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Pharm > GI > Flashcards

GI Flashcards

1
Q

3 Ways to Tx PUD

A
  • Decrease acid
  • Eliminate H. pylori
  • Protect mucosa
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2
Q

Antacids (4)

A
  • Aluminum
  • Mg
  • Calcium
  • Sodium bicarbonate
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3
Q

Causes diarrhea

A

Mg

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4
Q

Causes constipation

A

Aluminum

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5
Q

Often combined to cancel each other’s effect on GI motility out

A
  • Aluminum

- Magnesium

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6
Q

Considered “candy”

A
  • Antacids, Tums
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7
Q

Drug interactions with antacids common because ______, (4 drugs affected)

A

They form insoluble complexes with drugs like

  • Theophylline
  • Ketoconazole
  • Quinolone antibiotics
  • Tetracycline
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8
Q

Antacids decrease absorption of _______ (3 drugs)

A
  • Digoxin
  • Phenytoin
  • Propranolol
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9
Q

Antacids increase elimination of _____ (2 drugs)

A
  • Phenobarbital

- Salicylates

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10
Q

What do antacids do to urine?

A

Alkalinalize

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11
Q

Uses of Antacids (3)

A
  • Relief of heart burn, gastritis
  • Temporary fix
  • Adjunct to other drugs, because effect is quick
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12
Q

Systemic effects of antacids

A
  • Rare
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13
Q

Antacids affect (2)

A
  • Renal function

- CHF (watch Na)

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14
Q

H2 Antagonists (4)

A
  • Cimetidine
  • Ranitidine
  • Famotidine
  • Nizatidine
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15
Q

H2 Antagonists MOA

A
  • Decrease GI acid formation through H2 receptor blockade
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16
Q

H2 Blockers Tx

A
  • Ulcers
  • Most effective at night
  • GERD (as adjuncts)
  • Pre-anesthesia
  • With H1 antagonists for severe allergic rxn
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17
Q

H2 blocker metabolism (3)

A
  • Metabolized by liver, excreted by kidney
  • Usually oral
  • t 1/2 = 12 hrs
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18
Q

H2 blocker SE

A
  • Few, but worse in elderly
  • HA, dizziness, N
  • Rash, itch
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19
Q

Cimetidine SE

A
  • Anti-testosterone effect
  • May be useful in women (treat hirsutisim)
  • Chronic, high doses may cause gynecomastia, loss libido, impotence in men
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20
Q

Cimetidine Drug Interactions (2)

A
  • Inhibits CYP3A

- Warfarin, phenytoin, theophylline, digoxin

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21
Q

Proton Pump Inhibitors (4)

A
  • Omeprazole
  • Esomeprazole
  • Lansoprazole
  • Rabeprazole
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22
Q

Proton Pump Inhibitor MOA (2)

A
  • Activated in gastric parietal cell

- Irreversible block of acid formation

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23
Q

DOC for GERD

A

PPI

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24
Q

Proton Pump Inhibitor MOA (2)

A
  • Activated in gastric parietal cell to sulfenamide
  • Irreversible block of acid formation
  • Administered as pro-drugs
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25
Q

PPI SE (6)

A
  • N/D/Colic
  • Osteoporosis (decrease Ca absorption)
  • Dec Mg absorption (leg cramps)
  • HA, dizziness, sleepiness uncommon
  • Increase ALT, AST
  • Skin rash, bacterial overgrowth possible
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26
Q

May inhibit CYP2C19 –> phenytoin, warfarin, diazepam, clopidogrel possible interactions

A

Omeprazole

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27
Q

PPI Uses (4)

A
  • Ulcers that haven’t responded to H2 antagonists
  • Heal duodenal ulcer or gastric ulcer
  • Pts on NSAID
  • ZE syndrome
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28
Q

Cytoprotective Agents

A
  • Sucralfate
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29
Q

Cytoprotective MOA

A
  • Polymerizes to provide protective barrier cells in ulcer base
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30
Q

Sucralfate SE

A
  • Constipation (contains aluminum)
  • Upset stomach
  • Drug interactions
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31
Q
  • Prostaglandin E1 analogue
A

Misoprostol

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32
Q

Misoprostol Tx

A
  • Prevent or reduce NSAID - induced damage
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33
Q

NOT used in pregnancy, can induce abortion

A

Misoprostol

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34
Q

D2 Antagonist

A

Metocloropramide

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35
Q

Metocloropramide MOA

A
  • D2 antagonists –> increases ACh release
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36
Q

Metocloropramide SE (3)

A
  • Parkinson’s like symptoms
  • Increase prolactin
  • Methemoglobinemia in infants (NOT to be used in pregnancy)
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37
Q

Bethanechol MOA

A
  • M agonist
38
Q

Used in diabetic gastroparesis

A

Erythromycin

39
Q

Prokinetic agents

A
  • Metoclopramide
  • Bethanechol
  • Erythromycin
40
Q

IBS Tx

A
  • Glycopyrrolate
  • Dicyclomine
  • TCA (good for pain)
41
Q

Proton Pump Inhibitors (5)

A

“Prazole”

  • Omeprazole
  • Esomeprazole
  • Lansoprazole
  • Rabeprazole
  • Pantoprazole
42
Q

IBS due to ______ (4)

A
  • Stimulation of 5HT4 receptors on nerve terminal increases ACh release
  • Increases peristalsis
  • Release of 5 HT from EC stimulates 5HT3 receptors
  • Sends pain signal to CNS
43
Q

Alosetron MOA

A
  • 5HT3 receptor antagonist
44
Q

Alosetron Tx

A
  • IBS with severe diarrhea in women
45
Q

Alosetron SE (3)

A
  • Constipation
  • GI obstruction, perforation
  • MANY contraindications –> risk benefit statement required
46
Q

Taken off market due to cardiac events

A

Tegaserod

47
Q

Tegaserod MOA

A

5 HT4 partial agonist

48
Q

5 HT3 Antagonists (4)

A

“Setron”

  • Ondansetron
  • Granisetron
  • Dolasetron
  • Palonosetron
49
Q

Very effective for N/V induced by chemo, radiation, gastric dz

A

5 HT3 antagonists (“Setron”)

50
Q

Prochlorperazine, Promethazinen MOA

A

Block DA, muscarinic, histamine receptors

51
Q

Prochlorperazine, Promethazinen Tx (4)

A
  • Post op
  • Gastroenteritis
  • Chemo
  • Motion sickness (not DOC though)
52
Q

Prochlorperazine, Promethazinen SE

A
  • Highly sedating
53
Q

Used for chemo induced N/V, stimulates appetite

A
  • Dronabinol, Medical marijuana, Nabilone
54
Q

Laxative MOA (4)

A
  • Increase GI motility
  • Prevent reabsorption of water/electrolytes
  • Enhance secretion of water/electrolytes
  • Dissolve or lubricate feces
55
Q

Bulk forming agents

A
  • Fiber (dietary, methylcellulose, psyllium, polycarbophil)

- High fiber diet best

56
Q

Fiber SE

A
  • Bloating and flatulence common
57
Q

Osmotic laxatives (3)

A
  • Mg Hydroxide (stimulate GI tract, increase peristalsis)
  • Na Salts (oral, enema)
  • Sorbitol, Mannitol, Sucralose (sweeteners)
58
Q

Polyethylene glycol MOA

A
  • Insoluble, holds water in intestine
59
Q

Polyethylene glycol Tx

A
  • Prep for colonoscopy
60
Q

OTC for ocassional constipation

A

Miralax used for up to 7 days

61
Q

Lactulose Tx

A
  • Used in cirrhosis and liver dz to decrease blood ammonia levels
62
Q

Lactulose MOA (2)

A
  • Conversion to lactic acid, decrease pH in gut lumen

- Traps ammonium in gut lumen

63
Q

Lactulose SE (2)

A
  • Flatulence

- Diarrhea

64
Q

Mucosal Agents (3)

A
  • Bisacodyl
  • Senna
  • Castor oil
65
Q

Mucosal Agent MOA

A
  • Stimulate peristalsis

- Enhance secretion/inhibit absorption H2O

66
Q

Intense Mucosal agent that is not recommended

A

Castor oil

67
Q

Mucosal Agent Tx (2)

A
  • Surgery

- Diagnostics

68
Q

Mucosal Agent requires _____

A

Bile

69
Q

Mucosal Agents CI

A
  • Pregnancy (stimulates uterus)
70
Q

Lubricants/Softeners MOA

A
  • Increase bulk

- Soften and lubricate stool

71
Q

Lubricants/Softeners (3)

A
  • Mineral Oil
  • Docusate
  • Glycerin
  • – Not very effective
72
Q

Mineral Oil MOA

A

Fat soluble vitamins, inhalation orally (aspiration PNA), leaking (need to wear depends)

73
Q

Docusate MOA

A

Emulsifies, softens, may incraese water

74
Q

Glycerin MOA

A

Lubricate

75
Q

Lubiprostone MOA

A
  • Prostaglandin E1 analogue

- Activates CIC-2 Cl channels in luminal cells to increase fluid secretion

76
Q

Lubiprostone Features (6)

A
  • Softer stool, better motility
  • Fewer symptoms of constipation
  • No effect on electrolytes
  • No lax dependence
  • N/D, HA
  • Not absorbed systemically
77
Q

Use of Laxatives (7)

A
  • Reduce straining
  • Maintain soft stools
  • Empty bowel for dx or surgical procedures
  • Decrease bowel tone
  • Geriatrics, preg
  • Get rid of pathogens/toxins
  • Constipation
78
Q

Contraindications of Laxatives

A
  • N/V
  • Abd cramps
  • Undx abd pain
  • Appendicitis
  • Intestinal obstruction
79
Q

Over use of laxatives can lead to (4)

A
  • Dependence
  • Fluid/electrolyte imbalance
  • Spastic colitis
  • Ulcerative colitis
80
Q

Diarrhea drugs MOA (3)

A
  • Absorb excess water (Fiber, Al salts)
  • Inhibit secretion
  • Decrease motility (opioids, anticholinergics)
81
Q

Absorbents MOA (3)

A
  • Absorb water, form gel-like mass
  • Increase bulk
  • Dietary (bananas, applesauce)
  • Not very effective
82
Q

Opioids in Diarrhea

A
  • Loperamide (Imodium)

- Diphenoxylate/ atropine (Lomotil)

83
Q

Loperamide (Imodium) Features (2)

A
  • Does NOT enter CNS (low abuse)

- May cause abd pain/constipation

84
Q

Diphenoxylate/ atropine (Lomotil)

A
  • With atropine, decreases abuse, increase effectiveness

- Anticholinergic SE

85
Q

Opioid CI

A
  • Infections (dec expulsion of pathogens)
  • Ulcerative colitis (toxic megacolon)
  • Recovering drug addicts (some abuse potential)
86
Q

Bismuth subsalicylate MOA

A
  • Absorb water

- Absorb pathogens

87
Q

Bismuth subsalicylate Tx

A
  • Traveller’s diarrhea
88
Q

Black tongue, mouth and stool

A

Bismuth subsalicylate

89
Q

Bismuth subsalicylate CI

A
  • Pts allergic to aspirin
  • Childrens (reyes)
  • Caution in asthmatics
90
Q

Simethicone MOA (FYI)

A
  • Coats gas, dissipates

- Decreases bloating flatulence

91
Q

Sulfsalazine (FYI)

A
  • Antiinflamm
  • 5 aminosalicylic acid plus sulfapyridine
  • Bacteria in GI tract activate it
  • Used in Inflamm bowel dz
  • Allergic rxn possible
  • Avoid in children (reyes)

Pharm (10 decks)

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