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Pharm > GI > Flashcards

GI Flashcards

1
Q

Amoxicillin

A

-Preferred component due to low resistance/toxicity

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2
Q

Clarithromycin

A

-Increasing resistance

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3
Q

Metronidazole

A

-alternative for patients allergic to penicllin

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4
Q

Tetracycline

A

-Used in Bismuth-base quadruple therapy

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5
Q

Bismuth Subsalicylate

A

-Colloidal therapy where salicylate is absorbed in the stomach and bismuth is secreted in feces
-MOA:
-antibacterial activity of bismuth against H. Pylori and E. coli enterotoxins,
-Forms barrier that protects ulcers from further damage
-anti-secretory and anti-inflammatory salicyclate
Therapy:
-PUD
-Diarrhea: inhibition of intestinal prostaglandin and chloride secretion
-Adverse effects:
-Reyes and salicylism

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6
Q

Magnesium Hydroxide Aluminum hydroxide

A
  • MOA:
    • Alkaline compounds that neutralize gastric acid and raise stomach pH, most raise to pH of 5
  • Pharm:
    • Rapid onset with shot duration of action
    • Mg can cause diarrhea due to stimulation of peristaltic activity but Al counteracts this effect
    • Ions aren’t well absorbed so don’t cause metabolic alkalosis
  • Uses:
    • relief of mild symptoms of dyspepsia and GERD
  • Can interfere with absorption of other drugs (2hr window)
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7
Q

Cimetidine

A

MOA: Competitive inhibitor of H2 on basolateral mem of parietal cells –> decreased Gastrin and ACh respons, slower onset than antacids but longer duration (prophylaxis)
USES:
-PUD: Short term promotes healing by decreasing nocturnal acidity
-GERD: Best for nocturnal modest post prandially
-Aspiration Pneumonitis: during anesthesia
Adverse RXN:
-ENDO: blocks androgen receptors –> gynecomastia, impotence, and loss of libido
-CNS: Elderly
-Pneumonia: Incr. bac colonization due to lower pH

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8
Q

Omeprazole (PPI)

A
  • MOA: activated within parietal cells and blocks H/K ATPase, final common pathway for basal and stimulated acid release, effects last until new ATPase are generated
  • Pharm: enteric coated, can react with 2C19 (Asians) and dose reduction with hepatic disease
  • Uses: PUD and Gerd, Zollinger Ellison, NSAID ulcers in people who continue to use NSAIDS
  • ADVERSE: Interactions with, Warfarin, Diazepam, cyclosporine, C. Diff, bone fractures, rebound hyper secretion
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9
Q

Sucralfate

A
  • Sulfated sucrose and AlOH
  • MOA: Gel at pH 4 and binds necrotic tissue to form a barrier, take on empty stomach
  • USES: Duodenal and stress ulcers, no risk of nosocomial infx
  • Adverse: Reduced absorption of other drugs
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10
Q

Misoprostol

A
  • Prostaglandin analog
  • MOA: substitutes for PGs when synthesis is inhibited by NSAIDS, reduces acid secretion from parietal cells and promotes bicarb and mucus secretion
  • USES: Prevention of gastric ulcers in long term NSAID therapy, NOT PREGNANCY!!!!!!!!!!!
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11
Q

Psyllium

A
  • Bulk forming (group III)
  • MOA: Non-digestable agents that swell with H2O increases volume of stool and stim. peristalsis
  • Uses: Temp treatment of mild constipation
  • Must BE ADMINISTERED WITH A FULL GLASS OF H2O
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12
Q

Docusate Sodium

A
  • Surfactant (Group III)
  • MOA: Lowers surface tension allows penetration of H2O
  • Uses: Mild Constipation, take with full glass of H2O
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13
Q

Bisacodyl

A

-Stimulant (group II)
-MOA: Stimulate (via irratation) GI motility and increase H2O and electrolytes within the lumen. (ORAL or ANAL)
-USES: Opioid induced constipation and constipation from slow intestinal transit
ADVERSE: Proctitis with long term use

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14
Q

Magnesium Hydroxide

A

-Osmotic laxative (Group I)
-MOA: Poorly absorbed salts or sugars which draw H2O in to the stool
USES:
-High Dose: Colonoscopy
-Low Dose: Mild to moderate constipation
-Purging to remove dead parasites
-Adverse RXN: Dehydration and electrolyte imbalance also Mg absorbtion may cause problems with people who have renal impairment

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15
Q

Lactulose

A

-Prevent hepatic encephalopathy by turning NH3 –> NH4 and trapping it in the stool

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16
Q

Loperamide and Diphenoxylate

A

-MOA: Agonists for myenteric opiate receptors that reduces secretory activity (delta) and GI motility (Mu)
-PK:
-Loperamide: Poor BBB penetration no abuse
-Diphenoxylate: High oral doses can produce morphine like responses (atropine)
Adverse Effects: Constipation with prolonged use, methylnaltrexone used to treat opiate induced constipation

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17
Q

Ondansetron

A
  • MOA:5HT3 antagonists at peripheral and central site (most effective but efficacy enhanced by corticosteroids)
  • PK: Administered IV, long duration of action
  • USES: prevent or minimize emesis form CINV and radiation, hyperemesis of pregnancy, NOT effective against motion sickness or DELAYED CINV
18
Q

Aprepitant

A
  • Blocks NK1 receptors in brain

- Uses: Delayed nausea cisplatin, improves efficacy of other CINV treatments

19
Q

Black Cohosh

A

-USE: Treat menopause and PMS
-Active ingredients: Triterpene glycosides and isoflavones (not related to female hormones)
-Efficacy: Probably not (no difference from placebos and inferior to estrogen)
AE: Liver toxicity
Drug Interactions: Potentiates antihypertensives and Oral diabetic medicines
-Avoid during pregnancy and in patients with breast cancer (blue cohosh stimulates uterine contractions

20
Q

Echinacea

A
  • Use stimulate immune function (URI)
  • Active ingredients: echinacosides, polysaccharides, flavonoids
  • MOA: INVITRO stimulation of Macrophage activity and t-lymphocyte proliferation but RCT no difference from placebos in treatment and no prevention
  • Drug interactions/Contraindications: immunosuppressants, autoimmune disorders
21
Q

Garlic

A
  • Use: Cholesterol and HTN
  • Active ingredient: Organic sulfur compounds, alliin -> allicin (enteric coated)
  • MOA: In vitro inhibition of HMG-CoA and reduces platelet aggregation
  • Efficacy: May have modest effect but RCT showed no difference in patients with mild hypercholesterolemia but mild blood pressure lowering
  • Drug interaction: Aspirin/anticoagulants, insulin/OHAS, saquinivir (incr. clearance)
22
Q

GInkgo

A
  • USE: Improve memory and concentration, vascular problems
  • Active ingredients: flavonoid glycosides
  • MOA: increase blood flow to CNS (vasodil.), free radical scavenger, suppresses synth of platelet activating factor
  • Efficacy: no difference from placebo in AD and cog decline, RCT showed effects similar to exercise
  • Adverse effects: Seeds are epileptogenic
  • Drug interactions: Anticoagulants
23
Q

Ginseng

A

Use: Tonic to enhance athletic performance

  • Active ingredients: ginsenosides
  • Efficacy: NOT
  • Adverse Effects: Weak estrogenic effects
  • Interactions: anticoagulants and insulin/OHA
24
Q

Ma Huang (ephedra)

A

-Use Reduce appetite and increase energy, narcolepsy, and nasal congestion
-Active ingredient ephendrine (release of NE)
Efficacy: Well established
Adverse effects” Excessive CNS and CV stimulation
Drug Interactions: CNS stimulants Beta agonist, nasal decongestants, MAOIs, Antihypertensives

25
Q

Kava

A

Use: anxiety and promote sleep
Active: Alpha pyrones or lactonoes
Efficacy: anxiolytic and muscle relaxant good evidence
Adverse effects: CNS depresses and abuse potential, severe liver damage
Drug interactions: Potentiate other CNS depressants (bentos, barbituates, opiod)

26
Q

St. Johns Wort

A

USE: relieve depression
Active ingredient: hyperforin
Efficacy: good evidence in mild to mod depression RCT no difference in mod to severe depression
Adverse: Some allergic RXNS, photo sensitivity, and Mania
Drug Interactions: Induction of CYP 3A4 and P-glycoprotein and serotonin syndrome with SSRIs

27
Q

Saw Palmetto

A
  • Relieve BPH symptoms
  • Active ingredient isn’t know, but extract is anti-androgenic
  • Efficacy RCT no difference from placebo for BPH
  • Adverse effects: Well-tolerated, may reduce PSA (no pregnant females
  • Drug interactions with finasteride
28
Q

Acid or Base ingestions

A

Don’t neutralize (excess heat), dilute with H2O

29
Q

Activated Charcol

A
  • Inert rapidly and irreversibly absorbs drugs and other organic compounds
  • Give in Slurry of H2O within 60 mins.
  • Adverse effects: Aspiration
30
Q

Syrup of Ipecac

A

-NOT RECOMMENDED TO BE USED

31
Q

Enhancement of Elimination

A
  • Urinary arlkalinization (weak organic acids) or acidification (weak bases) substances MUST BE ELIMINATED BY KIDNEY.
  • Hemodialysis
32
Q

Methylene Blue

A
  • Used to treat methylhemaglobinemia
  • Slowly infused
  • May cause serotonin syndrome in Pts taking SSRIs b/c it inhibits MAOs
  • DONT GIVE TO PEOPLE WITH G6PD
  • Can turn urine bluish green
33
Q

Intermittent Porphyria

A
  • Abnormal regulation of heme synthesis –> abnormal accumulation of heme precursors due to deficiency of porphobilinogen deaminase
  • SX: ab pain, peripheral neuropathy, mental dysfunction
  • Induced by drugs that increase rate of heme synthesis (induce CYP450) –> accumulation of toxic heme precursors
34
Q

TX of Intermittent Porphyria

A
  • Withdraw precipitating drug and confirm diagnosis

- Hematin inhibits ALA synthetase

35
Q

Carbon Monoxide

A
  • Combines with ferrous iron of hemoglobin with a 201 fold greater affinity –> Hypoxia
  • Long term affects: Parkinsonism, amnesia, cortical blindness, inhibition of iron containing proteins, NO like effects, may lead to hypoxia-reperfusion injury in CNS
  • TX: get away from CO and give O2
36
Q

Cyanide

A
  • HCN gas, NaCN, cyanogenic glycosides (seed), some people can smell
  • Combines with ferric iron to inactivated cytochrome oxidase and inhibit cellular respiration (onset hints at source)
37
Q

Cyanide treatment

A
  • Hydroxycombalamin: binds CN and forms a stable complex excreted in urine (reddish color of skin, membranes, and urine)
  • Sodium Nitrite: convert hemoglobin to methemoglobin which causes dissociation of CN from Cytochrome oxidase
  • excessive methemoglobinemia (methylene blue) excessive vasodilation causing hypotension
  • Sodium Thiosulfate: rhodanese catalyzed conversion of CN to thiocyanate which is excreted in the urine
38
Q

Chelation

A
  • formation of coordination complexes of metal ions with organic ring systems to prevent the free metal from causing toxicity, promotes urinary or biliary excretion of the metal
  • High affinity for the toxic metal and low affinity for the endogenous (CA,Mg,Zn) must reach sites of deposition, and from a chelates that are less toxic than free metal and are easily excreted
39
Q

Dimercaptol

A
  • Pb, As, Hg
  • Major use is in combo with EDTA fro severe Pb intoxication
  • Must be given IM and urine must be kept basic to prevent renal damage
  • Side effects:
    • Diphenhydramine to prevent histamine related side effects
    • Nausea and vomiting/ pain at injection site
    • Hemolytic Anemia in G6PD
40
Q

Succimer

A
  • chelates Pb in children
  • Pill
  • prevents seizures and fatalities from Pb encephalopathy
  • doesnt reduce long term neuro effects
41
Q

Ca disodium EDTA

A
  • Chelates Pb and Ca
  • Ca salt must be given to prevent tetany
  • IV or IM
  • Given after BAL for initial treatment of severe Pb intoxication (can increase intracranial pressure if given to pts with Pb encephalopathy) used alone for moderate Pb
  • Renal tubular necrosis
42
Q

Deferoxamine

A
  • Fe chelator
  • strip Fe bound to ferritin and hemosiderin but doesn’t affect Fe bound to hemoglobin or cytochrome
  • excreted in Urine and bile
  • acute iron poisoning or pts with thalessemias
  • IV or SC (overnight for chronic overload)
  • Hypotension of admin is too rapid (IV)
  • ARDS when given IV for long periods
  • Long term use may –> visual and auditory loss and increased risk of infx

Pharm (8 decks)

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