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Pharmacology Test 3 > GI > Flashcards

GI Flashcards

1
Q

Bismuth Subsalicylate (Pepto-Bismol)

A
  • NV
  • SUBSALICYLATE=BLEEDING
  • NO MORE THAN 4 G IN 24 HR
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2
Q 
Bismuth Subsalicylate (Pepto-Bismol) 
Pharm
A
  • Salicylate well absorbed in stomach, 80%
  • bismuth poor absorb, but coats ulcers well
  • Subsalicylate hydrolized in stomach into salicylate
  • sali excret in urine
  • bismuth excret in stool
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3
Q 
Bismuth Subsalicylate (Pepto-Bismol) 
SE
A
  • discolored tongue

- black stools

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4
Q 
Bismuth Subsalicylate (Pepto-Bismol) 
Contra
A
  • Peds (Reyes Syndrome)

- ALLERGY TO ASPRIN

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5
Q

Phenothiazines

A
  • NV
  • Promethazine (Phenergan), Prochlorperazine (Compazine)
  • NOT 1ST CHOICE
  • ANTIDOPAMINERGIC (BLOCKS DOPAMINE RECEPTERS)
  • SEDATION, DIZZINESS
  • no under 2 (resp depress)
  • mood changes
  • constipation
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6
Q

Phenothiazines
-Promethazine (Phenergan), Prochlorperazine (Compazine)
MOA

A

-ANTIDOPAMINERGIC (BLOCKS DOPAMINE RECEPTERS)
blocks vagus nerve in gi tract
-phenergan antihistamine to H1 recepters

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7
Q

Phenothiazines
-Promethazine (Phenergan), Prochlorperazine (Compazine)
Pharm

A
  • metab liver

- excret stool

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8
Q

Phenothiazines
-Promethazine (Phenergan), Prochlorperazine (Compazine)
SE

A
  • SEDATION
  • DIZZINESS
  • mood changes
  • constipation
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9
Q

Phenothiazines
-Promethazine (Phenergan), Prochlorperazine (Compazine)
Contra

A
  • bad HTN
  • no under 2 (resp depress)
  • BPH
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10
Q

Serotonin 5-HT Receptor Antagonists

A
  • NV
  • Ondansetron (Zofran), Palonosetron (Aloxi)
  • Selective 5-HT3 Receptor Antagonist binds in CNS and periphery, reducing vagal nerve stim
  • not clear if effects are from CNS or periphery
  • SE=QT Prolongation
  • Contra=Congenital Long QT Syndrome, Any Meds that prolong QT
  • well absorb po, especially w/ food
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11
Q

Serotonin 5-HT Receptor Antagonists
-Ondansetron (Zofran), Palonosetron (Aloxi)
MOA

A
  • Selective 5-HT3 Receptor Antagonist binds in CNS & periphery, reducing vagal nerve stim
  • not clear if effects are from CNS or periphery
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12
Q

Serotonin 5-HT Receptor Antagonists
-Ondansetron (Zofran), Palonosetron (Aloxi)
PHARM

A
  • well absorb PO, best with food
  • metab liver
  • 70% protein bound
  • excret urine
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13
Q

Serotonin 5-HT Receptor Antagonists
-Ondansetron (Zofran), Palonosetron (Aloxi)
SE

A
  • headache
  • dizziness
  • QT Prolongation
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14
Q

Serotonin 5-HT Receptor Antagonists
-Ondansetron (Zofran), Palonosetron (Aloxi)
Contra

A
  • allergy
  • Congenital Long QT Syndrome
  • No meds that prolong QT
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15
Q

Acid Reflux/ Gastritis

A
  • very common, 10%
  • No ONE CAUSE
  • transient lower esophageal sphinter relaxation
  • low resting esophag sphinc
  • bad esophag acid clearance
  • esophag motility defect
  • impaired mucosal resistance & other protective defenses
  • burning sensation, chest pain, globus sensation
  • acidic or spicy foods
  • lifestyle modification first
  • common in pregnancy
  • Kids can take anything for GERD
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16
Q

Antacids

A
  • Acid Reflex/Gastritis
  • Sodium Bicarbonate (Baking Soda), Calcium Carbonate, Magnesium Hydroxide, Aluminum Hydrozide
  • Alkalizing Agent
  • Bad Kidney=Don’t Give
  • Contra=Renal Failure for meds with Aluminum and Magnesium
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17
Q

Antacids
-Sodium Bicarbonate (Baking Soda), Calcium Carbonate, Magnesium Hydroxide, Aluminum Hydroxide
MOA

A
  • weak bases react w/ gastric acid to form a salt and water, which decreases gastric acidity
  • Alkalizing agent
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18
Q

Antacids
-Sodium Bicarbonate (Baking Soda), Calcium Carbonate, Magnesium Hydroxide, Aluminum Hydroxide
PHARM

A
  • bicarbonate some po absorb, better with food
  • hydroxide poor po
  • carbonate excret stool
  • aluminum and magnesium excret in urine
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19
Q

Antacids
-Sodium Bicarbonate (Baking Soda), Calcium Carbonate, Magnesium Hydroxide, Aluminum Hydroxide
SE

A

-dependence

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20
Q

Antacids
-Sodium Bicarbonate (Baking Soda), Calcium Carbonate, Magnesium Hydroxide, Aluminum Hydroxide
Contra

A
  • Renal Failure for those with Aluminum or Magnesium

- Bad Kidney, Don’t give!

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21
Q

Sucralfate (Carafate)

A
  • Acid Reflux/Gastritis
  • can change other meds
  • paste coats ulcers
  • post gastric bypass
  • dissolve in H2O for 30 mins
    • joins - to form protective barrier
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22
Q

Sucralfate (Carafate)

MOA

A
    • charged sucrose sulfate binds to - charged proteins in base of ulcers, forms adherent protective barrier from gatric acid and bile salts (+ joins - to form protective barrier)
  • dissolve in H2O for 30 mins
  • paste coats ulcers
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23
Q

Sucralfate (Carafate)

PHARM

A
  • little absorb

- excret in stool

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24
Q

Sucralfate (Carafate)

SE

A

-constipation

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25
Q

Sucralfate (Carafate)

Contra

A
  • allergy

- may affect absorb of other meds!

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26
Q

H-2 Receptor Antagonists

A
  • Acid Reflux/ Gastritis
  • Ranitdine (Zantac), Famotidine (pepcid), Cimetidine (Tagamet)
  • 1st line!
  • competitive inhibitors of H-2 Receptors in gastric parietal cells cause decrease gastric acid
  • No H1 or H3 efficacy, so no sedation
  • Gynecomastia
  • decrease ETOH, don’t take w/ wine
  • food in belly=wait 3 hrs
  • lay down
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27
Q

H-2 Receptor Antagonists
-Ranitdine (Zantac), Famotidine (pepcid), Cimetidine (Tagamet)
MOA

A
  • competitive inhibitors of H-2 Receptors in gastric parietal cells cause decrease gastric acid
  • No H1 or H3 efficacy, so no sedation
  • decrease ETOH, don’t take w/ wine
  • food in belly=wait 3 hrs
  • lay down
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28
Q

H-2 Receptor Antagonists
-Ranitdine (Zantac), Famotidine (pepcid), Cimetidine (Tagamet)
PHARM

A
  • good po
  • bioavail 50%
  • metab liver
  • excret urine
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29
Q

H-2 Receptor Antagonists
-Ranitdine (Zantac), Famotidine (pepcid), Cimetidine (Tagamet)
SE

A
  • headache
  • dizziness
  • confusion in elderly
  • gynecomastia
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30
Q

H-2 Receptor Antagonists
-Ranitdine (Zantac), Famotidine (pepcid), Cimetidine (Tagamet)
CONTRA

A
  • confusion in elderly

- potent P450 inhibitor

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31
Q 
Bismuth Subsalicylate (Pepto-Bismol) 
PTS
A

-no peds (Reyes Syndrome)

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32
Q

Phenothiazines
-Promethazine (Phenergan), Prochlorperazine (Compazine)
PTS

A
  • bad HTN
  • no under 2 (resp depress)
  • BPH
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33
Q

Antacids
-Sodium Bicarbonate (Baking Soda), Calcium Carbonate, Magnesium Hydroxide, Aluminum Hydroxide
PTS

A
  • Preg B

- BF OK

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34
Q

Serotonin 5-HT Receptor Antagonists
-Ondansetron (Zofran), Palonosetron (Aloxi)
PTS

A
  • allergy
  • Congenital Long QT Syndrome
  • No meds that prolong QT
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35
Q

Antacids
-Sodium Bicarbonate (Baking Soda), Calcium Carbonate, Magnesium Hydroxide, Aluminum Hydroxide
PTS

A
  • Bad Kidney, Don’t give!
  • Preg B
  • BF OK
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36
Q

Sucralfate (Carafate)

PTS

A
  • Preg B
  • Off label peds
  • allergy
  • can change absorb of other meds
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37
Q

H-2 Receptor Antagonists
-Ranitdine (Zantac), Famotidine (pepcid), Cimetidine (Tagamet)
PTS

A
  • Preg B
  • Peds OK
  • confusion in elderly
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38
Q

Proton Pump Inhibitors (PPIs)

A
  • Acid Reflux/ Gastritis
  • Omeprazole (Prilosec), Lansoprazole (Prevacid), Pantoprazole (Protonix), Esomeprazole (Nexium)
  • Good for Renal (mostly liver)
  • take on an empty stomach 1st thing in AM
  • low B12 increases pernicious anemia (long term take supplements)
  • Protein bound
  • 4-8 wks then diagnostics
  • ulcers
  • lower CA absorb
  • short half life
  • lower Clopidogrel activation
  • Prodrug, must survu=ive acidic environment to be absorb in small bowel
  • SE=increased risk of osteoporosis related fractures w/ prolonged use
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39
Q

Proton Pump Inhibitors (PPIs)
-Omeprazole (Prilosec), Lansoprazole (Prevacid), Pantoprazole (Protonix), Esomeprazole (Nexium)
MOA

A
  • binds irreversibly to H+/K+ exchanging ATPase pumps (Proton Pumps) in gastric parietal cells
  • decreases basal and stimulated acid secretion
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40
Q

Proton Pump Inhibitors (PPIs)
-Omeprazole (Prilosec), Lansoprazole (Prevacid), Pantoprazole (Protonix), Esomeprazole (Nexium)
PHARM

A
  • take on an empty stomach 1st thing in AM
  • low B12 increases pernicious anemia (long term take supplements)
  • Protein bound
  • short half life
  • lower Clopidogrel activation
  • Prodrug, must survu=ive acidic environment to be absorb in small bowel
  • good po avail, decreased w/ food
  • metab in liver
  • inhibits CYP2C19
  • excret in stool
  • adjust dose for hepatic disease
  • little renal excret
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41
Q

Proton Pump Inhibitors (PPIs)
-Omeprazole (Prilosec), Lansoprazole (Prevacid), Pantoprazole (Protonix), Esomeprazole (Nexium)
SE

A

-headache
-increase risk of C. Diff infection
-low Mg w/ prolonged use
increased risk of osteoporosis related fractures w/ prolonged use

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42
Q

Proton Pump Inhibitors (PPIs)
-Omeprazole (Prilosec), Lansoprazole (Prevacid), Pantoprazole (Protonix), Esomeprazole (Nexium)
CONTRA

A

-allergy

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43
Q

Proton Pump Inhibitors (PPIs)
-Omeprazole (Prilosec), Lansoprazole (Prevacid), Pantoprazole (Protonix), Esomeprazole (Nexium)
PTS

A
  • osteoporosis
  • hepatic pt adjust dose
  • Good for Renal (mostly liver)
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44
Q

Gastric Motility Agents

A
  • Metclopromide (Reglan)
  • gi motility caused by D2 Antagonism
  • emotion
  • concurrent use of drugs capable of causing EPS/TD (involuntary face movements)
  • no more than 8-12 wks
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45
Q

Gastric Motility Agents
-Metclopromide (Reglan)
MOA

A
  • binds to dopamine D2 Receptors in CNS and some 5-HT3 antagonism
  • gi motility caused by D2 Antagonism
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46
Q

Gastric Motility Agents
-Metclopromide (Reglan)
PHARM

A
  • well absorb po
  • bioavail 65-90%
  • metab liver
  • excret in urine
  • decrease dose in renal insuff
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47
Q

Gastric Motility Agents
-Metclopromide (Reglan)
SE

A
  • EPS secondary to dopamine blockade
  • high prolactin
  • gynemastia
  • galactorrhea
  • irreversible tardive dyskinesia (involun face movements)
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48
Q

Gastric Motility Agents
-Metclopromide (Reglan)
Contra

A
  • allergy

- concurrent use of drugs capable of causing EPS/TD (involuntary face movements)

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49
Q

Gastric Motility Agents
-Metclopromide (Reglan)
PTS

A
  • Safe Preg
  • No BF
  • Off-label in Peds
  • decrease dose in renal insuff
  • concurrent use of drugs capable of causing EPS/TD (involuntary face movements)
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50
Q

Constipation

A
  • ask what their normal pattern is
  • decreased stool passage
  • straining, hard pellet stools
  • Causes: potty training (control), meds, diet, tumors, kids w/ developmental delays (frequent small mushy stools, Encropresis)
  • 1st line always Osmotic Laxative, Polyethylene Glycol (Miralax) always 1st line med (doesn’t alter glucose or electrolyes like colace)
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51
Q

Osmotic Laxatives

-Magnesium hydroxide (Milk of magnesia), Lactulose, Magnesium Citrate, Polythylene glycol (Miralax)

A
  • constipation
  • “1st line treatment”
  • Polythylene glycol (Miralax) used first line medication
  • great option for long term treatment
  • 12 hours to work
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52
Q

Osmotic Laxatives
-Magnesium hydroxide (Milk of magnesia), Lactulose, Magnesium Citrate, Polythylene glycol (Miralax)
MOA

A
  • Causes water retention in stool

- Soluble but not nonabsorbable compounds

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53
Q

Osmotic Laxatives
-Magnesium hydroxide (Milk of magnesia), Lactulose, Magnesium Citrate, Polythylene glycol (Miralax)
PHARM

A
  • No PO absorption

- Eliminated in stool as unchanged drug

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54
Q

Osmotic Laxatives
-Magnesium hydroxide (Milk of magnesia), Lactulose, Magnesium Citrate, Polythylene glycol (Miralax)
SE

A
  • Diarrhea

- Abdominal complaints

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55
Q

Osmotic Laxatives
-Magnesium hydroxide (Milk of magnesia), Lactulose, Magnesium Citrate, Polythylene glycol (Miralax)
CONTRA

A
  • Existing electrolyte abnormalities

- Under 2 years of age

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56
Q

Osmotic Laxatives
-Magnesium hydroxide (Milk of magnesia), Lactulose, Magnesium Citrate, Polythylene glycol (Miralax)
PTS

A
  • no Existing electrolyte abnormalities

- no Under 2 years of age

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57
Q

Bulk Laxatives

A
  • constipation

- Metamucil, Fibercon

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58
Q

Bulk Laxatives
-Metamucil, Fibercon
MOA

A
  • Absorb water and enlarge stools

- Stimulates propulsive movements of lower GI tract

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59
Q

Bulk Laxatives
-Metamucil, Fibercon
PHARM

A
  • No PO absorption

- Excreted in stool as unchanged drug

60
Q

Bulk Laxatives
-Metamucil, Fibercon
SE

A
  • Nausea
  • Vomiting
  • Abdominal fullness
61
Q

Bulk Laxatives
-Metamucil, Fibercon
CONTRA

A
  • Bowel obstruction

- Use under 6 years old

62
Q

Bulk Laxatives
-Metamucil, Fibercon
PTS

A
  • Preg OK
  • BF OK-
  • Peds: not under 6
63
Q

Stimulant Laxatives

A
  • ,constipation
  • Senna (Sennakot, Exlax)
  • most common perscription
  • irritates intestinal lining
  • do not give w/ fecal impaction
  • hide from kids, looks like candy
  • 2nd degree burns in kids from exlax poop
  • dependence w/ reg use
  • 12 hrs
64
Q

Stimulant Laxatives
-Senna (Sennakot, Exlax)
MOA

A

-Irritates intestinal lining causing increased peristalsis and propulsion of intestinal contents

65
Q

Stimulant Laxatives
-Senna (Sennakot, Exlax)
PHARM

A
  • Minimal PO absorption

- Excreted in stool as unchanged drug

66
Q

Stimulant Laxatives
-Senna (Sennakot, Exlax)
SE

A
  • Diarrhea
  • Nausea
  • Dependence with Regular Use
67
Q

Stimulant Laxatives
-Senna (Sennakot, Exlax)
CONTRA

A
  • BF

- fecal impaction

68
Q

Stimulant Laxatives
-Senna (Sennakot, Exlax)
PTS

A
  • NO BF

- NO impaction

69
Q

Diarhea

A
  • 3 OR MORE A DAY
  • CHECK FLUIDS AND ELECTROLYTES
  • IDENTIFY CAUSE AND TREAT THE CAUSE.
  • kids: too much fruit
  • gum or candy sweetened w/ sorbital
70
Q

Opioid Agonist

A
  • diarhea
  • Loperamide
  • DOSE NOT CROSS BBB
  • SIGNIFICANT FIRST PASS METABOLISM
  • BF unknown
  • slows motility by opiod receptor activation
  • reduce volume and increase viscosity
71
Q

Opiod Agonist
-Loperamide
MOA

A
  • slows motility by opiod receptor activation

- reduce volume and increase viscosity

72
Q

Opioid Agonist
-Loperamide
PHARM

A
  • Little PO absorption
  • DOSE NOT CROSS BBB
  • SIGNIFICANT FIRST PASS METABOLISM
  • Excreted in stool
73
Q

Opioid Agonist
-Loperamide
SE

A
  • Fatigue
  • Dizziness
  • Constipation
  • Nausea
  • toxic mega colon
74
Q

Opioid Agonist
-Loperamide
CONTRA

A
  • High Fever
  • Bloody Diarrhea
  • Acute UC Flare
  • Age Less than 2
  • C Diff
75
Q

Opioid Agonist
-Loperamide
PTS

A
  • Safe in Pregnancy
  • UNKNOWN if distributed in breastmilk
  • High Fever
  • Bloody Diarrhea
  • Acute UC Flare
  • Age Less than 2
  • C Diff
76
Q

IRRITABLE BOWEL SYNDROME

A
  • DIAGNOSIS OF EXCLUSION! Lifestyle

- lifestyle changes/modifications then medication

77
Q

Antispasmodics

A
  • IBS

- Dicyclomine, hyoscyamine

78
Q

Antispasmodics
-Dicyclomine, hyoscyamine
MOA

A
  • Inhibit cholinergic receptors on smooth muscle

- not specific to GI smooth muscle

79
Q

Antispasmodics
-Dicyclomine, hyoscyamine
PHARM

A
  • Inhibit cholinergic receptors on smooth muscle

- not specific to GI smooth muscle

80
Q

Antispasmodics
-Dicyclomine, hyoscyamine
SE

A

-anticholergic

81
Q

Antispasmodics
-Dicyclomine, hyoscyamine
PTS

A
  • PREG OK
  • BF NO
  • No Infants less than six month
82
Q

5HT3 antagonist

A
  • IBS
  • Alosetron (Lotronex)
  • (Always remember: NO LONGER PRESCRIBED BY PRIMARY CARE)
  • for diarrhea
83
Q

5HT3 antagonist
-Alosetron (Lotronex)
MOA

A
  • Modulates enteric nervous system, slows GI activity

- Primarily for diarrhea predominant IBS

84
Q

Chloride Channel Activators

A
  • Lubiprostone (Amitiza)
  • IBS-C
  • empty stomach
  • only women
85
Q

Chloride Channel Activators
-Lubiprostone (Amitiza)
SE

A
  • diarhea

- nausea

86
Q

Chloride Channel Activators
-Lubiprostone (Amitiza)
CONTRA

A

-no pts with potential for chronic obstruction

87
Q

Chloride Channel Activators
-Lubiprostone (Amitiza)
PTS

A
  • only women IBS-C
  • Preg C
  • No BF
  • No Peds
  • No Men
88
Q

Chloride Channel Activators

A
  • IBS
  • Linaclotide, Linzess
  • FLATULENCE
  • FECAL INCONTINENCE
  • take on empty stomach 30 mins before meal
89
Q

Chloride Channel Activators
-Linaclotide, Linzess
MOA

A
  • Guanylate cyclase-C (GC) agonist
  • Binds to receptors in intestine activates CGMP which stimulates secretion of chloride and bicarbonate results in increased intestinal fluid
90
Q

Chloride Channel Activators
-Linaclotide, Linzess
PHARM

A
  • Minimal systemic availability; take 30 minutes prior to first meal of day on empty stomach
  • Metabolized within GI tract
  • Excretion primarily stool
91
Q

Chloride Channel Activators
-Linaclotide, Linzess
SE

A
  • Diarrhea
  • Dyspepsia
  • FLATULENCE
  • FECAL INCONTINENCE
92
Q

Chloride Channel Activators
-Linaclotide, Linzess
CONTRA

A

Patients with known obstruction

93
Q

Chloride Channel Activators
-Linaclotide, Linzess
PTS

A
  • No risk with hepatic or renal impairment
  • Only Adults
  • No Preg
  • NO BF
  • No Peds
  • Geri-unknown
94
Q

Inflammatory Bowel Disease

A
  • 1st line treatment for acute flare is steroid, then send to GI dr
  • Chrohns (mouth to anus) (Skip Lesions) (1st steroid, 2nd aminosalicylates)
  • UC (only colon)
  • immunomodulaters more popular, may allow pts to avoid steroids
95
Q

Aminosalicylates

A
  • Inflammatory Bowel Disease
  • Sulfasalazine (Azulfidine), Mesalamine (Asacol), Balsalazide (Cozaal)
  • mesalamine good for unclompicated UC
  • 2nd line for Crohns
  • metab liver
  • bone marrow suppression (R/T Reyes Syndrome)
  • blood disorders
  • liver function tests, CBC
  • decrese CBC
  • “REMISSION TX”
  • Children with Varicella or Flulike symptoms – R/T REYE SYNDROME (REMEMBER THIS MED IS A SALICYLATE just like the BISMUTH SUBSALICYLATE
96
Q

Aminosalicylates
-Sulfasalazine (Azulfidine), Mesalamine (Asacol), Balsalazide (Cozaal)
MOA

A
  • Not certain, likely blocks prostaglandin synthesis

- May inhibit cellular function of NK cells, mucosal lymphocytes and macrophages

97
Q

Aminosalicylates
-Sulfasalazine (Azulfidine), Mesalamine (Asacol), Balsalazide (Cozaal)
PHARM

A
  • Well absorbed in small intestine, but minimal colonic absorption
  • Up to 78% PROTEIN bound
  • Metabolized in liver
  • Excreted in stool
98
Q

Aminosalicylates
-Sulfasalazine (Azulfidine), Mesalamine (Asacol), Balsalazide (Cozaal)
SE

A
  • Nausea
  • GI upset
  • Headaches
  • Bone Marrow Suppression can be r/t Reye Syndrome
99
Q

Aminosalicylates
-Sulfasalazine (Azulfidine), Mesalamine (Asacol), Balsalazide (Cozaal)
CONTRA

A
  • Breastfeeding
  • Children with Varicella or Flulike symptoms – R/T REYE SYNDROME (REMEMBER THIS MED IS A SALICYLATE just like the BISMUTH SUBSALICYLATE)
100
Q

Aminosalicylates
-Sulfasalazine (Azulfidine), Mesalamine (Asacol), Balsalazide (Cozaal)
PTS

A
  • NO BF
  • -Children with Varicella or Flulike symptoms – R/T REYE SYNDROME (REMEMBER THIS MED IS A SALICYLATE just like the BISMUTH SUBSALICYLATE)
101
Q

Glucocorticoids

A
  • IBD
  • Budesonide (Entocort)
  • Metaolized EXTENSIBLY in liver
  • NOT FOR MAINTAINING DISEASE
  • HIGH FAT MEAL WILL DELAY ENTOCORT ABSORPTION
  • RECTAL PREPARATION FIST LINE FOR UC FLARE (reduce inflamation)
  • EVALUATE: Glucose, Electrolytes, and Bone Density
102
Q

Glucocorticoids
-Budesonide (Entocort)
MOA

A

-Antiinflammatory corticosteroids, reduce inflammation by suppressing migration of polymophonuclear leukocytes, decreases protoglandin synthesis

103
Q

Glucocorticoids
-Budesonide (Entocort)
PHARM

A
  • “FIRST LINE TREATMENT”
  • Not well absorbed
  • Entocort has max 21% BIOAVAILABILITY
  • Metaolized EXTENSIBLY in liver
  • Excreted in urine
104
Q

Glucocorticoids
-Budesonide (Entocort)
SE

A
  • Headache

- Nausea/Vomiting

105
Q

Glucocorticoids
-Budesonide (Entocort)
CONTRA

A
  • NOT FOR MAINTAINING DISEASE
  • Allergy
  • HIGH FAT MEAL WILL DELAY ENTOCORT ABSORPTION
106
Q

Glucocorticoids
-Budesonide (Entocort)
PTS

A
  • RECTAL PREPARATION FIST LINE FO UC FLARE

- NOT FOR MAINTAINING DISEASE

107
Q

Purine Analogs

A
  • IBD
  • Azathioprine (Imuran), 6-MP (Purinethol)
  • Azathioprine refractury UC
  • reducing immune response
  • Active malignancy (LONG TERM USE CAN INCREASE RISK OF MALIGNANCIES ESP LYMPHOMA)
  • check labs
108
Q

Purine Analogs
-Azathioprine (Imuran), 6-MP (Purinethol)
MOA

A

-Blocks Synthesis of purine which hinders DNA, RNA and protein synthesis in fast growing cells like lymphocytes, reducing immune response

109
Q

Purine Analogs
-Azathioprine (Imuran), 6-MP (Purinethol)
PHARM

A
  • Azathioprine has better absorption than 6-MP
  • 30% protein bound
  • Metabolized in liver
  • Excreted in urine
110
Q

Purine Analogs
-Azathioprine (Imuran), 6-MP (Purinethol)
SE

A
  • Pancytepenia
  • Infection
  • Hepatotoxicity
  • Pancreatitis
  • Active malignancies (Lymphoma) (long term)
111
Q

Purine Analogs
-Azathioprine (Imuran), 6-MP (Purinethol)
CONTRA

A

-Active malignancy (LONG TERM USE CAN INCREASE RISK OF MALIGNANCIES ESP LYMPHOMA)

112
Q

Purine Analogs
-Azathioprine (Imuran), 6-MP (Purinethol)
PTS

A
  • Preg No
  • BF No
  • Active malignancy (LONG TERM USE CAN INCREASE RISK OF MALIGNANCIES ESP LYMPHOMA)
113
Q

Immunosuppresive

A
  • IBD
  • Azathioprine (Imuran)
  • Methotrexate (Rheumatrex)
  • Cyclosporine (Sandimmune)
  • Evaluate: CBC, Serum Creatinine, Amylase, LFT
114
Q

Immunosuppresive
-Azathioprine (Imuran)
MOA

A

-Decrease inflammatory mediators

115
Q

Immunosuppresive
-Azathioprine (Imuran)
PHARM

A
  • Absorption- Oral well absorbed
  • Protein binding – 30%
  • Metabolism – Hepatic
  • Excretion – Urine
116
Q

Immunosuppresive
-Azathioprine (Imuran)
SE

A
  • Dependent on dosing
  • Hepatotoxic
  • Increased susceptibility to infection
  • Leukopenia
117
Q

Immunosuppresive
-Azathioprine (Imuran)
PTS

A
  • AVOID USE IN PREGNANCY

- AVOID IN BF

118
Q

Immunosuppresive
-Methotrexate (Rheumatrex)
MOA

A
  • Suppresses interleukin 1

- Folate antimetabolite

119
Q

Immunosuppresive
-Methotrexate (Rheumatrex)
PHARM

A

-Dose based on Renal function

120
Q

Immunosuppresive
-Methotrexate (Rheumatrex)
PTS

A

-No Preg

121
Q

Immunosuppresive
-Cyclosporine (Sandimmune)
MOA

A
  • Acute Exacerbations

- Suppresses Cell mediated Immunity

122
Q

Immunosuppresive
-Cyclosporine (Sandimmune)
PHARM

A
  • IV
  • Oral is INEFFECTIVE
  • decrease bone marrow
  • pancreatic and joint pain
123
Q

Immunosuppresive

-Cyclosporine (Sandimmune)

A
  • decrease bone marrow

- pancreatic and joint pain

124
Q

Biological Agents

A
  • IBD
  • TNF Inhibitors (Humira, Remicaide, Cimzia)
  • resistant Crohns Disease
125
Q

Biological Agents
-TNF Inhibitors (Humira, Remicaide, Cimzia)
SE

A
  • opportunistic infections
  • TB
  • Hep B reactivation
126
Q

Monitor for Toxicity

A
  • Aminosalicylates (CBC, LFT)
  • Corticosteroids (Glucose levels, Electrolytes, Bone Density)
  • Immunosuppressive (
127
Q

H2 Blockers: CimetiDINE, RanitiDINE, FamotiDINE, NizatiDINE

A
  • Clinical Use: decrease acid: peptic ulcer disease, gastritis, mild GERD
  • MOA: reversibly (competitive) block histamine H2; decrease H+ from parietal cells
  • **Cimetdine: crosses BBB–lipophilic, uncharged (confusion, dizziness, headaches)
  • P450 inhibitor
  • Antiandrogenic effects (prolactin release, gynecomastia, decrease male libido)
  • **Cimetidine & Ranitidine: decrease renal creatinine excretion
128
Q

PPI Proton Pump Inhibitor: OmePRAZOLE, LansoPRAZOLE, EsomePRAZOLE, PantoPRAZOLE, DexlansoPRAZOLE

A
  • Clinical Use: decrease acid: peptic ulcer, gastritis, GERD, Zollinger-Ellison Syndrome
  • MOA: Irreversibly (noncompetitive) block H+/K+ ATPace in parietal cells of stomach
  • SE: Increased risk of C.diff, pneumonia, hip fractures, decreased serum magnesium (long-term)
129
Q

Bismuth, Sulcralfate:

A
  • MOA: provides physical protection (coating) by binding to the GI ulcer
  • Allows HCO3 to promote mucous layer production
  • Clinical Use: Promote ulcer healing, traveler’s diarrhea
130
Q

Misoprostol:

A
  • MOA: PGE-1 analog
  • Stimulates production and secretion of gastric mucus
  • Decreased acid production
  • SE: Diarrhea, contraindicated in pregnancy (can cause abortion due to vasoconstriction)
  • Clinical Use: Prevent NSAID induced gastritis, traveler’s diarrhea
131
Q

Octreotide:

A

MOA: long-acting somatostatin analog

  • SE: (slows things down) nausea, cramps, steatorrhea (fat in stool due to system slowed down)
  • Clinical Use: acute variceal bleeding (painless, hematemesis, dilation), acromegaly (inhibits growth hormone), VIPoma (vasoactive intestinal peptide), Carcinoid tumors
  • Mallory-Weiss-painful hematemesis (alcoholics)
132
Q

Antacids:

A
  • MOA: drop the base
  • SE: can cause changes in absorption, bioavailability, urinary excretion
  • Clinical Use: decrease stomach acid
  • *Aluminum hydroxide-constipation
  • *Magnesium hydroxide-diarrhea, hyporeflexia (magnesium competes with sodium and creates a traffic jam…magnesium gets through but sodium can’t)
  • *Calcium carbonate-hypercalcemia
133
Q

Osmotic Laxatives: Magnesium hydroxide, lactulose, magnesium citrate, polyethylene glycol

A
  • SE: diarrhea, dehydration

- Clinical Use: constipation

134
Q

Sulfasalazine:

A

-MOA: Combination of 5-ASA anti-inflammatory; Sulfapyridine-antibacterial
SE: Malaise, nausea, sulfonamide poisoning, reversible oligospermia
-Clinical Use: Crohn’s disease (RLQ pain), Ulcerative colitis (LLQ pain)
-Loperimide –LOWERS mortality in IBD

135
Q

Ondansetron:

A
  • MOA: 5-HT3 antagonist; antiemetic especially in cancer patients
  • SE: headache, constipation (decreased motility)
  • Clinical Use: post-op vomiting, cancer chemotherapy
136
Q

Metoclopramide:

A
  • MOA: D2 (dopamine) receptor antagonist; increased gastric motility/tone
  • SE: Increased Parkinsonian effects, depression-like symptoms, interaction with digoxin and diabetes drugs
  • Clinical Use: gastroparesis (post-op, diabetics); antiemetic
  • Contraindications: SBO, Parkinson’s Disease
137
Q

RENAL FAILURE

A

NO MAGNESIUM OR ALLUMINUM

138
Q

PPIs

A

OSTEOPEROSIS

TAKE ON EMPTY STOMACH

139
Q

SEROTONIN 5-HT RECEPTOR ANTAGONISTS

A

CONSTIPATION

140
Q

REGLAN

A

TARDIVE KINESIA

141
Q

KIDS AND GERD

A

EVERYTHING!

142
Q

1ST LINE TREATMENT FOR IBC

A

GLUCOSTEROID

143
Q

CONSTIPATION

A

POLYTHENE GLYCOL/MIRALAX

144
Q

IBS-C

A

CHLORIDE CHANNEL ACTIVATORS
LUBIPROSTONE (AMITZIA)
WOMEN ONLY

145
Q

PHENERGAN

A

CONSTIPATION

MOOD CHANGES

Pharmacology Test 3 (5 decks)

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