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xPharm Exam 2 > GI > Flashcards

GI Flashcards

1
Q

Antacids (5 drugs)

A
  • Sodium Bicarbonate
  • Aluminum
  • Calcium Carbonate
  • Magnesium
  • Alginic Acid (not an acid, but falls in this category)

(A-SCAM)

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2
Q

H2 Receptor Antagonists (4 drugs)

A
  • Cimetidine
  • Ranatidine
  • Famotidine
  • Nizatidine

(CRFN -tidine)

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3
Q

Proton Pump Inhibitors (5 drugs)

A
  • Omeprazole
  • Lansoprazole (TQ)
  • Esomeprazole
  • Pantoprazole
  • Rabeprazole

(POLER)

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4
Q

Mucosal Protective Agents (3 drugs)

A
  • Bismuth
  • Prostaglandins (Misoprostol)
  • Sucralfate

(BPS)

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5
Q

Promotility Agents (2 drugs)

A
  • Bethanechol

- Metoclopramide

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6
Q

Laxatives (7 types)

A
  • Bulk forming
  • Osmotic
  • Saline
  • Iso-Osmotic Electrolyte Colonic Lavage Solutions
  • Fecal Softeners
  • Irritants/Stimulants
  • Lubiprostone (last resort)

(Laxatives cause you to FIB about SOILing your pants)

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7
Q

Bulk-Forming Laxatives (4 drugs)

A
  • Methycellulose
  • Carboxymethycellulose
  • Psyllium Seed
  • Bran

(MCdonalds & PB will bulk you up)

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8
Q

Osmotic Laxatives (1 drug)

A

-Lactulose

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9
Q

Saline Laxatives (2 drugs)

A
  • Milk of Magnesia (MOM)

- Sodium Phosphates

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10
Q

Iso-Osmotic Electrolyte Colonic Lavage Solution Laxatives (3 drugs)

A
  • GoLYTELY
  • Colyte
  • Miralax
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11
Q

Fecal Softener Laxatives (2 drugs)

A
  • Mineral Oil
  • Docusate

(Getting your MD will make you softer)

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12
Q

Irritant/Stimulant Laxatives (4 drugs)

A
  • Phenolphthalein
  • Castor Oil
  • Bisacodyl
  • Cascara

(PCBC)

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13
Q

Antiemetics (4 types)

A
  • Antihistamines/Anticholinergics
  • Dopamine Antagonists
  • Cannabinoids
  • Serotonin Receptor Antagonists

(CADS)

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14
Q

Antihistamine/Anticholinergic Antiemetics (4 drugs)

A
  • Diphenhydramine
  • Hydroxyzine
  • Scopolamine
  • Meclozine
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15
Q

Dopamine Antagonist Antiemetics (3)

A
  • Metoclopramide
  • Phenothiazine
    • Prochlorperazine
    • Promethazine
    • Thiethylperazine
  • Butyrophenone
    • Haloperidol
    • Droperidol
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16
Q

Cannabinoid Antiemetics (2 drugs)

A
  • Nabilone
  • Dronabinol

(Students at ND smoke cannabis)

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17
Q

Serotonin Receptor Antagonist Antiemetics (4 drugs)

A
  • Ondansetron
  • Granisetron
  • Tropisetron
  • Dolasetron

(T-DOG)

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18
Q

Inflammatory Bowel Disease (5 drugs)

A
  • Sulfasalazine
  • Azathioprine/5-MP
  • Cyclosporine
  • Methotrexate
  • Infliximab

(I-SCAM)

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19
Q

Irritable Bowel Syndrome (3 drugs)

A
  • Tegaserod
  • Alosetron
  • Crofelemer

(CATs are irritable)

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20
Q

Sodium Bicarbonate (5 things)

A
  • React with acid
  • Gold standard for GERD
  • Potent, irreversible, rapid acting, short DOA
  • Not for chronic use (causes perforation)
  • ADRs: Rebound effect, sodium overload/systemic alkalosis, milk alkali syndrome (if taken with milk/calcium), flatulence, perforation
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21
Q

Aluminum (3 things)

A
  • Can absorb pepsin
  • Increases bone absorption of aluminum (esp in renal dysfunction), binds dietary phosphate leading to osteopenia/osteoporosis
  • ADRs: constipation (contributes to obstruction, esp in patients with decreased motility, dehydration, fluid restriction)
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22
Q

Magnesium (3 things)

A
  • Forms insoluble salts that lead to osmotic diarrhea
  • Does not change gastric motility or alter transit time
  • ADRs: CNS depressant, may accumulate in renal disease
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23
Q

Alginic Acid (4 things)

A
  • Not an antacid, but falls under this category
  • In presence of saliva, reacts with bicarb to form highly viscous solution of sodium alginate
  • Barrier to reflux (whereas all others are acid modifiers)
  • No effect on lower esophageal sphincter
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24
Q

Cimetidine (5 things)

A
  • H2 receptor antagonist (gold standard)
  • Decreases action of histamine on heart and blood vessels
  • Inhibits CYP450
  • Unique use: immunomodulating effects for treatment of warts (TQ)
  • ADRs: CNS (slurred speech, delirium, confusion), Endocrine (gynecomastia, galactorrhea), Blood (granulocytopenia, thrombocytopenia, neutropenia, aplastic anemia), Cholestasis
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25
Q

Ranatidine (2 things)

A
  • H2 receptor antagonist (4x more potent)

- ADRs: Hepatitis

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26
Q

Famotidine (3 things)

A
  • H2 receptor antagonist (40-60x more potent)
  • Decreases cardiac output
  • ADRs: increases LFTs
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27
Q

Nizatidine (3 things)

A
  • H2 receptor antagonist (2-3x more potent)
  • Decreases cardiac output and heart rate
  • ADRs: increases LFTs
28
Q

Calcium Carbonate (7 things)

A
  • Most commonly used antacid
  • Most effect on lower esophageal sphincter pressure (TQ)
  • Potent, reversible, rapid, prolonged
  • Increases fecal bulk, excretion of fatty acids, bile salts
  • Less chance of systemic alkalosis than sodium bicarb
  • Does not alter transit time
  • ADRs: acid rebound, pancreatic enzyme secretion, gallbladder emptying
29
Q

Proton Pump Inhibitors (7 things)

A
  • Noncompetitive, irreversible inhibitors of intracellular acid pump
  • Takes a week to be effective (NOT immediate)
  • Inhibits daytime/nighttime secretion with once a day dosing (long DOA)
  • Prodrugs: omeprazole and lansoprazole
  • Esomeprazole: active S-isomer of omeprazole
  • Uses: peptic ulcer, reflux esophagitis, antimicrobial activity (against H. pylori)
  • ADRs: headache, diarrhea, rebound (take 7.5 days for full restoration), CYP interactions (omeprazole lowers phenytoin and warfarin), pH changes (increase digoxin, nifedipin, ASA, midazolam, DDI, methadone), decrease ketoconazole/itraconazole
30
Q

H2 Receptor Antagonists (5 things)

A
  • Reversibly compete with histamine at H2 receptor on parietal cells (external receptor)
  • Does NOT affect H1 receptor
  • Decreases acid secretion/gastric motility, little effect on smooth muscle function
  • Uses: peptic duodenal ulcer, benign gastric ulcer, erosive esophagitis (GERD), hypersecretory conditions (zolinger-ellison)
  • ADRs: Cimetidine is associated with most ADRs (inhibits CYP450)
31
Q

Proton Pump Inhibitors (8 things)

A
  • Noncompetitive, irreversible inhibitors of intracellular acid pump
  • Takes a week to be effective (NOT immediate)
  • Inhibits daytime/nighttime secretion with once a day dosing (long DOA)
  • Prodrugs: omeprazole and lansoprazole
  • Esomeprazole: active S-isomer of omeprazole
  • Uses: peptic ulcer, reflux esophagitis, antimicrobial activity (against H. pylori)
  • ADRs: headache, diarrhea, rebound (take 7.5 days for full restoration), CYP interactions (omeprazole lowers phenytoin and warfarin), pH changes (increase digoxin, nifedipin, ASA, midazolam, DDI, methadone and decrease ketoconazole/itraconazole)
  • Long term effects: malabsorptions of calcium and magnesium (esp in sedentary lifestyles, thiazides, HRT, corticosteroids), may increas infection of enteric bacteria (C. diff and CA-pneumonia)
32
Q

Bismuth (3 things)

A
  • Not readily absorbed, especially short term
  • Uses: promotes healing of gastric/duodenal ulcers by coating them, antimicrobial to H. pylori
  • ADRs: encephalopathy (chronic use), contains salicylates (may cause Reye’s Syndrome in children)
33
Q

Metoclopramide as a promotility agent (5 things)

A
  • Dopamine antagonist (blocks central and periphery)
  • Direct inhibitor of chemoreceptor trigger zone, blocks serotonin receptors at high doses
  • Improves gastric emptying, no effect on biliary, gastric or pancreatic enzymes
  • Uses: GERD and diabetic gastroparesis (also to control chemo-induced vomiting)
  • ADRs: sedation, extra-pyramidal symptoms (TQ), prolactin secretion
34
Q

Bulk Forming Laxatives (4 things)

A
  • Increase bulk of feces, which stretches the GI tract and stimulates peristalsis
  • Drink extra water
  • 2-3 days time to action
  • Methylcellulose, Carboxymethylcellulose, Psyllium Seed, Bran
35
Q

Lactulose (4 things)

A
  • Osmotic laxative
  • As colonic ostomotic osmolality increases, fluid movement occurs
  • 1-3 days time to action
  • ADRs: contraindicated in patients who are galactose sensitive
36
Q

Misoprostol/Prostaglandins (4 things)

A
  • Analogue of PGE-1
  • Well absorbed, metabolized to active compound
  • Approved for prevention of NSAID-induced ulcer
  • ADRs: cramps, abdominal pain, diarrhea, uterine contractions (spontaneous abortions)
37
Q

Saline Laxatives (6 things)

A
  • Help retain fluid in gut through osmotic effect
  • Drink extra water
  • 2-6 hours time to action
  • Soluble, inorganic salts (magnesium, sodium, potassium)
  • Given as liquids, powders or enemas
  • Milk of magnesiam (MOM), sodium phosphates
38
Q

Fecal Softener Laxatives (5 things)

A
  • Not absorbed from alimentary canal
  • Act by increasing bulk of feces and softening stool
  • 1-2 day times time to action
  • ADRs: chronic use may cause vitamin deficiencies
  • Mineral oil (dissolves and prevents absorption of fat-soluble vitamins [TQ]), Docusate (surfactant)
39
Q

Irritant/Stimulant Laxatives (3 things)

A
  • Act on gut mucosa to stimulate peristalsis
  • ADRs: GI pain
  • Phenolphtalein, Castor Oil, Bisacodyl (causes colonic contraction and inhibits water absorption), Cascara
40
Q

Lubiprostone (3 things)

A
  • Chloride channel activator
  • Uses: chronic constipation in adults (for patients when nothing else works)
  • ADRs: nausea, diarrhea, headache, abdominal pain/distension, flatulence
41
Q

Antihistamine/Anticholinergics (5 things)

A
  • Block emetic stimuli of vestibular origin
  • Meclozine: DOC for vestibular issues
  • Uses: motion sickness, nausea/vomiting in children (diphenhydramine) and after operation (hydroxyzine)
  • ADRs: anticholinergic effects (dry mouth, sedation, blurred vision, urinary retention)
  • Diphenhydramine, Hydroxyzine, Scopolamine (patch), Meclozine
42
Q

Metoclopramide as an antiemetic (6 things)

A
  • Direct inhibitor of chemoreceptor trigger zone, blocks serotonin recepetors at high doses
  • Blocks central and peripheral dompanine and sensitizes GI receptors to ACh
  • Structurally related to procainamide
  • Better efficacy as an anti-emetic with a corticosteroid (dexamethasone or methylprednisolone)
  • Uses: control chemo-induced vomiting (also GERD and diabetic gastroparesis)
  • ADRs: extra-pyramidal symptoms, sedation, diarrhea, hypotension
43
Q

Phenothiazines (4 things)

A
  • Widely prescribed, practical for long-term use
  • Uses: control morning sickness, nausea, vomiting, mildly emetogenic chemotherapy
  • ADRs: extrapyramidal symptoms (reversible with antihistamines), allergic reactions, sedation, blurred vision
  • Prochlorperazine, promethazine, thiethylperazine
44
Q

Butyrophenones (4 things)

A
  • Very potent antidopaminergic inhibitors of chemoreceptor trigger zone (CTZ)
  • Uses: effective against emetogenic chemo, usually used in combo with other agents
  • ADRs: extra-pyramidal symptoms, sedation, restlessness, hypotension, hallucinations
  • Haloperidol, Droperidol
45
Q

Cannabinoids (5 things)

A
  • Inhibits prostaglandin synthesis
  • Anticholinergic activity, may exert action through opiate receptors
  • Uses: refractory chemo-related emesis (TQ), esp in patients with previous marijuana use
  • ADRs: mood changes, memory loss, hunger, motor incoordination, euphoria, relaxation (so basically being high haha)
  • Nabilone, Dronabinol
46
Q

Serotonin Receptor Antagonists (5 things)

A
  • 5-HT-3 Antagonists
  • Uses: control chemo-related emesis, even highly emetogentic chemo (best on 1st round), post-op nausea and vomiting (PONV)
  • Does NOT interact with dopamine receptors, therefore no extra-pyramidal symptoms
  • ADRs: headache, constipation, lightheadness, abdominal pain/cramping, sedation, potentially fatal abnormal heart rhythms
  • Caution in those who are predisposed to low levels of K and Mg in blood and those received other meds that may lead to QT prolongation
47
Q

Granisetron (2 things)

A
  • Serotonin receptor antagonist

- Pure (5HT3), long T1/2, QD dosing

48
Q

Dolasetron (2 things)

A
  • Serotonin receptor antagonist

- Pure (5HT3), long T1/2, QD dosing

49
Q

Odansetron (3 things)

A
  • Serotonin receptor antagonist
  • Binds at 5HT3, 5HT1b, 5HT1c, a-adrenergic and mu opioid receptors
  • Shorter T1/2, dose 3-4 times daily
50
Q

Tropisetron (3 things)

A
  • Serotonin receptor antagonist
  • Binds at 5HT3, 5HT4
  • Long T1/2, QD dosing
51
Q

Sulfasalazine (4 things)

A
  • 5-ASA is active metabolite that inhibits the synthesis of inflammatory mediators
  • Composed of sulfapyridine and 5-aminosalicylate linked by an azo bond
  • Uses: part of primary mode of therapy for inflammatory bowel disease
  • ADRs: nausea/vomiting/headache (due to sulfa), inhibits absorption of folate, decreases bioavailability of digoxin
52
Q

Azathioprine/6-Mercaptopurine (AZA/6-MP) (4 things)

A
  • AZA is a prodrug (TQ) that is converted to 6-MP
  • Steroid sparing, reduces amount needed to maintain remission
  • Monitor CBC every 3 months
  • ADRs: allergic (pancreatitis, fever, rash, arthralgias, malaise), non-allergic (bone marrow depression, infections, hepatitis, malignancy)
53
Q

Cyclosporine (3 things)

A
  • Inhibits T-helper cell production of IL-2 and IFN-y (alters T and B cell function)
  • Uses: indicated for refractory patients
  • ADRs: renal dysfunction, hypertension, infection, paresthesias, tremor, hirsutism, gingival hyperplasia
54
Q

Methotrexate (6 things)

A
  • Folate analogue
  • Gold standard, PO or IM
  • Inhibits purine synthesis (needed to make DNA, RNA, protein)
  • Monitor levels
  • Antidote/”rescue”: leucovorine (TQ)
  • ADRs: increases LFTs, hepatic fibrosis, mucositis, headache, nausea, rash, bone marrow suppression, lymphoma
55
Q

Infliximab (4 things)

A
  • Anti-TNFa antibody mediator, monoclonal
  • IV only
  • Uses: Crohn’s, RA, rapid relief of symptoms
  • ADRs: fevers, chills, itching, chest pain, BP changes, dyspnea
56
Q

Tegaserod (4 things)

A
  • Selective 5HT4 (5-hydroxytryptamine-4) partial agonist (TQ)
  • Accelerates gastric empyting and small bowel and colonic transit time
  • Uses: treatment of abnominal pain/discomfort and constipation, chronic constipation, gastroparesis, GERD
  • ADRs: inhibits CYP1A2 and CYP2D6, diarrhea, headache, don’t use longer than 12 weeks
57
Q

Alosetron (7 things)

A
  • Selective 5HT3 antagonist
  • 10x as potent as ondansetron
  • Increases fluid absorption in SI, slows colonic contraction by 8 hours
  • Does NOT affect gastric emptying time, LESP, esophageal motility or small bowel transit time
  • Absorption decreased by food
  • Uses: patients (women) with severe diarrhea predominant IBS
  • ADRs: contipation, ischemic colitis, decreases concentration of levonorgestrel and ethinyl estradiol (decreases effectiveness of BC)
58
Q

Crofelemer (5 things)

A
  • Inhibits the cystic fibrosis transmembrane conductance regulator (CFTR) chloride channels and calcium-activated Cl channels at luminal membrane of enterocytes, which blocks Cl secretion and high water loss through the gut that results in diarrhea
  • Acts locally on enterocytes
  • Uses: for ymptomatic relief of non-infectious diarrhea in adults HIV/AIDS on anti-retroviral therapy (TQ)
  • No dose modifications recommended with respect to CD4 count
  • ADRs: may inhibit absorption of drugs
59
Q

7 Complications of Chronic Emesis

A
  • Anorexia
  • Weight loss
  • Malaise
  • Dehydration
  • Esophagastric tears
  • Electrolyte imbalances
  • Aspiration pneumonia
60
Q

Physiologic Mechanisms of Emesis (3 things)

A
  • Coordinated in the emetic center in the medulla
  • Chemoreceptor trigger zone (CTZ) is responsive to chemical stimulation (serotonin and dopamine)
  • Begins with nausea, increased salivation, pupillary dilation, sweating, pallor, retching and vomiting
61
Q

Inflammatory Bowel Disease (4 things)

A
  • Includes: ulcerative colitis, Crohn’s
  • Symptoms: bleeding, urgency, diarrhea, tenesmus
  • Primary mode of therapy involves corticosteroids and sulfasalazine
  • Immunomodifiers (AZA/6-MP, cyclosporine, MTX)are also used
62
Q

Irritable Bowel Syndrome (4 things)

A
  • Causes cramping, bloating, gas, diarrhea or constipation
  • Pain occurs during/after meal
  • No damage to the bowel
  • IBS is a chronic relapsing disorder
63
Q

Probiotics (5 things)

A
  • Live microorganisms administered to improve “microbial balance”
  • Saccharomyces boulardii and Lactobacillus rhamnosus, strain GG shown to prevent antimicrobial associated diarrhea
  • I. acidophilus, bifidobacterium longum, enterococcus faecium are others
  • Problems (TQ): unknown if organisms still living when administered, may cause infection, not regulated/ approved by FSA
  • Align (IBS), Activia (irregularity due to slow GI motility), VSL #3 (may reduce pain/bloating), Culturelle/Florastor (reduce stool frequency with antibiotic treatment)
64
Q

Bethanechol (5 things)

A
  • Cholinergic agent
  • Increases resting LESP, therefore decreasing reflux and improving esophageal clearing
  • Decreases symptoms and need for antacid use, also promotes healing
  • Uses: reflux esophagitis with H2 antagonists or proton pump inhibitors
  • ADRs: gastric acid production, cholinergic effects (cramps, diarrhea, urinary frequency, blurred vision)
65
Q

Iso-Osmotic Electrolyte Colonic Lavage Solutions (5 things)

A
  • Purge by excess volume (TQ)
  • Ingestion of 4 liters of iso-osmotic fluid over 3-4 hours
  • Uses: prior to procedures or post-poisonings
  • ADRs: not for patients with bowel obstruction or impaired gag reflex, tastes bad (mix with chicken bouillon)
  • GoLYTELY, Colyte, Miralax (common)

xPharm Exam 2 (8 decks)

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