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Advanced pharmacology > GI Medications > Flashcards

GI Medications Flashcards

1
Q

Aggressive Gastritis factors

A 
H. Pylori 
NSAIDS
Acid
Pepsin
Smoking
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2
Q

Defensive Factors

A

Mucus
Bicarbonate
Blood flow
Prostaglandins

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3
Q

Antacids MOA

A

MOA: reacts with gastric acid to produce neutral salts

By neutralizing acid, antacids decrease destruction of the gut wall

Reduce pepsin activity, enhances mucosal protection by stimulating production of prostaglandins

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4
Q

Antacids ( medication )

A 
Calcium carbonate ( tums)
Sodium bicarbonate (alka-seltzer)
Aluminum hydroxide 
Magnesium hydroxide ( milk of magnesia) - diarrhea 
Magnesium oxide ( mag-Ox)- constipation

Combo : maalox, mylanta,

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5
Q

Antacid ( admin and precaution, contra, preg)

A

Pt should take 1-2 hours after a meal or when symptom occur

Take 1 hour before or 2 hours after medication

Preacaution: kidney stones, geriatrics, renal impairment

Contraindications: hypercalcemia or hypophosohatemia

Preg: generally safe

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6
Q

Antacids ( adverse)

A

Sodium loading
Acid rebound
Milk-alkali syndrome - high blood calcium and metabolic alkalosis

Antacids with aluminum and calcium = constipation

Antacids with mag = diarrhea

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7
Q

Bulk Laxatives

A

Anti diarrhea

MOA: increases bulk and moisture content of stool, stimulates peristalsis

Adverse: bloating, cramping, flatulênce

Precaution : poor fluid intake

Safe in preg

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8
Q

Lomotil

A

Anti-diarrhea

MOA: slow GI motility and propulsion, allow fluid to be absorbed, decreasing fecal volume

Precautions: toxic megacolon

Scheduled V controlled substance

Low potential for physical dependence and abuse

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9
Q

Imodium

A

Anti-diarrhea

Best drug

MOA: slow GI motility and propulsion, allow fluid to be absorbed , decreasing fecal volume

Adverse : drowsiness dizziness, headache

Precaution: fluid rentention, and toxic megacolon

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10
Q

Bismuth Subsalicylate

A

MOA: anti-secretory antimicrobial

Adverse: darkening of stool and tongue

Precaution : caution in pt taking anticoagulation medication

Contra: 3rd trimester preg, allergy ASA, severe GI bleeding

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11
Q

Antidopaminergics

A

Compazine, Phenergan, Reglan

MOA: block D2 receptors in CTZ and other areas of brain

Adverse: extrapyramidal reactions ( tar dive dyskinesia)

Contraindications : Reye’s syndrome ( do not give in kids)

Preg: not reccomended

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12
Q

Reglan ( metoclopramide)

A

MOA: blocks D2 receptors, stimulates upper GI tract, increases peristalsis of Duodum and jejunem

Lowers sz control

Adverse: tardive dyskinesia

PrecautionL geriatrics increased risk for confusion

Contraindication : GI obstruction

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13
Q

Anticholinergics

A

Meclizine ( vertigo)

Dramamine ( motion sickness)

Scopolamine

MOA: reduce sensitivity of vestibular apparatus

Lots of side effects

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14
Q

NK1 Receptor Antagonist

A

Given ahead of chemo to prevent N/V. Will not treat N/V

Decreases effectiveness of oral contraceptives

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15
Q

5HT3 receptor antagonists

A

Zofran, Anzemet, Kytril, Aloxi

MOA: work peripherally intestinal wall by blocking 5HT3, work centrally in CTZ by blocking 5HT3 receptors

Zofran okay for < 4

Can give in pregnancy

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16
Q

Acute vomiting treatment

A

N = PO antiemetic

N/V : PR for short term period then switch to oral once vomiting is under control

17
Q

Anticipated Vomiting treatment

A

Premedication, antidopinergics : start low and increase PRN for symptom control

Anticholinergics for motion sickness and vertigo

NK1 and 5HT3 for Chemo emesis

18
Q

Stool softeners

A

MOA: lowers surface tension, permits easier defecation

Adverse: intestinal obstruction, diarrhea

Colas

19
Q

Osmotic Laxatives

A

MOA: cause water the tissue into the bowel, increases peristalsis

Miralax

20
Q

Amitiza

A

For opiod induced constiption and IBS in women

Not approved for children

21
Q

Stimulants

A

MOA: directly stimulates sensory nerves in intestinal mucosa

Bulcolax, senna

Precaution: fluid and electrolyte abnormalities

22
Q

Saline laxatives

A

Mag citrate

MOA: attract and retain water in bowel, índice contractions

Precautions: edema and HTN

Do not give to infants

23
Q

Constipation short term management

A

Start with bulk laxative or saline agent

Stimulants are third line

24
Q

Long term constipation management

A
  1. Bulk laxative and saline agent
  2. Opioid prophylaxis
  3. Add another stool softener

Do not take stimulants or saline laxatives long term

25
Q

Peptic ulcer disease

A

Break in the gastric or duodenal mucosa

Increase in acid, pepsin

Causes: NSAIDS and H. Pylori ( most common cause of gastric and duodenal ulcers)

26
Q

First line medication to eradicate H. Pylori

A

Quadruple bismuth RX

Very expensive

Long use and many pulls

PPI and 3 ABS,

27
Q

Histamine -2 blockers

A

Zantac, Tagamet, Pepcid

For : duodenal and gastric ulcers, GERD

Give at night or BID

28
Q

PPI

A

Omeprazole ( Prilosec) Nexium, Prevacid, Dexilant, Protonix, Aciphex

uses: gastric and duodenal ulcer, GERD, H. Pylori

Ad: 30-60 min before a meal, should not crush or chew capsules

Adverse: b12 deficiency , avoid grapefruit

29
Q

How to d/c PPI therapy

A

Cut the dose by 50 percent every week

If patients on BID dosing the initial reduction can be accomplished by decreasing the once in the morning before breakfast

Once on the lowest dose for one week the patients instructed to stop the medication

30
Q

Sucralfate ( calafate)

A

Anti-ulcer medication
Creates a protective barrier up to 6 hours against acid and pepsin

Uses for duodenal ulcer with NSAID for ulcer prevention

Anti acids may interfere with effects of sucralfate

31
Q

Mistoprostol

A

MOA: synthetic prostaglandin, increased museus and bicarbonate production and enhances blood flow to stomach

NSAID and ASA gastric protection

Take with food

Be aware if cv disease

32
Q

NSAID- induced Ulcer treatment

A

D/c NSAID if possible and add PPU or H2 blocker

If cant d/c then add a continuous PPR or H2 blocker or misiporstol

Consider COX-2 selective NSAID —> worry about CV risk

33
Q

Drugs to manage GERD

A

PPI - 1 st line

H2 -blockers

34
Q

Pharm treatment for cramping abd pain

A

Antispasmodic PRN

Bentyl and Levsin

MOA: relax smooth muscle tone , decrease HI motility

35
Q

Pharm treatment for abd pain frequency or severe

A

TCA’s ( elavil, Pamelor, tofranil, normpramin

36
Q

IBD pharm treatment

A

Aminosalicylates
Corticosteroids
Immunomodulator

37
Q

Aminosalicylates

A

Mesalamine

MOA: topical, inhibit prostaglandin production in colon

Increases liver enzymes

Advanced pharmacology (12 decks)

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