GI Flashcards
Disease States
(6)
-
Acid peptic diseases
- GERD
- PUD
- Stress related gastritis
- Impaired gastric emptying
- Constipation/Diarrhea
- Nausea and Vomiting
- Irritable Bowel Syndrome
- Inflammatory Bowel Disease
Acid Peptic Diseases
(3)
Gastroesophageal reflux disease (GERD)
Peptic ulcer disease (PUD)
Stress-related gastritis
Acid Reducing Agents
(3)
Antacids
Histamine 2 receptor Antagonists
Proton pump inhibitors
+Antacids
(3)
MOA
Sodium Bicarbonate (Alka-Seltzer)
Calcium Carbonate (Tums)
Magnesium/Aluminum Hydroxide (Maalox)
Reacts with HCL -> salt + (H20 or CO2) leading to reduction of intra-gastric acidity
+Antacids Pros
- FAST onset of action (15 min) - symptom relief!
- Inexpensive
- Available OTC
- Taks as needed
- Don’t need food
+Antacid Cons
- _____ duration of action
- ______ dosing required
- ___ ____
- Drug interactions
- _____ ph (alters drug dissolution/______) - e.g (1)*
- Binds to drug (_______ absorption)-e.g (2)
- short
- frequent (relief comes right back)
- Side effects
- DI
- Increases pH -> alters solubility - Itraconazole
- reduces - Levofloxacin, Tetracycline
- Itraconazole is an antifungal that needs an acidic environment to be digested*
- Phenytoin also DI*
+Proton Pump Inhibitors (PPIs)
MOA
Binds to H+/K+ ATP (proton pump) and irreversibly inactivates enzyme
- Not all inactivated after one dose ~ takes 72 hours
- Works at site of proton pump -> shuts off pump IRREVERSIBLY -> depletes a lot of the hydrogen production -> doesn’t inactivate all the pumps at once -> so need to be taken chronically -> given more for chronic diseases*
+PPI Admin
- How often is dosing?
- Is it used frequently?
- Active in ____ where they concentrate on _____ cells
- When do you give it?
- once a day
- most widely used acid reducing agent
- lumen, parietal
- 30-60 min before food = increased absorption
+PPIs
(6)
Routes/Which ones are OTC
All very _____ in efficacy/_____
Inhibits >__% of total acid secretions
First 3 OTC
- Omeprazole
- Esomeprazole (also available IV)
- Lansoprazole
- Dexlansoprazole
- Pantoprazole (also available IV)
- Rabeprazole
similar, kinetics
90%
+PPI Adverse Effects
With short term use
Short term use (3-6 months)
Well tolerated (HA, Diarrhea)
more so long term AE on exam
+PPI Adverse Effects
With Long Term Use (4)
- Vitamin B12 Deficiency -> usually decreased pH releases B12 from food
- Hip Fractures -> inhibits osteoclast function, lowers Ca/Mg absorption
- Increased risk for Infection -> organism overgrowth from increase in pH (eg Clostridium Difficile)
- Gastric Carcinoid Tumors (animal studies) -> Chronic gastrin release to compensate -> hyperplasia of cells
- B12 needs a more acidic environment to be absorbed= so keep in mind chronic PPI use need to supplement VB12*
- Hyperplasia dt compensatory Gastrin - again in more chronic use*
Bulk Forming Medications are used for?
Constipation
- Both considered fairly safe supplements - just have to be cautious of DI-> absorbs other drugs*
- Can be used as fiber supplements esp for older pts who are not eating or exercising well*
Bulk Forming Meds
(2)
Psyllium (Metamucil) - OTC
Methylcellulose (Citrucel)- OTC
+Bulk Forming Meds
MOA
Absorbs water, forming a bulky compound that distends the colon and stimulates peristalsis
+Bulk Forming Meds PK and Interactions
- _____ derived (____ supplement)
- Non-absorbed = ___ tolerated
- Abdominal ___, b____, f_____
- Drug interactions: ______ drugs
- Take when?
- Very _____
- Plant (fiber)
- well
- pain, bloating, flatulence
- Absorbs
- Takes 2 hours before or after other drugs
- safe
Which of the following is considered a stimulant laxative?
- Psyllium
- Mineral oil
- Lubiprostone
- Docusate
- Bisacodyl
Bisacodyl
Match the following medications with their associated adverse events
- Harmless blackening of tongue/stool
- Nephrolithiasis
- Vitamin B-12 deficiency
- Dependence
- Pantoprazole (Protonix)
- Calcium Carbonate (Tums)
- Bisacodyl
- Bismuth Subsalicylate (Peptobismol)
Match the following agents with their respective onset time
- Antacids
- PPIs
- Docusate
- Bisacodyl
- 1-3 days
- 15 min
- 1-3 days
- ~6-10 hrs
Match the following agents with their respective warnings/contraindications
- Prokinetic agents
- Loperamide
- Misoprostol
- PPIs
- Sodium Phosphate
- Bloody diarrhea, sign of systemic disease
- Use of itraconazole
- Pregnancy
- GI obstruction
- History of cardiac/renal disease
Match the following with their respective class of laxative
- Psyllium/methylcellulose
- Docusate/Glycerin
- Bisacodyl/Senna
- Polyethylene Glycol (PEG)/Lactulose
- Stimulant laxatives
- Stool softeners
- Osmotic laxatives
- Bulk laxatives
