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Pharm 23 Objectives Flashcards

1
Q

Describe the physiology of the protective gastric mucosal layer

A

secreted by gastric mucosal cells, protective layer.

blood flow vitally maintains mucosal barrier

tight junctions –> relatively impermeable to acid

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2
Q

Describe the physiology of the protective gastric epithelium

A

Epithelial regeneration - rapid cell turnover

The epithelium of the mouth and stomach –> most frequently replaced cells in the body

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3
Q

Prostaglandins effects on gastric acidity

A

Inhibit gastric acid secretion by the parietal cell

Enhance mucosal defense mechanisms (bicarb)

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4
Q

Misoprostol MOA

A

Synthetic PGE1 analog

Inhibits basal and nocturnal gastric acid secretion via direct action on parietal cell

Stimulates mucosal protectant effect

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5
Q

What pregnancy category does Misoprostol fall under?

A

Category X

can cause miscarriage, uterine contraction, and teratogenic.

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6
Q

Indication for Misoprostol?

A

Indicated for NSAID induced gastric ulcer prophylaxis

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7
Q

ASES of Misoprostol?

A

Diarrhea, dose-dependent abdominal pain, headache, flatulence, n/v

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8
Q

List and compare measures to prevent GI ulcers in patients who take NSAIDs long term

A

Find an alternative to systemic NSAIDs

Add Misoprostol or PPI to and NSAID (reduce risk for GI bleed)

Choose a COX-2 selective NSAID

Reduce direct irritation of the GI mucosa (ie. DR tabs and prodrugs)

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9
Q

What is the role of gastrin that stimulates parietal cell acid secretion?

A

Released in response to stomach distension and Ach

Increases intracellular calcium levels in parietal cells

Acids in the stomach is a negative feedback on gastrin release

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10
Q

What is the role of pepsin that stimulates parietal cell acid secretion?

A

Most active at pH 2.0

Becomes progressively less active at higher pH

Irreversibly inactive at pH of 8

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11
Q

What is the role of acetylcholine that stimulates parietal cell acid secretion?

A

Released in response to amino acids in foods and stomach distention

Increase intracellular calcium levels in parietal cells

The most potent stimulator of pepsinogen secretion from chief cells

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12
Q

What is the role of Histamine that stimulates parietal cell acid secretion?

A

Release of histamine is stimulated by Ach and gastrin

The most potent stimulator of gastric acid secretin

Receptor = Gs protein linked —> increase cAMP

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13
Q

What is the role of H+/K+-ATPase that stimulates parietal cell acid secretion?

A

Stimulated via protein kinases

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14
Q

MOA of antacids

A

Increases pH

Inactivated pepsin (at least temporarily)

Bind bile salts

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15
Q

Adverse effects of antacids?

A

Diarrhea, constipation, acid-base disruption and excessive sodium intake, drug interactions that can result in treatment failures:
- mostly chelation issues, which prevents absorption of both drug and mineral

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16
Q

Clinical use/effectiveness of antacids?

A

Rapid onset and short duration of action

Rapid relief

OTC and inexpensive

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17
Q

Molecular formula of calcium carbonate

A

CaCO3

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18
Q

Molecular formula of magnesium hydroxide

A

Mg(OH)2

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19
Q

Molecular formula of sodium bicarbonate?

A

NaHCO3

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20
Q

Mg(OH)2 is frequently added to what?

A

Calcium or aluminum to be constipation neutral

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21
Q

H2 receptor antagonist (H2RA) drug names?

A

Ranitidine

Famotidine

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22
Q

H2 receptor antagonist (H2RA) efficacy?

A

Strongest stimulator of parietal cell

Reduce total volume of gastric juice –> decreasing pepsin secretion

1st line for GERD

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23
Q

H2 receptor antagonist (H2RA) FDA indications?

A

Duodenal ulcer disease

Erosive esophagitis

Gastric hypersecretion

Gastric ulcer

GERD

H. pylori gastrointestinal tract infection, Indigestion

Zollinger-Ellison syndrome

Night time symptoms

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24
Q

H2 receptor antagonist (H2RA) pharmacokinetics?

A

First mass metabolism –> reduces bioavailability 30-60%

Do cross the BB

Are excreted in breast milk

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25
H2 receptor antagonist (H2RA) onset of action?
Peak [ ] in serum in 1-3 hrs
26
H2 receptor antagonist (H2RA) drug interactions?
Cimetidine - gynecomastia, heart rate changes (brady (MC) or tachy) Nizatidine - insomnia, somnolence, anemia
27
H2 receptor antagonist (H2RA) common ASEs?
``` Headache Diarrhea N/V Constipation Vertigo/dizziness Fatigue Confusion ```
28
H2 receptor antagonist (H2RA) severe ASEs?
Organ impairment/toxicity: | - hepatic, cardiac, pancreatic, renal
29
H+/K+ ATPase (PPI) efficacy?
More effective and longer lasting effects than H2RAs/antacids. Suppress daytime, nocturnal, and meal stimulated acid secretion
30
H+/K+ ATPase (PPI) FDA indications?
Erosive esophagitis GERD Duodenal ulcer H. Pylori
31
H+/K+ ATPase (PPI) pharmacokinetics?
Short half lives metabolize by the liver by CYP2C19 and CYP3A4 to inactive metabolites
32
H+/K+ ATPase (PPI) onset of action?
0.6 - 1.9 hrs
33
H+/K+ ATPase (PPI) drug interactions?
Ketoconazole Amphetamines Citalopram Clopidogrel
34
PPI + ketoconazole causes?
May impair the GI absorption of ketoconazole leading to loss of therapeutic effect. (drink coke if need to take the two together)
35
PPI + Amphetamines causes?
Increases the absorption of amphetamine
36
PPI + citalopram causes?
Citalopram tox: serotonin syndrome, QT prolongation.
37
PPI + clopidogrel causes?
PPI may decrease serum [ ] of the active metabolites of clopidogrel.
38
H+/K+ ATPase (PPI) ASEs?
"GI" side effects HA Hypomagnesemia (long term use) Gastric atophy Iron and B12 deficiencies Hypersensitivity rxn: immunologic, dermatologic, hematologic, hepatic manifestation.
39
H+/K+ ATPase (PPI) appropriate duration?
2 wks, 4wks, up to 8-12 wks | - lowest effective dose for the shortest duration possible.
40
What is hypergastrinemia caused by a PPI?
High gastrin [ ] in the blood. | - cellular and hormonal changes that increase gastric acid secretion capacity.
41
Sucralfate MOA?
Reacts with HCl Adherent, paste-like substance, an acid buffer Binds electrostatically to proteins on ulcer surface (protective barrier)
42
Sucralfate proper dosing?
1 gram QID on empty stomach for 4 weeks Acid neutralizers should not be taken within one-half hour before or after administration Avoid H2RAs, fluroquinolones, tetracyclines, or digoxin within 2 hours before administration
43
Sucralfate ASEs?
Potential aluminum toxicity with long term use, esp. in patient with kidney dysfunction Hypophosphatemia Flatulence HA
44
Safe and effective therapeutic treatment of PUD w/ H pylori?
MC = the PPI-based 3-Drug Regimen - first choice if local resistance is low. 3 Drugs = 1 Acid Reducer + 2 Antibiotics - Amoxicillin, clarithromycin, lansoprazole - Amoxicillin, clarithromycin, omeprazole Pts w/ penicillin allergy: used metronidazole over amox.
45
Safe and effective therapeutic treatment of PUD w/ dyspesia?
Acid suppression: Antacids, H2RAs, PPIs
46
Safe and effective therapeutic treatment of PUD w/ GERD phase 1?
phase 1: | - OTC antacids, H2RA, or PPI x2 wks
47
Define what a “prokinetic” drug would do?
increases GI transit rates
48
Describe the relative lack of availability of “prokinetic” agents within the U.S.
Reported CV deaths
49
Metoclopramide MOA
Promotes motility in upper GI tract, sensitizes tissues to ACh action w/o stimulation of gastric secretions. Decreases the flow in the esophageal varices causing a reduction in variceal pressure Dopamine (D2) central and peripheral receptor inhibition w/o antipsychotic or tranquilizing activity Weak 5-HT3 receptor antagonism
50
Metoclopramide clinical use
GERD Relief of symptoms in adults with acute and recurrent diabetic gastroparesis Chemotherapy-induced or postoperative nausea/vomiting MAX 12 wks
51
Metoclopramide ASEs
Tardive dyskinesia (BB warning) Headache, somnolence, fatigue, N/V
52
Production of serotonin?
Tryptophan - 5-HTP (5-hydroxytryptophan) ---> 5-HT (5-hydroxytryptamine) = serotonin
53
Distribution of serotonin?
95% in GI tract of the 95%: - 90% is in Enterochromaffin cells - 10% is in Enteric neurons
54
Metabolism of serotonin through pineal gland?
``` Serotonin (5-HT) ---> pineal gland ---> melatonin ---> 6-sulfaoxymelatonin ```
55
Metabolism of serotonin through MAO?
``` Serotonin (5-HT) ---> MAO ---> 5-hydroxyindolacetic acid ```
56
Location of serotonin receptors?
Gut has 7 types of receptors - Gut: increase tone and facilitate peristalsis - CNS - PNS - Lungs- bronchoconstriction - Enteric nerves: bady, hypoTN, nausea.
57
List the drugs that agonize the 5- HT4 receptor?
Tegaserod | Prucalopride
58
Describe gastrointestinal therapeutic applications of drugs that act on the agonize the 5- HT4 receptor?
Speeds GI transit Stimulates peristalsis Improves BM frequency Soften stool
59
List the drugs that antagonize the 5- HT3 receptor?
Alosetron Ondsanserton Cilansetron
60
Describe gastrointestinal therapeutic applications of drugs that act on the antagonize the 5- HT3 receptor?
Nausea/vomiting Irritable-bowel (diarrhea predominant)
61
Safe and effective therapeutic treatment of PUD w/ GERD phase 2?
- Rx H2RA (6-12wks) | - Rx PPI (4-8wks) or prokinetic agent if motility disorder.
62
List the 5 primary antiemetic drugs classes
1. 5-HT3 antagonist 2. Dopamine 2 antagonist 3. Substance P/Neurokinin-1 antagonist 4. Antimuscarinics 5. 1st gen antihistamines
63
5-HT3 antagonist most appropriate clinical uses?
Nausea Vomiting IBS
64
Dopamine 2 antagonist most appropriate clinical uses?
Psychiatric disorders
65
Substance P/Neurokinin-1 antagonist most appropriate clinical uses?
Vasodilation Inflammation Pain Mood Vomiting
66
Antimuscarinics most appropriate clinical uses?
Motion sickness (scopolamine patch)
67
1st gen antihistamines most appropriate clinical uses?
Motion sickness Anxiety for flights
68
5-HT3 antagonist ASEs?
HA Constipation Fever Diarrhea Prolonged QT interval Cardiac arrhythmias
69
Dopamine 2 antagonist ASEs?
Extrapyramidal sxs QT Prolongation NMS
70
Substance P/Neurokinin-1 antagonist ASEs?
Steven johnson syndrome Diarrhea Constipation
71
Antimuscarinics ASEs?
Dry mouth and skin Blurred vision Hot flashes
72
1st gen antihistamines ASEs?
Sedation Fatigue Dizziness Anticholinergic side effects (dry mouth, tachy, blurred vision)
73
What drug is used for motion sickness and temporarily as a sleep aid?
First generation antihistamines ie. Dimenhydrinate (Dramamine), promethazine.
74
Name the drug under the class: substance p/neurokinin 1 receptor antagonists?
Aprepitant

GI (16 decks)

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