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GI 1 > Pharm - GI Potpourri > Flashcards

Pharm - GI Potpourri Flashcards

1
Q

What are the salts commonly used in antacids?

A
  • Mg++ salts
  • Al++ salts
  • Ca++ carbonate
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2
Q

ADRs Mg salts

A
  • diarrhea

- avoid in renal dysfunction

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3
Q

ADRs of Al salts and Ca carbonate

A
  • constipation

- avoid in renal dysfunction

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4
Q

What is the place in therapy in the tx of GERD for antacids?

A
  • used for pts w/ mild/intermittent sx

- can be taken on an “as needed” basis

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5
Q

MoA of antacids

A
  • weak bases that neutralize gastric acid to form salt and water
  • also enhance GI mucosal defenses by stimulating prostaglandin production or binding substances that may be toxic
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6
Q

onset and duration of antacids

A
  • rapid onset

- short duration: 30min - 3 hrs

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7
Q

counseling points for antacids

A
  • separate by 2 hrs from tetracyclines and fluoroquinolones

- take 1 hr following a meal for most relief

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8
Q

What are the H2 receptor antagonist (H2RAs) products?

A
  • famotidine (pepcid)
  • ranitidine (zantac) - preferred in pregnancy
  • nizatidine (axid)
  • cimetidine (tagamet)
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9
Q

What is H2RA dosing based on?

A

a low dose (OTC) and standard dose (Rx)

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10
Q

common ADR of H2RAs

A

tachyphylaxis (body learns how to work around it)

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11
Q

place in therapy for H2RAs in the tx of GERD

A
  • effective for mild to moderate GERD

- can be used on an “as needed” basis

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12
Q

MoA of H2RAs

A
  • reversible**, competitive antagonist of histamine at the H2 receptor on the membrane of acid-secreting parietal cells
  • selective for H2, does not effect H1
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13
Q

onset and duration of H2RAs

A
  • slower onset compared to antacids

- reaches peak at 2.5 hrs but duration is 4-10 hrs

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14
Q

counseling points for H2RAs

A
  • faster osnet than PPIs, but tolerance develops
  • use has declined since intro of PPIs
  • pregnancy category B
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15
Q

What is the drug of choice for the tx of moderate to severe GERD and PUD?

A

-PPIs: omeprazole

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16
Q

ADRs of PPIs

-these are important to know

A
  • infections: c. diff, pneumonia
  • malabsorption
  • kidney dz
  • drug induced lupus
  • mortality
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17
Q

what malabsorption risks occur in using a PPI?

A
  • mild reduction in iron
  • mild reduction in B12
  • significant impairment of magnesium absorption - hypomagnesemia
  • significant impairment of Ca absorption
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18
Q

what is the place in therapy for PPIs in the tx of GERD?

A

drug of choice in moderate-severe GERD

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19
Q

MoA of PPIs

A
  • irreversibly inhibits H+/K+ ATPase (proton pump) in the gastric parietal cell
  • prodrugs
  • irreversible and covalently bound so very powerful
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20
Q

onset and duration of PPIs

A

-more potent and longer lasting than H2RAs

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21
Q

counseling points for PPIs

A
  • take 30 min before meals
  • usually taken in the morning but can be taken at night if nighttime sx
  • administer daily, not “as needed”
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22
Q

drug interactions of PPIs

A

-omeprazole and clopidigrel** b/c omeprazole inhibits CYP2C19

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23
Q

what are the PPI products available?

A
  • omeprazole (prilosec) (one we have to know)
  • lansoprazole (prevacid)
  • dexlansoprzole (dexilant)
  • esomeprazole (nexium)
  • pantoprazole (protonix)
  • rabeprazole (aciphex)
  • omeprazole/sodium bicarb (Zegerid)
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24
Q

Al hydroxide / sucrose sulfate product

A

-sucralfate (carafate)

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25
Q

sucralfate place in therapy for the tx of GERD

A

-most commonly used in the tx of and prevention of PUD

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26
Q

MoA of sucralfate

A
  • forms viscous gel in the presence of acid
  • adheres to epithelial cells and ulcers creating a barrier
  • enhances GI mucosal protective factors
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27
Q

lifestyle modifications for the tx of GERD

A
  • elevate head of bed (esp if night sx)
  • weight reduction in obese pts
  • avoid: fats, chocolate, alcohol, peppermint/spearmint
  • avoid: spicy foods, OJ, tomato juice, coffee
  • eat small meals
  • avoid eating immediately prior to sleeping
  • stop smoking
  • avoid tight fitting clothes
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28
Q

drugs to avoid in GERD

A
  • drugs that have a direct irritant effect on esophageal mucosa
  • bisphosphonates
  • tetracylcines
  • K+Cl
  • iron salts
  • aspirin
  • NSAIDs
  • if can’t be avoided: take w/ plenty of liquid
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29
Q

Tx of mild/intermittent GERD? And what is the appropriate step up therapy?

A
  1. lifestyle modifications
  2. PRN low dose H2RAs and/or antacids
  3. increase to standard dose of H2RAs for 2 wks
  4. if still not working, dc H2RA and start PPI (8 weeks max)
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30
Q

tx of severe/frequent sx of GERD or erosive esophagitis

A

-start w/ standard dose PPI daily for 8 weeks plus lifestyle change

31
Q

management of recurrent sx and maintenance therapy of GERD

A
  • many pts relapse when acid acid suppression is dc
  • all GERD pts should have a trial off meds unless they have erosive esophagitis, they should remain on PPI
  • pts w/ recurrent sx should be managed w/ same tx
32
Q

given a pt w/ h. pylori, what is the first line combo tx for PUD?

A
  • bismuth quadruple therapy:
  • drug 1: omeprazole 20 mg po BID
  • drug 2: bismuth subsalicylate (525 mg QID)
  • drug 3: metronidazole 250-500 mg QID
  • drug 4: tetracycline 500 mg QID
33
Q

what is the duration of tx for the bismuth quadruple regimen for tx of PUD d/t h. pylori?

A

10-14 days

34
Q

given a pt w/ h. pylori, what is another first line combo tx for PUD?

A
  • concomitant regimen
  • drug 1: omeprazole 20 mg po BID
  • drug 2: clarithyomycin 500 mg po BID
  • drug 3: metronidazole 250-500 mg QID
  • drug 4: amoxicillin 1 g BID
35
Q

what are the reasons for tx failure in PUD?

A
  • poor compliance
  • resistance of h. pylori strain
  • clarithromycin resistance
  • prior use of macrolide abx, metronidazole, and levoflaxacin increases risk of resistnace
36
Q

what is the approach to salvage therapy when tx of PUD d/y h. pylori has failed?

A
  • abx choice should be guided by pts initial tx
  • can increase Bismuth quadruple therapy to 14 days
  • levofloxacin triple therapy for 10 days
  • high dose dual therapy for 14 days
  • last resort: rifabutin therapy
37
Q

levofloxacin triple therapy for salvage tx

A
  • levofloxacin
  • amoxicillin
  • PPI
  • 10-14 days
38
Q

high dose dual therapy for salvage tx

A
  • amoxicillin 1 g TID (or 750 mg QID)
  • PPI
  • 14 days
39
Q

rifabutin therapy for salvage tx

A
  • rifabutin 150 mg BID
  • amoxicillin 1 gm BID
  • PPI BID
  • 10 days
40
Q

What are the classes of med used to tx n/v

A
  • dopamine receptor antagonists
  • 1st generation H1 antagonists
  • anticholinergics
  • serotonin (5-HT3) antagonists
41
Q

dopamine receptor antagonists

A
  • prochlorperazine (compazine, compro)

- metoclopramide (reglan)

42
Q

1st generation H1 antagonists

A
  • dimenhydrinate (dramamine)
  • promethazine (phenergan)
  • meclizine (antiver, bonine)
43
Q

anticholinergics

A

-scopolomine (transderm scop)

44
Q

serotonin (5-HT3) antagonists

A

-ondansetron (zofran)

45
Q

ADR of prochlorperazine

A
  • **cardiac arrhythmias (QT prolongation, torsades)
  • **extrapyramidal sx
  • hypotension
  • sedation
  • neuroleptic malignant syndrome
46
Q

ADR of metoclopramide (reglan)

A
  • extrapyramidal syndrome
  • sedation
  • tardive dyskinesia
  • acute dystonic reactions
  • nausea
  • galactorrhea
47
Q

contraindications of metoclopramide (reglan)

A
  • GI obstruction/perforation, concurrent drugs that can cause extrapyramidal syndrome, hx of seizures
  • black box warning: irreversible tardive dyskinesia w/ higher dosing and long term use
48
Q

general ADRs of the first generation H1 antagonists

A
  • anticholinergic
  • CNS depression
  • confusion
  • sedation
  • constipation
  • dry mouth
  • urinary retention
  • blurred vision

*promethazine: EPS

49
Q

ADRs of scopolomine

A
  • orthostatic hypotension
  • zerostomia
  • blurred vision
  • constipation
  • urinary retention
50
Q

ADRs of serotonin antagonists

A
  • QT prolongation (at higher doses)
  • contipation
  • abdominal pain
  • HA
  • sedation
  • zerostomia
  • blurred vision
  • fatigue
51
Q

What med classes are used in the tx of constipation?

A
  • stimulants
  • stool softener
  • osmotic laxative
  • bulk forming agents
52
Q

stimulants

A
  • bisacodyl

- senna

53
Q

stool softeners

A

-docusate sodium/docusate calcium

54
Q

osmotic laxative

A
  • magnesium salts (hydroxide, citrate)
  • sodium phosphates (fleet)
  • glycerin (fleet)
  • lactulose
  • polyethlyn glycol (miralax)
55
Q

bulk forming agents

A
  • psyllium (metamucil)

- polycarbophil calcium (fibercon)

56
Q

bulk forming agent (psyllium) MoA

A

soluble fiber that absorbs water in the intestine to form a viscous liquid to promote peristalsis and reduce transit time

57
Q

magnesium salts (osmotic laxative) MoA

A

-osmotically increases water content of feces and fluid volume in the intestinal lumen resulting in increased intraluminal pressure
which exerts a mechanical force to stimulate peristalsis

58
Q

polyethylene glycol (miralax) (osmotic laxative) MoA

A

osmotically retains water to produce laxation

59
Q

stool softener/docusate sodium MoA

A

surfactants that reduce the surface tension and allow intestinal fluids and fatty substances to penetrate the fecal material

60
Q

stimulants MoA

A
  • act as local irritant of intestinal mucosa
  • increase propulsive activity
  • increase motility by selective action on intramural nerve plexus
  • increase mucosal permeability resulting in movement of fluid and electrolytes into intestinal lumen
61
Q

What is the general approach in the tx of constipation?

A
  • good hx is key
  • look at all things before starting tx: drug cuases, diseases, lifestyle
  • start w/ bulk forming agent
  • then can go to osmotic laxative
  • can add stimulant or use as rescue
62
Q

what med classes are used in the tx of diarrhea?

A
  • adsorbents:
  • bismuth subsalicylate (pepto-bismol)
  • opiods:
  • loperamide (imodium)
  • diphenoxylate/atropine (lomotil)
63
Q

pepto bismol MoA

A
  • bismuth has direct antimicrobial effects and binds enterotoxins
  • salicylate component is thought to inhibit intestinal prostaglandin and chloride secretion
  • leads to reduced stool frequency and liquidity
64
Q

loperamide (imodium) MoA

A
  • slows intestinal transit

- enhances water and electrolyte absorption and strengthens rectal sphincter tone

65
Q

diphenoxylate/atropine (lomotil) MoA

A

-diphenoxylate inhibits excessive GI motility and propulsion

66
Q

What is the appropraite tx regimen to prevent traveler’s diarrhea?

A
  • CDC no longer recommends prophylaxis d/t resistance and ADRs
  • can be considered in pts at high risk of complications d/t dehydration (IBD, sever vascular, renal or cardiac dz, or immunocompromised)
  • non pharmacologic: common sense, avoid ice, certain foods, safe water, “boil it cook it peel it or forget it” and rule of “Ps”
67
Q

What is the tx regiment to tx traveler’s diarrhea?

A
  • fluid replacement - important
  • restricted diet (clear liquids)
  • abx:
  • fluoroquinolones
  • azithromycin
  • rifaxamin
  • loperamid w/ abx
  • bismuch subsalicylate
68
Q

What med classes are used to provide symptomatic relief of hemorrhoids?

A
  • topical analgesics and steroids: for acute pain and shrinking
  • vasoactive agents: reduce swelling
  • antispasmotic agents: reduce spasms
  • sitz bath: relive inflammation/edema and relax muscles; releive pruritis
  • protectants
  • astringents
69
Q

role of a low FODMAP diet in IBS

A
  • only one w/ evidence
  • eliminate FODMAPs for 6-8 weeks then gradual reintroduction to determine tolerance
  • has been shown to improved IBS sx (abd pain, bloating, flatulence and dissatisfaction w/ stool consistency)
70
Q

Given a pt w/ IBS-C, what is the appropriate tx regimen?

A
  1. Fiber: increase in dietary fiber, supplementation, or both.
  2. If not responsive to fiber, add osmotic laxative.
  3. If 1+2 didn’t work, consider lubiprostone (Amitiza) or linaclotide (linzess)
71
Q

Fiber supplementation in IBS-C

A
  • start low then increase dose
  • use soluble
  • psyllium (metamucil) is preferred
72
Q

Given a pt w/ IBS-D, what is the appropriate tx regimen?

A
  1. dietary modification
  2. loperamide (imodium) - needs to be dosed regularly
  3. Viberzi - controlled substance, contraindicated if pt doesn’t have GB
  4. in pts w/ persistent diarrhea despite antidiarrheals, consider bile acid sequestrants
73
Q

What is the max dose of loperamide (imodium)?

A

16 mg/day

74
Q

What are the meds used to tx pain and bloating in IBS?

A
  • dietary modification
  • antispasmodics/anticholinergics:
  • dicyclomine (Bentyl)
  • hyoscyamine (Anaspaz, Levsin)

GI 1 (16 decks)

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