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Pharmacology > GI > Flashcards

GI Flashcards

1
Q

Name a systemic antacid

A

Sodium bicarbonate (NaHCO3)

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2
Q

NaHCO3 MOA:

A

bicarbonate ion is absorbed into the blood and slightly increases pH (alkalosis) + increases stomach pH

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3
Q

NaHCO3 indication:

A

acute, short-term reduction of stomach acid

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4
Q

Name 3 problems with NaHCO3:

A

1) alkalotic urine can increase calcium and phosphate deposition –> kidney stone
2) increase in blood sodium –> HTN exacerbation
3) acid rebound due to feedback regulation

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5
Q

Name 3 non-systemic antacids

A

1) CaCO3
2) Al(OH)3
3) Mg(OH)2
* does not contain bicarb ion so does not affect extracellular or blood pH*

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6
Q

Name 2 problems with non-systemic antacids:

A

1) acid rebound

2) Al + Ca = constipating (may be combined with Mg = laxative)

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7
Q

How are muscarinic receptors associated with stomach acid?

A

Muscarinic Ach receptors in parietal cell stimulate HCl secretion

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8
Q

__% to __% of stomach acid needs to be inhibited to get effective control

A

60-70

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9
Q

Name a muscarinic type 1 Ach R blocker

A

Pirenzipine

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10
Q

What are cytoprotectives?

A

Drugs that protect cells from acidic damage (directly or through mucus stimulation)

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11
Q

What are 2 major drugs considered as cytoprotectives?

A

1) Sucralfate (Al based salt)

2) Misoprostol

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12
Q

Sucralfate MOA:

A

1) Binds to H ions to form paste –> increased pH

2) Binds to degenerating cells to form protective layer over them (artificial mucus)

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13
Q

What is 1 problem with sucralfate?

A

It can inhibit absorption of other drugs (but itself is not absorbed into the bloodstream)

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14
Q

Sucralfate DOA:

A

8-12 hours

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15
Q

Misoprostol MOA:

A

Prostaglandin (PG) analogue that stimulates production of mucosal barrier

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16
Q

Name 1 SE of Misoprostol:

A

Diarrhea

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17
Q

Name 3 histamine H2 blockers

A

1) Cimetidine (Tagamet)
2) Ranitidine (Zantac)
3) Famotidine (Pepcid)

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18
Q

Histamine H2 blockers MOA:

A

Inhibits H2 receptor of parietal cell to decrease HCl production (very specific and no AE on mucosa)

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19
Q

Cimetidine results in __% to __% reduction in acidity

A

50-60

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20
Q

Cimetidine DI:

A

Binds to cyp450

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21
Q

Name 1 AE of cimetidine

A

1) Binds to androgen receptors (may result in gynecomastia, reduced libido, impotence)

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22
Q

Cimetidine does not affect bone rigidity!

A

No effect on osteoporosis

23
Q

Ranitidine results in __% to __% reduction in acidity

A

65-70%

24
Q

Name 2 advantages ranitidine over cimetidine:

A

1) Has less DIs (bc only binds to CYP450 at high doses)

2) Does NOT bind to androgen receptors

25
Q

Name 3 advantages Famotidine has over Cimetidine and Ranitidine:

A

1) More effective
2) Does not bind to CYP450 at all
3) Very few SEs

26
Q

Proton pump inhibitor (PPI) MOA:

A

1) Inhibits gastric H+/K+ ATPase

2) Binds to H+ extrusion sites to block release of H+ and Cl-

27
Q

PPI results in __% reduction in acidity

A

90%

28
Q

PPI indication:

A
  • Rapid reduction of acid (bc does not need to bind to receptors)
  • GERD
29
Q

If PPI taken chronically, osteoporosis is seen!

A

Management: higher doses of Pepcid instead

30
Q

Name 2 drug examples of PPIs:

A

1) Omeprazole (prilosec)

2) Esomeprazole (nexium)

31
Q

What are 4 ways to test for a H. pylori infection?

A

1) Urea breath test
2) Serological
3) Culture
4) Histology

32
Q

Why are H. pylori infections difficult to treat?

A

Because they are not extensively in contact with the bloodstream

33
Q

Triple therapy for H. pylori tx:

A

1) PPI- to control acid

2) + 3) 2 effective ABs to kill HP

34
Q

Quadruple therapy for H. pylori tx:

A

Same as triple therapy + bismuth to prevent ulcer from growing

35
Q

Name 3 drugs that can contribute to a reduction in lower esophageal sphincter pressure (to allow reflux)

A

1) B-blockers
2) Ca channel blockers
3) Nicotine

36
Q

Name lifestyle changes that can help tx GERD1

A

1) Avoid foods such as: caffeine, chocolate, peppermint, alcohol, fatty foods
2) Avoid large meals (esp right before bed)
3) Stop smoking
4) Weight reduction (if overweight)

37
Q

What is ulcerative colitis (UC)?

A
  • Submucosa inflammation

- Ulcerations that may ctsly cover colon’s entire surface

38
Q

What are the signs and sx associated with UC?

A

1) Diarrhea, bleeding, severe pain
2) Nutrition loss, anemia
3) Stiff colon due to scarring –> bursts –> peritonitis

39
Q

What is Crohn’s disease (CD)?

A
  • Inflammatory disease that can cover entire digestive system
  • Inflammation sites can be isolated regions
40
Q

What are signs and sx associated with CD?

A
  • Fistulas may form
  • Intestinal wall may become breached (infection risk)
  • Severe skin inflammation
  • Ulcerations in skin, eye
41
Q

Surgical removal of colon can eliminate UC, but not always CD

A

Management:

  • drink extra L of water/day
  • Vitamin B supplements
  • no long-acting drugs will work on pts w/o colon
42
Q

Name 3 goals of treatment for UC and CD:

A
  • Treat acute outbreak
  • Induce and retain remission
  • Treat complications
43
Q

What is the first-line tx for mild-moderate UC?

A

5-Amino Salicylic acid, 5-ASA (less useful in severe UC, CD)

44
Q

5-ASA MOA:

A
  • Unknown but does NOT work via COX inhibition bc systemic NSAIDs exacerbate disease
  • 5-ASA is only released in large intestine in sulfasalzine by bacteria
45
Q

What are steroid-responsive pts?

A

Pts whose
- sx improve over 1-2 weeks
- disease remains in remission as steroids are tapered off
(seen in 40% of pts)

46
Q

What are steroid-dependent pts?

A

Pts who
- respond to steroids, but experience disease relapse when steroids are tapered off (not remission, just suppressing disease- seen in 30% of pts)

47
Q

What are steroid-unresponsive pts?

A

Pts who do not respond to steroid tx (seen in 15-20% of pts)

48
Q

GC Indication:

A

acute tx of mod-severe UC/CD - not useful in maintaining remission

49
Q

GC SEs (4):

A

1) weight gain
2) stress, emotional responses
3) steroid-dependent diabetes
4) increased infection risk

50
Q

Name 2 opioid related agents used to treat diarrhea

A

Diphenoxylate (Lomotil), Loperamide (Imodium)

51
Q

Adsorbents MOA:

A

Coats GI tract wall and adsorbs bacteria/toxins causing diarrhea

52
Q

Name 2 adsorbents:

A

Pepto-bismol, kaopectate

53
Q

Immunosuppressives

A

same as immunosuppressive lecture??

Pharmacology (9 decks)

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