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Pharm 3 module 2 > GI medications > Flashcards

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
Q

Which drugs does ondansetron interact with

A

amioderone
QT prolongation drugs
CYP3A4 inducers

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26
Q

Which drugs are QT prolongators

A

SSRI
Antiarrhythmic agents
tramadol
St. Johns wart

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27
Q

What drugs are cannabinoids

A

Dronabinol

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28
Q

What are the side effects of cannabinoids

A

Euphoria, abdominal pain, vomiting, flushing, palpitations, xerostoma, vertigo

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29
Q

What major interactions do cannabinoids have

A

alcohol, anticholinergics, CNS depressants, CYP3A4 effectors, metronidazole, disulfiram, warfarin

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30
Q

What drugs are histamine antagonists

A

Promethazine
Meclizine
Dimenhydrinate

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31
Q

What is the MOA of Promethazine

A

Blocks the mesolimbic dopaminergic receptors in postsynaptic sites

blocks the release of hormones from the hypothalamus

blocks H1 in brainstem

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32
Q

What serious issue is associated with injectible promethazine

A

Tissue injury with extrav

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33
Q

What is the MOA of meclizine

A

Block H1 and prevents vasodilation, bronchoconstriction, and spasmodic contraction of GI smooth muscle

*may effect CTZ

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34
Q

What are the side effects of meclizine

A

Sedation
headaches
vomiting
blurred vision

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35
Q

Which patients should not receive meclizine

A

glaucoma
asthma
urinary retention
pyloric/duodenal obstruction

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36
Q

What does meclizine have major interactions with

A

alcohol
amphetamines
anticholinergics
nitro
K

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37
Q

What is the MOA of Dimenhydrinate

A

Binds the H1 receptor sites in peripheral sites including GI tract, respiratory tract, and blood vessels. Blocks CTZ and has central anticholinergic activity

38
Q

What are the side effects of Dimenhydrinate

A

Tachycardia, sedation, dizziness, xerostoma, anorexia, blurred vision, thickened bronchial secretions, SJS

39
Q

Which patients should you avoid using dimenhydrinate in

A

CVD, Thyroid dysfunction, respiratory disease, urinary obstruction, glaucoma, seizures

*dont use with ototoxic abx

40
Q

What drug classes are used for Diarrhea and IBS-D

A

Opiod agonist
seretonin modulators
Bile Acid sequestrants
anti-spasmodics
antimicrobials

41
Q

What is the MOA of opioid agonists

A

activates opioid receptor in the GI tract and alters peristalsis by preventing smooth muscle contraction

reduces stool volume and can prevent electrolyte depletion

42
Q

Which patients should not use an opioid agonist

A

Those with infectious diarrhea or toxic megacolon

43
Q

Which drugs are opioid agonists

A

Loperamide
Octreotide
Eluxadoline
Diphenoxylate/atropine

44
Q

What are the side effects of loperamide

A

Constipation, dizziness, abdominal pain/cramping

45
Q

What is the BBW with loperamide

A

cardiac arrest with large doses

46
Q

Which opioid agonist contains atropine to prevent abuse

A

Diphenoxylate/atropine

47
Q

What are the side effects of diphenoxylate/atropine

A

Flushing, tachycardia, xeroderma, toxic megacolon, urinary retention

48
Q

What major interactions do diphenoxylate/atropine have

A

Azelistine, glucagon, pro kinetic agents, opioids, kava kava, nitro, zolpidem

49
Q

What is the MOA of octreotide

A

Inhibits serotonin release and inhibits the secretion of gastrin, VIP, insulin, secretin, motion, and pancreatic polypeptide

50
Q

What are the side effects of octreotide

A

bradycardia, fatigue, headache, dizziness, pruritic, hyperglycemia, cholelithiasis, biliary obstruction, URI, cardiac arrhythmias

51
Q

Which drugs cannot be taken with octreotide

A

anti diabetic agents, cyclosporin, midodrine, MAOIs, quinolones, salicylates, SSRI

52
Q

What is the MOA of Eluxadoline

A

Binds to mu, kappa, and delta opioid receptors in the intestinal lumen. Decreases intestinal motility without causing constipation

53
Q

What are the side effects of Eluxadoline

A

Dizziness, drowsiness, constipation, N/V, elevated LFTs, URI, pancreatitis

54
Q

Which patients cannot take Eluxadoline

A

those with ETOH abuse
hx of obstruction

55
Q

Which drugs cannot be taken with Eluxadoline

A

alcohol, CNS depressants, aldosterone, opioid agonist, rosuvastatin, rifampin

56
Q

When is Alosetron used

A

chronic, severe IBS-D

57
Q

Which serotonin receptor modulator is used in emergencies only and why

A

Tegaserod d/t risk of cardiac arrest

58
Q

Which drugs are serotonin modulators

A

Alosteron
Tegaserod

59
Q

What is the MOA of Alosteron

A

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
Q

What are the side effects of Alosteron

A

Constipation, fatigue, headaches, abdominal pain, nausea, ischemic colitis

61
Q

What is the MOA of bile acid sequestrants

A

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
Q

What are the side effects of bile acid sequestrants

A

Bloating, biliary colic, gallbladder calcification, melena, dental erosion, tinnitus

*dont admin within 4-6 hours of other meds… can interfere with absorption

63
Q

Which IBS-D drugs are antimicrobials

A

Rifamixin
Metronidazole
ciprofloxacin
amoxicilin
Neomycin

64
Q

What is the MOA of Rifamixin

A

Binds to bacterial DNA dependent RNA polymerase thus inhibiting RNA synthesis

65
Q

What are the side effects of Rifamixin

A

Peripheral edema
dizziness
ascites
headache

66
Q

What may happen is rifamixin is used chronically

A

pseudomembranous colitis

67
Q

Which drugs should rifamixin NOT be used with

A

cyclosporin
lactobacillus
sodium picosulfate

68
Q

Which drugs are anti-spasmodics

A

Hyoscyamine
Dicyclomine

69
Q

What is the MOA of anti-spasmodics

A

blocks acetylcholine at parasympathetic receptors. Antagonizes histamine and serotonin

70
Q

What are the side effects of anti-spasmodics

A

tachycardia
mental status changes
impotence
urinary retention
increased IOP

71
Q

Which groups of medications can be used for constipation

A

stool softeners
bulking laxative
osmotic laxatives
stimulant laxatives
selective opioid antagonists
guanylate cyclase- C agonists

72
Q

What drugs are stool softeners

A

Docusate sodium

73
Q

What is the MOA for decussate sodium

A

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
Q

What is a side effect of decussate sodium

A

throat irritation

75
Q

Which drugs are bulking laxatives

A

methylcellulose
psyllium husk powder
wheat dextrin
calcium polycarbophil

76
Q

What is the MOA of bulking laxatives

A

absorb and retain water in the intestine thus increasing the mass of stool which promotes peristalsis through distention of intestinal lumen

77
Q

What are the side effects of bulking laxatives

A

bloating, flatulence, GI distress

78
Q

Which drugs are osmotic laxatives

A

Saline
Lactulose
polyethylene glycol
glycerin

79
Q

What is the MOA with saline laxatives

A

retain water in the intestine thus increasing the intraluminal pressure and promotion of peristalsis

80
Q

What are some side effects of saline laxatives

A

Bloating, abd pain, phosphate nephropathy, hypokalemia

*caution with myasthenia gravis

81
Q

What is the MOA of lactulose

A

disaccharide that promotes fluid retention in the intestine to increase intraluminal pressure and promote peristalsis

82
Q

What are the side effects of lactulose

A

electrolyte imbalance, hypernatremia, hypokalemia, diarrhea

83
Q

What are the side effects of Glycerin suppository

A

rectal burning, abdominal cramping, tenesmus, irritation

84
Q

What drugs are stimulant laxatives

A

Dulcolax
Senna

85
Q

What is the MOA of stimulant laxatives

A

alter the fluid excretion by acting directly on the cells of the intestinal mucosa and increase motility by acting on cells

86
Q

Which drugs are opioid antagonists

A

naloxegol
methylnaltrexone

87
Q

What is the MOA of naloxegol

A

Mu receptor antagonist by binding to polyethylene glycol to prevent crossing BBB

88
Q

What are the side effects of Naloxegol

A

abdominal pain, headaches, diarrhea, nausea, GI perforations

89
Q

What meds are IBS-C

A

Lubiprostone
Linaclotide

90
Q

What is the MOA of Lubiprostone

A

Activates chord channels and increases fluid secretion by the cells in the intestinal membrane

also counteracts the anti secretory effects of opioids

91
Q

What is the MOA of Linaclotide

A

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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