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Pharmacology > GI > Flashcards

GI Flashcards

1
Q

N/V Gastroenteritis or Drug PATHWAY

A

CTZ

Receptors: Serotonin & Dopamine

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2
Q

N/V Gastroenteritis or Drug PATHWAY TREATMENT

A

Top choices:
Dopamine receptor: promethazine&raquo_space; inexpensive, EPS SEs
Serotonin receptor: generic, still expensive

other options: antihistamines

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3
Q

N/V Motion Sickness PATHWAY

A

Vestibular pathway

Receptors: Acetylcholine-muscarinic, histamine

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4
Q

N/V Motion Sickness PATHWAY TREATMENT

A

First line:
Antihistamines&raquo_space; sedation
Anticholinergics (antimuscarinics)&raquo_space; CAN’T SEE, PEE, SPIT, SHIT

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5
Q

N/V Emotional/Anticipatory PATHWAY

A

Limbic system

Receptors: GABA, histamine

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6
Q

N/V Emotional/Anticipatory PATHWAY TREATMENT

A

Benzodiazepines: INC activity of GABA, an inhibitory neurotransmitter

Antihistamines: Hydroxyzine DOC for its antiemetic/sedating properties

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7
Q

Patient-specific treatment: PONV

A

5 HT3 blocker
phenothiazine
NK1 receptor blocker

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8
Q

Patient-specific treatment: PEDs

A

Phenothiazine
Antihistamine/Anticholinergic

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9
Q

Patient-specific treatment: PREGNANCY

A

Antihistamine/Anticholinergic
5 HT3 blockers: controversial
Promethazine: controversial

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10
Q

Patient-specific treatment: CIINV

A

5 HT3 blockers
NK1 receptor blockers
Cannabinoid
Benzodiazepine
Corticosteroid
Metoclopramide
Phenothiazines
Antihistamines

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11
Q

TREAT THE CAUSE

A

N/V is a SYMPTOM

most of the time, it is self-limiting = resolve on its own

newborn = congenital obstruction
infant = obstructive lesions, metabolic disease, nutrient intolerance
children/adolescents/adults = drug induced; metabolic disorders; GI disorder; Motility disorder; Acute abdomen; Infection of abdomen; CV disease; Neurological process; emotional

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12
Q

Phenothiazines MOA/USES

A

oldest
(-zine) = promethazine (phenergan) and prochlorperazine (compazine)

MOA: block dopamine in CTZ; block cholinergic, alpha1-adrenergic, histamine receptors in vomiting center

monotherapy in mild - mod nausea, or combo for severe nausea

block nausea from blood and CSF: pathogenic toxins, opiates, to much body electrolytes, partying, GI bug, trauma

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13
Q

Phenothiazines ADVANTAGES/DISADVANTAGES

A

ADVANTAGES:
inexpensive, except SR form
variety of forms
viable and practical option for LONG-TERM USE

DISADVANTAGES:
causes sedation&raquo_space; CAUTION w/ CNS depressants
Preg C
NO anticonvulsants, Coumadin

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14
Q

Phenothiazines AEs

A

SAME AS ANTIPSYCHOTICS

Extra-pyramidal sx: tremors, tardive dyskinesia, dystonia
CONTRAINDICATED: Parkinson’s

AE: sedation, resp depression (NO children <2, elderly start low dose, resp disorders)
may suppress cough reflex

anticholinergic effects: dry mouth, dry eyes, blurred vision, urinary retention, urine color change

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15
Q

Antihistamines-Anticholinergics MOA/USES

A

MOA: block histamine and cholinergic receptors along vestibular pathway and in vomiting center

antihistamines: block H1 receptors, bind to central cholinergic receptors responsible for N/V
anticholinergics: DEC secretion of saliva and GI motility

BLOCK N/V originating from inner ear&raquo_space; motion sickness, vertigo

motion sickness: take 30-60 min before event
patch: apply 1-2 hrs before event and may reapply q3 days

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16
Q

Antihistamines-Anticholinergics MEDS

A

dimenhydrinate (dramamine)&raquo_space; Pre B
Diphenhydramine (benadryl)&raquo_space; Preg B
Hydroxyzine (vistaril, atarax)
meclizine (antivert)
scopolamine
trimethobenzamide (tigan)

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17
Q

Antihistamines-Anticholinergics Contraindications

A

Antihistamines: CAUTION asthma, glaucoma, GI/GU obstruction
NO LACTATION

Anticholinergics: CAUTION: glaucoma, bladder neck obstruction, GI obstruction

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18
Q

Antihistamines-Anticholinergics AEs

A

Antihistamines: sedation, drowsiness, confusion

Anticholinergics: CAN’T SEE, PEE, SPIT, SHIT
mydriasis, blurred vision, urinary retention, dry mouth, constipation

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19
Q

Benzodiazepines MOA/USES

A

MOA: blocks signals from limbic system from reaching vomiting center

usually used in combo w/ other agents for CINV

USES: N/V and provide an anxiolytic and amnesic effect

most beneficial w/ anticipatory N/V

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20
Q

Benzodiazepines DOC/Contraindications/AEs

A

DOC: Lorazepam

Preg D

CONTRAINDICATIONS: hepatic/renal failure

AE: CNS depression, paradoxical CNS stimulation

**MONITOR LFTs before dosing

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21
Q

Serotonin Receptor Blockers MOA/USES

A

MOA: block 5HT3 receptors (many in GI tract)

USES: initially for CINV, but expanded to radiation induced N/V and PONV

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22
Q

Serotonin Receptor Blockers AEs

A

oral administration encouraged

Preg B

AE: few
HA, fatigue, dizziness, constipation, pruritis, fever

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23
Q

Cannabinoids

A

MOA: unknown

does NOT involve CTZ

AE: sedation, ataxia, dysphonia, may develop tolerance to most AEs w/ repeated dosing, but NOT antiemetic effect

Appetite stimulant&raquo_space; the munchies

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24
Q

Cannabinoids Routes PROBLEMS

A

Smoking: works like PCA, risk of high THC levels producing AEs

Vaporizing: patient control intake, risk HIGH initial blood levels, NOT easily nebulized, coughing/irritation

oral: predictable onset, absorption rate variable, first-pass effect; difficult to titrate optimum dose

sublingual: patient controlled, rapid onset, less AEs, ONLY IN UK

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25
Q

NK1 Receptor Antagonists

A

newest

aprepitant (emend)

Crosses BBB to occupy NK1 receptors

MOA: inhibit substance P from binding to NK1 receptor = no N/V

augment activity of 5HT3 receptor blockers

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26
Q

NK1 Receptor Antagonists AEs

A

AE: fatigue, dizziness, hiccups, **elevated LFTs

CYP3A4 inducer

**can cause life threatening reactions when combined w/ certain drugs

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27
Q

N/V Other Meds

A

Metoclopramide: A Prokinetic

Corticosteroids: used for CINV
MOA: unknown
BEWARE GI irritation, Hyperglycemia
AE: steroid psychosis, HA, insomnia, glucose intolerance&raquo_space; long-term use

Antacids: coat the stomach or neutralize acid

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28
Q

GERD Patho

A

relaxed LES or cardiac sphincter allows contents to be splashed into esophagus

ACID burns esophageal tissue

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29
Q

GERD Causes

A
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30
Q

GERD Risk Factors

A
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31
Q

GERD Diagnostic criteria

A
32
Q

PUD Patho

A

supply and demand: supply of gastric assaults > gastric defenses

types: duodenal and gastric ulcers

33
Q

PUD Causes

A

Duodenal:
1st: H. pylori
2nd: NSAIDs

Gastric: H. pylori
INC acid and pepsin secretion, NSAIDs, impaired mucosal protection, pyloric stenosis, chronic gastritis

34
Q

PUD Risk Factors

A

smoking
NSAIDs
ETOH
H. pylori

35
Q

PUD Diagnostic criteria

A
36
Q

H2 Receptor Antagonists MOA/USES

“-idine”
ranitidine, famotidine

A

MOA: reduce HCl secretion by blocking one of the triggers of H+ production

USES:
self-tx heartburn
NO first-line tx GERD

Used as maintenance after PPI for GERD
Used in PUD for continued acid suppression after ulcer healed

37
Q

H2 Receptor Antagonists Contraindications

A

CAUTION: elderly, renal patients = CNS effects

38
Q

H2 Receptor Antagonists AEs

A

antiandrogen (gynecomastia, impotence)

CNS: confusion, agitation, psychosis, depression, disorientation

hematologic: rare, but need to monitor

drowsiness, dizziness, N/V/D, constipation

**may raise LFTs, d/c if it does

39
Q

H2 Receptor Antagonists Interactions

A

Antacids DEC absorption

uses CYP450 pathway: cimetidine

40
Q

PPI MOA/USES

A

MOA: inhibit H/K/ATPase pump, blocking the final step in H+ secretion

41
Q

PPI Contraindications

A

Contra: hypersensitivity

CAUTION: hepatic dysfunction, elderly

42
Q

PPI AEs

A

Common: dizziness, drowsiness, abd pain, constipation, diarrhea, flatulence

long-term = nutrient deficiencies, INC risk c diff, INC hip fracture, gastric CA

43
Q

PPI Interactions

A

Food DEC absorption

44
Q

Antacids

A

MOA: neutralize acid

CAUTION: renal issues or hypercalcemic state (renal calculi)

Drug absorption effect: give other agent first, take antacid 2 hrs later

Be careful of Na content

45
Q

Sucralfate

A

alkaline aluminum salt

MOA: binds to necrotic tissue at ulcer site; protective barrier to acid, pepsin, bile salts

USES: duodenal ulcers NOT from H. pylori

stress ulcer prophylaxis

PREGNANCY SAFE
EMPTY STOMACH
AVOID ANTACIDS

AE: constipation

may DEC absorption of drugs = separate dosing by 2 hrs

46
Q

Misoprostol

A

inhibit gastric secretion by inhibiting histamine-stimulated cycle

Mod DEC in pepsin concentration

produces UTERINE CONTRACTIONS

NO PREGNANCY

CAUTION: renal impairment, >65 yo

AE: diarrhea

47
Q

GERD algorithm

A
48
Q

PUD algorithm

A
49
Q

H. Pylori MULTI-TREATMENT

A

First-line:
1) PPI, amoxicillin, clarithromycin
2) PPI, clarithromycin, metronidazole

Second-line:
1) PPI, amoxicillin, clarithromycin, tinidazole
2) bismuth subsalicylate, metronidazole, tetracycline, PPI

Salvage tx only: PPI, amoxicillin, levofloxacin

50
Q

Diarrhea PATHO

A

Osmotic: pulls water into intestine (lactose intolerance, high sugar intake, poorly absorbed salts)

Secretory: Cl secretion, disrupt NaCl reuptake (cholera, celiac disease, crohn’s, bacterial endotoxins)

Exudative: inflammation of mucosa (enteritis, colitis, inflammatory conditions)

Altered Intestinal Motility: INC motility = DEC reabsorption (bowel resection, vagotomy, meds)

51
Q

Diarrhea CAUSES

A

infections
medications
disease states

52
Q

Diarrhea Diagnostic

A

INC in frequency of loose, watery stools over a period of 24-48 hrs

53
Q

Constipation CAUSES

A

diet
lifestyle
meds
disease

54
Q

Bulk forming laxatives

fiber lax

A

preferred agents for constipation relief

pull water into stool to swell and INC stool bulk

bulk stimulates movement of intestines

NO tx opioid induced constipation

Can be used as antidiarrheal

work in 12-24 hrs

55
Q

Bulk forming laxatives CONTRAINDICATIONS

A

esophageal strictures
GI ulcerations
GI stenosis
GI obstruction

CAUTION: DM (carb content from fiber)

56
Q

Bulk forming laxatives AEs/INTERACTIONS

A

AE:
INC flatulence
INC bloating
abd fullness, cramping
N/V w/ excess use

INTERACTIONS:
contains aspartame
AVOID gluten intolerance
quinolones or TCN = absorption blocking

57
Q

Hyperosmotic laxatives

A

INC osmotic pressure = stimulates intestinal motility

does not degrade colonic bacteria so less bloating

supp for promotes rectal stimulation

58
Q

Hyperosmotic laxatives CONTRAINDICATIONS

A

lactulose:
CAUTION DM
Appendicitis, acute abd, fecal impaction, intestinal obstruction

long-term use causes dependence

not useful: IBS, severe bloating or fullness

59
Q

Hyperosmotic laxatives AE

A

glycerin: safest; may cause rectal irritation

GI upset
Diarrhea
nausea
cramps
bloating

60
Q

Saline laxatives

A

draw water into intestine via osmosis = INC intraluminal pressure = INC motility

similar to hyperosmotic lax

used as pre-procedure PREP

61
Q

Saline laxatives CONTRAINDICATIONS/AE

A

Contraindications:
low salt diet
renal disease = hypoK, hyperMg, hypoCa, hyperNa

CAUTION ELDERLY

AE: dehydration

62
Q

Saline laxatives INTERACTIONS

A

separate administration from:

Azoles
antifungals
quinolones
TCN

63
Q

Stimulant laxatives

bisacodyl, senna, castor oil

A

INC peristalsis of intestine, promote fluid accumulation

AVOID long-term tx

work 6-10 hrs after oral administration; 15-120 min after rectal administration

64
Q

Stimulant laxatives CONTRAINDICATIONS

A

acute abdomen
fecal impaction
intestinal obstruction

may cause exacerbation of hemorrhoids or rectal fissures

65
Q

Stimulant laxatives AEs

A

N/V
abd cramping
laxative dependence

66
Q

Surfactant laxatives (stool softeners)

docusate sodium
docusate calcium

A

DEC surface tension of liq contents of bowel

Incorporates more liq into stool forming a softer mass

LOC to prevent straining

PREVENT CONSTIPATION – NO TX

combo w/ fiber products

67
Q

Surfactant laxatives CONTRAINDICATIONS/INTERACTIONS

A

NO contraindications

useful in those on restricted Na diets

interaction w/ mineral oil–INC absorption which INC risk for liver toxicity

68
Q

Surfactant laxatives AEs

A

well-tolerated
stomach upset
mild cramping
diarrhea
throat irritation

PEARL: can be used to soften cerumen before irrigation

69
Q

CONSTIPATION TREATMENT

A

TLCs

First-line: bulk-forming lax

Second-line: MOM

Third-line: stimulant (high abuse potential; mineral oil)

70
Q

Antimotility Agents

Loperamide
Diphenoxylate w/ atropine

A

Derivative of OPIATES

Slows GI motility by effecting intestinal musculature

INC transit time = INC absorption

71
Q

Antimotility agents CONTRAINDICATIONS/AEs/INTERACTIONS

A

Contraindications: exacerbate infectious diarrhea by DEC expulsion of infecting organism

AE: Abd discomfort, constipation, dry mouth

NO CHILDREN <4
Atropine SE

INTERACTIONS: diphenoxylate = CNS depression

Loperamide - HIGH first pass effect = CAUTION LIVER FAILURE

72
Q

Atypical antidiarrheals

A

antisecretory, antimicrobial, adsorbent properties

TX: traveler’s diarrhea

contains salicylate: CAUTION ASA sensitivity or treatment

NO CHILDREN = Reye’s syndrome

AE: black stools, black tongue, tinnitus

73
Q

Adsorbents
(Kaolin, pectin, attapulgite)
Donnagel, Kaopectate)

A

Adsorb water and solidify stools

given after each BM until diarrhea resolved

AE: constipation, feeling of fullness, upset stomach, bloating, flatulence

relatively safe

interactions: may adsorb nutrients and meds

74
Q

Absorbents
polycarbophil (fibercon, fiberall)

A

absorbs water from GI tract

AE: constipation, feeling of fullness, upset stomach, bloating, flatulence

relatively safe

interactions: may adsorb nutrients and meds

75
Q

Diarrhea TREATMENT

A

TLCs: diet (low fiber, lactose free, gluten free, BRAT)

First-line: LOPERAMIDE

Second-line: Adsorbent or bismuth subsalicylate; do NOT use bismuth w/ flu in <18yr

Third-line: diphenoxylate w/ atropine

76
Q

Anthelmintic (PINWORMS)

Pyrantel pamoate

A

Reece’s pinworm medicine OTC

KILLS ADULT WORM ONLY, DOSE REPEATED (for eggs)

NO PREGNANT
AE: rash, HA, dizziness, sleepiness, N/V

May take w/ food

77
Q

Anthelmintic (PINWORMS)

Mebendazole

A

RX needed = KILLS ADULT WORMS

Preg C

AE: angioedema, fever, dizziness, HA, rash, abd pain, N/V/D

tablet can be crushed and mixed w/ food

Pharmacology (12 decks)

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