Jen's GI pharm Flashcards
Bind bile acids and inhibit peptic activity. Promote angiogenesis in injured mucosa. Heavy metals suppress H. pylori
antacids
General class of pharm treatment that antacids interfere with
antibiotics
Inhibit acid secretion by blocking histamine H2 receptors on the parietal cell
MOA of H2 blockers
Can rarely cause gynecomastia and impotence, oolymyositis, Interstitial nephritis. Cleared through the P450 system so has multiple drug interactions
Cimetidine
Prevents chemical induced mucosal damage. Heals chronic ulcers
Sulcralfate (Carafate)
Binds to the ulcer base best at a pH below 3.5 so should be administered 30-60 min prior to meals
Sulcralfate (Carafate)
Should not be administered in combination with aluminum antacids in patients with renal failure. No administration w/citrate containing compounds
Sulcralfate (Carafate)
What is the suffix for all proton pump inhibitors?
-azole
What are the generic names for the proton pump inhibitors?
Prilosec, prevacid, protonix, nexium, kapidex, aciphex
MOA of proton pump inhibitors
blocks acid secretion of parietal cells
At what time of day should PPIs be admininstered?
before the first meal of the day
PPI with the lowest potential for P450 drug interactions
Pantoprazole (Protonix)
PPIs metabolized via CYP2C19 and have the greatest potential for drug interactions
Omeprazole (Prilosec, Zegrid) and esomeprazole (Nexium)
Common blood thinner that has a significant interaction with omeprazole
clopidogrel (Plavix)
Long term administration of PPIs may increase the incidence of what two infections
c. difficile and pneumonia
Long term administration of PPIs may lead to the malabsorption of what dietary elements?
B12, Mg+ (magnesium), and Fe (iron)
Suppresses H. pylori infection. Not helpful in treatment of non H pylori induced ulcers
Bismuth
Inhibition of peptic activity but not pepsin secretion. Recruits macrophages to the edge of the ulcer crater to promote healing
Bismuth
First line therapy for gastroparesis for no longer than 12 weeks unless benefits outweigh risks
Metaclopramide (Reglan)
Improves gastric emptying by increasing gastric antral contractions and decreasing postprandial fundus relaxation
Metaclopramide (Reglan)
Dopamine receptor antagonist. 5-HT4 agonist. Weak 5-HT3 receptor antagonist
Metaclopramide (Reglan)
Extrapyradimal side effects associated with metaclopramide (Reglan)
dystonia and tardive dyskinesia
Name the phenothiazines that can be used as antiemetics because of their effects as dopamine receptor antagonists
Prochlorperazine (Compazine) and Promethazine (Phenergan)
What is the treatment for EPS side effects that can be caused by phenothiazines?
Benadryl or Cogentin
Which phenothiazein has a higher incidence of EPS side effects?
Prochlorperazine (Compazine)
Great for postoperative and chemotherapy induced emesis. Does poor job with vestibular system etiology. Commonly given 30” prior to chemo tx.
Serotonin 5-HT3 Antagonists
What is the suffix for Serotonin 5-HT3 Antagonists?
-setron
What are the generic names for Serotonin 5-HT3 Antagonists?
Zofran, Kytril, Anzemet, Aloxi
caution for serotonin syndrome, QT prolongation, monitor liver function tests if prolonged use
Odansetron (Zofran)
What is the antiemetic that is also good for treating pruritis?
Hydroxyzine (Atarax, Vistaril)
Contraindications for the use of Antihistamines/Anticholinergcs as antiemetics
narrow angle glaucoma, asthma, prostatic hypertrophy
Only for symptomatic treatment of patients with acute diarrhea in whom fever is absent or low grade and the stools are not bloody
Loperamide (Imodium)
Bile acid-binding agent used for hyperlipidemia. Good for diarrhea post-cholecystectomy
Cholestyramine (Questran)
First line pharmacotherapy for the treatment of constipation
Psyllium (Metamucil) and Ducosate sodium (Colace)
First line pharmacotherapy for the treatment of constipation used for infants
Glycerin
Not systemically absorbed. Bind to the fecal contents and pull water into the stool. Softens and lubricates the stool. NEEDS TO BE TAKEN WITH WATER
Bulk forming agents (ie Metamucil)
What bulk forming agent can decrease absorption of tetracycline and quinolones?
Fibercon
Surfactant laxatives. Reduces the surface tension of the liquid contents of the bowel. Commonly referred to as “stool softeners”
Ducusate derivatives
Use for patients who should not strain with bowel movements and for those on narcotics. Only prevent constipation – don’t treat
Ducusate derivatives
Is a saline laxative. Draws water into the bowel through osmosis. Increases intraluminal pressure & motility.
milk of mangesia
Use if failed bulk forming agents, mangnesium hydroxide (MOM). Hyperosmotic laxatives. Use with caution in diabetics
Lactulose or sorbitol
Not for long term use. Increase peristalsis through direct effects on the smooth muscle of the intestines. Promote fluid accumulation in the colon and small intestine
Senna (Senokot) and Bisacodyl (Dulcolax)
Contraindications to Senna (Senokot) and Bisacodyl (Dulcolax)
surgical abdomen, fecal impaction
Used for bowel prep for endoscopy procedures
Magnesium citrate
Considered best for colonic disease, although also considered 1st line therapy for Crohn’s
Sulfasalazine (Asulfidine)
Often used with proximal intestinal Crohn’s
Mesalamine (Asacol, Pentasa)
Blocks prostaglandin production. Perhaps interferes with production of inflammatory cytokines. May inhibit natural killer cells, lymphocytes and macrophages
aminosalicylates
Immune modulator with short half life that is pregnancy category D
6-mercaptopurine
Has drug toxicity with concurrent use of Allopurinol
immune modifiers
Immune modifier that is pregnancy category X and Inhibits the metabolism of folic acid
methotrexate
Name the TNF inhibitor that neutralizes TNF that is a last ditch effort in severe Crohn’s
Infliximab (Remicade)
Black box warning of Infliximab (Remicade)
Reactivation of latent TB
