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Pharm > GI * > Flashcards

GI * Flashcards

1
Q

H pylori tx *

A

First line quadruple therapy - bismuth subsalicylate, metronidazole, tetracycline and PPI
Triple therapy- PPI with amoxicillin (metronidazole for PCN allergy) and clarithromycin
Usually antibiotic +H2/PPI + protective agent

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2
Q

H2 receptor antagonist*

A

Drugs-cimetidine (tagemet), famotidine (Pepcid), nizatidine (axid)
MOA- Histamine H2 receptor antagonist acts selectively on h2 receptors in the stomach without effects on h1 receptors they are competitive antagonist of histamine are fully reversible
Uses-PUD, heart burn, decreased since use of PPI
-PUD- all drugs equally effective for this disease, if NSAIDs induced should use PPI,
-stress ulcers-IV infusion associated in critical care settings
-GERD-decrease acid secretion may not relieve heart burn synths for up to 45 minutes
ADE-cimedtidine can have endocrine effects like gynecomastia and galactorrhea acts as a non steroidal antiandrogen, confusion, AMS in elderly in IV infusion
D-D interactions- may reduce efficacy of drugs that require an acidic environment for absorption, cimetidine inhibits several cytochrome P450 and interferes with warfarin, clopidogrel, phenytoin

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3
Q

Inhibitors of H/K ATPase proton pump *

A

Drugs- dexlansoprazole (Dexilant) esomeprazole (nexium) landoprazole( prevacid) omeprazole (prilosec) pantoprazole (protonix), rabeprazole (aciphex)
MOA- prodrug with an acid resistant enteric coating to protect them from premature degradation by gastric acid, inhibit both basal and stimulated gastric acid secretion by more than 90%
Uses- GERD, erosive esophagitiis, active duodenal ulcer, Zollinger-Ellison syndrome, reduce risk of bleeding ulcers by NSAIDs, stress ulcer prophylaxis, h pylori
Kinetics- take 30-60 minutes before breakfast or largest meal, dexlansoprazole is ER esomeprazole and pantoprazole are in IV form
ADE-increase risk of fractures, for greater than 1 year use, prolonged acid suppression, low vitamin b12, diarrhea, c.diff
D-D- clopidogrel-

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4
Q

Prostaglandins *

A

Drug- misoprostol (cytotec)
Produced by gastric mucosa
Inhibits secretin of acid and bicarbonate
Decrease in prostaglandins is thought to be a cause of PUD
Misoprostol is approved for Prevention of NSAIDs induced gastric ulcers, for those who have NSAIDs and are moderate to high risk for ulcers
Contradicted in pregnancy
Can cause diarrhea

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5
Q

Antacids*

A

Drugs- aluminum hydroxide, calcium carbonate (tums), magnesium hydroxide (milk of magnesia)
Weak bases that react with gastric acid and diminish gastric acidity, making water and salt
Efficacy depends on capacity to neutralize gastric HCL and if stomach is empty or full
Food delays stomach emptying allowing more time for antacid to react and prolong duration of action
Systemic absorption can cause metabolic alkalosis
Uses-PUD, GERD, heartburn
Administer after meals for optimal effectiveness
ADE-aluminum can cause constipation, magnesium can cause diarrhea, can cause issues in renal impaired patients, sodium based antacids can cause issues in HTN or CHF pts

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6
Q

Bismuth*

A

-bismuth subsalicylate (peptide bismol) uses- component of quadruple therapy for h pylori related ulcers, antimicrobial actions,
MOA- inhibits pepsin, increases secretion of mucus and interacts with glycoproteins in necrotic mucosal tissue to coat and protect ulcer
Contraindicated in pregnancy, coagulation disorder, GIB, renal impairment
ADE- Reye’s syndrome

bismuth subsalicylate (pepto bismol) can also be used for Prevention and treatment of travelers diarrhea
MOA- decreases fluid secretion in bowel
ADE- black tongue and black stools (salicylate content)

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7
Q

Phenothiazines *

A

Drugs-prochlorperazine
MOA-acts by blocking dopamine receptors in chemoreceptor trigger zone
Uses-effective for chemo induced NV or breakthrough NV
ADE-dose limited

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8
Q

5 HT3 receptor antagonist *

A

Drugs- dolasetron (anzemet), granisetron (sancuso, sustol), ondansetron (zofran), palanosetron (aloxi)
MOA- block 5 HT3 decors in peripheral and in central
Uses-CINV, superior efficacy and longer duration of action, palanosetron has longest half life so repeated dose not recommended, post operative NV
Dose adjustments in liver patients needed
ADE-prolong QT with high doses

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9
Q

Substance P/neurokinin 1 receptor antagonist *

A

Drugs- aprepitant, fosaprepiant (emend), netupitant, fosnetupitant (akynzeo), rolapitant (varubi)
MOA- targets neuokinin receptor in the vomiting center and blocks the action of substance P
Uses- highly or moderately emetogenic chemotherapy, usually administer with dexamethasone, and 5HT3 antagonist
Drug-drug- st johns wort, CYP3A4 metabolism and liver metabolism
ADE-fatigue, diarrhea, abd pain, hiccups

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10
Q

Corticosteroids *

A

Drugs-dexamethasone (decadron)
Used with mildly to moderately emetogenic chemo
Used in combo with 5 HT3 receptor anatomist or P/neuokinin 1 receptor for prevention of moderate to high CINV
MOA- ? Block prostaglandins

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11
Q

Second generation antipsychotics *

A

Drugs-olanzapine (zyprexa)
MOA-blocks 5 HT2 receptor, dopamine, histamine 1 and alpha 1 receptors
Used in prevention of CINV in combo with 5HT3 receptor antagonist (or PN1 receptor antagonist), and corticosteroids, for moderate to highly emetogenic chemo

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12
Q

Substituted benzamides *

A

Drugs- metoclopramide (reglan)
MOA- inhibits dopamine
Uses- high dose emetogenic like cisplatin, less effective compared to other agents, should be reserved for those with inadequate response to 5HT3 receptors antagonist or P/neurokinin receptor antagonist, for breakthrough NV, gastroparesis
ADE- extra pyramidal symptoms, limit long term high dose use
BLACK BOX WARNING FOR USE FOR MORE THAN 12 WEEKS DUE TO TARDIVE DYSKINESIA

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13
Q

Butyrophenones *

A

Drugs- droperidol, haloperidol (haldol)
MOA-block dopamine receptors
Uses- moderate CINV, breakthrough CINV, reserve for patients with NV post op or inadequate other agents
ADE- prolong QT

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14
Q

Benzodiazepines *

A

Drugs- alprazolam (Xanax), lorazepam (ativan )
Uses- low potency, beneficial effect may be sedative, anxiolytic, amnesia
Alcohol increase effects and CNS depression

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15
Q

Anti motility agents *

A

Drugs- diphenoxylate with atropine (lomotil) and loperamide (imodium)
MOA- analogs of meperidine and opioid like action in gut, activate pre synaptic opioid receptors and decrease peristalsis, at normal doses lack analgesic effects
Uses- diarrhea, travelers diarrhea
High doses and overuse of loperamide have been observed in patients trying to obtain euphoria or prevent withdrawal of opioids
BLACK BOX WARNING REGARDING IMPORTANCE OF FOLLOWING RECOMMENDED DOSAGES TO AVOID SEVERE ADE
Contraindications-active UC, young children due to respiratory depression, cardiac events, coma death
Patients with severe or infectious diarrhea should avoid as self treatment

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16
Q

Adsorbents *

A

Drugs- aluminum hydroxide and methylcellulose (citrucel)
Uses- diarrhea
MOA- absorbing intestinal toxins or microorganisms and or by coating or protecting the intestinal mucosa
Less effect than motility agents and can interfere with other drug absorption.

17
Q

Agents that modify fluid and electrolyte transport *

A

Drug-bismuth subsalicylate (pepto bismol)
Uses- Prevention and treatment of travelers diarrhea
MOA- decreases fluid secretion in bowel
ADE- black tongue and black stools (salicylate content)

18
Q

Irritants and stimulants *

A

Drugs- Bisacodyl (correctol, dulcolax), castor oil, senna (ex-lax, senokot)
Senna- evacuation of bowels in 6-13 hrs, water and electrolyte evacuation, useful when combined with docusate containing product for opioid induced constipation
Bisacodyl- suppository or EC, potent stimulator of colon, acts on direct nerve fibers in colon
Castor oil- irritating to stomach and increase peristalsis, do not give in pregnancy, generally not recommended due to poor palate and GI adverse effects

19
Q

Bulk laxatives *

A

Drugs- methylcellulose (citrucel), psyllium (metamucil)
Form gels in the large intestine causing water retention, intestinal distention, increase peristalsis
Used in caution in immobile patients due to risk for obstruction
Can reduce other drug absorption, administer 2 hrs apart

20
Q

Saline and osmotic laxatives *

A

Drugs- lactulose (constulose, enulose), magnesium citrate (citroma), magnesium hydroxide (milk of magnesia), polyethylene glycol (golytely, miralax)
Salt, distends bowels, increases intestinal activity
PEG used for colonic Lavage for prep
Lactulose increases osmotic pressure and fluid, also used to reduce ammonia in liver patients

21
Q

Stool softeners *

A

Drugs- docusate sodium and calcium (colace)
Surface active agent that becomes emulsified with the stool and produces softer feces and easier passage of stool
Can take days to be effective often used as prophylaxis
Should not be used with mineral oil

22
Q

Lubricant laxatives *

A

Drugs- glycerin suppository, mineral oil
Lubricants and acts by facilitating passage of hard stools, mineral oil should be taken orally and in upright position to avoid aspiration

23
Q

Chloride channel activators *

A

Drugs- lubiprostone
MOA-activates chloride channels to increase fluid secretion in the intestinal lumen, eases passage of stool with little electrolyte balance
Uses- chronic constipation and IBS with constipation

24
Q

IBS-c agents

A

Constipation predominant
Drugs
- linaclotide (linzess)/plecanatide (trulance) -guanylate Cyclase C agonist, ADE-diarrhea, not for GI obstruction
-lubiprostone (amitiza)- chloride channel activator, ADE-NVD, not for GI obstruction
-tefaserod (zelnorm)- 5HT4 partial agonist, ADE-diarrhea, not for GU obstruction or Hx of MI, CVA, CP
-tenapanor (isbrela)-sodium hydrogen exchange 3 inhibitor, ADE-diarrhea, not for GI obstruction

25
Q

IBS D agents

A

Alosetron (lotronex)- 5 HT3 antagonist, ADE-constipation, NV, heartburn, ischemic colitis
Eluxadoline (viberzi)- opioid receptor agonist, ADE- constipation, and pain, nausea, pancreatitis, avoid in alcoholism and pancreatitis
Rifaximin (xifaxan)- decreases bacterial load, ADE- nausea fatigue, HA, dizziness, peripheral edema C. Diff infection

26
Q

Agents for IBS-C and IBS-D

A

Dicyclomine (bentyl)- antimuscarinic, decreases GI spasms and motility, ADE-anticholinergic effects, drowsiness, dry mouth
Hyoscyamine (anaspaz, levbid, levsin)- antimucarinic, decreased GI spasms and motility, ADE-anticholinergic effects, OD can produce hallucinations, arrhythmias, NV

27
Q

5 aminosalicylates

A

Drugs- ORAL balsalazide (colazal), mesalamine (asacol, pentasa), olsalazine (dipentum), sulfasalazine (azulfidine) RECTAL mesalamine enema (rowasa), mesalamine suppository (canasa)
MOA- sulfasalazine is prodrug, antinflammatory and immunosuppressive properties in IBD, exact MOA is unknown, maybe due to inhibition of cytokines, and prostaglandins, inhibition of leukotrienes, or scavenging of free radicals or inhibition of T cell proliferation,
Uses- UC
ADE- HA, nausea, fatigue, hemolytic anemia, myelosuppresion, hepatitis, pneumonitis, nephrotoxicity, fever, rash, SJS, can interfere with folate absorption in long term use

28
Q

Corticosteroids

A

Drugs - ORAL budesonide delayed release (entocort EC), budesonide ER (uceris), hydrocortisone (cortef), prednisone (deltasone), methylprednisolone (medrol), IV hydrocortisone (solu-cortef), methylprednisolone (solu-medrol), RECTAL- budesonide foam (uceris rectal), hydrocortisone suppository (anucort-HC), hydrocortisone edema (cortenema), hydrocortisone foam (cortifoam)
Long term use not recommended
Rectal drugs have fewer ADE
Decrease inflammation in bowels

29
Q

Biological inhbitors

A

TNF alpha inhibitors- adalimumab (humira), certolizumab (cimzia), golimumab (Simponi), infliximab (remicade)
-moderate to severe UC, second line agents when failed 5ASA, first line for those with severe disease or high risk for progression, can develop immunogenicity and anti drug antibodies
Alpha 4 integrin inhibitors- vedolizumab (entyvio)
-moderate to severe UC and CD, ADE- HA, arthralgia, nausea, fatigue, musculoskeletal pain
IL 12/23 inhibitor- ustekinumab (stelara)
-psoriasis, psoriatic arthritis, and CD, ADE- HA, arthralgia, infection, nausea, nasopharyngiits

30
Q

Janius Kinase inhibitors

A

Drugs- tofacitinib (xeljanz)
Uses- RA, psoriasis, UC
MOA- interferes with JAK STAT signaling pathway results in decreasing proliferation and differentiation of macrophages and T cells , for those intolerant to TNF alpha blockers,
Can increase risk for infection, like HZ virus

31
Q

Immunomodulators

A

Drugs- azathioprine (imuran), 6 mercaptopurine, methotrexate
Methotrexate- for CD, not recommended for maintenance, administer folic acid with
Others- for UC, and CD, for corticosteroids sparing patients, first line for maintenance of remission, limited due to concerns for toxicity, bone marrow suppression, hepatotoxic, monitor CBC, and liver fx

32
Q

Sucrafate *

A

MOA- creates a barrier that protects the ulcer from pepsin and acid and allows ulcer to heal
Uses- effective for duodenal ulcers, and prevention of stress ulcers,
D-D- not be be administer with PPI/h2 antagonist/antacid as acidic environment is needed, multiple other drug interactions
Give prior to meals

Pharm (16 decks)

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