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Pharmacology > GI Drugs > Flashcards

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
Q

GI cytoprotectant examples

A

Misoprostol / Cytotec (prostaglandin analog)
Sucralfate / carafate (coating agent)
bismuch / pepto bismol (coating agent)

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26
Q

GI cytoprotectant MOA

A

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

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27
Q

Indication for misoprostol

A

prevention of NSAID induced ulcers

28
Q

indication for sucralfate

A

treatment of duodenal and gastric ulcers

prevention of ulcer recrrence

29
Q

indication for bismuth

A

adjunctive therapy in H. pylori eradication
acute diarrhea
heartburn

30
Q

misoprostol CIs

A
  1. pregnancy (category X)

2. caution in patients with renal impairment

31
Q

bismuth CIs

A
  1. children or teenagers with viral infections

2. may be trigger for Reye’s Syndrome - has salicylate

32
Q

Misoprostol S/E

A
  1. diarrhea
  2. abdominal cramping
  3. uterine contraction (pregnancy)
33
Q

sucralfate S/E

A

minimal systemic side effects

rarely constipation

34
Q

bismuth S/E

A
  1. black, tarry stools
  2. discoloration of the tongue - black tongue
  3. constipation
  4. tinnitus at high doses
35
Q

GI cytoprotectant drug of choice in women of child bearing age for treatment of active duodenal ulcers not caused by NSAIDs

A

sucralfate

36
Q

patient ed on taking sucralfate

A

requires acidic environment to be active

don’t take antacids within 30 min of sucralfate

37
Q

Dopamine antagonist examples

A
  1. metoclopramide / Regland
38
Q

Dopamine antagonist MOA

A

increase lower esophageal sphincter tone and stimulate contractions of the stomach and small intestine
also inhibit vomiting center

39
Q

Dopamine antagonist indications

A
  1. gastroparesis
  2. nausea/vomiting (last line in pregnant women)
  3. GERD that fails to respond to H2 antagonists or PPIs (3rd line)
40
Q

Dopamine antagonist CIs

A
  1. patients with obstruction, perforation, or hemorrhage
  2. Parkinson’s Disease
  3. caution in patients with renal impairment
41
Q

Dopamine antagonist S/E

A
  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
Q

disadvantage of metoclopramide

A

may decrease absorption of drugs from stomach while accelerating absorption from small intestine

43
Q

serotonin antagonist examples

A

ondansetron / zofran

44
Q

serotonin antagonist MOA

A

blocks serotonin 3 receptors located in vagal nerve terminals and central nervous system chemoreceptors trigger zones

45
Q

serotonin antagonist indications

A

nausea
vomiting
IBS

46
Q

serotonin antagonist S/E

A 
generally well tolerated
1. constipation or diarrhea
2. headache
3. light-headedness 
Serious side effects
1. ischemic colitis
2. QT prolongation
47
Q

what are serotonin antagonist good/bad for?

A

good - chemo induced N/V

bad - motion sickness

48
Q

Antidiarrheals Examples

A

loperamide / imodium

49
Q

loperamide MOA

A

inhibits peristalsis by direct effect on circular and longitudinal muscles of intestinal wall

50
Q

Antidiarrheals indications

A
  1. diarrhea
  2. traveler’s diarrhea (due to bacteria in contaminated food/water)
  3. chronic diarrhea associated with IBD (w/ caution)
51
Q

Antidiarrheal CIs

A
  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
Q

Antidiarrheal S/E

A

all: constipation
opiates: CNS effects, low abuse potential

53
Q

Laxative examples

A
  1. stimulants
    - sennosides /senokot
    - bisacodyl / dulcolax
  2. osmotics: polypethylene glycol / Miralax
  3. saline: magnesium
  4. softeners: docusate / colace
54
Q

Laxative indications

A
  1. constipation

2. as cathartics in prep for radiologic or surgical procedures

55
Q

Laxative CIs

A
  1. fiber in patient with obstructive symptoms or megacolon

2. undiagnosed abdominal pain

56
Q

Laxative S/E

A

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
Q

what are osmotic sugar laxatives (ie. Miralax) useful for

A

treatment of constipation caused by opiates and constipation in the elderly

58
Q

what else is lactulose used for

A

treatment of hepatic encephalopathy - decreases intestinal pH which traps ammonia w/in lumen of gut, facilitating its exit from body

59
Q

Amitiza indication

A
  1. idiopathic constipation

2. IBD-C

60
Q

Amitiza CIs

A
  1. severe diarrhea

2. bowel obstruction

61
Q

Amitiza MOA

A

increases intestinal fluid secretion, causes softening of stool and increase in GI motility

62
Q

Amitiza S/E

A

well tolerated

nausea - eat prior to taking to lessen this s/e

63
Q

Methylnaltrexone / Relistor Indication

A

opioid induced constipation caused by long term use in chronically ill patients

64
Q

Methylnaltrexone / Relistor CIs

A
  1. known or suspected GI obstruction

2. caution in nursing mothers

65
Q

Methylnaltrexone / Relistor MOA

A

peripheral mu-opioid receptor antagonist - counteracts opioid effects like itching and constipation
*does not cross blood-brain barrier

66
Q

Methylnaltrexone / Relistor S/E

A
  1. abdominal pain
  2. flatulence
  3. nausea
  4. diarrhea
  5. dizziness
67
Q

what cytoprotectant do you give in hospital if pt has an ulcer

A

sucralfate

Pharmacology (27 decks)

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