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PHARM 2 > GI > Flashcards

GI Flashcards

1
Q

AE of antacids

A

decreases oral absorption of tetracyclines with milk (Ca), antacids (Ca/Mg) or iron containing meds (via chleation)

increaes oral absorption of weak bases (quinidine)

decreases oral absorption of weak acids (warfarin)

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2
Q

enhancement of gastric acid secretion

A

1) histamine
2) acetylcholine
3) gastrin

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3
Q

MgOH AE

A

produces Mg salt - poor absorption –> diarrhea

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4
Q

AlOH AE

A

reacts with HCL –> AlCl = insoluble and causes constipation and hypophosphatemia

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5
Q

CaCO3 AE

A

hypercalcemia
nephrolithiasis
constipation –> fecal compaction

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6
Q

Reversible H2 blockers

A

1) cimetidine
2) ranitidine
3) famotidine
3) nizatidine

cimetidine = shortest acting, and least potent

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7
Q

H2 blocker use in ICU pt

A

prophylaxis for acute stress ulcers

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8
Q

H2 AE

A

nausea, HA, dizzy

cimetidine: anti-androgenic effects - newer H2’s don’t do this and don’t inhibit CYP450

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9
Q

Cimetidine AE

A

1) gynecomastia
2) inc prolactin
3) dec libido
4) confusion in elderly

crosses BBB and placenta

cimetidine+ranitidine = dec renal excretion of creatinine

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10
Q

Cimetidine contraindicated with

A

CYP 450 inhib - AE with warfarin, procainamide, phenytoin, benzo, theophylline, imipramine, quinidine

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11
Q

Omeprazole contraindicated with

A

warfarin, clopidogrel, phenytoin, diazepam, cyclosporine

  • omeprazole inhibits their metabolism
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12
Q

PPI AE

A

inc in respiratory and GI infection

dec Mg serum levels – hip fractures

prolonged use with H2 blockers = dec avail of B12, digoxin, and ketoconzaole

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13
Q

1st lines for h pylori

A

macrolides: clarithromycin
B-lactam: amoxicillin
antiprotozoals: metronidazole
broad spec: tetracycline

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14
Q

clarithromycin MOA

A

bacteriostatic

binds 23S rRNA of 50s = prevents translocation

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15
Q

clarithromycin uses

A 
h pylori
atypical PNA
CAPNA
pertussis
corneybacteria
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16
Q

clarithromycin AE

A

binds motilin receptors - GI upset: n/v
prolonged QT = arrhythmias
hepatitis
eosinophilia
affect oral anticoagulants via CYP450 inhibition
**resistance: methylation of 23s binding site - no binding of drug

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17
Q

Amoxicillin MOA

A

bactericidal - bind transpeptidase = prevent cross linking of PTGN - autolytic enzymes activated

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18
Q

amoxicilin use

A

h pylori

G+ and some G(-)’s

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19
Q

amoxicilin AE

A

rash, hypersensitivity, pseuomembranous colitis

resisitance = b-lactamase cleaves b-lactam ring

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20
Q

metronidazole MOA

A

bactericidal

inhib. electron transport system - toxic metabolites that damage DNA

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21
Q

metronidazole use

A

h pylori
c diff
bacteroides
antiprotozoal

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22
Q

metronidazole AE

A

flushing
tachycardia
low BP with alcohol (like disulfiram)
metallic taste

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23
Q

tetracycline MOA

A

binds 30s and prevents aminoacyl-tRNA attachment

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24
Q

tetracycline AE

A

GI upset, discolored teeth, inhibited bone growth in kids, photosensitivity

resistance: reduced uptake/inc efflux out of bacterial cells by plasmid encoded transp pumps

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25
Q

metoclopramide MOA

A

5HT3 and D2 blocker = anti-emetic

5HT4 agonist - muscarinic activity = prokinetic

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26
Q

metoclopramide use

A

diabetic, post op gastroparesis, relief GERD sxs

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27
Q

prokinetics (4)

A

1) metoclopramide
2) 5HT4 agonists
3) cholinomimetics
4) macrolides

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28
Q

metoclopramide AE

A

anti-dopaminergic: sedation, diarrhea, parkinsonian

possib inc prolactin = infertility

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29
Q

cisapride MOA

A

5HT4

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30
Q

cisapride use

A

gastroparesis, GERD, constipation via Ach stimulation

  • not a first line b/c of AE
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31
Q

cisapride AE

A

arrhythmias

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32
Q

Cholinomimetics types

A

1) neostimgine - colonic pseudoobstruction

2) bethanechol - resistance to cholesterase: long duration for post op bladder/bowel atony

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33
Q

erythromycin MOA

A

acts on motilin receptors

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34
Q

erythromycin use

A

gastric emptying before endoscopic procedures

  • if used for extended period, develops tolerance
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35
Q

anti-emetic agents

A

1) 5HT3 inhib
2) H1 antihistamine and anti-muscarinic
3) NK1 blocker
4) corticosteroids
5) D2 blocker
6) metoclopramide
7) cannabinoids

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36
Q

Ondansetron MOA

A

5HT3 blocker

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37
Q

Ondansetron AE

A

QT prolongation/arrhtyhmias

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38
Q

H1 antihistamines MOA

A

block peripheral and CNS H1

block alpha and muscarinic

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39
Q

HI antihistamine uses

A

hay fever, angioedema, motion sickness

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40
Q

NK1 drugs

A

1) arepitant = PO

2) fosaprepitant = IV

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41
Q

NK1 use

A

decreasing early and delayed emesis in cancer chemo

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42
Q

glucocorticoid agonists AE

A 
adrenal suppression
growth inhibition
muscle wasting
osteoporosis
salt retention
glucose intolerance
behavior changes
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43
Q

glucocorticoid agonists (2)

A

1) dexamethasone

2) methylprednisolone

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44
Q

first line chemo induced nausa/vomiting

A

dexamethasone Or methylprednisolone + ondansetron or combination of both

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45
Q

D2 blockers (3)

A

1) phenothiazines: D2 and M blockers
2) promethazine: anti-dop and anticholinergic
3) droperidol: anti-dopaminergic, antiemetic, antipsychotic, neuroleptic analgesic

46
Q

Benzodiazepines (3)

A

lorazepam
alprazolam
diazepam

47
Q

Dronabinol

A

acts on CB1 as agonist - cannabinoid

48
Q

anti-diarrheals

A

1) opoid agonist (loperamide, diphenoxylate)
2) somatostatin analog (octreotide)
3) bismuth

49
Q

Methotrexate - be sure to give (high/low) doses

A

LOW doses when not for cancer treatment

50
Q

IBS tx (4)

A

1) anticholinergics: hyoscyamine, dicyclomine, glycopyrrolate, methscopalamine
2) 5HT3 blockers: alosetron
3) opioid agonists: loperamide
4) chloride channel activators: lubiprostone

51
Q

PPI MOA

A

PPIs once in parietal cell - converted to active form, react with cysteine residue of H/K ATPase = stable covalent bond forms = IRREVERSIBLE inactivation of enzyme

52
Q

Mucosal protective agents (3)

A

sucralfate
bismuth subsalicylate
misoprostol

53
Q

sucralfate MOA

A

selectively binds to necrotic tissue = barrier to acid
stimulates PG synthesis

mucosal protective

54
Q

sucralfate contraindications

A

ineffective if given with H2 blockers or PPI = requires acidic environment for activation

55
Q

bismuth subsalicylate MOA

A

selectively binds ulcer and forms coating = protect from acid and pepsin

56
Q

misoprostol MOA

A

prevent gastric ulcers induced by NSAIDs: activate EP receptors = inc HCO3 and mucus

PGE1

also ineffective with PPI or H2

57
Q

misoprostol AE

A

diarrhea
uterine cramping
abortifacient
exacerbate IBD

58
Q

loperamide

A

antidiarrheal opiate derivate

59
Q

diphenoxylate

A

antidiarrheal opiate derivative

60
Q

Opiate derivates for antidiarrheal MOA

A

act at GI mu opioid receptors: inhib Ach and dec peristalsis

61
Q

Diphenoxylate AE

A

high doses can cause CNS effects

formulated with atropine to reduce abuse

62
Q

octreotide

A

somatostatin analog - anti-diarrheal

63
Q

somatostain analog use

A

diarrhea
carcinoid syndrome associated flushing
VIP secreting tumors
control bleeding from esophageal varices and acromegaly

64
Q

ocreotide AE

A

GI disturbance
gall stones
bradycardia
cardiac conduction anomalies

65
Q

Laxative mechanisms

A

1) stimulants
2) bulk forming agents
3) osmotic agents
4) stool softeners
5) chloride channel activator
6) opioid receptor antagonist

66
Q

senna

A

laxative - stimulant

67
Q

bisacodyl

A

laxative - stimulant

68
Q

methylcellulose

A

laxative - bulk forming agent

69
Q

psyllium

A

laxative - bulk forming agent

70
Q

bran

A

laxative - bulk forming agent

71
Q

magnesium oxide

A

laxative - osmotic agent

72
Q

magnesium hydroxide

A

laxative - osmotic agent

73
Q

lactulose

A

laxative - osmotic agent

74
Q

polyethylene glycol

A

laxative - osmotic agent

75
Q

osmotic agents as laxatives AE

A

Mg may be absorbed and cause toxicity in renal impairment

76
Q

lactulose USE

A

hepatic encephalopathy - draws out NH3 from body to prevent hyperammonia

77
Q

glycerin

A

stool softening laxative

78
Q

docusate

A

stool softening laxative

79
Q

lubiprostone

A

chloride channel activator laxative

80
Q

tx for IBS associated constipation

A

lubipristone

81
Q

tx for opioid induced constipation

A

senna + docusate OR opioid receptor antagonists (alvimopan/methylnaltrexone)

82
Q

alvimopan

A

opioid receptor antagonist laxative

83
Q

methylnaltrexone

A

opioid receptor antagonist laxative

84
Q

Drugs used in IBD

A

1) aminosalicylates
2) glucocorticoids
3) immunosuppressants
4) anti-TNFalpha
5) anti-integrins

85
Q

sulfasalazine

A

aminosalicylate used for IBD

86
Q

sulfasalazine MOA

A

inhibits eicosanoid inflam mediators

87
Q

sulfasalazine contraindications/AE

A

avoid in pt with sulfa allergy

HS. reversible oligospermia. BM suppression

88
Q

mesalamine

A

aminosalicylate used for crohns and UC

89
Q

mesalamine target

A

distal ileum and colon

90
Q

Balsalazide

A

aminosalicylate used for UC

91
Q

balsalazide target

A

large intestine - targets site of UC

92
Q

glucocorticoids used for IBD

A

1) hydrocortisone
2) prednisone
3) prednisolone
4) budesonide

93
Q

budesonide target

A

glucocorticoid used for IBD = distal ileum and colon

94
Q

immunosuppressant used to treat IBD

95
Q

MTX AE

A 
nausea
mucosal ulcers
hematotoxicity
hepatotoxicity
teratogen
96
Q

6 mercaptopurine

A

immunosuppressant tx UC and CD

97
Q

azathioprine

A

immunosuppressant tx UC and CD

98
Q

6-MP AE

A

myelosuppression, immunosuppresion, hepatotoxicity

99
Q

infliximab

A

anti-TNF alpha drug for UC and CD

100
Q

adalimumab

A

anti-TNF alpha drug for UC and CD

101
Q

anti-TNF alpha AE

A

reactivation of latent TB

102
Q

natalizumab

A

anti-integrin: blocks leukocyte integrins and can cause PML

103
Q

IBS tx (4)

A

1) anticholinergic
2) 5HT3 antagonists
3) opioid agonist
4) chloride channel activators

104
Q

anticholinergics for IBS

A

1) hyoscyamine
2) dicyclomine
3) glycopyrrolate
4) methscopalamine

105
Q

anticholinergic IBS drugs AE

A

delirium, hallucinations, coma, tachy, HTN, hyperthermia

106
Q

Alosteron

A

5 HT3 antagonist tx IBS

107
Q

alosteron AE

A

ischemic colitis

108
Q

loperamide

A

opioid agonist in IBS - diarrhea!

109
Q

lubiprostone

A

chloride channel activator in IBS - constipation

110
Q

ursodiol

A

bile acid therapy for gallstones

PHARM 2 (18 decks)

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