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PHARM EXAM 2 > IBS, IBD, antiemetics, Prokinetic Agents > Flashcards

IBS, IBD, antiemetics, Prokinetic Agents Flashcards

1
Q

IBS- Idiopathic chronic relapsing disorder

A

Do not know hwat is causing it

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2
Q

Chronic relapsing IBS

A

comes & goes @ times better @ times worse

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3
Q

Inflammatory Bowel

A

Crohn’s and Ulcerative Colitis

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4
Q

Goal of irritable bowel therapy

A

relieve abdominal discomfort & improve bowel function

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5
Q

is irritable bowel a relapsing condition or a chronic progressibe condition

A

chronic relapsing condition not a chronic progressive condition

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6
Q

IBS components

A

pain, diarrhea, constipation- you just treat the syndromes

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7
Q

IBS with Diarrhea

A

diarrhea and fecal urgency

resolves spontaneously

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8
Q

RXs for IBS with Diarrhea

A

Loperamide

Dipenoxylate

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9
Q

IBS with constipation

A

bulk forming agents are best

not make the diarrhea worse- although if they cause cramping they can increase pain

bulk formers are not enough to relieve constipation can try osmotic agents

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10
Q

IBS with abdominal pain

A

trycyclics TCAD works best

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11
Q

RXs used in IBS with abdominal pain

A

Amitriptyline
desipramine
nortriptylline

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12
Q

Antispasmodics

A

acute attacks of abdominal pan or before meals in patients with post prandial symptoms

work through their anticholinergic effect inhibiting muscarinic input in the enteric plexus & on smooth muscle

higher doses too antichlolinergic & not tolerated well

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13
Q

Antispasmodic RXs

A

Dicyclomine (Bentyl)
Hyoscyamine (Levsin)

Not very effective and many adverse rxns, on beers list, not covered by medicare

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14
Q

Are antispasmodics covered my medicare

A

No, dangerous for old ppl. on BEERS list

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15
Q

Serotonin 5-HT3 Receptor Antagonists MOA

A

5-HT receptors in GI tract activate pain sensation and regulate intestinal motility and secretions

MOA: Inhibit pain sensation from gut to spinal cord, inhibit motility & increase transit time of bowel.

decrease nausea, bloating, pain

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16
Q

Alosetron (Lotronex)

A

-Serotonin 5-HT3 Receptor Antagonists

for IBS with severe diarrhea

allowed to be prescribed by those with special training

Decreases pain 10-20% more than placebo, decreases number of BMs, abdominal pain, cramps, & urgency

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17
Q

MAJOR ADR of Alosetron (Lotronex)

A

Ischemic Bowel Syndrome

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18
Q

RX Chloride Chemical Activator

A

Lubiprostone

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19
Q

Lubiprostone MOA

A

Prostaglandin derivative that activates chloride channels in GI tract, stimulating intestinal fluid secretion

used for idiopathic constipation IBS

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20
Q

Contraindication of Lubiprostone MOA

A

patients with GI obstruction

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21
Q

Probiotics RX

A

lactobacillus & bifidobacterium

50 billion units/dau

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22
Q

Antibiotic RX

A

Rifaximin

imporvies IBS symptoms and bloating

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23
Q

IBD

A

Ulcerative Colitis and Crohn’s Dz

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24
Q

6 groups of Rxs used to treat IBD

A

1) Aminosalicylates
2) Corticosteroids
3) Immunosuppressants
4) TNF inhibiotrs
5) Antibiotics
6) Probiotics

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25
Q

Aminosalicylates

A

these drugs contain 5-aminosalicylic acid (5-ASA)

used for the induction and maintenance of remission

used for the induction and maintenance of remission

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26
Q

Two types of aminosalicylates

A

Mesalamine

Azo compounds

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27
Q

Mesalamine (5-ASA) RXs

A

5-ASA alone

Pentasa: time release formulation- SMALL INTESTINE

Asacol- pH in DISTAL ILEUM AND PROXIMAL COLON dissolve it

Rowasa or Canasa: apply at anus RECTUM and SIGMOID COLON- enema

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28
Q

Azo Compounds

A
  • 5-ASA bound to another molecule
  • binding allows it to get through stomach
  • broken down in ileum and colon
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29
Q

what enzyme breaks down Azo compounds in the ileum and colon?

A

azoreductase

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30
Q

Azo RXs

A

Sulfasalazine (Azulfidine) breaks down into 5 ASA and sulfapyridine

Olsalazine (Dipentum) breaks down into 5-ASA & an inactive compound

Balsalazide (Colazal)- 5-ASA & inactive compound

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31
Q

Aminosalicylates whould not be administered with what?

A

antacids, change in pH cause premature dissolution and coating

32
Q

MOA of Aminosalicylates

A

of 5- ASA works topically on the surface of the intestine to inhibit prostaglandins and other mediators of inflammation.

33
Q

5-ASA inhibits which inflamatory mediators?

A

1) IL-1
2) TNF alpha
3) prostoglandins

34
Q

Clinical uses of Aminosalicylates

A

Ulcerative colitis- first line for mild to moderate ulcerative colitis, induces and maintains remission

35
Q

Sulfasalazine

A

5-ASA

Sulfasalazine- highest incidence of side effects due to absorption of sulfapyridine

36
Q

Sulfasalazine ADRs

A

arthralgias
bone marrow suppression
SJS

37
Q

Antibiotics used in IBS particulary Crohn’s

A

Metronidazole (Flagyl)
Ciprofloxacin (Cipro)
Rifaximin (Xifaxan)

38
Q

Glucocorticoids For Inflammatory MOA

A

suppress inflammation

inhibits production of inflammatory cytokines

39
Q

Clinical uses of steroids in IBD

A

: moderate to severe active inflammatory bowel, once in remission, taper and try not to use for maintenance

40
Q

Steroids RX

A

oral prednisone
hydrocortisone enemas
Budesonide

41
Q

Budesonide

A

15 times more potent than prednisone

Can be used on a daily basis, only works in the bowel

high first-pass metabolism allow for a 2 week overlap when changing from prednisone to budesonide

42
Q

Budesonide RXs

A

Entocort

Uceris

43
Q

Entocort

A

for mild to moderate Crohns

44
Q

Uceris

A

for mild to moderate UC

45
Q

Immunomodulatory Agents

A

Azathioprine & Mercaptopurine

Methotrexate

Cyclosporine

Tacrolimus

46
Q

Azathioprine & Mercaptopurine USE and MOA

A

maintain remission in both ulcerative colitis and Crohn’s

inhibit purine synthesis; anti-proliferative effects and induce t-cell apoptosis

47
Q

Methotrexate-Use and MOA

A

-one day/week
-Used for moderate to severe steroid-dependent and steroid resistant Crohn’s
MOA: inhibits DNA synthesis and causes cell death

48
Q

Cyclosporine

A

-patients w/ severe steroid resistant UC

49
Q

Tacrolimus

A

Alternative to cyclosporine

50
Q

Meds for IB biologic agents

A

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

-mab- all target TNF

Used for moderate to severe ulcerative colitis and/or crohns’

51
Q

Antiemetics

A

One drug usually enough if simple nausea and vomiting

52
Q

Pathophysiology of vomiting

A

A vomiting center is located in the brainstem, when stimulated it tells the stomach to contract & expel contents.

This center has muscarinic, histamine & serotonin receptors. Drugs that block these receptors can have an antiemetic effect.

53
Q

areas that trigger vommiting

A

Chemoreceptor trigger zone: outside the blood brain barrier : dopamine, opioid, serotonin, & neurokinin receptors

Vestibular system: muscarinic & histamine receptors

Pharyngeal area: gag reflex

GI tract

54
Q

Major Antiemetic Rx Groups

A 
Serotonin 5HT3 antagonists 
Corticosteroids  
Phenothiazines
Benzamides
Anti-histamines
Scopolamine
Dronabinol
55
Q

Serotonin 5HT3 Antagonists MOA

A

Block receptors at chemoreceptor trigger zone

56
Q

Serotonin 5HT3 Antagonists Clinical Use

A
  • acute chemo

- radiation

57
Q

ADR of Serotonin 5HT3 Antagonists

A

Prolonged QT

58
Q

Serotonin 5HT3 Antagonists RXs

A

Ondansetron (Zofran)
Granisetron (Kytril)
Dolasetron (Anzemet)
Palonosetron (Aloxi)- chemo therapy

59
Q

Corticosteroid antiemetic RXs

A

Dexamethasone & prednisone

60
Q

Dexamethasone & Cortecosteroid antiemetic use

A

Acute & delayed N,V due to chemotherapy

make 5HT3 work better when used in combination

61
Q

Phenothiazines

A

anti-psychotics and very sedating, also are potent anti-emetics

Most effective in simple N,V

SEDATION

62
Q

Phenothiazines RXs

A

-antipsychotics

Prochlorperazine (Compazine)
Promethazine (Phenergan)

63
Q

Phenothiazine Black Box

A

contraindicated if 2years old b/c of fatal respiratory suppression

64
Q

Benzamides RXs

A

Metaclopramide (Reglan)

Trimethobenzamide (Tigan)

65
Q

benzamides MOA and ADR

A

-dopamine receptor blockade

ADR- Parkinson like syndrome

66
Q

Anti-Histamines Clincial use and ADR

A

-motion sickness

ADR- Anticholinergic effects, sedating

67
Q

RXs Anti-histamines

A

Diphenhydramine (Benadryl)
Dimenhydrinate (Dramamine)
Meclizine (Antivert)
Doxylamine (Unisom)

68
Q

Hyoscine

A
  • antihistamine/antichlolinergic
  • best for motion sickness
  • apply patch 4 hrs before travel
  • up to 72 hrs
69
Q

Dronabinol (Marinol)

A

THC
chemo
increases appetite

70
Q

Simple N,V

A

use phenothizine

71
Q

post chemo

A

use multiple meds

72
Q

Prokinetic Agents

A
  • increases gut motility

- GERD b/c move acid out of stomach so less in esophagus, gastroparesis

73
Q

2 RXs of Prokinetics

A

Cholinomimetics

Metoclopramide

74
Q

Cholinomimetics MOA

A

Stimulate cholinergic receptors on muscles cells & myenteric plexus, increasing GI motility

75
Q

Neostigmine

A

Cholinomimetics

IV in hospital for acute pseudo-obstruction. Moves bowel but get a lot of GI side effects

76
Q

Metoclopramide (Reglan) MOA

A

MOA: Dopamine receptor antagonist that causes increased esophageal peristalsis, increased lower esophageal sphincter pressure, increased gastric empting

77
Q

Clincial use Metoclopramide and ADRs

A
  • GERD- use w/ H2s and PPIs
  • Diabetic gastroparesis
  • mildly effective anti-emetic b/c of dopamine receptors on chemoreceptor trigger zone

ADR- antipsycotic CNS, tardive dyskinesia, extrapyramidal effects

PHARM EXAM 2 (3 decks)

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