GI Drugs (Upper And Lower) Flashcards
1
Q
Antacids indications
A
hyperacidity caused by Heartburn, GERD, acid indigestion, sour stomach, peptic ulcer
2
Q
Aluminum antacids side effects
A
Constipation , intestinal impaction, anorexia, weakness, tremors and bone pain
3
Q
Calcium antacids side effects
A
Metabolic alkalosis, hypercalcemia, vomiting, confusion, headache, rebound hyperacidity, renal calculi, and neurological impairment
4
Q
Sodium bicarbonate antacids side effects
A
systemic Alkalosis and rebound hyperacidity
5
Q
Antacids considerations
A
Impair absorption of some other drugs
6
Q
Histamine H2 antagonists ex
A
-tidine: cimetidine, famotidine, nizatidine, ranitidine,
7
Q
Histamine H2 antagonists indications
A
Heartburn, acid indigestion, sour stomach, GERD, gastric or duodenal ulcer, gastric hypercecretory conditions, stress related ulcers, acute GI bleeding in critically ill patients,
8
Q
Proton pump inhibitors indications
A
GERD, erosive esophagitis, prevent bleeding in patients using antiplatelet drugs, gastric and duodenal ulcers associated with h. pylori infections, pathologic hypersecretory conditions
9
Q
Proton pump inhibitors considerations
A
Work better than H2 Agonists
10
Q
Proton pump inhibitors ex
A
-prazole: omeprazole, lansoprazole, pantoprazole, rabeprazole, esomeprazole, dexlansoprazole,
11
Q
Proton pump inhibitors administration
A
Take before eating
12
Q
Sucralfate MOA
A
Pepsin inhibitor/mucosal protective drug
13
Q
Sulfacrate indication
A
Used in the short term treatment of duodenal ulcers, preferred in pregnant women with GERD symptoms and for treatment of stress ulcers
14
Q
Misoprostol indications
A
Decreases risk of NSAID induced gastric ulcer in high risk patients (elderly or critically ill)
15
Q
Misoprostol consideration
A
Women MUST be on birth control
16
Q
Antiemetic side effect
A
Drowsiness
17
Q
Metoclopramide indication
A
Delayed gastric emptying and emesis
18
Q
Metoclopramide MOA
A
Increases mobility of upper GI tract without increasing secretion production, and inhibits stimulation of the vomiting center in the brain
19
Q
aminosalicylate interactions
A
reduced absorption of Digoxin, methotrexate increases risk of immunosuppression, hypoglycemics decrease blood glucose level, warfarin increases risk of bleeding
20
Q
Olsalazine pregnancy cat
A
C
21
Q
Diphenoxylate indications
A
Decrease peristalsis, and decrease lower GI motility, usually combined with atropine, and also used for diarrhea, and is chemically related to opioids
22
Q
Diphenoxylate consideration
A
Can have sedative and euphoric effect, but it is NOT an analgesic, reduced abuse potential
23
Q
Diphenoxylate interaction
A
Atropine
24
Q
Loperamide MOA
A
Acts on wall of bowel to slow motility
25
Loperamide restriction
Not during pregnancy
26
Loperamide side effect
Dizzy/headache, sedation/euphoria, anorexia, constipation
27
Antidiarrheals restrictions
Not for people with bacterial diarrhea (e. Coli, salmonella, shigella) kids under 2, jaundice, pseudomembranous colitis, abdominal pain of unknown origin
28
Antidiarrheals precautions
Severe hepatic impairment, pregnancy (cat C),
29
Antidiarrheals interactions
Antihistamines
30
Antiflatulents ex
Simethicone, charcoal
31
Antiflatulents side effects
None
32
Charcoal uses
Prevention of nonspecific pruritud associated with kidney dialysis, and as an antidote in poisoning
33
Laxatives indication
Prevent occasional constipation
34
Lactulose indications
Hypersmotic agent, ammonia toxicity
35
Magnesium considerations
Caution with renal impairment
36
Aminosalicylates ex
Sulfasalazine (MUST maintain high fluid intake)
37
Aminosalicylates indications
Ulcerative colitis, crohn disease, and other inflammatory diseases
38
Aminosalicylates side effects
Abdominal pain, nausea, diarrhea, headache, dizziness, weakness, fever, and low sperm count
39
Aminosalicylates interactions
Cardiotonics, hypoglycemics, anticoagulants
40
Stimulant laxatives ex
Senna, or bisacodyl, cascara sagrada, sennosides, bisacodyl
41
Stimulant laxatives side effects
Brown urine, dark Colon mucosa
42
Docusate indications
Stool softener (relieve constipation)
43
Sucralfate indication
Protect coating for stomach lining
44
Gastric stasis
Failure of the body to remove stomach contents normally
45
Gastroesophageal reflux disease (GERD)
Reflux or backup of gastric acid contentos into the esophagus
46
Hydrochloric acid
Stomach acid that aids in digestion
47
Hypersecretory
Characterized by excessive secretion of a substance
48
Upper GI system includes
Mouth, esophagus and stomach
49
Proton pump inhibitors use
Treatment of helicobacter pylori infection in people with duodenal ulcers
50
Antacids MOA
Neutralize of reduce the acidity of the stomach and duodenal contents by increasing the pH of the stomach acid
51
Antacids ex
Aluminum, magaldrate, magnesium
52
Aluminum carbonate use
Hyperphosphatemia, or as an adjunct to a low phosphate diet to prevent formation of phosphate based urinary stones
53
Calcium use
Calcium deficiencies, such as menopausal osteoporosis
54
Magnesium uses
Magnesium deficiencies, magnesium depletion from malnutrition, restricted diet, or alcoholism
55
Magnesium antacids side effects
Severe diarrhea, dehydration, hypermagnesemia
56
Antacids contraindications
Severe abdominal pain of unknown cause, lactation
57
Sodium antacids contraindications
Cardiovascular problems, and people on sodium restricted diets
58
Calcium antacids contraindications
Renal calculi, hypercalcemia
59
Aluminum antacids precautions
Gastric outlet obstruction, or upper GI bleeding , decreased kidney function,
60
Antacids pregnancy cat
C, caution
61
Calcium antacids precautions
Respiratory insufficiency, renal impairment, cardiac disease
62
Magnesium antacids precautions
Decreased kidney function
63
Antacids interactions
Decreased absorption and decreased effect of digoxin, isoniazid, phenytoin, and chlorpromazine, decreased effectiveness of tetracycline, decrease anti inflammatory properties of corticosteroids, salicylates are excreted faster in the urine
64
Histamine H2 antagonists MOA
Inhibit the action of histamine at H2 receptor cells of the stomach, reducing the secretion of gastric acid, (selective only in stomach, so don’t cause the reactions of general body H2 receptors)
65
Histamine H2 antagonists side effects nature
Mild and very rare
66
Histamine H2 antagonists side effects
Dizziness, somnolence, headache, confusion, hallucinations, diarrhea, reversible impotence
67
Histamine H2 antagonists precautions
Renal or hepatic impairment, severely ill, elderly, debilitated patients, pregnancy (cat B), and lactation
68
Nizatidine pregnancy cat
C
69
Histamine H2 antagonists interactions
Antacids, and metoclopramide decrease absorption of H2 antagonists, carmustine decreases white blood cell count, opioid analgesics increase risk of respiratory depression, oral anticoagulants increase risk for bleeding, and increased serum digoxin levels
70
Proton pump inhibitors MOA
Suppress gastric acid secretions by inhibition of the hydrogen-potassium adenosine triphospatase (ATPase) enzyme system of the gastric parietal cells
71
Combination therapy for H. pylori in people with duodenal ulcers
One PPI + 2 anti-invectives, bismuth + 2 anti-invectives ,
72
Proton pump inhibitors side effects
Headache, nausea, diarrhea, abdominal pain
73
Proton pump inhibitors precautions
Elderly, hepatic impairment, prolonged treatment can reduce ability to absorb vitamin B12, causing anemia
74
Proton pump inhibitors contraindications
Pregnancy (cat B), lactation
75
Omeprazole pregnancy cat
C
76
Proton pump inhibitors menopausal women considerations
Increase in features in hip, wrist, and spine in people taking high PPI doses and undergoing osteoporosis treatment with biophosphonates
77
Proton pump inhibitors interactions
Sulfacrate decreases proton pump inhibitor absorption, decreased absorption of ketoconazole and ampicillin, oral anticoagulants increase risk of bleeding, increased absorption of digoxin, risk for toxic level of anti seizure drugs (benzodiazepines and phenytoin), biophosphonates increase risk of fracture
78
Omeprazole interactions
Clarithromycin risks an increase in plasma levels in both drugs
79
Cholinergic blocking drugs for GI disorders ex
Propantheline, and glycopyrrolate, these have been largely replaced by H2 antagonists
80
Sucralfate side effects
Constipation
81
Sucralfate interactions
Similar interactions to PPIs
82
Misoprostol MOA
Inhibits production of gastric acid and has mucosal protective properties
83
Misoprostol Sadie effects
Headache, nausea, diarrhea, abdominal pain
84
Misoprostol interactions
Antacids decrease misoprostol effects
85
GI stimulants uses
GERD, gastric stasis in diabetic people, people with nausea and vomiting associated with chemo, and in the immediate postoperative period
86
Metoclopramide side effects nature
Usually mild, but higher doses or prolonged administration can exacerbate them
87
Metoclopramide side effects
Restlessness, drowsiness, dizziness, extrapyramidal effects (tremor, involuntary limb movements, muscle rigidity), facial grimacing and depression
88
GI stimulant contraindications
GI obstruction, gastric perforation or hemorrhage, or pheochromocytoma, Parkinson, seizure disorder, people taking drugs likely to cause extrapyramidal symptoms
89
GI stimulants precautions
Diabetes and cardiovascular disease, pregnancy (cat B), lactation
90
Metoclopramide pregnancy cat
B
91
GI stimulant interactions
Decreased absorption of cimetidine decreased absorption of digoxin, MAOIs increase risk of hypertensive episode
92
Metoclopramide interactions
Cholinergic blocking drugs and opioid analgesics decrease metoclopramide effectiveness, and decreased levels of levodopa and metoclopramide with levodopa
93
Antiemetic drugs uses
Inhibiting the CTZ and dopamine and acetylcholine
94
Motion sickness drugs ex
Dimenhydrinate, diphenhydramine, meclizine, scopolamine
95
5-HT3 receptor antagonists MOA
Target serotonin receptors both at the CTZ and peripherally at the nerve endings in the stomach (reduces non-GI adverse effects)
96
Antiemetic use
Before surgery to prevent vomiting during surgery, immediately after surgery when patient is recovering from anesthesia, while administering antineoplastics, during radiation therapy where the GI tract is the treatment field, and during pregnancy for hyperemesis, bacterial and viral infections and adverse drug reactions
97
Antiemetic contraindications
Severe CNS depression
98
5-HT3 receptors antagonists contraindications
Heart block, prolonged QT intervals, pregnancy, lactation, uncomplicated vomiting in young children
99
Prochlorperazine contraindications
Bone marrow depression, blood dyscrasias, Parkinson’s disease, or severe liver or cardiovascular disease
100
How to treat severe nausea and vomiting
NOT using only antiemetic drugs (cause should be investigated)
101
Severe nausea and vomiting being treated with antiemetics considerations
Antiemetics can hide signs of brain tumor/injury, appendicitis, intestinal obstruction, drug toxicity
102
Cholinergic blocking antiemetics precautions
Glaucoma, obstructive disease of the GI or genitourinary system, renal or hepatic dysfunction, and in older men with possible prostatic hypertrophy
103
Promethazine precautions
Hypertension, sleep apnea, epilepsy
104
5-HT3 receptor antagonists precautions
Cardiac conduction problems, or electrolyte imbalances
105
5-HT3 receptor antagonists uses
Hyperemesis
106
Antiemetics pregnancy cat
B
107
5-HT3 receptor antagonists pregnancy cat
B
108
Pregnancy cat C antiemetic drugs
Perphenazine, prochlorperazine, promethazine, scopolamine, chlorpromazine
109
Antiemetics interactions
CNS depressants increase risk of sedation, antihistamines increase anticholinergic side effects, antacids decrease absorption of antiemetics,
110
5-HT3 receptor antagonists interactions
Rifampin decreases 5-HT3 effectiveness
111
Prochlorperazine interactions
Lithium increases risk of extrapyramidal effects
112
Emetic use
Induced vomiting, used when people accidentally ingest a poison or drug overdose, but not all are treated with emetics
113
Emetics MOA
Local irritation of the stomach and by stimulation of the vomiting center in the medulla
114
Metoclopramide consideration
Tardive dyskinesia can occur with long term use (12+ weeks)
115
Antacids ex
Aluminum carbonate, aluminum hydroxide, calcium carbonate, magnesia, magnesium oxide, sodium bicarbonate
116
Misc acid reducers ex
Sucralfate, and misoprostol
117
GI stimulants ex
Metoclopramide
118
Antidopaminergic antiemetics
Chlorpromazine, perphenazine, prochlorperazine, promethazine
119
Anticholinergic antiemetics ex
Trimethobenzamide
120
5-HT3 receptor antagonists ex
Dolasetron, granisetron, odansetron, palonosetron
121
Misc antiemetics
Dronabinol, nabilone
122
Emetogenic
Causing vomiting
123
Chemoreceptor trigger zone (CTZ)
Group of nerve fibers located on the surface of the 4th ventricle of the brain, that, which stimulated, results in vomiting
124
Antiflatulents
Drugs that work against flats (gas)
124
Constipation
Hardened fecal matter that is difficult to pass
124
Diarrhea
Loose, watery stool
124
Inflammatory bowel disease
Inflammation of the bowel (crohn disease, and ulcerative colitis)
124
Obstipation
Watery stool leakage around a hard fecal impaction
124
Symptoms of crohn disease
Abdominal pain and distension, as the disease progresses, anorexia, diarrhea, weight loss, dehydration and nutritional deficiencies can occur
124
Drugs used to treat IBD
Antibiotics, corticosteroids, biologic agents, and aminosalicylates
125
Aminosalicylates MOA
Exert a topical anti-inflammatory effect in the bowel
126
Aminosalicylates contraindications
Allergy to salicylate-containing drugs, allergy to sulfonamides and sulfites, intestinal obstruction, kids younger than 2, pregnancy (cat B), and lactation
127
Natalizumab use
Parenteral, used for crohn disease and multiple sclerosis
128
Natalizumab side effects
Rare brain infection called leukoencephalopathy. Risk for this is greater if taking immunosuppressants or have been exposed to John cunning virus (JCV)
129
Generic name of lomotil
Diphenoxylate
130
Difenoxin use
Chemically related to opioid drugs, decrease intestinal peristalsis (used for diarrhea), are usually combined with atropine
131
Loperamide use
Chronic diarrhea associated with IBD
132
Crofelemer MOA
Blocks the secretion of chloride, which causes high water volume loss in the diarrhea associated with HIV/AIDS
133
Antidiarrheals side effects
Anorexia, vomiting, constipation, abdominal discomfort, pain and distension, dizzy, drowsy, headache, sedation, euphoria, rash
134
Loperamide pregnancy cat
B, but isn’t recommended for use during pregnancy and lactation
135
Crofelemer pregnancy cat
C, hasn’t been stifled for pregnancy, lactation, or pediatric use
136
Antidiarrheals interactions
Antihistamines, opioids, hypnotics, and sedatives increase risk of CNS depression, antihistamines and antidepressants increase anticholinergic side effects,
MAOIs increase risk of hypertensive crisis
137
Simétrico e MOA
Deforming action that dispersed and prevents the formation of gas pockets in the intestine
138
Charcoal MOA
Helps bind gas for expulsion
139
Antiflatulents uses
Relieve painful symptoms of excess gas in the digestive tract that may be caused by postoperative gaseous distention and air swallowing, dyspepsia, peptic ulcer, IBS or diverticulosis
140
Charcoal pregnancy cat
C
141
Simethicone precautions
Pregnancy (cat not known, but may be safe)
142
Charcoal interactions
Decrease in efedtcveness of other drugs because charcoal adsorbs them, and can adsorb drugs in the GI tract
143
Bulk producing laxatives MOA
Add bulk and water to the contents of the intestines, not digested by the body, which stimulates peristalsis, moves the products of digestion through the intestine and encourages evacuation of the stool
144
Bulk producing laxatives ex
Psyllium, and polycarbophil, and methylcellulose
145
Stool softeners MOA
Promote water retention in the fecal mass and soften the stool
146
Stool softener ex
Docusate
147
Emollient laxatives ex
Mineral oil
148
Emollient laxatives MOA
Lubricate the intestinal and soften stool
149
Hypersmolar laxatives MOA
Dehydrated local tissues, which causes irritation and increased peristalsis
150
Hypersmolar laxatives ex
Glycerin, lactulose, lubiprostone
151
Stimulant laxatives MOA
Increase peristalsis by direct action on the intestine
152
Saline laxatives MOA
Attract water into the intestine, increasing pressure, which is followed by an increase in peristalsis
153
Saline laxatives ex
Magnesium
154
Stimulant laxatives use
Evacuate colon for rectal and bowel examinations
155
Emollient laxatives use
Evacuate colon for rectal and bowel examinations
156
Saline laxatives use
Evacuate the colon for rectal and bowel examinations
157
Stool softeners use
Prevention of strain during defecation (after anorectal surgery or myocardial infarction)
158
Mineral oil use
Prevention of strain during defecation (after anorectal surgery or myocardial infarction)
159
Psyllium use
IBS and diverticular disease
160
Polycarbophil use
IBS and diverticular disease
161
Hypersmotic agents use
Reduction of blood ammonia levels in hepatic encephalopathy
162
Laxatives side effects
Diarrhea, loss of water and electrolytes, abdominal pain, nausea, vomiting, perianal irritation, fainting, bloating, flatulence, cramps, and weakness
163
Prolonged use of laxatives can result in
Serious electrolyte imbalances, or dependance on a laxative to have a bowel movement
164
Bulk forming laxatives side effects
Obstruction of the esophagus, stomach, small intestine, and colon when these are administered without good fluid intake or in people with intestinal stenosis
165
Mineral oil considerations
The very young, very old, and debilitated are at the highest risk for the aspiration of mineral oil into lungs, which can cause a lipid pneumonitis
166
Laxatives contraindications
Persistent abdominal pain, nausea, vomiting of unknown cause, signs of acute appendicitis, fecal impaction, intestinal obstruction, or acute hepatitis, or sensitive to tartrazine
167
Magnesium precautions
Renal impairment
168
Laxatives precaution
Rectal bleeding, pregnancy, lactation
169
Pregnancy cat C laxatives
Cascara sagrada, docusate, glycerin, phenophthalein, magnesium, senna
170
Mineral oil interactions
Can impair the absorption of fat soluble vitamins (
| A, D, E, K), and surfactants can increase mineral oil absorption,
171
Laxatives interactions
Can reduce absorption of other drugs in the GI tract by combining with them chemically or hastening their passage through the intestinal tract
172
Bisacodyl tablets interactions
Milk, antacids, histamine H2 antagonists and PPIs shouldn’t be administered 1-2 hours before bisacodyl tablets
173
Orlistat MOA
Inhibits lipase, which can result in loose stools and increased flatulence
174
Orlistat use
Obesity management
175
Orlistat side effects nature
Side effects usually diminish by the 4th week, but can come back when a meal high in fat is eaten
176
Orlistat side effects
Loose stools, increased flatulence, fecal urgency, incontinence with fat or oily stools
177
Orlistat contraindications
Gallstones
178
Charcoal interactions considerations
Since charcoal can absorb other drugs, it shouldn’t be given 2 hours before or 1 hour after the administration of other drugs
179
Aminosalicylates ex
Balsalazide, mesalamine, olsalazine, sulfasalazine
180
Biológicas for bowel disorders ex
Adalimumab, certolizumab, infliximab, natalizumab,
181
Misc drugs for bowel disorders ex
Alosetron, alvimopan, eluxadoline, linaclotide, methylnaltrexone
182
Andidiarrheals ex
Bismuth, crofelemer, difenoxin with atropine, diphenoxylate with atropine, loperamide, tincture of opium
183
Antiflatulents ex
Charcoal, simethicone
184
Bulk producing laxatives ex
Methylcellulode, psyllium, polycarbophil
