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Pharm 6 > GI Drugs > Flashcards

GI Drugs Flashcards

1
Q

What is reflux esophagitis and what factors contribute?

A

Heartburn

When esophageal sphincter opens and it shouldnt

Larger meal→More relfux

Factors that decrease esophageal closure:

  • Alcohol
  • Peppermint
  • Chocolate
  • Fats
  • Acidic beverages
  • Red Wine
  • Carbonated drinks
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2
Q

-tidine

A

GI drug

Decrease acid secretion

Mech: H2 receptor blockers

SE:

  • Confusion in elderly
  • Bradycardia

Cimetidine:

  • Inh. P450
    • Prevent synth of test.
    • Anti-androgenic
      • Cause gynecomastia
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3
Q

-prazole

A

GI drug

Decrease acid formation

Mech: ATPase inhibitor

Known as proton pump inhibitor (PPI) but actually irreversibly inhibit ATPase required to drive H+ pump

Best available class of GI drugs

Prodrug-activated by acid

They are weak bases though→ stay in parietal cell

SE:

  • Hypochlorhydria-lack of H+ production
  • Decrease Ca absorption→osteoporosis
  • Decrease Vit B12 absorption
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4
Q

Systemic vs non-systemic antacids

So, what is the order of cation absorption and why does this matter?

A

Na>>Ca>Mg>Al

More readily the cation is absorbed the more the anion is absorbed→ systemic alkylation

Particularly important for kidney dysfunction

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5
Q

Sodium Bicarbonate

NaHCO3

A

Antacid

Speed-rapid

Duration-short

Neutralizing-high

SE:

  • CO2 production
  • Belching
  • Na may compromise low sodium diets
  • Systemic absorption
    • Contains Na
    • Important in those w/ kidney dysfunction
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6
Q

Calcium carbonate

CaCO3

A

Antacid

Speed-rapid

Duration-medium

Neutralizing-high

SE:

  • Constipating
  • Hypercalcemia
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7
Q

Aluminum hydroxide

Al(OH)3

A

Antacid

Speed-slow

Duration-long

Neutralizing-low

SE:

  • Constipation
  • Adsorbs drugs
  • Loss of phosphate
  • Al toxicity
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8
Q

Magnesium hydroxide

Milk of magnesia

A

Antacid

Speed-slow

Duration-medium

Neutralizing-high

SE:

  • Laxative
  • Some Mg toxicity
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9
Q

Sucralfate

A

GI drug-Enhance mucosal defense

Aluminum salt

Tx: Ulcers

Mech: Complex that becomes viscous and binds to damaged mucosa when exposed to acid

SE:

  • Constipation
  • Excess Al absorption

Contraindication: H+ depleters (PPI or antacids)

SucrALfate=ALuminum salt→Excess Al

Sucralfate=sucrose=sticky…so this sticks to damaged mucosa

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10
Q

Bismuth subsalicylate

A

GI drug-Enhance mucosal defense

Anti-diarrheal agent–absorbing agent

Mech: Increase mucous production in stomach

Inh. growth of H. pylori

Unpleasant taste+odor

SE:

  • Long term use→Darkening of feces, tongue, and teeth
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11
Q

Misoprostole

A

GI drug-Enhance mucosal defense

Tx: Ulcers

Drop in PGs→Ulcer

Asprin (NSAIDs) and GCs can decrease PGs

Mech: Prostaglandin analog

SE:

  • Uterine contractility (abortifacient)
  • You eat miso soup when you have a stomach ache because it is prostagrandin anarog (say that w/ a strong asian accent)*
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12
Q

Antibiotic combo for H pylori infection

A

GI drug-Enhance mucosal defense

Metronidazole

+/-

Amoxicillin

+/-

Clarithromycin

+/-

Tetracycline

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13
Q

Metoclopramide

A

Tx: Gastroparesis

prokinetic agent–agents that increase stomach emptying rate

Also used for hiccups

Mech: DA and possible 5HT antagonist

Route: Oral or IV

Increase motility w/o secretion (of H or gastrin)

SE:

  • Sedation
  • Depression
  • Parkinson like symptoms

Metoclopramide increases motility

  • All that motility→shakes (parkinson like symptoms)*
  • All those shakes →sedation *
  • All that sedation→depression *
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14
Q

Erythromycin

A

Tx: Gastroparesis

prokinetic agents–agents that increase stomach emptying rate

Mech: Acts directly on motilin receptor

Route: Oral but IV possible if oral is not

SE:

  • ototoxicity
  • pseudomemb. colitis
  • cardiac arrythmia
    • Especially if metabolism is inh by P450
  • Remember erythro is a macrolide*
  • Motiliy*
  • Arrythmias*
  • Cholesteric toxicity (liver tox)/Colitis*
  • Restricts P450*
  • Ototoxicity*
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15
Q

Alvimopan

A

Tx: Gastroparesis

prokinetic agents–agents that increase stomach emptying rate

Mech: Blocks opiate receptor in gut but not anywhere else

Blocks constipation due to post op opioid use

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16
Q

Dioctal sodium sulfosuccinate

A

GI Drug

Cathartic–Stool softener

Detergent

Mech: Emulsifies contents of colon

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17
Q

Mineral oil

A

GI Drug

Cathartic–Stool softener

Mech: Acts like a lubricant

Why mineral oil should NOT be used:

  • Prevents fat soluble vitamin absorption
  • Aspiration pnemonia →may damage lungs
  • May contain carcinogens
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18
Q

What are the bulk adding agents?

A

Bran

Methylcellulose

Polycarbophil

Psyllium

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19
Q

Bran

A

GI Drug

Cathartic–Bulk adding agent

Mech: Like eating fiber

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20
Q

Methylcellulose

A

GI Drug

Cathartic–Bulk adding agent

Mech: Like eating fiber

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21
Q

Polycarbophil

A

GI Drug

Cathartic–Bulk adding agent

Mech: Like eating fiber

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22
Q

Psyllium

A

GI Drug

Cathartic–Bulk adding agent

Mech: Like eating fiber

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23
Q

Cascara

A

GI Drug

Cathartic–Gastric Irritants

Mech: Stimulate gastric nn

Increase motility

Increase electrolyte secretion into gut

SE:

  • Nephritis
  • Liver damage
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24
Q

Senna

A

GI Drug

Cathartic–Gastric Irritants

Mech: Stimulate gastric nn

Increase motility

Increase electrolyte secretion into gut

SE:

  • Nephritis
  • Liver damage
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25
Q

Castor oil

A

GI Drug

Cathartic–Gastric Irritants

Mech: Stimulate gastric nn

Increase motility

Increase electrolyte secretion into gut

SE:

  • Nephritis
  • Liver damage
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26
Q

Bisacodyl

A

GI Drug

Cathartic–Gastric Irritants

Mech: Stimulate gastric nn

Increase motility

Increase electrolyte secretion into gut

SE:

  • Nephritis
  • Liver damage
27
Q

MgSO4

A

GI Drug

Cathartic–Osmotic agent

28
Q

Mg(OH)2

A

GI Drug

Cathartic–Osmotic agent

AKA Milk of Magnesia

29
Q

Polyethylene glycol

A

GI Drug

Cathartic–Osmotic agent

DOC for colonoscopy

30
Q

Lubiprostone

A

GI Drug

Cathartic–Secretion enhancer

Mech: Acts on PGE receptor

PGE1 derivative

Also acts on Cl channel in intestine

31
Q

Linaclotide

A

GI Drug

Cathartic–Secretion enhancer

Mech: Activate guanylate cyclase

Increase Cl secretion in stomach

32
Q

What are the stool softeners?

A

Dioctal sodium sulfosuccinate

Mineral oil

33
Q

What are the gastric irritants used as cathartics?

A

Cascara

Senna

Castor oil

Bisacodyl

34
Q

What are the osmotic cathartics?

A

MgSO4

Mg(OH)2

Polyethylene glycol

35
Q

Adverse effects of cathartics

A
  • Fluid imbalances
    • K+ loss, etc
  • Mucosal injury
  • Malabsorption of nutrients
  • Suppress reflex fxns
36
Q

What is essential to treat diarrhea?

What do we have to be careful about?

A

Rehydration

Diarrhea is a process to rid bacteria so we must be careful if we are stopping this process

37
Q

Codeine

A

Tx: Diarrhea

Narcotic agent

Mech: act a specific receptor

Not generally used for obvious reasons

38
Q

Diphenoxylate

A

Tx: Diarrhea

Narcotic agent

Mech: act a specific receptor

Acts primarily in gut

Opiate like effects in CNS though too

Given in comb w/ atropine to avoid abuse

39
Q

Difenoxin

A

Tx: Diarrhea

Narcotic agent

Active metabolite of diphenoxylate

Mech: act a specific receptor

Acts primarily in gut

Opiate like effects in CNS though too

Given in comb w/ atropine to avoid abuse

40
Q

Loperamide

A

Tx: Diarrhea

Narcotic agent

Narcotic DOC for diarrhea

Mech: act a specific receptor

Acts ONLY in gut–no CNS effects

41
Q

Atropine

A

Tx: Diarrhea

Anti-cholinergic agent

Mech: Blocks muscarinic receptor

SE: Many systemic

42
Q

Scopolamine

A

Tx: Diarrhea

Anti-cholinergic agent

Mech: Blocks muscarinic receptor

SE: Many systemic

43
Q

Crofelemer

A

Tx: Diarrhea

Mech: Blocks Cl channel in gut

Also decreases secretion of Na and H2O

CrofeLemer blocks CL channels

  • or *
  • CROws block the CLouds*
  • CROfelemer blocks CL channels*
44
Q

Simethicone

A

Tx: Diarrhea

Mech: Changes gas surface tension of gas pocket in gut

45
Q

Alpha galactosidase

A

Tx: Diarrhea

Mech: Increase metab. of oligosacc.→digestible sugars

Oligosacc. produce gas

  • Alpha GAlactoSidase inh. GAS production*
  • *Be careful there are alpha-glucosidase inh in the diabetes section**
46
Q

Ulcerative colitis vs Chron’s disease

A

Ulcerative-mucosal inflammation

Chron’s-mucosa and even into muscle of gut–more severe

47
Q

-sala-

A

Sulfasalazine

Mesalamine

Olsalazine

Balsalazide

Tx: IBS–Salicylates

Mech: Decrease PG synth

Online it says mech is unclear–may not be the same as aspirin

Not systemically absorbed-like a topical drug for the stomach

SE:

  • Diarrhea
  • Take 3-5 weeks to work
48
Q

Which GCs used for IBS

A

Prednisone

Budesonide

49
Q

Infliximab

A

Tx: IBS

Mech: Binds TNF alpha

50
Q

Immunosuppressants for IBS

A

Methotrexate

Cyclosporine

51
Q

(Apo)morphine

A

Emetic–central stimulant

Mech: Stimulates DA sites in CTZ

52
Q

Digoxin

A

Emetic–central stimulant

Mech: Stimulates DA sites in CTZ

53
Q

Ipecac

A

Emetic–reflex stimulant

Mech: Act. receptors in GI mucosa

Instant severe vomiting

SE: Cardiotoxic

54
Q

Diphenhydramine

or

Dimenhydramine

A

Anti-emetic–Antihistamine

Mech: Block H1 receptor

SE: Anticholinergic effects

55
Q

Meclizine

A

Anti-emetic–Antihistamine

Mech: Block H1 receptor

SE: Anticholinergic effects

56
Q

Cyclizine

A

Anti-emetic–Antihistamine

Mech: Block H1 receptor

SE: Anticholinergic effects

57
Q

Which antihistamines are used as anti-emetics?

A

Diphenhydramine

Dimenhydramine

Meclizine

Cyclizine

58
Q

What other drugs mentioned will cause emesis?

A

NSAIDs

Anti-neoplastic

Iron salts

59
Q

Scopolamine

A

Anti-emetic–anti-cholinergic

Mech: Block muscarinic receptor

Route: Patch

SE:

  • Dry
  • Drowsy
  • Etc.
60
Q

Dronabinol

A

Anti-emetic–THC derivative

Mech: Bind cannabinoid receptor

SE: Increased appetite

61
Q

Nabilone

A

Anti-emetic–THC derivative

Mech: Bind cannabinoid receptor

SE: Increased appetite

62
Q

Compazine

A

Anti-emetic

Mech: DA blocker

*Related to anti-psychotic drugs *(phenothiazine)

SE: Extrapyramidal effects

63
Q

-setron

A

Ondansetron

Granisetron

Dolasetron

Palonosetron

Anti-emetic (for IBS+chemo)

Mech: 5HT receptor blocker

Affect CTZ +rec. in gut

SE: Constipation

_SE_lective _T_e_R_minators _O_f _N_ausea

-SETRON

-setron blocks serotonin

Pharm 6 (7 decks)

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