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GI II > Pharm > Flashcards

Pharm Flashcards

1
Q

receptors that trigger N/V

A

5HT3, H1, M1, D2, NK1 (substance P)

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2
Q

what kind of receptor might we agonize to alleviate N/V

A

cannabinoid

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3
Q

what do we use to help with anticipatory N/V

A

benzodiazepines

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4
Q

-setron medications (ondansetron, dolasetron, granisetron, palonosetron) antagonize what receptor to help with N/V

A

5HT3

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5
Q

-pitant medications (aprepitant, fosaprepitant, netupitant, rolapitant) antagonize what receptor to help with N/V

A

NK1 (substance P)

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6
Q

what are H1 antagonists that alleviate N/V

A

diphenhydramine, dimenhydrinate, hydroxyzine, promethazine, meclizine, cyclizine

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7
Q

which M1-R antagonist is used to help control N/V

A

scopolamine

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8
Q

what are the cannabinoid receptor AGONISTS used to treat NV

A

dronabinol, nabilone

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9
Q

what are serotonin receptor antagonists indicated for

A

strong antiemetic- chemotherapy, radiation, post operative, or pregnancy induced NV

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10
Q

most worrisome adverse affect of 5HT3 antagonists (especially dolasetron)

A

dose dependent QT prolongation / torsades

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11
Q

QT prolonging agents and antiarrythmics are interactions with 5HT3R blockers because why

A

they all use cyp450

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12
Q

the only IV NK1 inhibitor

A

fosaprepitant

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13
Q

what are NK1 receptor antagonists indicated for

A

moderate antiemetic: chemotherapy or prophylaxis post operation

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14
Q

H1-R antagonists are weak anti emetics originally designed for other purposes but found to exhibit varying levels of central _____

A

anticholinergic at CTZ

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15
Q

what are H1 receptor antagonists indicated for use in NV related to motion sickness or vertigo

A

meclizine, cyclizine

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16
Q

H1-R, M1, and D2-R antagonists have what adverse side effects

A

typical anticholinergic (drowsy, dry mouth, constipation, urinary retention, blurred vision, low BP)

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17
Q

what are the 2 families of D2 R antagonists used in NV tx

A

phenothiazine, metoclopramide

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18
Q

when is a D2 inhibitor indicated

A

weak to moderate antiemetic: also enhances GI motility (especially metoclopramide)

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19
Q

when are cannabinoids indicated for use

A

strong antiemetic only indicated after a patient has tried other anti emetics that are not effective (chemotherapy), appetite stimulation

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20
Q

cannabinoids have interactions with what kinds of drugs

A

CNS depressants, CV agents, sympathomimetics

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21
Q

high emetogenic (severe NV due to chemotherapy) regimen

A

3 drugs (NK antagonist, 5HT3 antagonist, corticosteroid) ((add cannabinoid if tx resistant))

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22
Q

moderate emetogenic (NV due to chemotherapy) regimen

A

2 drugs (5HT3 R antagonist, corticosteroid)

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23
Q

this med is given for diabetic gastroparesis which helps with NV and dysmotility

A

metoclopramide

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24
Q

antacids do not affect the amount of acid produced, they simply neutralize whatever is in the lumen. what else do they do

A

increase LES tone

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25
Q

what are the two preferred OTC antacids

A

calcium, magnesium

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26
Q

dose related side effects of using aluminum as an antacid

A

constipation, hypophosphatemia

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27
Q

what are the side effects of using calcium as antacid

A

constipation, hypercalcemia, hypophosphatemia

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28
Q

antacids have what unique risk when it comes to drug interactions

A

ALL meds should be taken 1-2 hr after or 2-4 hr before antacids (messes with absorption otherwise)

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29
Q

-tidine meds (cimetidine, famotidine, nizatidine, rinitidine) antagonize what receptor to help fix ulcers

A

H2

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30
Q

-prazole meds (lansoprazole, dexlansoprazole, omeprazole, esomeprazole, pantoprazole, rabeprazole) antagonize what receptor to help with ulcers

A

PPI’s

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31
Q

how does sucralafate (sucrose + aluminum) help with ulcers

A

surface acting agent (a bandaid)

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32
Q

how does misoprostol help with ulcers

A

PGE1 analog

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33
Q

which H2 blocker (used for ulcers) is the prototypical inhibitor of several CYP450 enzymes

A

cimetidine

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34
Q

which class of anti-ulcer drug can potentially block ALL formation of acid in the stomach

A

PPI’s (block H/K ATPase of parietal cells)

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35
Q

PPI’s and H2 blockers can help to heal an ulcer in 4-8 weeks EXCEPT under what circumstance

A

H pylori ulcers: these require an antibiotic also!

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36
Q

why must we stop PPI use in a patient who develops diarrhea

A

CDAD (C diff associated diarrhea – can lead to death)

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37
Q

which PPI (used for ulcers) is the prototypical inhibitor of several CYP450 enzymes

A

omeprazole

38
Q

PGE2 analog that protects from ulcer by increases mucosal defenses and decreases acid production

A

misoprostol (diclofenac is misoprostol + NSAID = protection from NSAID induced ulceration)

39
Q

this all around champ of a drug was developed as anti diarrheal but also helps with ulcers, antimicrobial, reflux, indigestion, stimulates production of prostaglandins and probably so much more

A

bismuth compound

40
Q

adverse effect of bismuth compounds (pep to bismol)

A

constipation, black or dark stools

41
Q

how do you treat ulcers caused by h pylori

A

2 antibiotics and a PPI / H2 blocker

BID 14 days PPI + clarithromycin + amoxicillin or metronidazole) (10 days if you add bismuth

42
Q

what do you give pregnant lady with PUD (no h pylori)

A

short course of antacid (ranitidine or if severe lansoprazole) or sucralafate

43
Q

what classes of drugs might be used to alleviate symptoms caused by UC

A

5 ASA, corticosteroids, TNF alpha inhibitors, alpha 4 integrin inhibitors

44
Q

what classes of drugs might be used to alleviate symptoms caused by CD

A

IL12/23 inhibitor, corticosteroid, TNF alpha inhibitor, alpha 4 integrin inhibitor

45
Q

sulfasalazine, mesalamine, olsalazine, and balasalazinde are all what family of drug

A

5 ASA drugs used in UC

46
Q

5 ASA drugs have what MOA

A

inhibit prostaglandin / leukotriene synthesis and decrease chemotaxis of macrophage and PMN

47
Q

who should never be prescribed a 5 ASA drug

A

allergies! (to 5ASA and no sulfasalazine for sulfonamide allergic people)

48
Q

at what severity of UC should you prescribe 5 ASA agents

A

mild to moderate active disease or for maintenance of remission

49
Q

IBD can benefit from TNF alpha inhibitors which are anti inflammatory and all share what suffix

A

-mab (adalimumab, infliximab, golimumab, certolizumab)

50
Q

what is unique about certolizumab compared to the rest of the TNF alpha inhibitors

A

made from Fab of Ab. does not fix complement or cause ADCC

51
Q

TNF alpha inhibitors carry risk for what kind of infection

52
Q

which TNF alpha inhibitor is used in CD and not UC

A

certolizumab

53
Q

which TNF alpha inhibitor is used in UC and not CD

54
Q

patients who are on alpha 4 integrin inhibitor drugs (used in IBD) for more than 2 years, who have prior immunosuppressant treatment, or who have anti JC virus Ab’s are at increased risk for developing what condition

A

PML (brain infection)

55
Q

this alpha 4 integrin inhibitor is indicated to treat moderate to severe CD and as maintenance therapy only after other drugs have failed

A

natalizumab

56
Q

this alpha 4 integrin inhibitor is indicated to treat moderate to severe CD or UC and as maintenance therapy only after other drugs have failed

A

vedolizumab

57
Q

what is the MOA for ustekinumab (for treating CD)

A

IL12/23 inhibitor

58
Q

what infection is common with use of IL12/23 inhibitor drugs

59
Q

which class of IBD treatment causes increased glucose, BP, and lipid profile, fluid retention, increased appetite, anxiety / insomnia, and bone defects

A

corticoteroids

60
Q

when should we use corticosteroids for IBD

A

only after conventional therapy fails (not for maintenance – these are potent immunosuppressant meds)

61
Q

Loperamide

A

for diarrhea- opioid agonist without the analgesia

62
Q

there is a small quantity of atropine added to what drug

A

diphenoxylate (lomotil – antidiarrheal)

63
Q

indicated for use in IBS-D (diarrheal subtype)

A

eluxadoline

64
Q

main side effect of eluxadoline (used for IBS-D)

A

pancreatits that can lead to death (esp if pt has no gallbladder)

65
Q

alosteron

A

for IBS-D in women if other therapies have failed

66
Q

this rare anti-diarrheal has a black box warning for ischemic collitis

67
Q

cl channel inh for diarrhea in HIV patients

A

crofelemer

68
Q

what can we give for abdominal pain / spasm

A

anti muscarinic (hyoscyamine, dicyclomine, clidinium, chlordiazepoxide)

69
Q

linaclotide

A

for IBS-C and idiopathic constipation, GCC agonist

70
Q

lubiprostone

A

for IBS-C and chronic idiopathic constipation and opioid induced constipation (no cancer pt), PGE derivative

71
Q

when do you prescribe the osmotic agent prepopik (PEG3350)

A

before colonoscopy only

72
Q

lactulose is a sugar that helps draw fluid into the GI tract and is used in what scenario

A

severe liver disease (change in pH traps ammonia in GI to be excreted)

73
Q

interferon alpha injections (which revs up the body’s immune response to virus while inhibiting viral replication) can be used in treating HBV patients under what conditions

A

well compensated liver disease (decompensated cirrhosis is dangerous)

74
Q

first line agent to treat HBV infection

A

nucleosides/tides (inh reverse transcriptase, viral polymerase, and they are oral) lamivudine, telbivudine, entecavir, tenofovir, adefovir

75
Q

nucleotide adenosine analog used to treat wtHBV when patients are resistant to other nucleoside agents (rarely is a virus resistant to this guy)

A

tenofovir (nephrotoxic)

76
Q

whats an effective anti-HBV drug that you can use in pt with renal insufficiency

77
Q

for HCV infection we still use INF alpha but we add what nucleoside agent

A

ribavirin (contraindicated in anemic or pregnant pts)

78
Q

what NS5B inhibitor is useful in eradicating an HCV infection (RNA pol inh)

79
Q

HCV drugs simeprevire, telaprevir, boceprevir, grazoprevir have what MOA

A

protease inh

80
Q

vancomycin (used to treat c diff) has what adverse affect

A

red man syndrome

81
Q

this antibiotic should not be used with alcohol, has a metallic taste and can cause nausea or peripheral neuropathy

A

metronidazole

82
Q

this drug is useful if c diff recurs after eradicated by vancomycin. it spares anaerobic flora and inhibits bacterial RNA pol

A

fidaxomicin

83
Q

what drug is used to treat entamoeba histolytic infection (kills trophozoites but not cysts)

A

metronidazole (or tinidazole) AND luminal amebicide (like paromomycin or iodoquinol)

84
Q

this infection presents as greasy fatty smelly diarrhea with NO BLOOD in the stool after drinking from creek

A

giardia lamblia

85
Q

treat giardia infxn

A

supportive care plus nitazoxanide

86
Q

side effect of nitazoxanide (treats giardia, cryptosporidium)

A

yellow eyes and bright yellow urine

87
Q

itchy toes, anemia, diarrhea, abdominal pain, weight loss

A

necator americanus, ancylostoma duodenale

88
Q

how do strongyloides stercoralis infections exit the human body (before we get rid of them with IVERMECTIN)

A

eggs hatch into larvae and are excreted in feces

89
Q

this is diagnosed with football shaped EGGS in the feces causing abdominal pain and diarrhea

A

trichuric trichiura / whip worm

90
Q

severe perianal itching can lead to hand to mouth transmission of the enterobius vermicularis (pinworm) which is detected by what in the lab

A

scotch tape test (no eosinophilia)

91
Q

while they should not be used in cirrhotic or pregnant patients, most nematodes can be eradicated by what

A

albendazole, mebendazole

92
Q

schistosomas (blood flukes) are treated with

A

praziquantel

GI II (3 decks)

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