GI COPY Flashcards

Question

eluxadoline

Answer 1

IBS treatment * kappa opioid agonist/ delat opioid antagonist * Eluxadoline * Diarrhea predominant IBS * Reduces neuronal drive on peristalsis * Spasm in sphincter of oddi can result in pancreatitis

Answer 2

histamine H1 antagonist * Histamine H1 antagoinists * First generation H1 blockers * Produce sedation and antimuscarnic activity * Prevents motion sickness * Drugs: dimenhydrinate, diphenhydramine, cyclizine, meclizine

Answer 3

bulk forming laxatives ## Footnote contain lots of soluble fiber and other stuff to give you more material in feces Methylcellulose, lactulose and polycarbophil Still have to keep hydrated - need water to move everything along

Answer 4

IBS treatment * Antibiotic * Rifaximin * Diarrhea predominant IBS * Synthetic antibiotic similar to rifampin * May alter bacterial content of GI tract

Answer 5

H2 receptor antagonists * All are over the counter structural histamine analogs -\> block H2 receptors selectivlty to reduce gastric acid and pepsin secretion * Doesn’t affect H/K ATPase, H1 or any other receptors * Best at inhibiting nocturnal secretion (largely driven by histamine) * AE * Diarrhea, headaches, fatigue, myalgias, constipation, bradycardia * Don’t give to pregannt women or nursing women - they can cross placenta and get into milk * Mental changes: confusion, hallucinations and agitation may occur with IV administration in patents who are old or have renal or hepatic dysfunction * Cimetidine can cuase gynecomastia or impotence in men * Cimetidine inhibits dihydrotestosterone to androgen receptors * Can also interfere with CYP 450 pathways for other drugs * They stop formation of protons at the canaliculi of parietal cells = less activation of PPDs * Uses * All equally effective for healing and preventing recurrence of PUD * Given once a day at bed time * We have better drugs so they are used less now * Can be combined with antibiotics and bismuth for treatment of H pylori

Answer 6

antiobesity SERT and NET inhibitor reduces appetitie Tox: cardiovascular - tachy, hypertension

Answer 7

NK-1 antagonists

Answer 8

tums and others - antacids doesnt really cuase constipation or diarrhea

Answer 9

bulk forming laxatives ## Footnote contain lots of soluble fiber and other stuff to give you more material in feces Methylcellulose, lactulose and polycarbophil Still have to keep hydrated - need water to move everything along

Answer 10

PPI * Benzimidazole compounds irreversibly inhibit parietal cell proton pump (H/K ATPase) * The inhibition persists after stoping the drug (because its an irreversible inhibitor) - have to wait for new pumps to be made * They are pro drugs that are inactive at neutral pH (need acid to be active) * Take with meals = food -\> more gastric secretion * These drugs are unstable at low pH - enteric coating (only disolves in alkaline pH) to get past stomach - absorbed in intestines -\> carried in circulation to parietal cells where it acts * The drug acts at the intracellular canaliculi which is upstream from the proton pump (this is how it stays chornically active even when it shuts down gastric acid secretion ) (it still needs acidic envionrment to work) * Drugs * Esomeprazole, omeprazole, lansoprazole, dexlansoprazole, pantroprazole, rabeprazole * Curretnly the most effective drugs for suppressing gastric acid secretion because gastric response to all stimuli is inhibited\ * Can give a single daily dose * AE * GI effects (nausea, colic, flatulence, constipation, diarrhea) * CNS effects (headaches, dizziness, somnolence) * Skin rashes * With prolonged use diarrhea often occurs due to GIT bacterial overgrowth from removal of natural acid barrier * Hypergastrinemia can happen * Hepatic metabolism with negligible renal clearance * Uses * Promote peptic ulcer healing and prevent recurrence * Effective in patienst unresponsive to H2 antagonists * More effective than H2 antagonists for GERD or NSAID induced peptic ulcers

Answer 11

antidiarrheal drug * Loperamide, difenoxin and diphenoxylate - these are basically non effective opioids - give constipation but don’t relieve pain * Act on intestinal opioid receptors -\> inhibit ACH release -\> decreases motility

Answer 12

antiobesity CB1 receptor antagonists (canabanoid receptor antag - bascially anti weed) reduces appetitie TOX: depression, anxiety, nausea

Answer 13

osmotic laxatives - saline laxatives - nondigestible sugars and alcohols

Answer 14

stimulant or irritant laxatives (castor oil) * Local irritant -\> increases intestinal secretion and motility * Now seldom used due to unpleasant taste and toxic potential

Answer 15

phenothiazine - antiemetic

Answer 16

antidiarrheal drug * Somatostatin/octreotide - endogenous hormones = reduce motility * Inhibits secretion of: gastrin, cholecystokinin, glucagon, growth hormone, insulin, secretin, pancreatic polypeptide, VIP, and 5-HT * Slows motility and inhibits gallbladder contraction * Reduces portal and splanchnic blood flow * Used more in chronic cases of diarhea (more serious drugs)

Answer 17

pancreastic enzyme replacment * Pancreatic enzyme supplements * Exocrine pancreastic insufficiency caused by cystic fibrosis, chronic pancreastitis, or pancreastic resection * Can lead to steatorrhea, azotorrhea, vitamin malabsorption and weight loss * Supplements * Pancreatin * Pancrelipase * Administed with each meal and snack - need the enzymes to digest the food * High purine content of extracts can lead to hyperuricosuria and renal stones

Answer 18

stimulant or irritant laxatives * Bisacodyl * Enteric coated tablets taken at bedtime to take effect next morning * Don’t chew = break the capsule

Answer 19

stimulant or irritant laxatives * Anthraquinones like: aloe, cascara sagrada, or senna * Poorly absorbed in small intestine and require activation in the colon (laxative effects 6-12 hours later) * Long term use can cuase melanomic pigmentation of colonic mucosa and cathartic colon (colon dilated and ahaustral)

Answer 20

osmotic laxatives - saline laxatives - nondigestible sugars and alcohols * Glycerin - * Trihydroxy alcohol that acts as a lubricant and osmotic agent * Lactulose, sorbitol, mannitol - non absorbable sugars * Saline laxatives - non absorbable salts containing magnesium cations (mag citrate) or phosphate anions (sodium phosphate) * Have a very bitter taste - people commonly add to fuit juices * Avoid in patients with * Renal insufficiency - theses patients already have issues with water balance * Heart disease * Electrolyte imbalance * Diuretic drug co treatment

Answer 21

stool softener * Agents that soften stools and facilitate expulsion * Given orally or rectally * Include: mineral oil, glycerin suppositories, docusate sodium * Docusate is often prescribed to prevent straining in hospitalized patienst * Also can be given with opiates to prevent constipation

Answer 22

mucosal protective agent * Misoprostol - Methyl analog of PGE1 * Binds to PG receptors on parietal cells to inhibit acid secretion * NSAIDs inhibit production of PG - but you can replace the PG in the stomach to stop the ulcers from forming * Use * Prevent NSAIDs ulcers from forming * AE * Diarrhea and abdominal pain * May cause abortion by stimulating uterine contractions

Answer 23

antacid * Aluminum hydroxide, calcium carbonate, combination aluminum hydroxide and magnesium hydroxide * AE * Aluminum hydroxide - produces constipation *

Answer 24

peto-bismol * Bismuth subsalicylate (pepto bismol) - colloidal bismuth * Protective coating of ulcers - precipitates out in the stomach forming a lining on the stomach * The precipitate is black - can turn your tongue black * Antibacteiral agaisnt H pylori

Answer 25

HT3 antagonists * * Currently used for nausea and vomiting during cancer chemo

Answer 26

stimulant or irritant laxatives * Anthraquinones like: aloe, cascara sagrada, or senna * Poorly absorbed in small intestine and require activation in the colon (laxative effects 6-12 hours later) * Long term use can cuase melanomic pigmentation of colonic mucosa and cathartic colon (colon dilated and ahaustral)

Answer 27

stool softener * Agents that soften stools and facilitate expulsion * Given orally or rectally * Include: mineral oil, glycerin suppositories, docusate sodium * Docusate is often prescribed to prevent straining in hospitalized patienst * Also can be given with opiates to prevent constipation

Answer 28

histamine H1 antagonist * Histamine H1 antagoinists * First generation H1 blockers * Produce sedation and antimuscarnic activity * Prevents motion sickness * Drugs: dimenhydrinate, diphenhydramine, cyclizine, meclizine

Answer 29

benzodiazepine - antiemetic

Answer 30

IBS treatment * 5-HT4 partial agonist * Tegaserod * Emergency treatment only (IBS with constipation) where no alternative exists * Serious cardiovascular events can occur

Answer 31

mucosal protective agent * Binds selectively to necrotic ulcer tissue and acts as a barier * Polymerizes to produce a viscous gel that adheres to the epi cells * Effective in healing duodenal ulcers * AE * Constipation = most common * Requires acidic pH for activation - don’t give with antacids, H2 antagonists or PPIs