GI Pharmacology 3 Flashcards
acute treatment of esophageal variceal hemorrhage
*OCTREOTIDE (splanchnic vasoconstrictor that decreased blood flow + pressure)
*transfusion and fluids
*mechanical interventions
octreotide - MOA
*somatostatin analogue that leads to:
-decreased secretion of GI hormones + fluids
-slows GI motility
-decreased portal + splanchnic blood flow
note - octreotide is a splanchnic vasoconstrictor, leading to decreased blood flow and pressure
prevention of esophageal variceal hemorrhage
*non-selective beta blocker (decreases cardiac output, which decreases blood flow and pressure)
*mechanical interventions
octreotide - uses
-endocrine tumors
-diarrhea
-decreases pancreatic secretion
-GI bleeding (ex. ESOPHAGEAL VARICEAL HEMORRHAGE)
octreotide - ADEs
*nausea + vomiting
*abdominal pain
*steatorrhea
*gallbladder sludge + stones
*hypothyroidism
*hyper- or hypo-glycemia
non-selective beta blockers - specific drugs
*propranolol
*nadolol
*carvedilol
non-selective beta blockers - MOA
*decreased cardiac output, blood flow, and portal pressure
non-selective beta blockers - uses
*prevention of esophageal variceal bleeding
*HTN and other cards diseases
diuretic treatment of ascites
*SPIRONOLACTONE (competitive aldosterone antagonist)
*furosemide (inhibits sodium reabsorption in the loop of Henle)
note - we use MUCH LARGER DOSES of spironolactone FOR ASCITES than we use for normal diuresis and CHF
furosemide
*drug class: loop diuretic
*MOA: inhibits sodium reabsorption in loop of Henle
*uses: ASCITES (+ others)
*ADEs: hypokalemia
spironolactone
*drug class: aldosterone antagonist
*MOA: blocks actions of aldosterone in renal tubule
*uses: ASCITES (+ others)
*ADEs: hyperkalemia, gynecomastia, decreased libido
treatment for primary spontaneous bacterial peritonitis (SBP)
*acute: ceftriaxone (3rd gen cephalosporin - binds to PBPs to inhibit cell wall synthesis)
*prevention/prophylaxis: ciprofloxacin (fluoroquinolone - inhibits DNA synthesis by binding to topoisomerase)
ciprofloxacin
*drug class: fluoroquinolone
*MOA: inhibits DNA synthesis by binding to 2 topoisomerases
*uses: PREVENT SBP; tx traveler’s diarrhea & intrabdominal infections
*ADEs: CNS at high doses; QTc prolongation; GI; tendon rupture?; aortic aneurysm?
treatment regimen for hepatic encephalopathy
lactulose or rifaximin
lactulose - treating hepatic encephalopathy
*drug class: osmotic cathartic (synthetic disaccharide)
*MOA: traps ammonia in colon; cathartic effect
*uses: HEPATIC ENCEPHALOPATHY; constipation
*ADEs: bloating, diarrhea, epigastric pain, flatulence, nausea
why does lactulose help in hepatic encephalopathy
*colonic bacteria degrade lactulose and form lactic acid, acetic acid, and formic acid
*reducing colonic pH “traps” ammonia (NH3) as NH4+, which is not readily absorbed and is therefore excreted in the stool
rifaximin - treating hepatic encephalopathy
*drug class: antibiotic
*MOA: inhibits protein synthesis by binding to RNA polymerase (kills ammonia-producing bacteria in HE)
*uses: hepatic encephalopathy, IBS-D, traveler’s diarrhea, SIBO
*ADEs: well-tolerated but expensive
treatment of acetaminophen overdose/toxicity
N-acetylcysteine (NAC)
N-acetylcysteine (NAC) - MOA
REPLETES LIVER GLUTATHIONE to treat acetaminophen toxicity
N-acetylcysteine (NAC) - uses
acetaminophen toxicity
N-acetylcysteine - adverse effects
*nausea and vomiting
*diarrhea
*GI reflux
*anaphylactoid reaction (if given IV)
*stinks like rotten eggs
treatment recommendations for pancreatitis
*only give ABX if infected (necrotic or have ongoing SIRS)
*treat with:
1. cefepime + metronidazole
OR
2. pip/tazo
difference between cefepime and ceftriaxone
*cefepime covers Pseudomonas; ceftriaxone does not
pancrelipase
*drug class: pancreatic enzyme replacement
*MOA: replaces lipase, amylase, and protease
*uses: pancreatic insufficiency (cystic fibrosis, chronic pancreatitis)
*ADEs: abdominal pain
GLP-1 agonists - specific drugs
-dulaglutide
-exenatide
-semaglutide
-liraglutide
GLP-1 agonists - MOA
*increased insulin secretion
*decreased glucagon secretion
*decreased appetite (leads to weight loss)
GLP-1 agonists - uses
*DM2
*prophylaxis of cardiac disease in DM2 and/or overweight patients
*obesity
GLP-1 agonists - ADEs
*abdominal pain
*constipation or diarrhea
*nausea and vomiting
*medullary thyroid cancer?
*cholelithiasis
*pancreatitis
oral vancomycin
*drug class: ABX for C diff
*MOA: binds to D-ala-D-ala terminal group to inhibit cell wall synthesis
*uses: C diff
*ADEs: minimal
note - not absorbed; don’t treat systemic infection with this product
fidaxomicin
*drug class: ABX for C diff
*MOA: inhibits protein synthesis by binding to RNA polymerases
*uses: C diff
*ADEs: minimal
note - VERY EXPENSIVE
