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GI Flashcards

1
Q

What is the most commonly used class of antiemetics and their MOA?

A

metoclopromide is a dopamine antagonists that can cause tardive dyskinesia

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2
Q

5-HT3 receptor antagonists are also called what?

A

serotonin receptor antagonists or serotonin blockers, by inhibiting serotonin from binding to the 5-HT3 receptors aka ZOFRAN

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3
Q

What is the MOA of 5-HT3 antagonists?

A

works on the vagal nerve terminals in the GI system and centrally in the chemoreceptor trigger zone

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4
Q

What is tardive dyskinesia?

A

It is a constant, involuntary rhythmic movement that like the movement of perioral muscles that results in smacking or pursing of lips. can progress over months to years

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5
Q

The most common side effect of Mg is what?

A

diarrhea

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6
Q

The most common side effect of Al is what?

A

constipation

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7
Q

Which medication is an abortifacient and cervical ripening?

A

misoprostol

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8
Q

What are the most potent suppressors of gastric acid secretion?

A

Proton Pump Inhibitors (PPIs)

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9
Q

What are the clinical use of PPIs?

A

Red is normal. PPIs lower it the most. GERD, Peptic ulcer disease, H pylori-associated ulcers, NSAID-associated ulcers, prevention of rebleeding from peptic ulcers, non-ulcer dyspepsia, prevention or stress-related mucosal bleeding, gastrinoma and other hypersecretory conditions.

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10
Q

What is the treatment of H. pylori?

A

Combination of two antibiotics and a PPI.
Two 14-day treatment regimen.

Triple therapy x 10-14 days:
1. PPI
2. Clarithromycin
3. Amoxcilin (or metronidazole)

Quadruple Therapy x 10-14 days:
1. PPI
2. Bismuth subsalicylate
3. Metronidazole
4. Tetracycline
The PPI should be continued once daily for a total of 4-6 weeks to ensure complete ulcer healing. TOTAL after you stop the other meds.

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11
Q

In regards to the escalation of therapy for chronic diseases, what are the goals?

A

find a regimen that reduces the use of steroids while still being therapeutic

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12
Q

What areas of the colon does Crohn’s disease affect?

A

colon and distal ileum

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13
Q

What area of the colon does UC affect?

A

sigmoid colon

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14
Q

How is obesity diagnosed?

A
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15
Q

What are anti-hepatic agents?

A

acute hepatitis care is primarily supportive. Likelihood progression to chronic HBV infection is less than 5%. Antiviril agent for chronic HBV include: Pegays and nucleotide analogs.

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16
Q

How long does a patient have to have chronic viral hepatitis to be considered for diagnosis?

A

longer than 3-6 months

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17
Q

How do you diagnosis chronic viral hepatitis?

A

antibody tests and viral nucleic acid serum

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18
Q

What are the potential side effects of Lamivudine?

A

lactic acidosis

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19
Q

What are the potential side effects of Pegasys?

A

flu-like sx, fatigue, mood disturbances, cytopenias

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20
Q

What are the disadvantages of Interfern as an anti-hepatitis agent?

A

less than 50% of persons treated will respond

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21
Q

What treatment regimen is recommended for HCV infections?

A

Sofosbuvir and Ledipavir
Genotypes 1, 4, 5 and 6

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22
Q

What are the various combinations of hemorrhoidal suppositories and rectal ointments made from?

A

emollients, topical anesthetics, vasoconstrictors, astringents, and corticosteroids

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23
Q

What are some patient education tips about flatus?

A

avoid gun chewing and carbonated beverages (#1 way to reduce)
Avoid FODMAPS
Beano is supposed to reduce gas, but it is not very effective.
Simethicone has no proven benefits, but is known to reduce pain

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24
Q

Define FODMAPS

A

fermentable, oligosaccharides, disaccharides, monosaccharides, and polypols

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25
Q

What is the MOA of ondansetron?

A

5-HT3 antagonist
works on intestinal vagal and spinal afferent nerves

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26
Q

What is the important patient education associated with ondansetron?

A

Apomorphine (Parkinson’s drug) and non selctive dopamine agonists are contraindicated due to risks of QT prolongation and cardiac arrhythmias

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27
Q

What are the safety concerns for ondansetron?

A

ECG for electrolyte abnormalities, CHF, bradyarrhythmias, or other medicines

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28
Q

What is the MOA of metoclopramide?

A

dopamine receptor blockade

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29
Q

What are the uses of metoclopramide?

A

no longer the drug of choice for chemotherapy induced N/V, but IS USEFUL for gastric emptying

Prokinetic: GERD, diabetic gastroparesis, small bowel intubation

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30
Q

What is the patient education in relation to metoclopramide?

A

never use in larger amount sthan recommended or for longer than 12 weeks

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31
Q

What is the safety warning for metoclopramide?

A

BB WARNING for IRREVERSIBLE tardive dyskinesia
contraindicated in GI blockage perforation or bleeding

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32
Q

What is the MOA of prochlorperazine?

A

blocking H1 receptors can have sedative effects

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33
Q

What are the uses of prochlorperazine?

A

N/V, anxiety, and schizophrenia

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34
Q

What is the patient education in relation to prochlorperazine?

A

tablets, IM injection, suppository

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35
Q

What is the safety warning for prochlorperazine?

A

BEERS CRITERIA for dementia-related psychosis is not approved. Increases mortality risk in elderly dementia patients on conventional or atypical antipsychotics. BB WARNING for tardive dyskinesia

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36
Q

What is the MOA of Chlorpromazine?

A

antagonizes dopamine D2 receptors

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37
Q

What are the uses of chlorpromazine?

A

Intractable hiccups and psychosis (antipsychotics)

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38
Q

What is the patient education in relation to chlorpromazine?

A

tablets, injection (IM/IV)

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39
Q

What is the safety warning for Chlorpromazine?

A

BEERS CRITERIA for dementia-related psychosis is not approved. Increases mortality risk in elderly dementia patients on conventional or atypical antipsychotics. BB WARNING for tardive dyskinesia

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40
Q

What is the MOA of promethazine?

A

anatagonizes central and peripheral histamine H1 receptors

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41
Q

What is the patient education in relation to promethazine?

A

extrapyridamal sx like tremor. Contraindicated in kids younger than 2 years. Can cause Reye’s syndrome

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42
Q

What is the safety warning for promethazine?

A

Can cause severe tissue damage if IV extravasates or given IM. BB WARNING for tissue damage and gas gangrene

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43
Q

What is the MOA of scopolamine?

A

anticholinergic, muscarinic receptor antagonist and works onthe vestibular system, but has weak antiemetic activity

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44
Q

What are the uses of scopolamine?

A

patch for motion sickness

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45
Q

What is the patient education in relation to scopolamine?

A

dry mouth, visual disturbances, drowsiness

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46
Q

What is the safety warning for scopolamine?

A

BB WARNING for angle closure glaucoma

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47
Q

What is the MOA of NK-1 antagonists?

A

inhibit NK-1 receptors to prevent nausea nin patients receiving chemo

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48
Q

What is the patient education in relation to NK-1 antagonists?

A

given in conjunction with steroid and 5-HT3 antagonist

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49
Q

What is the MOA of Aluminum Hydroxide, Magnesium Hydroxide?

A

directly reduces intragastric acidity through chemical neutralization

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50
Q

What are the uses of Aluminum Hydroxide, Magnesium Hydroxide?

A

relieves heartburn and upset stomach

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51
Q

What is the MOA of Calcium Carbonate?

A

directly reduces intragastric acidity through chemical neutralization

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52
Q

What are the uses of Calcium Carbonate?

A

relieves heartburn and upset stomach. calcium for dietary supplementation and reducing the risk of osteoporosis.

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53
Q

What is the patient education in relation to Calcium Carbonate?

A

hypomagnesia

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54
Q

What is the MOA of sucralfate?

A

tenacious paste that binds selectively to ulcers or erosions and “coats” the mucosa. Stimulates prostaglandin production

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55
Q

What are the uses of sucralfate?

A

duodenal ulcer
gastric erosion due to aspirin

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56
Q

What is the patient education in relation to sucralfate?

A

not systemically absorbed
4x daily on EMPTY stomach

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57
Q

What is the safety warning for sucralfate?

A

should not be used for prolonged periods in patients with renal insufficiency

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58
Q

What is the MOA of Misoprostol?

A

prostaglandin analog (E1)

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59
Q

What are the uses of Misoprostol?

A

NSAID GI ulcer prevention, cervical ripening, early pregnancy termination

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60
Q

What is the safety warning for Misoprostol?

A

BB WARNING
Use in pregnant women can cause birth defects, abortion, premature birth, or uterine rupture. Women of childbearing age potential do not use to decrease the risk of NSAID-induced ulcers unless HIGH-risk gastric ulcer

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61
Q

What is the MOA of Famotidine?

A

selectively antagonizes H2 receptors in parietal cells

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62
Q

What are the uses of Famotidine?

A

GERD

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63
Q

What is the safety warning for Famotidine?

A

adjust for renal failure

64
Q

What is the MOA of PPIs?

A

inhibits gastric parietal cell hydrogen pump ATPase (proton pump inhibitor)

65
Q

What two PPIs are the most potent and irreversible?

A

Omeprazole and Lansoprazole

66
Q

What are the uses for PPIs?

A

GERD, gastric ulcer, H pylori, hypersecretory conditions

67
Q

What is the saftey warning for PPIs?

A

consider Mg at baseline

68
Q

What is the safety warning for protonix?

A

no renal/hepatic adjustments

69
Q

What is the MOA of loperamide?

A

binds gut opioid receptors, inhibiting peristalsis, increases sphincter tone

70
Q

What are the uses for loperamide?

A

diarrhea, does not cross the blood-brain barrier. No analgesic properties

71
Q

What is the patient education in relation to loperamide?

A

should not use if you have bloody diarrhea. Safe when used as directed, but taking too much can cause serious heart problems or death.

72
Q

What is the safety warning for loperamide?

A

BB WARNING for Torsades De Point and sudden death. contraindicated in patients under 2 YO

73
Q

What is the MOA of diphenoxylate/atropine?

A

binds gut wall opioid receptors inhibiting peristalsis, subtherapeutic atropine discourages overdose

74
Q

What are the uses for diphenoxylate/atropine?

A

prescription only

75
Q

What is the patient education in relation to diphenoxylate/atropine?

A

pts can develop dependence with prolonged use

76
Q

What is the safety warning for diphenoxylate/atropine?

A

do not use if you have diarrhea that is caused by bacteria or by taking an abx. Do not use if you have a bile duct disorder causing jaundice. Keep this medication out of the reach of children, as it can cause overdose and fatality

77
Q

What is the MOA of bismuth subsalicylate?

A

possesses topical mucosal effects, reduces secretions, binds to bacterial toxins, antimicrobial effects

78
Q

What are the uses for bismuth subsalicylate?

A

diarrhea, H pylori infection, traveler’s diarrhea prophylaxis

79
Q

What is the patient education in relation to bismuth subsalicylate?

A

You should not use this medication if you have a bleeding issue or are allergic to aspirin

80
Q

What is the safety warning for bismuth subsalicylate?

A

reyes syndrome
black fecal discoloration, black tongue discoloration
may lead to salicylate toxicity

81
Q

What is the MOA of octreotide?

A

man-made. acts like somatostatin, inhibits multiple hormones including growth hormone, glucagon, insulin, LH, VIP and inhibits portal and splanchnic blood flow

82
Q

What are the uses for octreotide?

A

acromeagly
secretory diarrhea, especially in patients with HIV
esophageal varices

83
Q

What is the MOA of docusate?

A

facilitate a mixture of stool fat and water. STOOL SOFTNER

84
Q

What are the uses for docusate?

A

prevent constipation
decrease straining during defecation

85
Q

What is the patient education in relation to docusate?

A

diarrhea due to increased fluid and electrolyte secretion

86
Q

What is the MOA of psyllium?

A

increases stool bulk
BULK FORMING LAXATIVE

87
Q

What are the uses for psyllium?

A

relieving constipation
supplementing fiber intake

88
Q

What is the patient education in relation to psyllium?

A

swallow one at a time and separate form other drugs by >2 hrs

89
Q

What is the MOA of methylcellulose?

A

increases stool bulk
BULK FORMING LAXATIVE

90
Q

What are the uses for methylcellulose?

A

relieving constipation

91
Q

What are the uses for bisacodyl?

A

constipation and bowel prep

92
Q

What is the MOA of bisacodyl?

A

stimulant laxative promotes peristalsis

93
Q

What is the patient education in relation to bisacodyl?

A

do not crush, chew, or break. Swallow with a full glass of water
taken PO should produce a BM in 6-12 hrs

94
Q

What is the safety warning for bisacodyl?

A

do not use for more than 1 wk. DO NOT chronically use for constipation. Electrolyte imbalances and cathartic colon

95
Q

What is the MOA of polyethylene glycol?

A

causes water retention in stool, producing a laxative effect
OSMOTIC LAXATIVE

96
Q

What are the uses for polyethylene glycol?

A

relieving constipation

97
Q

What is the safety warning for polyethylene glycol?

A

electrolyte imbalance
laxative dependence

98
Q

What is the MOA of Polyethylene glycol/ Electrolytes?

A

causes water retention in the stool, producing a laxative effect

99
Q

What are the uses for Polyethylene glycol/ Electrolytes?

A

bowel prep

100
Q

What is the patient education in relation to Polyethylene glycol/ Electrolytes?

A

this medication can be abused by bulimics

100
Q

What is the safety warning for Polyethylene glycol/ Electrolytes?

A

Monitor BUN/Cr., Ca, K, Na at baseline and post colonoscopy if seizures hx

101
Q

What is the MOA of sodium phosphate rectal?

A

bowel cleansing
CONSTIPATION OSMOTIC LAXATIVE

102
Q

What are the uses for sodium phosphate rectal?

A

constipation
bowel prep for enemas

103
Q

What is the safety warning for sodium phosphate rectal?

A

for best results, stay lying down and hold in the enema until you feel the urge to have a BM

104
Q

What is the MOA of Linaclotide?

A

activates guanylate cyclase-C stimulation cGMP production

105
Q

What are the uses for Linaclotide?

A

chronic idiopathic constipation
IBS

106
Q

What is the safety warning for Linaclotide?

A

contraindicated in patients < 6 years old and deaths have occurred due to dehydration within 24 hours in nonclinical studies

107
Q

What is the MOA of Methylnaltrexone?

A

selectively antagonizes peripheral mucoid receptors, inhibiting opioid-inducing GI hypermotility

108
Q

What are the uses for Methylnaltrexone?

A

opioid-induced constipation

109
Q

What is the patient education in relation to Methylnaltrexone?

A

avoid use if concern for bowel obstruction perforation

110
Q

What is the safety warning for Methylnaltrexone?

A

opioid withdrawal (only if the blood-brain barrier is disrupted)

111
Q

What is the MOA of Dicyclomine?

A

antagonizes Ach at muscarinic receptors (anticholinergic), relaxes smooth muscle, inhibits bradykinin and histamine-induced spasms

112
Q

What are the uses for Dicyclomine?

113
Q

What is the patient education in relation to Dicyclomine?

A

Stop using and call right away of you have side effects such as confusion, hallucinations, unusual thoughts, fast or uneven heart rate, or urinate less than usual or not at all.

114
Q

What is the MOA of Hyoscyamine?

A

antagonizes Ach receptors (anticholinergic)

115
Q

What are the uses for Hyoscyamine?

A

IBS, bladder spasms

116
Q

What is the MOA of Sulfasalazine?

A

blocks COX and inhibits prostaglandin production, producing anti-inflammatory effects

117
Q

What are the uses for Sulfasalazine?

A

UC
Crohn’s

118
Q

What is the MOA of Mesalamine?

A

blocks COX and inhibits prostaglandin production, producing anti-inflammatory effects

119
Q

What are the uses for Mesalamine?

A

UC
Crohn’s

120
Q

What is the patient education in relation to Mesalamine?

A

renal toxicity

121
Q

What is the safety warning for Mesalamine?

A

caution in patients over 65

122
Q

What is the MOA of 6-Mercaptopurine?

A

inhibits DNA synthesis

123
Q

What are the uses for 6-Mercaptopurine?

A

ALL
Crohn’s
UC

124
Q

What are the uses for Adalimumab?

A

Crohn’s
UC
HS
uveitis

125
Q

What is the safety warning for 6-Mercaptopurine?

A

pregnancy avoid in 1st trimester

125
Q

What is the MOA of Adalimumab?

A

binds and inhibits TNF-a, reducing inflammation and altering immune response

126
Q

What is the patient education in relation to Adalimumab?

A

sub-Q, every 6 weeks, Expensive

127
Q

What are the uses for orlistate?

A

diet needs to be less than 30% fat. fat-soluble vitamin supplement is recommended

128
Q

What is the MOA of orlistate?

A

inhibits lipases reducing fat absorption

128
Q

What is the safety warning for Adalimumab?

A

Malignancy: lymphoma and other malignancies, some fatal reported in children and adolescents treated w/ TNF blockers

129
Q

What is the patient education in relation to orlistate?

A

steatorrhea

130
Q

What is the safety warning for orlistate?

A

pregnancy contraindicated

131
Q

What is the MOA of pancreatic enzymes?

A

disintegrates into trypsin, amylase, and lipase which break down proteins, carbs, and fat

132
Q

What are the uses for pancreatic enzymes?

A

exocrin pancreatic insufficiency

133
Q

What is the patient education in relation to pancreatic enzymes?

A

the number on the capsule is the umber of thousands of units

134
Q

What is the safety warning for pancreatic enzymes?

A

you should not take pancrelipase if you are allergic to pork protiens

135
Q

What is the MOA of Urodiol?

A

decreased cholesterol synthesis, secretion, and absorption, alters bile cholesterol and composition

136
Q

What is the safety warning for Urodiol?

A

capsules are not for treating gallstones that are calcified

137
Q

What is the MOA of Pegylated Interferon Alfa 2A?

A

inhibits viral replication, various antivirals, antiproliferative, and immunomodulatory effects. attached to polyethylene glycol leads to longer half-life.

138
Q

What are the uses for Pegylated Interferon Alfa 2A?

A

chronic Hep B

139
Q

What is the safety warning for Pegylated Interferon Alfa 2A?

A

aggravate fatl or life threatening neuropsychiatric, autoimmune, ischemic, and infectious disorders,

140
Q

What is the MOA of Lamivudine?

A

nucleoside reverse transciptase inhibitor

141
Q

What is the patient education in relation to Lamivudine?

A

higher dose for HIV infection

142
Q

What are the uses for Lamivudine?

A

chronic Hep B

143
Q

What is the safety warning for Lamivudine?

A
  1. HIV testing: rapid emergences of HIV resistance
  2. Hep B exacerbation
144
Q

What is the MOA of Lepidasvir/sofosbuvir?

A

inhibits non-structural protein 5A (NS5A), limiting viral replication. inhibits non structural protein 5B RNA-dependent RNA polymerase, terminating viral replication

145
Q

What are the uses for Lepidasvir/sofosbuvir?

146
Q

What is the safety warning for Lepidasvir/sofosbuvir?

A

BB WARNING for Hep B reactivation. Screen all patients for HBV co-infection

147
Q

What is the MOA of hydrocortisone/pramoxine topical?

A

corticosteroid and topical anesthetic

148
Q

What are the uses for hydrocortisone/pramoxine topical?

A

hemorrhoids

149
Q

What is the patient education in relation to hydrocortisone/pramoxine topical?

A

apply after BM for external use
no systemic med, hemorrhoids common in pregnant women

150
Q

What is the safety warning for hydrocortisone/pramoxine topical?

A

HPA axis suppression (prolonged use)
caution advised during pregnancy especially if long term use

151
Q

What is the MOA of Simethicone (Gas-X)?

A

alters bubble surface tension

152
Q

What are the uses for Simethicone (Gas-X)?

A

silicone based antifoaming agents for relieving gas

Pharm II (5 decks)

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