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GI Exam 1 > GI Meds > Flashcards

GI Meds Flashcards

1
Q

Guanylate Cyclase-C (GC-C) Agonists

A

● Linaclotide (Linzess)
● Plecanatide (Trulance)

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2
Q

Chloride Channel activator

A

Lubiprostone (Amitiza)

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3
Q

What is OIC?

A

Opioid Induced Constipation:
● Chronic opioid use is very common in US medicine. (Opioid Epidemic)
● Opioids cause decreased motility and decrease peristalsis.
● Potential for constipation and ileus.

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4
Q

Management of OIC?

A

● Prophylactic laxative or stool softener
● Increase fluid intake

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5
Q

Peripherally-Acting Opioid Antagonists

A

● Naloxegol (Movantik)
● Methylnaltrexone (Relistor)
● Naldemedine (Symproic)

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6
Q

Peripherally-Acting Opioid Antagonists indication/MOA

A

Blocks action at the mu receptor
Indication: Opioid-induced constipation

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7
Q

Black Box Warnings of Guanylate Cyclase-C (GC-C) Agonists

A

Risk of serious dehydration in pediatric patients younger than 2 years

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8
Q

Antiemetics include:

A

Anticholinergic Agents:
Dopamine Receptor Antagonists:
● Phenothiazines: Promethazine (Phenergan),
Prochlorperazine (Compazine)
● Benzamide: Metoclopramide (Reglan)
5-HT3 Receptor Antagonists:

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9
Q

Antacids and Acid Reducers:

A

PPIs
Histamine 2 receptor agonists
Antacids/alkalinizing agents
Mucosal Protective Agents
Anti-Diarrheals (Antimotility) Agents

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10
Q

Laxatives include

A

Bulk-Forming Laxatives
Osmotic Laxatives
Stimulant Laxatives
Lubricant Laxative
Stool Softener (Surfactant)
Guanylate Cyclase-C (GC-C) Agonists
Peripheral acting Opioid receptor antagonists
Chloride Channel Activator

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11
Q

Anticholinergic Agent

A

Scopolamine

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12
Q

Scopolamines form of medication

A

72- hour transdermal patch

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13
Q

D2 Receptor Antagonists - Phenothiazines MOA

A

● Promethazine (Phenergan)
● Prochlorperazine (Compazine)
Selectively antagonize the
Dopamine D2 receptors centrally

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14
Q

BOX WARNINGS for D2 Receptor Antagonists - Phenothiazines

A

○ Promethazine - severe respiratory depression and death in Pts under 2.
○ Promethazine - severe tissue injury and gangrene with injectable form.
○ Prochlorperazine - not be used in patients with dementia-related psychosis.

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15
Q

Anticholinergic Side effects

A

Hot as hell
Blind as a bat
Dry as as bone
Red as a beet
Mad as a hatter
Stuffed as a pipe

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16
Q

Side Effects of Phenothiazines

A

Significant drowsiness, sedation, extrapyramidal symptoms (dystonia, Parkinson’s symptoms), hypotension

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17
Q

D2 Receptor Antagonists - Benzamides MOA

A

○ Increases gastric motility by blocking
intestinal Dopamine receptors.
○ Increases LES tone and stimulates
contractions, thereby increasing GI
motility and decreasing the sensation
of nausea.

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18
Q

Contraindications of D2 Receptor Antagonists - Benzamides

A

Confirmed or suspected bowel obstruction, perforation, or hemorrhage

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19
Q

Hyperprolactinemia can occur as a side effect of ____

A

D2 Receptor Antagonists - Benzamides
(Dopamine inhibits prolactin release)

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20
Q

Box Warning of D2 Receptor Antagonists - Benzamides

A

can potentially cause Tardive Dyskinesia, which is often
irreversible. Risk increases with longer duration of treatment and
higher total cumulative dose

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21
Q

5-HT3 Receptor Antagonists

A

● Ondansetron (Zofran)
● Granisetron

22
Q

5-HT3 Receptor Antagonists MOA

A

○ Act as anti-nausea medication by
blocking Serotonin (5-HT3) receptors
on afferent nerves in the gut.

23
Q

For which medication are we concerned about QT prolongation as an adverse effect?

A

5-HT3 Receptor Antagonists
Odansetron (Zofran)

24
Q

Proton Pump Inhibitors (PPIs) MOA

A

○ Block gastric acid secretion and decrease
intragastric H+.
○ Done by inhibiting hydrogen-potassium
ATPase pump on the luminal surface of
parietal cells

25
Q

Maximum acid inhibition for PPIs is reached after ____ days of use.

A

3-4

26
Q

Histamine 2 Receptor Antagonists

A

● Famotidine (Pepcid, Zantac 360)
● Cimetidine (Tagamet)
● Nizatidine (Axid)

27
Q

Histamine 2 Receptor Antagonists MOA

A

Blocks Histamine 2 receptors on parietal
cells, preventing histamine-induced acid
secretion.
■ Decreases gastric acidity

28
Q

Long term Cimetidine has been associated with _____

A

Gynecomastia.

29
Q

Antacid (Alkalinizing) Agents

A

● Calcium Carbonate (Tums)
● Sodium Bicarbonate
(Alka-Seltzer)
● Magnesium and Aluminum
Hydroxide (Maalox brand
discontinued, Mylanta)

30
Q

Antacid (Alkalinizing) Agents MOA

A

○ These are all considered “buffers”
and interact with H+ in the gastric
lumen, neutralizing the acid,
raising the pH.

31
Q

Calcium carbonate- Should not be taken if _____

A

frequent kidney stones or in
patients with hypercalcemia

32
Q

Mucosal Protective Agents

A

Sucralfate (Carafate)
Misoprostol (Cytotec)

33
Q

Sucralfate (Carafate) MOA and Indications

A

○ Acts primarily by forming a physical barrier
over the injured epithelium and also
increasing the secretion of mucous.
Indications -
○ Duodenal Ulcers
○ GERD in pregnancy

34
Q

Misoprostol (Cytotec) MOA

A

Mechanism of Action: A prostaglandin analogue, which stimulates mucous
production and weakly inhibits the proton pump.

35
Q

Misoprostol (Cytotec) Indications

A

○ Peptic Ulcer Disease
○ Prevention of NSAIDs induced gastric ulcers.
○ Cervical Ripening and Labor Induction (Given vaginally).
○ Medical termination of pregnancy before 70 days

36
Q

Misoprostol (Cytotec) BBW

A

Contraindicated during pregnancy (other than for induction) because it may cause birth defects, abortion, or premature birth (BBW)
○ Do not use in a female patient within childbearing age, unless you ensure
they are not pregnancy and are on birth control (BBW)

37
Q

Bismuth Subsalicylate MOA

A

○ Antisecretory, antimicrobial, and antiinflammatory action.
○ Reduces irritation of stomach and intestinal lining through
inhibition of prostaglandin

38
Q

Bismuth Subsalicylate contraindications

A

Children with a recent history of viral infection. It is converted to salicylic acid (like Aspirin) and increases risk of Reye’s Syndrome.

39
Q

Opiate Receptor Agonists

A

● Loperamide (Imodium)
● Diphenoxylate + Atropine (Lomotil

40
Q

Opiate Receptor Agonists MOA

A

These bind to opioid receptors in the bowel and lead to decreased bowel peristalsis (↓ propulsion) and
decreased secretions (↓ motility). This equals increased intestinal transit time and harder stool.

41
Q

Loperamide Indications

A

Mild/moderate, acute, non-febrile, non-bloody diarrhea
■ Chronic diarrhea associated with Irritable Bowel Syndrome.

42
Q

Opiate Receptor Agonists contraindications

A

○ Some forms of significant infectious diarrhea
○ Contraindicated in diarrhea secondary to Inflammatory Bowel Disease.

43
Q

Loperamide BBW

A

potential to cause Torsades
and sudden cardiac death if taken at too high of a dose.

44
Q

Stool Softener

A

Docusate Sodium (Colace)

45
Q

Docusate Sodium (Colace) MOA

A

○ Reduces surface tension of the
oil-water interface of the stool resulting
in enhanced incorporation of water and
fat, leading to softer feces.

46
Q

Bulk-Forming Laxatives (Fiber)

A

● Psyllium (Metamucil)
● Methylcellulose (Citrucel)
● Polycarbophil (FiberCon)
● Wheat dextrin (Benefiber)

47
Q

Bulk-Forming Laxatives (Fiber) MOA

A

● These are polysaccharides or cellulose
derivatives that resist digestion and retain
water
● Fiber promotes intestinal motility by increasing the bulk of the stool.
● The result is increased frequency of stooling and softer consistency
of stool.

48
Q

Osmotic Laxatives

A

● Sodium Phosphate (Fleet Enema)
● Lactulose (a synthetic disaccharides)
● Polyethylene Glycol (MiraLax,
GoLytely)
● Glycerin (can be suppository)
Saline-type osmotic laxatives:
● Magnesium Hydroxide (Milk of
Magnesia)
● Magnesium Sulfate (Epsom Salt)
● Magnesium Citrate

49
Q

Osmotic Laxatives MOA

A

● These increase the luminal osmolality,
creating an inward osmotic force,
pulling water from the vasculature
into the lumen of the intestines.

50
Q

______ is the safest and most gentle Osmotic Laxative.

A

Polyethylene Glycol

51
Q

Stimulant Laxatives

A

● Senna (Ex-Lax)
○ “Sennosides”
● Bisacodyl (Dulcolax)

52
Q

Stimulant Laxatives MOA

A

○ Also known as “irritant laxatives,” these
work by irritating the intestinal wall, which
leads to an accumulation of fluid and
electrolytes, which increases motility and
produces a bowel movement.

GI Exam 1 (5 decks)

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