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DEMS > GI/Liver Pharmacology > Flashcards

GI/Liver Pharmacology Flashcards

1
Q

H2 Antagonists vs. PPIs - pharmacodynamics

A

H2 are less effective, but ARE good at NOCTURNAL acidity; more rapidly absorped and less protein bound.

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2
Q

Hereditary Hemochormatosis tx

A

Phelbotomy

chelation with Deferasirox, deferoxamine, deferiprone

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3
Q

Triple Theraty

A

PPI + Clarithrymycin + Amoxicillin

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4
Q

Adalimumab

A

TNF-alpha antagonist used to tx IBD

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5
Q

Wilson Dz treamtnt

A

Copper chelation with D-penicillamine, trientine

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6
Q

Area Postrema

A

area outside of BBB that is acted on my cancer drugs

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7
Q

Uses of PPI

A

First line: GERD, PUD, H Pylori triple therapy
NSAID ulcers: Tx and prevention
Prevention of stress gastritis
ZE syndrome

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8
Q

Bidacodyl - ADRs

A

Dangerous electrolyte and fluid imbalances
most widely abused
interpatient variation

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9
Q

ADRS of PPIs

A

Very safe
minor side effects of HA, Abdominal pain, N, C, Diarrhea
Increased risk of C diff infection or pneumonia.
Rebound acidity with discontinuation

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10
Q

Cimetidine - type

A

H2 Receptor antagonist - Anti-acid medication

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11
Q

Pharmacokinetics of PPIs

A

best if taken before a meal
short half life, but long acting
metabolized by CYP450, dosage reduction required with severe hepatic disease only

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12
Q

Magnesium hydroxide uses and ADRs

A

used to create osmotic diarrhea to counteract Al and Ca side effects.
Avoid in renal diseases due to retention of Mg

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13
Q

Sulfasalazine

A

5- Aminosalicylate used to tx IBD

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14
Q

Bidacodyl uses

A

Constipation that fails fiber and osmotically active.

Opiod constipation

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15
Q

Pharmacodynamics of PPis

A

prodrug administered into systemic circulation that diffuses into parietalc ells and is activated to sulfanamide and trapped.
Only inactivates ACTIVE pumps - sso delayed effect

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16
Q

Loperamide

A

Mu opioid agonist that decreases intestinal motility and secretion.
used for travelers diarrhea
ADRS; low addiciton, overdose can cause CNS depression, cardiotoxicity (QT prolongation),

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17
Q

Milk of Magnesia

A

Used for mild to moderate constipation and opioid constipation.
ADRS: avoid with renal dysfunction due to hypermagnesium

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18
Q

Adsorbent antidiarrheals

A

Kaolin, pectin, bismuth
used for mild/mod diarrhea - promote formed stool, but little effect on volume secretion.
Avoid subsalicylate in children under 12

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19
Q

Lansoprazole - mechanism and Type

A

PPI - irreversibly inactivates H/K ATPase pump on Apical side of Parietal cells to decrease Acid secretion

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20
Q

Cisapride ADRs

A

QT prolongation, life threatening arrythmias

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21
Q

Tegaserod/Cisapride uses

A

Diabetic Gastroparesis
IBS constipation
IBS- reduced bloating

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22
Q

Mesalamine

A

5- Aminosalicylate used to tx IBD

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23
Q

Omeprazole - Mechanism and Type

A

PPI - irreversibly inactivates H/K ATPase pump on Apical side of Parietal cells to decrease Acid secretion

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24
Q

Cisapraide - type

A

Promotility - agonist of 5HT4 R on ENS ACh.

Acts as Class III antiarrhthmic by blocking K channels

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25
Q

Bidacodyl

A

Stimulant/irritative laxative

Increases peristalsis by low grade inflammation to promote water accumulation by activating PG, NO, cGMP

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26
Q

Sucralfate - pharmacokinetics

A

inactive- but activated by pH <4 - best on empty stomach.

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27
Q

Sequential therapy

A

PPI + Amox for 7 days

PPI + clarithromycin + Metronidazole 7 days

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28
Q

Calcium Carbonate - type and mechanism

A

Gastric antacid that raise stomach pH

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29
Q

Prochlorperazine ADRs

A

Extrampyramidal SE

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30
Q

Magnesium Hydroxide - type and mechansim

A

gastric antacid by being osmotic agent.

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31
Q

Tegaserod

A

Serotonin 5HT3 agonist to promote gastric emptying and motility.
Renal and hepatic metabolism - contraindicated in renal and liver failure
used for women under 55 with constipation assoc. IBS
ADRs: Diarrhea, MI, stroke, unstable angina

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32
Q

H2 Antagonists - excretion

A

renal - requires dosage adjustment for renal failure

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33
Q

Tx of autoimmune heptatitis

A

Azathloprine - t cel inhbitor

34
Q

Sodium Bicarbonate - type

A

Gastric antacid
Contraindicated for prolonged use due to systemic effects - Na overload and alkalosis.
avoid if pregnant, CHF, HTN, edema, renal fialure

35
Q

ADRs for sucralfate

A

constipation

36
Q

Misprostol - type and mechansim

A

Cytoprotective prostaglandin analogue that protects against stomach acid.
binds to BL membrane and decreases cAMP to indirectly inhibit K/H ATPase
increases bicarbonate and mucus foramtion

37
Q

Uses of H2 Antagonists

A

Second line treatment: GERD, PUD

Stress Gastritis

38
Q

Prochlorperazine - mechanism

A

D2 Receptor angatonist in the CTZ

Antiemetic

39
Q

6-Mercaptopurine

A

immunomodulator used to tx IBD - UC

40
Q

Scopalamine

A

Transdermial Anticholinergic used for motion sickness prevention and post op emesis

41
Q

Ranitidine - mechanism and type

A

H2 Receptor antagonist that is a reversible, competitive block on H2 Receptor of BL membrane of Parietal cell. Decreases cAMP to decrease activation of K/H ATPase.
Less complete block because gastrin and ACh still act to increase H/K ATPase

42
Q

Octreotide - mechanism and use

A

Somatostatin Analog that inhibits G cells

Used for ZE syndrome

43
Q

Treatment of PBC

A

Ursodeoxycholic acid

44
Q

ADRs of antihistamine (antiemetics)

A

sedation, anti muscarinic SE

45
Q

Polycarbophil

A

absorbs water and prevents fecal dsiccation

Diarrhea and constipation treatment!

46
Q

Methotrexate

A

immunomodulator used to tx IBD

47
Q

Meclizine

A

H1R antagonist that crosses BBB to become antiemetic

48
Q

Quadruple Therapy

A

PPI + Tetracycline + Bismuth + metronidazole

49
Q

Diphenylhydramine

A

Antihistamine - antiemetic h1R atagonist

50
Q

tx for acalasia

A

Sildenafil, Nitrate, Ca Channel block

51
Q

ADRs of misprostol

A

Diarrhea

Uterine stimulation - contraindicated in pregancy

52
Q

what category are PPIs compared to H2 Receptor antagonists?

A

PPI: anti-secretory
H2: anti secretory

53
Q

Olsalazine

A

5- Aminosalicylate used to tx IBD

54
Q

Metoclopramide ADRS

A 
Extrapyramidal side effects - dystonic rxn, tradive dyskinesia,
QT prolongation
depression, Fatigue
Neuroepileptic malignancy
Hyperprolactinemia
55
Q

Calcium Carbonate uses and ADRs

A

calcium supplement, reflux - not chronic use.

Constipation, renal calculi

56
Q

ADRs with H2 Antagonists

A

well tolerated
Minor: mental status changes, gynecomastia with cimetidine, galactorrhea, impotence
DDIs: Inhibitor of CYP450 so toxic for warfarin.

57
Q

Uses of Misprostol

A

NSAID induced ulceration - not used anymore

58
Q

Uses and ADRs of Aluminum hydroxide/carbonate

A

CKD

can cause constipation and CNS toxicity with long term use

59
Q

Lactulose

A

Osmotic active laxative by adding non-digestable sugars
used for acute constipation in elderly and cirrhosis hepatic encephalopathy
ADRs: flatulence and cramps

60
Q

Side Effects of Ondanstron

A

QT prolongation
Constipation
Serotonin Syndrome

61
Q

Ducosate

A

surfactant stool wetting lacative that facilitate mixing with acqesous and fat
used: primarily prevention of constipation, when initiating opioids,

62
Q

Balsalazide

A

5- Aminosalicylate used to tx IBD

63
Q

Use of Ondansetron

A

Most effective antiemetic
Use with chemo drugs, post op use of opioids
N/V of pregnancy (hospitalization)

64
Q

Sildenafil

A

inhibit PDE-5 to increase cGMP in smooth muscle

used to treat acalasia - not too effective

65
Q

Doxylamine

A

H1Angatonist used with pryidoxine for morning sickness

66
Q

Pyridoxine

A

Vitamin B6 - first line with Doxylamine for morning sickenss

67
Q

Metoclopramide - uses

A

Diabetic gastroparesis (not with obstruction)
N/V of chemo
Post-Op emesis
3rd line for pregnancy associated N/V

68
Q

Osmotically active laxatives

A

Milk of Magnasia (Mg OH), Polyethylene glycol, lactulose

Osmotic retention of water leading to peristalsis

69
Q

Polyethelyene Glycol Solution

A

osmotic active laxative
used for bowel cleaning for colonoscopy
or for very difficult constipation.

70
Q

Aluminum hydroxide- type and mechanism

A

gastric antacid that raises stomach acid by binding to phosphate in gut

71
Q

tegaserod ADRs

A

QT prolongation, D, HA, stroke, MI agina

72
Q

Azathioprine

A

immunomodulator used to tx IBD - Crohns

73
Q

Ondansetron - type and mechanism

A

Antiemetic

5HT3 antagonists that block receptors in CTZ, STN and visceral afferents

74
Q

Absorbent antidiarrheal - mechanisms

A

absorb toxin material that cause irritation

75
Q

Uses of Antihistamines H1

A

antiemetic - useful for motion sickness

post op emesis

76
Q

Sucralfate type and mechanism

A

mucosal protective anti-acid
sulfated disaccharide aluminum salt binds to necrotic tissue to protect from pepsin and H
binds to Pepsin in bile acids

77
Q

Natalixumab

A

TNF-alpha antagonist used to tx IBD

78
Q

Infliximab

A

TNF-alpha antagonist used to tx IBD both

79
Q

Alosetron

A

Serotonin 5HT3 antagonist to reduce pain and inhibit motility.
P450 metabolism
Used with severe diarrhea of IBS
ADRS: constipation, ischemic colitis

80
Q

Tegaserod - type

A

Promotility - agonist of 5HT4 R on ENS ACh to create corrdianted contraction in stomach, esophagus, SI, ascending colon
Acts as Class III antiarrhthmic by blocking K channels

81
Q

Metoclopramide - type and mechanism

A

Promotility and Antiemetic
Antagonist at presynaptic D2 receptor to inhibit ACh release to create coordianted contraction to enhance transit time.
blocks D2 receptor in CTZ
Weak 5HT3 antagonists in CTZ

DEMS (5 decks)

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