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Pharmacology Exam 5 > GI Meds > Flashcards

GI Meds Flashcards

1
Q

Proton Pump Inhibitors

A

Omeprazole

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2
Q

Administration of omeprazole

A

administered as inactive acid-liable pro-drugs that have an enteric coating to protect against rapid destruction in the stomach. Dissolved and absorbed in the intestines.

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3
Q

Mechanism of Omeprazole

A

Absorbed in intestine where it is acid activated and blocks H-K-ATPase irreversibly by forming a covalent bond with SH-groups of H-K_ATPase. ATLEAST 18 HOURS ARE REQUIRED FOR FORMATION OF A NEW ATPASE

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4
Q

How often is Omeprazole given?

A

Once daily, twice is severe GERD, should be given 30 min before meal for peak plasma levels.

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5
Q

By what percent does food decrease the bioavailability of Omeprazole?

A

50%

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6
Q

Why does ir take 3-4 days of daily medication for full acid inhibition?

A

Not all H-pumps are inactivated with the first dose

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7
Q

Uses of omeprazole

A

gastric ulcers, alone or in combo with H. pylori; also used in GERD

DRUG OF CHOICE WITH ZOLLINGER ELLISON SYNDROME

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8
Q

T/F: Proton pump inhibitors are superior to H2 receptor antagonists and to mucosal protectants in the healing of NSAID Peptic Ulcers

A

True

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9
Q

WHy should you avoid omeprazole and plavix?

A

Omeprazole is a moderate CYP2C19 inhibitor, that reduces the pharmacological activity of plavix(clopidogrel). Avoid using concomitantly or 12 hrs apart.

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10
Q

Histamine H2-receptor antagonist

A

Cimetidine

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11
Q

Main role of cimetidine

A

Inhibits fasting secretion of gastric acid with a smaller effect on food stimulated gastric acid secretion. Competetive inhibitor at the parietal cell H2-receptor. ALSO BLUNTS RESPONSES TO GASTRIN AND ACH

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12
Q

Uses of cimetidine

A

gastric ulcers, GERD, and heartburn

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13
Q

How safe is cimetidine?

A

Very safe its is available over the counter

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14
Q

Drug interactions of cimetidine

A

interferes with metabolism of other drugs due to inhibition of cytochrome p450

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15
Q

Mucosal Protective agents

A

Misoprostol, Sucralfate, Bismuth subsalicylate

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16
Q

Misoprostol

A

A stable analog of PGE that bings to the PG receptro and causes a modest inhibition of acid secretion. Cytoprotective.

PROMOTES SECRETION OF MUCUS AND BICARB

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17
Q

Uses of misoprostol

A

prevention of gastric damage due to chronic use of NSAIDs

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18
Q

Side effects of Misoprostol

A

diarrhea and abdominal cramps. DO NOT USE IF PREGNANT- CAN CAUSE ABORTION DUE TO UTERINE CONTRACTION

19
Q

Sucralfate

A

Complex of Al(OH)3 and sulfated sucrose. Cytoprotective. Coats gastric mucosa and stimulates PGE production.

20
Q

Drug interactions of sucralfate

A

reduces absorbtion of digoxin, phenytoin

21
Q

Bismuth Subsalicylate

A

Cytoprotective, may inhibit pepcin activity and increase mucus , prostaglandin and bicarb secretion.

22
Q

Uses of Bismuth Subsalicylate

A

mild diarrhea, been used in clinical trails for eradication of h. pylori. may also have some antibacterial effect against H. pylori (used to eradicate h. pylori)

People dont like it because of bad taste

23
Q

Adverse effects of bismuth:

A

patients sensitive to asprin may show sensitivty to salicylate

24
Q

Drugs that stimulate gi motility

A

Metoclopramide and Erythromycin

25
Q

Metoclopramide

A

A dopamine D2 receptor agonist that releases Ach from cholinergic neurons in myenteric plexus, enhancing tone and motility in esophagus and stomach stimulating gastric emptying with out stimulating acid secretion

only works on upper gi

26
Q

Uses of metoclopramide

A

GERD, heartburn, disorders of gastric emptying and intractable hiccup

27
Q

Adverse effects of metoclopramide

A

extrapyramidal side efects such as parkinsonism, contraindicated in people with seizure disorders and in mechanical obstruction of GI tract

28
Q

Erythromycin

A

Stimulates motilin receptors (motilin is a polypeptide hormone that mediates intestinal smooth muscle contraction)

29
Q

Uses of erythromycin

A

used in diabetic gastrophoresis and in upper gi hemorrhages to promote gastric emptying before endoscopy

30
Q

Anti emetics

A

5-HT3 receptor antagonist: ondansetron

31
Q

odansetron

A

prevents peripheral and central stimulation of VC by blocking 5-ht3 receptors in stomach, STN and CTZ.

has a long half life, given once or twice daily

32
Q

interesting effect of odansetron

A

increases qt interval but not usaully clinically significant

33
Q

uses of odansetron

A

effective against chemotherapy and pregnancy induced nausea and vomiting

34
Q

Drugs used in IBD

A

5-aminosalicylic acid, sulfasalazine (need to supress the inflammatory and immune responses)

35
Q

Glucocorticoids

A

prednisone and prednisolone (Budesonide is a synthetic analog of prednisone that releases the drug into the distal ileum and colon where it is absorbed)

36
Q

Uses of glucocorticoids

A

treat moderate to severe FLARES of IBD

37
Q

Purine analogs

A

Azathioprine and 6- mercaptopurine (immunosuppressants)

38
Q

Adverse effects of purine analogs

A

nausea vomiting, bone marrow depression and hepatic toxicity

39
Q

Methotrexate

A

may interfere with inflammatory action of IL 1, increase release of adenosine, stimulates the death of activated t cells

40
Q

Uses of methotrexate

A

induce and maintain remission of crohns

41
Q

Adverse effects at higher doses with methotrexate

A

bone marrow depression, megablastic anemia, and alopecia

42
Q

How do you avoid adverse effects of methotrexate

A

supplement with folate

43
Q

Inflixamab

A

monoclonal antibody to TNF alpha, inhibits it from binding to receptor.

44
Q

Uses and adverse effects of Inflixamab

A

uses: UC CD
ae: infection due to suppression of inflammatory response

Pharmacology Exam 5 (8 decks)

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