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Year 1: Patho/Pharm > GI PHARM > Flashcards

GI PHARM Flashcards

1
Q

MOA of Serotonin receptor antagonists

A

Prevent nausea and vomitting by blocking serotonin receptors at two sites

  1. chemoreceptor trigger zone
  2. afferent vagal nerves
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2
Q

Example Sertoninin receptor antagonists

A

OndanSETRON
ganiSETRON
dolaSETRON
palonoSETRON

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3
Q

Indication for serotonin receptor antagonists

A

Nausea and vomiting

  • post operative
  • chemotherapy induced
  • pregnancy
  • gastritis
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4
Q

Contraindications
Serotonin receptor antagonists

A

Prolonged QT interval

Cardiac abnormalities:
Bradydysrhythmias
heart failure

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5
Q

MOA
Antihistamines H1 receptor antagonists

A

Block H1 receptor in the vomiting centre

Prevent signal from inner ear to vomiting centre

Prevention of N/V/motion sickness

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6
Q

SE
H1 receptor antagonists

A

Muscarinic blockade: dry mouth, constipation, urinary retention, glaucoma, blurred vision, sedation, delirium/paradoxical reaction

H1 receptor blockade: hypertension

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7
Q

Contraindications
H1 receptor antagonists

A

Third trimester pregnancy - neonatal sedation

breast feeding - neonatal sedation

Conditions made worse by muscarinic blockade: asthma, BPH, constipation, elderly, children

Infants < 6 months

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8
Q

Examples of H1 receptor antagonists

A

Dimenhydramine (benadryll)
Dimenhydrinate (gravel)
Meclizine
Cyclizine

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9
Q

MOA
Glucocorticoids (for N/V)

A

unknown mechanism of action

synergistic for N/V if given with other anti-emetics

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10
Q

SE
Glucocorticoids

A

Bones: osteoporosis, growth suppression, fractures

Skin: infections, striation, poor wound healing

GI: ulcers, perforations, hemorrhages

Cushingoid appearance: central fat, degradation muscles, moon face, hump back; adrenal suppression

Electrolytes: hyperglycaemia, hypernatremia, hypokalemia, FVO, weight gain

Eyes: glaucoma, cataracts

CSN: mania, depression

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11
Q

Contraindications
Glucocorticoids

A

pregnancy / breastfeeding - teratogenic

Caution: children and elderly, growth suppression, fractures, adrenal insufficiency

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12
Q

Example
Antacids

A

magnesium hydroxide
aluminum hydroxide
calcium carbonate
sodium bicarbonate

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13
Q

MOA
Ant-acids

A
  1. neutralize HCl –> rise in pH
  2. prevent activation pepsinogen to pepsin
  3. activation prostaglandin –> increase mucous, bicarb, blood flow mucosa barrier
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14
Q

SE
antacids

A

calcium carbonate - constipation, acid rebound

magnesium hydroxide - magnesium toxicity, diarrhea

sodium bicarbonate - metabolic alkalosis, hypernatremia

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15
Q

Contraindications
ant-acids

A

sodium bicarbonate
- metabolic alkalosis, hypernatremia, heart failure or kidney disease

Increase clearance of acidic drugs in urine

prevent absorption of drugs - give 1 hour apart

Magnesium hydroxide
Kidney failure or disease

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16
Q

MOA
H2 receptor antagonists

A

Prevents gastric acid secretion

Blocks H2 receptors on parietal cells. Prevents cAMP signal which H/K ATPase excretes H+ into gastric lumen (blocked)

increase pH stomach

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17
Q

SE
H2 receptor antagonists

A

CNS: depression, hallucinations, agitation

pneumonia: increase bacterial colonization stomach, secondary respiratory infections (aspiration)

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18
Q

Contraindications
H2 receptor antagonists

A

Caution: pregnancy, breast feeding (sedation)

Caution: kidney and hepatic impairment (dose adjustment)

Drug interactions: CYP450 inhibitor (increase warfarin, phenytoin) ; antacids prevent H2 receptor antagonist absorption

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19
Q

Examples
H2 receptor antagonists

A

raniTIDINE
cimeTIDINE
famoTIDINE
nizaTIDINE

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20
Q

Indication
H2 receptor antagonists

A
  1. Treatment PUD
  2. Ulcer healing
    Duration 8-12 weeks gastric
    Duration 4-6 weeks duodenal
  3. GERD
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21
Q

MOA
proton pump inhibitors

A

Prevent secretion and synthesis of HCl

Block H/K ATPase in the parietal cells. Irreversible inhibition. Lasts lifetime of cell (3-5 days)

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22
Q

Indications
PPIs

A
  1. Prophylaxis and treatment of PUD
  2. GERD
  3. erosive esophagitis
  4. Zollinger-Ellison syndrome
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23
Q

SE
PPIs

A

Hypomagnesium - cramps, dysrhythmias, tremors

Hypocalcemia - fractures (convulsions, reflex hyperactive, anorexia, muscle spasms/tetany, positive trauseau, chvostek, parenthesia)

Pneumonia

C. Diff diarrhea

Acid rebound - wean, do not D/C abruptly, PRN H2 receptor antagonist

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24
Q

Contraindications
PPI

A

pneumonia

osteoporosis

hypomagnesemia, hypocalcemia

C. diff diarrhea

DRUG INTERACTIONS
clopidogrel - decrease conversion to active form (PRN PPI for gastric protection)

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25
Q

Example PPIs

A

OmePRAZOLE
lansoPRAZOLE

26
Q

Patient education PPI

A

Don’t D/C abruptly - hyperacid secretion

Report - diarrhea (c. diff)

Report - dry cough, fatigue, fever (pneumonia)

Report - leg cramps, palpitations, tremors (hypo magnesium)

Take PRN vitamin D and calcium

27
Q

MOA metoclopromide

A
  1. block HT and DA receptors in CTZ = prevention N/V
  2. Increase Ach in GI = increase GI motility “Pro-kinetic agent”
28
Q

Indications
Metoclopromide

A

GERD
Diabetic gastroparesis
N/V chemotherapy, 1st trimester pregnancy
hiccups

29
Q

SE
Metoclopromide

A

Diarrhea

Tardive dyskinesia (DA blockade): involuntary movement legs, arms, face

30
Q

Contraindications Metoclopromide

A

GI obstruction, perforation, hemorrhage

2nd and 3rd trimester of pregnancy

Start low, go slow (Tardive dyskinesia), shortest duration

31
Q

MOA
Sucrafalate

A

Forms a protective gel that coats an ulcer crater at low pH

aluminum hydroxide + sulphated sucrose + low pH = protective gel

32
Q

SE and contraindications
Sucrafalate

A

prevention drug absorption
administer 2 hours apart
No systemic SE
No contraindications

33
Q

Indicaiton
Sucrafalate

A

PUD
gastric or duodenal ulcers

Protective coating for the ulcers

34
Q

MOA
Misoprostol

A

Prostaglandin E1 analog

Binds Prostaglandin E1 receptor on parietal cells
1. prevents cAMP signal which prevents H+ secretion into lumen (H/K ATPase)
2. promotes mucous , bicarbonate secretion, and blood flow

35
Q

Indications
Misoprostol

A
  1. PUD secondary to NSAID therapy
  2. Induce labour / abortions
36
Q

SE
Misoprostol

A

abdominal pain, diarrhea

dysmenorrhea, spotting

induction labour, abortions

37
Q

Contraindication
Misoprostol

A

Pregnancy

Written and oral dangers
birth control
HCG negative
start on 2nd day of period

38
Q

MOA
Clarithromycin

A

Macrolide antibiotic

Prevent protein synthesis by blocking Ribosome 50S inhibitor
Bacteriostatic

Active against
Gram positive
Some gram negative
Atypicals

39
Q

Indication
Clarithromycin

A

H. pylori infections PUD

Triples:
Clarithromycin + amoxicillin/metronidazole + PPI

40
Q

SE
Clarithromycin

A

GI: N/V/D, metallic taste

Cardio: Sudden cardiac death, prolonged QT interval

Ottotoxic

41
Q

Contraindications
Clarithromycin

A

Drugs that prolong QT interval

Long QT syndrome, ventricular dysrhythmias

CYP3A4 inhibitors (5x cardiac sudden death)
Azole anti fungals
CCB (verapamil, diltiazem)
HIV medications

42
Q

MOA
Metronidazole

A

Kills anaerobic bacteria

Anaerobic bacteria convert to active form; causes DNA breaks, prevents nucleic acid synthesis, results in cell death

43
Q

SE
Metronidazole

A

N/V/HA

44
Q

Contraindications
Metronidazole

A

Alcohol
Disulfram reaction
Wait 3 days before drinking

45
Q

Indication
Metronidazole

A

H. pylori infection

Quadruple therapy (Metronidazole + bismuth + tetracycline + PPI)

Triple therapy (Metronidazole + clarithromycin + PPI)

46
Q

MOA
Bismuth Subsalicylate

A
  1. Bacterial cell wall lysis
  2. inhibits H. pylori urease - preventing adhesion to gastric epithelial cells
47
Q

SE
Bismuth subsalicylate

A

Black colour on tongue and in stool (false positive melena stool)

Constipation

Bleeds, acidosis

48
Q

AE
Bismuth Subsalicylate

A

Neurotoxicity (high dosage, long term use): tinnitus, loss of hearing

Melena stools (GI bleeds): salicylate

Reye’s syndrome and acidosis

Decreased kidney perfusion, hypertension

49
Q

Contraindications
Bismuth Subsalicylate

A

Salicylate: pregnancy, breast feeding, children (Reyes syndrome), acidosis

50
Q

MOA
Tetracycline

A

bacteriocidal
Blocks 30S Ribosome preventing protein synthesis

Broad spectrum antibiotic
gram postive, gram negative, MRSA

51
Q

SE
Tetracycline

A

Deposition in teeth and long bones
Yellow teeth
Hypoenamel
Fractures
Diarrhea - C. Diff
Phototoxicity
Teratogenic

52
Q

AE
Tetracycline

A

C. diff infections
hepatotoxicity (post partum)
phototoxicity
Teratogenic

53
Q

Contraindications
Tetracycline

A

pregnancy
post partum (caution)
children < 8 years
liver and kidney disease

54
Q

Indication
Tetracycline

A

H. pylori infections

Quadruple therapy

Tetracycline + bismuth subsalicylate + metronidazole + PPI

Can also use for CAP
Monotherapy, dual therapy

55
Q

Indication
Bismuth Subsalicylate

A

H. pylori infection
Quadruple therapy
Bismuth subsalicylate + tetracycline + metronidazole + PPI

Travellers diarrhea first line with imodium

56
Q

MOA
Amoxicillin

A
  1. prevent cell wall peptidoglycan cross linking
  2. promote increase autolysin activity - cell wall degredation

Destruction bacterial cell wall resulting in cell lysis

gram positive, some gram negative infections

57
Q

SE
Amoxicillin

A

GI: N/V/D

allergic reactions IgE mediated 7% people (1% cross reactivity with 1st generation cephalosporins)

Neuropsych SE when toxicity (renal impairment)

58
Q

Contraindications
Amoxicillin

A

renal impairment

hypersensitivity reactions

59
Q

MOA
Fluroquinolones

A

Block DNA gyrase (prevent supercoiling DNA)

Block DNA topoisomerase (prevent separation daughter strands)

Broad spectrum
anaerobic, gram positive, gram negative, pseudomonas

60
Q

SE
Fluroquinolones

A

Cardiac: prolonged QT interval

GI: N/V/D/C. diff

MSK: tendon ruptures

SKIN: phototoxicity

Teratogenic

61
Q

Contraindications
Fluroquinolones

A

Pregnancy - teratogenic

Children < 18 years

Long QT intervals

Myasthenia Gravis

Caution:
Adults > 60 years
transplants
glucocorticoids

62
Q

Indication
Levofloxacin

A

H. Pylori infection
Triples
Amoxicillin + levofloxacin + PPI

Back up for CAP resistant

Year 1: Patho/Pharm (39 decks)

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