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Advanced Pharmacology > GI > Flashcards

GI Flashcards

1
Q

Indications for __________:

dyspepsia (heartburn), mild GERD and PUD

A

Antacids (Aluminum, Calcium, Sodium, and Magnesium- based)

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2
Q

MOA of __________:
*neutralize hydrochloric acid in the stomach, thereby increasing gastric pH > 4

*weak bases that react w/ HCl to form water and salt

*lasts 20-40 mins on empty stomach and 2-3 hrs on full stomach

A

Antacids (Aluminum, Calcium, Sodium, and Magnesium- based)

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3
Q

Safety Considerations/SE of ____________:
Warfarin (Coumadin)- may reduce absorption
Constipation

A

Aluminum-Based Antacids

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4
Q

Contraindications of __________:

Patients w/ renal insufficiency (high aluminum levels deposit in bone → osteomalacia)

A

Aluminum-Based Antacids

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5
Q

Special Note about _________:

Be sure to separate from other medications by 2 hours

A

Antacids

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6
Q

Example of Aluminum-Based Antacid

A

Aluminum Hydroxide- Amphogel

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7
Q

Contraindications of __________:

Patients w/ renal calculi

A

Calcium-Based Antacids

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8
Q

SE/Interactions of ________:

Constipation

A

Calcium-Based Antacids

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9
Q

Special Note about _________:

Used in calcium deficiency (w/ vit D)

A

Calcium-Based Antacids

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10
Q

Examples of Calcium-Based Antacids

A

Calcium Carbonate-Tums®, Rolaids®

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11
Q

Contraindications of __________:
Patients with cardiovascular disease (HTN)
Avoid in Pregnancy

A

Sodium-Based Antacids

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12
Q

SE/Interactions of ________:

May contribute to hypertension

A

Sodium-Based Antacids

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13
Q

Avoid ________ in patients with severe abdominal pain of unknown origin.

A

Antacids

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14
Q

SE of ________:

Diarrhea

A

Magnesium-Based Antacids

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15
Q

Contraindications of __________:

Patients w/ renal insufficiency (unable to excrete Mg → hypermagnesemia)

A

Magnesium-Based Antacids

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16
Q

All ________ increase or decrease absorption/SE of other drugs and increase absorption/SE of enteric coated drugs.

A

Antacids

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17
Q

Special Note about _________:

Used in Mg deficiency

A

Magnesium-Based Antacids

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18
Q

Example of Sodium-Based Antacids

A

Sodium Bicarbonate(Alka Seltzer®)

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19
Q

Example of Magnesium-Based Antacids

A

Magnesium Hydroxide(Milk of Magnesia®)

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20
Q

Do not take ______ with Iron or PNV

A

Antacids

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21
Q

H2RA (Histamine Receptor Agonists) Examples

A

cimetidine (Tagamet)
ranitidine (Zantac)
famotidine (Pepcid)

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22
Q

Indications for __________:
Heartburn
Prevents gastric/duodenal ulcers after one has healed
GERD after PPI therapy

A

H2RA (Histamine Receptor Agonists)

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23
Q

MOA of _________:
Inhibit acid secretion by gastric parietal cells by blocking H2 receptors
-Certain drugs in this class may affect gastric emptying and lower esophageal sphincter pressure also

A

H2RA (Histamine Receptor Agonists)

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24
Q

Safety Consideration for __________:
metabolized by CYP450 enzyme system in liver → increased concentration of other drugs metabolized by CYP450
Caution in patients w/ renal impairment (CNS adverse reactions)
Caution in older adults

A

H2RA (Histamine Receptor Agonists)

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25
Q

Contraindications of __________:

Patients w/ liver disease (can cause hepatitis)

A

Ranitidine (Zantac)

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26
Q 
SE of \_\_\_\_\_\_\_\_\_:
Drowsiness
Dizziness
GI upset
Hematologic changes
A

H2RA (Histamine Receptor Agonists)

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27
Q

SE of _________:
Gynecomastia
Impotence in men

A

Cimetidine (Tagamet)

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28
Q

Of the H2RA (Histamine Receptor Agonists), __________ has most drug interactions and adverse effects and __________ has the fewest.

A

Cimetidine (Tagamet)- most

Famotidine (Pepcid)- fewest

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29
Q

H2RA (Histamine Receptor Agonists) are Pregnancy Category ___

A

B

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30
Q

H2RA (Histamine Receptor Agonists) that are safe in children

A

Ranitidine (Zantac)

Famotidine (Pepcid)

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31
Q

Special Note about _______:

Look out for GI bleeds!

A

H2RA (Histamine Receptor Agonists)

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32
Q

Indications for __________:
gastric conditions characterized by hyperacidity like erosive gastritis, GERD, Zollinger-Ellison syndrome
***part of a multidrug regimen for PUD caused by H. pylori

A

Proton Pump Inhibitors (PPI)

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33
Q

MOA of ________:

Suppress gastric acid secretion (antisecretory) by inhibiting Hydrogen/Potassium pump

A

Proton Pump Inhibitors (PPI)

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34
Q 
SE of \_\_\_\_\_\_\_\_\_\_:
Achlorhydria (absence of hydrochloric acid in the stomach)
Dizziness
Drowsiness
GI upset
A

Proton Pump Inhibitors (PPI)

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35
Q

Safety Consideration for __________:
Metabolized by CYP450 → interaction w/ other drugs metabolized by CYP450
Decreased absorption of meds that need acidic environment to be absorbed
Caution in patients w/ hepatic dysfunction (metabolized in liver)
Caution in the elderly (excreted by kidneys)
Caution with use of clopidogrel (Plavix)
Long-term use:
Nutritional deficiencies (iron, vit B12, and Ca need acid to be absorbed)
Osteoporosis
Increased risk for infection including C diff and pneumonia (impaired defense against microbes)
Gastric cancer risk (hyperplasia of cells)

A

Proton Pump Inhibitors (PPI)

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36
Q

Contraindications of __________:

Clopidogrel (Plavix) → decreased effectiveness of clopidogrel → increased clot formation because both drugs use CYP2C19

A

omeprazole and esomeprazole (PPIs)

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37
Q

PPIs except omeprazole are Pregnancy Category ___

A

B

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38
Q

Omeprazole is Pregnancy Category ___

A

C

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39
Q

Special Notes about __________:
No adverse effects in breastfed infants
FDA approved in 1+ yo patients
Increased monitoring of INR for patients on warfarin
Be on the lookout for signs of GI bleed!!

A

Proton Pump Inhibitors (PPI)

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40
Q

Indication for __________:

prevention of peptic ulcers (chronic NSAID use)

A

Prostaglandin Analogs

Misoprostol (Cytotec)

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41
Q

MOA of _________:

inhibits gastric section and encourages mucus production by binding to prostaglandin E receptors

A

Prostaglandin Analogs

Misoprostol (Cytotec)

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42
Q

Safety Considerations/SE of __________:
Caution in patients w/ renal impairment which doubles the half-life
GI upset
Increased diarrhea risk w/ magnesium based antacids

A

Prostaglandin Analogs

Misoprostol (Cytotec)

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43
Q

Contraindications of _________:
Pregnancy (uterine contractions)
Pregnancy Category X

A

Prostaglandin Analogs

Misoprostol (Cytotec)

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44
Q

Examples of Stimulant Laxatives

A

Senna
Bisacodyl
Castor Oil
Cascara sagrada

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45
Q

MOA of ____________:
Stimulates myenteric plexus and acts on intestinal mucosa
Stimulate release of prostaglandins and increase in cAMP → secretion of electrolytes → stimulation of peristalsis

A

Stimulant Laxatives

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46
Q

Contraindications of ___________:

Castor oil in pregnancy (contractions)

A

Stimulant Laxatives

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47
Q

Safety Considerations of _________:
Caution for patients w/ severe CVD (bisacodyl)
Caution for patients w/ ETOH intolerance (cascara has ETOH in it)

A

Stimulant Laxatives

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48
Q

these drugs are good for constipation caused by reduced mobility, constipating drugs, and IBS because they work quickly and should be used for short-term only

A

Stimulant Laxatives

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49
Q

__________ is a Pregnancy Category C because it can cause diarrhea in infant if breastfeeding

A

Cascara sagrada

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50
Q

Bisacodyl is Pregnancy Category ____

A

B

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51
Q

Examples of Osmotic Laxatives

A

magnesium hydroxide
magnesium citrate
polyethylene glycol

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52
Q

MOA of _________:

draws water into intestines to increase pressure (hypertonic salt-based solutions)

A

Osmotic Laxatives

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53
Q

Contraindications of ALL ___________:

Patient w/ nausea/vomiting, undiagnosed abdominal pain, or suspected bowel obstruction

A

Laxatives

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54
Q

Contraindications of ___________:
Patients with:
Renal insufficiency (unable to excrete magnesium)
Hypermagnesemia
Hypercalcemia
Heart block
Children < 4 yo (can cause electrolyte disturbance)

A

Osmotic Laxatives

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55
Q 
SE of ALL \_\_\_\_\_\_\_\_\_:
Cramping
Flatulence
Bloating
Perianal irritation
A

Laxatives

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56
Q

Examples of Bulk-Producing Laxatives

A

psyllium

methylcellulose

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57
Q

MOA of _______:
Similar to increasing fiber in diet because drug is made of polysaccharides and cellulose
**When combined w/ water they expand and increase peristalsis

A

Bulk-Producing Laxatives

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58
Q

Safety Considerations of _________:

Caution in patients w/ narrow esophageal or intestinal lumen

A

Bulk-Producing Laxatives

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59
Q

Special Notes about _________:
Good for long-term use w/ simple chronic constipation. Work slower but fewer adverse effects
Safe in pregnancy

A

Bulk-Producing Laxatives

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60
Q

Example of Lubricant Laxative

A

mineral oil

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61
Q

MOA of ________:
Prevents colonic absorption of fecal water which softens stool and lubricates the intestine to allow stool to flow more easily

A

Lubricant Laxatives

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62
Q

Safety Considerations of _________:
Decreases absorption of fat soluble vitamins (ADEK)
Potential for aspiration in children <4 yo if given orally
Caution with:
Elderly
Patients w/ dysphagia → lipid pneumonia
Pregnancy (due to decrease in fat soluble vitamins)
Newborns (causes issues)

A

Lubricant Laxatives

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63
Q

Special Notes about _________:

Good for fecal impactions

A

Lubricant Laxatives

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64
Q

Examples of Surfactants Laxatives

A

docusate sodium
docusate calcium
docusate potassium

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65
Q

MOA of ________:

facilitate mixture of fat and water in the stool causing an emollient effect

A

Surfactants Laxatives

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66
Q

Type of laxative that can be used in infants through older adults and is safe in pregnancy

A

Surfactants Laxatives

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67
Q

Type of laxative that is good for dry, hard stools, when straining should be avoided, and when passing stool is painful

A

Surfactants Laxatives

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68
Q

Examples of Hyperosmolar Laxatives

A

glycerin

lactulose

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69
Q

MOA of _________:

glycerin irritates the intestines and draws water into the intestine bringing more liquid into the stool

A

Hyperosmolar Laxatives

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70
Q

Safety Considerations of _________:
caution in patients with:
Volume depletion
DM (lactulose can cause hyperglycemia)

A

Hyperosmolar Laxatives

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71
Q

Type of laxative that is good for fecal impaction for patients w/ neurogenic bowel and chronic constipation in older adults

A

Hyperosmolar Laxatives

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72
Q

Hyperosmolar Laxatives:
glycerin pregnancy category __
lactulose pregnancy category __

A

C

B

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73
Q

Example of Absorbent Preparation Antidiarrheal

A 
bismuth subsalicylate (Pepto Bismol)
kaolin pectin
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74
Q

MOA of ___________:

antisecretory with some antimicrobial effects

A

Absorbent Preparation Antidiarrheal

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75
Q

Contraindications of ____________:
Salicylate in children
Patients w/ aspirin hypersensitivity

A 
Absorbent Preparation Antidiarrheal
bismuth subsalicylate (Pepto Bismol)
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76
Q

Safety Considerations of _________:

Increased risk for toxicity w/ aspirin use

A 
Absorbent Preparation Antidiarrheal
bismuth subsalicylate (Pepto Bismol)
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77
Q

Absorbent Preparation Antidiarrheals are all Pregnancy Category ___ except kaolin pectin which is a ___.

A

C…B

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78
Q

Example of Opiate Antidiarrheal

A

loperamide (Imodium)

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79
Q

MOA of _________:

binds to opiate receptors in intestinal wall → decreased motility

A

Opiate Antidiarrheal

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80
Q

SE of all ___________:

Rebound constipation

A

Antidiarrheals

81
Q

Safety Considerations of ALL _________:

Caution in older adults due to risk of impaction

A

Antidiarrheals

82
Q

Safety Considerations of _________:
Increased transit time can lead to toxic megacolon (discontinue if abdominal distention occurs)
May prolong diarrhea caused by infectious agents
Risk for CNS depression w/ other CNS depression drugs

A

Opiate Antidiarrheals

83
Q

All Opiate Antidiarrheals are Pregnancy Category ___ except loperamide which is a ___

84
Q

Anticholinergic Antidiarrheals are indicated for _________ and _________.

A

diarrhea and IBD

85
Q

MOA of ___________:

antispasmodic and decrease water content in bowels

A

Anticholinergic Antidiarrheals

86
Q

Safety Considerations of _________:

Risk for anticholinergic SEs w/ other anticholinergics

A

Anticholinergic Antidiarrheals

87
Q

Anticholinergic Antidiarrheals are Pregnancy Category ___

88
Q

Examples of Antihistamine Antiemetics

A

dimenhydrinate (Dramamine)

hydroxyzine (Vistaril)

89
Q

MOA of _________:
block H1 receptors → decreased salivation
bind to cholinergic receptors → decreased n/v

A

Antihistamine Antiemetics

90
Q 
Safety Considerations of \_\_\_\_\_\_\_\_\_:
Similar to anticholinergics..Caution in patients with:
Narrow angle glaucoma
Seizure disorders
Hyperthyroidism
CVD
Prostatic hypertrophy
A

Antihistamine Antiemetics

91
Q 
SE of \_\_\_\_\_\_\_\_\_\_\_ and \_\_\_\_\_\_\_\_\_\_\_\_:
drowsiness
dry mouth
blurred vision
urinary retention
constipation
dry eyes
A

Antihistamine Antiemetics

Phenothiazines Antiemetics

92
Q

Contraindications of ____________:

Patients w/ severe liver disease (metabolized by liver)

A

Antihistamine Antiemetics

93
Q

these drugs are helpful in nausea r/t motion sickness d/t their ability to depress vestibulocerebellar pathway

A

Antihistamine Antiemetics

94
Q 
Special Notes about \_\_\_\_\_\_\_\_\_:
have anticholinergic properties
may need to reduce dose in older adults
paradoxical excitation in kids
better for long-term use d/t less severe adverse effects
A

Antihistamine Antiemetics

95
Q

Example of Phenothiazines Antiemetics

A

promethazine (Phenergan)

96
Q

Antihistamine Antiemetics are all Pregnancy category ___ except hydroxyzine (Vistaril) which is category __

97
Q

MOA of _________:

block dopamine receptors in chemoreceptor trigger zone (CTZ), cholinergic receptors and H1 receptors

A

Phenothiazines Antiemetics

promethazine (Phenergan)

98
Q 
Safety Considerations of \_\_\_\_\_\_\_\_\_:
Can cause sedation and extrapyramidal SE
Can cause silent pneumonia due to suppression of cough reflex and vomit aspiration
Caution in patients with: 
Acute/ Chronic respiratory disorders
Children <5 yr (extrapyramidal SE/respiratory depression) 
Hypotension w/ Antihypertensives
Lithium increases extrapyramidal SE risk
A

Phenothiazines Antiemetics

promethazine (Phenergan)

99
Q 
Contraindications of \_\_\_\_\_\_\_\_\_\_\_\_:
Patients with:
Parkinson’s
Narrow-angle glaucoma
Bone marrow depression
Severe cardiovascular disease
Severe hepatic disease
Children <2 yr (respiratory depression)
A

Phenothiazines Antiemetics

promethazine (Phenergan)

100
Q

Phenothiazines Antiemetics are Pregnancy Category ___

101
Q

Pediatric Cautions for ___________:

children more prone to extrapyramidal symptoms so use lowest effective dose

A 
Phenothiazines Antiemetics (promethazine (Phenergan)
Prokinetic (metoclopramide (Reglan)
102
Q

__________ can change urine color to pink or reddish brown

A

Phenothiazines Antiemetics

promethazine (Phenergan)

103
Q

Special Notes about _________:

can cause bone marrow depression in long-term use so monitor CBC and consider short-term use only

A

Phenothiazines Antiemetics

promethazine (Phenergan)

104
Q

Example of Cannabinoid Antiemetic

A

cannabinoid dronabinol (Marinol)

105
Q

Indication for __________:

chemotherapy-induced n/v

A 
Cannabinoid Antiemetic
cannabinoid dronabinol (Marinol)
106
Q

MOA of _________:

appetite stimulant

A 
Cannabinoid Antiemetic
cannabinoid dronabinol (Marinol)
107
Q

Caution for __________:

may lower seizure threshold in those w/ seizure disorders

A 
Cannabinoid Antiemetic
cannabinoid dronabinol (Marinol)
108
Q

Safety Considerations of _________:

Increased CNS depression w/ other meds causing DNS depression

A

Antihistamine Antiemetics
Phenothiazines Antiemetics
Cannabinoid Antiemetics

109
Q 
SE of \_\_\_\_\_\_:
euphoria
dizziness
depression
paranoid thoughts
tachycardia
hypotension
A 
Cannabinoid Antiemetic
cannabinoid dronabinol (Marinol)
110
Q

Special Notes about __________:
high potential for abuse
Pregnancy category C

A 
Cannabinoid Antiemetic
cannabinoid dronabinol (Marinol)
111
Q

Example of 5-HT3 receptor antagonists Antiemetic

A

ondansetron (Zofran)

112
Q

MOA of _________:

blocks serotonin peripherally and centrally

A

5-HT3 receptor antagonists Antiemetic

ondansetron (Zofran)

113
Q

Caution for __________:
May mask progressive ileus
Caution in patients with PKU (contains aspartame)

A

5-HT3 receptor antagonists Antiemetic

ondansetron (Zofran)

114
Q 
SE of \_\_\_\_\_\_:
headache
constipation
fatigue
dizziness
***QT PROLONGATION
A

5-HT3 receptor antagonists Antiemetic

ondansetron (Zofran)

115
Q

5-HT3 receptor antagonists Antiemetic

ondansetron (Zofran) is Pregnancy Category ___

116
Q

Example of Anticholinergics Antiemetic

A

scopolamine (Transderm Scop)

117
Q

inhibits muscarinic receptors in parasympathetic nervous system
blocks cholinergic transmission from reticular center to vomiting center
decrease saliva and GI motility

A

Anticholinergics Antiemetic

scopolamine (Transderm Scop)

118
Q 
Cautions for \_\_\_\_\_\_\_\_\_: 
Elderly due to CNS effects
Patients with:
Open-angle glaucoma
GI or bladder neck obstruction
A

Anticholinergics Antiemetic

scopolamine (Transderm Scop)

119
Q

Contraindications of ____________:

Patients with narrow-angle glaucoma

A

Anticholinergics Antiemetic

scopolamine (Transderm Scop)

120
Q

SE of ______:
dry mouth
drowsiness
blurred vision

A

Anticholinergics Antiemetic

scopolamine (Transderm Scop)

121
Q

Special Notes about ________ and __________:
Pregnancy category C
Not approved in Peds

A 
Anticholinergics Antiemetic (scopolamine (Transderm Scop)
NK1 receptor antagonists Antiemetic (aprepitant (Emend)
122
Q

Example of NK1 receptor antagonists Antiemetic

A

aprepitant (Emend)

123
Q

Indications for ___________:

chemotherapy-induced n/v and post-op

A

NK1 receptor antagonists Antiemetic

aprepitant (Emend)

124
Q

MOA of _________:
crosses blood brain barrier and binds to NK1 receptors which increases the antiemetic activity of 5-HT3 receptor antagonists

A

NK1 receptor antagonists Antiemetic

aprepitant (Emend)

125
Q

Caution for __________:
Increases concentrations of birth control and other chemotherapy meds because…
it inhibits CYP3A4 → elevated concentrations of meds that are metabolized by CYP3A4

A

NK1 receptor antagonists Antiemetic

aprepitant (Emend)

126
Q

SE of ______:
fatigue
dizziness
elevated AST/ALT and BUN

A

NK1 receptor antagonists Antiemetic

aprepitant (Emend)

127
Q

Example of Prokinetic

A

metoclopramide (Reglan)

128
Q

Indication for ________:

when GI motility is a problem: gastroparesis, GERD, n/v associated w/ chemotherapy

A

Prokinetic (metoclopramide (Reglan)

129
Q

MOA of _________:
stimulate upper GI motility by sensitizing tissues to ACh which causes increased gastric contractions and relaxed pyloric sphincter
dopamine receptor antagonist in CNS which produces antiemetic effects (similar to phenothiazines)

A

Prokinetic (metoclopramide (Reglan)

130
Q

Safety Considerations for __________:
Can cause EPS and sedation
Decrease dose in those w/ decreased renal function
Anticholinergics reverse the effects of metoclopramide and vice versa
Risk for tardive dyskinesia w/ long-term use- don’t use > 12 wks if possible
Caution in patients with:
Hx of depression (dopamine activity)
Renal impairment

A

Prokinetic (metoclopramide (Reglan)

131
Q 
Contraindications for \_\_\_\_\_\_\_\_\_\_\_:
MAOIs- hypertensive crisis
Disorders where GI stimulation would be dangerous: 
GI hemorrhage
Obstruction
Perforation
A

Prokinetic (metoclopramide (Reglan)

132
Q

SE of ______:
dizziness
diarrhea
hypoglycemia in diabetics

A

Prokinetic (metoclopramide (Reglan)

133
Q

_________ is helpful in n/v due to delayed gastric emptying (gastroparesis)

A

Prokinetic (metoclopramide (Reglan)

134
Q

Prokinetic (metoclopramide (Reglan) is Pregnancy Category ___

135
Q

__________ is excreted in breast milk but present in lower doses than an infant would be prescribed

A

Prokinetic (metoclopramide (Reglan)

136
Q

__________ improve abdominal pain, global assessment scores, and overall symptom scores. (Statistically Significant Benefit)

A

Antidepressants (SSRIs TCAs “Tricyclic Antidepressants)

137
Q

_______ may be beneficial in determining an association between certain foods and IBS symptoms in individual

A

food diary

138
Q

________ reduce IBS symptoms and decrease pain and flatulence

A

Probiotics

139
Q

__________ treatments effectively improve IBS symptoms and include cognitive behavior therapy, psychotherapy, and relaxation with stress management strategies

A

Psychological

140
Q

_________ decrease stool frequency and increase stool consistency. (For IBS)

A

Antidiarrheals

141
Q

_________ improve stool frequency but do not lessen abdominal pain. (for IBS constipation)

142
Q

Gram negative bacteria that causes chronic inflammation that weakens and damages the stomach lining and can lead to ulcers and increased risk of gastric cancer…major cause of PUD

143
Q

Treatment often takes 3-4 drugs due to resistance. Multi-med regimen can lead to decreased compliance increasing resistance even more. QUADRUPLE therapy is now required unless the practicitioner is aware of clarithromycin resistance rates <15%.

144
Q

Duration of therapy for all regimens is PO medications for 14 days
There are 2 first line therapy options listed, both using a 4 drug or quadruple regimen
***Know resistance patterns in your area to determine treatment.

A

H.Pylori Treatment

145
Q

Some H. Pylori regimens include __________ which is contraindicated in pregnancy.

A

tetracycline

146
Q

type of diarrhea most frequently caused by a viral infection and most episodes are self-limiting

A

Acute Diarrhea

147
Q

Stool Thickeners include:

A

Loperamide (imodium)
Kaopectate
Bulk-forming laxatives

148
Q

_______ is protective to the bowel for mild diarrhea but doesn’t slow peristalsis

A

Bismuth subsalicylate (pepto bismol)

149
Q

__________ is a “salicylate” (as is aspirin) and may lead to gastric irritation…contraindicated under same conditions as aspirin

A

Bismuth subsalicylate (pepto bismol)

150
Q

occurs from exposure to non-familiar enteric bacterial (usually e.coli). Self-limiting condition usually lasting 2-3 days

A

Travelers’ diarrhea

151
Q

_______ diarrhea lasts longer than 7 days

152
Q

Treatment for _________:
Usually 1-5 days of :
Nonpregnant:
Azithromycin+quinolone abx (Cipro)+Rifaximin
Pregnant: Azithromycin only
Faster relief is obtained when both an antibiotic and a medication that slows intestinal transit time (imodium) are given together

A

Travelers’ diarrhea

153
Q

Treatment for __________:
Tetracycline or Sulfamethoxazole 800+
Trimethoprim 160 (Septra or Bactrim)+
Fluoroquinolone (Ciprofloxacin, Cipro)

A

Dysenteric disease and Cholera

154
Q

diarrhea secondary to exposure to salmonella, shigella, campylobacter or giardia

A

Dysenteric disease and Cholera

155
Q

Causesof _________:
Giardia
e. Histolytic

A

Salmonella

156
Q

Treatment of _________:

Metronidazole (flagyl)

A

Salmonella

157
Q

Treatment of _______ in _________:
First line: Loperamide (imodium) (category B): likely safe in breastfeeding due to minimal oral absorption and very small amounts in breast milk.
Diphenoxylate (lomotil) (category C): caution is advised during breastfeeding due to limited studies.

A

Diarrhea in Pregnancy

158
Q

Avoid ___________ in pregnancy because it’s effect is uncertain and due to the salicylate component, it should be avoided in pregnancy and lactation.

A

Bismuth subsalicylate (pepto bismol, kaopectate)

159
Q

_______ diagnosis is based on clinical history, physical examination, and absence of alarm symptoms suggesting other pathology

160
Q

alarm symptoms of IBS

A

weight loss
rectal bleeding
anemia
mass
family history of colon or ovarian cancer
age > 60 years old with change in bowel habits

161
Q 
These ppear to improve symptoms of \_\_\_\_\_\_:
Exercise
Antibiotics
Antispasmodics
***Peppermint oil
***Probiotics
162
Q

Due to chelation, conditions such as osteoporosis may be increased when a patient takes ________ long term

163
Q

__________ is effective in reducing abdominal pain, distention, flatulence and bowel movements in patients with IBS

A

Peppermint oil

164
Q

Adverse effect of peppermint oil

165
Q

Peppermint oil is safe to take up to ____ weeks

166
Q

MOA of ___________:
Antispasmodic effect on intestinal smooth muscles, reduction of gastric motility, and an anti-inflammatory and antimicrobial effect in the small intestine

A

Peppermint oil

167
Q

form of probiotic likely effective in treating IBS

A

Bifidobacteria

168
Q

typically colonize in the colon and disappears from the feces within 2 weeks of stopping it - so continued use is necessary
Products stored for long periods of time or stored improperly (stored in refrigerator) may contain few life and active organisms and can lessen effectiveness

A

Bifidobacteria

169
Q

Taking this for 4-8 weeks (improvement usually seen in 1 week) reduces abdominal pain, bloating, and bowel movement difficulty and relieves constipation

A

Bifidobacteria

170
Q

when used in a probiotic combinations: supplements containing ________ and _________ along with helicobacter therapy increases the rate of eradication of H. pylori and reduces the incidence of side effects of helicobacter therapy alone

A

lactobacillus and bifidobacteria

171
Q

_____________ can also help with rotaviral diarrhea and traveler’s diarrhea, and can lead to increase remission of ulcerative colitis

A

Combination probiotics

172
Q

Adverse Effects of ________:
Bloating
Flatulence

A

Bifidobacteria

173
Q

Cautions for __________:

severely immunosuppressed patient

A

Bifidobacteria

174
Q

used to treat and prevent all sorts of GI distress
Can prevent infectious types of diarrhea such as rotaviral diarrhea in children and traveler’s diarrhea, can prevent antibiotic associated diarrhea.
Can be added to triple therapy for improving H. Pylori eradication rates

A

Lactobacillus

175
Q

_______ is safe for children, during pregnancy and lactation.

A

Lactobacillus

176
Q

Separate _______ by at least 2 hours with other medications

A

Lactobacillus

177
Q

FODMAPS

A

Fermentable Oligo-, Di-, Mono-saccharides And Polyols

178
Q

Foods high in ________ can lead to bloating, abdominal pain, and gas

A

FODMAPs (Fermentable Oligo-, Di-, Mono-saccharides And Polyols)

179
Q

Foods low in __________ have shown to be very effective in treating patients with IBS

A

FODMAPs (Fermentable Oligo-, Di-, Mono-saccharides And Polyols)

180
Q

To follow this diet, patients eliminate all _________ food for about 3-8 weeks. Some patients notice relief in 1 week, others it can take 8 weeks. It should not last forever. Slowly, these food can be reintroduced to determine threshold.

A

high FODMAP

181
Q

wheat, rye, legumes, and various fruits and vegetables, such as garlic and onions

A

Oligosaccharides

182
Q

milk, yogurt and soft cheese. Lactose is the main carb

A

Disaccharides

183
Q

varius fruit including figs, mangos, and sweeteners such as honey and agave nectar. Fructose is the main carb

A

Monosaccharides

184
Q

certain fruits and vegetables including blackberries and lychee, as well as some low-calorie sweeteners like those in sugar free gum

185
Q

Use: treating constipation
Adverse effects: transient flatulence, abdominal distention
Consume with enough water or it can cause esophageal and bowel obstruction

A

Black psyllium

186
Q

Uses: soften stools for constipation (can be as effective as senna and colace, but not as effective as prunes)
Functional constipation: great option for kids.
Taking a combination product containing this, acacia fiber, and fructose for 8 weeks can improve symptoms of constipation by 78%

A

Blonde psyllium

187
Q

Reduce nausea, vomiting, and the use of rescue antiemetic in adults and children postoperatively.
Pregnancy: sea bands

A

Acupressure

188
Q

Step 1: lifestyle and diet changes
Step 2: treatments that do not use medications
Ginger: 1g per day (1 day =24 hours)
Helps reduce the nausea (not necessarily the vomiting)
Acupressure
Step 3: medications (OTC and prescription)

A

Steps in N/V Treatment in Pregnancy

189
Q

First line drug for pregnancy N/V that help the body through metabolization of fat and protein

A

B6 (pyridoxine)

190
Q

Needed for healthy skin, hair, eyes, and liver
Help body make neurotransmitters (this may be part of the reason they work in n/v because of the transmitters)
Help nervous system function properly
Involved in brain development in pregnancy and infancy and immune function
Can be used as a single agent alone, or in combination with doxylamine (antihistamine) - some providers will tell them how to make their own or they prescribe diclectin

A

B6 (pyridoxine)

191
Q

first line drug for pregnancy N/V that is higher cost than making your own with B6 and doxylamine, but nice delayed release
Delayed release tablet of B6 (pyridoxine) and doxylamine

192
Q 
Other drugs for \_\_\_\_\_\_\_\_:
Dimenhydrinate
Prochlorperazine (antipsychotic)
Promethazine
Metoclopramide
Ondansetron
Last resort treatment: Methylprednisolone
A

Pregnancy N/V

193
Q

BBW:
MANY drug to drug interactions including Warfarin, calcium channel blocker, and metronidazale
CP450 inhibitor—this should not be a first line med for anyone taking other medications

A

cimetidine (Tagemet)

194
Q

BBW:

Pregnancy–Teratogenic

A

omeprazole (Prilosec)

195
Q

BBW:
crosses the placental barrier and may cause extrapyramidal signs and methemoglobinemia in neonates with maternal administration during delivery
In patients with a history of tardive dyskinesia (TD) or a dystonic reaction to metoclopramide
• When stimulation of gastrointestinal motility might be dangerous (e.g., in the presence of gastrointestinal hemorrhage, mechanical obstruction, or perforation).
• In patients with pheochromocytoma or other catecholamine-releasing paragangliomas- may cause a hypertensive/pheochromocytoma crisis, probably due to release of catecholamines from the tumor
• In patients with epilepsy, may increase the frequency and severity of seizures
• In patients with hypersensitivity- Reactions have included laryngeal and glossal angioedema and bronchospasm
***chronic use may cause tardive dyskonesia; avoid treatment for over 12 weeks

A

metoclopramide (Reglan)

196
Q

BBW:
May cause tardive dyskinesia
No use in children under 2 or people with Parkinson’s disease
May cause severe respiratory depression, especially in children

A

promethazine (Phenergan)

197
Q

Tagamet ________ the effect of __________ because it inhibits the enzyme that breaks it down, causing it to stay in the system longer. This leads to ________.

A

increases
Warfarin
Bleeding

198
Q

If a drug is a CYP450 inhibitor, it will ___________ the Area Under the Curve because it will stop the other drug(s) from being metabolized and being excreted.

Advanced Pharmacology (8 decks)

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