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Pharmacology Spring Semester > GI drugs > Flashcards

GI drugs Flashcards

1
Q

H2 Receptor Antagonists

A

Ranitidine

Famotidine

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2
Q

Proton Pump Inhibitor

A

Omeprazole

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3
Q

Antacids

A

Mg(OH)2
Al(OH)3
CaCO3

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4
Q

Mucosal Protective Agents

A

Sucralfate

Bismuth Subsalicylate

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5
Q

Anti-Emetics

A

Metoclopramide

Ondansetron

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6
Q

Stimulant Laxative

A

Lubiprostone

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7
Q

Saline Laxative

A

Mg(OH)2

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8
Q

Antidiarrheal

A

Loperamide

Alosetron

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9
Q

Mesalamine drug

A

Sulfasalazine

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10
Q

Corticosteroid GI Drug

A

Predisone

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11
Q

Thiopurine anti-metabolite

A

azathioprine

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12
Q

TNF alpha inhibitor

A

Infliximab

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13
Q

Peptic Acid Disease

A 
Gastroesophageal Reflux
Acute - hearburn
Chronic - GERD
Esophageal damage
Risk factors include hiatal hernia, weakened esophageal sphincter, obesity.
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14
Q

Principles of treatment of peptic acid disease

A

Reduce acid secretion
Neutralize acid
Eradicate H. Pylori
Enhance mucosal defenses

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15
Q

H2 receptor antagonists mechanism of action and pharmacology

A

Block H2 receptors, stopping histamine-mediated HCl release, Also reduce parietal cell response to ACh and Gastrin.
Low toxicity but reduce dose in renal dysfunction.

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16
Q

NSAIDs and H2 blockers

A

Famotidine reduces ulcers caused by long term NSAID use.

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17
Q

PPI mechanism of action

A

IRREVERSABLY inhibit proton pumps (H/K ATPase), inhibiting gastric acid secretion.

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18
Q

PPI pharmacology

A

Administered as prodrug, accumulates in parietal cell canaliculus. Protonated form binds to the enzyme. Recovery of proton pump function requires synthesis of new pumps, which takes time.

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19
Q

PPI adverse effects

A

Generally well tolerated, Nausea, diarrhea, and dizziness can occur.
Possible risk of pneumonia, possibly due to increased bacteria in stomach. That’s just based on one study, though.

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20
Q

Indications for PPI use

A

Ulcers, GERD, 1st line in Zollinger-Ellison Syndrome.

Not great for occasional heartburn.

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21
Q

Antacids - mechanism of action and indication

A

They are weak bases, neutralize stomach acid. Good for occasional heartburn.

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22
Q

Antacid DDI’s

A

Changes to pH change absorption and excretion of a lot of different drugs. Increase in urinary pH alters elimination of acidic and basic drugs.

23
Q

H. Pylori - Treatment

A

Proton pump inhibitor and several antibitoics.

24
Q

Sucralfate mechanism of action

A

Binds to positively charged proteins at low pH. Forms a paste-like gel that adheres to the epithelium of the stomach. This coating protects the cells against acid and pepsin.

25
Q

Sucralfate problems and DDI’s

A

Can adsorb other drugs.

Do not co-admin with antacids - needs a low pH to work.

26
Q

Bismuth Subsalicylate mechanism of action and indication

A

Binds to ulcers selectively, protects against HCl and pepsin.

27
Q

Bismuth subsalicylate side effects

A

Blackens stool and tongue.

28
Q

Ondansetron (zofran) mechanism of action

A

Selective 5HT3 receptor antagonist. Little effect on muscarinic or dopaminergic receptors.

29
Q

Metoclopramide mechanism of action

A

Complex, seratonin pathway.
5HT4 receptor agonist, 5HT3 receptor antagonist (vagal)
Enhances ACh release in myenteric plexus, increased esophageal clearance.

30
Q

Metoclopramide indications

A

chemotherapy induced nausea and vomiting.

31
Q

Metoclopramide adverse

A

Dopamine D2 receptor antagonist - Parkinson-like symptoms.

32
Q

Stimulant laxative

A

Lubiprostone

33
Q

Lubiprostone mechanism of action

A

Cl channel activator - increases intestinal fluid secretion.

34
Q

Lubiprostone indications

A

idiopathic chronic constipation

35
Q

Saline laxative

A

Mg(OH)2 - works like mannitol for the GI tract, keeping fluids inside by raising osmotic pressure -

36
Q

Saline laxative indication

A

Cathartic dose - complete evacuation in less than 3 hours., for colonoscopy prep.

37
Q

Antidiarrheal agent

A

Loperamide

38
Q

Loperamide mechanism of action

A

Opiod - causes constipation by stimulating mu opiod receptors in intestinal smooth muscle.

39
Q

Loperamide adverse

A

Constipation, toxic megacolon

Low abuse potential compared to other opiods because PO absorption is very low.

40
Q

IBS definition and etiology

A

Chronic, recurring episodes of abdominal discomfort, pain, distension, and bloating. It is a functional disease, without underlying structural or biochemical abnormalities.

41
Q

IBS treatment goals

A

Treat the symptoms. It could be diarrhea or constipation. Think about the psychological-cognitive side too. Treat with antidepressants and psychotherapy if the drugs don’t help.

42
Q

IBS with dominant diarrhea - Treatment plan

A

Loperamide
Anticholinergics
Alosetron in treatment resistant women.

43
Q

Alosetron mechanism of action

A

5HT3 seratonin receptor antagonist. Decreased colonic motility.

44
Q

Alosetron limitations and adverse effects

A

Prescribing physician must be enrolled in a special prescribing program.

Serious, rare side effect of ischemic colitis, can be fatal.

45
Q

Constipation predominant IBS treatment options

A

Mg(OH)2 to increase frequency and loosen consistency.

Emergency only - tegasarod, taken off the market by the FDA due to risk of heart attack and stroke. Can request approval for a specific patient in a life threatening emergency.

46
Q

Inflammatory Bowel Disease

A

A serious, chronic structural disease, characterized by inflammation, lesions, bleeding, and immune response. Includes Ulcerative colitis and crohn’s disease.

47
Q

Ulcerative Colitis vs Crohn’s disease

A

Ulcerative colitis - lesions only in colon, mucosal and submucosal only.

Crohn’s - Lesions along the entire GI tract, involving all 4 layers of bowel wall.

48
Q

Active IBD treatment

A

Glucocorticoid (prednisone) - treat inflammation.

49
Q

Long term IBD therapy

A

Immunosuppressive therapy

Azathioprine

50
Q

Azathioprine mechanism of action and adverse

A

Purine anti-metabolite, reducing conversion of GMP to GDP. Only effective topically on GI wall. Causes bone marrow suppression, rash, fever, nausea.

51
Q

Ulcerative colitis treatments

A

5-aminosalicylic acid - Sulfasalazine first line.

52
Q

Sulfasalazine Adverse

A

Nausea, Headache, hypersensitivity, bone marrow suppression. Up to 40% of patients can’t tolerate it.

53
Q

Other treatment options for IBD

A

Infliximab, antibiotics to alter gut flora

54
Q

Infliximab mechanism of action

A

Antibody to TNF-alpha. Blocks its inflammatory effect.

Adverse - immunosuppression - increased infections.

Pharmacology Spring Semester (8 decks)

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