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GI Drugs Flashcards

1
Q

Antacid examples

A

Calcium carbonate (TUMS)
Aluminum hydroxide
Magnesium hydroxide (MoM)
Maalox contains aluminum and magnesium

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2
Q

Antacids MOA

A

React locally in stomach with H+ to increase pH

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3
Q

Route of administration of antacids

A

Suspension more effective than tablets and powders

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4
Q

Antacids indications

A

Hyperacidity
reflux
Indigestion

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5
Q

Antacids CIs

A

Poor renal function

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6
Q

Antacids S/E

A

Magnesium —> diarrhea
Calcium —> Hypercalcemia, renal calculi, bloating, flatulence, belching, nausea, constipation
Aluminum —> hypophosphatemia, constipation

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7
Q

Antacids drug interactions

A

Bind to tetracycline resulting in decreased bioavailability

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8
Q

Which antacids are often combined

A

Aluminum and magnesium
Mg is rapid onset/Al is slower onset
Mg causes diarrhea/aluminum causes constipation

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9
Q

What is added to antacids to reduce bloating

A

Simethicone

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10
Q

H2 antagonist examples

A

Ranitidine / Zantac

Famotidine / Pepcid

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11
Q

H2 antagonist MOA

A

Inhibit histamine at H2 receptors of the gastric parietal cells, which reduces gastric acid secretion

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12
Q

H2 antagonist indications

A

GERD
PUD
Dyspepsia
Gastritis

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13
Q

H2 antagonist CIs

A

Caution in patients with renal impairment

Liver failure or liver disease

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14
Q

H2 antagonist S/E

A

Generally well tolerated
Common - diarrhea, headache, drowsiness, fatigue, muscle pain, constipation
Rare - CNS side effects (confusion, delirium, hallucinations, slurred speech), thrombocytopenia

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15
Q

disadvantages of H2 antagonists

A

less effective than PPIs
tolerance can develop
lots of drug interactions with Cimetidine

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16
Q

PPI Examples

A
  1. omeprazole / prilosec
  2. pantoprazole / protonix
  3. esomeprazole / nexium
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17
Q

PPI MOA

A

act within gastric parietal cell, inactivate the acid pump and inhibit secretion of hydrochloric acid into stomach

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18
Q

PPI Indications

A
  1. gastric and duodenal ulcers
  2. GERD
  3. Upper GI bleeding (Mallory Weiss)
  4. Zollinger-Ellison Syndrome
  5. H. pylori infection
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19
Q

PPI CIs

A

co-administration of other drugs

all interfere with absorption of drugs given orally that depend on gastric acid pH to be effective - vit B12, ampicillin, ketoconazole

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20
Q

formulation of PPIs

A

all have enteric coating to protect them from acidic environment until they reach small intestine for absorption - don’t break up the tablets

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21
Q

when to take PPIs

A

take 30-60 min prior to meals

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22
Q

PPI metabolism

A

liver

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23
Q

PPI S/E

A

generally well tolerated
Common: nausea, abdominal pain, constipation, diarrhea, flatulence
Less Common: hypergastrinemia –> rebound hypersecretion of gastrin if PPI stopped
Long term use: increased risk of fractures of the wrist, hip, spine (over 1 year of daily use)

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24
Q

benefits of PPIs

A

most effective for GERD - reduce acid by 85-90%

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25
GI cytoprotectant examples
Misoprostol / Cytotec (prostaglandin analog) Sucralfate / carafate (coating agent) bismuch / pepto bismol (coating agent)
26
GI cytoprotectant MOA
protect cells in lining of stomach - either increase gastric pH or enhance mucosal barrier sulcralfate selectively binds to necrotic tissue, covers ulcer site, acts as barrier to acid, pepsin, bile salts
27
Indication for misoprostol
prevention of NSAID induced ulcers
28
indication for sucralfate
treatment of duodenal and gastric ulcers | prevention of ulcer recrrence
29
indication for bismuth
adjunctive therapy in H. pylori eradication acute diarrhea heartburn
30
misoprostol CIs
1. pregnancy (category X) | 2. caution in patients with renal impairment
31
bismuth CIs
1. children or teenagers with viral infections | 2. may be trigger for Reye's Syndrome - has salicylate
32
Misoprostol S/E
1. diarrhea 2. abdominal cramping 3. uterine contraction (pregnancy)
33
sucralfate S/E
minimal systemic side effects | rarely constipation
34
bismuth S/E
1. black, tarry stools 2. discoloration of the tongue - black tongue 3. constipation 4. tinnitus at high doses
35
GI cytoprotectant drug of choice in women of child bearing age for treatment of active duodenal ulcers not caused by NSAIDs
sucralfate
36
patient ed on taking sucralfate
requires acidic environment to be active | don't take antacids within 30 min of sucralfate
37
Dopamine antagonist examples
1. metoclopramide / Regland
38
Dopamine antagonist MOA
increase lower esophageal sphincter tone and stimulate contractions of the stomach and small intestine also inhibit vomiting center
39
Dopamine antagonist indications
1. gastroparesis 2. nausea/vomiting (last line in pregnant women) 3. GERD that fails to respond to H2 antagonists or PPIs (3rd line)
40
Dopamine antagonist CIs
1. patients with obstruction, perforation, or hemorrhage 2. Parkinson's Disease 3. caution in patients with renal impairment
41
Dopamine antagonist S/E
1. hyperprolactinemia - galactorrhea, gynecomastia, dysmenorrhea 2. CNS effects - drowsiness, restlessness, insomnia, anxiety, agitation, depression 3. extrapyramidal effects - abnormal muscle tone, parkinson-like symptoms 4. tardive dyskinesia
42
disadvantage of metoclopramide
may decrease absorption of drugs from stomach while accelerating absorption from small intestine
43
serotonin antagonist examples
ondansetron / zofran
44
serotonin antagonist MOA
blocks serotonin 3 receptors located in vagal nerve terminals and central nervous system chemoreceptors trigger zones
45
serotonin antagonist indications
nausea vomiting IBS
46
serotonin antagonist S/E
``` generally well tolerated 1. constipation or diarrhea 2. headache 3. light-headedness Serious side effects 1. ischemic colitis 2. QT prolongation ```
47
what are serotonin antagonist good/bad for?
good - chemo induced N/V | bad - motion sickness
48
Antidiarrheals Examples
loperamide / imodium
49
loperamide MOA
inhibits peristalsis by direct effect on circular and longitudinal muscles of intestinal wall
50
Antidiarrheals indications
1. diarrhea 2. traveler's diarrhea (due to bacteria in contaminated food/water) 3. chronic diarrhea associated with IBD (w/ caution)
51
Antidiarrheal CIs
1. acute dysentery (any blood diarrhea) 2. bacterial enterocolitis (salmonella, shigella, campylobacter) 3. pseudomembranous colitis 4. severe IBD in which a reduction in GI motility could lead to serious sequelae such as ileus, megacolon, toxic megacolon (more likely in UC than Crohn's)
52
Antidiarrheal S/E
all: constipation opiates: CNS effects, low abuse potential
53
Laxative examples
1. stimulants - sennosides /senokot - bisacodyl / dulcolax 2. osmotics: polypethylene glycol / Miralax 3. saline: magnesium 4. softeners: docusate / colace
54
Laxative indications
1. constipation | 2. as cathartics in prep for radiologic or surgical procedures
55
Laxative CIs
1. fiber in patient with obstructive symptoms or megacolon | 2. undiagnosed abdominal pain
56
Laxative S/E
generally well tolerated 1. diarrhea (osmotic and stimulant agents) 2. abdominal distention (bulk agents) 3. abdominal distention, flatulence (osmotic sugars) 4. electrolyte abnormalities (osmotic salts) 5. mineral oil can interfere with fat soluble vitamins, elicit foreign body reaction in gut and cause lipid pneumonitis
57
what are osmotic sugar laxatives (ie. Miralax) useful for
treatment of constipation caused by opiates and constipation in the elderly
58
what else is lactulose used for
treatment of hepatic encephalopathy - decreases intestinal pH which traps ammonia w/in lumen of gut, facilitating its exit from body
59
Amitiza indication
1. idiopathic constipation | 2. IBD-C
60
Amitiza CIs
1. severe diarrhea | 2. bowel obstruction
61
Amitiza MOA
increases intestinal fluid secretion, causes softening of stool and increase in GI motility
62
Amitiza S/E
well tolerated | nausea - eat prior to taking to lessen this s/e
63
Methylnaltrexone / Relistor Indication
opioid induced constipation caused by long term use in chronically ill patients
64
Methylnaltrexone / Relistor CIs
1. known or suspected GI obstruction | 2. caution in nursing mothers
65
Methylnaltrexone / Relistor MOA
peripheral mu-opioid receptor antagonist - counteracts opioid effects like itching and constipation *does not cross blood-brain barrier
66
Methylnaltrexone / Relistor S/E
1. abdominal pain 2. flatulence 3. nausea 4. diarrhea 5. dizziness
67
what cytoprotectant do you give in hospital if pt has an ulcer
sucralfate

Pharmacology (27 decks)

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