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GI/Hepatology > GI drugs > Flashcards

GI drugs Flashcards

1
Q

Hepatitis A Vaccine: Mechanism of Action

A

Gamma globulin

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2
Q

Immunoglobulin: Mechanism of Action

A

Passive immunity to Hep A, for travel to endemic areas

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3
Q

Hepatitis B Vaccine: Mechanism of Action

A

Recombinant Vaccine, active immunity

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4
Q

PEGylated Interferon: Sub

A

HepB AND HepC

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5
Q

Tenofovir, Entecavir, Lamivudine

A

HepB only

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6
Q

Tenofovir, Entecavir: Mechanism of Action

A

Competitively decreases DNA polymerase, replication

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7
Q

PEGylated Interferon: Indication(s)

A

For all types of hepatitis C

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8
Q

Ribavirin: Indication(s)

A

For Hepatitis C genotype 2/3

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9
Q

Ribavirin: Mechanism of Action

A

Synthetic nucleoside analog

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10
Q

Ribavirin: Adverse Effects

A

causes anemia

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11
Q

Boceprevir, teleprevir: Indication(s)

A

For Hep C genotype 1

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12
Q

Boceprevir, telaprivir: Mechanism of Action

A

Protease inhibitors

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13
Q

Diuretics: Sub AND Indication(s)

A

Ascites (Cirrhosis, PHTN)

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14
Q

Diuretics: Mechanism of Action

A

Aldosterone inhibitor (aldactone) + loop diuretic (furosemide)

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15
Q

Diuretics: Adverse Effects

A

Gynecomastia (switch to amiloride or triamterene)

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16
Q

Diuretics: If ascites is refractory

A

Large volume paracentesis (LVP) or transjugular intrahepatic portosystemic shunt (TIPS)

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17
Q

Conivaptan, Tolvaptan: Indication

A

for decreased Na+ in Cirrhosis, PHTN

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18
Q

Conivaptan: Mechanism of Action

A

Vasopressin antagonists

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19
Q

Conivaptan, Tolvaptan: Adverse Effects

A

Cerebral edema

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20
Q

Nadolol, Propanolol: Indication

A

Varices in Cirrhosis and PHTN

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21
Q

Nadolol, Propanolol: Mechanism of Action

A

Beta blockers decreases portal vein inflow

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22
Q

Lactulose: Indication(s)

A

Hepatic encephalopathy

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23
Q

Lactulose: Mechanism of Action

A

Draws out NH3

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24
Q

Rifaximin: Indication(s)

A

Hepatic encephalopathy AND IBS-D

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25
Q

Rifaximin: Mechanism of Action

A

Antibiotic AND Antibiotic, decreases bloating

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26
Q

N-acetylcysteine: Indication(s)

A

Acetaminophen toxicity (ALF)

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27
Q

N-acetylcysteine: Mechanism of Action

A

Bind NAPQI (toxic metabolite of Tylenol)

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28
Q

N-acetylcysteine: Dosing / Timing

A

PO/IV

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29
Q

Prednisone: Indication(s)

A

1st line Autoimmune Hepatitis

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30
Q

Prednisone: Mechanism of Action

A

Immunosuppressants

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31
Q

Prednisone & Azathioprine: Adverse Effects

A

Cushing’s, DM, cancer, etc. (70% have adverse effects)

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32
Q

Prednisone & Azathioprine: Notes

A

90% 10-yr survival; switch to monotherapy if severe adverse effects or for maintenance

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33
Q

Azathioprine: Sub

A

AIH first line AND 2nd line Remission Maintenance in Crohns

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34
Q

Azathioprine: Mechanism of Action

A

Immunosuppressants AND Prodrug of 6-MP

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35
Q

Cyclosporine: Class

A

Autoimmune Hepatitis AND UC/Crohn’s

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36
Q

Cyclosporine: Sub

A

AIH AND Acute Flares in Crohns

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37
Q

Cyclosporine: Indication(s)

A

2nd line (AIH) AND 4th line acute (Crohns)

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38
Q

Cyclosporine, Tacrolimus, mycophenylate: Mechanism of Action

A

Immunosuppressants

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39
Q

Cyclosporine, Tacrolimus, Mycophenylate: Adverse Effects

A

Presumably even worse adverse effects than Aza, prednisone

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40
Q

Tacrolimus, Mycophenolate: Indication

A

AIH (2nd line)

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41
Q

Ursodeoxycholic Acid: Indication

A

PBC

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42
Q

Ursodeoxycholic Acid: Mechanism of Action

A

Chemically synthesized bile acid replacement, also increases production of endogenous bile acid

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43
Q

Ursodeoxycholic Acid: Notes

A

Cytoprotective for hepatocytes (inhibits apoptosis, stabilizes membrane)

44
Q

Sodium Bicarbonate (Baking Soda) & Calcium Carbonate (Tums, Rolaids) & Aluminum Hydroxide + Magnesium Hydroxide (Mylanta, Maalox): Indication(s)

A

OTC for mild GERD and PUD

45
Q

Sodium Bicarbonate (Baking Soda) & Calcium Carbonate (Tums, Rolaids) & Aluminum Hydroxide + Magnesium Hydroxide (Mylanta, Maalox): Mechanism of Action

A

Weak basic inorganic salts, neutralize H+

46
Q

Sodium Bicarbonate (Baking Soda) & Calcium Carbonate (Tums, Rolaids) & Aluminum Hydroxide + Magnesium Hydroxide (Mylanta, Maalox): Dosing / Timing

47
Q

Sodium Bicarbonate (Baking Soda) & Calcium Carbonate (Tums, Rolaids): Adverse Effects AND Notes

A

Combining Na and Ca can result in mild alkali syndrome

48
Q

Aluminum Hydroxide + Magnesium Hydroxide (Mylanta, Maalox): Adverse Effects

A

Mg - diarrhea; Al - phosphate depletion, constipation

49
Q

Aluminum Hydroxide + Magnesium Hydroxide (Mylanta, Maalox): Notes

A

Often comes with Ca+ to prevent osteoporosis

50
Q

Cimetidine: Class

A

Peptic Ulcer Disease/GERD

51
Q

Cimetidine, Rantidine, Famotide, Nizatidine: Indication(s)

A

OTC for mild to moderate GERD

52
Q

Cimetidine, Rantidine, Famotide, Nizatidine: Mechanism of Action

A

Competitive inhibition of H2 receptors on parietal cells → decreases cAMP, HCl secretion

53
Q

Cimetidine, Rantidine, Famotide, Nizatidine: Dosing / Timing

A

PO BID usually

54
Q

Cimetidine, Rantidine, Famotide, Nizatidine: Adverse Effects

A

Headache, fatigue, confusion

55
Q

Cimetidine, Rantidine, Famotide, Nizatidine: Notes

A

Not as strong as PPIs, more effective vs. basal / nocturnal gastric acid

56
Q

Omeprazole (Prilosec), Lansoprazole, Pantoprazole, Rabeprazole, Esoprazole, Dexlansoprasol: Indication(s)

A

Moderate to severe GERD, healing PUD, acute bleeding ulcers, gastrinoma

57
Q

Omeprazole (Prilosec), Lansoprazole, Pantoprazole, Rabeprazole, Esoprazole, Dexlansoprasol: Mechanism of Action

A

PPI: Prodrugs cross membrane at neutral pH, become protonated in acidic parietal cell, inactivates H/K ATPase irreversibly

58
Q

Omeprazole (Prilosec) Lansoprazole, Pantoprazole, Rabeprazole, Esoprazole, Dexlansoprasol: Dosing / Timing

A

PO / IV (5% of US on one)

59
Q

Omeprazole (Prilosec), Lansoprazole, Pantoprazole, Rabeprazole, Esoprazole, Dexlansoprasol: Adverse Effects

A

Diarrhea, B12/Fe absorption deficiency, atypical fractures, c. diff, rebound hyper-secretion, dependence

60
Q

Omeprazole (Prilosec), Lansoprazole, Pantoprazole, Rabeprazole, Esoprazole, Dexlansoprasol: Notes

A

Gets concentrated 1000x in parietal cell canaliculi, 70% of hospital patients on a PPI

61
Q

Sucralfate: Indication(s)

62
Q

Sucralfate: Mechanism of Action

A

PO: Coats mucosal surface with viscous paste

63
Q

Bismuth Subsalicylate (Pepto-Bismol): Class

A

Peptic Ulcer Disease/GERD AND Diarrhea

64
Q

Bismuth Subsalicylate (Pepto-Bismol): Mechanism of Action

A

Coats ulcers and erosions, anti-h.pylori AND Antisecretory, antimicrobial, anti-inflammatory

65
Q

Bismuth Subsalicylate (Pepto-Bismol): Adverse Effects

A

Turns your tongue / stool black AND Tongue / stool turns black, neurotoxicity at high doses, Reye’s in theory

66
Q

Lansoprazole / Amoxicillin / Clarithromycin: Class

A

Peptic Ulcer Disease/GERD

67
Q

Lansoprazole / Amoxicillin / Clarithromycin: Mechanism of Action

A

PO: Most common PPI triple regimen (PPI + 2 Abx combo)

68
Q

Lansoprazole / Amoxicillin / Clarithromycin: Adverse Effects

A

Resistance to clarithromycin or metronidazole possible

69
Q

Lansoprazole / Amoxicillin / Clarithromycin: Notes

A

Eradication in 75%

70
Q

Mesalamine (Asacol, Lialda, etc.): Sub

A

UC/Crohns: Acute Flares AND Remission Maintenance

71
Q

Mesalamine (Asacol, Lialda, etc.): Indication(s)

A

1st line acute AND 1st line maint

72
Q

Mesalamine (Asacol, Lialda, etc.): Mechanism of Action

A

~Aspirin, anti-oxidant

73
Q

Mesalamine (Asacol, Lialda, etc.): Dosing / Timing

A

PO or PR AND PO

74
Q

Sulfasalazine: Sub

A

UC/Crohn’s Acute Flares, 1st line acute

75
Q

Sulfasalazine: Mechanism of Action

A

Prodrug of 5-ASA

76
Q

Steroids (Prednisone): Sub

A

UC/Crohns, 2nd line, Acute Flares

77
Q

Steroids (Prednisone): Dosing / Timing

78
Q

Steroids (Prednisone): Notes

A

Rapid action; budesonide for local

79
Q

Infliximab: Class

A

UC/Crohn’s

80
Q

Infliximab: Sub

A

UC/Crohns: 3rd line Acute Flares AND Remission Maintenance

81
Q

Infliximab: Mechanism of Action

A

Anti-TNFalpha, rapid action

82
Q

Infliximab: Adverse Effects

A

Re-activates latent TB

83
Q

Cyclosporine: Notes

A

Rapid action, fourth line acute

84
Q

J pouch anastomosis

A

UC/Crohn’s: acute flares, last resort

85
Q

6-Mercaptopurine: Class

A

UC/Crohn’s

86
Q

6-Mercaptopurine: Sub

A

UC/Crohns, 2nd Line Remission Maintenance

87
Q

6-Mercaptopurine: Dosing / Timing

A

Takes 2-4 months

88
Q

6-Mercaptopurine: Adverse Effects

A

decreases BM, pancreatitis

89
Q

Methotrexate: Class

A

UC/Crohn’s remission maintenance, not used in US

90
Q

Loperamide: Indication(s)

A

Non-Inflammatory Diarrhea AND IBS-D

91
Q

Loperamide: Mechanism of Action

A

Opioid receptor agonist selectively affects myenteric plexus, causes constipation” AND decreases Diarrhea”

92
Q

Loperamide, Diphenyloxylate: Adverse Effects

A

Constipation, bloating, nausea, megacolon if you misdiagnose infectious

93
Q

Loperamide: Notes

A

Doesn’t cross BBB; contraindicated in c. diff or any inflammatory diarrhea (bloody, fever) AND Less effective in IBS-D

94
Q

Diphenoxylate + Atropine : Indication(s)

A

Non-Inflammatory Diarrhea

95
Q

Diphenoxylate + Atropine : Mechanism of Action

A

Opioid receptor agonist that does cross BBB (atropine prevents abuse)

96
Q

Diphenoxylate + Atropine : Adverse Effects

A

Same as loperamide + possibility of dependence

97
Q

Alosetron: Indication(s)

98
Q

Alosetron: Mechanism of Action

A

5HT3R antagonist; decreases gut motility, diarrhea, hypersensitivity

99
Q

Alosetron: Notes

A

Best evidence

100
Q

Rifaximin: Indication and Mechanism

A

Relatively safe, IBS-D, antibiotic plus decreased bloating

101
Q

TCAs: Mechanism of Action and Indication

A

decreases Pain in IBS-D, anticholinergic

102
Q

Lubiprostone: Mechanism of Action and Indication

A

IBS-C: Cl- channel (ClC-2) activator

103
Q

Linaclotide: Mechanism of Action and Indication

A

IBS-C: GC-2 agonist increases cGMP, CFTR, Cl- secretion

104
Q

SSRIs: Mechanism of Action and Indication

A

IBS-C: decreases Pain

105
Q

Metronidizole, Vancomycin Indication

A

C. diff. Discontinue other antibiotics and give for two weeks

106
Q

Metronidizole notes

A

best response, lowest relapse rate

107
Q

Vancomycin notes

A

IV won’t work. Six weeks oral vanc could prevent relapse

GI/Hepatology (2 decks)

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