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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
Which classes of laxatives are Type I
high dose osmotics castor oil
26
Which classes of laxatives are Type II
low dose osmotics stimulant laxatives
27
Which classes of laxatives are Type III
Bulk forming surfactant
28
Explain what is meant by Type I, Type II, and Type III laxatives
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
29
How do bulk forming laxatives work?
Swell in the presence of water thereby increasing the bulk of stool = intestine stretch receptor stimulation & peristalsis
30
All laxatives should be given with:
adequate fluids
31
How do surfactant laxatives work?
Lower the surface tension of stool to allow for H2O to enter (increases size of stool = stretch receptor stimulation = peristalsis)
32
How do stimulant laxatives work?
stimulate intestinal motility & increases H2O/electrolyte secretion into intestinal lumen
33
How do osmotic laxatives work?
Drug remains in intestine and pulls water in via osmosis (increases size of stool = stretch receptor stimulation = peristalsis)
34
Another use for the osmotic laxative lactulose?
Decrease plasma ammonia concentration by improving fecal excretion
35
Laxatives for colonoscopy prep are not benign. Potential issues include:
electrolyte disturbances dehydration fluid overload
36
Treatment for laxative abuse
abrupt cessation fluids/fiber
37
Potential outcomes of long term laxative abuse
dehydration & e-lyte imbalances decreased defecatory reflexes colitis
38
Name a 5-HT receptor antagonist for nausea treatment
ondansetron
39
How do 5-HT receptor antagonists work in the treatment of nausea?
block 5-HT3 receptors in CTZ & afferent GI neurons
40
adverse effects of ondansetron
HA dizziness diarrhea QT prolongation
41
How do glucocorticoids work in the treatment of nausea?
unknown mechanism
42
adverse effect of glucocorticoids given for nausea
transient blood glucose increase
43
List a glucocorticoid given for the treatment of nausea
dexamethasone
44
List a substance P/neurokinin 1 receptor antagonist used for nausea treatment?
aprepitant
45
How do substance P/neurokinin 1 receptor antagonists work in the treatment of nausea?
antagonize NK1 receptors in CTZ
46
Major drug interactions with SubP/NK1 receptor antagonists?
CYP450 induction = decreased effectiveness of warfarin & hormonal birth control **REQUIRES patient education to use alternative form of birth control x30 days
47
List 4 dopamine antagonists that are used for nausea treatment
promethazine haloperidol droperidol metoclopramide
48
adverse effects of dopamine antagonists used for nausea treatment
hypotension sedation respiratory depression EPS w/ long term use promethazine = tissue injury w/ extravasation haldol & droperidol = QT prolongation
49
mechanism of action of anticholinergics in nausea treatmnet
decrease neuronal transmission from vestibular apparatus to vomiting center
50
When should scopolamine be administered?
prior to the start of nausea (i.e. before getting on boat, before surgery, etc.)
51
adverse effects of scopolamine
dry mouth blurred vision drowsiness/disorientation (esp elderly)
52
most frequent route of administration of scopolamine
transdermal (behind ear)
53
mechanism of action of antihistamines in the treatment of nausea
antagonize muscarinic & histamine receptors (decrease transmission from vestibular apparatus to vomiting center)
54
List an anticholinergic used for nausea treatment
scopolamine
55
adverse effects of antihistamines used for nausea treatment?
dry mouth blurred vision urinary retention constipation *since these drugs also block M receptors
56
Which are more effective for nausea treatment: anticholinergics or antihistamines?
anticholinergics
57
Complications of diarrhea?
dehydartion electrolyte depletion
58
How do opioids work in the treatment of diarrhea?
agonize opioid receptors = decrease bowel motility
59
Are opioids used for diarrhea scheduled drugs?
Some are unscheduled, some schedule IV They are often formulated with a drug that creates unpleasant side effects if the dose is increased
60
List two opioids used for diarrhea
loperamide opium tincture (common in neonates)
61
Treatment of travelers diarrhea
+/-antibiotics symptomatic relief = loperamide
62
Treatment of c.diff
strong antibiotics
63
How does alosteron work
antagonize 5-HT3 = increased transit time = decreased diarrhea
64
contraindications of alosteron
GI obstruction constipation GI perforation
65
4 classes of drugs that are used in the treatment of IBD
5-aminosalicylates glucocorticoids immunosuppressants immunomodulators
66
list a 5-aminosalicylate
sulfasalazine
67
which glucocorticoid is specifically helpful for IBD in that it is formulated to release at site of inflammation?
budesonide
68
adverse effects of sulfasalazine
nausea/vomiting rash arthralgia rarely: agranulocytosis or hemolytic anemia
69
name a TNF inhibitor used for IBD
infliximab
70
adverse effects of TNF inhibitors
infections infusion reactions that can be serious
71
How does metoclopramide work?
DA & 5-HT antagonism in CTZ = decreased nausea/vomiting enhancement of ACh = increased upper GI motility (faster gastric emptying)
72
adverse effects of metoclopramide
sedation diarrhea long term can = EPS symptoms
73
contraindications of metoclopramide administration
GI obstruction GI perforation GI hemorrhage

Pharm (27 decks)

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