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Pharm > GI: N/V/D/C > Flashcards

GI: N/V/D/C Flashcards

1
Q

vomiting: receptor involvement (4)

A

dopamine
cholinergic
histamine
serotonin

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2
Q

dopamine: vomiting

A

dopamine is found in GIT, the vomiting center of the brain, and the chemoreceptor trigger zone. lower medulla of brain.

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3
Q

cholinergic: vomiting

A

vomiting center

visceral afferents

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4
Q

histamine: vomiting

A

vomiting center

visceral afferents

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5
Q

serotonin: vomiting

A

vomiting center

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6
Q

assessing pt with vomiting

A 
temporal relationship with meal or med?
characteristics of vomit
frequency
past similar symptoms
other symptoms
lab values
psych assessment
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7
Q

1st line tx: nausea

A

serotonin antagonists
phenothiazines
benzamides

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8
Q

2nd line tx: nauses

A 
benzo
corticosteroids
antihistamines
anticholinergics
NK1 antagonists
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9
Q

phenothiazines drug examples (2)

A

prochlorperazine

promethazine

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10
Q

MoA phenothiazines

A

dopamine antagonist

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11
Q

indications for phenothiazines

A

chemo induced nausea/vomiting
motion sickness
post op

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12
Q

SEs phenothiazines

A 
sedation
dry mouth
urinary retention
blurred vision
EPS
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13
Q

routes of phenothiazines

A

PO
paraenteral
rectal

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14
Q

benzamides: drug examples

A

metoclopramide

trimethobenzamide

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15
Q

MoA benzamides

A

inhibits dopamine receptors in GIT/CTZ

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16
Q

EPS may be seen in what drug groups?

A

phenothiazines

benzamides, less so

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17
Q

SE benzamides

A

sedation

EPS

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18
Q

serotonin antagonists drug suffix`

A

-setron

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19
Q

serotonin antagonist MoA

A

inhibits serotonin receptors in the vomiting center

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20
Q

uses of serotonin antagonists

A

severe chemo induced n/v

post op

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21
Q

YEs of serotonin antagonists

A

headache, malaise, constipation, hypotension, EPS, anorexia

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22
Q

issue with serotonin antagonists

A

QTc prolongation

watch electrolytes

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23
Q

dose limit for ondansetron re: QTc prolongation

A

16g single dose max

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24
Q

benzos: nausea

MoA

A

prevent limbic input from reaching the vomiting center

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25
Q

benzos: nausea

indication

A

lorazepam

anticipatory nausea

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26
Q

corticosteroids: nausea

A

dexamethasone for chemo induced n/v

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27
Q

Moa corticosteroids for nausea

A

unknown

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28
Q

antihistamines and anticholinergics for nausea

A

motion sickness

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29
Q

MoA of antihistamines/anticholinergics for nausea

A

inhibits cholinergic receptors which decrease stimulation of vomiting center

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30
Q

aprepitant (emend)

A

NK receptor antagonist

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31
Q

MoA aprepitant

A

quiets NK receptors found in GIT/CTZ are responsible for chemo induced N/V or post op

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32
Q

emend should be given with

A

corticosteroid

serotonin antagonist

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33
Q

combination therapy for nausea

A

using first line with one or two second lines, all with different MOAs. may decrease side effects bc you arent maxing out any of them

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34
Q

chemo induced nausea/vomiting

combo

A

ondansetron plus dexamethasone plus lorazepam

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35
Q

FYI for combination therapy for nausea

A

maintain hydration

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36
Q

mild N/V tx: (4)

A

benzos
antihistamines
anticholinergics
other remedies like coke syrup

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37
Q

moderate n/v tx: (4)

A

phenothiazines
dexamethasone
butyrophenones
benzamides

38
Q

severe n/v tx:

A

metoclopramide
serotonin antagonists
aprepitant
combo regimens

39
Q

diarrhea can be

A

acute
chronic
drug induced

40
Q

acute diarrhea

A

lasts 72 hours after onset

41
Q

chronic diarrhea

A

> 2 weeks

42
Q

leading cause of diarrhea

A

viral gastroenteritis

43
Q

if someone has chronic diarrhea, what is imprint to ask about

A

history of episodes

44
Q

before treating diarrhea, consider

A

if it is wise to stop the diarrhea

45
Q

non pharm diarrhea tx

A

stop solid foods for 24 h
avoid dairy
rehydrate

46
Q

anti peristaltic agents for diarrhea:

A

loperamide

diphenoxylate/atropine

47
Q

antisecretory agents for diarrhea:

A

bismuth

octreotide

48
Q

adsorbent agents for diarrhea

A

polycarophil
kaolin pectin
attapulgite

49
Q

MoA octreotide

A

blocks serotonin and other peptides, used in VIPomas

50
Q

anti peristaltic agent MoA

A

slows GI motility

51
Q

anti peristaltic agents should be used cautiously in

A

infectious diarrhea

52
Q

fyi for anti peristaltics

A

may see some sedation

53
Q

anti peristaltic agents in children

A

use cautiously

54
Q

adsorbants MoA

A

adsorb water - absorbs water in the GI tract

55
Q

issue with adsorbants like polycarbophil, attapulgite, kaopectate

A

may absorb other drugs

56
Q

main use for bismuth

A

traveler’s diarrhea

57
Q

properties of bismuth subsalicylate

A

antisecretory
antimicrobial
adsorbant

58
Q

bismuth subsalicylate toxicity

A

broken down into salicylate, watch if patient is on AC or excessive ASA.

59
Q

treating acute diarrhea without fever or other symptoms

A

fluids and lytes
loperamide or diphenoxylate
diet restrictions

60
Q

treating acute diarrhea with fever or other symptoms

A

check feces for WBC/RBC/O&P

61
Q

after checking stool for WBC/RBC/O&P in the patient with diarrhea and fever, what do you do if symptoms are neg? pos?

A

neg: symptomatic therapy
pos: appropriate abx and symptomatic therapy

62
Q

treating chronic diarrhea:

A

identify possible cause

do appropriate diagnostics (cultures, sigmoidoscopy, biopsy)

63
Q

if no diagnosis is made in chronic diarrhea…

A

rehydrate
loperamide
adjust diet

64
Q

if diagnosis is made in chronic diarrhea:

A

treat cause

65
Q

diarrhea is often

A

minor and self limiting

66
Q

who do we worry about re: diarrhea?

A

children
AIDs patients
elderly
immusuppressed

67
Q

goals of diarrhea tx:

A

prevent excessive water/lyte loss
relieve symptoms
treat curable causes and secondary disorders

68
Q

when do you order a GI consult for the pt with diarrhea? (8)

A 
children < 3
pregnant
frail/elderly
mod/severe volume depletion
chronic heart/renal/liver disease
AIDs
high fever
bloody/mucous stools
69
Q

contipation “defined”

A

< 2 BMs a week

70
Q

most common cause of constipation

A

low fiber and inactivity

71
Q

non pharm mgmt of constipation

A 
diet changes
inc fiber
correct underlying disease
increase fluids
exercise
72
Q

pharmacologic mgmt of constipation

A

laxatives CAREFULLY

73
Q

drugs for constipation 5

A 
bulk forming laxatives
surfactants
saline agents
hyper osmotic agents
stimulants
74
Q

bulk forming laxatives are preferred because

A

they are not systemically absorbed

75
Q

DoA bulk forming laxative

A

1-3 days

76
Q

MoA bulk forming

A

holds water into stool increasing bulk and then stimulating a BM

77
Q

AE bulk forming lax

A

flatulence

78
Q

bulk forming lax is not

A

for quick relief

79
Q

surfactants DoA

A

1-3 days

80
Q

MoA surfactant (colace)

A

facilitates mixture of fats and aqueous materials

81
Q

surfactants should be used as a

A

preventative, eps in those who shouldn’t be straining

82
Q

saline laxatives should be used for

A

occasional constipation or bowel prep

83
Q

use saline lax cautiously in

A

HTN
sodium restricted diets
renal disease

84
Q

osmotic agents

A

lactulose
sorbitol
glycerin
polyethylene glycol

85
Q

osmotic MoA

A

metabolizes solutes in GI tract, moving water osmotically and facilitating propulsion and evacuation.

86
Q

stimulants: bisacodyl cause

A

colonic contractions and thus evacuation

87
Q

why is bisacodyl enteric coated

A

so that it does not dissolve until it reaches the colon

88
Q

bisacodyl is not for

A

everyday use

89
Q

DoA stimulants for constipation

A

6-12 hrs

90
Q

stimulant: senna

A

similar to bisacodyl but gentler. also promotes fluid accumulation in colon.

91
Q

institue bowel regimens for those who take

A

opioids

verapamil

Pharm (31 decks)

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