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Pharmacology (Dale Turley) > H2, PPI, Prokinetics, Anti (emetics, diarrhea's, constipation), IBS > Flashcards

H2, PPI, Prokinetics, Anti (emetics, diarrhea's, constipation), IBS Flashcards

1
Q

GERD stepwise approach ?

A

Sleep head bed elevated 6-8 inches

Avoid lying down within 3 hours eating

No exercise within 3 hours after eating

No excessive squatting or bending within 3 hours after eating

Body weight

Avoid foods acidic, spicy, excessive fat

Avoid chocolate, peppermint, citric acids

Avoid alcohol, coffee, tea

Overeating

Stop smoking

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2
Q

H2 receptor antagonist Blockers MOA?

A

Inhibit acid secretion by gastric parietal cells through reverse blockade of histamine at the H2 receptor

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3
Q

H2 examples?

A

cimetidine (Tagament)

ranitidine (Zantac)

famotidine (Pepcid)

nizatidine (Axid)

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4
Q

H2 pharmacokinetics?

A

Metabolized Cytochrome P450 enzymes liver

Half-life 3-4 hours

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5
Q

Indications for H2?

A

GERD

Duodenal and PUD

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6
Q

H2 interactions?

A

May increase blood alcohol levels

Antacids and anticholinergics may decrease absorption of cimetidine

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7
Q

H2 contraindications?

A

-

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8
Q

Adverse reactions H2?

A

Arrhythmias, rash, nausea, vomiting, diarrhea, pancreatitis, granulocyte leukemia, thrombocytopenia, confusion, agitation, depression

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9
Q

H2 education for patients?

A

Taken after meals and before bed
Avoid drugs that interact or lowered pH affects activity
Smoking affects absorption of histamine blockers

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10
Q

PPI MOA?

A

Inhibition of the H+/K+/ATPase enzyme at the surface of the parietal cell

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11
Q

PPI examples?

A

Omeprazole (Prilosec)

Lansoprazole (Prevacid)

Esomeprazole (Nexium)

Pantoprazole (Protonix)

Rabeprazole (Aciphex)

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12
Q

PPI pharmacokinetics?

A

Metabolizeed by liver
Half-life 2 hours
Rapid absorption

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13
Q

PPI Indications?

A 
GERD
Erosive gastritis
Hyper-secretory states
Zollinger-Ellison syndrome
Short term treatment of PUD caused by H.pylori
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14
Q

PPI interactions?

A

Drugs cytochrome P450 enzymes

Drugs that require higher pH (digoxin, ketoconazole, ampicillin)

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15
Q

PPI adverse reactions?

A

Long term use may result in increased fracture risk (believed to be result of calcium absorption decrease)

Rash

Abd. pain, N/V diarrhea,

constipation

Flatulence

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16
Q

PPI patient education?

A

Taken before meals / AM

Avoid taking with antacids

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17
Q

Contraindications for PPIs?

A

Older adults - cause osteopuritic, and renal disease

Liver and renal disease

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18
Q

PPI Tx for moderate to severe disease: step 1?

A

Lifestyle modifications and PPIs are used initially

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19
Q

PPI Tx for moderate to severe disease: step 2?

A

If sxs. do not improve, increase the dose of PPIs

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20
Q

PPI Tx for moderate to severe disease: step 3?

A

Add H2 blockers or pro kinetic agent

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21
Q

PPI Tx for moderate to severe disease: step 4?

A

Step down the proton pump inhibitor dose once the initial symptoms have resolved

In addition, the patient may be stepped down to an H2 blocker
Failure of results within a 3-month span requires a gastroenterologist referral

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22
Q

Prokinetic Agents/Gastrointestinal Stimulants MOA?

A

Stimulate the motility

Does not stimulate gastric, biliary, or pancreatic secretions

Sensitizes tissues to the action of ACH

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23
Q

Metoclopramide (Reglan) pharmokinetics?

A

Increases resting tone of the LES

Increases tone and amplitude of gastric secretions

Increases peristalsis of the duodenum and jejunum

Accelerated gastric emptying

**settles down nausea, they get a little less GERD; adjunct to GERD , it increases resting tone of the LES*

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24
Q

Indications for Metoclopramide?

A

Acute and recurrent diabetic gastroparesis

Antiemetic properties

Adjunct therapy migraines

Short term therapy GERD with failure H2 and PPI

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25
Q

Adverse reactions and indications with Metoclopramide?

A

Restless, drowsiness, mental depression which may include SI

Extrapyramidal symptoms 1 in 500 patients, especially pediatric and older patients

Include Tardive dyskinesia

Hypotension, hypertension, tachycardia

Bowel disturbance, diarrhea

Neutropenia, leukopenia

**if on SSRi’s make sure to use caution with this medication cause it can cause dyskinesia especially if they have had it before with same type of medication or ar eat high risk of getting this side effect then just avoid this drug*

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26
Q

Contraindications to Metoclopramide?

A

GI hemorrhage, obstruction, perforation

Pheochromocytoma (HTN crisis)

Renal disease

Patients with epilepsy or history of medication induced extrapyramidal

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27
Q

Metoclopramide patient education?

A

Impair / sedate ( not great for GERD but can be used if failure of H2’s)

Take 30 min before meals

Watch for extrapyramidal symptoms

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28
Q

is Metoclopramide pregnancy safe?

A

this medicine is safe in pregnancy ( once of the few that is indicated in pregnancy especially for hyperemesis)

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29
Q

Antiemetics facts?

A

Nausea and vomiting common in the primary care setting

Treatment is often nonpharmacological

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30
Q

Antiemetics MOA?

A

Provide symptom relief - to get fluids in them - so they stop puking etc.

Prevent fluid and electrolyte disturbances

Consider treatment of cancer patients

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31
Q

Antiemetics: Seritonin blocker agents?

A

Palonosetron (Aloxi)

Dolasetron (Anzamet)

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32
Q

Antiemetics: Phenoththiazines?

A

Prochlorperazine (Compazine)

Promethazine (Phenergan)

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33
Q

Antiemetics: 5-HT3 receptor antagnist ?

A

Ondansetron (Zofran)

  • 5HT3’s - was used for hyperemesis in pregnancy until we started seeing birth defects **
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34
Q

Antiemetics pharmacokinetics?

A

Rapid absorbed (Zofran 100% IV or IM, 50% oral)

Crosses blood brain barrier and placenta

Metabolized liver

Half life:

Promethazine 9-16 hr - longer HF
Prochlorperazine 3-5 hr
Ondansetron 3-6 hr

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35
Q

Adverse reactions with Antiemetics?

A

Arrhythmias ( Zofran prolonged QT)

Rash

Watch ANC / WBC Compazine

Aplastic anemia

Agitation extrapyramidal systems -

BBW-Dementia related psychosis Compazine - ( watch for it if they are taking serotonin)

Current concern pregnancy Zofran

Phenothiazine’s - Watch small children and older adults - more extrapyramidal sxs in our elderly

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36
Q

Meclizine ( Antivert) subclass?

A

Subclass: Antihistamines, 1st generation; Nausea/Vomiting; Vertigo/Motion Sickness

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37
Q

Meclizine ( antivert) MOA?

A


non-selectively antagonizes central and peripheral histamine H1 receptors; antagonizes cholinergic receptors, producing antiemetic effects

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38
Q

Dose of Antivert?

A

non selectie H1 like benadryl
25 mg PO to start
12.5 mg for PEDS dosing

**only PO , may need to start with another antiemetic if they are N/V, maybe zofran first to relax them and chill them out so the can take the anti vert *

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39
Q

Practical Pharmacology of Antidiarrheal’s are used?

A

acute versus chronic

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40
Q

Using Antidiarrheal’s pay attention in children and the elderly cause?

A

Quickly experience dehydration

Usually self limited

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41
Q

Antidiarrheals three main classes of drugs?

A

Absorbent preparations

Opiates

Anticholinergics

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42
Q

Antidiarrheal’s: absorbent preparations?

A

Bismuth subsalicylate (Pepto-Bismal, Kaopectate)

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43
Q

Antidiarrheal’s: Opiates?

A

Diphenoxylate with atropine (Lomotil)

44
Q

Antidiarrheals: Anticholinergics (IBS)?

A

Belladonna

Scopalamine

45
Q

Antidiarrheal’s MOA of absorbent preparations??

A

Bismuth subsalicylate (Pepto-Bismal, Kaopectate

Absorb moisture in stool without effecting total water loss

Bismuth has anti-secretory and antimicrobial effect

Mucosal protectant - good for erosive bacteria etc

46
Q

Antidiarrheal’s MOA of opiates?

A

Diphenoxylate with atropine (Lomotil)

Constipating effect

atropine is anticholinergic slows peristalsis

no used if C.diff cause you do not want to encapsulate it and keep it in

slowing down peristalsis can keep bacteria in the gut an cause more problems

47
Q

Antidiarrheal’s MOA of Anticholinergics (IBS)

A

Belladonna, scopolamine

Inhibits peristalsis direct effect on smooth muscle intestinal wall

Diminishes loss fluids and electrolytes

No direct opioid effect

48
Q

Adverse reactions and interactions with Bismuth?

A

Pg. 181

ASA
TCL
Coumadin
Tongue and stools gray-black

49
Q

Adverse reactions and interactions with Lomotil?

A

CNS

Alcohol

Antihistamines

Opioids

**remember contents of lomotil *

50
Q

Adverse reactions and interactions with Pectin?

A

Digitalis will be extremely elevated

yellow vision if dig is to high
in a lot of the anti-diarrheal

51
Q

Adverse reactions and interactions with Imodium?

A

CNS
Alcohol
Antihistamines
opioids

52
Q

Antidiarrheal’s contrindications?

A

Atropine ( ACH) with glaucoma

Children with Downs hypersensitive to atropine

Atropine can cause urinary retention in older people

53
Q

Use all _____________ with caution in elderly

A

antidiarrheal’s

54
Q

antidiarrheal’s are not used in children under _ years old, under _ they have more supportive care.

A

2

2

55
Q

Antidiarrheal’s (cont’d) make sure to use caution in?

A

Caution in digoxin, cephalosporins, warfarin, heparin, CND depressants

56
Q

Antidiarrheal’s patient education?

A

Hand washing

BRAT diet
bananas, rice, apple sauce, toast = bulk agents

Stop Milk / lactose

57
Q

Causes of constipation?

A

what drugs? Pg 190

58
Q

Non-pharmacological intervention for constipation?

A

Fiber intake
Hydration
Physical activity

59
Q

Constipation treatment categories?

A

Bulk forming agents
Emollient stool softeners
Rapidly acting lubricants and laxatives

60
Q

Constipation: bulk producing laxatives?

A

Metamucil

Fiberall

FiberCon

Citracel

61
Q

Constipation: emollient stool softeners?

A

Mineral oil - slow colonic fecal water absorption

62
Q

Constipation: rapidly acting lubricants and laxatives?

A

Magnesium citrate

63
Q

Constipation: GI stimulant?

A

Reglan

64
Q

Constipation: stool softeners?

A

MiraLax

Lactulose

Ducusate / Colace - degeneration of nerve plexus

65
Q

Adverse reactions and interactions with constipation meds?

A

Nausea, vomiting, anal irritation, flatulence

Obstruction

66
Q

Contraindications with constipation meds?

A

Signs of appendicitis

Obstruction

Undiagnosed abd pain - work up further

67
Q

Saline enemas MOA?

A

draw water into the colon.

68
Q

Mineral oil enemas MOA?

A

ease passage of stool, lubricating passage

moisten and soften the hardened stool.

69
Q

Emollient enemas MOA?

A

reduces tension in the lumen - allows easier passage

contain substances that softenthe stool.Examples are Microenema and Colace.

70
Q

Phosphate enemas MOA?

A

cause contractions of the muscle in the colon

cause contractions in the muscles of the colon.Examples are Fleet phosphosoda

71
Q

What is one of the most common gastric pathogens?

A

H. Pylroi

72
Q

H. Pylori has an important role in the pathogenesis of?

A

Peptic ulcer disease

Gastric malignancy

Chronic gastritis

73
Q

Tx of H. Pylori?

A

Clarithromycin-based triple therapy

Bismuth quadruple therapy

74
Q

Clarithromycin-based triple therapy contains?

A

a PPI, clarithromycin, and amoxicillin, or metronidazole for 14 days ( usually 2 times a day )

75
Q

Bismuth quadruple therapy

contains?

A

H2 or PPI blocker , bismuth, metronidazole, and tetracycline for 10–14 days to eradicate

used first line in clindamycin resistant area or active infections

76
Q

Cytoprotective Agents combats ulcers bot by reducing gastric acid but by increasing _______________

A

mucosal protection

77
Q

Prostaglandins physiology?

A

protect the stomach mucosa against injury by increasing gastric mucus secretion

commonly utilized agents: sucralfate, misoprostol

**more of a bandaid over the area , long tern NSAIDs medications nd need to promote healing *

78
Q

Cytoprotective Agents examples?

A

Sucralfate

Misoprostol (Cytotec)

79
Q

Sucralfate is what ?

A

sucrose sulfate-aluminium complex - alumni covers the ulcer and acts as a barrier - prevent degradation fo the mucosa

80
Q

Sucralfate MOA?

A

binds to the ulcer, creating a physical barrier that protects the gastrointestinal tract from stomach acid and prevents the degradation of mucus

promotes bicarbonate production and acts like an acid buffer

**used main in pregs and non- NSAIDS induced treatment more for local treatment take on empty stomach *

81
Q

Misoprostol (Cytotec) is what?

A

Prostaglandin analog - mucosa protective quality

82
Q

Misoprostol (Cytotec) MOA?

A

use in the prevention of NSAID-induced gastric

inhibiting the secretion of gastric acid decreased intracellular cyclic AMP levels

**used more in NSAID - induced ulcers it is systemically absorbed take on full stomach *

83
Q

Misoprostol is a prostaglandin _______?

A

analog

84
Q

what cytoprotective agent is used to initiate labor in pregnancy?

A

Misoprostol (Cytotec)

85
Q

Misoprostol (Cytotec)

uses?

A

Used to initiate labor in pregnancy

Post-partum bleeding contraction uterus

Used in other countries to produce abortion

Decrease the effects of Warfarin - make sure to watch INR

86
Q

Misoprostol (Cytotec) pregnancy category?

A

X

87
Q

What is IBS?

A

Chronic functional bowel disorder characterized by abdominal pain and altered bowel habits in the absence of specific and unique organic pathology

88
Q

IBS treatment drugs?

A

IBS-A- alternating

IBS-C- constipation dominant

IBS-D- diarrhea

IBS-M- mixed

89
Q

What are the two drugs used to treat IBS and both agents decrease GI motility?

A

Anticholinergics

Antispasmodics

**act on smooth muscle *

90
Q

Anticholinergics example?

A

Glycopyrrolate (Robinul)

91
Q

Glycopyrrolate (Robinul)

MOA?

A

Mechanism of Action
antagonizes acetylcholine receptors (anticholinergic)

relieves smooth muscle spasms GI tract

92
Q

Glycopyrrolate (Robinul)

adverse reactions and interactions?

A

hypersensitivity rxn

anaphylaxis

intestinal obstruction

seizures

arrhythmias

93
Q

Glycopyrrolate (Robinul)

contraindications?

A

neonates (benzyl alcohol-containing INJ forms) “Gasping Syndrome” - causing death in neonates - so avoid in any neonate - significant catastrophic events

glaucoma, angle-closure

obstructive uropathy

GI obstruction

94
Q

Glycopyrrolate (Robinul)

pregnancy cat?

A

B

95
Q

Glycopyrrolate (Robinul)

Lactation and dose?

A

Lactation: Safety Unknown

Dose - 1 mg TID

96
Q

Antispasmodics example?

A

Dicyclomine (Bentyl)

97
Q

Dicyclomine (Bentyl)

MOA?

A

antagonizes acetylcholine at muscarinic receptors (anticholinergic)

relaxes smooth muscle

inhibits bradykinin- and histamine-induced spasms

98
Q

Dicyclomine (Bentyl)

adverse reactions and interactions?

A

psychosis

Hallucinations, delirium

paralytic ileus

dizziness, blurred vision,
nausea, somnolence

99
Q

Dicyclomine (Bentyl)

pregnancy cat?

A

B

100
Q

Dicyclomine (Bentyl)

lactation and dose?

A

Lactation: Possibly Unsafe

Dose- 20 mg QID , can be used PO / IM

101
Q

Anticholinergic/Belladonna Alkaloids

examples?

A

Atropine sulfate (Donnatal)

atropine, hyoscamine, scopolamine

102
Q

Anticholinergic/Belladonna Alkaloids MOA?

A

antagonize acetylcholine at muscarinic receptors

relaxing GI smooth muscle

decreasing GI motility and gastric secretion (anticholinergic)

Sedating effect

affect CNS sites and does cross BBB so it cause sedating affects in patients

103
Q 
Atropine sulfate (Donnatal)
interactions and cautions?
A

urinary hesitancy/retention

blurred vision

palpitations/tachycardia

Mydriasis, cycloplegia, IOP incr. ( glaucoma)

loss of taste

Headache, nervousness,
drowsiness, weakness

104
Q 
atropine sulfate (Donnatal)
Pregnancy category?
A

C

105
Q 
atropine sulfate (Donnatal)
lactation and dose?
A

Lactation: Possibly Unsafe

Dose - 0.4 mgs PO q4-6

Pharmacology (Dale Turley) (31 decks)

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