GI (Annie👵🏻) Flashcards
What is milk-alkali Syndrome and what class of medications is it associated with?
It is a hypercalcemia with renal insufficiency and metabolic ALKALOSIS******
From taking a TON of antacids plus eating a lot of dairy
Magnesium causes (constipation/diarrhea).
Aluminum causes (constipation/diarrhea).
What do we do about this?
Mg = diarrhea
Al = constipation
Give em together to even it all out!
Antacids are inorganic _____ that neutralize ____ to form salts and H2O.
Bases
HCl
What are the commonly used compounds in antacids?
Aluminum
Calcium carbonate******
Sodium bicarb
Magnesium
What happens if you give magnesium to renal patients?
Possible toxicity
What could be a bad effect of patients not telling you they are taking antacids because they just think they are “candy”?
Lots of drug interactions!!
What class of drugs are the -tidines?
Cimetidine (Tagamet)
Ranitidine (Zantac)
Famotidine (Pepsid)
Nizatidine (Axid)
H2 histamine receptor antagonists
Which GI drug can be used in anaphylaxis also?
Why?
H2 blockers
Because they decrease the H2-mediated vasodilation that occurs with anaphylaxis
What side effect happens with chronic cimetidine at high doses?
Who is this bad for an who is it good for?
Antiandrogen effect
Men can get moobs
Women can use it for treating masculinization
Which GI drug can cause an antiandrogen effect with chronic use at high doses?
Cimetidine (Tagamet)
What is another use for H2 blockers besides GERD/ulcers/ZES?
In anaphylaxis used with H1 blockers
Which H2 blocker has a LOT of drug interactions?
Does it induce or inhibit CYP3A4?
Cimetidine
Inhibits
Which drugs will cimetidine interact with?
Any drug with a narrow therapeutic range!!
Warfarin Phenytoin Theophylline BZs Digoxin TCAs Etc.
Do all H2 blockers inhibit CYP3A4?
NOPE
Just cimetidine
What is the MOA of proton pump inhibitors?
IRREVERSIBLE binding to the HK-ATPase in the parietal cells
What is the DOC in GERD with esophagitis?
PPIs
Do PPIs have a lot of side effect?
Why or why not?
NOPE
They are activated within the parietal cells so they don’t effect other cells?
If someone does have side effects from PPIs, what will it be?
Some GI upset
Why do PPIs take a few days to take full effect?
Because not all proton pumps are always active
What happens if you stop taking a proton pump inhibitor?
You’ll still get the benefit of the drug for 24-48 hours after because of the IRREVERSIBLE action of the drug
What drug class is associated with an increased risk of pneumonia and other upper respiratory infections?
PPIs
What is a side effect of long term PPI use?
Reduced absorption of calcium, magnesium and B12
What diseases can long term PPI use put you at risk for?
Pneumonia
Osteoporosis (from calcium deficiency)
Chronic kidney disease
Macrocytic anemia (from B12 deficiency)
What PPI inhibits CYP2C19?
Omeprazole (Prilosec)
What drugs can omeprazole interact with?
It can decrease the metabolism of:
Phenytoin
Diazepam
Warfarin
What is the MOA of Misoprostol (Cytotec)?
It’s a Prostaglandin E1 analogue
It increases the secretion of mucus and decreases acid secretion
What does Misoprostol (Cytotec) do to mucus and acid in the stomach?
Increases mucus (cytoprotective)
Decreases acid
Who can ABSOLUTELY NEVER NEVER EVER HAVE MISOPROSTOL (CYTOTEC)?
PREGGOS
YOU WILL KILL THE BABY AND GET FIRED
What is the MOA at metoclopramide (Reglan)?
It’s a D2 receptor antagonist
It enhances motility and tone of smooth muscle in the upper GI
What GI drug has the big side effect of EXTRAPYRAMIDAL SYMPTOMS??
Metoclopramide (Reglan)
What is the main use for Metoclopramide (Reglan)?
Decreases nausea and gets the GI tract moving again after surgery
What are the possible side effects of metoclopramide (Reglan)?
GI cramping
Diarrhea
Can metoclopramide (Reglan) be used in preggos?
NO
What is the MOA of bethanechol (Urecholine)?
Muscarinic agonist
It increases tone and motility of GI tract
What are the side effects of dicyclomine (Bentyl)?
All things antimuscarinic:
Dry mouth
Constipation
Sedation
What is the use for dicyclomine (Bentyl)?
Reduce abdominal cramping and spasms
What is the MOA of dicyclomine (Bentyl)?
Muscarinic blocker
What is the MOA of amitriptyline (Elavil)?
Muscarinic blocker
a2 stimulator/NE increaser
(It’s a TCA)
What is the use for Amitriptyline (elavil) in GI?
IBS-D
Muscarinic blockers decrease spasticity and diarrhea
What is the MOA of eluxadoline (Viberzi)?
Peripherally acting opioid agonist at the mu and kappa receptors
What is the main side effect of eluxadoline (Viberzi)?
Severe constipation
Get ready
What is the use for eluxadoline (VIberzi)?
IBS-D
What are a couple options for treating severe IBS-D?
Amitriptyline (Elavil)
Eluxadoline (Viberzi)
Is ondansetron (Zofran) a good option for motions sickness?
No
That would require muscarinic and histamine blockade. Zofran is 5HT3 only.
What is the MOA of ondansetron (Zofran)?
Selective 5HT3 blockade
What is the use for ondansetron (Zofran)?
Nausea/vomiting
Adverse side effects of ondansetron (Zofran)?
Headache
Constipation
Dizziness
What is the MOA of prochlorperazine (Compazine)?
D2, muscarinic, and H1 blocker
What is the MOA of promethazine (Phenergan)?
D2, muscarinic, and H1 blocker
What is the main side effect of prochlorperazine (Compazine) and promethazin (Phenergan)?
Major sedation
Are prochlorperazine (Compazine) and promethazine (Phenergan) good for motion sickness?
Yes!!
What drug is a cannabinoid and a form of THC?
Dronabinol
What is Dronabinol used for?
Chemo-induced nausea, vomiting, weight loss
What is the MOA of aprepitant (Emend)?
NK1 receptor blocker
What is aprepitant (Emend) usually combined with?
A 5HT3 antagonist
Like zofran
Is laxative use in intestinal blockage, perforation or toxic megacolon a good idea?
NO
What is the BEST WAY to prevent constipation and diverticulitis?
Dietary fiber
What are 2 supplemental forms of dietary fiber?
Methylcellulose
Psyllium
What are the most common side effects of adding in some dietary fiber?
Bloating
Gas 🐑💨
What piece of patient education should be given when a patient begins fiber?
Drink a looot of water!!
“So you dont get a basketball in there” 🏀
What osmotic laxative should NOT be given to patients with congestive heart failure?
Sodium Salts (Fleet) oral or enema
What osmotic laxative is given long term to people with cirrhosis?
Lactulose
Why is lactulose given to people with cirrhosis?
It traps the ammonia in the colon so you poop it out instead of it going to your liver and making things worse
Should osmotic laxatives be used long term?
NO
Exception: lactulose in people with cirrhosis
What type of laxative is magnesium hydroxide (Milk of Mag)?
Osmotic laxative
What type of laxative are sorbitol and mannitol?
Osmotic laxative
What osmotic laxative is most commonly used in colonoscopy prep?
Polyethylene glycol (miralax)
What are 2 mild constipation drugs that act on the mucosa?
Bisacodyl (Dulcolax)
Senna (Senokot)
What is the MOA of Bisacodyl (Dulcolax)?
Inhibits water absorption and can stimulate peristalsis by irritation of the mucosa
Contraindication of castor oil
Biliary obstruction
What is the MOA of docusate sodium (Colace)?
Emulsifying agent that allows water to penetrate the colonic contents and soften them
Contraindications of laxative use
Nausea and vomiting
Abdominal cramps
Undiagnosed abdominal pain
Appendicitis
Intestinal obstruction
What is the main effect of laxative overuse?
Electrolyte imbalance***
What are the ONLY ONLY ONLY TWO constipation drugs that can be used chronically?
Lubiprostone (Amitiza)
Linaclotide (Linzess)
What 2 drugs are used for IBS-C?
Lubiprostone (Amitiza)
Linaclotide (Linzess)
What is the MOA of lubiprostone (Amitiza)?
Activates ClC-2 chloride channels within the intestinal lumen cells
What is the MOA of linaclotide (Linzess)?
Activates cGMP which activates cystic fibrosis transmembrane conductor (CFTR)
This increases chloride secretion
Does Loperamide (Imodium) have abuse potential? Why or why not?
Not really
At therapeutic doses it doesn’t affect the CNS
Cholinergic inputs ____ the GI tract and opioids _____ the GI tract.
Stimulate
Inhibit
Why is diphenoxylate plus atropine (Lomotil) mixed like it is?
The diphenoxylate is the opioid derivative which stope the runs but has abuse potential due to its CNS effect
The atropine lowers intestinal spasm AND lowers the abuse potential of the diphenoxylate
In whom in pesto bismol contraindicated?
ASPIRIN ALLERGY
And kids due to Reyes
What is a side effect of Pepto bismol? 💩
Black poops
In whom in sulfasalazine (Azulfidine) contraindicated?
Aspirin allergy
What is sulfasalazine (Azulidine) made of?
Why is this combo important?
5-aminosalicylic acid linked to sulfapyridine
This linkage prevents GI absorption of the drug until the gut bacteria break that linkage. This means it can be delivered locally.
In whom is sulfasalazine (Azulfidine) most effective?
Ulcerative colitis
What is the med used for gas?
🐋💨
Simethicone (Gas-X)
