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SUMPHARM > GI RX-GERD, PUD, Constipation > Flashcards

GI RX-GERD, PUD, Constipation Flashcards

1
Q

What are atypical sx w/ GERD?

A

Erosion of teeth enamel. 1. Less burn bc Barret esophagus 2. Haliosis

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2
Q

What RX inc GERD?

A

Anticholinergics, Benoz, Estrogen, Dopamine, Alendronate-bisphosphonate, Iron

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3
Q

Pregnant women have GERD bc?

A

pressure, slowed emptying, Transit is 4x faster

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4
Q

If NSAIDs is the problem with GERD what is TX?

A

H2 blocker, PPI, DEC Dose

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5
Q

These agents neutralize/buffer stomach HCL to form what?

A

Antacid form salt and H2O 1. Inc LES pressure 2. Inc PH

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6
Q

What are the Antacids?

A

Al, Mg, NaHCO(baking soda, alka seltzer

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7
Q

What antacid is combined with alginic acid, forms a viscous solution that floats on surface, create a barrier for the LES reflux?

A

Gaviscon

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8
Q

What is side effects of ADE?

A
  1. Gassy d/t CO2 production-TX simethicone 2. Gi upset, alkalosis, 3. Nephrolithiasis 4 TSH low bone marrow suppression-Al+
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9
Q

Why should Pt avoid taking antacids w/ PPI dosing?

A
  1. Avoid oral med 1-2hr of other RX 2. Reduce bioavailability of H2 blockers 3. INC pH-enteric coated drugs may be release early, goal is to get to duodenal to get absorbed, IF PH HIGH in stomach will not get absorbed in ideal location 4. INC urine PH
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10
Q

What agents competitively and selectively inhibit histamine form the ECL cells, which DEC signaling parietal cells to make HCL?

A

H2 blocker- Ranitidine and Famotidine

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11
Q

What are benefits for H2 blocker?

A

Rare ADE- safe 2. CNS mental confusion, dizzy w/ High does on elderly in ICU

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12
Q

Which H2RA has hihg DI w/ CYPs?

A

Cimetidine Tagamet- avoid all drugs warfarin, quinidine, SSRI

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13
Q

Which H2RA has less DIs?

A

Ranitidine- hepatotoxicity rare

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14
Q

What should be avoided with H2RA?

A

Antacid and PPI

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15
Q

What agent irreversibly bind to H/K-atpase enzyme that transports HCL across parietal cell, inhibit H+, thus INC PH?

A

Proton pump inhibitors- block 90% of 24 hr gastric acid secretion. ONLY drug to maintain pH>4 post prandial

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16
Q

WHat agents protect itself from acid of pH by enteric coating?

A

omeprazole/Prilosec, lansoprazole/Prevacid- coated granules. AVOID antacids or alkaline juices bc may break enteric coat. IDEAL Monotherapy and with a MEAL- bc only works when proton pumps engaged to work

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17
Q

What is best agent for nighttime GERD?

A

PPI-prazoles

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18
Q

What are ADEs of PPIs?

A
  1. CNS-ha dizzy 2. Lungs- PNA, 2- CVD MI , B12 deficiency 3. C. diff 4. Osteoporosi
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19
Q

What race group is warning w/PPI?

A

Asian- Dose DEC omeprazole d/t interaction w/ clopidogrel

20
Q

Stress ulcers in scene in hospital from trauma, what agent mucosal protective agent is PREG X?

A

misoprostol- binds prostaglandin, INC blood flow. Produced uterine contractions. USED- NSAID induced PUD

21
Q

What agent binds to damage ulcer and forms a barrier to injury?

A

Sucralfate

22
Q

How does Pepto Bismol work?

A

Bismuth subsalicylate-coats ulcers and erosions, stimulates mucous prostaglandins, HCO3, binds to microbial

23
Q

What can bismuth be used for?

A

Dyspepsia, Acute diarrhea, Travelers diarrhea. H.pylori- PPI+bismuth+ABX

24
Q

What are the weird SIDE of bismuth?

A

Black stools and tongue. Ask pt if taking before DX with melena 2. AVOID in renal dysfunction- toxicity encephalopathy (CNS)

25
Q

What agent kill H. Pylori?

A

ABX ONLY!. PPI only INC PH thus ABX can work better on H. pylori in the stomach. AVOID H2 blocker in h.pylori NO INC PH effects.

26
Q

What is tX for H. Pylori?

A

Quad-PPI BID + Clari + amox+metronidazole x 14 days or Bismuth instead of PCN

27
Q

What agent lower LES pressure, accelerated gastric emptying w/o stimulate gastric secretions. IF OD provide anticholinergic?

A

Metoclopramide- AND extrapyramidal effects d/t antagonizes Dopamine

28
Q

What agent is used for gastric emptying/Diabetic gastroparesis?

A

Metoclopramide

29
Q

What other agents INC gastric motility?

A

Bethanechol, neostigmine, erythromycin-ABC inc diarrhea. Used or endoscopic emergence?

30
Q

What are the main approached for constipation

A
  1. Find their relative normal 2. Diet- INC fiber for bulk 3. Underlying condition 4 Surgery expectations
31
Q

What class of drugs cause constipation?

A

Analgesic- OPIATES 2. Anticholinergics 3. Succinylcholine 4 Calcium antacids 5 CCB 6 Diuretics 7. IRON

32
Q

Which agents is all much and no push and should not be RX with opiates?

A

Docusate and Senna

33
Q

Name a few stool softeners that work 1-3d?

A

Psyllium, Docusate, Lactulose, Sorbitol, Mineral oil

34
Q

Name a few stool softener w/ semi fluid stools that work 6-12?Too harsh for mild constipation

A

Senna, Mg-Sulfate, Bisacodyl

35
Q

Name a few watery stool producers w/ 1-6h? Ideal for severe constipation

A

Mg+: citrate, H2O2, sulfate, 4.Na phosphate, Bisacodyl, Polyethethylene glycol

36
Q

What is firstline in treating constipation?

A

Diet

37
Q

What agents are indigestible, absorb water to form bulk, promote peristalsis?

A

Methylcellulose, polycarbophil, psyllium- ADE: Bloating, INC sugars(AVOID DM) USE- IBS DEC TC and LDL

38
Q

Which laxative is least effective but good for pregnancy, reduce surface film tension, all mush and no push, prevent dry stools?

A

Emollient Docusates-softener only. NON STIMULANT ADE- skin, GI

39
Q

Which Lax is AVOIDED in bed bound due to aspiration, AVOID LT due to ADEK impaired, Leaks?

A

Mineral oil- DEC stool transit time, so less water absorbed from feces. USE- fecal impaction short term

40
Q

Which lax is USED for bed bound, neuro impaired, and not for pregnancy, appendicitis, lactation?

A

Castor oil

41
Q

Which LAX discolors urine?

A

cascara, sagrade, senna- pink red red brown

42
Q

Which LAX are for acute, chronic, and prevention, last resort bc potent?

A

Osmotic Mg and Na: prompt bowel evacuation, rapid water movement into distal small, leads to high stool vol.

43
Q

AVOID this lax in elderly, frail, renal impaired, CHF pt?

A

Saline- no long term. ADE/ DD- reduce ciprofloxacin, alkalosis

44
Q

What lax is non absorbable osmotic active sugar w/ Na+, K+, prevent water absorption in intestine, for bowel cleansing?

A

PEG(miralax, glycolax) -ADE- less GI

45
Q

What lax stimulate this channel opening in intestine, inc liquid secretion, shorten transit time-produces diarrhea?

A

Cl channel activator-chronic constipation, IBS w/ constipation, OPioid non CA. ADE- NAUSEA, Preg C, LAST resort

46
Q

Metoclopramide- ADE extrapyramidal effects d/t antagoinizes Dopamine

A

INC DDI d/t CYP3A4-ADE-GI issues. CY INDUCERS- DEC drug level, INHIB-INC Drug level

SUMPHARM (26 decks)

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