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Pharm II Final > GI Drugs > Flashcards

GI Drugs Flashcards

1
Q

When can aspiration occur?

A

When barrier pressure (the difference between LES pressure and gastric pressure) decreases

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2
Q

What positing puts patients at risk for aspiration?

A

Lithotomy

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3
Q

What are patient risk factors for aspiration?

A

Intestinal obstruction, non-fasted, delayed gastric emptying, hiatal hernia, GERD, pregnancy, obesity, neuromuscular disease, decreased laryngeal reflexes, male, elderly

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4
Q

What is the rule of thumb in prevention of aspiration pneumonitis?

A

Reduce gastric content acidity pH >2.5

Reduce amount of gastric content

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5
Q

What is the mechanism of action for Reglan?

A

Acts peripherally as a cholinomimetic (facilitates ACh transmission at selective muscarinic receptors) and centrally as dopamine receptor antagonist

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6
Q

What type of drug is Reglan?

A

Prokinetic

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7
Q

What are the effects of Reglan use?

A

Enhances stimulatory effects of ACh on intestinal smooth muscle, increases LES tone, speeds gastric emptying and lowers gastric fluid volume

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8
Q

What is the dose of Reglan?

A

10-20mg PO or IV

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9
Q

Why is it important to administer Reglan slowly when given IV?

A

Intense feeling of anxiety and restlessness, followed by drowsiness, may occur with rapid administration.

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10
Q

How is Reglan metabolized and excreted?

A

Metabolized in the liver and excreted in the urine

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11
Q

How is Reglan metabolized and excreted?

A

Metabolized in the liver and excreted in the urine

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12
Q

What type of drugs block Reglan effects?

A

Anticholinergics

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13
Q

What conditions is Reglan contraindicated in?

A

Bowel obstruction
Parkinson’s disease
Pheochromocytoma (HTN crisis)

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14
Q

How do pheothiazines and droperidol interact with Reglan?

A

Extrapyramidal effects potentiated with concurrent use

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15
Q

What are two other medications that can be used as a prokinetic?

A

Erythromycin

Neostigmine

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16
Q

Why isn’t Erythromycin typically used as a prokinetic?

A

Limited use due to possibility for developing antibiotic resistant bacteria

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17
Q

What is the mechanism of action of proton pump inhibitors?

A

Selective and irreversible bind to the parietal cells in gastric mucosa causing suppression of gastric acid secretion through inhibition of H+ / K+ ATPase enzyme system at the surface of the parietal cells

18
Q

What is the dose of Prilosec?

A

Dose: 20-40mg PO

19
Q

How is Prilosec metabolized and excreted?

A

Metabolized by the liver after undergoing extensive first pass effect and excreted in the urine and feces

20
Q

When should PPIs be given prior to surgery?

A

The night before and morning of surgery

21
Q

When should PPIs be given prior to surgery?

A

The night before and morning of surgery

22
Q

What kind of drug interactions do PPIs have?

A

CYP2C19 inducers (St. Johns wart, rifampin), antiretrovirals, clopidogrel (decrease in antiplatelet effects), reduced clearance of diazepam and warfarin

23
Q

What is the mechanism of action of histamine-2 receptor antagonists?

A

Selective inhibition of histamine at H2 receptors of the gastric parietal cells resulting in reduced gastric acid secretion, gastric volume and hydrogen ion concentration

24
Q

How are H2 antagonists metabolized and excreted?

A

Metabolized in the liver and excreted in the urine

25
Q

What is the appropriate use of H2 antagonists in an allergic response?

A

Aids in histamine induced allergic response, but cannot be used for premedication (does NOT prevent histamine release from occurring)

26
Q

What H2 antagonist has lost favor in its use?

A

Tagamet due to multiple side effects that accompany its use

27
Q

How does Tagamet alter other drugs pharmacokinetics?

A

Alters absorption of some drugs by increasing gastric fluid pH such as lidocaine, propranolol, diazepam, theophylline, phenobarbital, warfarin, phenytoin

28
Q

How does Tagamet affect the male population?

A

Can cause gynecomastia and impotence

29
Q

Why are symptoms such as lethargy, hallucinations, and seizures seen with Tagamet use?

A

It crosses the BBB in high doses, especially in the elderly

30
Q

Why are symptoms such as lethargy, hallucinations, and seizures seen with Tagamet use?

A

It crosses the BBB in high doses, especially in the elderly

31
Q

What is the mechanism of action of antacids?

A

Neutralize acidty of gastric contents by providing a base (hydroxide, carbonate, bicarb, citrate) that reacts with H+ ions to form water

32
Q

What type of antacids are used preoperatively?

A

Only non-particulate used pre-operatively

33
Q

Why aren’t particulate antacids used preoperatively?

A

Aspiration of particulate antacids produces abnormalities in lung function which can result in pulmonary edema, arterial hypoxemia, ARDS

34
Q

What are two non-particulate antacids that can be used preoperatively?

A

Bicitra

Polycitra

35
Q

How can non-particulate antacids affect other drugs?

A

Alter gastric and urinary pH: slow absorption of digoxin, cimetidine, ranitidine, speed absorption of phenobarbital
Immediate onset

36
Q

When should non-particulate antacids be given preoperatively?

A

Should give 15-30 minutes prior to induction (Duration of effectiveness: 30-60 minutes)

37
Q

What is the dose of bicitra and what electrolyte does it contain?

A

15-30 mL PO

Each mL contains 1meq of Na and equals 1meq HCO3

38
Q

What is the dose of polycitra and what electrolyte does it contain?

A

15-30 mL PO

Each mL contains 1meq of Na, 1meq K, and equals 1meq HCO3

39
Q

Long term use of antacids can have what kind of effects?

A 
Alterations in acid base status
Infections
Acid rebound
Milk-Alkali Syndrome
Phosphorus depletion
Drug interactions
40
Q

Long term use of antacids can have what kind of effects?

A 
Alterations in acid base status
Infections
Acid rebound
Milk-Alkali Syndrome
Phosphorus depletion
Drug interactions
41
Q

What is milk-alkali syndrome?

A

Milk-alkali syndrome is caused by the ingestion of large amounts of calcium and absorbable alkali, with resulting hypercalcemia. If unrecognized and untreated, milk-alkali syndrome can lead to metastatic calcification and renal failure.

Pharm II Final (12 decks)

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