Pharm lectures Flashcards
what are 6 things that can cause diarrhea?
- inflammation
- excess secretion
- decreased absorption
- infection
- altered bacterial content
- rapid transit (bowel, stimulants/drug SE)
name the four places that somatostatin is released?
- paracrine cells
- D cells
- enteric nerve cells
- hypothalamus
what are the 5 functions of somatostatin?
- inhibits like every GI prodigestive enzyme
- inhibits intestinal fluid and pancreatic secretions
- slows GI motility and gallbladder contraction
- vascular smooth muscle contractor, reducing blood flow
- inhibits release of anterior pituitary hormones
what anti-diarrheal do you not want to use in someone who has obstruction, IBD, or IBS?
Loperamide
what anti-diarrheal is an opoid that isn’t used for analgesia? why?
loperamide
since doesn’t cross the blood brain barrier, despite being an opiod
what are the two anti-diarrheal drugs that can absorb medications and decrease their effectiveness?
- koalin-pectin
2. dietary fiber (metamucil, citrucel, fibercon)
what is the name of the anti-diarrheal that is used for both diarreah or constipatation depending on the dose?
dietary fiber (metamucil, citrucel, fibercon)
A dietary fiber in high dose is used to treat…
diarreah
a dietary fiber in a low dose is used to treat…
constipation
is dietary systemicaly absorbed?
NO!…so has very little interactions with medications
what can the anti-diarrheal Octreotide cause?
Gallstones in 50% with long term use
explain what happens with the anti-diarreal octreotide when giving at high or low doses?
low dose=increase motility
higher dose=decrease motility
what two anti-inflammatory drugs are released in the colon?
sulfasalazine
osalazine
what is the name of the PH sensitive anti-inflammatory drug?
mesalamine PH sensitive release
what is the antiinflammatory drug that has delayed release capsules?
mesalamine delayed release capsules…slighting in the stomache mostly in the intestines
Chrons disease is thought to come from and increase in what cells? causing an increase in what 5 things?
TH1 cells
increase in INF-y, TNFalpha, IL1 IL6, IL12
it is thought that ulcerative collitis comes form atypical what cells? which increase the production of what 3 things?
atypical TH2 cells
increased production of IL1, IL6, and TNFalpha
what are the two anti-inflammatoires you shouldn’t use if the patient has a sulfa allergi?
- mesalamine or 5-ASA
2. sulfasalazine
what is sulfazalasine a combination of? 2
- 5-ASA
2. sulfapyridine
what is the name of the drug that has a oral, enema, and rectal supplement that is an antiinflammatory?
mesalamine or 5-ASA
what do you need to do for both the 5-ASA drugs including mesalamine and sulfasalazine?
supplement with folic acid!! these drugs inhibit folic acid absorption
explain how sulfazalazine makes it to the colon before become activated?
bacteria in the colon cleave the inactive sulfasalazine into sulfapyridine and active 5-ASA
what is the name of the drug that is restricted by FDA programs for antiinflammatory drugs? why?
natalizumab
it can cause multifocal leukoencephalopathy
what is gallstone medication name? what is it helpful for?
ursodiol
helpful in pt that doesn’t qualify for surgery for relief
what is the name of the laxitive stimulate we will see most commonly in primary care?
senokot
what is the MOA Of senokot?
stimulates enterocytes, enteric neuros, so GI SM makes low grade inflammation causing fluid production that stimulates the motility
when should senokot not be used?
if the patient has a bowel obstruction
what do you need to keep in mind when giving someone lactulose? what should it not be used with?
oral abx may make it less effective because it prevents the conversion of NH3 to NH4 so not as much gets trapped in the gut for excretion with the bowels
when thinking of octeotide…what should you think of it txing?
great for GI bleeds especially esophageal varices
what does interferon and pegylated interferon do?
increase the halflife of interferons
what are two SE of interferon and peglated interferon?
- FLU LIKE SYMPTOMS
2. DEPRESSION
what does interferon and peglated interferon used to tx?
hep B
hep C
what abx is commonly used to tx travelers diarreah?
ofloxacin
what is abx used to tx travelers diarreah?
ofloxacin
what is lamivudine used to tx?
HBV
what is the goal of lamivudine?
used to SUPPRESS HBV replication by inhibiting HBV DNA polymerase
when can a person with HBV develop resistance to lamivudine?
70% develop resistance within 5 years
what is the goal of ribavirin?
HCV ERADICATION!!!
what does a woman need to do if being txed with ribavirin?
test for pregnancy monthly
what is ribavirin usually used in combination with?
PEG INTERFERON
is the hepatitis vaccine pre or post exposure?
BOTH
is there a combination hep A and hep B vaccine?
YES! twinnix!! has protection against both!
what can the hepatitis vaccine B vaccine cause?
relapse of MS
of the two vaccines, hep A and B, which one is inactivated and which one is recombinant?
HEP A is inactivated
HEP B is recombinant
what are the 3 functions of interferons which PEG interferon uses?
- ANTIVIRAL-inhibts all phases of viral infiltration
- IMMUNOMODULARY-ehance expression of MHC to macrophages
- VIRAL ANTIPROLIFERATION: increases proliferation of cytotoxic T cells
what are the 3 enzymes that are included in the pancreatic supplement pacrealipase?
lipase, amylase, protease
what is the initial dosing for pancrealipase?
30,000
when do you give the pancrealipase?
dose with meals and before bed
why is pancrealipase different than the other enzyme replacement? so what must you do?
this is the only one that isn’t enteric coated so must dose with a PPI
what are the three shapes that the pancrealipase comes in?
pancrelipase= beads
creon=microspheres
pacrease=microtablets
of the pancreatic replacements, which can be sprinkled on food?
croen, the microspheres
what is merperidine synthetic opoid apporoved for? 2
peri-op short term and acute pancreaittis
PPIs are ____
PRODRUGS
how many times more do PPIs concentrat in the parietal cells?
1000x
what happens to the bioavalibility of PPIs when they are taken with food?
decrease by 50%
when should you take PPIs?
on empty stomach 1 hour before meals so the max number of pumps operating get the activity
how long does the effects of PPIs work?
less than 24 hours
how many days does it take to get full acid inhibition with a PPI?
3-4 days
what do you need to do when taking a PPI and you want to stop the medication?
down titrate to prevent full acid rebound
what can the long term use of PPIs cause, esp in elderly?
increase the risk of hip fracture
by what percent does omeprazole PPI decrease gastric acid secretion?
90-98% so very effective!!!
what is the drug class for vancomycin?
glycopeptide abx
what can vancomycin do when taking orally?
bitter taste
what do you need to be cautious of when giving vancomycin IV?
RED MAN SYNDROME!!!! causes red neck esp….caused by infusing too quickly so stop and restart at a lower rate
what are the two important indiactions of vanco for this module?
PSEUDOMEMBRANEOUS COLLITIS
MRSA
what is the 3 drug regimen used to tx h. pylori?
omeprazole
amoxicillin
clarithromycin
what is the 4 drug reimen used to tx H. pylori?
omeprazole
metronidazole
tetracycline
bismuth
what is the function of the PPI in the combination regiments used to treat H. pylori
it raises the PH of the stomach and therefore lowers the antibiotic MIC needed to H. pylori eradication
what is restitution?
where cells migrate to areas of injury in the lining to seal small erosions
what do mucosal prostaglandins stimulate?
mucous and bicarb secretion
what drug on our drug tables is a abortifactant that increases uterine contractions?
misoprostol
what drug do you absolutely not want to use in pregnancy because it is used for abortions?
misoprostol
what drug used for nausea is a transdermal patch that must be removed for MRI because it contains aluminum?
scopolamine
when is scopoloamine administered for nasuea/vertigo post op?
1 patch HS prior to surgery
when is scopolamine administered for motion sickness or nausea for motion sickness?
1 patch 4 h prior and every 72 hours
what is the phenothiazine that is EXTREMELY sedating?
promethazine
what is the name of the purified cannibis drug?
dronabinol
what is the drug class for dronabinol
cannaboids dopamine antagoinis (THC)
what are the two uses of dronabinol?
appetite stimulation
anti-emetic (chemo)
what is a SE experienced with dronabinol?
euphoria/dysphoria, better tolerated in younger people
what is the drug class for ondansetron? (zofran)
serotonin antagonists
what is the MOA of ondansetron? (zofran)
periphreal and CRTZ 5-HT3 receptor blockade
what is the indication for ondansetron? (zofran)
ONLY for
- post op
- radiation and chemotherapy induced
what is the indication for aprepitant?
prevention of chemo induced N/V
what is the drug class for aprepitant?
neuokinin-antagonist
what is the MOA of aprepitant?
blocks the central NK1 receptors
how effective is the combination of Neurokinin-1, serotonin antagoinsts, and corticosteroids at preventing N/V from chemo? what 3 drugs?
90% effecitve when used as combo
- ondansetron
- aprepitant
- dexamethasone
