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GI medications Flashcards

1
Q

Where is the vomiting/emesis center in the brain

A

medulla oblongata

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2
Q

What does the vomiting/emesis center in the brain do

A

coordinates contractions of the pharyngeal, GI, and abdominal wall to expel gastric contents

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3
Q

What activates the vomiting center

A

Afferent fibers in the gut
CTZ
Cerebral cortex
vestibular apparatus

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4
Q

What is CTZ

A

chemoreceptor trigger zone

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5
Q

What are the chemoreceptors that effect the vomiting center of the brain

A

Seretonin 5-HT3
Dopamine D2
Muscarinic M1

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6
Q

How does the vestibular apparatus activate the vomiting center of the brain

A

There are afferent fibers that go into the cerebellum and triggers the release of acetylcholine / histamine

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7
Q

How does the Gut activate the committing center of the brain

A

There is a vagal afferent pathway to the solitary tract nucleus and then to the vomiting center

There is nerve stimulation of CTZ

D2, 5-HT3 and NK1 receptors

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8
Q

What groups of drugs are used for N/V

A

Cholinergic/muscarinic antagonist
Dopamine antagonist
seretonin antagonist
Cannabinoids
Histamine antagonists

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9
Q

What drugs for N/V are cholinergic antagonists

A

Scopolamine (Patch/IV)

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10
Q

What is the MOA of Scopolamine

A

Blocks acetylcholine at parasympathetic sites and reduces histamine and serotonin activity

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11
Q

What is the PK of scopolamine

A

Onset 6-8hours
lasts 72 hours
hepatic metabolism

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12
Q

What are the side effects of scopolamine

A

bradycardia, tachycardia, flushing, orthostatic hypotension, cognitive impairment, psychosis & hallucinations

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13
Q

Which patients cannot use scopolamine

A

Contraindicated in narrow-angle glaucoma
*or any agents containing belladonna

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14
Q

Which N/V medications are dopamine receptor antagonists

A

Phenothiazines
Butyrophenones
Benzamides

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15
Q

Which drugs are phenothiazines

A

Prochlorperazine

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16
Q

Which drugs are Butyrophenones

A

Haloperidol
Droperidol

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17
Q

Which drugs are benzamides

A

Metoclopramide
Trimethobenzamide

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18
Q

What is the MOA of dopamine receptor antagonists

A

Acts on CTZ and afferent pathways primarily in the gut

Does have M1 and Hq blocking effects

*metoclopramide has weak 5-HT3 blockage at higher doses

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19
Q

What are the side effects of dopamine receptor antagonists

A

Extrapyramidal rxns, QT prolongations, CNS effects, Hyperprolactinemia, tar dive dyskinesia

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20
Q

What major interactions do dopamine agonists have

A

TCA, SSRI, alcohol, anticholinergics, potassium

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21
Q

Which drugs are serotonin receptor antagonists

A

Ondansetron
Granisteron

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22
Q

What is the MOA of ondansetron

A

Blocks seretonin centrally

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23
Q

What are the side effects of Ondansetron

A

QT prolongation, dizziness, confusion, SOB, constipation

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24
Q

What are things to monitor with ondansetron

A

EKG monitoring
K+Mg levels
seretonin syndrome

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25
Which drugs does ondansetron interact with
amioderone QT prolongation drugs CYP3A4 inducers
26
Which drugs are QT prolongators
SSRI Antiarrhythmic agents tramadol St. Johns wart
27
What drugs are cannabinoids
Dronabinol
28
What are the side effects of cannabinoids
Euphoria, abdominal pain, vomiting, flushing, palpitations, xerostoma, vertigo
29
What major interactions do cannabinoids have
alcohol, anticholinergics, CNS depressants, CYP3A4 effectors, metronidazole, disulfiram, warfarin
30
What drugs are histamine antagonists
Promethazine Meclizine Dimenhydrinate
31
What is the MOA of Promethazine
Blocks the mesolimbic dopaminergic receptors in postsynaptic sites blocks the release of hormones from the hypothalamus blocks H1 in brainstem
32
What serious issue is associated with injectible promethazine
Tissue injury with extrav
33
What is the MOA of meclizine
Block H1 and prevents vasodilation, bronchoconstriction, and spasmodic contraction of GI smooth muscle *may effect CTZ
34
What are the side effects of meclizine
Sedation headaches vomiting blurred vision
35
Which patients should not receive meclizine
glaucoma asthma urinary retention pyloric/duodenal obstruction
36
What does meclizine have major interactions with
alcohol amphetamines anticholinergics nitro K
37
What is the MOA of Dimenhydrinate
Binds the H1 receptor sites in peripheral sites including GI tract, respiratory tract, and blood vessels. Blocks CTZ and has central anticholinergic activity
38
What are the side effects of Dimenhydrinate
Tachycardia, sedation, dizziness, xerostoma, anorexia, blurred vision, thickened bronchial secretions, SJS
39
Which patients should you avoid using dimenhydrinate in
CVD, Thyroid dysfunction, respiratory disease, urinary obstruction, glaucoma, seizures *dont use with ototoxic abx
40
What drug classes are used for Diarrhea and IBS-D
Opiod agonist seretonin modulators Bile Acid sequestrants anti-spasmodics antimicrobials
41
What is the MOA of opioid agonists
activates opioid receptor in the GI tract and alters peristalsis by preventing smooth muscle contraction reduces stool volume and can prevent electrolyte depletion
42
Which patients should not use an opioid agonist
Those with infectious diarrhea or toxic megacolon
43
Which drugs are opioid agonists
Loperamide Octreotide Eluxadoline Diphenoxylate/atropine
44
What are the side effects of loperamide
Constipation, dizziness, abdominal pain/cramping
45
What is the BBW with loperamide
cardiac arrest with large doses
46
Which opioid agonist contains atropine to prevent abuse
Diphenoxylate/atropine
47
What are the side effects of diphenoxylate/atropine
Flushing, tachycardia, xeroderma, toxic megacolon, urinary retention
48
What major interactions do diphenoxylate/atropine have
Azelistine, glucagon, pro kinetic agents, opioids, kava kava, nitro, zolpidem
49
What is the MOA of octreotide
Inhibits serotonin release and inhibits the secretion of gastrin, VIP, insulin, secretin, motion, and pancreatic polypeptide
50
What are the side effects of octreotide
bradycardia, fatigue, headache, dizziness, pruritic, hyperglycemia, cholelithiasis, biliary obstruction, URI, cardiac arrhythmias
51
Which drugs cannot be taken with octreotide
anti diabetic agents, cyclosporin, midodrine, MAOIs, quinolones, salicylates, SSRI
52
What is the MOA of Eluxadoline
Binds to mu, kappa, and delta opioid receptors in the intestinal lumen. Decreases intestinal motility without causing constipation
53
What are the side effects of Eluxadoline
Dizziness, drowsiness, constipation, N/V, elevated LFTs, URI, pancreatitis
54
Which patients cannot take Eluxadoline
those with ETOH abuse hx of obstruction
55
Which drugs cannot be taken with Eluxadoline
alcohol, CNS depressants, aldosterone, opioid agonist, rosuvastatin, rifampin
56
When is Alosetron used
chronic, severe IBS-D
57
Which serotonin receptor modulator is used in emergencies only and why
Tegaserod d/t risk of cardiac arrest
58
Which drugs are serotonin modulators
Alosteron Tegaserod
59
What is the MOA of Alosteron
Selective 5-HT3 agonist. Acts on the enteric neurons both centrally and peripherally. Affects visceral pain, colonic transit, and alters secretions in the GI tract
60
What are the side effects of Alosteron
Constipation, fatigue, headaches, abdominal pain, nausea, ischemic colitis
61
What is the MOA of bile acid sequestrants
Binds to bile salts in the intestine. Inhibits reuptake of bile salts, increases fecal loss of bile salts bound to LDL cholesterol as well. *50% have bile acid malabsorption
62
What are the side effects of bile acid sequestrants
Bloating, biliary colic, gallbladder calcification, melena, dental erosion, tinnitus *dont admin within 4-6 hours of other meds... can interfere with absorption
63
Which IBS-D drugs are antimicrobials
Rifamixin Metronidazole ciprofloxacin amoxicilin Neomycin
64
What is the MOA of Rifamixin
Binds to bacterial DNA dependent RNA polymerase thus inhibiting RNA synthesis
65
What are the side effects of Rifamixin
Peripheral edema dizziness ascites headache
66
What may happen is rifamixin is used chronically
pseudomembranous colitis
67
Which drugs should rifamixin NOT be used with
cyclosporin lactobacillus sodium picosulfate
68
Which drugs are anti-spasmodics
Hyoscyamine Dicyclomine
69
What is the MOA of anti-spasmodics
blocks acetylcholine at parasympathetic receptors. Antagonizes histamine and serotonin
70
What are the side effects of anti-spasmodics
tachycardia mental status changes impotence urinary retention increased IOP
71
Which groups of medications can be used for constipation
stool softeners bulking laxative osmotic laxatives stimulant laxatives selective opioid antagonists guanylate cyclase- C agonists
72
What drugs are stool softeners
Docusate sodium
73
What is the MOA for decussate sodium
lowers the surface tension at the oil-water interface of the feces, allowing for water and lipids to penetrate the stool to help hydrate and soften the fecal material
74
What is a side effect of decussate sodium
throat irritation
75
Which drugs are bulking laxatives
methylcellulose psyllium husk powder wheat dextrin calcium polycarbophil
76
What is the MOA of bulking laxatives
absorb and retain water in the intestine thus increasing the mass of stool which promotes peristalsis through distention of intestinal lumen
77
What are the side effects of bulking laxatives
bloating, flatulence, GI distress
78
Which drugs are osmotic laxatives
Saline Lactulose polyethylene glycol glycerin
79
What is the MOA with saline laxatives
retain water in the intestine thus increasing the intraluminal pressure and promotion of peristalsis
80
What are some side effects of saline laxatives
Bloating, abd pain, phosphate nephropathy, hypokalemia *caution with myasthenia gravis
81
What is the MOA of lactulose
disaccharide that promotes fluid retention in the intestine to increase intraluminal pressure and promote peristalsis
82
What are the side effects of lactulose
electrolyte imbalance, hypernatremia, hypokalemia, diarrhea
83
What are the side effects of Glycerin suppository
rectal burning, abdominal cramping, tenesmus, irritation
84
What drugs are stimulant laxatives
Dulcolax Senna
85
What is the MOA of stimulant laxatives
alter the fluid excretion by acting directly on the cells of the intestinal mucosa and increase motility by acting on cells
86
Which drugs are opioid antagonists
naloxegol methylnaltrexone
87
What is the MOA of naloxegol
Mu receptor antagonist by binding to polyethylene glycol to prevent crossing BBB
88
What are the side effects of Naloxegol
abdominal pain, headaches, diarrhea, nausea, GI perforations
89
What meds are IBS-C
Lubiprostone Linaclotide
90
What is the MOA of Lubiprostone
Activates chord channels and increases fluid secretion by the cells in the intestinal membrane also counteracts the anti secretory effects of opioids
91
What is the MOA of Linaclotide
Acts on guanylate cyclase on the epithelium of the intestine, increasing cyclic guanosine monophosphate. Stimulates chloride and bicarbonate secretion and intraluminal pressure promoting peristalsis

Pharm 3 module 2 (2 decks)

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