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Advanced Pharmacology > GI system management > Flashcards

GI system management Flashcards

1
Q

Oral stage of swallowing

A
  • can be initiated voluntarily or involuntarily

- food bolus formed and propelled backward toward pharynx

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2
Q

Pharyngeal stage of swallowing

A
  • complex involuntary event activated by swallowing center
  • swallowing centers stimulated, soft palate pulled upward, vocal cords approximated, epiglottis swings back, UES relaxes
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3
Q

Esophageal stage of swallowing

A
  • food moves down esophagus via primary peristalsis over 8-10 secs
  • secondary peristalsis occurs if food is still in esophagus after primary wave
  • LES is relaxed
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4
Q

4 phases of proton pump secretion

A
  • Basal (Interdigestive)
  • Cephalic
  • Gastric
  • Intestinal
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5
Q

Basal phase of secretion

A
  • occurs at night
  • <30% max acid output
  • controlled via Ach and histamine
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6
Q

Cephalic phase of secretion

A
  • waking up in AM
  • emotional/sensory stimuli produce excitation of vagal fibers
  • vagal (parasympathetic) stim of parietal cells and antral G cells to produce H+ and peristalsis
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7
Q

Gastric phase of secretion

A
  • food enters stomach

- intragastric buffering enhances secretion by maintaining less acidic pH

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8
Q

Intestinal phase of secretion

A
  • food in intestine releases inhibitory factors

- <10% max acid output

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9
Q

Management of diarrhea

A
  • Motility inhibitors
  • Bulk formers
  • Probiotics
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10
Q

Motility inhibitors

A
  • Bismuth subsalicylate (Peptobismal)
  • Diphenoxylate HCl with atropine (Lomotil)
  • Loperamide (Imodium)
  • Opium tincture
  • Paregoric
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11
Q

Mechanism of action of motility inhibitors

A

-inhibit Ach receptors (parasympathetic) to slow GI motility by promoting water absorption in large bowl

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12
Q

Side effects of motility inhibitors

A
  • Anticholinergic- dry mouth, urinary retention, blurred vision, tachycardia
  • CNS- drowsiness, HA
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13
Q

Calcium polycarbophil (Fibercon)

A
  • bulk former
  • absorbs water in large bowel
  • produces gel-like stool
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14
Q

Probiotics

A
  • helpful for chronic diarrhea
  • enhances microbial growth to inhibit harmful bacteria and promotes water reabsorption
  • Culturelle
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15
Q

Managing Nausea/Vomiting

A
  • CTZ suppressors
  • H1 receptor antagonists
  • Metoclopramide
  • Dronabinol
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16
Q

Mechanism of action of CTZ suppressors

A
  • most powerful antiemetic

- blocks postsynaptic dopamine receptors in chemoreceptor trigger zone (CTZ)

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17
Q

Mechanism of action of H1 receptor antagonists

A
  • antihistamines that cross the BBB
  • mechanism not well known
  • produces anticholinergic effects
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18
Q

Metoclopramide

A
  • antiemetic
  • accelerate GI motility - promotes gastric emptying
  • decreases N/V d/t GI overdistention
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19
Q

CTZ suppressors

A
  • antiemetics
  • Benzquinamide HCl
  • Bulizine HCl
  • Chlorpromazine
  • Diphenidol
  • Droperidol
  • Prochlorperazine (Compazine)
  • Thiethylperazine
  • Trimethobenzamide HCl
  • Ondansetron HCl (Zofran)
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20
Q

H1 receptor antagonists

A
  • antiemetics
  • Cyclizine
  • Dimenhydrinate
  • Diphenhydramine HCl
  • Hydroxyzine
  • Meclizine
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21
Q

Side effects of CTZ suppressors

A
  • CNS depression (foggy, tired)
  • hypotension
  • resp. depression
  • anticholinergic
  • extrapyramidal effects (rare)
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22
Q

Medications for peptic ulcer disease

A 
Antibiotics
Bismuth subsalicylate
PPI
H2 receptor antagonist
Sucralfate
Prostaglandin E analog- Misoprostol
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23
Q

Antibiotics used for peptic ulcer disease

A
  • Metronidazole
  • Clarithromycin
  • Tetracycline
  • Amoxicillin
  • Levofloxacin
24
Q

Mechanism of action of proton pump inhibitors

A

inhibits proton pump to decrease H+ ions => decreases gastric acidity => increased pH promotes gastric healing

25
Q

Proton pump inhibitors

A 
Omeprazole (Prilosec)
Lansoprazol (Prevacid)
Rabeprazol (Aciphex)
Pantoprazol (Protonix)
Esomeprazole (Nexium)
Dexlansoprazole (Dexilant)
26
Q

Mechanism of action of H2 receptor antagonists

A

-inhibits binding of histamine at receptors in parietal cells => decreased pumping of H+ ions from parietal cells into gut => decreased acid irritation

27
Q

H2 receptor antagonists

A

Cimetidine (Tagamet)
Famotidine (Pepcid)
Nizatidine (Axid)
Ranitidine (Zantac)

28
Q

Side effects of H2 receptor antagonists

A
  • dizziness, drowsiness, confusion
  • abd discomfort, diarrhea
  • overall well tolerated
29
Q

What drug interactions are notable for H2 receptor antagonists

A

Antacids- decrease absorption

30
Q

What labs can be effected by H2 receptor antagonists

A

Prolonged PT
Thrombocytopenia
Neutropenia

31
Q

Sucralfate

A
  • mucosal protective agent
  • forms paste-like substance that adheres to damaged mucosa to protect from acid/irritants
  • can alter absorption of other drugs- take 1-2 hrs from other drugs
  • take several times a day
  • shown to decrease risk of aspiration pneumonia since it does not change pH of gut
32
Q

Misoprosol

A
  • Protaglandin E analog
  • replaces protective prostaglandins that are inhibited by NSAIDs => inhibits GI mucosal breakdown
  • Side effects- diarrhea, HA
33
Q

Management of H. pylori PUD

A

Combo of 2 abx and 1 acid suppressor (PPI or H2) x 14 days (triple, quadruple, sequential, or salvage regimens)

34
Q

Triple drug regimen for H. Pylori

A

PPI + Clarithromycin + Amoxicillin or Flagyl x 10-14 days (80% success rate)

35
Q

Quadruple drug regimen for H. Pylori

A

PPI + bismuth + metronidazole + tetracycline x 14 days

- for pts allergic to PCN or taking macrolides

36
Q

Sequential regimen for H. Pylori

A
  • may be more effective than triple therapy
  • consider if pts recently on clarithromycin or metronidazole
  • PPI + amox x 5 days, then PPI + clarithromycin + tinidazole x 5 days
37
Q

Salvage therapy for H. Pylori

A
  • for when initial treatment didn’t work
  • use quadruple therapy if not already used
  • PPI + amox +levofloxacin x 10 days
38
Q

What patients are at high risk for peptic ulcers

A
  • prior hx of ulcers or GI bleed
  • taking high dose NSAID
  • taking corticosteroids or anticoagulant
39
Q

What prophylaxis is given to patient at risk for peptic ulcers

A
  • COX2 NSAID with PPI (high risk)

- nonselective NSAID with PPI (moderate risk)

40
Q

Management of duodenal ulcers

A 
*more common
Sucralfate QID 
or 
PPI QD x 4 wks 
or 
H2 receptor blocker QHS x 6 wks
41
Q

Management of gastric ulcers

A

*more concerning, complicated
H2 receptor blocker BID x 8-12 wks
or
PPI BID x 6-8 wks

42
Q

Regimen to prevent NSAID ulcer relapse

A
  • COX2 NSAID with PPI once daily

- COX2 NSAID with misoprostol TID or QID

43
Q

Management of GERD

A

PPI

  • give in AM, 30-60 min prior to breakfast
  • can do second dose prior to dinner
44
Q

What medications can be used for both forms of IBS

A
  • bulk-formers- Psyllium (Metamucil) and Methylcellulose (Citrucel)
  • TCAs and SSRIs
45
Q

Management of IBS-C

A
  • 5HT4 agonists (not available in US)
  • Polyethylene glycol (Miralax)
  • Lubiprostone (Amitiza)
  • Linaclotide (Linzess)
  • Tenapanor (Ibsrela)
46
Q

Lubiprostone (Amitiza)

A
  • selective chloride channel activator
  • increases fluid secretion into sm bowel => stim. GI motility
  • side effect- benign chest tightness/SOB, resolves within 3hrs of admin
47
Q

Linaclotide (Linzess)

A
  • Guanylate cyclase-C agonist
  • increases fluid secreation into gut by chloride and HCO3 channel activation
  • decreases activation of pain-sensitive nerves
  • primary adverse effect- diarrhea
48
Q

Tenapanor (Ibsrela)

A
  • very recently approved
  • Na/H+ exchanger
  • inhibits Na absorption to increase H2O in bowel => increases transit time and soften stool
49
Q

Management of IBS-D

A 
Eluxadoline (Viberzi)
Probiotics
Antidiarrheals
Rifaximin (Xifaxin)
Alosetron (Lotronex)
Loperamide
TCAs (2nd or 3rd line)
50
Q

Eluxadoline (Viberzi)

A
  • for IBS-D
  • mu and kappa receptor agonist => analgesia
  • delta receptor antagonist => decrease motility
  • not for patient with: alcohol abuse, GI motility issues, or chronic/severe constipation
51
Q

Alosetron (Lotronex

A
  • for IBS-D
  • 5HT3 recept. antagonist
  • may cause ischemic colitis- black box warning: prescribers must be enrolled and patient has to sign agreement
52
Q

Management of inflammatory bowel disease (IBD)

A
  • monoclonal antibodies (TNF-alpha blockers)

- Mesalamine-5-ASA

53
Q

Infliximab (Remicade)
Adalimumab (Humira)
Certolizumab (Cimzia)

A
  • IBD (mod-severe)
  • monoclonal antibodies that block receptors for TNF-alpha, a key inflammatory mediator
  • trend is now to use earlier in therapy
  • black box warning- risk for infections like TB
54
Q

Mesalamine-5-ASA

A
  • IBD
  • decreases inflammation
  • Pentasa, Rowasa, Asacol
55
Q

Naloxagel (Movantik)

A

for Opioid-Induced Constipation

56
Q

Methylnaltrexone (Relistor)

A

for Opioid-Induced Constipation

-SQ injection daily

57
Q

PAMORA

A

for Opioid-Induced Constipation

Advanced Pharmacology (9 decks)

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