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x Surgery M3 > GI Pharm from FA > Flashcards

GI Pharm from FA Flashcards

1
Q

what class?

Cimetidine

Ranitidine

Famotidine

Nizatidine

A

H2 blockers

Take H2 blockers before you dine: “Table for 2”

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2
Q

H2 blockers: mech?

A

Reversible block of histamine H2 receptors

-> decr H+ secr by parietal cells

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3
Q

H2 blockers: use?

A

peptic ulcers, gastritis, mild esophageal reflux

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4
Q

Which H2 blockers have the most toxicity?

what is that tox?

A

Cimetidine: inhibits cytochrome P-450 -> multiple drug interactions.

Also is an anti-androgen -> prolactin release, gynecomastia, impotence, decr libido in males

Crosses BBB -> confusion, dizziness, headaches

crosses placenta.

Both Cimetidine and Ranitidine decrease renal excr of creatinine (could be a reason for elevated creatinine without another cause)

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5
Q

Name the H2 blockers that have no toxic effects listed in FA? (2)

A

Famotidine

Nizatidine

(Ranitidine has only one tox effect: decr renal excr of creatinine. Cimetidine has a boatload.)

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6
Q

What class?

Omeprazole, Lansoprazole, Esomeprazole, Pantoprazole, Dexlansoprazole

A

Proton Pump Inhibitors

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7
Q

Mechanism?

Omeprazole, Lansoprazole, Esomeprazole, Pantoprazole, Dexlansoprazole

A

Irreversibly inhibit H/K ATPase in stomach parietal cells

(receptors on LUMEN side of the stomach)

(Proton Pump Inhibitors: inhibit “primary active transport”)

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8
Q

Clinical Use?

Omeprazole, Lansoprazole, Esomeprazole, Pantoprazole, Dexlansoprazole

A

Peptic ulcer, gastritis, esophageal reflux, Zollinger-Ellison syndrome

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9
Q

Toxocity?

Omeprazole, Lansoprazole, Esomeprazole, Pantoprazole, Dexlansoprazole

A

Incr risk of C Diff infection

Pneumonia

With long term use: hip fractures, decr serum Mg2+

(I’m sure this all has something to do with acid.)

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10
Q

Bismuth, Sucralfate: Mech?

A

Binds to ulcer base –> physical protection, allows Bicarb secretion to re-establish pH gradient in the mucous layer.

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11
Q

Bismuth, Sucralfate: Use?

A

Allows ulcer healing

Traveler’s diarrhea

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12
Q

Misoprostol

Mech?

A

PGE1 analog

  • Incr production/secretion of gastric mucous barrier
  • Decr acid production
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13
Q

Misoprostol

Use?

A
  • Prevents peptic ulcers from NSAID use (NSAIDs block PGE1 production)
  • Maintains PDA
  • Ripens cervix -> induces labor

(miso soup steams things open (PDA, cervix). Also is Jen’s hangover cure: aspirin + miso soup)

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14
Q

Octreotide

Mech?

A

Long-acting somatostatin analog

Acts on ECL cell, not parietal cell

(Endocrine connection: somatostatin from hypothal decr GH and TSH release. If hypothalamus is destroyed, Octreotide can replace somatostatin)

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15
Q

Octreotide

Use?

A
  • Acute variceal bleeds
  • Acromegaly (blocks GH release from pituitary)
  • VIPoma
  • carcinoid tumors
  • helpful for ‘secretory’ diarrhea
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16
Q

Octreotide

Tox?

A

nausea, cramps, steatorrhea

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17
Q

What class?

Aluminum hydroxide

Calcium carbonate

Magnesium hydroxide

A

Antacids

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18
Q

Antacids: general tox?

A
  • affect absorption, bioavailability, or urinary excr of other drugs by altering gastric and urinary pH or by delaying gastric emptying
  • Hypokalemia
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19
Q

Aluminum hydroxide: tox?

A

Antacid general tox = alter gastric/urinary pH or delay gastric emptying -> affect other drugs; hypokalemia

Specific to Al hydroxide: constipation, hypophosphatemia, prox muscle weakness, osteodystrophy, seizures

“Aluminimum amount of feces”

20
Q

Calcium carbonate: tox?

A

Antacid general tox = alter gastric/urinary pH or delay gastric emptying -> affect other drugs; hypokalemia

Specific to Ca carbonate: hypercalcemia, rebound acid increase.

Can chelate and decr effectiveness of other drugs (ex tetracycline)

21
Q

Magnesium hydroxide: tox?

A

Antacid general tox = alter gastric/urinary pH or delay gastric emptying -> affect other drugs; hypokalemia

Specific to Mg hydroxide: diarrhea, hyporeflexia, hypotension, cardiac arrest

“Mg = Must Go to the bathroom”

22
Q

Class?

Magnesium hydroxide

Magnesium citrate

Polyethylene glycol

Lactulose

A

Osmotic laxatives

23
Q

Osmotic laxatives: mech?

(Magnesium hydroxide

Magnesium citrate

Polyethylene glycol

Lactulose)

A

Provide osmotic load to drive water out

Lactulose treats hepatic encephalophy (gut flora degrade it into lactic acide and acetic acid -> promotes nitrogen excretion as NH4+

24
Q

Osmotic laxatives: use?

(Magnesium hydroxide

Magnesium citrate

Polyethylene glycol

Lactulose)

A

Constipation

Lactulose: hepatic encephalopathy

25
Q

Osmotic laxatives: tox?

(Magnesium hydroxide

Magnesium citrate

Polyethylene glycol

Lactulose)

A

diarrhea

dehydration

abuse by bulimics

26
Q

Infliximab: mech?

A

Monoclonal antibody to TNF-a

27
Q

Infliximab: use?

A

Crohn’s

Ulcerative colitis

rheumatoid arthritis

ank spondylitis

psoriasis

28
Q

Infliximab: tox?

A

Infection (possible reactivation of latent TB)

fever

hypotension

29
Q

sulfazalazine: mech?

A

combination of sulfapyridine (antibacterial) + 5-aminosalicylic acid (anti-inflammatory)

Activated by colonic bacteria

30
Q

Sulfasalazine: use?

A

Ulcerative colitis

Crohn’s

31
Q

Sulfasalazine: tox?

A

Malaise

nausea

sulfonamide tox

decr sperm count (reversible)

32
Q

metoclopramide: mech?

A

D2 receptor antagonist.

decr resting tone, contractility, LES tone, motility

does not change colon transport time

33
Q

metoclopramide: use?

A

diabetic and post-surg gastroparesis (paralysis)

Anti-emetic

34
Q

metoclopramide: tox?

A

incr parkinsonian effects

restlessness, drowsiness, fatigue, depression, nausea, diarrhea.

Interacts with digoxin and diabetic agents

35
Q

metoclopramide: CI in what patients?

A

pts with small bowel obstruction

Parkinson dz patients (D1-receptor blockade)

36
Q

Odansetron: mech?

A

5-HT3 antagonist; decr vagal stimulation

Powerful central-acting antiemetic

“Keep on dancing with odansetron!”

37
Q

Odansetron: use?

A

control vomiting post-op

patients undergoing cancer chemo

38
Q

Odansetron: tox?

A

headache

constipation

39
Q

Diphenoxylate: mech?

A

binds mu receptors in GI; slows motility

40
Q

Diphenoxylate: use?

A

opiate anti-diarrheal (similar to meperidine - opioid agonist)

in low doses, can slow gut motility with no euphoric effects

packaged with atropine to discourage abuse!

41
Q

Treatment for Crohn’s disease? (5)

A

Corticosteroids

Azathioprine

Methotrexate

Infliximab

Adalimumab

42
Q

Treatment for Ulcerative Colitis? (4)

A

ASA preparations (sulfasalazine)

6-mercaptopurine

infliximab

Colectomy

43
Q

Treatment for hepatic encephalopathy?

A

Lactulose (bacterial action -> acid produced -> NH3 becomes NH4, ammonium trap)

Low protein diet (less nitrogen intake)

Rifaximin (kills intestinal bacteria)

44
Q

Treatment for Crigler-Najjar syndrome?

(type I, Type II)

A

Type I: plasmapheresis, phototherapy

Type II (less severe): phenobarbital (incr liver enzyme synthesis)

45
Q

Treatment for Wilson disease?

A

Penicillamine or Trientine

46
Q

Treatment of hereditary hemochromatosis?

A
  • repeated phlebotomy
  • Iron chelation (deferasirox, deferoxamine)

x Surgery M3 (4 decks)

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