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Diarrhea Bugs > Pharm Gi > Flashcards

Pharm Gi Flashcards

0
Q

Active comonent is 5- aminosalicylic acid . Thought to inhibit prostaglandin synthesis, block neutrophil migration.

A

Sulfasalazine and active metabolite mesalamine

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1
Q

Dicyclomine

A

Anti-spasmodic by blocking muscarinic receptors on enteric plexus and smooth muscle.

At high doses it will have anti- chollinergic side effects like dry mouth blurred vision

Not used freq

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2
Q

Side effects and administration of sulfasalazine and mesalamine respectfully

A

Side effects due to sulfa pyridine component - nausea GI upset arthralgias myalgias bone marrow suppression hypersentivitiy rxn

Mesalalamine can be administered as rectal suppository

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3
Q

Other drugs used

A

Azathioprine and 6- mercaptopurine - immunosuppressive drugs
Metronidazole
Methotrexate - crohns not uc
Anti TNF drugs

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4
Q

MOA of metronidazole a s tinidazole

A

The nitro gourd is reduced in anaerobic bacteria and protozoan
The reactive products are responsible for its anti microbial activity

Works against gut anaerobes and is cidal against obligate anaerobes

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5
Q

C. Diff, giardia lamblia, entamoeba histolytica

A

Metronidazole and tinidazole

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6
Q

Bacteriodes , fusobacterium , trichomonoas

A

Metronidazole and tinidazole

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7
Q

Moderately active against h. Pylori

A

Metronidazole and tinidazole

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8
Q

Side effects of metronidazole

A

Nausea, headache, anorexia,band metallic taste

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9
Q

Drug rxns with metro and tinidazole

A

Tin has fewer side effects

Abstain from etoh bc of disulfiram rxn - m-24hrs t-72 hr
Inhibit warfarin metabolism potentiating it’s effects

Met class b
Tin class c for pregnancy
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10
Q

Salmonella , shigella , E. coli and campylobacter

A

Tmp/smx and fluoroquinolones

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11
Q

Severe campylobacter

A

Erythromycin

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12
Q

Amebic infections

A

Iodoquinol and metronidazole - iod remains in lumen and may cause diarrhea and rash

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13
Q

Ending - tidine

A

Histamine H2 receptor antagonist

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14
Q

Only h2 receptor antagonist that causes issues

A

Cimetidine - anti androgenic - causes gynecomastia

And potent p450 inhibitor

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15
Q

Ending - prazole

A

Proton pump inhibitors - omeprazole and lansoprazole an esomeprazole

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16
Q

Moa of proton pump inhibitors

A

Acid labile prodrugs administered in enteric coated tablets. The uncharged form enters the cytoplasm of the partial cell. In the acidic caniculus it’s converted to active sulfonamide form. Which forms a covalent disulfide link with cysteinyl residue in the proton pump on luminal side of parietal cell. This depends on the conformational change of the active H/K-ATPase pump. So it’s taken 30-60 min before meals. Irreversible and better than h2 blockers

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17
Q

Use of h2 antagonist

A

Dyspepsia - give 30 min befor meals
Peptic ulcer disease - at night on empty stomach - relapse need to treat h. Pylori
Gerd and lpr

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18
Q

Use of ppis

A

Peptic ulcer diseas - more effective ths. H2 blockers

NSAID associated ulcers , gerd, lpr, zollinger- Ellison syndrome

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19
Q

Adverse effects of PPIs

A

Lack of acidic environment in stomach will lead to poor absorption of some nutrients like calcium. And can increase c. Diff

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20
Q

Drug interactions of PPIs

A

Metabolized by CYP 450 . Pts with polymorphism in 2c19 will clear them more slowly.

Omeprazole can inhibit met of warfarin, diazepam, phenytoin, and carbamazepine

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21
Q

Adverse effects of Antacids - aluminum, magnesium hydroxides and calcium carbonate

A

Aluminum- constipation
Magnesium - diarrhea
So give together
Calcium- lead go greater absorption of sodium bicarbonate - transient metabolic alkalosis

22
Q

Sucralfate

A

Sulfated polysaccharide that adheres to ulcer creators and epithelial cells, inhibit pepsin- catalyze hydrolysis of mucosal proteins and stim prostaglandin synthesis. This forms a protective barrier that allows the ulcer to heal.

PUD but elf effective than h blockers and PPIs
Inhibit absorption of digoxin

23
Q

Bismuth sub salicylate

A

Anti secretory anti inflammatory and anti microbial effects

  • pepto-bismol
  • nausea and cramps relieved by thus

Dark stools and black tongue.

24
Q

H. Pylori treatment

A

Combos

PPIs and amoxicillin and then switch to ppi clarithromycin and metronidazole

25
Q

Entecavir

A

Nucleoside analogue used in primary treatment of hep b.
Inhibits all three functions of hbv polymerase.

Low drug resistance, excellent choice for patients not exposed to lamivudine but resistance mat develop in pts resistant to lamivudine

26
Q

Tenofovir

A

Treat hbv low rate of resistance. Effective against lamivudine resistant hbv .

Possible renal impairment

27
Q

Telbivudine

A

nucleoside analogue. Tx hbv . Dose resistance emerging

28
Q

Interferon alpha or pegylated interferon

A

Treatment hbv - May be associated with severe flare up often precluded to HBeAg clearance but in pts with cirrhosis in pts it can lead to liver failure. Needs to be injected so limits it’s use

29
Q

Adefovir

A

Nucleoside analogue - hbv

Not first line bc takes too long may cause Renal impairment, and resistance develops

30
Q

Lamivudine

A

Nucleoside analogue . Hbv

Resistance is a problem. Can be used in pregnant pts

31
Q

Side effects of nucleoside and tides

A

Headache, fatigue , nausea , lactic acidosis, hepatotoxicity

32
Q

Treatment genotype 2 hep c

A

Pegylated interferon Alpha + ribavarin

33
Q

Treatment genotype 1 hep c

A

Boceprevir or telaprevir in combo with pegylated interferon alpha and ribavirin. Inhibit replication of hcv in host cells by binding to NS3/4 protease of HCV

34
Q

MOA of the bendazoles ( al, me, thia)

A

Bind beta tubulin and thereby inhibit the production of tubulin dimers which then impairs glucose uptake and depletes glycogen stores

Contra for pregnant ppl

35
Q

Pyrantel

A

MOA: activated cholinergic nicotine receptors in nematode so causing a depolarization blockade

Alternative to bendazoles

36
Q

Ivermectin

A

MOA : increase chloride permeability, which hyper polarizes the cell membrane resulting in paralysis of pharyngeal muscles

Use: scabies , pediculus humanus, strongyloiadiasis, ancylostoma braziliense, onchocerca volvulus

One dose a yr can prevent river blindness

37
Q

Treatment of Cestodes and schistomiasis

A

Praziquantel

38
Q

Praziquantel

A

MOA : outer surface of schistosomes is unique double membrane suture that protects it from host immune system. Praziquantel increases calcium per eabitiy in the tegumentnleading to its breakdown, allowing the host immune cells access to the worm antigens.

39
Q

MOA methylphenidate

A

Dopamine uptake inhibitor ( dopamine motivation and reward)

ADHD

40
Q

Side effects of methylphenidate

A

Anorexia , insomnia , nervousness, GI distress, irritability, tachy, dose depending motor and vocal tics

ADHD

41
Q

Types of methylphenidate

A

Ritalin, methylin, concerta, the patch , dexamethypheindate

ADHD

42
Q

Concerta

A

Triphasic release duration 10-12 hrs

ADHD

43
Q

Dexamethypheindate

A

Can be sprinkled duration 12 hrs ADHD

44
Q

MOA amphetamines

A

Enhances release and blocks reuptake of dopamine and ne. ( ne alert, attending, orienting)

ADHD

45
Q

Adverse effects amphetamine / contraindications

A

Anxiety, motor tics, MAOI , cardiac abnormalities, hs drug abuse , seizure disorders glaucoma

ADHD

46
Q

Types of amphetamines

A

Dextroamphetamine
Mixed amphetamine salts ( adderall)
Lisdexamfetamine

ADHD

47
Q

Adderall

A

Cardiac abnormalities contraindicated

ADHD

48
Q

Lisdexamfetamine

A

Amphetamine prodrug. Activated in the gut less potential for abuse

ADHD

49
Q

Atomoxetine

A

ADHD

Norepi reuptake inhibitor

Ae- nausea, anorexia,increase pulse/ BP, constipation hepatotoxic
May take 1-2 weeks to work

50
Q

Bupropion

A

ADHD

Dopamine and ne reuptake inhibitor

Ae: bulimia/ anorexia, seizure disorder, he substance abuse, head trauma

Improvement hyperactivity, hospitality and sleep

51
Q

Clonidine

A

Central alpha 2 adrenergic agonist ( post synaptic for ADHD )

Sedation big side effect , orthostatic hypotension, dry mouth

More Effective for impulsivity and hyperactivity than in attentiveness. No worsen tics.

52
Q

Guanfacine

A

Central alpha 2 Adrenergic agonist ( post synaptic for ADHD)

Sedation ( less than clonidine) orthostatic hypotension, dry mouth

More Effective for impulsivity and hyperactivity than in attentiveness. No worsen tics.

Diarrhea Bugs (5 decks)

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