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GI Flashcards

1
Q

Causes of Nausea/Vomiting

A
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2
Q

Which neurotransmitters trigger Nausea/Vomiting

A
  • Histamine
  • Ach
  • Serotonin
  • Dopamine
  • CHEMO Induced N/V (CINV)
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3
Q

Types of Anti-emetics

A
  • Antihistamines
  • Anticholingerics
  • Dopamine Antagonists
  • Serotonin (5-HT3) Receptor Antagonists
  • Neurokinin 1 receptor Antagonists
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4
Q

What type of Antiemetics are these?

Dimenhydrinate (Dramamine)
Meclizine (Antivert, Bonine)
Diphenhydramine (Benadryl)

A

Antihistamines

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5
Q

What type of Antiemetics are these? (“-setron”)

Ondansetron (Zofran)
Palonosetron (Aloxi)
Dolasetron (Anzamet)
Granisetron (Kytril)

A

Serotonin (5-HT3 Receptor) Antagonists

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6
Q

What type of Antiemetic is this?

Scopolamine (Transderm-Scop)

A

Anticholinergic

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7
Q

What type of Antiemetics are these?

  • Phenothiazines -> Promethazine (Phenergan), Prochlorperazine (Compazine)
  • Metoclopramide (Reglan)
A

Dopamine Antagonists

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8
Q

What type of Antiemetics are these? (“-pitant”)

Aprepitant (Emend)
Fosaprepitant for injection (Emend)
Rolapitant (Varubi)

A

Neurokinin 1 receptor antagonists
For CHEMO Induced N/V (CINV)

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9
Q

Are Antihistamines & Anticholinergics better for prophylaxis or trmnt of N/V?

A

Prophylaxis

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10
Q

Which Antiemetic blocks the chemoreceptor trigger zone and diminishes vestibular and reticular stimulation

A

Antihistamines

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11
Q

Which Antiemetic blocks the chemoreceptor trigger zone and diminished vestibular and reticular stimulation

A

Antihistamines

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12
Q

Which antiemetics are safe for refractory N/V in pregnancy

A

Serotonin Antagonists (“-setron”)

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13
Q

Serotonin Antagonists cannot be taken with other meds thay may prolongate the QT, such as…

A

Macrolides
Antiarrhythmics
Azole Antifungals
Fluoroquinolones

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14
Q

Which antiemetic agent has these considerstions:
- DO NOT GIVE TO < 2yo for risk of resp depression
- Suppresses bone marrow if used long-term (>1-2wks)

A

Phenothiazines (Dopamine Antagonists)

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15
Q

Which dopamine antiemetic inhibits dopamine receptors in brain, Blocks histamine (H1), cholinergic, & blocks adrenergic receptors

A

Phenothiazines

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16
Q

What are Extrapyramidal Symptoms (EPS)?

A

Involuntary tics, muscle contractions, restlessness (think parkinsons like tics)

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17
Q

What Antiemetics cause Extrapyramidal Symptoms (EPS)

A

Dopamine Antagonists

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18
Q

Antiemetics

Long-term use (>8-12wks) of ______ is avoided because it can lead to Tardive Dyskinesia (an often irreversible movement disorder)

A

Metoclopramide (Reglan) - Dopamine Antagonist

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19
Q

Which Antiemetics are used for CHEMO induced N/V (CINV) & may interact with warfarin therapy?

A

Neurokinin 1 receptor antagonists
* Aprepitant (Emend)
* Fosaprepitant for injection (Emend)
* Rolapitant (Varubi)

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20
Q

Diarrhea <___wks = Acute

A

< 2 wks = Acute
> 2 wks = Chronic

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21
Q

Pt presents with diarrhea and has been taking anti-diarrheals. Labs confirm Infx ET. Wdyd?

A

Discontinue Antidiarrheals (Especially of C. diff infx -> Toxic Megacolon risk)

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22
Q

What type of agent is Pepto Bismol?

A

Anti-secretory

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23
Q

Pepto Bismol contains Salicylate and Bismuth. What are the specific MOA of these two compounds?

A

Salicylate -> anti-secretory and anti-inflammatory
Bismuth -> antimicrobial to bacteria & viruses

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24
Q

Pepto Bismol Contraindications

Salicylate may interact with _____ and lead to Salicylism (Tinnitus, N/V)

A

Anticoagulants (Aspirin)
Salicylate + Aspirin = Salicylism

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25
Which GI med cannot be given to children/teens with or recovering from **influenza** or **Zoster** infection -> Reye’s Syndrome (swelling/inflammation of liver & brain -> altered mental status + Vomiting)
Pepto Bismol
26
Which GI meds are Gastric μ-opioid receptor agonists (μ = mu)
Antimotility or Opiate Derivatives **- Loperamide (Imodium) - Diphenoxylate with atropine (Lomotil)** - Difenoxin with atropine (Motofen)
27
# Opiate Derivatived Anti-diarrheals Subtherapeutic amounts of _______ are added to formulations added to discourage abuse
****ATROPINE****
28
# PUD What are the aggressive and protective factors?
29
Halitosis is more commonly associated with ____ - GERD? - PUD?
GERD
30
GERD & PUD Trmnt Agents
31
Which GI med can cause Milk-Alkali Syndrome?
Antacids
32
# Antacids SE Mg -> ________ Al & Ca -> _______
**Mg** -> diarrhea (laxative effect), renal failure **Al and Ca** -> constipation, hypophosphatemia
33
Caution giving Antacids to those who have ___ dysfunction
renal
34
Which H2RA has many drug interactions, is a potent multiple CYP450 inhibitor, and is generally avoided (eg. warfarin, phenytoin, nifedipine)
Climetidine (Tagamet)
35
How do PPIs inhibit the proton pump? What needs to happen for acid secetion to resume?
PPIs form covalent bond with H+K+ATPase and **irreversibly inhibit** proton pump Acid secretion only resumes after new pump molecules are secreted and inserted into the luminal membrane
36
When should PPIs be taken?
30 min BEFORE MEALS
37
Caution giving PPIs if there is _____ dysfunction
hepatic
37
You need to Rx Omeprazole/Esomeprazole (Prilosec) for GERD to a patient with a laundry list of meds. You need to see if they are already taking _____, _____, or _______ because adding this drug may increase the concentration of these other 3.
clopidogrel, diazepam, or warfarin
38
What are the 2 different Cytoprotective Agents for GERD or PUD?
* **Misoprostol (Cytotec)** - Prostaglandin analog * **Sucralfate (Carafate)** - fills in ulcer holes
39
Which GI med is approved for NSAID induced mucosal injury but **TRIGGERS IBD FLARES** and is **TERATOGENIC (Preg Category X)**?
Misoprostol (Cytotec)
40
# Cytoprotective Agents * Misoprostol (Cytotec) * Sucralfate (Carafate) Which ones gives you **Diarrhea**? Which one gives you **Constipation**?
Misoprostol (Cytotec) -> Diarrhea Sucralfate (Carafate) -> Constipation
41
Which Cytoprotective agent can treat other ulcers including: * Canker Sores * Radiation Induced Ulcers * **Radiation Proctitis and Rectal Ulcers** (when given rectally)
Sucralfate (Carafate)
42
Untreated H. pylori -> _______
Gastric Cancer
43
**Low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma** is an indication for ____ WU
H. pylori
44
H. pylori infx leads to: ______ Gastrin & Acid ______ Bicarb | High or Low
HIGH Gastrin & Acid LOW Bicarb ## Footnote H. pylori infx **decr inhibition of gastrin production** resulting in abundance of gastrin and subsequent increased acid production and reduced duodenal bicarbonate production **= HIGH GASTRIN & ACID; LOW BICARB**
45
1st line Quadruple Therapy for H. pylori
1. PPI BID or Esomeprazole QD (or H2RA) 2. Bismuth Subsalicylate (Pepto Bismol) 3. Tetracycline 4. Metronidazole | 14 Day trmnt
46
Dx of IBS
47
IBS-D Trmnts
48
# Type of drug, MOA, & Use ? * Hyoscyamine (Anaspaz, Levsin, Levbid) * Dicyclomine (Bentyl)
Anticholinergic/Antisposmodics **MOA**: blocks Ach at parasymp sites in smooth muscle, secretory glands, and CNS **Use**: IBS-D (Diarrhea)
49
Which anti-diarrheal may aggrivate diarrhea associated with E. coli, C. diff, Salmonella, and Shigella?
Loperamide (Imodium) - Antimotility or Opiate Derivative
50
IBS-C Agents
* Bulk Forming Laxatives * Osmotic Laxatives * Stimulants * Surfactants * Emollients/Lubricants * Chloride Channel Activators
51
# What type of agents are these? MOA? When to take? Psyllium (Metamucil, others) Methylcellulose (Citrucel) Calcium Polycarbophil (Fibercon)
Bulk-forming laxatives **MOA:** creates gel-like matrix in stool, soaks up fluid in loose stool and adding bulk Take with a lot of water (2hrs before or after other meds)
52
Which IBS-C agent is #1 in pregnancy?
**_Bulk-Forming Laxatives_** Psyllium (Metamucil, others) Methylcellulose (Citrucel) Calcium Polycarbophil (Fibercon)
53
What drugs are Osmotic Laxatives?
- **Magnesium Hydoxide/Citrate/Sulfate** - **Polyethylene Gycol (Miralax)** - **Lactulose (Enulose)** - Na+ Phosphates (Fleets) - **Glycerin (Pedialax)**
54
Which IBS-C med makes your pee pink/red?
Senna (Senokot) - Stimulant
55
What IBS-C drug should be used when stool is HARD and DRY?
Docusate (Colace) - Surfactant
56
Aspirating which IBS-C med can lead to **Lipid Pneumonitis?**
Mineral Oil (Emollients/Lubricants) **MOA:** coats the bowel and stool mass with water repelling film, keeping moisture in the stool and make it easier to shit (slip N slide)
57
Which IBS-C agents should be avoided in those with Mechanical Bowel Obstruction (MBO) or are taking Methadone?
Lubiprostone (Amitiza) - Chloride Channel Activator ## Footnote Methadone decreases Lubiprostone's effects
58
pts with IBS-C, chronic idiopathic constipation, or opiod-induced constipation with chronic non-cancer pain should take _______
Lubiprostone (Amitiza) - Chloride Channel Activator
59
If you are constipated and straining should be avoided, you can take ________ or _______
Surfactants -> Docusate (Colace) Emollients/Lubricants (Mineral Oil)
60
Chronic opiod use requires regular use of _______ laxatives
Stimulant - Senna (Senokot) - Bisacodyl (Dulcolax)
61
When should Stimulant laxatives be given?
30 min AFTER meal
62
Stimulant Laxatives for non-opiod induced IBS-C should be used <____ days to avoid dependence
7

Pharmacology (14 decks)

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