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Pharm GI Flashcards

1
Q

what are the five classes of antiemetics

A

H1 antihistamines/antimuscarinics
dopamine receptor agonists
glucocorticoids
5-HT3 receptor antagonists
Neurkinin receptor antagonists

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2
Q

when are H1 antihistamines used

A

vestibular disturbances like vertigo or motion sickness

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3
Q

when are dopamine receptor antagonists used

A

postoperative nausea
motion sickness

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4
Q

which class of medication is the go-to for radiotherapy and chemotherapy-induced nausea and vomiting

A

5-HT3 receptor antagonists

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5
Q

when are glucocorticoids used

A

chemotherapy-induced emesis

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6
Q

what is the mechanism of action of metoclopramide (reglan)

A

dopamine-receptor blocker, works in the chemoreceptor trigger zone

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7
Q

what are the two primary uses for metoclopramide

A

antiemetic
prokinetic

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8
Q

which antiemetic medication is also used as a prokinetic

A

metoclopramide

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9
Q

when is the use of metoclopramide contraindicated and why

A

when there is a GI bleed or perforation because metoclopramide is a prokinetic which would stimulate/worsen the bleed

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10
Q

what is the blackbox warning for metoclopramide

A

tardive dyskinesia

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11
Q

what is the mechanism of action of ondansetron

A

selectively antagonizes serotonin 5-HT3 receptors
works in all 3 areas: GI tract, vomiting center, and chemoreceptor triggering zone

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12
Q

what is ondansetron used for

A

prevention of nausea/vomiting from chemo, radiation, postop, and gastroentertitis

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13
Q

what preparation of ondansetron should be used when patients are actively vomitting

A

IV

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14
Q

what is the biggest/most serious side effect of ondansetron

A

QTc elongation which could cause Torsades

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15
Q

what is the mechanism of action of prochlorperazine

A

inhibits dopamine and muscarinic receptors; works in the chemoreceptor and vomiting center of the brain

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16
Q

what is a side effect of prochlorperazine

A

sedation because of the antihistamine active
also causes tardive dyskinesia

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17
Q

what are the uses for prochlorperazine

A

severe nausea/vomiting
non-psychotic anxiety
schizophrenia

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18
Q

what group of people should not take proclorperazine

A

dementia patients because of dementia-related psychosis

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19
Q

what is chlorpromazine used for

A

N/V
intractable hiccups
psychosis
off-label serotonin syndrome

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20
Q

what is the mechanism of action of scopolamine

A

antagonizes the acetylcholine receptors
works in the vestibular system

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21
Q

what are the side effects of scopolamine

A

all of the anti-cholinergic effects
mad as a hatter, dry as a hare, blind as a bat, etc

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22
Q

what is one off label use of scopolamine

A

can be used in comfort care to help dry up secretions to prevent coughing/choking/death rattle

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23
Q

what is the mechanism of action of promethazine

A

non-selectively antagonizes central and peripheral histamine H1 receptors

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24
Q

what are the most common uses of promethazine

A

motion sickness
urticaria
nausea/vomiting

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25
what antiemetic medication is contraindicated in patients under 2 years old
promethazine due to Reye's syndrome
26
what is the black box warning of promethazine
could cause severe gangrene/tissue gangrene if given IV or IM
27
what are the goals of therapy when prescribing medications for peptic acid diseases
neutralize the acid protect mucosa block acid production target helicobacter pylori
28
what is the goal of antacids
neutralizing the hydrogen ions symptomatic treatment
29
how does Maalox work (and what is in it)
directly reduces intragastric acidity through chemical neutralization contains aluminum hydroxide and magnesium hydroxide
30
what is one risk of of Maalox in patients with renal issues
aluminum toxicity because of decreased kidney function
31
how does calcium carbonate work (Tums)
directly reduces intragastric acidity through chemical neutralization
32
when are antacids used
relieving heartburn, upset stomach
33
what class of medication is misoprostol
mucosal protective
34
what is the mechanism of action of misoprostol
inhibits gastric secretion and protects GI mucosa, and also is a synthetic prostaglandin
35
what are the side effects of calcium carbonate
hypercalcemia and hypomagnesemia
36
what can misoprostol also be used for acid from reducing gastric acid secretion
dilates the cervix to cause abortification cervical ripening
37
what peptic acid medication should not be used in pregnancy
misoprostol
38
how does sucralfate work
mucosal protective agent that selectively binds to ulcers/erosions; stimulates prostaglandin production which enhances mucosal protective layer
39
what medication forms a physical barrier that restricts further causative damage from gastric acid
sucralfate
40
how do H2 blockers work
inhibits parietal cell H2 receptor which suppresses acid secretions works before the parietal cell by inhibiting cAMP pathway which produces hydrogen ions reduces acid production
41
what are the three H2 blockers
famotidine ranitidine cimetidine
42
what are H2 blockers used for
GERD erosive esophagitis maitenance and active ulcer treatment
43
what H2 blocker was taken off the market due to carcinogenic effects
ranitidine
44
what is the first line peptic disease medication if the patient can tolerate it
H2 blocker -- famotidine
45
what are the most potent peptic acid disease medication
proton pum inhibitors
46
what are proton pump inhibitors used for
GERD peptic ulcer disease H. pylori NSAIDs prevention of rebleeding from peptic ulcers non-ulcer dyspepsia (heartburn) gastrinoma and other hypersecretory conditions
47
when is there a spike of acid production in the stomach
at night which is why there are worsening symptoms at night
48
what are adverse effects of proton pump inhibitors
increased risk of acute interstitial nephritis and chronic kidney disease lowers B12 and calcium which could cause an increased risk for hip, spine, and wrist fracture respiratory and enteric infections
49
why is there an increased risk of respiratory and enteric infections with proton pump inhibitors
when taking PPI's they reduce the acid concentration which promotes overgrowth of bacteria leading to C. diff (enteric) and aspiration pneumonia (respiratory)
50
what are the four proton pump inhibitors
omeprazole lansoprazole pantoprazole esomeprazole
51
what is the mechanism of action of proton pump inhibitors
inhibits gastric parietal cell hydrogen-potassium ATPase, which ultimately reduces hydrogen ion
52
what are the advantages of pantoprazole and esomeprazole compared to the other PPI's
it comes in an injectable form
53
which PPI has the lowest bioavailability
omeprezole
54
which PPI's have the highest bioavailability
lansoprazole and pantaprazole
55
how do NSAIDs cause peptic ulcer disease
blocks prostaglandins which increase H+ and increase hydrogen
56
what is in triple therapy for an H. pylori infection
PPI clarithromycin amoxicillin (or metronidazole)
57
what is in quadruple therapy
PPI bismuth subsalicylate metronidazole tetracycline
58
what are the medication classes for diarrhea
opioid agonists colloidal bismuth compounds octreotide
59
what are the medication classes for constipation and obstipation
bulk forming laxatives osmotic laxatives opioid receptor antagonists enemas
60
what are the four antidiarrheal medicines
loperamide diphenoxylate/atropine bismuth subsalicyclate octreotide
61
what is the mechanism of action of loperamide (imodium)
binds to the gut wall opioid receptor, inhibiting peristalsis, increases anal sphincter tone
62
when is loperaide (imodium) used for
acute and chronic diarrhea it is an OTC opioid agonist
63
what is the OTC opioid agonist with anti-diarrheal properties
loperamide does not cross the BBB, so no analgesic properties or addiction potential
64
what is the black box warning for loperamide
could cause sudden cardiac death when using more than the recommended dosage
65
what is the mechanism of action of diphenoxylate/atropine (Lomotil)
diphenoxylate binds to the gut wall opoid receptors, inhibiting peristalsis; the atropine discourages overdose
66
what is the purpose of atropine in lomotil
to discourage overdose due to the anticholinergic side effects
67
what is the active ingredient in lomotil
diphenoxylate
68
what is bismuth subsalicylate
pepto-bismol
69
what is the mechanism of action behind bismuth subsalicylate
coats ulcers and erosions, reduces stool frequency and liquidity in acute infectious diarrhea
70
what are the uses of bismuth subsalicylate
acute diarrhea prophylaxis for traveler's diarrhea H pylori infection --> quadruple therapy
71
what are the common side effects of bismuth subsalicylate
tongue and stool turn black also causes Reye's syndrome in kids
72
how does octreotide work
inhibits multiple hormones
73
what is octreotide used for
esophageal varices acute carcinoid crisis secretory diarrhea carcinoid tumor symptoms acromegaly
74
what are the causes of constipation
low fiber low motility physical obstructions pain during defecation immobility chronic opioid use
75
what are the five classes of laxatives
stool softeners bulk forming osmotic stimulants opioid receptor antagonists
76
what is the preventative medication for constipation
stool softeners
77
what is the first line treatment of constipation
bulk forming agents
78
how do stool softeners work
moistens and makes the stool easier to pass facilitates the mixture of stool fat and water
79
how do bulk forming laxatives work
absorb water, provide lubrication, and bulk to promote peristalsis extends the colon by pulling water into stool
80
how do osmotic laxatives work
works by pulling water into the colon through osmosis, swells and distends the colon to help stool pass
81
what is the most commonly used stool softener
docusate (colace)
82
what is the bulk forming laxative
bisacodyl (dulcolax)
83
what are the osmotic laxatives
magnesium hydroxide (milk of magnesia) sorbital and lactulose magnesium citrate polyethylene glycol (PEG)
84
how do stimulants work
direct stimulation of the enteric nervous system to stimulate the colon to contract (peristalsis) which forces stool out
85
what is one side effects of a stimulant laxative
melanosis coli
86
what class of laxatives can patients become dependent upon and why
stimulants because the colon will not move without the stimulant
87
how do opioid receptor antagonist work for constipation
do not cross the BBB, reverse opioid analgesivs without reversing pain control
88
what is polyethylene glycol used for (MiraLax)
osmotic laxative for relieving constipation can cause electrolyte imbalance
89
what laxative contains electrolytes to prevent an imbalance
polyethylene glycol with electrolytes
90
what laxative is used for colonoscopy prep
PEG with electrolytes
91
how does linalotide work
enhances chloride and bicarb into the intestinal lumen which causes water to be pulled in
92
when is linalotide (linzess) used
constipation-predominant IBS chronic idiopathic constipation
93
what is the black box warning for linalotide
do not use in children because it could cause severe dehydration and lead to death
94
what is methylcellulose
bulk formation, increases stool bulk
95
what is methylcellulose used for
bulk laxative for relieving constipation and maintaining regularity
96
how does psyllium work
increases stool bulk bulk laxative
97
when is psyllium used
relieves constipation, maintaining regularity, supplementing fiber intake
98
what are common side effects of psyllium
esophageal and GI obstruction if patients are not drinking enough water
99
what is the mechanism of action behind methylnaltrexone
selectively antagonistives peripheral mu-opioid, inhibits opioid-induced GI hypomotility
100
when is methylnaltrexone used
opioid induced constipation
101
when are enemas used
severe impaction of stool bowel preparation
102
what are the two antispasmodic medications
dicyclomine hyoscyamine
103
how do antispasmodic medications work
antagonize acetylcholine at muscarinic receptors; relaxes smooth muscle and inhibits bradykinin-and-histamine induced spasms
104
when is dicyclomine used
IBS
105
when is hyoscyamine used
GI tract spasms IBS bladder spasms pelvic ulcer disease
106
what is the first line treatment of mild to moderate active ulcerative colitis
aminosalicylates
107
what are the two aminosalicylates
sulfasalazine mesalamine
108
how does sulfasalazine
blocks cyclooxygenase and inhibits prostaglandin production, which causes anti-inflammatory effects
109
when is sulfasalazine used
ulcerative colitis crohn disease rheumatoid arthritis
110
why do you need to monitor CBC when prescribing aminosalicylates
because of the side effects causing renal toxicity and liver toxicity also blood dyscrasias
111
what are the two purine analogues
azathioprine 6-Mercaptopurine
112
how to purine analogues work
immunosuppressive agents by inhibiting T-lymphocytes and DNA synthesis
113
when is azathioprine used
rheumatoid arthritis crohn's disease ulcerative colitis kidney transplant rejection prophylaxis
114
what is the black box warning for azathioprine
malignancy risk and mutagenic potential to both men and women
115
when is 6-Mercaptopurine used
to treat ALL crohn's disease ulcerative colitis
116
where do corticosteroids work
the earliest stages of the inflammatory cascade to inhibit everything
117
when are corticosteroids used
rescue medications for patients experiencing an ulcerative colitis or inflammatory bowel disease flare
118
what purine analogue is a pro-drug
azathioprine --> 6-MP

Pharmacology (5 decks)

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