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PHARM II TEST 1 > GI Meds > Flashcards

GI Meds Flashcards

1
Q

Pharm approach to GERD, always start with TLC then…

A

Mild (<1wk) = H2 + antacids…fail after 4 wks = PPI

>1wk = PPI

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2
Q

Causes of PUD

A

H. Pylori
NSAID induced
Stress
Zollinger-Ellison Syndrome

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3
Q

H. Pylori treatment has two therapy options, 1st line is Triple therapy and 2nd line is Quadruple therapy, explain both:

A

Triple: PPI + clarithromycin + amoxicillin (or metronidazole)

Quadruple - for patients that cannot take clarithromycin: tetracycline + metronidazole + bismuth subsalicylate

Treatment is 14 days Abx, if PUD present, 4-8wks PPI for duodenal ulcers and 8-12wks for gastric ulcers

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4
Q

NSAID induced ulcers tend to be the result of which type of NSAID?

A

COX-1 selective - increased blood flow to gastric mucosa and kidneys, increased platelet aggregation via TXA2 pathway

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5
Q

Treatment of NSAID-induced ulcers

A

Stop the NSAID, if you can’t, reduce the dose, switch to APAP/ASA, reserve Celecoxib (Celebrex) as last line b/c of CV risk

Can co-therapy w/PPI or misoprostol

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6
Q

Weak bases that neutralize gastric acid by reacting w/ hydrochloric acid to form a salt and water…rapid onset, short duration, frequent dosing

A

Antacids - 1st line therapy for intermittent (< twice weekly) symptoms, breakthrough therapy for those on PPI/H2 therapy

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7
Q

Taking these can lead to an accumulation of aluminum or magnesium in renal disease w/repeated dosing

A

Antacids

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8
Q

Excessive calcium carbonate antacids can lead to…

A

Metabolic alkalosis and hypercalcemia

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9
Q

AE of magnesium hydroxide (milk of magnesia) antacid…

A

Osmotic diarrhea

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10
Q

Aluminum hydroxide AEs…

A

Constipation, caution in renal insufficiency

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11
Q

Simethicone relieves flatulence with a deforming action, but the pt will then do what soon?

A

Bowel movement

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12
Q

Are H2 receptor antagonists more or less effective than PPIs in healing erosive esophagitis? (Ulcers)

A

Less

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13
Q

H2RAs have anticholinergic effects, but specifically Cimetidine (the first H2RA) is associated with the rare development of what?

A

Gynecomastia

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14
Q

Ranitidine, an H2RA, is the preferred H2RA for which route of use?

A

IV

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15
Q

All PPIs end in which suffix?

A

Prazole

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16
Q

How long before meals should PPIs be given?

A

30-60 minutes

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17
Q

What are the 4 possible major AEs associated w/PPIs?

A

Risk of fracture (hip, wrist, spine)

Hypomagnesaemia

C-diff diarrhea

Community-acquired pneumonia

Also, besides the normal AEs for all meds, may be associated with a higher risk of incident CKD

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18
Q

Sucralfate (mucosal protective agent) is sort of what H2RA/PPIs are tested against in terms of efficacy, but why isn’t it really used itself?

A

Multiple doses per day, large tablets, need to be separate from meals

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19
Q

What mucosal protective agent is best for prevention of NSAID-induced ulcers, but is rarely used because of high AE profile and pregnancy category X?

A

Misoprostol

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20
Q

Stimulates mucus secretion, antimicrobial, binds toxins, reduces diarrhea, commonly used EXCEPT IN KIDS IT CAN’T BE (mucosal protective agent)

A

Bismuth subsalicylate (pepto)

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21
Q

Harmless blackening of stool and darkening of tongue are benign AEs associated with which mucosal protective agent?

A

Pepto

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22
Q

Prokinetic dopamine antagonist that stimulates motility, anti-emetic, used for GERD, antiemetic in chemo, impaired gastric emptying

A

Metoclopramide - EXTRAPYRAMIDAL AES (dystopias, akathisia, Parkinsonian features)

23
Q

Macrolide Abx best used now as a prokinetic in pts with gastroparesis

A

Erythromycin

24
Q

What are the Anti-Emetics to know?

A 
5HT3
Phenothiazine
Corticosteroids 
Butyrophenones
Benzodiazepines
Benzamides
Antihistamines/Anticholergic
Cannbinoids
NK1 Antagonist
25
Q

Antiemetic class best used for post op N/V, chemo N/V, radiation induced N/V, but can cause QT prolongation

A

5HT3 Antagonists

THE SETRONS (E.G. ONDANSETRON)

26
Q

Anti-emetic class best used at the vestibular apparatus to prevent N/V due to motion sickness (all cause some drowsiness/anticholinergic effects)

BEST USED IN PREGNANT WOMEN TOO

A

1st Gen Antihistamines

E.G. Meclizine, Benadryl, Dramamine, Unisom, Diclegis

27
Q

Promethazine and Prochlorperazine are two antiemetics that block stuff in the chemoreceptor trigger zone (CTZ), which class are they from?

A

Phenothiazines

28
Q

This antiemetic, indicated as a surgical adjunct to block short-term memory and decrease saliva?

A

Scopolamine

29
Q

Antiemetic that used to be used as an antipsychotic, now used either for post-op N/V or MC for sedation in endoscopy and surgery often in combo with benzos?

A

Butyrophenones (Droperidol for example)

30
Q

Dopamine antagonist that blocks serotonin receptors resulting in anti-emetic action/ acid reducer to prevent N/V from chemo?

A

Metoclopramide

Causes extrapyramidal effects though

31
Q

Antiemetic used for apomorphine pre-treatment in Parkinson’s pts?

A

Trimethobenzamide (Tigan)

32
Q

In terms of N/V, corticosteroids like dexamethasone and methylprednisone are used for?

A

Chemo induced N/V with 5HT3 antagonists

33
Q

Benzos like diazepam and lorazepam are used before chemo initiation to reduce what?

A

Anticipatory N/V caused by anxiety

34
Q

Mu opioid agonist that doesn’t cross the BBB used to control mild to moderate non-invasive diarrhea?

A

Loperamide (Imodium)

35
Q

Mu opioid agonist with some anticholinergic properties used for refractory diarrhea, but no in young kids or pts with severe colitis?

A

Diphenoxylate/Atropine (Lomotil)

36
Q

3 misc agents used to treat diarrhea, and what kind?

A

Pepto: mild-moderate, traveler’s

Octreotide: GHIH suppression, treatment of tumor-associated diarrhea/HIV associated diarrhea

Lactase enzyme: for lactase deficiency or intolerance

37
Q

This class of laxatives rapidly moves water into the distal small bowel to treat acute/intermittent constipation pre-op

A

Osmotic laxatives (magnesium sulfate, magnesium citrate, magnesium hydroxide, sodium phosphate)

38
Q

What are the cautions in osmotic laxatives?

A

Electrolyte abnormalities, BB warning for nephropathy with oral products in the sodium one

39
Q

What it’s he only laxative that you can used with renal failure or when ammonia levels are high?

A

OSMOTIC LAXATIVES

40
Q

Polyethylene Glycol (PEG) solutions (GoLyte) used for?

A

Pre-op colon prep for endoscopic or radiologic procedures (safe in renal/hepatic disease and pregnancy)

41
Q

Miralax is approved for what type of IBS?

A

IBS-C (safe in renal, hepatic, pregnancy)

42
Q

Stimulant laxative, causes after/electrolyte secretion into the bowel, short-term relieves intermittent constipation and long term for PREVENTION OF OPIOID-INDUCED CONSTIPATION

A

SENNA (BM W/I 6-12 HRS)

43
Q

This stimulant laxative is used for short term/intermittent constipation or as part of pre-op/colonoscopy bowel prep.

A

Bisacodyl (Dulcolax)

44
Q

What is the only real constipation treatment recommended when pregnant?

A

Stool softeners (stool surfactant agents) - docusate sodium/calcium

Can be used in combo with Senna to prevent opioid induced constipation too

45
Q

Lubiprostone

A

Chloride channel activator: stimulates secretion of chloride-rich fluid into the intestinal lumen, USED FOR IBS-C IN WOMEN >18 YRS OLD

46
Q

Tegaserod (Zelnorm)

A

Serotonin-4 Partial agonist used for short-term, emergent treatment of IBS-C and Chronic Idiopathic Constipation (CIC) in women <55yrs old where no other therapy exists

EMERGENT ONLY

47
Q

Linaclotide (Linzess)

A

IBS-C and CIC

48
Q

Methylnaltrexone SubQ

A

Treatment of opioid induced constipation when inadequate response to other treatments

49
Q

Naloxegol

A

Treatment of opioid induced constipation in chronic non-cancer pain

50
Q

First line product for treatment of IBD (aminosalicylate)

A

Mesalamine

51
Q

TCA and SSRI use in IBS

A

TCAs - primarily IBS-D

SSRIs - both IBS-D and IBS-C

52
Q

Antibiotic derived from rifampin, used to treat IBS-D or traveler’s diarrhea caused by E.coli

A

Rifaximin

53
Q

Opioid receptor agonist/antagonist used in which type of IBS?

A

IBS-D

54
Q

IBS-D drug, specifically for women, but with a BB warning of ischemic colitis and constipation (5HT3 Antagonist)

A

Alosetron

PHARM II TEST 1 (6 decks)

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