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GI drugs Flashcards

1
Q

Peptic Ulcer Disease
Cause

A

Imbalance between mucosal defenses and aggressive factors

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2
Q

Peptic Ulcer Disease
Symptoms

A

Burning Pain: A burning or gnawing pain in the upper abdomen, typically between the navel and the breastbone.
Pain Relief: Pain may temporarily improve after eating, drinking milk, or taking antacids.
Nighttime Pain: Pain may worsen at night and wake the person from sleep.
Nausea and Vomiting: Nausea and occasional vomiting may occur.
Indigestion: Feeling bloated, full, or uncomfortable after eating, along with belching or gas.
Loss of Appetite: Decreased interest in food due to discomfort.
Unintended Weight Loss: Loss of weight without intentional diet changes.
Dark Stools: Stools may appear dark and tarry due to bleeding from the ulcer.

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3
Q

Aggressive factors that cause PUD

A

H. pylori
NSAIDs
Acid
Pepsin
Smoking

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4
Q

Defensive factors of PUD

A

Mucus
Bicarbonate
Blood flow
Prostaglandins (stimulate secretion of mucus and bicarbonate)

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5
Q

Why do NSAIDs cause ulcers?

A

Inhibit the biosynthesis of prostaglandins

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6
Q

How do antiulcer drugs work?

A

-Eradicate H. pylori
-Reduce gastric activity (antisecretory agents, misoprostol)
-Enhance mucosal defenses
(sucralfate, misoprostol)

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7
Q

H. Pylori treatment

A

Antibiotics
Antisecretory agent (H2 blocker or PPI)

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8
Q

H. Pylori antibiotic treatment

-which ones?
-how long?

A

2-3 of the following:

Amoxicillin
Clarithromycin
Bismuth compounds
Tetracycline
Metronidazole

Can require up to 12 pills/day up to 14 days

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9
Q

Histamine 2 Receptor Blockers end in _______

A

tidine

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10
Q

Cimetidine (Tagamet)
Ranitidine (Zantac)
Famotidine (Pepcid)

are all ______

A

H2 blockers

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11
Q

H2 Receptor Blockers
Mechanism

A

Suppress secretion of gastric acid

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12
Q

First-choice drugs for treating gastric and duodenal ulcers

A

H2 blockers

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13
Q

Cimetidine (Tagamet)
Adverse effects

A

-May cause CNS effects like confusion (esp older patients)
-IV bolus may experience hypotension and dysrhythmias
-P450 inhibitor
-Antiandrogenic effects (impotence)

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14
Q

Cimetidine vs Ranitinide

A

Ranitidine is 2nd generation and preferred because it does not anti-andronergic effects, causes fewer drug interactions

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15
Q

PPIs
Therapeutic uses

A

Most effective drugs for suppressing secretion of gastric acid

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16
Q

PPIs
Adverse effects

A

-Fracture
-Pneumonia
-Acid rebound
-C. diff

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17
Q

Omeprazole (Prilosec)
Class

A

PPI

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18
Q

Omeprazole
Mechanism

A

Inhibits gastric secretion

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19
Q

Omeprazole
Half-life

A

Short half-life (but active metabolites bind to proton pump) so effects last several days

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20
Q

Sucralfate
Mechanism

A

Protective barrier up to 6 hours

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21
Q

Misoprostol (Cytotec)
Class

A

Synthetic prostaglandin

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22
Q

Misoprostol
Uses

A

Gastric ulcers caused by NSAIDs

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23
Q

Misoprostol
Adverse effects

A

Dose-related diarrhea
Contraindicated in pregnancy

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24
Q

Antacids (calcium, magnesium, and aluminum compounds)
Mechanism

A

React with gastric acid to produce neutral salts or salts of low acidity

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25
Antacids Which patients should you use with caution in?
Pts with renal impairment
26
What causes nausea?
Complex reflex after activating vomiting center in medulla oblongata
27
Types of receptors involved in emetic response
Serotonin, glucocorticoids, substance P, neurokinin, dopamine, acetylcholine, and histamine
28
Ondansetron (zofran) Mechanism
Serotonin receptor antagonist
29
What was zofran first approved for?
Chemotherapy-induced nausea and vomiting (CINV)
30
Zofran works much better when used with _______
dexamethasone
31
First line treatment for highly emetogenic chemotherapy
Ondenastron + dexamethasone
32
Aprepitant (Emend) Mechanism
Substance P/neurokinin antagonist
33
Aprepitant Use
Antiemetic Prolonged duration of action - helpful for DELAYED N/V caused by chemo
34
Benzodiazepine use as antiemetic
Suppression of anticipatory emesis
35
Phenothiazine (prochlorperazine, promethazine) Use
Antiemetic
36
Phenothiazine (prochlorperazine, promethazine) Adverse effects
Extrapyramidal reactions Anticholinergic effects Hypotension and sedation
37
Metoclopramide (Reglan) Use
Antiemetic
38
Metoclopramide (Reglan) Mechanism
Dopamine antagonist
39
Dronabinol (Marinol) Class
Cannabinoid
40
Nabilone (Cesamet) Class
Cannabinoid
41
When to administer antiemetics
More effective in preventing nausea than suppressing nausea in progress
42
Scopolamine Use
Motion sickness
43
Scopolamine Class
Muscarinic antagonist (Anticholinergic)
44
Scopolamine Adverse effects
Dry mouth Blurred vision Drowsiness
45
Drugs for motion sickness
Scopolamine & antihistamines
46
Meclizine (Antivert) Class/use
Antihistamine Drug for motion sickness
47
Dimenhydrinate (Dramamine) Class
Antihistamine
48
Antihistamine side effects
-Sedation -Anticholinergic effects (dry mouth, blurred vision, urinary retention, constipation)
49
Diarrhea Causes
-Infection -Maldigestion -Inflammation -Functional disorders of the bowel (IBS)
50
Lomotil (Diphenoxylate) Imodium (Loperamide) Uses
Antidiarrheal
51
What deters abuse for antidiarrheal opiods?
Many are not water-soluble and can't be injected
52
Function of the colon
-Absorbs water and electrolytes
53
What is considered normal frequency of bowel elimination?
2-3 times/day to 2x/week
54
How does dietary fiber help bowel function?
Absorbs water, softens feces, and increases size
55
When do you hold off on laxative use?
-Abdominal pain, nausea, cramps, guarding/extreme tenderness upon palpation - do NOT give laxatives until further work up rules out other GI conditions such as appendicitis or diverticulitis -Fecal impaction
56
What are the 4 types of laxatives?
-Bulk-forming -Surfactant -Stimulant -Osmotic
57
Docusate sodium is a ____ laxative
Surfactant
58
Bisacodul [Dulcolax] is a ____ laxative
stimulant
59
Class of the following medications: Milk of magnesia (MOM) Polyethlyene gycol (PEG) Sodium phosphate
Osmotic laxatives
60
Which laxatives work more quickly (6-12 hours)?
Stimulant and Osmotic laxatives
61
Which laxative is used for opioid-induced constipation?
Stimulant medications
62
Metamucil Citrucel Class
Bulk-forming laxatives
63
What is a rare adverse effect of bulk-forming laxatives? How do you prevent it?
Esophageal obstruction Take with a full glass of water
64
What laxative is used to prevent opioid-induced constipation?
Surfactant laxative (e.g. docusate sodium - colace)
65
Osmotic laxatives Adverse effects
-Dehydration -Acute renal failure -Exacerbated heart failure, hypertension, edema
66
In which patients would you use sodium phosphate products with caution?
Patients with renal or cardiac disease
67
Sodium phosphate, Prepopik, and PEG-ELS (polyethylene glycol pls electrolytes) are all used for _____
Bowel cleansing products for colonoscopy
68
Sodium phosphate Tonicity
Hypertonic
69
Sodium picosulfate Magnesium Oxide Citric Acid Components of which drug?
Prepopik
70
Which bowel cleansing product is best for patients with renal and cardiac disease?
PEG-ELS Polyethylene glycol plus electrolytes (Isotonic - does not cause electrolyte shifts)
71
Sodium phosphate Adverse effects
Nausea Bloating Abdominal discomfort Risk of dehydration Electrolyte disturbances Kidney damage Hyperphosphatemia
72
GoLTYELY Generic name
Polyethylene Glycol
73
GoLYTELY Administration for bowel prep
250-300mL every 10 minutes for 2-3 hours
74
GoLYTELY Adverse effects
Nausea Bloating Abdominal discomfort
75
Low volume bowel prep that is a combo of osmotic and stimulant laxatives
Prepopik
76
Bowel replenishment after evacuation can take ____ days
2-5
77
Consequences of laxative abuse
Diminished defecatory reflexes leading to further reliance on laxatives

Pharmacology (21 decks)

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