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Pharm II MHM - Exam 3 > GI Part II > Flashcards

GI Part II Flashcards

1
Q

Goals of mild constipation IBS treatment?

A

Increase dietary fiber and fluid intake

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2
Q

Goals of moderate constipation IBS treatment?

A

Add bulk forming laxatives with or without antispasmodics

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3
Q

Goals of severe constipation IBS treatment?

A

Add chloride channel activator

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4
Q

Goals of mild diarrhea IBS treatment?

A
  • Dietary restriction

- Avoid contributing meds

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5
Q

Goals of moderate diarrhea IBS treatment?

A

-Add loperamide or other antispasmodics

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6
Q

Goals of severe diarrhea IBS treatment?

A

Add 5HT3 antagonists

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7
Q

IBS diarrhea drug choices

A
  1. Loperamide
  2. Anticholinergics
  3. Serotonin receptor blockers
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8
Q

IBS constipation drug choices

A
  1. Fiber supplements
  2. Osmotic laxatives
  3. Cl Channel Activators
  4. Guanylate Agonist
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9
Q

Describe antispasmodics

A
  • Anticholinergic (anti-SLUD)
  • Used for diarrhea
  • Side effects are dry mouth, blurred vision, urinary retention, constipation
  • Dicyclomine
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10
Q

What are TCAs and what type of IBS are they used to treat?

A
  • Tricyclic Antidepressants
  • Anticholinergic action
  • Decreases GI secretion and motility
  • Used for diarrhea
  • May help chronic abdominal pain
  • Amitriptyline, desipramine
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11
Q

What are 5HT3 receptor blockers and what type of IBS are they used to treat?

A
  • Serotonin receptor blockers
  • Mediate visceral pain
  • Inhibits colonic motility
  • Used for diarrhea
  • Alosetron
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12
Q

What is Alosetron and how is it used?

A
  • Selective 5HT3 blocker

- Used for severe diarrhea IBS in women (efficacy in men not established)

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13
Q

Side effects of Alosetron?

A
  • Constipation (can be severe)

- Ischemic colitis (fatalities reported, black box warning)

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14
Q

Describe bulk forming laxatives

A
  • Anti constipation

- Form bulky emollient gel that distends colon and promotes peristalsis

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15
Q

Describe osmotic laxatives

A
  • Anti constipation

- Nonabsorbable compounds that result in increased stool liquidity (due to obligate increase in fecal fluid)

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16
Q

What are chloride channel activators?

A
  • Approved for constipation IBS in women (efficacy in men not shown)
  • Lubiprostone/Amitiza
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17
Q

What is Lubiprostone?

A
  • Chloride channel activator
  • For constipation IBS in women
  • Works on small intestine
  • Enhances Cl-rich secretions and intestinal motility
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18
Q

Contraindications of lubiprostone? Adverse effects?

A
  • Avoid in women of CBP (preg cat C)

- Nausea, diarrhea, HA

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19
Q

What is linaclotide?

A
  • Guanylate agonist
  • Used for constipation
  • Causes rise of cGMP leading to rise of Cl and bicarb into intestinal lumen
  • Fluid increases, transit time decreases
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20
Q

Side effects of linaclotide?

A
  • Diarrhea
  • Flatulence
  • GI upset
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21
Q

What are serotonin 5HT4 receptor blockers?

A
  • Results in release of NTs promoting peristaltic reflex
  • Proximal bowel contraction and distal bowel relaxation
  • For constipation
  • No agent available in US
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22
Q

Drug classes for IBD treatment

A
  • Aminosalicylates
  • Glucocorticoids
  • Purine analogs
  • MTX
  • Anti-TNF
  • Anti-integrins
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23
Q

Drugs for mild IBD

A
  1. 5-aminosalicylates
  2. Abx
  3. Topical corticosteroids
  4. Budesonide
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24
Q

Drugs for moderate IBD

A
  1. Azathioprine/6-mercaptopurine
  2. MTX
  3. Oral corticosteroids
  4. TNF blockers
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25
Q

Drugs for severe IBD

A
  1. IV corticosteroids
  2. TNF blockers
  3. Cyclosporine
  4. Natalizumab
  5. Surgery
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26
Q

What is the active compound of all aminosalicylates?

A

5-ASA

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27
Q

MOA of aminosalicylates?

A

Unclear

  • May affect inflamm mediators
  • May interfere w/cytokine production
  • May inhibit immune cells
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28
Q

How do aminosalicylates work in IBD treatment?

A
  • Topically on affected areas of GI mucosa
  • So must get to affected site
  • Pure oral 5-ASA is more than 80% absorbed which means little left over to go to needed area
  • Formulations are made to avoid so much absorption
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29
Q

What are the different formulations of aminosalicylates?

A
  • Azo compounds

- Mesalamine compounds

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30
Q

What are the azo aminosalicylate drugs?

A
  • Sulfasalazine
  • Olsalzine
  • Balsalazide
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31
Q

What are the mesalamine aminosalicylate drugs?

A
  • Pentasa
  • Asacol
  • Lialda
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32
Q

How do azo compounds work?

A
  • N=N azo bond reduces absorption after oral absorption

- At ileum and colon, bacteria cleave the molecules and release active 5-ASA

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33
Q

How do mesalamine compounds work?

A
  • Each is uniquely formulated to deliver 5-ASA
  • Pentasa is timed-release microgranules
  • Asacol, apriso, lialda are coated in a pH resin that dissolves in distal ileum and colon
34
Q

Mesalamine compounds provide ___ concentrations to sites in ___ GI tract

A

High

Lower

35
Q

What drug class is considered first line in mild to moderate UC?

A

Aminosalicylates

36
Q

Sulfasalazine limitations

A
  • Many pts can’t tolerate dosing
  • Many ADRs (nausea, HA, arthralgias)
  • Hypersensitivity reactions
37
Q

What supplementation does sulfasalazine require?

A

Folic acid due to impaired absorption

38
Q

MOA of glucocorticoids in IBD

A

Inhibit production of inflammatory cytokines like TNF-a, IL-1, IL-8

39
Q

How are glucocorticoids used in IBD?

A
  • Moderate to severe disease

- Helpful in early treatment but not to maintain remissions

40
Q

What is the MC oral glucocorticoid used for IBD?

A

Prednisone

41
Q

What is budesonide and how is it used?

A
  • Oral prednisolone analog

- Used in mild to moderate Crohn’s

42
Q

Side effects of glucocorticoids

A
  • Hyperglycemia
  • Adrenal suppression
  • Peptic ulcers
  • Immunosuppresion
43
Q

Describe purine analogs

A
  • Oral
  • Delayed onset of action of several weeks due to metabolic conversions
  • Azothioprine to 6-MP to 6-thioguanine
44
Q

How do purine analogs work in IBD?

A
  • Provide immunosuppressive action
  • Used to induce and maintain remissions in both UC and Crohn’s
  • Often used with steroids to reduce steroid dose
45
Q

ADRs of purine analogs

A
  • NV
  • Bone marrow suppression
  • Liver toxicity
  • Hypersensitivity reactions
46
Q

Which med should be avoided when taking purine analogs?

A
  • Allopurinol

- Can cause leukopenia

47
Q

What is methotrexate?

A
  • Folic acid analog
  • Anti-inflamm in low doses (cytotoxic at high doses)
  • Used to induce or maintain remission in Crohn’s (unknown effect in UC)
48
Q

ADRs of MTX

A
  • Myelosuppression, mucositis, alopecia

- Liver toxicity

49
Q

How do anti-integrins work?

A
  • Prevent inflamm cells from using integrins to bind to vascular cells
  • Used for refractory Crohn’s
50
Q

What is natalizumab and how is it used?

A
  • Anti-integrin
  • Mod to severe Crohn’s
  • Requires pt enrollment in CD touch due to adverse effects
51
Q

What should happen if patients are on steroids and then given natalizumab?

A

Taper once response is observed

52
Q

Major ADR of natalizumab

A

Progressive multifocal leukoencephalopathy

  • A/w exposure to JC virus
  • Occurs in IC pts
  • Increased duration of med increases risk
53
Q

What are the MC causes of cirrhosis and hepatocellular carcinoma?

A

HBV and HCV

54
Q

Goal of hepatitis treatments?

A

Suppressive rather than curative

55
Q

HAV treatment

A
  • NONE

- Vaccine to prevent

56
Q

Drug classes for HBV treatments

A
  • Nucleoside/tide analogs

- Interferons

57
Q

How are nucleoside/tide analogs used in HBV treatment?

A

Usually combined with interferon

58
Q

What is lamivudine?

A
  • Nucleoside/tide analog
  • Inhibits HBV DNA pol
  • Requires phosphorylation to become activated
59
Q

What is adefovir dipivoxil?

A
  • Nucleoside analog
  • Inhibits HBV DNA pol
  • 2nd line treatment
  • Less toxic than other nucleosides
60
Q

What is entecavir?

A
  • Nucleoside analog
  • Inhibits HBV DNA pol
  • Effective in lamivudine-resistant strains
  • Take on EMPTY stomach
61
Q

What is telbivudine?

A
  • Nucleoside analog
  • Inhibits HBV DNA pol
  • Requires phosphorylation to active form
  • Give with or w/o food
62
Q

What is tenofovir?

A
  • Nucleotide analog of adenosine

- Inhibits reverse transcriptase

63
Q

Describe interferons

A
  • Family of cytokines, provide antiviral action

- Alfa (2a and 2b), beta, gamma available

64
Q

IFN alfa 2a is used to treat:

A

HBV AND HCV

65
Q

IFN alfa 2b is used to treat:

A

ONLY HCV

66
Q

Treatment options for HCV:

A
  • IFN alfa 2a or 2b
  • Ribavirin
  • Telapravir
  • Boceptrevir
67
Q

How is treatment of HCV directed?

A

Based on genotype

68
Q

Describe IFN used to treat HCV

A
  • Genotypes 3-6
  • Often used w/ribavirin
  • Were once cornerstone of treatment but now newer agents available
69
Q

Describe ribavirin

A
  • Guanosine analog for HCV
  • Blocks RNA dependent RNA pol
  • Available oral or IV
  • Combined with IFN
70
Q

Describe simeprevir

A
  • Inhibits HCV NS3/4A protease

- 1st line treatment w/other agents

71
Q

What is currently recommended as 1st line treatment w/other agents for HCV?

A

Simeprevir (NS3/4A protease inhibitor)

72
Q

Describe paritaprevir

A
  • HCV NS3/4A protease inhibitor
  • Often 1st line w/other agents
  • E.g. viekira pak
73
Q

What is ledipasvir and sofosbuvir?

A
  • NS5A inhibitors for HCV tx

- 1st line agent

74
Q

How are HCV genotypes 5 and 6 treated?

A

Peg-IFN alfa 2a WITH ribavirin for 48 weeks

75
Q

What are the protease inhibitors used to treat HCV?

A
  • Simeprevir
  • Paritaprevir
  • Boceprevir
76
Q

What are the NS5A protein inhibitors used to treat HCV?

A
  • Ledipasvir/Sofosbuvir
  • Ombitasvir
  • Sofosbuvir and Dasabuvir
77
Q

What is 1st line to treat ascites?

A

Diuretics

78
Q

Meds for variceal bleeding prophylaxis?

A

-Nonselective B blockers (propranolol, nadolol)

79
Q

Meds for acute variceal hemorrhage?

A
  • Vasoconstrictors (octreotide, vasopressin)

- Abx

80
Q

Meds for spontaneous bacterial pritonitis?

A

-Abx (cefotaxime)

81
Q

Treatment of hepatic encephalopathy?

A
  • Targeted to decrease NH3 blood concentration (via abx)
  • Neomycin and metronidazole
  • Rifaximin

Pharm II MHM - Exam 3 (5 decks)

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