pharm chart Flashcards
Anti-diarrheals Opioid
Loperamide [Imodium]
MOA of Loperamide [Imodium]
Inhibition of presynaptic cholinergic nerves in colonic submucosal and myenteric plexus slows transit time
Indications of Loperamide [Imodium]
Mild to moderate diarrhea w/o obstruction,
IBD, IBS
Anti-diarrheals Non- Opioid
Kaolin-Pectin
MOA of Kaolin-Pectin
A clay (Kaolin) and a plant polysaccride (Pectin) combination that absorbs fluids & bacterial toxins
indications of Kaolin-Pectin
Mild diarrhea
Anti-diarrheals Laxative
Dietary Fiber
[Metamucil, Citrucel, Fibercon]
MOA of Dietary Fiber
[Metamucil, Citrucel, Fibercon]
Absorb and bind fluids, provides stool bulk
Indications of Dietary Fiber
[Metamucil, Citrucel, Fibercon]
Mild to moderate diarrhea,
constipation
Anti-Diarrheal
Synthetic Somatostatin Analogue
Octreotide [Sandostatin]
MOA of Octreotide [Sandostatin]
Synthetic analogue of somatostatin with longer half-life;
inhibits bowel secretion;
dose related impact on motility;
splanchnic arteriole constriction
Indications of Octreotide [Sandostatin]
Diarrhea sec to bowel dysmotility, carcinoid, VIP-oma, pancreatic fistulas, vagotomy, dumping syndrome, short bowel syndrome, HIV diarrhea; GI bleeding
Anti-diarrheals
Bismuth Subsalicylate [Pepto- Bismol]
MOA of Bismuth Subsalicylate [Pepto- Bismol]
Anti-secretory (salicylate) and anti-microbial (bismuth) action
Indications of Bismuth Subsalicylate [Pepto- Bismol]
sxs treatment of mild, nonspecific diarrhea,
traveler’s diarrhea,
as part of multi- drug regimen for H. pylori
what are the 2 
5ASA Anti- Inflammatories
- Mesalamine or 5-ASA [Asacol]
- Sulfasalazine [Azulfadine]
5-ASA + sulfapyridine
what is the MOA of the 5ASA Anti- Inflammatories
Local colon anti- inflammatory action and systemic prostaglandin inhibition
Inidacation of Mesalamine or 5-ASA [Asacol]
Ulcerative colitis, proctosigmoiditis, proctitis
Indication of Sulfasalazine [Azulfadine]
5-ASA + sulfapyridine
Ulcerative colitis,
rheumatoid arthritis,
Crohn’s disease, psoriasis
Purine Analogues Immunosuppressant
Azathioprine [Imuran]
MOA of Azathioprine [Imuran]
Inhibits synthesis of DNA, RNA, proteins
Indications of Azathioprine [Imuran]
Steroid sparing for steroid dependent Crohn’s Disease, Ulcerative colitis;
maintain remission in CD;
fistulizing CD;
kidney transplant, rheumatoid arthritis
Purine Analogues Anti-Inflammatory
Methotrexate [Rheumatriex]
MOA of Methotrexate [Rheumatriex]
Decreases protein synthesis via inhibition of dihydrofolate reductase;
inhibits interleukin-1;
incr release of anti- inflammatory adenosine
Indications of Methotrexate [Rheumatriex]
Crohn’s Disease;
+/- Ulcerative colitis;
psoriasis, rheumatoid arthritis
Anti-TNF Alfa Compounds
Infliximab [Remicade]
MOA of Infliximab [Remicade]
Decr TH1-cell activation/proliferation;
block TNF alfa receptor (TNFR) & decr cytokine (IL-12) release;
decr leukocyte migration, fibroblast collagen production, & hepatic acute phase reactants;
incr apoptosis of activated cells
Indications of Infliximab [Remicade]
Acute and maintenance Tx mod to severe Crohn’s Disease & Ulcerative colitis
Anti-integrin
Natalizumab
MOA of Natalizumab
Inhibit integrins on leukocyte surface and inhibit their adhesion to vascular endothelium and their migration into tissue
Indications of Natalizumab
Subset of patients with mod to severe Crohn’s ds who have failed other therapies
Ursodeoxycholic Acid Gallstone Dissolution Agent
Ursodiol [Actigall]
MOA of Ursodiol [Actigall]
Reduces hepatic secretion of cholesterol reducing enterohepatic circulation of cholesterol, reduces hepatic absorption of cholesterol;
metabolized to lithocolic acid by colonic bacteria; excreted in stool and bile
Indications of Ursodiol [Actigall]
Gallstones;
prevention of stones in rapid weight loss,;
primary billiary cirrhosis
Laxative Stimulant
Senokot [Senna]
MOA of Senokot [Senna]
stimulate enterocytes, enteric neurons,
GI smooth muscle inducing low-grade inflammation, fluid accumulation and
stimulate intestinal motility
INdications of Senokot [Senna]
constipation (without bowel obstruction)
Laxative Calcium Channel Activator
Lubiprostone [Amitiza]
MOA of Lubiprostone [Amitiza]
Activates calcium channels to increase bowel fluid secretion and motility
Indications of Lubiprostone [Amitiza]
Chronic idiopathic constipation;
IBS constipation- dominant in women >18yo;
opioid induced constipation
Laxative cGMP agonist
Linaclotide [Linzess]
MOA of Linaclotide [Linzess]
Agonizes guanylate cyclase-C (cGMP) on luminal surface of bowel epithilium, increases cGMP resulting in chloride and bicarbonate secretion into intestinal lumen
Indications of Linaclotide [Linzess]
IBS-C (in adults not responsive to PEG); or, Chronic Idiopathic Constipation (CIC) in adults
Osmotic Laxative; PEG
Polyethylene Glycol (PEG) 3350 Electrolyte Solution [GoLYTELY] [MiraLax]
MOA of Polyethylene Glycol (PEG) 3350
Electrolyte Solution [GoLYTELY] [MiraLax]
Causes water retention in stool and incr stool frequency
Indications of Polyethylene Glycol (PEG) 3350
Electrolyte Solution [GoLYTELY] [MiraLax]
Occasional Constipation
Short Term Use
Osmotic Laxative
Lactulose [Enulose]
MOA of Lactulose [Enulose]
a) synthetic disaccharide (osmotic) laxative;
b) bacterial digestion of lactulose produces acid pH converting NH3 to NH4+ which can’t cross gut wall;
c) enhances diffusion NH3 from serum into gut lumen
Indications of Lactulose [Enulose]
Px & Tx portal- systemic encephalopathy (PSE)
Magnesium Laxative
MgCitrate [Citroma]
MOA of MgCitrate [Citroma]
Osmotic retention of bowel fluid distending colon and increasing peristalsis
INdications of MgCitrate [Citroma]
Occasional constipation, study prep
Stool Softener
Docusate Na [Colase]
MOA of Docusate Na [Colase]
….
Indications of Docusate Na [Colase]
…..
Anticholinergic, Anti-emetic & anti-vertigo
dermal patch
Scopolamine [Transderm Scop]
MOA of Scopolamine [Transderm Scop]
Blocks activity of acetylcholine at PSNS sites in smooth muscle, secretory glands, and CNS
Fast onset, short duration
INdications of Scopolamine [Transderm Scop]
Nausea, vertigo
H1 Antagonist Antihistamine
Meclizine [Antivert]
MOA of Meclizine [Antivert]
Central anticholinergic blockage in chemoreceptor trigger zone and decreases excitability of vestibular- cerebellar pathways
Indications of Meclizine [Antivert]
Prevention & treatment of motion sickness
Phenothiazines
Promethazine [sPhenergan]
MOA of Promethazine [sPhenergan]
Blocks CNS dopamine receptors (D2); competes for H1 receptors in brain and systemically
(anti-histamine and anti-dopaminergic)
Indications of Promethazine [sPhenergan]
Anti-emetic, motion sickness,
sedative
Butyrophenones
Typical anti- psychotic
Haloperidol [Haldol]
MOA of Haloperidol [Haldol]
Blocks post-synaptic mesolimbic D1 & D2 receptors; also suppresses the reticular activating system (RAS) thereby reducing emesis
Indications of Haloperidol [Haldol]
Anti-emetic; schizophrenia Tourette’s disorder;
emergency sedation of agitated- aggressive patients (off label)
Benzamides
some refer to as pro kinetic
Metoclopromide [Reglan]
MOA of Metoclopromide [Reglan]
Blocks D and 5-HT receptors in CRTZ; overcomes inappropriate direction of peristalsis experienced with vomiting
Indications of Metoclopromide [Reglan]
Anti-emetic;
diabetic gastroparesis (decreased stomach emptying d/t inadequate peristalsis),
GERD
cancer chemo-induced emesis & radiation sickness
Corticosteroid
Dexamethasone [Maxidex]
MOA of Dexamethasone [Maxidex]
Enhance effect of 5- HT3-receptor (in heart, stomach, brain: area postrema & nucleus of tractus solitarius) antagonists CRTZ
Indications of Dexamethasone [Maxidex]
Anti-emetic pre- chemo;
immune modulation
Cannaboids
Tetrahydrocanna binol (THC)
Dopamine antagonist
Dronabinol [Marinol]
MOA of Dronabinol [Marinol]
Unknown
INidcations of Dronabinol [Marinol]
Appetite stimulant;
anti-emetic (Chemo related);
adjunct to surgical anesthesia
Serotonin Antagonists
Ondansetron [Zofran]
MOA of Ondansetron [Zofran]
Peripheral and CRTZ 5-HT3 receptor blockade
Indications of Ondansetron [Zofran]
ONLY for post- op, radiation & chemotherapy induced N/V
Neurokinin-1 Antagonist
Aprepitant [Emend]
MOA of Aprepitant [Emend]
Blocks central NK1 receptors
Augments anti- emetic effect of 5- HT3 receptor antagonism & corticosteroids
Indications of Aprepitant [Emend]
Prevention chemo induced N/V;
post-op N/V
Peripherally- acting Opioid Antagonist
Naloxegol [Movantik]
MOA of Naloxegol [Movantik]
Mu-opioid receptor antagonist (conjugated with PEG reducing its ability to cross BBB) so acts peripherally in GI tract
Indications of Naloxegol [Movantik]
Opioid Induced Constipation
H Pylori Combo- Triple Drug and 4 drug combo
- Omeprazole Amoxicillin Clarithromycin
2. Omeprazole Metronidazole Tetracycline Bismuth SS
MOA of H Pylori Combos
Raise gastric pH and antibiotic action on H pylori
Indications of H Pylori Combos
Eradication of H pylori-associated ulcers
H2R Antagonists
in another drug table this is under: Gastric Acid Suppressants and it is a H2 Receptor blocker
Ranitidine [Zantac]
MOA of Ranitidine [Zantac]
Competitive inhibition of H2-receptors of gastric parietal cells reduce basal and stimulated acid production
Indications of Ranitidine [Zantac]
Peptic ulcer disease, GERD
2 drugs that are in the class:
Proton Pump Inhibitors (PPI)
- Omeprazole [Prilosec]
2. Pantoprazole [Protonix]
mOA of Proton Pump Inhibitors (PPI)
Inhibits basal and stimulated parietal cell proton pump acid secretion
Indications of Proton Pump Inhibitors (PPI)
Peptic ulcer disease, GERD;
prevention of NSAID ulcers;
stress ulcer prophylaxis in critically ill
Mucosal Surfactants
Sucralfate [Carafate]
MOA of Sucralfate [Carafate]
In water or acidic solutions, forms a paste that forms barrier by binding selectively to gastric mucosal ulcers and erosions; stimulates mucosal prostaglandin & bicarb secretion
Indications of Sucralfate [Carafate]
Duodenal or gastric ulcers or erosions, stomatitis (off label)
Muscarinic Antagonists
Anti- Spasmodic
Dicyclomine [Bentyl]
MOA of Dicyclomine [Bentyl]
M receptor anticholinergic drug
Indications of Dicyclomine [Bentyl]
Irritable Bowel Syndrome (cramps)
Antacids
AlOH [Alternagel]
Aluminum Hydroxide
MOA of AlOH [Alternagel]
Aluminum Hydroxide
Neutralizes HCl in stomach to form Al(Cl)3 & H20
Indications of AlOH [Alternagel]
Aluminum Hydroxide
hyperacidity, hyperphosphatemia
Antacids Laxative
MgOH [MOM]
MOA of MgOH [MOM]
reacts with HCl acid to form MgCl;
osmotic absorption of fluids distends colon and increases peristaltic activity
Indications of MgOH [MOM]
dyspepsia; constipation
Mucosal, NSAID Protectants
Prostaglandin
Misoprostol [Cytotec]
MOA of Misoprostol [Cytotec]
synthetic prostaglandin E1 analog replaces protective PG inhibited by NSAID therapy
Indications of Misoprostol [Cytotec]
NSAID-induced gastric ulcers;
people at high risk for NSAID induced bleeding
GLP-1 Receptor Agonist
Liraglutide [Saxenda]
MOA of Liraglutide [Saxenda]
incr glucose dependent insulin secretion;
decr inappropriate glucagon secretion;
incr Beta-cell growth & replicaton;
decr gastric emptying; decr food intake
Indications of Liraglutide [Saxenda]
T2DM adjunct therapy;
weight loss
Lipase Inhibitor
Orlistat [Xenical]
MOA of Orlistat [Xenical]
Reversible inhibitor of gastric and pancreatic lipase resulting in ~30% reduction in fat absorption
Indications of Orlistat [Xenical]
Management of obesity in individuals w/ BMI >30 or >27 with other risk factors (diabetes, HTN, dyslipidemia)
Anorexiant
5HT2c Receptor Agonist
Lorcasarin [Belviq]
MOA of Lorcasarin [Belviq]
Preferentially activates 5HT2C receptor initiating hormonal cascade resulting in decreased appetite, early satiety
Indications of Lorcasarin [Belviq]
Wt management in individuals w/ BMI > 30 or > 27 with other risk factors (diabetes, HTN, dyslipidemia)
what are the 3 weight loss agents?
- Liraglutide [Saxenda]
- Orlistat [Xenical]
- Lorcasarin [Belviq]
Pancreatic Enzymes
Pancrelipase [Viokase]
MOA of Pancrelipase [Viokase]
Supplemental enzymes (Lipase, Amylase, Protease)
Indications of Pancrelipase [Viokase]
Chronic pancreatitis
Opioid Analgesics Synthetic
Meperidine [Demerol]
MOA of Meperidine [Demerol]
Binds to mu opioid receptors in CNS & inhibits ascending pain pathways
INdications of Meperidine [Demerol]
Short-term use peri-op and acute pancreatitis
??less sphincter of Oddi spasm??
Somatostatin Analogue
Octreotide [Sandostatin]
MOA of Octreotide [Sandostatin]
Synthetic analogue of somatostatin with longer half-life;
inhibits bowel secretion;
dose related impact on motility;
splanchnic arteriole constriction
Indications of Octreotide [Sandostatin]
Diarrhea sec to bowel dysmotility, carcinoid, VIP-oma, pancreatic fistulas, vagotomy, dumping syndrome, short bowel syndrome, HIV diarrhea; GI bleeding
Antibiotic
Anti- Pseudomonas
Anti-Anerobes
Imipenem- cilastin [Primaxin]
MOA of Imipenem- cilastin [Primaxin]
Inhibits bacterial cell wall synthesis with lyses of bacterial cells
Indications of Imipenem- cilastin [Primaxin]
Intra-abdominal infxns,
liver abcess,
lower respiratory tract and GYN organ infxns
Antibiotic
Fluoroquinol one
Ciprofloxacin [Cipro]
MOA of Ciprofloxacin [Cipro]
Inhibits DNA gyrase
Indications of Ciprofloxacin [Cipro]
Diverticulitis, mild; traveler’s diarrhea; UTIs, Anthrax (inhalational, cutaneous, GI), chlamydial infections, cholera, salmonosis, shigella
Misc ABX
Metronidazole [Flagyl]
MOA of Metronidazole [Flagyl]
Disrupts DNA structure inhibiting protein synthesis producing cell death
Indications of Metronidazole [Flagyl]
Anaerobic bacterial and protozoal infections:
Diverticulitis; C Diff; vaginitis;
brain abcess; rosacea, amebiasis,
giardiasis, trichomonas
Glycopeptide Antibiotic
Vancomycin [Vancocin]
MOA of Vancomycin [Vancocin]
Inhibits bacterial cell wall synthesis by blocking glycopeptide polymerization
Indications of Vancomycin [Vancocin]
PO treatment of staph enterocolitis or antibiotic- associated pseudomembra nous (C. Diff) colitis:
IV MRSA, HAP , meningitis,
pre-op Px infective endocarditis
Synthetic Somatastatin Analogue
Anti-Diarrheal
Octreotide [Sandostatin]
MOA of Octreotide [Sandostatin]
Synthetic analogue of somatostatin with longer half- life;
inhibits bowel secretion;
dose related impact on motility; splanchnic arteriole constriction
Indications of Octreotide [Sandostatin]
Diarrhea sec to bowel dysmotility, carcinoid, VIP-oma, pancreatic fistulas, vagotomy, dumping syndrome, short bowel syndrome, HIV diarrhea; GI bleeding
Interferon
Interferon-alpha & Pegylated Interferon- alpha
MOA of Interferon-alpha & Pegylated Interferon-alpha
Multiple anti-viral, immune modulating, & viral anti- proliferative
Indications of Interferon-alpha & Pegylated Interferon-alpha
Hepatitis B, Hepatitis C
Quinolone Abx
Ofloxacin Floxin]
MOA of Ofloxacin Floxin]
Inhibits bacterial DNA replication by binding to DNA gyrase & topoisomerase
Indications of Ofloxacin Floxin]
Infections with susceptible GI, GU bacteria &
traveler’s diarrhea (off label)
Cytosine Analogue Anti-Viral (NRTI)
Lamivudine [Epivir]
MOA of Lamivudine [Epivir]
Inhibits HBV DNA polymerase (& HIV reverse transcriptase); suppresses HBV replication
Indications of Lamivudine [Epivir]
HBV
HIV
Guanosine Analogue Anti-viral
Ribavarin [Virazole]
MOA of Ribavarin [Virazole]
Inhibits replication of wide range of DNA & RNA viruses
influenza A & B, RSV, parainfluenza virus
Indications of Ribavarin [Virazole]
HCV, HIV;
goal is eradication of HCV
Direct Acting Antiviral
Polymerase Inhibitor
Sofosbuvir [Sovaldi]
MOA of Sofosbuvir [Sovaldi]
Inhibits HCV RNA-dependent RNA polymerase preventing HCV replication
Indications of Sofosbuvir [Sovaldi]
Acute or Chronic Hepatitis C
the other Direct Acting Antiviral
Polymerase Inhibitor
that is just one pill for it all!!!!
Ledipasvir/ Sofosbuvir [Harvoni]
MOA of Ledipasvir/ Sofosbuvir [Harvoni]
Ledipsavir inhibits HCV protein needed for replication;
sofosbuvir inhibits RNA- dependent polymerase preventing replication
Indications of Ledipasvir/ Sofosbuvir [Harvoni]
Chronic Hepatitis C, genotype 1
Misc Antibiotic from Hepatic disorders drug table
Rifaximin [Xifaxan]
MOA of Rifaximin [Xifaxan]
Inhibits bacterial RNA-synthesis by binding to bacterial RNA- polymerase
Indications of Rifaximin [Xifaxan]
Hepatic encephalopathy,
IBS-Diarrhea predominant, Traveler’s diarrhea;
Off-label: C Diff associated diarrhea (CDAD)
Hepatitis Vaccines:
Inactivated Vaccine
Hep A Vaccine [Havrix]
MOA of Hep A Vaccine [Havrix]
Stimulates HAV antibody response
Indications of Hep A Vaccine [Havrix]
Active HAV prophylaxis;
Pre- and post- exposure;
2 doses
Hepatitis Vaccines:
Recombinant Vaccine
Hep B Vaccine [Engerix-B]
MOA of Hep B Vaccine [Engerix-B]
Stimulates anti-HBV antibody formation
Indications of Hep B Vaccine [Engerix-B]
Active HBV prophylaxis
3 doses