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Pharmacology - Exam 3 > GI > Flashcards

GI Flashcards

1
Q

What are the three gastric gland cell types?

A
  • Parietal
  • Chief
  • Mucoid
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2
Q

What cells are the primary site of action for many acid-controller drugs?

A

Parietal cells

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3
Q

What do parietal cells secrete?

A

HCl

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4
Q

What do chief cells secrete?

A

Pepsinogen

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5
Q

What does pepsin break down?

A

Proteins

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6
Q

What does mucous protect against?

A

Self-digestion by HCl

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7
Q

What is the pH of the stomach?

A

1-4

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8
Q

What are three stimuli for HCl secretion?

A
  • Excessive amounts of alcohol
  • Large, fatty meals
  • Emotional stress
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9
Q

Acid-related GI disorders are due to an imbalance of what?

A

The three gastric gland secretions

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10
Q

What is the most common kind of acid-related GI disorder?

A

Hyperacidity

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11
Q

What are three lay terms for hyperacidity?

A
  • Sour stomach
  • Acid stomach
  • Heart burn
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12
Q

What is peptic ulcer disease (PUD)?

A
  • Lesion in stomach (gastric)
  • Lesion in small intestine (duodenal)
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13
Q

What are six predisposing factors of PUD?

A
  1. Heavy ETOH use
  2. Smoking
  3. Heavy caffeine use
  4. Chronic use of ASA (aspirin) and other NSAIDs
  5. Chronic use of systemic corticosteroids (injection or pill… NOT inhaler)
  6. Excessive psychological stress
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14
Q

What are two primary etiologies for PUD?

A
  • Chronic NSAID use
  • Heliobacter pylori infection
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15
Q

What is a rare condition of hypersecretion of HCl due to gastrinoma?

A

Zollinger-Ellison Syndrome

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16
Q

In Zollinger-Ellison Syndrome, what does the tumor secrete and what does this cause?

A

Tumor secretes gastrin

Hypersecretion of HCl

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17
Q

In what age group do duodenal ulcers frequently occur?

A

30-50

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18
Q

How does a duodenual ulcer manifest?

A

Hematemesis or melena

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19
Q

In a duodenal ulcer, what can the pain be relieved by?

A

Eating

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20
Q

Gastric ulcers are more common in what age group?

A

Over 60

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21
Q

What do gastric ulcers present with?

A
  • Anorexia
  • Weight loss
  • Vomiting
  • Epigastric pain that may/may not be relieved by eating
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22
Q

What are two forms of inflammatory bowel disease (IBD)?

A
  • Crohn’s Disease
  • Ulcerative Colitis
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23
Q

Where can inflammation occur in Crohn’s Disease?

A

Anywhere along the alimentary canal

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24
Q

What is the most common site of inflammation in Crohn’s Disease?

A

Terminal Ileum

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25
Q

What are the characteristics of the lesions in Crohn’s Disease?

A

They are “skip lesions”

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26
Q

True or False:

Extraintestinal mainfestations are very common in Crohn’s Disease.

A

False

(Extraintestinal manifestations less common)

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27
Q

Where does inflammation and ulceration take place in Ulcerative Colitis (UC)?

A

Large intestine

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28
Q

True or False:

Extraintestinal manifestations are very common in Ulcerative Colitis (UC)

A

True

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29
Q

In UC, where does pyoderma gangrenosum usually occur?

A

Cutaneous ulcerations usually in legs

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30
Q

What is erythema nodosum?

A

Inflammation, scarring, and destruction of bile ducts

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31
Q

What are ten extraintestinal manifestations that occur in IBD (mostly UC)?

A
  1. Sacroiliitis
  2. Osteoporosis
  3. Peripheral arthritis
  4. Uveitis
  5. Scleritis
  6. Episcleritis
  7. Nephrolitiasis
  8. Thromboembolic events
  9. Pyoderma gangrenosum
  10. Primary sclerosing cholangitis
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32
Q

What is gastroesophageal reflux disease (GERD)?

A

HCl from stomach splashes up into esophagus

↓ ↓

Results in severe heartburn and other chest symptoms

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33
Q

What is GERD caused by?

A

Ineffective lower esophageal sphincter

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34
Q

What are some complications that arise from GERD?

A
  • Esophageal ulcers
  • Barrett’s esophagitis
  • Esophageal strictures
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35
Q

What happens to the squamous epithelium in the distal esophagus when a person has Barrett’s esophagitis?

A

Converts to columnar epithelium

(Not normally found here → Pre-malignant)

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36
Q

How do esophageal strictures cause disphagia?

A

Esophageal lining damaged from HCl

↓ ↓

Develops scar tissue

↓ ↓

Esophageal lining becomes still and scar tissue builds up

↓ ↓

Esophageal narrowing around scar tissue

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37
Q

What are three goals for pharmacotherapy of PUD and GERD?

A
  1. Provide relief from symptoms
  2. Promote healing of ulcer
  3. Prevent future recurrence of disease
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38
Q

What is the MOA for antacids?

A

Promote gastric mucosal secretion

Mucus is rich in bicarbonate so it buffers HCl.

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39
Q

True or False:

Antacids prevent the over-production of acid.

A

False

(Antacids DO NOT prevent the overproduction of acid)

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40
Q

True or False:

Antacids neutralize the acid once it’s present in the stomach.

A

True

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41
Q

Chronic use of antacids may lead to what?

A

Rebound hyperacidity

(especially calcium formations)

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42
Q

Raising gastric pH from 1.3 to 1.6 (0.3) neutralizes what percentage of the gastric acid?

What percentage would be neutralized by raising it from 1.3 to 2.3 (1.0)?

A

50%

90%

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43
Q

What are five OTC formulations of antacids?

A
  1. Capsules and tablets
  2. Powders
  3. Chewable tablets
  4. Suspensions
  5. Effervescent granules and tablets
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44
Q

What are four types of antacids?

A
  1. Aluminum salts
  2. Magnesium salts
  3. Calcium salts
  4. Sodium bicarbonate
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45
Q

Why are aluminum salts are often used with magnesium?

A

Counteract constipation

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46
Q

What is an example of an aluminum?

A

Aluminum carbonate (Basaljel)

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47
Q

Aluminum causes _________ while magnesium is a __________.

A

Constipation; laxative

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48
Q

Why do you need to use caution when giving magnesium to a patient with renal failure?

A

Failing kidney cannot excrete extra Mg

↓ ↓

Magnesium accumulation

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49
Q

What is an example of magnesium?

A

Magnesium hydroxide (MOM)

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50
Q

What is an example of a combo of magnesium and aluminum?

A

Maalox and Mylanta

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51
Q

What is the most common form of calcium?

A

Carbonate

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52
Q

What might calcium cause?

A

Constipation

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53
Q

Calcium might contribute to the development of what?

A

Kidney stones

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54
Q

What are two examples of calcium salts?

A
  • Tums
  • Rolaids
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55
Q

Sodium bicarb is more commonly known as what?

A

Baking soda

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56
Q

What are three sodium content cautions?

A
  • CHF
  • Htn
  • Renal insufficiency
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57
Q

What is a special precaution of sodium bicarb and why?

A

Alkaseltzer

Because it has sodium bicarb, citric acid, and aspirin

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58
Q

Antiflatulents relieve painful symptoms associated with what?

A

Gas

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59
Q

Antiflatulents are often added to what combination products?

A

Antacid

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60
Q

What is the OTC antiflatulent?

A

Simethicone

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61
Q

What is the MOA of simethicone?

A

Alters elasticity of mucus-coated bubbles

↓ ↓

Bubbles break

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62
Q

What are five examples of simethicone?

A
  1. Phazyme
  2. Flatulex
  3. Mylicon
  4. Gas-X
  5. Mylanta Gas
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63
Q

Aluminum and calcium cause _________; magnesium causes ________; calcium carbonate causes _______ and __________.

A

Aluminum and calcium cause CONSTIPATION; magnesium causes DIARRHEA; calcium carbonate causes GAS and BELCHING.

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64
Q

To prevent gas and belching, calcium carbonate is often combined with what?

A

Simethicone

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65
Q

What is chelation?

A

Chemical binding with other drugs

↓ ↓

Drugs become inactive

↓ ↓

Insoluble complexes

↓ ↓

Reduced absorption of bioactive drug

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66
Q

What are three drug interactions of antacid?

A
  1. Chelation
  2. Inceased gastric pH
  3. Increased urine pH
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67
Q

Why does gastric pH rise from taking antacids?

A
  • Increased absorption of basic drugs
  • Decrease absorption of acidic drugs
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68
Q

What are five drug interactions of calcium compounds?

A
  1. Quinolones
  2. Tetracycline
  3. Corticosteroids
  4. Calcium channel blockers (CCBs)
  5. Phosphate supplements
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69
Q

Histamine stimulates ________ cells in the stomach to produce ______.

A

Parietal; HCl

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70
Q

What do H2 antagonists block? What does this cause?

A

Histamine at the parietal cell H2 receptors

Decreased production of HCl from stomach

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71
Q

True or False:

H2 antagonists are all available OTC.

A

True

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72
Q

True or False:

H2 anagonists are more popular than PPIs.

A

False

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73
Q

What are four H2 antagonists?

A
  1. Cimetidine (Tagamet)
  2. Famotidine (Pepcid)
  3. Nizatidine (Axid)
  4. Ranitidine (Zantac)
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74
Q

What is the MOA of H2 anatgonists?

A

Histamine stimulates parietal cells to produce HCl

↓ ↓

H2 antagonists block histamine (H2) at the parietal H2 receptors

↓ ↓

Decreased production of HCl from parietal cells in stomach

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75
Q

What are six indications for H2 antagonists?

A
  1. Heal active ulcers
  2. Maintenance therapy ulcers
  3. Reduction of GERD symptoms
  4. Heal erosive esophagitis
  5. Zollinger-Ellison Syndrome
  6. Prevent GI bleed in critical care patients (stress ulcers)
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76
Q

True or False:

H2 antagonists are also used in management of severe or refractory allergic conditions.

A

True

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77
Q

What are H2 antagonists used in conjunction with to manage severe or refractory allergic conditions?

A
  • H1 blockers
  • Antihistamines
  • Corticosteroids
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78
Q

True or False:

H2 antagonists have a large number of side effects.

A

False

(Low side effect profile overall - less than 3%)

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79
Q

Cimetadine (Tagamet) might induce what two conditions?

A
  • Impotence
  • Gynecomastia
80
Q

What happens when Cimetidine (Tagamet) interacts with the P-450 microsomal oxidase system in the liver?

A

Inhibits oxidation (metabolism) of many drugs

↓ ↓

Higher risk of increased bioactive drug levels

81
Q

What decreases effectiveness of H2 blockers?

82
Q

Why must you use caution with H2 antagonists in elderly patients?

A

Greater risk of CNS side effects (especially Tagamet)

83
Q

What is the “proton pump”?

A

When parietal cells release H+ ions (protons) during HCl production

84
Q

True or False:

H2 antagonists and antihistamines inhibot the action of the proton pump.

A

False

(They do not inhibit the proton pump)

85
Q

What is the MOA for proton pump inhibitors (PPIs)?

A

Irreversibly block H+/K+ ATPase system (proton pump) in parietal cells

↓ ↓

Prevetn the release of H+ ions from parietal cells

↓ ↓

Blocks ALL gastric acid secretion

86
Q

What is achlorhydria?

A

Total inhibition of gastric acid secretion

87
Q

What are the seven currently available PPIs?

A

They all end in “-prazole”

  1. Lansoprazole (Prevacid)
  2. Omeprazole (Prilosec)
  3. Omeprazole + sodium bicarb (Zegerid)
  4. Rabeprazole (Aciphex)
  5. Pantoprazole (Protonix)
  6. Esomeprazole (Nexium)
  7. Dexlansoprazole (Dexilant)
88
Q

What are five indications for PPIs?

A
  1. GERD maintenance therapy
  2. Erosive esophagitis
  3. Short-term treatment of active duodenal and benign gastric ulcers
  4. Zollinger-Ellison syndrome
  5. Treatment of H. pylori-induced ulcers
89
Q

Are H2 antagonists or PPIs better to use for GERD?

A

PPIs

(H2 are not as popular as PPIs now.)

90
Q

PPIs have pretty benign side effects. What are they?

A
  1. Headache
  2. Diarrhea
  3. Abdominal pain
  4. Nausea
  5. Constipation
  6. Bloating
91
Q

PPI’s might increase serum levels of _________ and _________. We must take precautions before prescribing.

A

Diazepam; Phenytoin

92
Q

A patient is taking Coumadin. Is it OK to prescribe a PPI? If not, why?

A

No.

May cause increased risk of bleeding.

93
Q

What is Dr. Dill’s favorite PPI?

94
Q

What percentage of duodenal ulcers are related to H. pylori?

What about gastric ulcers?

95
Q

True or False:

If H. pylori is not treated, the infection could remain active for life.

96
Q

Iradication of H. pylori organism leads to two things. What are they?

A
  • Ulcers heal more rapidly
  • Results in longer remission
97
Q

What are four antibiotics commonly prescribed as part of H. pylori therapy? How many are usually prescribed?

A
  1. Amoxicillin (Amoxil)
  2. Clarithromycin (Biaxin)
  3. Metroniadazole (Flagyl)
  4. Tetracycline

Two or more

98
Q

What are two reasons why we prescribe antibiotics for H. pylori therapy?

A
  1. Increase effectiveness of therapy
  2. Lower bacterial resistance potential
99
Q

What are bismuth compounds added to H. pylori therapy?

A

Inhibit bacterial growth

100
Q

What drug would you prescribe for an H. pylori ulcer?

A

Prevpac + Bismuth compound

101
Q

What is contained in one dose of Prevpac?

A
  • Lansoprazole (Prevacid), 30 mg
  • Amoxicillin, 1 gram
  • Clarithromycin (Biaxin), 500 mg
102
Q

What is the adult Sig of Prevpac?

A

One dose bid x 14 d

103
Q

How long should antibiotic therapy for H. pylori ulcers last?

104
Q

How does Sucralfate (Carafate) work?

A

Attracted to and binds to base of ulcers

↓ ↓

Forms protective barrier

105
Q

What does Sucralfate (Carafate) protect the damaged areas of ulcers from?

A

Harmful effects of pepsin

106
Q

True or False:

Sucralfate (Carafate) allows excessive absorption from the gut.

A

False

(Minimal absorption from the gut)

107
Q

Since Sucralfate (Carafate) allows only minimal absorption from the gut, what could this impair?

A

Absorption of other drugs (especially tetracycline)

108
Q

What does Sucralfate (Carafate) bind to?

109
Q

Sucrlafate is also used in CFR (chronic renal failure) to _______ phosphate levels.

110
Q

What are the three indications for Sucralfate (Carafate)?

A
  1. Stress ulcers (damage to GI mucosa associated with critical illness)
  2. Erosive esophagitis
  3. Adjunct PUD
111
Q

What are three side effects of Sucralfate (Carafate)?

A
  1. nausea
  2. dry mouth
  3. constipation
112
Q

What is a prostaglandin?

A

Group of lipid compounds derived from fatty acids

113
Q

What does Misoprostol (Cytotec) act like? What is this called?

A

A prostaglandin

Cytoprotective

114
Q

True or False:

Prostaglandins have a very short half-life.

115
Q

Prostaglandins have what two types of effects?

A
  • Paracrine (local)
  • Autocrine (same cell)
116
Q

What are seven functions of prostaglandins?

A
  1. Vasoconstriction / dilation of smooth muscle
  2. Aggregration or disaggregation of platelets
  3. Sensitize spinal nuerons to pain
  4. Regulate inflammatory mediation
  5. Regulate calcium movement
  6. Control hormone regulation
  7. Control cell growth
117
Q

Misoprostol (Cytotec) is a synthetic __________ analogue.

A

Prostaglandin

118
Q

Misoprostol (Cytotec) protects gastric mucosa from injury by enhancing what?

A

Local production of mucus

119
Q

What does Misoprostol (Cytotec) promote in local cells?

A

Regeneration

120
Q

What happens when there is enhanced mucosal blood flow? What drug causes this?

A

Enhanced mucosal integrity

Misoprostol (Cytotec)

121
Q

What are said to inhibit prostaglandins?

A

NSAIDs

(Get it? What are “said”… just a little joke to lighten the tension!!)

122
Q

Misoprostol (Cytotec) inhibits activation of what?

A

Proton pump

123
Q

What is / are the indiciation(s) for Misoprostol (Cytotec)?

A
  1. Prevention of NSAID-induced gastric ulcer
  2. Used in conjunction with RU486 for early pregnancy termination
  3. Cervical ripening at / near term pregnancy
  4. Severe refractory (nothing works) constipation
124
Q

Does Misoprostol (Cytotec) have a therapeutic effect in duodenal ulcers?

A

Only with high doses

↓ ↓

This will likely cause abdominal cramps, diarrhea

125
Q

What is the BLACK BOX WARNING for Misoprostol (Cytotec)?

A

Abortification

126
Q

What are the indications for Metoclompromide (Reglan)?

A
  • GERD (nobody uses it for this anymore…)
  • Diabetic gastroparesis (hypomotility)
  • Prevention of N/V in chemotherapy
  • Prevention of N/V in post-op patients
127
Q

What are the two anticholinergics for PUD?

A
  • Glycopyrrolate (Robinul)
  • Propantheline
128
Q

Are anticholinergics for PUD primary or adjunct treatment?

A

Adjunct treatment

129
Q

What is the MOA of anticholinergics for PUD?

A

Cholinergic blockers (anticholinergics) at muscarinic receptors

↓ ↓

Inhibit autonomic receptors for gastric acid secretion (via vagus nerve)

130
Q

Diarrhea could be what of three things?

A
  • Abnormal frequent passage of loose stool
  • Abnormal passage of stools with increased
    • frequency
    • fluidity
    • weight
  • Abnormal passage of stools with increased stool / water excretion
131
Q

What is acute diarrhea?

A

Sudden onset in a previously healthy person

132
Q

How long does acute diarrhea last for?

A

3 days to 2 weeks

133
Q

True or False:

Acute diarrhea is self-limiting.

134
Q

True or False:

Acute diarrhea sometimes causes sequelae.

135
Q

How long does chronic diarrhea last for?

A

Over 3 to 4 weeks

136
Q

What is chronic diarrhea?

A

Recurring passage of diarrheal stool

137
Q

Chronic diarrhea may include what four symptoms?

A
  • Fever
  • Anorexia
  • Nausea and vomiting
  • Weight loss
138
Q

What are six causes of acute diarrhea?

A
  1. Bacterial
  2. Viral
  3. Protozoal
  4. Drug-induced
  5. Hyperthryoidism
  6. Nutritional
139
Q

What are four causes of chronic diarrhea?

A
  1. Tumors
  2. Diabetes
  3. Addison’s
  4. IBS
140
Q

What are four antidiarrheals?

A
  1. Adsorbents
  2. Anticholinergics
  3. Intestinal Flora Modifiers
  4. Opiates
141
Q

What is the MOA for adsorbents?

A

Prevents absorption

Coats walls of GI tract

↓ ↓

Binds to bacteria or toxin

↓ ↓

Eliminated through the stool

142
Q

What are two examples of adsorbnents?

A

Bismuth subsalicylate OTC

Cholestyramine Rx

143
Q

What kind of diarrhea is cholestyramine used for?

A

C. diff diarrhea

144
Q

What is the MOA for anticholinergics?

A

Decrease intestinal muscle tone and peristalsis of GI tract

↓ ↓

Slows movement of fecal matter through the GI tract

145
Q

What are two examples of anticholinergics?

A
  • Donnatal
    • phenobarbital
    • hyoscyamine
    • atropine
    • scopolamine
  • Motofen (Sched IV)
    • difenoxin
    • atropine
146
Q

What are intestinal flora modifiers?

A

Bacterial cultures of Lactobacillus organisms

147
Q

What are two things that intestinal flora modifiers do?

A
  • Supply missing bacteria to the GI tract
  • Suppress growth of diarrhea-causing bacteria
148
Q

What are two examples of intestinal flora modifiers?

A
  • Lactobacillus acidophilus (Probiotic)
  • Yogurt w/ live active cultures
149
Q

What is the B.R.A.T.Y diet?

A
  • Bananas
  • Rice
  • Applesauce
  • Toast / crackers
  • Yogurt w/ live active cultures
150
Q

What is the MOA for opiates?

A
  • Decrease bowel motility and relieve rectal spasms
  • Increases transit time (slows) through the bowel
151
Q

Opiates increase transit time through the bowel. What does this allow?

A

More time for water and electrolytes to be absorbed

152
Q

What are examples of opiates?

A
  • Diphenoxalate / Atropine (Lomotil) Sched V
  • Loperamide (Imodium) Rx/OTC
153
Q

Adsorbents may ________ absorption of many agents.

(Increase or decrease?)

154
Q

Antacids may ________ anticholinergic / antidiarrheal effect.

(Increase or decrease?)

155
Q

What are the two trade names of Bismuth Subsalicylate (OTC)?

A
  • Pepto Bismol
  • Kaopectate
156
Q

What is Bismuth Subsalicylate contraindicated in?

What is there a risk of if you give this drug?

A

Children under age of 16 or teenages with chicken pox

Reye’s syndrome associated with ASA

157
Q

What is constipation?

A

Abnormally infrequent and / or difficult passage of tool

↓ ↓

Disorder of movement through the colon and / or rectum

158
Q

What are two metabolic / endocrine disorders that cause constipation?

A
  • Diabetes
  • Hypothyroidism
159
Q

What are five neurogenic disorders of constipation?

A
  • Autonomic neuropathy
  • Multiple sclerosis
  • Spinal cord lesions
  • Parkinson’s disease
  • CVA
160
Q

What are nine drug causes of constipation?

A
  1. Anticholinergics
  2. Iron supplements
  3. Opiates
  4. Aluminum antacids
  5. Calcium antacids
  6. Antispasmodics
  7. Antidepressants
  8. Diuretics
  9. Anticonvulsants
161
Q

What are six lifestyle causes of constipation?

A
  1. Poor bowel habits
  2. Inadequate fluid intake
  3. Low-residue (roughage) diet
  4. Stress and / or anxiety
  5. Excessive consumption of dairy products
  6. Physical inactivity
162
Q

What are five kinds laxatives?

A
  1. Bulk-forming
  2. Emollient
  3. Hyperosmotic
  4. Saline
  5. Stimulant
163
Q

What is the MOA of bulk-forming laxatives?

A

High fiber

Absorbs water to increase bulk

↓ ↓

Distends bowel to initiate reflex bowel activity

164
Q

What are three examples of bulk-forming laxatives?

A
  • Psyllium (Metamucil) OTC
  • Methylcellulose (Citrucel) OTC
  • Calcium Polycarbophil (FiberCon) OTC
165
Q

What is the MOA for emollients?

A

Stool softener

Not absorbed through GI tract (stay in lumen)

↓ ↓

Adds water / fat to stool

↓ ↓

Lubricate the fecal material and intestinal walls

166
Q

What is an example of a stool softener?

A

Docusate salts (Colace) OTC

167
Q

What is an example of a lubricant?

A

Mineral oil OTC

168
Q

What is the MOA of hyperosmotics?

A

Increase osmolality in lumen of GI tract

↓ ↓

Water attracted due to increase osmotic pressure

↓ ↓

Bowel distension

↓ ↓

Increased peristalsis

↓ ↓

Evacuation

169
Q

What are four hyperosmotic examples?

A
  1. Polyethylene glycol (MiraLax) Rx
  2. Sorbitol
  3. Gylcerin
  4. Lactulose (Kristalose) Rx
170
Q

What is the MOA for saline laxatives?

A

Soluble inorganic salts with charged particles (anions / cations)

↓ ↓

Charged particles attract fluid

↓ ↓

Colon distension

↓ ↓

Activates stretch receptors

↓ ↓

Increased colon peristalsis

171
Q

What are three examples of saline laxatives?

A
  1. Magnesium sulfate (Epsom salts) OTC
  2. Magnesium hydroxide (MOM) OTC
  3. Magnesium citrate Rx
172
Q

What’s another name for saline laxatives?

173
Q

What is the MOA for stimulant laxatives?

A

Increases peristalsis via intestinal nerve stimulation

174
Q

What are five examples of stimulant laxatives?

A
  • Castor oil
  • Senna (Senokot)
  • Cascara (Herbal)
  • Bisacodyl (Dulcolax)
  • Docusate sodium + Senna (Peri-Colace)
175
Q

What are three indications for bulk forming laxatives?

A
  1. Acute and chronic constipation
  2. Irritable bowel syndrome (IBS)
  3. Diverticulosis
176
Q

What are two indications for emollient laxatives?

A
  1. Acute and chronic constipation
  2. Fecal impaction
177
Q

What are two indications for hyperosmotic laxatives?

A
  1. Chronic constipation
  2. Diagnostic / surgical preps
178
Q

What are three indications for saline laxatives?

A
  1. Occasional constipation
  2. Diagnostic / surgical preps
  3. Removal of helminths and parasites
179
Q

What are two indications for stimulant laxatives?

A
  1. Acute constipation
  2. Diagnostic / surgical preps
180
Q

What is a side effect / precaution for bulk-forming laxatives?

A

Fluid overload impaction

181
Q

What are two side effects / precautions for emollient laxatives?

A
  • Skin rashes
  • Increase absorption of fat-soluble vitamins
182
Q

What are two side effects / precautions for hyperosmotic laxatives?

A
  • Abdominal bloating
  • Rectal irritation
183
Q

What are four side effects / precautions for saline laxatives?

A
  1. Magnesium toxicity (with renal insufficiency)
  2. Cramping
  3. Diarrhea
  4. Increased thirsty
184
Q

What are four side effects / precautions for stimulant laxatives?

A
  1. Nutrient malabsorption
  2. Skin rashes
  3. Gastric irritation
  4. Rectal irritation
185
Q

What can all laxatives cause an imbalance in?

A

Electrolytes

186
Q

What is the MOA for Lubiprostone (Amitiza)?

A

Chloride channel activator

↓ ↓

GI motility enhancer

187
Q

What are two indications for Lubiprostone (Amitiza)?

A
  1. Chronic idiotpathic constipation
  2. Constipation-predominant IBS
188
Q

What are two contraindications for Lubiprostone (Amitiza)?

A
  • Not recommended for children
  • Contraindicated in pregnancy
189
Q

What is irritable bowel syndrome (IBS)?

A

Abdominal pain with altered bowel habits in the absence of an organic explanation

190
Q

What are the three categories of IBS?

A
  1. IBS-D: Diarrhea predominant
  2. IBS-C: Constipation predominant
  3. IBS-M: Mixed type
191
Q

Why is work-up critical for IBS patients?

A

Rule out other etiologies

  • Not life-threatening
  • No single therapy proven effective
  • No single established etiology
  • No specific diagnostic marker
192
Q

What are three antispasmodics used to treat IBS?

Which two of these three are first line?

A
  • Dicyclomine HCl (Bentyl)
  • Hyoscyamine sulfate (Levsin)
  • Donnatal (Combo drug)

(1st line in bold. Use Donnatal very cautiously)

193
Q

What is currently the only laxative approved for IBS in the US?

A

Lubiprostone (Amitiza)

194
Q

What are four drugs in Donnatal?

A
  1. Phenobarbital
  2. Hyoscyamine
  3. Atropine
  4. Scopolamine
195
Q

What two drugs are in Librax?

A
  1. Chlordiazepoxide HCl (Benzo)
  2. Clidinium (Anticholinergic)
196
Q

What are five select antiemetics?

A
  1. Prochlorperazine (Compazine)
  2. Promethazine (Phenergan)
  3. Metoclopramide (Reglan)
  4. Trimethobenzamide (Tigan)
  5. Ondansetron (Zofran)
197
Q

What are three indications for Zofran (Ondansetron)?

What is / are the route(s)?

A
  1. Cancer chemotherapy-related N & V
  2. Cancer radiation therapy-related N & V
  3. Post-op N & V prevention

IV, PO, IM

Pharmacology - Exam 3 (4 decks)

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