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Pharm test 3 > GI > Flashcards

GI Flashcards

1
Q

Where do ulcers occur?

A

stomach and duodenum

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2
Q

Why are ulcerations in the duodenum common?

A

because it has to deal with acid from the stomach

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3
Q

Who are stress ulcers most common in? Why?

A

critically ill
ventilated patients (48 hours)
head and burn trauma –They are hypermetabolic. They require more calories. All these people require PPX.

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4
Q

Which medicine most likely causes ulcers? by what mechanisms? (3)

A

NSAIDS

  1. decrease gastric mucus production
  2. Anticoagulation (bleeding)
  3. lower pH via ASA
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5
Q

Which bacteria causes ulcers? How do they survive? How do they cause ulcers? How do you treat it?

A

H. pylori
It is Gram neg that secretes bicarb. This allows them to survive in the acidic environment.
It produces low grade inflammation.
Tx-antibiotics

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6
Q

What is ZE syndrome?

A

Zollinger-Ellison syndrome -

tumor that produces acid

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7
Q

How do you treat ulcers? (Generally)

A

increase mucous and decrease acid

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8
Q

How is GERD treated?

A

reduce acid, coat and protect esophagus, improve LES tone, lower abdominal pressure

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9
Q

What is a sign of GERD (other than pain)?

A

Cough because acid triggers the cough reflex.

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10
Q

What is achalasia? how do you treat it?

A

too much LES tone

CCB –N and A

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11
Q

What is the sphincter that separates stomach and duodenum?

A

pyloric

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12
Q

PGs have what role in the gut?

A

produces mucus and protects lining

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13
Q

How do NSAIDS affect the mucus lining?

A

NSAIDS block PGs, thereby decreasing mucus production, and increasing risk of ulcers.

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14
Q

Sucralfate does/does not prevent ulcerations?

A

NO, it acts as a bandaid once an ulcer is already there.

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15
Q

Does sucralfate have many or few AEs? Why?

A

Few because it is not absorbed in the gut. Has a local effect.

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16
Q

How does sucralfate affect the pH of the stomach?

A

It doesn’t affect it.

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17
Q

Disadvantage of sucralfate?

A

Has to be taken 4x a day on EMPTY stomach. otherwise it would to food.
Also, its a chelator. It binds to heavy metals like iron, zinc, magnesium/Na (which are in antacids and vitamins). So, when it binds, it ends up in the poop….not used very much anymore!

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18
Q

What is another chelator?

A

milk - because it has calcium in it

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19
Q

What cell is involved in the stomach and what do they do? What two chemicals tell them to do that (ring the doorbell)?

A

Parietal cells secrete H+.

histamine and ACh

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20
Q

Shocking or not shocking that ACh tells parietal cells to secrete acid?

A

NOT SHOCKING. because parasympathetic NS stimulates the gut to digest food. (Epi/NE decrease acid production)

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21
Q

Which receptor does histamine bind to in the gut? what about in the periphery (nose)?

A

H2 - stimulates acid

H1 - stimulates allergic rxn in the nose and releases mucus

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22
Q

What are examples of H2RB? Are they OTC or prescription? Are they well- tolerated?

A

Cimetidine, Famotidine, Nizatidine, Ranitidine

Some are OTC, some are IV. Generally very well tolerated.

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23
Q

what are the common AE of H2RB?

A

CNS alterations-confusion

thrombocytopenia

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24
Q

All H2RB are _________eliminated?

A

Renally

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25
Q

Why would patients be on H2RB in the ICU? What common side effect could occur? What even worse condition could happen?

A

They are on stress ulcer PPX!
Confusion
Bacterial translocation leading to nosocomial PNA…Raising the pH of the stomach allows growth of bacteria and the transport from the gut to the lungs.

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26
Q

what 4 drugs needs acid to be absorbed?? What happens when you decrease acid production in the stomach with H2RB?

A 
Itraconzaole
digoxin
iron
atazanavir
You decrease their effects because it cannot be absorbed.
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27
Q

What is iron coformulated with?

A

Vitamin C – its asorbic acid

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28
Q

How do PPIs work?

A

They block the pump that pumps acid out of the parietal cell. So regardless of how much the cell is stimulated, it is IRREVERSIBLY SHUT DOWN.

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29
Q

Why are PPIs more potent than H2RBs?

A

Because they also shut down the effects of ACh (which H2RB do not affect). PPIs lock the door!

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30
Q

What other heart drug also inhibits the final common pathway?

A

GP2/3 inhibitors

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31
Q

PPIs have what ending to their names?

A

-“prazole”

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32
Q

T/F PPIs are slow on, slow off. How is this different from H2RB?

A

True.

H2RB are faster-acting.

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33
Q

PPIs are ________ eliminated. Why is this convenient?

A

Hepatically.

H2RB are renally eliminated. So you can switch between them when there is a problem with either kidneys or liver.

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34
Q

Would spacing your PPI from your iron help? With H2RB?

A

No. They are so potent that it wouldn’t help. with the h2rb, maybe.

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35
Q

T/F: PPIs also interact with drugs which require acid to be absorbed (like iron).

A

True.

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36
Q

Prokinetics stimulate ________. and what 3 things are they used for?

A

They stimulate peristalsis.

Anti-emetics for GERD, gastroparesis, and to facilitate feeding tube placement.

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37
Q

Metoclopramide is a type of what drug class?

A

prokinetics

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38
Q

How does metoclopramide work? and what are 3 results that stimulate peristalsis?

A

Enhances upper GI smooth muscle response to ACh

  1. increases GI motility
  2. accelerates gastric emptying
  3. blocks DA receptors in the chemo trigger zone (vomiting center of the brain).
39
Q

You want the feeding tube to be where in the stomach?

A

Post-pyloric to decrease reflux

40
Q

What does DA have to do with metoclopramide? What patients should probably not take it? What is a side effect related to this concept?

A

It blocks the DA receptors. DA is an adrenergic drug, which is anti-cholinergic and slows digestion. You want to block it.
It could exacerbate Parkinson’s dz (which lacks DA).
Tremor.

41
Q

Name another prokinetic other than metaclopromide (Reglan). Like Reglan, it works by doing what, and has what 3 effects does it have on the gut?

A

Cisapride (Propulsid)…Enhances GI response to ACh at the mysteric plexus.

  1. Increases LES tone
  2. Increases GI motility
  3. Accelerates GE
42
Q

What does Propulsid have to do with ACh?

A

it enhances GI response to ACh at the mesenteric plexus

43
Q

How is Propulsid different from Reglan (as far as the effects go)

A

Propulsid effects are seen throughout the entire GI tract. It is more potent (may cause diarrhea).

44
Q

What are common AE of prokinetics?

A

diarrhea, dizziness, confusion

45
Q

What is a serious side effect of cisapride (propulsid)?

A

QT prolongation - torsades de pointes – now it is a closed distribution drug.

46
Q

What other drugs may interact with prokinetics?

A

anti-cholinergics (which are the opposite of what you want!)

47
Q

How do antacids work? What do they contain?

A

Neutralize acid with base (do not affect production).

Contain salt – usually aluminum, sodium or magnesium

48
Q

ACMD?

A

aluminum – constipation

Magnesium – diarrhea

49
Q

What are 2 cautions with antacids?

A
  1. Na load. People with HTN or CV issues do not like salt retention.
  2. Chelation.
50
Q

Alginic Acid is a treatment for what condition?

A

GERD

51
Q

Why don’t we use antacids a lot?

A

They are liquid, chalky, cause taste disturbances, need to take them QID.

52
Q

Milk of mag is what time of drug?

A

antacid

53
Q

What is misoprostol?

A

Prostaglandin analog that stimulates mucus formation in the gut!

54
Q

What is the only indication for Misoprostol?

A

prevention of NSAID induced ulcers (Cytotec, Arthrotec).

55
Q

What are the AE’s of misoprostol?

A

diarrhea, uterine contractions

56
Q

Is misoprostol safe for pregnant patients?

A

NO. it causes contractions.

57
Q

What drugs cause constipation?

A

Narcotics and aluminum

58
Q

What do we use to treat constipation?

A

laxatives

59
Q

what is the #1 risk of laxative overuse? and how does it present?

A

electrolyte disturbances, particularly hyponatremia…seizures!

60
Q

Magnesium sulfate is what type of drug?

A

laxative

61
Q

How does lactulose work?

A

It is a synthetic sugar (that is not absorbed) that pulls water into the gut.

62
Q

Polyethylene glycol (PEG) has what brand name? What it is used for? How does it work?

A

GoLYTELY.
Used pre-colonoscopy.
Sugar that pulls water into colon.

63
Q

What drug is a stool softener?

A

docusate sodium.

64
Q

How does bisacodyl (Dulcolax) work?

A

stimulant that increases colon motility.

65
Q

How does Castor oil help with constipation?

A

lubricates the stool

66
Q

What is SENA?

A

stimulant to increase motility.

67
Q

What is sorbitol?

A

Laxative. Sugar that sucks fluid into the colon.

68
Q

What is propylene glycol?

A

diluent

69
Q

What is ethylene glycol?

A

anti-freeze

70
Q

What drug causes diarrhea?

A

magnesium

71
Q

What can we use to treat flatulence?

A

Simethicone.

72
Q

How does simethicone work?

A

Surfactant that decreases gas bubble formation in the colon.

73
Q

What OTC product prevents gas bubble formation?

A

BEANO

74
Q

What causes gas in the stomach?

A

Bacteria in colon that break down sugars (that cannot be absorbed) and releases gas as a byproduct.

75
Q

Antimotility agents are supposed to be avoided in what patients?

A

C. DIFF

76
Q

Diphenoxylate + Atropine = …

A

Lomotil

77
Q

What is Lomotil used for? Why is this obvious?

A

anti-motility. Atropine is the father of anti-cholinergics, which slow gastric motility.

78
Q

What are two other anti-motility agents other than Lomotil?

A

Codeine and Loperamide (Immodium)

79
Q

What is Loperamide?

A

Immodium.

80
Q

What causes Traveler’s Diarrhea? What is the tx?

A

E. coli, salmonella, Norwalk virus, Giardia

Ciprofloxacin 500 mg PO BID x 3days

81
Q

What is the tx for C DIFF?

A

PO vancomycin.

82
Q

Where do people get Norwalk Virus?

A

crew ships

83
Q

Where do kids get Giardia?

A

standing water, like kiddy pools

84
Q

What are the 3 treatments for ulcerative colitis? Which ones would you try first?

A

Local antiinflammatary agents designed to be released in the colon- Sulfasalazine & Masalamine
Glucocorticosteroids, too.
Use S & M first because they have localized effects.

85
Q

Is oral vancomycin hydrophilic or lipophilic? Why?

A

Hydrophilic because it needs to stay in the colon.

86
Q

What is the only drug used for IBS? how does it work?

A

Dicyclomine (Bentyl)

It is an anti-spasmodic/anti-cholinergic drug that is very specific to intestinal musculature.

87
Q

T/F We could use stomach specific anti-cholinergic drugs to treat peptic ulcer disease?
Do they exist?

A

True because ACh stimulates the gut.
No. The reason we do not use anti-cholinergics because they have so many systemic effects (sedation, dry mouth, urinary retention, tachycardia).

88
Q

T/F Prokinetics and be used as anti-emetics.

A

T

89
Q

Name 6 anti-emetics.

A
  1. Antihistamine (Meclizine-Dramamine)
  2. Phenothiazines (PO, IV, PR)
  3. 5-HT3 RB (Zofran) in the CTZ
  4. BDZs (additive) - anti-anx
  5. Cannabinoids - appetite stimulant, too
  6. Corticosteroids (DM)
  7. Substance P RB
90
Q

Why is dexamethasone the steroid of choice to treating N/V?

A

It is highly lipophilic and crosses the BBB. It reaches the CTZ.

91
Q

What is substance P?

A

It modulates pain and N/V.

92
Q

Name a “table-strength” prescription antiemetic.

A

Phenothiazines - Prochlorperazine (Compazine)

93
Q

What is phenergan?

A

Promethazine - in the phenothiazine class

94
Q

What CrCl leads to dose adjustment for H2RBs? What happens if you don’t adjust?

A

Pharm test 3 (9 decks)

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