GI Flashcards
Name the Antiemetic drugs
Ondansterone
(“Ribbon dancer blocking the hammer throw”)
Metoclopramide
(“Tickler blocking the D-rings”)
Meclizine
Diphenhydramine
(“Bee swatters”)
Scopolamine
(“Telescope”)
Aprepitant
(““participants”)
Ondansetrone MOA /USE
(“Ribbon dancer blocking the hammer throw”)
antagonizes 5-HT3 receptor on vagal afferents in the GI tract
- treats chemo-induced or post-op vomiting
Ondansetron Side Effects
(“Ribbon dancer blocking the hammer throw”)
-can cause constipation
(“Hammer tightening gut”)
-can cause headache and dizziness
(“Hammer hitting head”)
-can prolong the QT interval and induce torsade’s
(“Twisted torsade’s streamer”)
-can cause serotonin syndrome
(“Pile of smiley faces”)
Diphenhydramine
Meclizine
MOA
(“Bee Swatters”)
1st generation H1 receptor blockers
- the vestibular system contains H1 histamine receptors coupled to Gq
(“Allergy inducing, Q shaped dandelions”)
- treat vestibular nausea (motion sickness)
Scopolamine MOA
(“Telescope”)
blocks M1 muscarinic receptors found in the vestibular system
(“M1 motorcycle parking”)
- treats vestibular nausea (motion sickness)
Metcoclopramide MOA
(“Tickler”)
antagonizes D2 receptors in the area postrema
(“Extreme posture 2 D-Ring ropes”)
- treats chemotherapy induced vomiting
- **also antipsychotics block D2**
Metoclopramide is useful because …
- treats chemotherapy induced vomiting
- has upper GI prokinetic effects
- useful for treatment of delayed gastric emptying due to post- surgical disorders and diabetic gastroparesis
(“Contracted stomach”)
metoclopramide (D2 Antagonist) is contraindicated in …
small bowel obstruction
(“Do not obstruct”)
Metoclopramide
Side Effects
-can cause diarrhea -prokinetic effects
can cause drowsiness, especially in the elderly
(“Sleeping judge”)
-can cause depression (central D2 blockade)
(“Crying coach”)
-Can cause extrapyramidal effects due to central D2 blockade (dystonia, akathisia, parkinsonian features)
(“EXTRA pyramidal newspaper hat”)
- can cause tardive dyskinesia with chronic use (central D2 blockade), especially in the elderly (“Sticking out tongue”)
-can cause neuroleptic malignant syndrome
(“Now More Spicy chicken”)
-can cause elevated prolactin levels (central D2 blockade), leading to gynecomastia, amenorrhea, and decreased libido
(“Elevated milk release”)
can cause QT prolongation and induce torsade’s
(“Twisted torsade’s streamer”)
(“Mud puddle”)
Aprepitant MOA
(“all participants subtance pee check”)
aprepitant antagonizes the NK1 receptors in the area postrema
(“plaNK1 pommel horse”)
(“Extreme posture”)
- treats chemotherapy induced vomiting
what are the 2 mechanisms by which acid secretion can be inhibited ?
H2 histamine receptor antagonists
(“2 bee swatters”)
Proton Pump Inhibitors (PPI’s)
(“Girl scout blocking puree pump”)
H2 receptor Antagonists MOA
Ranitidine
Nizatidine
Cemitidine
Famotidine
(“Tie dye t-shirt”)
- Inhibit acid secretion by parietal cells
- Vagal stimulation will also stimulate the parietal cell directly to secrete acid during meals and therefore H2 antagonists has only a modest inhibitory effect on acid secretion during and after meals
H2 receptor antagonists can treat …
-prevent nocturnal secretion of acid that is largely dependent on histamine
-treat GERD
(“Gargling”)
-treat duodenal ulcers **PPI’s are first line**
(“Ulcerated sidewalk”)
Cimetidine
(“Tie dye kid on the cement”)
-H2 blocker with antiandrogenic side effects
-can cause gynecomastia when used long term or in high doses
(“Pot lids on chest”)
-can cause impotence
(“Droopy honey wand”)
-can cause elevated serum prolactin levels
(“Milk shooting from nose”)
-inhibits cytochrome P-450
(“Dented chrome bumper”)
Proton Pump Inhibitors (PPI’s)
Pantoprazole
Omeprazole
(“PRIZE”)
MOA
-irreversibly inhibit the H+/K+ ATPase (the final common pathway for H+ secretion)
Proton Pump Inhibitors (PPI’s) can treat …
Pantoprazole
Omeprazole
(“PRIZE”)
- first line treatment GERD but PPI’s .
(“Gargling”)
-faster symptom relief for gastric and duodenal ulcers
(“Ulcerated sidewalk”)
-gastrinoma causing hypersecretion of gastric acid
Zollinger-Ellison syndrome – treat with PPI’s
(“Jumbo gas tank on mower with crab logo”)
-PPI’s treat H.Pylori infection, with clarithromycin or amoxicillin/metronidazole
(“Helicopter hat”)
Proton Pump Inhibitors (PPI’s) Adverse Effects…
Pantoprazole
Omeprazole
(“PRIZE”)
- PPI’s increase the risk for C.Diff infection
- Normally inactivated by acidic environment
-increase the risk for respiratory infections (pneumonia)
(“Dirty lung spots”)
-decrease the absorption of Ca2+, Mg2+, and Fe2+ (requires acidic environment)
(“Medals bound to wagon”)
-increase the risk of osteoporotic hip fractures
(due to decreased Ca2+ absorption)
(“Fractured Axel”)
-may worsen osteoporosis (due to decreased Ca2+ absorption)
-can cause hypomagnesia
(“Falling magnets on girl scout”)
(“Chocolate fondue fountain”)
Octreotide MOA
(“Octagon shape of stop sign”)
A long acting Somatostatin analoge
- inhibits release of histamine by ECL cells
- inhibits the release of gastrin by G cells
⇒ and SST receptor (+) gastrinomas
Name osmotic laxatives
magnesium hydroxide
magnesium sulfate
magnesium citrate
(“Magnets”)
polyethylene glycol (PEG)
(“PEG drain cover”)
lactulose
(“Relaxulose”)
Lactulose can be useful in treatment of…
(“relaxulose”)
hepatic encephalopathy - buildup of ammonia in brain
- intestinal bacteria metabolize lactulose into acidic metabolites → ammonia (NH3) is trapped as ammonium (NH4+) in the acidic lumen and then excreted
(“Cirrhotic liver and brain coral”)
laxatives can cause …
diarrhea and dehydration
(“Spoiling mud bath”)
Name a bulk forming laxative
(“Bulky seaweed outside of the shop”)
Psyllium
- indigestible hydrophilic colloid absorbs water → distension→ peristalsis
Name a stool softener
Docusate
- surfactant agent that facilitates penetration Of stool by water and lipids
(“Water penetrating a canoe at the DOCK”)
Name a stimulant laxative a.k.a cathartic
Senna
(“Stimulating suntan lotion”)
(stimulation of enteric nervous system and colonic secretions)
chronic use of senna causes…
melanosis coli → brown pigmentation of the colon
(“Brown gut”)
Name Antidiarrheal Agents
(“Muddy slippers left outside”)
Diphenoxylate
(“Dolphins”)
Loperamide
(“Lop-eared rabbit”)
Antidiarrheal Agents MOA
(“Utopia”)
Opiate agonists activating mu-opioid receptors in the GI tract and treat diarrhea
(“MUssage”)
opioid agonists (loperamide) increase colonic phasic segmenting activity → increased colonic transit time
- Loperamide →does not cross the BBB→ no analgesia or potential for addiction
- Diphenoxylate some ability to cross the BBBcombines with atropine to prevent abuse
antidiarrheal agents are contraindicated in patients with …
-bloody diarrhea or fever (treat the underlying cause)
(“Red stool and inflammatory candles outside door”)
Antidiarrheal agents Side Effects
opioids can cause constipation
(“Clogged”)
treats the symptoms of secretory diarrhea caused by VIPoma and carcinoid syndrome
(“VIP CUSTOMERS only crab”)
Octreotide
(“STOP sign”)
