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Pharmacology III > GI Drugs > Flashcards

GI Drugs Flashcards

1
Q

Histamine binds H2 receptors on the _____ cell which increases the intracellular concentration of ________ to stimulate the _______

A

parietal cell

cAMP

stimulates proton pump (H+/K+ ATPasae)

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2
Q

What substance decreases cAMP production and therefore reduces proton pump activity? It also increases mucous and bicarb production…

A

PGE3

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3
Q

What drug can be used with NSAID administration to protect against ulcers?

A

misoprostol (PG analog)

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4
Q

Tritec is the h. pylori triple therapy that includes…

A

ranitidine, bismuth citrate + clarithromycin

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5
Q

Helidec is the h. pylori quadruple therapy that includes…

A

metro, amoxicillin, tetracycline, clarithromycin

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6
Q

_______ increases gastric motility and may cause diarrhea…

A

magnesium

antacid

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7
Q

________ relaxes smooth muscle and may cause constipation…

A

alumininium

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8
Q

These drugs neutralize HCl to form salts and water.

A

antacids

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9
Q

Antacids are commonly hydroxides of what 4 compounds?

A

aluminium
magnesium
sodium bicarb
calcium

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10
Q

Mg antacids are well tolerated, but can be a problem/toxicity in the presence of what condition?

A

renal impairment

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11
Q

Two main uses for antacids…

A

Sx relief

GERD Adjunct

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12
Q

sodium bicarb should be avoided with what condition?

A

CHF

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13
Q

How do antacids cause drug interactions?

A

alter rate of dissolution/absorption

complex formation

delayed gastric emptying

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14
Q

When are H2 receptor blockers most effective?

A

overnight

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15
Q

H2 receptor blockers are effective at treating which condition?

A

PUD

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16
Q

H2 receptor blockers can be considered an adjunct in what 2 conditions?

A

GERD

Zollinger-Ellison

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17
Q

Which GI drug is given pre-op to reduce stomach acidity in case of aspiration?

A

H2 receptor blockers

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18
Q

Why are H2 receptor blockers given in allergic rxns?

A

reduce vasodilation

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19
Q

Duration of H2 blockers

A

12 hours

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20
Q

H2 blockers have low S/E profile… but which one has an anti-androgen effect?

A

cimetidine

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21
Q

cimetidine inhibits…

A

CYP3A4

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22
Q

DOC for GERD.

A

PPIs

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23
Q

PPIs cause reversible or irreversible inhibition at the parietal cell?

A

irreversible (covalent bonding)

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24
Q

how long before 80% inhibition of acid secretion with PPIs?

A

2-5 days

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25
Q

How long do PPIs last? why?

A

24-48 hours

requires synth of new pumps

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26
Q

T or F… all PPIs are prodrugs converted to active form (Sulfenamide) by acid…

A

true

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27
Q

Recommended dosing regimen for PPIs

A

take in morning on empty stomach 30 min before 1st meal

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28
Q

PPIs are generally well tolerated, but what are two SEs that may occur?

A

PNA

Abd. Colic/GI sxs

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29
Q

chronic PPI use can cause decreases in… (3)

A

Calcium
Magnesium
B12

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30
Q

long term PPI use can cause what 2 diseases?

A

CKD

osteoporosis

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31
Q

________ inhibits CYP2C19, decreasing metabolism of phenytoin, diazepam, warfarin and conversion of clopidogrel to active compound.

A

omeprazole

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32
Q

C/I for misoprostol…

A

pregnancy, or could become pregnant

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33
Q

What is a cytoprotective agent used to protect the gastric mucosa?

A

misoprostol

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34
Q

This is a D2 receptor antagonist, which enhances ACh release on M3 receptors in the GI tract

A

metoclopramide

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35
Q

What effect does metoclopramide have?

A

enhances motility and SM tone

36
Q

Metoclopramide can have anti-emetic properties by acting on…

A

chemoreceptor trigger zone in CNS

37
Q

MC use of metoclopramide…

A

post-op hypomotility

38
Q

what serious S/Es can accompany metoclopramide? Why?

A

EPS, due to D2 receptor blockade

39
Q

Can metoclopramide be used in pregnancy?

A

no

40
Q

Which muscarinic agonist can be used to increase GI tone and motility?

A

Bethanechol

41
Q

This drug stimulates motilin receptors, which causes potent contraction of the GI tract…

A

erythromycin

42
Q

When can erythromycin be considered as a prokinetic agent?

A

last line

43
Q

this is a muscarinic antagonist that decreases intestinal overactivity

A

Dicycloamine

44
Q

this IBS drug blocks muscarinic receptors and increase NE release. NE then stimulates alpha 2 receptors to reduce pain.

A

Amitriptyline

45
Q

Which antispasmodic is a mu and kappa opioid AGONIST and a delta opioid ANTAGONIST?

A

Eluxadoline

46
Q

Eluxadoline is useful for…

A

IBS-D

47
Q

The CTZ, which stimulates the brain’s vomiting center, is rich in what 3 receptor types?

A

5HT3, D2, NK1

48
Q

Ondansetron selectively blocks what receptors and where?

A

5HT3 in CTZ and GI

49
Q

2 uses for ondansetron?

A

chemo N/V and vagal stimulation

50
Q

Is ondansetron useful in motion sickness?

A

no

51
Q

Which two anti-emetics block D2 and H1 receptors?

A

Prochlorperazine

Promethazine

52
Q

When are prochlorperazine and promethazine considered for use?

A

post-op N/V

53
Q

major S/E of prochlorperazine and promethazine and why?

A

Significant sedation

H1 and Muscarinic blockade

54
Q

Arepitant blocks what receptor?

A

NK1

55
Q

Arepitant should be combined w… (2)

A

5HT3 antagonist + CS

56
Q

When can arepitant be considered?

A

severe chemo nausea and vomiting

57
Q

3 absolute C/Is for laxatives

A

obstruction
perf
toxic megacolon

58
Q

best way to prevent constipation and diverticulitis…

A

high fiber diet

59
Q

2 fiber supplements…

A

methylcellulose

psyllium

60
Q

Sodium salts should be used in the presence of what condition?

A

CHF

61
Q

Which osmotic laxatives are also sweeteners?

A

sorbitol

mannitol

62
Q

Which osmotic laxative ionizes ammonia to ammonium, trapping it in the colon?

A

Lactulose

63
Q

Lactulose is used for…

A

decrease ammonia in cirrhosis

64
Q

Describe the use of osmotic laxatives…

A

bowel prep

65
Q

Which is the only osmotic laxative that can be used chronically, but not for constipation tx…?

A

lactulose

66
Q

Which three laxatives can produce a semi-formed stool within 2-8 hours by irritating mucosa?

A

Biscodyl
Senna
Castor oil

67
Q

Describe the effectiveness of senna…

A

mild

68
Q

Castor oil shouldn’t be used in the presence of… (2)

A

biliary obstruction, pregnancy

69
Q

Which 3 laxatives are lubricating agents/stool softeners?

A

mineral oil
docusate
glycerin

70
Q

Mineral oil can decrease absorption of…

A

ADEK

71
Q

this laxative can cause lipoid PNA if inhaled into the lungs…

A

mineral oil

72
Q

This laxative is an emulsifying agent

A

docusate

73
Q

This laxative lubricates the distal end of the bowel via suppository

A

glycerin

74
Q

what can cause the below?

 laxative dependence
 fluid and electrolyte imbalances
 spastic colitis
 increased risk of ulcerative colitis

A

laxative overuse

75
Q

This is a PGE1 derivative activates the ClC-2 chloride channels.

A

lubiprostone

76
Q

This laxative stimulates the CFTR to secrete Cl

A

linaclotide

77
Q

Linaclotide is approved for…

A

IBS-C

78
Q

Opioid antagonists that acts selectively in the GI tract, with no central effect used to antagonize opioid-induced constipation post-operatively (2)

A

Alvimopan, Methylnaltrexone

79
Q

Can fiber compounds be used to treat diarrhea?

A

yes

80
Q

opioid that decreases peristalsis, low abuse potential w. no CNS effects.

Available OTC

A

loperamide

81
Q

Opioid with atropide to inhibit cholinergic receptors.

CNS effects w. abuse potiential, but reduced w. atropine

A

Diphenoxylate + Atropine

82
Q

When should opioids not be used for diarrhea?

A

penetrative intestinal organisms

UC

83
Q

How does colloidal bismuth treat diarrhea?

A

absorbs extra water

84
Q

2 S/Es of colloidal bismuth…

A

dark stools

Reye’s syndrome (via salicylate allergy)

85
Q

in children with ASA allergy, what can be used instead of colloidal bismuth?

A

bismuth citrate

86
Q

Which IBD drug is better for UC

A

Sulfasalazine

87
Q

this drug coats and dissipates gas…

A

simethicone

Pharmacology III (15 decks)

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