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GT BSN/CNL PHARM > GI Drugs > Flashcards

GI Drugs Flashcards

1
Q

pharmacologic treatment of H. pylori?

A

10-14 course of abx + an H2RA/PPI

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2
Q

How do NSAIDs predispose patients for PUD?

A

decrease submucosal blood flow d/t decreased PGs

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3
Q

drug options to decrease stomach acid?

A

H2RA
PPI
antacid

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4
Q

Drug options to increase defensive factors?

A

sucralafate
misoprostol

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5
Q

what is a disulfiram-like reaction?

A

unpleasant –> dangerous adverse effect of combining EtOH with some drugs
(i.e. with disulfiram or some antibiotics)

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6
Q

Two classes of drugs that decrease the secretion of stomach acid

A

H2RA
PPI

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7
Q

Which is more effective - PPI or H2RA?

A

PPI

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8
Q

List two H2RAs

A

cimetidine
famotidine

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9
Q

adverse effects of H2RAs

A

anti-androgenic effects
CNS effects (in higher risk populations d/t loss of H receptor selectivitiy)
Pneumonia

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10
Q

List 3 PPIs

A

omeprazole
lansoprazole
pantoprazole

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11
Q

mechanism of action of PPIs

A

IRREVERSIBLE inhibition of proton pump (H+/K+ ATPase)

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12
Q

duration of action of PPIs

A

1/2 life of drug is 1hr but duration of action is longer d/t the irreversible inhibition.
Can take weeks to re-manufacture more proton pumps

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13
Q

adverse effects of PPIs

A

HA, N/V, diarrhea
PNA
hypocalcemia, hypomagnesemia
rebound acid hypersecretion

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14
Q

How do antacids work?

A

Directly neutralize stomach acids

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15
Q

List the different families of antacids

A

aluminum
sodium
calcium
magnesium

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16
Q

What is the ANC

A

acid neutralizing capacity

basically the potency of the antacid

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17
Q

ALL antacids may contain a high amount of _____.

A

sodium

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18
Q

How does sucralfate work?

A

polymerize in the stomach and maintains a sticky gel barrier over the gastric wall
(protects the ulcer)

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19
Q

How does misoprostol work in increasing defensive factors?

A

misoprostol = PG

PG = vasodilation of submucosal vessels = improved mucus secretion & more H+ removal from stomach

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20
Q

absolute contraindication of misoprostol for PUD?

A

pregnancy

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21
Q

Name a bulk forming laxative

A

psyllium

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22
Q

Name a surfactant laxative

A

docusate

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23
Q

Name 3 stimulant laxatives

A

bisacodyl
senna
castor oil

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24
Q

Name a couple osmotic laxatives

A

polyethylene glycol
lactulose

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25
Q

Which classes of laxatives are Type I

A

high dose osmotics
castor oil

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26
Q

Which classes of laxatives are Type II

A

low dose osmotics
stimulant laxatives

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27
Q

Which classes of laxatives are Type III

A

Bulk forming
surfactant

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28
Q

Explain what is meant by Type I, Type II, and Type III laxatives

A

Type I = rapid onset with watery stool consistency
Type II = 6-12hr onset with semifluid stool consistency
Type III = 1-3 day onset with formed stool consistency

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29
Q

How do bulk forming laxatives work?

A

Swell in the presence of water thereby increasing the bulk of stool = intestine stretch receptor stimulation & peristalsis

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30
Q

All laxatives should be given with:

A

adequate fluids

31
Q

How do surfactant laxatives work?

A

Lower the surface tension of stool to allow for H2O to enter

(increases size of stool = stretch receptor stimulation = peristalsis)

32
Q

How do stimulant laxatives work?

A

stimulate intestinal motility & increases H2O/electrolyte secretion into intestinal lumen

33
Q

How do osmotic laxatives work?

A

Drug remains in intestine and pulls water in via osmosis

(increases size of stool = stretch receptor stimulation = peristalsis)

34
Q

Another use for the osmotic laxative lactulose?

A

Decrease plasma ammonia concentration by improving fecal excretion

35
Q

Laxatives for colonoscopy prep are not benign. Potential issues include:

A

electrolyte disturbances
dehydration
fluid overload

36
Q

Treatment for laxative abuse

A

abrupt cessation
fluids/fiber

37
Q

Potential outcomes of long term laxative abuse

A

dehydration & e-lyte imbalances
decreased defecatory reflexes
colitis

38
Q

Name a 5-HT receptor antagonist for nausea treatment

A

ondansetron

39
Q

How do 5-HT receptor antagonists work in the treatment of nausea?

A

block 5-HT3 receptors in CTZ & afferent GI neurons

40
Q

adverse effects of ondansetron

A

HA
dizziness
diarrhea
QT prolongation

41
Q

How do glucocorticoids work in the treatment of nausea?

A

unknown mechanism

42
Q

adverse effect of glucocorticoids given for nausea

A

transient blood glucose increase

43
Q

List a glucocorticoid given for the treatment of nausea

A

dexamethasone

44
Q

List a substance P/neurokinin 1 receptor antagonist used for nausea treatment?

A

aprepitant

45
Q

How do substance P/neurokinin 1 receptor antagonists work in the treatment of nausea?

A

antagonize NK1 receptors in CTZ

46
Q

Major drug interactions with SubP/NK1 receptor antagonists?

A

CYP450 induction = decreased effectiveness of warfarin & hormonal birth control

**REQUIRES patient education to use alternative form of birth control x30 days

47
Q

List 4 dopamine antagonists that are used for nausea treatment

A

promethazine
haloperidol
droperidol
metoclopramide

48
Q

adverse effects of dopamine antagonists used for nausea treatment

A

hypotension
sedation
respiratory depression
EPS w/ long term use
promethazine = tissue injury w/ extravasation
haldol & droperidol = QT prolongation

49
Q

mechanism of action of anticholinergics in nausea treatmnet

A

decrease neuronal transmission from vestibular apparatus to vomiting center

50
Q

When should scopolamine be administered?

A

prior to the start of nausea (i.e. before getting on boat, before surgery, etc.)

51
Q

adverse effects of scopolamine

A

dry mouth
blurred vision
drowsiness/disorientation (esp elderly)

52
Q

most frequent route of administration of scopolamine

A

transdermal (behind ear)

53
Q

mechanism of action of antihistamines in the treatment of nausea

A

antagonize muscarinic & histamine receptors (decrease transmission from vestibular apparatus to vomiting center)

54
Q

List an anticholinergic used for nausea treatment

A

scopolamine

55
Q

adverse effects of antihistamines used for nausea treatment?

A

dry mouth
blurred vision
urinary retention
constipation

*since these drugs also block M receptors

56
Q

Which are more effective for nausea treatment: anticholinergics or antihistamines?

A

anticholinergics

57
Q

Complications of diarrhea?

A

dehydartion
electrolyte depletion

58
Q

How do opioids work in the treatment of diarrhea?

A

agonize opioid receptors = decrease bowel motility

59
Q

Are opioids used for diarrhea scheduled drugs?

A

Some are unscheduled, some schedule IV
They are often formulated with a drug that creates unpleasant side effects if the dose is increased

60
Q

List two opioids used for diarrhea

A

loperamide
opium tincture (common in neonates)

61
Q

Treatment of travelers diarrhea

A

+/-antibiotics
symptomatic relief = loperamide

62
Q

Treatment of c.diff

A

strong antibiotics

63
Q

How does alosteron work

A

antagonize 5-HT3 = increased transit time = decreased diarrhea

64
Q

contraindications of alosteron

A

GI obstruction
constipation
GI perforation

65
Q

4 classes of drugs that are used in the treatment of IBD

A

5-aminosalicylates
glucocorticoids
immunosuppressants
immunomodulators

66
Q

list a 5-aminosalicylate

A

sulfasalazine

67
Q

which glucocorticoid is specifically helpful for IBD in that it is formulated to release at site of inflammation?

A

budesonide

68
Q

adverse effects of sulfasalazine

A

nausea/vomiting
rash
arthralgia

rarely: agranulocytosis or hemolytic anemia

69
Q

name a TNF inhibitor used for IBD

A

infliximab

70
Q

adverse effects of TNF inhibitors

A

infections
infusion reactions that can be serious

71
Q

How does metoclopramide work?

A

DA & 5-HT antagonism in CTZ = decreased nausea/vomiting

enhancement of ACh = increased upper GI motility (faster gastric emptying)

72
Q

adverse effects of metoclopramide

A

sedation
diarrhea

long term can = EPS symptoms

73
Q

contraindications of metoclopramide administration

A

GI obstruction
GI perforation
GI hemorrhage

GT BSN/CNL PHARM (26 decks)

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