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GI > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Medications for the stomach, duodenum, and esophagus

A 
Antacids
H2 blockers
PPI's
Sulcralfate
Bismuth
Metachlopramide (Reglan)
Misoprostol (Cytotec)
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2
Q

Types of Antacids

A

Aluminum salts
Magnesium hydroxide
Calcium carbonate

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3
Q

MOA of Antacids

A

Neutralizes gastric acid
Bind bile acids
Inhibit peptic activity
Promote angiogenesis in injured mucosa

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4
Q

Drug Interactions of Antacids

A

Variety
Can bind with drugs taken at the same time
Many antibiotics

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5
Q

Brand Names for Magnesium Salts

A 
Maalox
Alamag
Mag-Al
Mag-Al Ultimate
Mylanta
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6
Q

Magnesium Salt SE

A 
Diarrhea
Constipation
Abdominal cramps
N/V
Hypermagnesemia
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7
Q

When should you use magnesium salts with caution?

A

Renal insufficiency

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8
Q

Brand Names for Aluminum Salts

A

Acid gone

Gaviscon

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9
Q

When should you use aluminum salts with caution?

A

Renal insufficiency

Can block absorption of phosphate

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10
Q

Brand Names of Calcium Carbonate

A 
Tums
Maalox regular chewable
Cclci-Chew
Rolaids
Chooz
Alka-Mints
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11
Q

Indications for Calcium Carbonates

A 
Constipation- excess Ca
Bloating
Gas
N/V
Abdominal pain
Xerostomia
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12
Q

When should calcium carbonates be taken?

A

2 hours after other medications

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13
Q

When should you use calcium carbonate with caution?

A

Renal insufficiency

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14
Q

Types of H2 Blockers

A

Cimetidine (Tagamet)
Ranitidine (Zantac)
Famotidine (Pepcid)
Nizatidine (Axid)

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15
Q

H2 Blockers Indications

A

PUD: treatment & maintenance
GERD
Dyspepsia: management

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16
Q

MOA of H2 Blockers

A

Inhibit acid secretion by blocking histamine H2 receptors

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17
Q

When should you take H2 blockers?

A

30-60 minutes prior to a meal

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18
Q

SE of H2 Blockers

A 
Thrombocytopenia
Neutropenia
Anemia
Pancytopenia
Renal toxicity: rare
Hepatic toxicity: rare
CNS: rare
Cardiac: rare
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19
Q

Rare CNS SE of H2 Blockers

A 
Confusion
Restlessness
Somnolence
Agitation
Headaches
Dizziness
Hallucinations
Focal twitching
Seizures
Unresponsiveness
Apnea: renal &/or hepatic failure
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20
Q

Rare Cardiac SE of H2 Blockers

A 
Bradycardia
Hypotension
AV block
Prolongation of QT interval
Sinus & cardiac arrest
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21
Q

Unique SE of Cimetidine

A 
Gynecomastia
Impotence
Polymyositis
Interstitial nephritis
Multiple drug interactions (P450)
Cardiac arrhythmias
Hypotension
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22
Q

Absorption of H2 blockers

A

Well absorbed
Peak concentration within 1-3 hours
Reduced if taken with antacids or PPIs

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23
Q

Type of PPIs

A 
Omeprazole (Prolisec, Zegrid)
Lansoprazole (Prevacid)
Pantoprazole (Protonix)
Esomeprazole (Nexium)
Dexlansoprazole (Kapidex)
Rabeprazole (AcipHex)
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24
Q

Indications for PPIs

A 
PUD
GERD
Zollinger-Ellison syndrome
NSAID-associated ulcers
Eradication of H. pylori infection
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25
Q

MOA of PPIs

A

Irreversibly bind to and inhibits the hydrogen-potassium ATPase pump on the parietal cell membrane
Parietal cells need to be active
Administered before 1st meal of day

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26
Q

Onset of Action of PPIs

A

About 1 hours

Peak concentration in 2 hours

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27
Q

SE of PPIs

A

Diarrhea
Headache
Flatulence (Protonix)

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28
Q

Lowest Potential for Drug Interactions

A

Pantoprazole (Protonix)

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29
Q

Greatest Potential for Drug Interactions

A

Omeprazole (Prilosec, Zegrid)

Esomeprozole (Nexium)

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30
Q

Significant drug interaction occurs between clopidogrel and what PPI?

A

Omeprazole (Prilosec, Zegrid)

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31
Q

Black Box Warning for Omeprazole & Clopidogrel

A

Clopidogrel efficacy decreased

Can clot easier

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32
Q

Long term administration of PPIs increases incidence of what infections?

A

C. difficile

pneumonia

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33
Q

Long term administration of PPI’s increases what type of fractures?

A

Hip
Wrist
Spine

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34
Q

Long term administration of PPI’s increases the malabsorption of what key items?

A

B12
Magnesium
Iron

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35
Q

Administration of PPI’s

A

30-60 minutes before first meal of day

30-60 minutes prior to last meal of day (2x/day)

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36
Q

Other Medications to Treat the Esophagus, Stomach, and Duodenum

A

Sulcralfate (Carafate)
Bismuth (Pepto-bismol)
Misoprostol (Cytotec)

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37
Q

MOA of Sucralfate (Carafate)

A

Stimulates angiogenesis and formation of granulation tissue likely due to growth factor binding

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38
Q

When should sucralfate be administered?

A

30-60 minutes prior to meals

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39
Q

Cautions of Using Sucralfate

A

Do not use with aluminum containing antacids or citrate containing compounds

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40
Q

MOA of Bismuth

A

Inhibition of peptic activity but not pepsin secretion
Bind to ulcer craters
Recruits macrophages to ulcer
May increase mucosal prostaglandin production & mucus bicarbonate secretion

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41
Q

Misoprostol (Cytotec) Indications

A

Prevention & treatment of NSAID induced ulcers

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42
Q

Pregnancy Category of Misprostol

A

Category X

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43
Q

Black Box Warning for Misoprostol

A

May cause abortion, birth defects, or premature birth

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44
Q

Prokinetic Medication

A

Metaclopramide (Reglan)

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45
Q

Indications for Metaclopramide (Reglan)

A

Gastroparesis

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46
Q

MOA of Metaclopramide (Reglan)

A

Improves gastric emptying by increasing gastric astral contractions & decrease postprandial funds relaxation

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47
Q

Metaclopramide SE

A 
Anxiety
Restlessness
Depression
Hyperprolactinemia
QT prolongation
Dystonia
Tardive dyskinesia
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48
Q

Dangerous Drug Interactions with Metaclopramide

A 
Antipsychotics
Droperidol (Inapsine)
Promethazine (Phenergan)
Tetrabenazine (Xenzine)
Trimetazidine (Vastarel MR)
SSRI's
TCAs
Atovaquone (Mepron)
Metyrosine (Demser)
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49
Q

Types of Antiemetics

A

Anticholinergics
Antihistamines
Dopamine receptor antagonists (Phenothiazines, benzamides)
Sertonin antagonists

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50
Q

Neurotransmitter receptor sites involved in vomiting reflex

A 
M1-muscarinic
D2- dopamine
H1- histamine
5-hydroxytryptamine (HT)-3
Neurokinin 1 receptor (NK1)
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51
Q

What receptor does the anticholinergic agents act on?

A

M1- muscarinic receptor

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52
Q

Main Drug of the Anticholinergic Agents

A

Scopolamine

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53
Q

Anticholinergic Agent SE

A

Dry mouth
Drowsiness
Vision disturbance

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54
Q

What receptor does the antihistamines act on?

A

H1 blockers

55
Q

What is the primary use for anticholinergic agents?

A

Motion sickness

56
Q

What is the primary use for antihistamines?

A

Motion sickness

57
Q

Examples of Antihistamines

A

Diphenhydramine (Benadryl)
Cylizine (Cyclivert)
Dimenhydrinate (Dramamine)
Meclizine (Dramimine-less drowsy)

58
Q

Antihistamine SE

A

Sedation
Dry mouth
Vision disturbances

59
Q

3 Subclasses of Dopamine Receptor Antagonists

A

Phenothiazines
Butyrophenones
Benzamides

60
Q

Examples of Phenothiazines

A

Prochlorperazine (Compazine)

Promethazine (Phenergan)

61
Q

Examples of Butyrophenones

A

Antipsychotics

62
Q

Examples of Benzamides

A

Metachlorpramide (Reglan)

Trimethobenzamide (Tigan)

63
Q

Phenothiazines

A

Antagonistic properties at D2, H1 & M1

Oral, rectal, IV

64
Q

SE of Phenothiazines

A 
Dystonia
Tardive dyskinesia
Hypotension
Sedation
Drowsiness
Dry mouth
Urinary retention
Blurred vision
65
Q

What can acute dystonia be treated with?

A

Diphenhydramine

66
Q

Precautions with Phenothiazines

A 
Elderly
With other CNS depressants
Poorly controlled seizures
Severe liver dysfunction
Confusion
Delirium
67
Q

What receptors do benzamides interact at?

A

Central & peripheral D2

5-HT3

68
Q

MOA of Metachlopramide (Reglan)

A

Stimulates cholinergic receptors on gastric smooth muscle cells & enhance acetylcholine release at neuromuscular junction

69
Q

MOA of Benzamides

A

Works centrally in area of the medulla oblongata

70
Q

Serotonin 5-HT3 Antagonists

A

Mediated medially through central 5-HT3 receptor blockage in vomiting center & chemoreceptor tiger zone blockade of 5-HT3 receptors

71
Q

Clinical Uses of Serotonin 50HT3 Antagonists

A

Postoperative & chemotherapy induce N/V

Most cases of N/V except in vertigo

72
Q

Common SE of 5-HT3 Receptor Antagonists

A

Headache
Dizziness
Constipation

73
Q

Examples of 5-HT3 Receptor Antagonists

A

Ondansetron (Zofran)
Granisetron (Kytril)
Dolasetron (Anzemet)
Palonosetron (Aloxi)

74
Q

Who is odansetron (Zofran) approved for?

A

Children

Adults

75
Q

Pregnancy Category of odansetron (Zofran)

A

B/C

76
Q

Drug Interactions with odansetron (Zofran)

A

Serotonin syndrome
QT prolongation
Monitor LFTs

77
Q

Con of using odansatron (Zofran)

A

Expensive

78
Q

Differential Diagnosis of N/V

A 
Medications/toxicities
Infections (GI, ear)
Gut disorders
CNS causes
Endocrine
Post-operative
Cardiace
Radiation
79
Q

Recommended Antiemetic for Migraine Headache

A

Metoclopramide (Reglan)
Prochlorperazine (Compazine)
Metoclopramide
Serotonin antagonists

80
Q

Recommended Antiemetic for Vestibular Nausea

A

Antihistamines

Anticholinergics

81
Q

Recommended Antiemetic for Pregnancy-induced Nausea

A

Ginger

Vitamine B6

82
Q

Recommended Antiemetic for Gastroenteritis

A

Dopamine antagonists

Serotonin Antagonists

83
Q

Prevention of Post-op N/V

A

Serotonin Antagonists
Droperidol (inapsine)
Dexamethasone

84
Q

Treatment of Post-op N/V

A

Dopamine antagonists
Serotonin antagonists
Dexamethasone

85
Q

Antibiotics for Treatment of Infectious Diarrhea

A 
Ciprofloxacin
Norfloxacin
Levofloxacin
Azithromycin
Erythromycin
86
Q

Symptomatic treatment of diarrhea if no fever or bloody in stool

A

Antimotility agents

87
Q

What is best to use to reduce symptoms & treatment of traveler’s diarrhea?

A

Bismuth subsalicylate (Pepto-Bismol)

88
Q

MOA of Bismuth subsalicylate

A

Stimulating absorption of fluid & electrolytes across the intestinal wall
Inhibiting synthesis of prostaglandin responsible for intestinal inflammation and hyper motility when hydrolyzed to ASA

89
Q

SE of Bismuth subsalicylate

A

Dark stools

Black tongue

90
Q

Cautions with Bismuth subsalicylate

A

Don’t take with other ASA agents

Potentiate anticoagulants

91
Q

Contraindications to Bismuth subsalicylate

A

ASA allergy

Infants & children

92
Q

Symptomatic Treatment of Diarrhea

A

Loperamide (Imodium)
Diphenoxylate/atropine (Lomotil)
Cholestyramine

93
Q

MOA of Loperamide (Imodium)

A 
Inhibits peristalsis & prolongs transit time
Reduces fecal volume
Diminishes fluid & electrolyte loss
Demonstrates anti-secretory activity
Increases tone on the anal sphincter
94
Q

Pregnancy Category of Loperamide (Imodium)

A

C

95
Q

SE of Loperamide (Imodium)

A 
Abdominal pain
Abdominal distention
Constipation
Dry mouth
Nausea
Dizziness, drowsiness
96
Q

MOA of Dipenoxylate/atropine (Lomotil)

A

Inhibits peristalsis & slows intestinal motility
Inhibits GI propulsion
Prolongs the movement of fluid & electrolytes through the bowel

97
Q

Pregnancy Category of Dipenoxylate/atropine (Lomotil)

A

C

98
Q

When should you avoid Dipenoxylate/atropine (Lomotil)?

A

Enteroinvasive organism

99
Q

When should you avoid Loperamide (Imodium)?

A

Enteroinvasive organism

100
Q

SE of Dipenoxylate/atropine (Lomotil)

A 
Paralytic ileus, toxic megacolon
Drowsiness, dizziness
Euphoria
Tachycardia
Pruritis, urticaria
Respiratory depression
Anticholinergic effects
101
Q

Pregnancy Category of Cholestyramine

A

C

102
Q

SE of Cholestyramine

A 
Constipation
Abdominal pain & bloating
Vomiting
Excessive flatulence, diarrhea
Weight loss
Decreased absorption of warfarin, thyroid hormones, digoxin, and thiazide diuretics
103
Q

Examples of Laxatives

A 
Bulk forming
Lubricants & surfactants
Saline agents
Hyperosmotic agents
Stimulants
104
Q

First Line of Laxatives

A

Bulk forming

Surfactant agents

105
Q

Second Line of Laxatives

A

Saline

Hyperosmotic laxatives

106
Q

Third Line of Laxatives

A

Stimulant laxatives

107
Q

First Line Pharmacotherapy for the Treatment of Constipation

A

Psyllium (Metamucil): bulk forming agents
Ducosate sodium (Colace): ducosate derivatives
Glycerin: suppository

108
Q

OTC Bulk Forming Laxatives

A

Metamucil (psyllium)
Fibercon *Polycarbophil)
Citrucel (methylcellulose)
Benefiber (wheat dextrin)

109
Q

MOA of Bulk Forming Agents

A

Softens & lubricates the stool

110
Q

When does the action of bulk forming agents occur?

A

Onset 12-24 hours but may take 3 days for full effect

111
Q

SE of Bulk Forming Agents

A

Flatulence
Bloating
Abdominal cramping
Excessive use can cause N/V

112
Q

Contraindications of Bulk Forming Agents

A 
Esophageal strictures
GI ulcerations
Strictures along GI tract
Celiac patients: gluten free formulation
Caution in DM
113
Q

Fibercon Drug Interactions

A

Decrease absorption of tetracycline & quinolone

114
Q

Examples of Ducosate Derivatives

A 
Ducosate sodium (Colace)
Ducosate calcium (Surfak)
115
Q

What is the common name of decorate derivatives?

A

Stool softeners

116
Q

When should you use surfactant laxatives?

A

Patients who should not strain with BM

Patients on narcotics

117
Q

SE of Surfactant Laxatives

A

Stomach upset
Mild abdominal cramping
Diarrhea

118
Q

First Line Therapies

A

Bulk Forming Agents

Decorate derivatives Surfactant laxatives

119
Q

Second Line Therapies

A

Phillips Milk of Magnesia
Magnesium sulfate (Epsom salt)
Lactulose
Sorbitol

120
Q

MOA of Magnesium hydroxide (Milk of Magnesia)

A

Draws water into bowel through osmosis

Increases intraluminal pressure & motility

121
Q

When should you avoid magnesium hydroxide?

A

Renal dysfunction

Elderly

122
Q

SE Magnesium Hydroxide

A

GI upset

Diarrhea

123
Q

When should you use Lactulose or sorbitol?

A

Failed bulk forming agents & magnesium hydroxide

124
Q

SE of Lactulose and Sorbitol

A

GI upset
Diarrhea
Flatulence

125
Q

Third Line Therapies

A 
Stimulant laxatives
Mineral oil
Sodium biphosphates
Magnesium citrate
Castor oil
126
Q

Examples of Stimulant Laxatives

A

Senna (Senokot)

Bisacodyl (Dulcolax)

127
Q

MOA of Stimulant Laxatives

A

Increase peristalsis through direct effects on the smooth muscle of the intestines
Promote fluid accumulation in the colon and small intestine

128
Q

Onset of Action of Stimulant Laxatives

A

15 min-2 hours

129
Q

SE of Stimulant Laxatives

A

N/V

Abdominal cramping

130
Q

Contraindications of Stimulant Laxatives

A

Surgical abdomen

Fecal impaction

131
Q

What can be exacerbated by stimulant laxatives?

A

Rectal fissures

Hemorrhoids

132
Q

What Medications can be used for a Bowel Prep?

A

Sodium phosphate
Magnesium citrate (Citroma)
Polyethylene glycol electrolyte solution (Golytely)

133
Q

SE of Golytely

A 
Sleep disorder
Rigors
malaise
Increased thirst
Abdominal distention
Pain
Anorectal pain
Bloating
Nausea

GI (20 decks)

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