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Pharmacology Unit 6 > GI Diseases > Flashcards

GI Diseases Flashcards

1
Q

What four criteria should be considered when treating ulcers?

A
  • relief of symptoms
  • promotion of healing
  • prevention of complications
  • prevention of recurrence
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2
Q

When treating ulcers, what drugs are used with the goal of neutralizing acid?

A

Antacids: calcium carbonate, sodium bicarbonate, magnesium hydroxide or carbonate, aluminum hydroxide

  • all relieve pain and achieve faster healing
  • elevate gastric pH to at least 5 to reduce proteolytic action of pepsin
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3
Q

Which antacid is useful in patients with renal failure?

A

aluminum hydroxide

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4
Q

When treating ulcers, what drugs are used with the goal of decreasing acid production?

A

Anticholinergics, H2 blockers, H/K ATPase inhibitors

- all of these work directly on the parietal cell

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5
Q

What are the anticholinergic drugs used to treat ulcers and what are their side effects? Contraindications?

A

atropine, propantheline, and metantheline bromide

  • adverse effects: dry, blurred vision, constipation, drowsiness, mental confusion
  • CI: pyloric obstruction, hiatal hernia, peptic esophagitis
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6
Q

What histamine receptor blockers are used to treat ulcers? What are adverse effects? What should you be aware of when stopping them?

A

Cimetidine, ranitidine, famotidine, nizatidine (all competitive inhibitors)

  • adverse effects: HA, lethargy, confusion, p450 interactions
  • during use, parietal cell will upregulate histamine receptors, so have to stop use of H2 blockers gradually
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7
Q

What H/K ATPase inhibitors are used to treat ulcers? What are the adverse effects?

A

omeprazole, lansoprazole, rabeprazole, esomeprazole, pantoprazole, dexlansoprazole (all are noncompetitive inhibitors)
- these drugs are activated by acid pH, and exhibit better pain relief and faster healing than H2 blockers

  • adverse effects: HA, gynecomastia, inhibition of P450
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8
Q

Which H/K ATPase inhibitor exhibits the least interaction with other drugs? Which exhibits the most interaction?

A

pantoprazole (least - lowest P450 inhibition)

omeprazole (most - highest P450 inhibition)

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9
Q

Which drugs increase mucosal resistance by directly coating the ulcer crater?

A

bismuth salts - precipitates out in acid environments, lower ulcer recurrence than H2 blockers

sucralfate - binds to ulcerated tissues, as effective as H2 blockers

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10
Q

Which drugs increase mucosal resistance as prostaglandin E2 analogs?

A

misoprostol - decreases acid production, increases mucous and bicarbonate secretion

  • best effect is seen if patients are on NSAIDs (used for prevention of long term NSAID induced ulcers)
  • adverse effects: diarrhea, cannot use in pregnancy
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11
Q

Which drugs are used to eradicate H. pylori?

A

bismuth salts, metronidazole + tetracycline or amoxicillin

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12
Q

What is triple therapy for H. pylori?

A
  • PPI (2x/day)

- add 2 of: amoxicillin, clarithromycin, metronidazole (2x/day)

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13
Q

What is quadruple therapy for H. pylori?

A
  • PPI (2x/day)
  • tetracycline (4x/day)
  • bismuth subsalicylate (4x/day)
  • metronidazole (3x/day)
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14
Q

What are lifestyle modifications that can be suggested in the treatment of GERD?

A

elevate head of bed, avoid food or liquid 2-3 hrs before bed, avoid fatty or spicy foods, avoid cigarettes and alcohol, take a liquid antacid

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15
Q

What drugs are used to treat persistent GERD symptoms without esophagitis?

A
  • alginic acid antacids (simethacone, magnesium)
  • promotility drugs (cisapride, metoclopramide, reglan)
  • H2 blockers (cimetidine, ranitidine, famotidine, nizatidine)
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16
Q

What treatments are used for persistant GERD with esophagitis? What must you be sure of before you start treatment?

A
  • make sure there is no Barrett’s or cancer present
  • H2 blockers
  • promotility drugs
  • H/K ATPase inhibitors (PPIs)
  • antireflux surgery
17
Q

How do promotility drugs work?

A
  • enhance gastric emptying and increase the tone of the LES
  • metoclopramide is a local dopamine antagonist
  • cisapride is associated with risk of sudden cardiac death
  • reglan has the adverse effect of tremor
18
Q

Which antiemetics have actions on the chemo receptor trigger zone in the medulla and are considered phenothiazines?

A
  • prochlorperazine (dopamine antagonist with side effects of torticollis)
  • promethazine (H1 blocker, anticholinergic with side effect of somnolence)
19
Q

Which antiemetics have actions on the chemo receptor trigger zone in the medulla and are considered benzamide derivatives?

A
  • trimethobenzamide (pediatrics)

- metochlopramide (dopamine antagonist, SE tremor)

20
Q

Which antiemetics have actions on the chemo receptor trigger zone in the medulla and are considered 5HT3 antagonists?

A
  • ondansetron (most commonly prescribed)
  • granesitron and dolasetron (used for anesthesia induced emesis)
  • all have adverse effects of HA, dizziness, somnolence
21
Q

How does tetrahydro cannabinol work as an antiemetic?

A

anticholinergic

22
Q

What drugs are used to treat gastro paresis (outlet obstruction or loss of gastric tone), as seen in diabetes mellitus?

A
  • promotility drugs (metochlopramide, cisapride, domperidone)
23
Q

What drugs are used to treat diarrhea by decreasing GI secretion or motility?

A
  • anticholinergics (atropine sulfate)
  • opioid agonists ( loperamide, diphenoxylate, codeine sulfate)
  • loperamide - safest for traveler’s diarrhea
  • dephenoxylate/codeine - don’t give to kids!
24
Q

What are the colloids and pectins and how do they work?

A

metamucil and kaopectate, respectively

  • absorb water, but don’t prevent potential dehydration (bulk up stool and decrease incontinence/feeling of urgency)
25
Q

What is the treatment of constipation?

A
  • irritants or stimulants (castor, senna, bisacodyl)
  • osmotic cathartics (magnesium, lactulose for liver failure, milk of magnesia)
  • bulk-forming (psyllium, methycellulose)
  • lubricant and fecal softeners - might use with stimulant (dioctyl sodium succinate, poloxalkol)
26
Q

What antiinflammatory drugs are used acutely for IBD?

A
  • mesalamine - ulcerative colitis
  • sulfasalazine - ulcerative colitis
  • olsalazine - ulcerative colitis
  • also, corticosteroids and antibiotics
27
Q

What immunosuppressive drugs are used chronically for IBD?

A
  • azathioprine - purine antimetabolite that interferes with DNA synthesis
  • corticosteroids
  • infliximab - neutralizes TNFa
  • cyclosporine - suppresses T helper and T suppressor lymphocytes
28
Q

What are drug options for treating irritable bowel syndrome?

A
  • bulk forming agents (metamucil, fibercon)
  • opioids (loperamide)
  • anticholinergics
  • antidepressants (5HT3 antagonist alosteron for diarrhea predominant, 5HT4 antagonist tegaserod maleate for constipation predominant)

Pharmacology Unit 6 (15 decks)

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