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Pharmacology (Dale Turley) > Octreotide, Loperamide, Creon, URSO, Ribavirin, Rifaximin, Hemorrhoid agents > Flashcards

Octreotide, Loperamide, Creon, URSO, Ribavirin, Rifaximin, Hemorrhoid agents Flashcards

1
Q

Octreotide class?

A

Sandostatin

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2
Q

Octreotide sub-class?

A

diarhea, other endocrine / metabolism

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3
Q

What is Octreotide?

A

Man-made protein that is similar to a natural hormone in the body called somatostatin

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4
Q

Octreotide MOA?

A

Somatostatin antagonist

inhibits multiple hormones including growth hormone, glucagon, insulin, LH, and vasoactive intestinal polypeptide (VIP)

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5
Q

Octreotide MOA cont..?

A

Reduce blood flow

Inhibit gastric acid secretion

May have gastric cytoprotective effects

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6
Q

Indications for Octreotide?

A

Management of variceal bleeding

Used as adjunctive therapy before endoscopy, or when endoscopy is unsuccessful, contraindicated, or unavailable

Also used for acromegaly, carcinod tumor symptoms, diarrhea

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7
Q

Octreotide pharmacokinetics?

A

Metabolized liver CYP450

Half-life 1-2 hrs (increased by age, liver disease) cirrhosis

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8
Q

Octreotide cautions and interactions that must be considered?

A

Hepatic, Renal, Biliary disease

Arrhythmias, HTN, CHF exacerbation

Diabetics – hyperglycemia (endocrine and VIP actions)

Many drug-drug interactions

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9
Q

Octreotide pregnancy cat?

A

B

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10
Q

Octreotide facts?

A

Means to help stabilize patients before definitive therapy can be performed

Given IV 50mcg/hr

Unknown lactation

Peds with close monitoring

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11
Q

loperamide (Imodium)
 Class?

A

Anti-diarrheal’s

Opiate

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12
Q

Indictions for loperamide (Imodium)
?

A

diarrhea

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13
Q

loperamide (Imodium)
 MOA?

A

Inhibits peristalsis by direct effect on circular and longitudinal muscles of the intestinal wall

Increases viscosity and bulk

Diminishes loss of fluid and electrolytes

Increases sphincter tone

No analgesic opioid effect

Anticholinergic effects

**low K you need to check magnesium level , K based medications watch drug interactions *

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14
Q

loperamide (Imodium)
 dosing?

A

2 mg PO per dose
Start: 4 mg PO x1, then 2 mg PO after each loose stool; Max: 16 mg/day

Peds dosing by age

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15
Q

loperamide (Imodium)
 Pharmacokinetics?

A

Metabolized by Liver CYP450

Half-life 10 hr

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16
Q

loperamide (Imodium)
 interactions and cautions?

A

Toxic megacolon / paralytic ileus

Avoid with potassium based
drugs

Many drug-drug interactions

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17
Q

loperamide (Imodium) pregnancy cat?

A

C

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18
Q

loperamide (Imodium) special populations?

A

Lactation probably safe

Monitor in lever disease – toxicity

Peds dosing based on age parameters over 2 years old

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19
Q

Drugs Treating Pancreatic Insufficiency?

A

Pancrelipase (Creon, Pancreaze)

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20
Q

Pancrelipase (Creon, Pancreaze)

class?

A

Digestive Enzymes

pancreatic enzyme replacement products (PERPs)

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21
Q

Pancrelipase (Creon, Pancreaze)
 MOA?

A

commercial mixture of pig-derived pancreatic amylase, lipase and chymotrypsin

Pills disintegrate into trypsin, amylase, and lipase, which break down proteins, carbohydrates, and fats

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22
Q

Pancrelipase (Creon, Pancreaze)
 indications?

A

Exocrine pancreatic insufficiency

Chronic pancreatitis

Cystic fibrosis have increased incidence of pancreatic insufficiency

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23
Q

Pancrelipase (Creon, Pancreaze) story?

A

Along with food, the CREON capsule enters the stomach.

Capsule releases enteric-coated spheres sized between 0.7 and 1.6 mm in diameter.

Enteric coating allows the spheres to travel beyond the low pH of the stomach through the pylorus, releasing enzymes into the small intestine at a pH ≥5.5.

CREON enteric-coated spheres dissolve in the small intestine, releasing pancreatic enzymes to mix with food.

CREON replaces enzymes missing in patients with EPI. In the small intestine, these enzymes work to break down fats, proteins, and carbohydrates in food.

24
Q

Pancrelipase (Creon, Pancreaze) dosing?

A

Dosing

500-2500 lipase units/kg PO w/ meals/snacks
Peds dosing by age / weight

25
Q

Pancrelipase (Creon, Pancreaze) pharmacokinetics?

A

Metabolized in GI tract, minimal systemic

Half-life unknown

26
Q

Pancrelipase (Creon, Pancreaze) interactions and cautions?

A

Pork allergy (Porkinetics aka Prokenetics)

Gastric pH sensitive ( voided by concomitant use acid reducers)

Caution with Gout, Renal Dz, Crohns Dz

27
Q

pancrelipase (Creon, Pancreaze) pregnancy cat?

28
Q

pancrelipase (Creon, Pancreaze) special populations?

A

Lactation safety unknown

Peds dosing by age including infants

29
Q

Ursodiol (Urso 250) class?

A

Hepatobiliary

30
Q

Ursodiol (Urso 250) MOA?

A

decreases cholesterol synthesis, secretion, and absorption

alters bile cholesterol composition (dissolve gallstones)

31
Q

Indications for using Ursodiol (Urso 250)?

A

primary biliary cirrhosis

steatohepatitis, non-alcoholic

primary sclerosing cholangitis

32
Q

Ursodiol (Urso 250) dosing?

A

Primary biliary / sclerosing cirrhosis

Steatohepatitis (non-alcoholic)

33
Q

Pharmacokinetics for Ursodiol (Urso 250)?

A

Metabolized by liver CYP450

Half-life unknown

34
Q

Ursodiol (Urso 250) interactions and cautions?

A

jaundice
LFTs elevated
leukopenia
thrombocytopenia

35
Q

Ursodiol (Urso 250) pregnancy category?

36
Q

Ursodiol (Urso 250) special populations?

A

Pregnancy Cat. B
Lactation unknown
Ped’s not available

37
Q

Treatment of HCV Infection?

A

Ribavirin (RBV, Rebetol)

38
Q

Ribavirin (RBV, Rebetol)

MOA?

A

Inhibits viral RNA polymerase inhibiting protein synthesis

Combined with interferon therapy

Not for monotherapy

39
Q

Ribavirin is often combined with ?

A

interferon therapy

Not for monotherapy

40
Q

BBW for Ribavirin (RBV, Rebetol)?

A

Hemolytic anemia

May worsen cardiac disease

teratogenic

41
Q

Ribavirin (RBV, Rebetol)

pharmacokinetics?

A

Metabolized CYP450

42
Q

_________ must be used together with an_______________(such as Pegasys, PegIntron, Sylatron, or Intron A) to treat chronic hepatitis C.

A

Ribavirin

interferon alfa product

43
Q

Ribavirin (RBV, Rebetol)

for HCV information?

A

Dose: 400-700 mg PO bid

dose may depend on wt;

AASLD/IDSA hepatitis C guidelines

Give w/ food

peginterferon alfa 2a combo

Caution with pts w/ CrCl <30

Refer to AASLD/IDSA hepatitis C guidelines

44
Q


Rifaximin (Xifaxan)
 class?

A

anti-diarrheal, other antibacterial

45
Q


Rifaximin (Xifaxan)
 MOA?

A

bacteriostatic; inhibits DNA-dependent RNA polymerase

46
Q

Indications to use 
Rifaximin (Xifaxan)
?

A

Travelers diarrhea, E. coli-induced

IBS, diarrhea-predominant

47
Q

Pharmacokinetics of 
Rifaximin (Xifaxan)
?

A

Liver CYP450

Half-life 6 hr

48
Q

Interactions and cautions that use be considered if using Rifaximin ( Xifaxam)?

A

C. difficile-assoc. diarrhea (optional)

Superinfection

peripheral edema

Nausea, dizziness, fatigue, ascites, headache, muscle spasms, pruritus, abdominal pain

*can create another suer infection in the gut *

49
Q


Rifaximin (Xifaxan)
 pregnancy category?

A

Avoid 1st trimester otherwise probably safe

Lactation unknown

50
Q

Hemorrhoid Care medication example?

51
Q

What form does Anusol come in?

A

creams, ointments, and the suppository form

52
Q

Active ingredient in Anusol ointment and suppositories is __________________.

A

zinc sulfate monohydrate

53
Q

Anusol plus is zinc sulfate monohydrate and pramoxine HCL which is _________

A

antipruritic

54
Q

Anusol HC suppositories?

A

added steroid

55
Q

hydrocortisone/ lidocaine topical dose for hemorrhoid care?

A

Dosage forms: 0.5%/3%,1%/3% crm; 2.5%/3% gel

Pharmacology (Dale Turley) (31 decks)

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