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pharm 516 > GI Drugs > Flashcards

GI Drugs Flashcards

1
Q

Meds that cause GERD,

A

calcium channel blockers, glucocorticoids, muscle relaxants, theophylline, oral bronchodialators, diazepam, nicotine, etoh, coffee, chocolate, mint, fatty foods

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2
Q

risk factors for ulcers

A

H. pylori, OTC pain meds (aspirin and ibu)
Etoh
Smoing
Family Hx

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3
Q

4 types of antacids

A 
aluminum salts
magnesium salts
calcium salts
sodium bicarbonate
don't use antacids chronically
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4
Q

Aluminum Salts

A 
constipating
mag can counteract constipation
aluminum toxicity
aluminum carbonate (basaljel), hydroxide salt:AlternaGEL, combination with mag: Gaviscon, Maalox, Mylanta, Di-Gel
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5
Q

Magnesium salts

A

often cause diarrhea

dangerous with renal failure, can result in mag accumulation

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6
Q

Calcium Salts

A

may cause kidney stones
long duration of acid action can cause rebound hyperacidity
TUMS
stay away from it

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7
Q

Sodium bicarbonate

A 
high solubility
buffers acidic properties of HCL
quick onset, short duration
may cause metabolic alkalosis
high sodium content (CHF, HTN, renal insuf)
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8
Q

ppi therapy should

A

elinimate symptoms
heal erosive esophagitis
prevent the relapse of erosive esophagitis

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9
Q

PPI

A

wait 2-6 weeks before increasing dose
OTC is more expensive than rx
hates esomeprazole
give 1h before meals

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10
Q

H2 receptor antagonist

A

reversible competitive inhibitor of H2 receptor
highly selective
effective in inhibiting nocturnal acid secretion
modest impact on meal stimulated acid secretion
ranitidine and famotidine are good,
cimetidine is bad P450 inhibitor, gynecomastia, impotence, decreased levels of other drugs (warfarin, theophylline, phentoin, ethanol)
take 1h before or after antacids
assess for allergies, imp renal or liver function

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11
Q

H2 antagonist SE

A

HA, lethargy, confusion, diarrhea, urticaria, sweating, flushing, other effects, may decrease absorption of drugs that need acidic GI env

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12
Q

kaolin and pectin

A

absorbent antidiarrheal, clay like powder attracts and holds onto bacteria, then thickens.for simple diarrhea, act locally in bowel

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13
Q

bismuth subsalicylate

A

antisecretory and antibacterial, possibly anti-inflammatory, part of h.pylori tx, contains aspirin, CI in kids and teenagers, gray/black stools and black tongue are normal

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14
Q

diphenoxylate with atropine

A

constipating, opioid activity at high doses, anticholinergic properties, slows peristalsis, d/c if abd distension, caution in older adults, hepatorenal disease

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15
Q

loperamide

A

binds to opiate receptors of the intenstinal wall, slow gastric motility, diminishes fluid loss, d/c if abd distension

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16
Q

oral rehydration solution

A

8 oz water, 1/4 tsp baking soda, alternate with water with salt and honey. for severe diarrhea, more salt is needed

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17
Q

IBD diarrhea control

A

steroids and sulfasalazine, loperamide first

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18
Q

traveler’s diarrhea

A

bismuth subsalicylate, oral antimicrobials, loperamide (immodium)

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19
Q

cytoprotective agents

A

sucralfate (basic aluminum salt)- viscous gel adheres to ulcer’s crater, stress ulcer prevention and duodenal ulcer, taken on empty stomach, avoid concurrent antacid, and misoprostol - stimulates mucous and bicarb secretion(caution in renal impairment) for NSAID induced problems, cat X, GI sx, with food

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20
Q

5 classes of antiemetics

A

antihistamines, phenothiazines, sedative hypnotics, cannabinoids, and 5_HT receptor antagonists

21
Q

antihistamines

A

good for motion sickness, dimenhydrinate, diphenhydramine, hydroxyzine, and meclizine, strong anticholinergic effects, CI in severe liver disease, better for long term applications

22
Q

phenothiazines

A

block dopamine receptors, sedating, have extrapyramidal effects (limiting), prochlorperazine and promethazine (fatal resp dep younger than 2, bone marrow depression)), metoclopramide (prokinetic), CI in Parkinson’s, narrow-angle glaucoma, bone marrow depression, severe CV or hepatic disease. some anticholinergic effects. may discolor urine pink/reddish-brown. additive hypontensive effects. CBC prior to initiating therapy, blood dyscrasias 4 to 10 weeks after therapy starts

23
Q

cannabinoids

A

decrease n/v/appetite stimulant, works in the CNS, may lower seizure threshold, palpitations, tachycardia, hypotension, interacts with other CNS depressants

24
Q

5-HT receptor antagonists

A

block serotonin on the peripheral vagal nerve terminals and centrally, used with chemotherapy, may mask progressive ileus, constipation, HA, fatigue

25
Q

drugs that cause peptic ulcers

A

NSAID, glucocorticoids, cytotoxic agents

26
Q

colloidal bismuth compounds

A

coats ulcer, stimulates mucus and bicaarb, direct action against H. pylori, blackening of tongue and stool, not for long term use - bismuth toxicity

27
Q

IBD therapy

A

sulfasalazine and 5-ASA, (mesalamine, active molecule) 2 moeity’s, mild to moderate CD/UC

28
Q

5-ASA delivery systems

A

Pentasa - esop-rectum, for Chrons’, slow release
Asacol-ileum and colon effected, 60-70%
Rowasa-if only rectal, avoids systemic
Colazal-very expensive, colon

29
Q

antibiotics

A

CD only, not UC, metronidazole has anti-fistula properties, cipro, pouchitis biologics if metronidazole doesn’t work

30
Q

steroids

A

for flare-ups, not long-term, hospitalize if can’t tolerate PO, if unable to taper, try antimetabolite or infliximab, topical can be used in rectum

31
Q

azathioprine and 6 MP

A

for steroid dependent IBD, measure CBC q2w, takes months to work, major durg-drug ALLOPURINOL

32
Q

methotrexate

A

IV for active CD or maitenance of CD remission, induction with steroid withdrawal, weekly IM, monitor CBC, LFT, renal function

33
Q

cyclosporine

A

induction in UC, CD in high doses (toxicity), steroid refractory UC, used to bridge to AZA as maintenance

34
Q

infliximab

A

tnf alpha antibody - CD and UC with inadequate response to conventional tx, withdrawal concomitant steroids. avoid infection, demyelinating d/o, CHF, malignancy, screen for

35
Q

metoclopramide

A

stimulates motility in GI, postprandial and daytime heartburn, 30 min prior to meal, r/f tardive dyskinesia, don’t use more than 12 weeks or when GI motility is CI (obstruction), used for GERD and diabetic gastroparesis

36
Q

PPI’s interfere with absorption of…

A

Warfarin, ketoconazole, digoxin, esters of ampicillin, iron salts. inc monitoring of INR. clopidogrel efficacy dec. by 50%. lansoprazole does not interfere with warfarin

37
Q

tx of duodenal and gastric ulcers

A

PPI for 12 weeks, once daily in the am before meals, also test for H. pylori

38
Q

GERD management

A

lifestyle and antacid PRN, then H2RA, then PPI. If refractory after 4-8 weeks, inc. PPI. if symptoms gone, decrease PPI after 4 weeks. if no relief after BID, referral to gastroenterologist or if endoscopy shows erosive disease. failure to achieve symptom relief after 3 months, gastroenterology referral.

39
Q

alarm symptoms that require endoscopy

A

dysphagia, painful swallowing, noncardiac chest pain, weight loss, hematemesis, and choking. PPI may mask gastric CA.

40
Q

stimulant laxatives

A 
release of prostaglandins
inc cAMP concentration
increases secretion of electrolytes
stimulates peristalsis
rapid response, short term
cascara (has etoh, CI pregnancy), senna, bisacodyl, and castor oil
used for reduced mobility, constipating drugs, reduced motility, ibs, neurogenic bowel
caution with severe CV disease
41
Q

osmotic laxatives

A

draw water into intestinal lumen to inc pressure
hypertonic salt-based solutions
cause diffucion of fluid from the plasma inot the intestine
most powerful
mag hydroxide, mag citrate, PEG (CI in kids d/t electrolyte probs), used for bowel prep
CI in renal insufficiency, hyper mag, hypocalcemia, heart block

42
Q

bulk producing laxatives

A

most physiological, safest,
natural and semisynthetic polysaccharides and cellulose
mechanical distention that increases peristalsis
long-term management of simple, chronic const
useful in avoiding straining to stool
mgt of chronic, watery diarrhea
CI narrowed esophageal or intestinal lumen and impaction
watch for sugar or salt

43
Q

lubricants

A

mineral oil, retards colonic absorption of fecal water and softens stool
used with fecal impaction
lubricates intestines
may decrease absorption of fat soluble vitamins, avoid in pregnancy
r/f aspiration under 4 y.o.

44
Q

surfactants

A

stool softeners, emollient action, good for hard, dry stool, anorectal conditions, painful stool, avoiding straining, safe for all ages.
no specific CI

45
Q

CI of all laxatives

A

presence of n/v or undiagnosed abd pain or bowel obstruction.

46
Q

miscellaneous

A

glycerin is local irritant, hyperosmotic, draws water. lactulose, hyperosmotic transformed to lactic acid and acetic and formic acid, lowers pH of colon. glycerin, for fecal impaction, neurogenic bowel.

47
Q

hyperosmolar considerations

A

lactulose causes hyperglycemia, caution in presence of volume depletion,

48
Q

chronic use of laxatives

A

r/f abuse and dependency, fluid and electrolyte imbalances, steatorrhea, osteomalacia, and vit and min deficiencies.

pharm 516 (12 decks)

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