defects and premature birth.**

24
Q

H. Pylori Therapy

A
  • Bismuth
  • Clarithromycin
  • Amoxicillin
  • Tetracyline
  • Metronidazole
25
Q

Bismuth Quadruple Therapy

A
  1. Bismuth
  2. PPI (omeprazole or pantoprazole)
  3. Metronidazole
  4. Tetracycline
26
Q

Nausea and vomiting neurotransmitters

A
27
Q

Main pharm agents for nausea and vomiting

A
  • Antihistamines & Anticholinergics
  • Dopamine agonists
  • Selective Serotonin Antagonists
28
Q

Antihistamine/Anticholinergic as anti-nausea/vomiting

Mechanism of Action and examples

A

Dimenhydrinate, Hydroxyzine, Meclizine, Promethazine, Scopolamine

Block the physiologic action of histamine (H1)/acetylcholine at the receptor site

Interrupts visceral afferent pathways that are responsible for stimulating n/v reflex

Most commonly used in motion sickness

29
Q

Dopamine antagonists

Mechanism of Action

A

Centrally acting: inhibiting the dopamine receptors in the medullary chemoreceptor trigger zone

Peripherally Acting: block the vagus nerve in the gastrointestinal tract resulting in stimulation of GI motility

30
Q

Centrally Acting Phenothiazines

Side effects and contraindications

A

Promethazine, Prochlorperazine

Side effects: blurred vision, dry mouth, dizziness, restlessness, seizure, extrapyramidal symptoms, tardive dyskinesia

Contraindicated: glaucoma, liver disease, prostate and bladder issues

31
Q

Peripherally Acting Phenothiazines

Side Effects

A

Metoclopramide (central and peripheral activity)

Diarrhea, fatigue, QT prolongation, extrapyramidal side effects

**Beers Criteria**

32
Q

Serotonin (5HT3) Antagonist

Indicatons and Side Effects

A

Ondansetron

Used in chemotherapy induced n/v, postop, severe n/v, pregnancy

May cause headache, constipation, need to monitor LFTs with prolonged use, QT prolongation, QRS widening

33
Q

What drugs/classes of drugs can lower lower esophageal sphingter tone increasing risk of reflux?

A

Anticholinergics

Benzodiazepines

Caffeine

Calcium channel blockers (dihydropyridines)

Estrogen/progesterone

Nicotine

Nitrates

Theophylline

Tricyclic antidepressants

2022 Adv Pharm Faculty Landing Page (22 decks)

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