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Fall Pharm Block 4 > GI Medications > Flashcards

GI Medications Flashcards

1
Q

What two parts of the GI tract are most common sites of ulcers?

A

stomach and duodenum

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2
Q

What type of patients get stress ulcers?

A

Mechanically ventilated 48+ hours, burn, and TBI

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3
Q

Define TPN and is it commonly used?

A

TPN = total parenteral nutrition. Not hot - should always use the gut for nutrition when possible.

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4
Q

What medication class causes ulcers and state three reasons why?

A

NSAIDs - because they are acidic, decrease mucus, and they anti-coagulate.

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5
Q

What bacteria is the most common cause of ulcers and why?

A

H. Pylori because it coats itself in HCO3 to protect itself from stomach acid.

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6
Q

What is an acid producing tumor in the stomach that can cause ulcers?

A

Zollinger-Ellison Syndrome

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7
Q

Describe the three general ways we can treat ulcers?

A

increase mucus, decrease acid, eradicate H. Pylori

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8
Q

Describe GERD.

A

Gastric acid refluxes into the esophagus s/p decreased esophageal sphincter tone.

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9
Q

What condition results from chronic GERD and what results from too much esophageal sphincter tone?

A

Chronic GERD - Barrett’s Esophagus

Inc Tone - Achalasia

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10
Q

What drug is used to treat achalasia?

A

Nifedipine (Ca Channel Blocker)

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11
Q

Describe the mechanism of action of sucralfate.

A

Not absorbed PO - it binds to the ulcer site like a band-aid and protects it from acid.

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12
Q

Why is sucralfate not commonly used?

A

Because it has to be dosed QID

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13
Q

What drugs will sucralfate interact with?

A

Tetracyclines and Fluoroquinolones because sucralfate has aluminum in it and the other drugs are chelators.

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14
Q

What cells in the stomach produce acid and what are two common pathways by which they are stimulated that we may antagonize pharmacologically?

A

Parietal cells stimulated by H-2 (histamine) receptors and the proton pump.

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15
Q

What neurotransmitter stimulates parietal cell acid production?

A

Acetylcholine

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16
Q

Name 4 H-2 receptor antagonists.

A

Cimetidine, Famotidine, Nizatidine, Ranitidine.

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17
Q

Are H-2 receptors available by Px or OTC?

A

Both depending on dose.

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18
Q

If taking only one H-2 receptor antagonist per day, when should it be taken and why?

A

At night - most stomach acid is produced at night.

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19
Q

What are two AEs of H-2 receptor antagonists?

A

Thrombocytopenia and confusion (especially in elderly or other patients in which the drug may accumulate)

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20
Q

How are H-2 receptor antagonists eliminated and how is this clinically relevant?

A

Renally eliminated - adjust dose at CrCl < 50

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21
Q

What drugs will H-2 receptor antagonists interact with and why?

A

Digoxin, itraconazole, iron - these drugs need acid to be absorbed. H2RAs increase pH.

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22
Q

What is the final common pathway by which parietal cells are stimulated to produce acid?

A

Proton Pump

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23
Q

Name five proton pump inhibitors.

A

Omeprazole, Esomeprazole, Lansoperazole, Rabeprazole, Pantoprazole.

24
Q

T/F: PPIs act faster than H2RAs.

A

False: PPIs are slow on, slow off.

25
Q

How are PPI drugs eliminated and why is this clinically relevant?

A

Hepatically eliminated - can use PPI in renal failure and H2RA in liver failure.

26
Q

What drugs will PPIs interact with and why?

A

Digoxin, itraconazole, iron - these drugs need acid to be absorbed. PPIs increase pH.

27
Q

What are prokinetic agents and what are they used for?

A

Increase peristalsis - used as an anti-emitic, GERD, gastroparesis, facilitate feeding tube placement to get it past the pyloric valve.

28
Q

Define gastroparesis and what patients get it?

A

Decrease peristalsis from GI neuropathy - common in DM patients.

29
Q

What is the father of prokinetic agents and what are its effects?

A

Metoclopramide - enhances upper GI smooth muscle response to Ach enhancing GI motility and increased gastric emptying. Also blocks dopamine receptors in the chemo trigger zone (vomit center in CNS).

30
Q

What chronic disease may be exacerbated by metoclopramide use and why?

A

Parkinson’s because it blocks dopamine in the CNS.

31
Q

Describe the effect of metoclopramide on GI tract pH.

A

No effect on pH at all.

32
Q

Name a prokinetic agent that is rarely used and state why.

A

Cisapride - can cause significant QT prolongation. Must jump through a lot of hoops to get cisapride.

33
Q

Describe the potency of cisapride and state the clinical effect.

A

Very potent - causes diarrhea.

34
Q

List three salts included in antacids and what is the major AE associated with each?

A

Al - constipating
Mg - diarrhea
Na(HCO3) - heart failure/edema

35
Q

Describe the efficacy of and adherence potential of antacids.

A

Very effective but difficult to take bc you have to take multiple doses per day, they don’t taste good, most are only available as liquids, and they can be expensive

36
Q

T/F: Antacids can be taken any time of day with any food or medication.

A

False: all antacids interact with chelators –> space from ingestion of quinolones and tetracyclines

37
Q

What is unique about Gaviscon?

A

It is an antacid indicated for GERD –> the med foams in the stomach and protects the esophagus in reflux

38
Q

What is the best antacid for a post-menopausal woman?

A

Tums bc it contains calcium carbonate

39
Q

What drug commonly mixed with an NSAID can be used in prevention of ulcers.

A

Misoprostol - PG that stimulates production of mucus in the gut.

40
Q

What is the brand name of misoprostol by itself and what is the name of its coformulation?

A

Cytotec - misoprostol by itself

Arthrotec - misoprstol plus diflocenac

41
Q

What are the two main AEs associated with misoprostol?

A

Diarrhea and uterine contractions

42
Q

What agents are used to manage constipation?

A 
Magnesium
Lactulose - draws water to it
Polyethylene glycol - draws water to it
Docusate Sodium - stool softener
Bisacodyl - increases motility
Castor oil - lubricant facilitates fecal expulsion
SENA - stimulant 
Sorbitol - sugar that draws water to it
43
Q

What drugs that we have studied are most known to cause constipation?

A

Opioids, Al containing antacids, Verapamil

44
Q

What is the primary use for polyethylene glycol?

A

Prep for colonoscopy (called Go Lightly)

45
Q

Differentiate propylene glycol from polyethylene glycol from ethylene glycol.

A

Propylene Glyc - diluent used to force drugs into solution that would otherwise not dissolve
Polyethylene Glyc - used in colonoscopy prep
Ethylene glycol - antifreeze

46
Q

How is diarrhea caused by antibiotics managed?

A

If typical diarrhea - no management

If C. Diff - treat with PO Vancomycin

47
Q

What agents can be used as anti-diarrheals?

A

Codeine - not commonly used bc it is C-5
Lomotil - combo of diphenoxylate (anti-motility) and atropine (anti-ach that slows peristalsis)
Loperamide

48
Q

What are five common causes of diarrhea?

A 
E. Coli
Salmonella
Norwalk virus (cruise ships)
Giardia (dirty water)
Shigella
49
Q

What is the only agent used to treat flatulence, how does it work, and what are the AEs?

A

Simethicone - surfactant that decreases gas bubbles in the colon. No AEs bc it is not absorbed.

50
Q

What is in the bucket for ulcerative colitis?

A

Locally acting anti-inflammatory agents - sulfasalazine, mesalamine, steroids PO (many AEs) or PR (if distal ulcerative colitis).

51
Q

What is the MOA of sulfasalazine and mesalamine?

A

Breaks down to 5-ASA to produce local anti-inflammatory effect

52
Q

What agent is used to treat irritable bowel syndrome?

A

Dicyclomine - Anti-spasmodic anti-Ach agent specific to the colon.

53
Q

What are the two most common causes of vomiting?

A

chemotherapy and Fe supplements

54
Q

What are the classes of drugs used as anti-emetics? What is their MOA? Give an example of each.

A
  1. Antihistamine - meclizine and dimenhydrimate
  2. Phenothiazines - dec vomit center activity - prochlorperazine
  3. Serotonin 3 receptor antagonists - serotonin 3 in brain stimulates N/V - ondansetron
  4. Prokinetics - inc peristalsis - metoclopramide
  5. Benzos - MOA unknonwn - lorazepam
  6. Cannabinoids - pharm grade THC - dronabinol
  7. Steroids - brain tumor and TBI induced N/V - dexamethasone (most lipophilic steroid)
  8. Substance P receptor blocker - P receptor agonism causes pain - aprepitant
55
Q

Which anti-emitics are currently the hottest and which is the newest and most expensive?

A

Hot - ondansetron

Newest/$$$ - aprepitant

56
Q

What type of N/V are meclizine and dimenhydrimate indicated for?

A

meclizine - vertigo (Meniere’s Disease)

dimenhydrimate - motion sickness

Fall Pharm Block 4 (4 decks)

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