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Final Exam Pharm > Mixed Bag > Flashcards

Mixed Bag Flashcards

1
Q

Name the GI Motility Inhibitors

A

Opiates and Anticholinergics
- diphenhydramine and atropine (Lomotil)
- loperimide (Immodium)
MOA; slows intestinal motility
AE; Sedation; dry mouth; constipation

Bulk formers
- psyllium (Metamucil) - decreases fluidity of stool; absorbs water and forms mass

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2
Q

Laxative Issues

A

often abused because misconception about daily stool

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3
Q

Three laxative examples

A

psyllim (metamucil)
methylcellulose (Citrucel)
polycarbophil (Fibercon)
MOA; absorbs water and forms a soft bulky mass
- best for long term use and not acute constipation
-72 hours to work
-must give with water
-bloating and flatus common

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4
Q

docusate sodium (Colace)

A

MOA: lowers surface tension and allows water to penetrate into stool; softens stools
- main value is to prevent straining

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5
Q

Name stimulant laxatives (3)

A

bisacodyl (Dulcolax)
senna (Senokot)
phenolphthalein (Ex-Lax)
MOA; stimulate GI motility and pull water into bowel.

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6
Q

Stimulant laxative considerations

A

Produces fluid stool in:
-PO 6-12 hours
-suppository 15-60 minutes
most abused laxatives causing elyte imbalance
- do not use longer than a week

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7
Q

Saline Cathartics

A

polyehtylene glycol elyte solution (golytely)
PEG 3350 miralax
Mg Citrate

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8
Q

Lactulose

A

Used to excrete ammonia from chronic liver disease

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9
Q

lubiprostone (Amitiza)

A

Notconsidered alaxative
*
Adults ONLY: Tx ofchronicidiopathicconstipation inadults&IBS(irritable bowelsyndrome)
*
Impacts chloride channels;increasingintestinalfluid secretion &motility
*
Fairlywell tolerated except nausea is sometimes aproblem

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10
Q

linaclotide (Linzess)

A

Activates guanylate cyclase-C, stimulating cGMPproduction&increases intestinalfluidsecretion & motility
*
Adults ONLY: chronicconstipation &IBS(irritable bowel syndrome)
*
QDdosing; take 30minbefore breakfast (taking withfood may cause loose stools)
*
AEs: abdcramping, diarrhea, abddistention

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11
Q

Antiemetic Centers and focus

A
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12
Q

Phenothaizines used as antiemetics

A

*
Common Drugs:
*
promethazine(Phenergan)
*
prechlorperazine(Compazine)
*
MOA:
*
Decrease responseoftheCTZ byinhibitingdopaminergicreceptors
*
AE:
*
Sedation
*
Anticholinergiceffects
*
Hypotension
*
Extrapyramidaleffects athighdoses-rare(dyskinesias–slowrhythmicalmovements; dystonia–facialgrimace,torticollis)
*
Black Box Warning: contraindicated in children < 2yo due to respiratory depression

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13
Q

Phenothaizine black box warning

A

Not given to children less than two; does not work on motion sickness

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14
Q

antihistamines & anticholinergics for N/V

A

Common Drugs:
*
diphenhydramine(Benadryl)
*
dimenhydrinate(Dramamine)
*
hydroxyzine(Vistaril)–goodforanxiety,sleep,itching
*
meclizine(Antivert)–goodformotionsickness
* scopolamine(TransDermScop)– (anticholinergic)changeq3days;applybefore travel
* MOA:
* Blockhistamineandcholinergicreceptorsprojectingtothevomitingcenter
*
Best agentsof motionsickness
*
AE:
*
Drowsiness
*
Anticholinergic(blurred vision, urinary retention, dry mouth,constipation, confusion)

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15
Q

Selective Serotonin Agonist used for N/V

A

ondansetron (Zofran)
MOA; Blocks serotonin 5-HT3 receptors

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16
Q

Prokinetic Agents - Example and MOA

A

metoclopramide (Reglan)Common Drugs:
*
diphenhydramine(Benadryl)
*
dimenhydrinate(Dramamine)
*
hydroxyzine(Vistaril)–goodforanxiety,sleep,itching
*
meclizine(Antivert)–goodformotionsickness
* scopolamine(TransDermScop)– (anticholinergic)changeq3days;applybefore travel
* MOA:
* Blockhistamineandcholinergicreceptorsprojectingtothevomitingcenter
*
Best agentsof motionsickness
*
AE:
*
Drowsiness
*
Anticholinergic(blurred vision, urinary retention, dry mouth,constipation, confusion)

17
Q

N/V; Antiemetics - corticosteroids

A

dexamethasone (Decadron)

18
Q

Peptic Ulcer Disease Overview

A
19
Q

PUD Continued

A
20
Q

Antacids

A

MOA; Raise pH above 3.5 in order to prevent conversion of pepsinogen to pepsin

21
Q

Antacids AE

A

*
Antacids
*
AE:
*
Diarrhea (magnesium)
*
Constipation (calcium & aluminum )
*
Rebound hyperacidity (calcium)
*
Hypermagnesium (magnesium…avoid in renal failure patients)
*
Sodium retention (ie, baking soda, alka‐seltzer effervescent tab…caution with hypertension & HF)
*
Considerations:
*
separate from other meds by 2 hours
*
liquids preferred (increase surface area; chew tablets)

22
Q

H2 Receptor Antagonist Common Drugs

A

Common Drugs:*
cimetidine (Tagamet) – interactions with P‐450; many drug‐drug interactions
* famotidine (Pepcid)
* ranitidine (Zantac)

23
Q

Proton pump inhibitors

A

*
Binds with H, K, ATPase to prevent the “pumping” or release of gastric acidinto the stomach lumen & therefore blocks the final step in acidproduction
*
Suppresses gastric acid secretion in response to all primary stimuli(histamine, gastrin, & acetylcholine)
*
Strong inhibitor of gastric acid secretion

24
Q

Common PPI

A

omeprazole (Prilosec)
pantoprazole (Protonix)
lansoprazole (Prevacid)

25
Q

PPI MOA

A

*
Binds with H, K, ATPase to prevent the “pumping” or release of gastric acidinto the stomach lumen & therefore blocks the final step in acidproduction
*
Suppresses gastric acid secretion in response to all primary stimuli(histamine, gastrin, & acetylcholine)
*
Strong inhibitor of gastric acid secretion

26
Q

PPI Considerations

A

Considerations:
*
Ideally should be taken 30‐60 min prior to other medications, breakfast or evening meal
* Warnings:
*
increased risk of osteoporosis & fractures (esp high dose, long‐term, >50 yo, female & other risk factors)
* Due to calcium needs an acidic environment for optimal absorption
*
may cause hypomagnesium (esp long‐term use >1 yr)
*
may predispose to c diff (long‐term use)
*
May also interfere with absorption of iron & vitamin B12 (due to acidic environment needed for optimal absorption)

27
Q

sucralfate (Carafate)

A

*
MOA:
*
An aluminum sucrose complex which binds to damaged tissue forming aprotective barrier that promotes healing
*
Does NOT alter acidity; mechanical barrier only!
*
Give on empty stomach 1 hour before meals & HS (admin multiple times/day)
*
Can decrease absorption of other meds; should be taken alone
*
Can cause constipation

28
Q

Prostaglandin E1 Analog

A

Prostaglandins E produced in mucosal cells of the stomach & duodenum, inhibitis gastric acidsecretion, increases mucous & bicarb and increases mucosal blood flow

29
Q

misoprostal (Cytotec)

A
  • MOA:

Enhances mucosal barrier by stimulating mucus and bicarbonate secretion. Used for NSAID induced injury to stomach.
Replaces protective prostaglandins which are used with NSAID therapy

Used with high risk pts: using high doses NSAIDs, >65 yo, hx GI bleed
*AE:
Diarrhea
Contraindicated in pregnancy (category X) –stimulate uterine contractions

30
Q

H pylori Rx

A

*
Combination therapy of at least:
2 antibiotics PLUS
1 acid suppressor (PPI or H2 blocker)
Usually 14 days
Ex:
PPI BID +
Clarithromycin BID +
Amoxicillin BID

31
Q

GERD

A
  • Antacids
  • H2 blockers
  • PPIs
    *
    Treatment of choice
    *
    Take in am before breakfast
    *
    If insufficient response, add second dose prior to dinner
    *
    Prokinetic agents
32
Q

Explain reverse transcriptinase

A
33
Q

Cimetidine side effects

A

-impotence and swelling of the breasts
-increased prolactin release
- inhibition of CYP450 enzymes which slow the metabolism of many drugs (warfarin & propranolol)

Final Exam Pharm (12 decks)

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