GI Drugs - Review Flashcards by Laney Gammons

what are the six antiemetics

metoclopramide
ondanseteron
prochlorperazine
chlorperazine
promethazine
scopolamine

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what is the MOA of metoclopramide

dopamine-receptor antagonist

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what is metoclopramide used for

used primarily for post-op N/V
also used a prokinetic

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when is metoclopramide contraindicated in (and why)

in those with a GI blockage, perforation, or bleed
do not want to stimulate an issue because it is a prokinetic

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what is the black box warning of metoclopramide

tardive dyskinesia during long-term use

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what is the MOA of ondanseteron

serotonin 5-HT3 receptor antagonist

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what is ondansetron used for

used primarily for preventing nausea and vomiting

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what is the black box warning for ondanseteron

can elongate the QT leading to Torsades de Pointes

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what is the MOA of prochlorperazine

inhibits dopamine and muscarinic receptors

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what is prochlorperazine used for

typically used as an anti-psychotic but also decreases N/V
it is sedative

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what is the black box warning for both prochlorperazine and chloraperazine

dementia-related pscychosis

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what is special about chlorperazine when using it as an antiemetic

can also be a solution for intractable hiccups

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what is the MOA of promethazine

H1 receptor antagonist –> also causes drowsiness

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when is promethazine (pheneragan) used

for motion sickness, N/V, urticaria
can also cause drowsiness and pyramidal symptoms

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what is the black box warning for promethazine

can cause gas gangrene with an IM injection if the SC is penetrated

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in what age is promethazine contraindicated in

under 2 years old because it could cause Reye’s syndrome

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what is special about scopolamine compared to other anti-emetics

it is in a patch form; also is a muscarinic receptor antagonist

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when is scopolamine used

motion sickness, post-operative N/V
NOT FOR CHEMO N/V

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what is the black boxed warning for scopolamine

could cause closed-angle glaucoma because of severe anti-cholinergic side effects

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what are the goals of peptic acid therapies

neutralize acid
protect mucosa
block acid production
target H. pylori infection

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how do antacids work

bind to the excess H+ ions with their base, reduce acidity through neutralization

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what is maalox

antacid
used to relieve heartburn

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what is the formulation of maalax

aluminum hydroxide and magnesium hydroxide
(poop neutral)

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how does sucralfate work

it is a mucosal protective agent that forms a viscous paste when acids are present

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when is sucralfate used

gastric erosion from aspirin acute and chronic duodenal ulcers

how does misoprostol work

inhibits gastric secretions and also produces uterine contractions it is a prostaglandin analog by binding to parietal cells and reducing gastrin secretion

when is misoprostol used

to prevent NSAID-induced ulcers

what is the black box warning for misoprostol

causes cervical ripening, which can cause abortion

how do H2 receptor antagonists

inhibits parietal cell H2 receptors which suppress acid secretions

what is the H2 receptor antagonist medication

famotidine

when is famotidine used

used for GERD gastric/duodenal ulcers erosive esophagitis

how do proton pump inhibitors work

inhibits gastric parietal cell hydrogen-potassium ATPase

how are PPI's adminstered

administered as an inactive prodrug to prevent breakdown too earliyw

what are the PPI medications

lansoprazole pantoprazole

what are the side effects of PPIs

nutritional deficiency --> specifically hypomagnesia bone density issues

when is lansoprazole (prevacid) used

used for GERD ulcer H. pylori infection

what is the difference between lansoprazole and pantoprazole

pantoprazole can be given as an injection commonly given with octreotide in the case of an emergent esophageal variceal rupture in the ER

what is included in triple therapy

PPI clarithromycin amoxicillin

what is included in quadruple therapy

PPI bismuth subsalicylate metronidazole tetracycline

when should anti-diarrheals not be prescribed

bloody diarrhea fever toxicity

how does loperamide (imodium) work

binds gut wall opioid receptor inhibiting peristalsis

when is loperamide used

for acute and chronic diarrhea an OTC opioid antagonist that does not cross the BBB

how does diphenoxylate/atropine (lomotil) work

it is an opioid agonist but the atropine prevents the addicting qualities by causing an increase in side effects

when is bismuth subsalicylate used

acute diarrhea H. pylori quadruple therapy can also be given as a prophylactic for traveller's diarrhea

what are the common side effects of bismuth subsalicyclate

black gums black stool could cause Reye's and aspirin toxicity

how does octreotide work

inhibits hormones in the GI system

when is octreotide used

used for esophageal varices because it reduces portal HTN secretory diarrhea carcinomas (VIPoma)

in what patient population is secretory diarrhea common in

patients with HIV/AIDs

what are the four types of laxatives

stool softener bulk formation stimulant osmotic

what is the laxative that is used for prevention of constipation

stool softeners

what is the first line laxative for constipation

bulk formation

how does docusate (colace) work

stool softener facilitates stool fat and water mixing to promote bowel movements

how does psyllium work

increases stool bulk maintains regularity supplementally fiber take

how does methylcellulose work

increases stool bulk

what are the two bulk formation laxatives

psyllium methylcellulose

what is bisacodyl

stimulant laxative; stimulates peristalsis

when is bisacodyl used

acute/chronic constipation often used for bed-bound patients or neurologically impaired

what is a common side effect of bisacodyl

common reaction is melanosis coli

what is the difference between balanced polyethylene gylcol and just polyethylene glycol

the presence of electrolytes

when is PEG primarily used

osmotic laxative for bowel prep

how does linaclotide work

activates cGMP which increases interstital fluid secretion and motility

when is linaclotide used

used for chronic idiopathic constipation and IBS constipation

what is the black box warning for linaclotide

pediatri death due to dehydration

what is sodium phosphate rectal

osmotic laxative in an enema form

what is an important thing to remember when using sodium phosphate rectal

patient needs to be alert enough to hold the enema in

what are antispasmodics used for

lower bowel muscle spasms to reduce abdominal pain related to cramping

what are the two antispasmodic medications

dicylocmine hyoscyamine

how does dicyclomine work

anti-cholinergic medication

when is dicyclomine used

for irritable bowel syndrome symptoms discontinue use after 2 weeks if not helping due to side effects

when is hyoscyamine used

commonly used for bladder spasms and GI tract spasms

what class of medication are the first line treatments for mild-moderate ulcerative colitis and crohns disease

aminosalicylates (5-asa)

what are thiopurines

purine antimetabolites that have immunosuppressive properties helps to reduce steroid use when combined with a biologic agent like humira

when is 6-MC used

used for ALL. crohns and ulcerative colitis

how do aminosalicylates work

they work topically not systemically in the GI tract

when is adalimub used

moderate-severe ulcerative colitis, crohns disease, rheumatoid arthritis, psoriatic arthritis

what is the black box warning for adalimub

can cause severe immunosuppression/sickness and malignancy

how does adalimub work

membrane-bound TNF inhibitor reduces inflammation and immune response

when is orlistat used

used to help weightloss

what is a common side effect of orlistat

steatorrhea

when are pancreatic enzymes used

for people with exocrine pancreatic deficiency

when is ursodiol used

for gallstone dissolution, prevention, and primary biliary cirrhosis not used for when gallstones are already calcified

when is peginterferon alfa 2a used

chronic hep b infection

what is the black box warning when using peginterferon alfa 2a

can cause neuropsych issues

when is lamivudine used

hep b infection

what do you need to test for prior to prescribing lamivudine

HIV

what is lepidasavir/sofosbuvir used for

chronic hep C need to test for hep b first

what is hydrocortisone/pramoxine used for

hemorrhoids

what is simethicone used for

pain associated with abdominal gas

what are the patient education tips for flatus

avoid gum and carbonated beverages