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Pharmacology > GI disorders > Flashcards

GI disorders Flashcards

1
Q

pathologic features of Chrohn’s disease

A

no rectal involvement, ilieal involved, strictures, fistulas, transmural involved, cobble stone appearance, granulomas, linear cleft, fever, bleeding, tenderness, mass, pain, fistulas, discontinuous, linear ulcers

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2
Q

Pathologic features of UC

A

Involves rectum, no ileal involved, no strictures, no fistulas, no transmural involved, no granulomas, no linear cleft, no fever, rectal bleeding, sometimes tenderness, no mass, no pain, no fistulas, continuous, no linear ulcers

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3
Q

Factors to consider when treating IBD

A

severity, location, drug factors

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4
Q

Severity to of acute disease

A

mild- 4 BM/day +/- blood; severe- >6 bloody BM/ day; >10 BM/day w/ continuous bleeding

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5
Q

Pharm options for IBD

A

5-aminosalicylates acid derivatives, corticosteroids, immunosuppressive agents, antimicrobials, biologics

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6
Q

5- aminosalicylate acid derivative MOA

A

anti-inflammatory, immunosuppressive, inhibition of leukocyte motility, interference w/ TNFa, transformation of growth factor B and nuclear factor, inhibition of leukotriene and prostaglandin production, suppression of IL-1 production

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7
Q

Sulfasalazine (Azulfidine)

A

large sulfa comp, treatment of mild to mod UC, adjunctive treatment in severe UC, prolonged remissions between UC acute attacks

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8
Q

Mesalamine (Canasa, rowasa, lialda, etc)

A

treatment of ulcerative proctitis, tx mild-mod distal UC, proctosigmoiditis or proctitis, induce and maintain remission in active, mil-mod UC, etc

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9
Q

Basalazide (Colazal)

A

treatment of mild to mod UC

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10
Q

Osalazine (Dipentum)

A

to maintain remission in UC who are intolerant of sulfasalazine

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11
Q

ADRs of 5-ASA

A

HA, nausea, rash, interstitial nephritis, pericarditis, pancreatitis, hepatitis, parodoxial exacerbation of colitis

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12
Q

ADRs of sulfasalazine

A

dose related rxns, hypersensitivity rxns, male infertility, discoloration

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13
Q

Balsalazide, olsalazine, mesalamine ADRs

A

hair loss, pneumotitis, diarrhea (olsalazine)

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14
Q

Sulfasalazine dose related ADRs

A

Dose >4 g/d, depends on metabolism status, ADRs- nausea dyspepsia, HA, fatigue, dizziness

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15
Q

Sulfasalazine hypersensitivity rxns

A

rash, fever, arthralgia, hepatic dysfunction, hematological toxicities

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16
Q

Corticosteroid agents

A

prednisone, prednisolone, methylprednisolone, budesonide, hydrocortisone, parenteral, oral, or rectal

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17
Q

Indication of corticosteroids

A

treatment of active UC or chrohn’s, induce remission

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18
Q

MOA of corticosteroids

A

antiinflammatory, inhibit cytokine and prostaglandins, immunosuppression, decreased margination of monocytes and neutrophils

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19
Q

Withdrawal sx of short-term steroid use

A

mood and sleep disturbances, inc appetitie, acne, adrenal insufficiency, fluid retention, impaired glucose metabolism

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20
Q

Withdrawal sx of long-term steroid use

A

abnormal fat deposits, hirsutism, htn, glaucoma/cataracts, osteopenia, osteoporosis, DM

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21
Q

Immunosuppressive agents

A

Azathioprine, 6-mercaptopurine, Methotrexate, cyclosporine & tacrolimus

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22
Q

Azathioprine and 6-mercaptopurine indication

A

not-FDA approved for tx of IBD, steroid sparing, combo w/ biologics

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23
Q

Azathioprine and 6-mercaptopurine MOA

A

immunosuppression, thought to suppress cell mediated hypersensitivities and cause alteration in ab productions

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24
Q

Azathioprine and 6-mercaptopurine onset

A

slow, 3 months

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25
Q

Azathioprine and 6-mercaptopurine black box warning

A

chronic immunosuppression cana inc risk of neoplasia, hematological toxicities, mutagenic potential

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26
Q

Azathioprine and 6-mercaptopurine adrs

A

GI upset, LFT, rash, hematologic toxicities, Preg cat D

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27
Q

Methotrexate indication

A

not FDA approved for tx of IBD, steroid sparing

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28
Q

Methotrexate MOA

A

immunosuppression

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29
Q

Methotrexate onset

A

slow, 2-8 weeks

30
Q

Cyclosporine & tacrolimus (Prograf) indication

A

not FDA approved for tx of IBD, reserved for severe, tx refractory colitis, lot of drug monitoring

31
Q

Cyclosporine & tacrolimus (Prograf) moa

A

immunosuppression

32
Q

Cyclosporine & tacrolimus (Prograf)onset

A

slow, 5-14 days

33
Q

Cyclosprorine Boxed warning

A

inc susceptibility to infection, possible development of llymphoma and other malignancies, inc hypertension, nephrotoxicity

34
Q

ADR of cyclosporine

A

hirsutism, HTN, hyperkalemia, hepatotoxicity, nephrotoxicity, tremor, gingival hyperplasia, hypomagnesemia, encephalopathy, HA, preg cat C

35
Q

Tacrolimus (Prograf) BBW

A

inc susceptibility to infection possible development of lymphoma and other malignancies

36
Q

Tacrolimus (Prograf) ADR

A

peripheral edema, erythema, pruritus, rash, constipation, N/V/D, anemia, paresthesia, HA, insomnia, tremor, alopecia, cat C

37
Q

Antibiotic indication

A

for abcesses or fistulas, intestinal or perianal disease, suspected infection

38
Q

Metronidazole (Flagyl)

A

MOA- anti-inflammatory, immunosuppressive, ADR- metallic taste, disulfiram reaction wen taken w/ EtOH

39
Q

Ciprofloxacin

A

MOA- anti-inflamm, immunosuppressive; ADR- vaginitis, abd pain, distal neuropathy, tendinopathy

40
Q

Biologics MOA

A

inhibits TNFa leading to dec GI inflammation and adhesion

41
Q

Biologic agents

A

adalimumab (Humira), Infiximab (Remicade), Golimumab (Simponi), Natalizumab (Tysabri), Certolizumab (Cimzia)

42
Q

Antimotility options for diarrhea

A

diphenoxylate/atropine (Lomotil), Loperamide (Imodium), paregoric, opium incture, difenoxin (Motofen)

43
Q

Absorbent options for diarrhea

A

kaolin-pentin mixture, polycarbophil, attapulgite

44
Q

Antisecretory options for diarrhea

A

Bismuth subsalicylate (Pepto), lacase, probiotics, octreotide (Sandostatin)

45
Q

Lomotil MOA

A

similar to opiate, atropine added in subtherapeutic amounts and serves to discourage abuse, CIV controlled

46
Q

Lomotil dose and onset

A

5 mg PO QID, 45-60 mins, if no response in 48 hrs, d/c

47
Q

Loperamide (Imodium) MOA

A

inhibits peristalsis by binding opioid receptors in intestinal muscle, also inc viscosity and diminishes fluid/electrolyte loss, inc anal sphincter tone

48
Q

Loperamide (Imodium) dose

A

4 mg PO at onset then 2mg PO after each loose stool, max 8 tabs/day

49
Q

Bismuth subsalicylate (Pepto) MOA

A

largely effective due to its antisecretory action, may have antimicrobial and antiinflammatory activity too

50
Q

IBS

A

Chronic abd pain and altered bowel habits, exact pathophysiology unknown, treatment based on predominant sx, diarrhea or constipation

51
Q

Treatment of constipation prominent IBS

A

inc dietary fiber and fluid, add bulk-laxative and consider antispasmodic agent, add serotonin-4 agonist (tegaserod), add psychotherapy for stress reduction, antidepressants

52
Q

Treatment of diarrhea prominent IBS

A

lactose-free, caffeine free diet, avoid certain foods, add loperamide or other antispasmodic, add serontonin-3 antagonist (alosetron), add psychotherapy for stress reduction, antidepressants

53
Q

Treatments for GERD

A

antacid, histamine H2 receptor antagonist, proton pump inhibitors, cytoprotective agents, promotility agents

54
Q

Histamine 2 antagonist

A

famotidine (Pepcid), Ranitidine (Zantec), nizatidine (Axid), cimetidine (Tagamet)

55
Q

PPI options

A

Omeprazole (Prilosec), Esomeprazole (Nexium), Pantoprazole (Protonix), Lansoprazole (Prevacid), Dexlansoprazole (Dexilant), Rabeprazole (Aciphex)

56
Q

Antacids

A

Neutralize gastric acid, increases pH, provides relief within mins, use for mild or infrequent sx, Ca, Al, Mg, NaHCO3, mag-alsimethicone, Mg and Al can accumulate in severe renal dysfuntion, 1-4 tabs PRN, 8000 mg/ day max

57
Q

H2 blockers

A

reversibly inhibits receptor on gastric parietal cells, reduction of gastric acid secretion, relief in 30-45 mins, lasts 4-10 hrs

58
Q

What is DOC in H2 blockers for peds and neonates

A

Ranitidine (Zantac)

59
Q

H2 blockers ADRs, warnings

A

BBW for elderly (not followed), overall very well tolerated, some agitation, vomiting in children

60
Q

Dosing of H2 blockers

A

Famotidine (Pepsi) 20 mg PO BID, Ranitidine (Zantec) 150 mg PO BID

61
Q

PPI

A

blocks gastric acid secretion by irreversibly binding to gastric H/K/ATP pump in parietal cells, full effect not seen for several hrs-few days, some OTC

62
Q

Which PPI is used in peds

A

omeprazole

63
Q

PPI warning and ADRs

A

increased risk of C diff, diarrhea, osteoporosis, pneumonia; overall well tolerated

64
Q

PPI dosage

A

Pantoprazole (Protonix)- 40 mg PO, Omeprazole (Prilosec) 20-40 mg PO, Esomeprazole (Nexium)- 40 Mg PO, Lansoprazole (Prevacid) 30 mg PO

65
Q

Cytoprotective agents

A

misoprostol (Cytotec), Sucralfate (Carafate)

66
Q

Misoprostol (Cytotec)

A

prostaglandin E1 analog, replaces the gastroprotective prostoglandins removed by NSAIDs, do not give w/ other drugs, Preg X, ADR- diarrhea, abd pain

67
Q

Sucralfate (Carafate)

A

sucrose-sulfate-alum complex- interacts w/ albumin and fibrinogen to form physical barrier over an open ulcer, very safe, rarely causes constipation, 1 Gm PO w/ meals, use w/ caution in renal impairment

68
Q

Promotility agents

A

Metoclopramide (Reglan), Erythromycin

69
Q

Metoclopramide (Reglan)

A

DA antagonist, enhances response to Ach in upper GI causing enhanced motility and accelerated gastric emptying, inc lower esophageal sphincter tone, 5-10 mg PO/IVw/ meals and hs, for diabetic gastroparesisi, used for neonatal reflux, also for chemo N/V

70
Q

Metoclopramide (Reglan) contraindications/ ADRs

A

may cause tardive dyskinesia, not for GI obstruction, perforation, hemorrhage, hx of seizures, can cause EPS, drowsiness, confusion

71
Q

Erythromycin

A

a macrolide abx used more regularly for promotility effects than abx, option for preprocedural bowel cleansing

Pharmacology (61 decks)

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