Pharmacology Flashcards
1
Q
Medications for the stomach, duodenum, and esophagus
A
Antacids H2 blockers PPI's Sulcralfate Bismuth Metachlopramide (Reglan) Misoprostol (Cytotec)
2
Q
Types of Antacids
A
Aluminum salts
Magnesium hydroxide
Calcium carbonate
3
Q
MOA of Antacids
A
Neutralizes gastric acid
Bind bile acids
Inhibit peptic activity
Promote angiogenesis in injured mucosa
4
Q
Drug Interactions of Antacids
A
Variety
Can bind with drugs taken at the same time
Many antibiotics
5
Q
Brand Names for Magnesium Salts
A
Maalox Alamag Mag-Al Mag-Al Ultimate Mylanta
6
Q
Magnesium Salt SE
A
Diarrhea Constipation Abdominal cramps N/V Hypermagnesemia
7
Q
When should you use magnesium salts with caution?
A
Renal insufficiency
8
Q
Brand Names for Aluminum Salts
A
Acid gone
Gaviscon
9
Q
When should you use aluminum salts with caution?
A
Renal insufficiency
Can block absorption of phosphate
10
Q
Brand Names of Calcium Carbonate
A
Tums Maalox regular chewable Cclci-Chew Rolaids Chooz Alka-Mints
11
Q
Indications for Calcium Carbonates
A
Constipation- excess Ca Bloating Gas N/V Abdominal pain Xerostomia
12
Q
When should calcium carbonates be taken?
A
2 hours after other medications
13
Q
When should you use calcium carbonate with caution?
A
Renal insufficiency
14
Q
Types of H2 Blockers
A
Cimetidine (Tagamet)
Ranitidine (Zantac)
Famotidine (Pepcid)
Nizatidine (Axid)
15
Q
H2 Blockers Indications
A
PUD: treatment & maintenance
GERD
Dyspepsia: management
16
Q
MOA of H2 Blockers
A
Inhibit acid secretion by blocking histamine H2 receptors
17
Q
When should you take H2 blockers?
A
30-60 minutes prior to a meal
18
Q
SE of H2 Blockers
A
Thrombocytopenia Neutropenia Anemia Pancytopenia Renal toxicity: rare Hepatic toxicity: rare CNS: rare Cardiac: rare
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
20
Q
Rare Cardiac SE of H2 Blockers
A
Bradycardia Hypotension AV block Prolongation of QT interval Sinus & cardiac arrest
21
Q
Unique SE of Cimetidine
A
Gynecomastia Impotence Polymyositis Interstitial nephritis Multiple drug interactions (P450) Cardiac arrhythmias Hypotension
22
Q
Absorption of H2 blockers
A
Well absorbed
Peak concentration within 1-3 hours
Reduced if taken with antacids or PPIs
23
Q
Type of PPIs
A
Omeprazole (Prolisec, Zegrid) Lansoprazole (Prevacid) Pantoprazole (Protonix) Esomeprazole (Nexium) Dexlansoprazole (Kapidex) Rabeprazole (AcipHex)
24
Q
Indications for PPIs
A
PUD GERD Zollinger-Ellison syndrome NSAID-associated ulcers Eradication of H. pylori infection
25
MOA of PPIs
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
26
Onset of Action of PPIs
About 1 hours
| Peak concentration in 2 hours
27
SE of PPIs
Diarrhea
Headache
Flatulence (Protonix)
28
Lowest Potential for Drug Interactions
Pantoprazole (Protonix)
29
Greatest Potential for Drug Interactions
Omeprazole (Prilosec, Zegrid)
| Esomeprozole (Nexium)
30
Significant drug interaction occurs between clopidogrel and what PPI?
Omeprazole (Prilosec, Zegrid)
31
Black Box Warning for Omeprazole & Clopidogrel
Clopidogrel efficacy decreased
| Can clot easier
32
Long term administration of PPIs increases incidence of what infections?
C. difficile
| pneumonia
33
Long term administration of PPI's increases what type of fractures?
Hip
Wrist
Spine
34
Long term administration of PPI's increases the malabsorption of what key items?
B12
Magnesium
Iron
35
Administration of PPI's
30-60 minutes before first meal of day
| 30-60 minutes prior to last meal of day (2x/day)
36
Other Medications to Treat the Esophagus, Stomach, and Duodenum
Sulcralfate (Carafate)
Bismuth (Pepto-bismol)
Misoprostol (Cytotec)
37
MOA of Sucralfate (Carafate)
Stimulates angiogenesis and formation of granulation tissue likely due to growth factor binding
38
When should sucralfate be administered?
30-60 minutes prior to meals
39
Cautions of Using Sucralfate
Do not use with aluminum containing antacids or citrate containing compounds
40
MOA of Bismuth
Inhibition of peptic activity but not pepsin secretion
Bind to ulcer craters
Recruits macrophages to ulcer
May increase mucosal prostaglandin production & mucus bicarbonate secretion
41
Misoprostol (Cytotec) Indications
Prevention & treatment of NSAID induced ulcers
42
Pregnancy Category of Misprostol
Category X
43
Black Box Warning for Misoprostol
May cause abortion, birth defects, or premature birth
44
Prokinetic Medication
Metaclopramide (Reglan)
45
Indications for Metaclopramide (Reglan)
Gastroparesis
46
MOA of Metaclopramide (Reglan)
Improves gastric emptying by increasing gastric astral contractions & decrease postprandial funds relaxation
47
Metaclopramide SE
```
Anxiety
Restlessness
Depression
Hyperprolactinemia
QT prolongation
Dystonia
Tardive dyskinesia
```
48
Dangerous Drug Interactions with Metaclopramide
```
Antipsychotics
Droperidol (Inapsine)
Promethazine (Phenergan)
Tetrabenazine (Xenzine)
Trimetazidine (Vastarel MR)
SSRI's
TCAs
Atovaquone (Mepron)
Metyrosine (Demser)
```
49
Types of Antiemetics
Anticholinergics
Antihistamines
Dopamine receptor antagonists (Phenothiazines, benzamides)
Sertonin antagonists
50
Neurotransmitter receptor sites involved in vomiting reflex
```
M1-muscarinic
D2- dopamine
H1- histamine
5-hydroxytryptamine (HT)-3
Neurokinin 1 receptor (NK1)
```
51
What receptor does the anticholinergic agents act on?
M1- muscarinic receptor
52
Main Drug of the Anticholinergic Agents
Scopolamine
53
Anticholinergic Agent SE
Dry mouth
Drowsiness
Vision disturbance
54
What receptor does the antihistamines act on?
H1 blockers
55
What is the primary use for anticholinergic agents?
Motion sickness
56
What is the primary use for antihistamines?
Motion sickness
57
Examples of Antihistamines
Diphenhydramine (Benadryl)
Cylizine (Cyclivert)
Dimenhydrinate (Dramamine)
Meclizine (Dramimine-less drowsy)
58
Antihistamine SE
Sedation
Dry mouth
Vision disturbances
59
3 Subclasses of Dopamine Receptor Antagonists
Phenothiazines
Butyrophenones
Benzamides
60
Examples of Phenothiazines
Prochlorperazine (Compazine)
| Promethazine (Phenergan)
61
Examples of Butyrophenones
Antipsychotics
62
Examples of Benzamides
Metachlorpramide (Reglan)
| Trimethobenzamide (Tigan)
63
Phenothiazines
Antagonistic properties at D2, H1 & M1
| Oral, rectal, IV
64
SE of Phenothiazines
```
Dystonia
Tardive dyskinesia
Hypotension
Sedation
Drowsiness
Dry mouth
Urinary retention
Blurred vision
```
65
What can acute dystonia be treated with?
Diphenhydramine
66
Precautions with Phenothiazines
```
Elderly
With other CNS depressants
Poorly controlled seizures
Severe liver dysfunction
Confusion
Delirium
```
67
What receptors do benzamides interact at?
Central & peripheral D2
| 5-HT3
68
MOA of Metachlopramide (Reglan)
Stimulates cholinergic receptors on gastric smooth muscle cells & enhance acetylcholine release at neuromuscular junction
69
MOA of Benzamides
Works centrally in area of the medulla oblongata
70
Serotonin 5-HT3 Antagonists
Mediated medially through central 5-HT3 receptor blockage in vomiting center & chemoreceptor tiger zone blockade of 5-HT3 receptors
71
Clinical Uses of Serotonin 50HT3 Antagonists
Postoperative & chemotherapy induce N/V
| Most cases of N/V except in vertigo
72
Common SE of 5-HT3 Receptor Antagonists
Headache
Dizziness
Constipation
73
Examples of 5-HT3 Receptor Antagonists
Ondansetron (Zofran)
Granisetron (Kytril)
Dolasetron (Anzemet)
Palonosetron (Aloxi)
74
Who is odansetron (Zofran) approved for?
Children
| Adults
75
Pregnancy Category of odansetron (Zofran)
B/C
76
Drug Interactions with odansetron (Zofran)
Serotonin syndrome
QT prolongation
Monitor LFTs
77
Con of using odansatron (Zofran)
Expensive
78
Differential Diagnosis of N/V
```
Medications/toxicities
Infections (GI, ear)
Gut disorders
CNS causes
Endocrine
Post-operative
Cardiace
Radiation
```
79
Recommended Antiemetic for Migraine Headache
Metoclopramide (Reglan)
Prochlorperazine (Compazine)
Metoclopramide
Serotonin antagonists
80
Recommended Antiemetic for Vestibular Nausea
Antihistamines
| Anticholinergics
81
Recommended Antiemetic for Pregnancy-induced Nausea
Ginger
| Vitamine B6
82
Recommended Antiemetic for Gastroenteritis
Dopamine antagonists
| Serotonin Antagonists
83
Prevention of Post-op N/V
Serotonin Antagonists
Droperidol (inapsine)
Dexamethasone
84
Treatment of Post-op N/V
Dopamine antagonists
Serotonin antagonists
Dexamethasone
85
Antibiotics for Treatment of Infectious Diarrhea
```
Ciprofloxacin
Norfloxacin
Levofloxacin
Azithromycin
Erythromycin
```
86
Symptomatic treatment of diarrhea if no fever or bloody in stool
Antimotility agents
87
What is best to use to reduce symptoms & treatment of traveler's diarrhea?
Bismuth subsalicylate (Pepto-Bismol)
88
MOA of Bismuth subsalicylate
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
SE of Bismuth subsalicylate
Dark stools
| Black tongue
90
Cautions with Bismuth subsalicylate
Don't take with other ASA agents
| Potentiate anticoagulants
91
Contraindications to Bismuth subsalicylate
ASA allergy
| Infants & children
92
Symptomatic Treatment of Diarrhea
Loperamide (Imodium)
Diphenoxylate/atropine (Lomotil)
Cholestyramine
93
MOA of Loperamide (Imodium)
```
Inhibits peristalsis & prolongs transit time
Reduces fecal volume
Diminishes fluid & electrolyte loss
Demonstrates anti-secretory activity
Increases tone on the anal sphincter
```
94
Pregnancy Category of Loperamide (Imodium)
C
95
SE of Loperamide (Imodium)
```
Abdominal pain
Abdominal distention
Constipation
Dry mouth
Nausea
Dizziness, drowsiness
```
96
MOA of Dipenoxylate/atropine (Lomotil)
Inhibits peristalsis & slows intestinal motility
Inhibits GI propulsion
Prolongs the movement of fluid & electrolytes through the bowel
97
Pregnancy Category of Dipenoxylate/atropine (Lomotil)
C
98
When should you avoid Dipenoxylate/atropine (Lomotil)?
Enteroinvasive organism
99
When should you avoid Loperamide (Imodium)?
Enteroinvasive organism
100
SE of Dipenoxylate/atropine (Lomotil)
```
Paralytic ileus, toxic megacolon
Drowsiness, dizziness
Euphoria
Tachycardia
Pruritis, urticaria
Respiratory depression
Anticholinergic effects
```
101
Pregnancy Category of Cholestyramine
C
102
SE of Cholestyramine
```
Constipation
Abdominal pain & bloating
Vomiting
Excessive flatulence, diarrhea
Weight loss
Decreased absorption of warfarin, thyroid hormones, digoxin, and thiazide diuretics
```
103
Examples of Laxatives
```
Bulk forming
Lubricants & surfactants
Saline agents
Hyperosmotic agents
Stimulants
```
104
First Line of Laxatives
Bulk forming
| Surfactant agents
105
Second Line of Laxatives
Saline
| Hyperosmotic laxatives
106
Third Line of Laxatives
Stimulant laxatives
107
First Line Pharmacotherapy for the Treatment of Constipation
Psyllium (Metamucil): bulk forming agents
Ducosate sodium (Colace): ducosate derivatives
Glycerin: suppository
108
OTC Bulk Forming Laxatives
Metamucil (psyllium)
Fibercon *Polycarbophil)
Citrucel (methylcellulose)
Benefiber (wheat dextrin)
109
MOA of Bulk Forming Agents
Softens & lubricates the stool
110
When does the action of bulk forming agents occur?
Onset 12-24 hours but may take 3 days for full effect
111
SE of Bulk Forming Agents
Flatulence
Bloating
Abdominal cramping
Excessive use can cause N/V
112
Contraindications of Bulk Forming Agents
```
Esophageal strictures
GI ulcerations
Strictures along GI tract
Celiac patients: gluten free formulation
Caution in DM
```
113
Fibercon Drug Interactions
Decrease absorption of tetracycline & quinolone
114
Examples of Ducosate Derivatives
```
Ducosate sodium (Colace)
Ducosate calcium (Surfak)
```
115
What is the common name of decorate derivatives?
Stool softeners
116
When should you use surfactant laxatives?
Patients who should not strain with BM
| Patients on narcotics
117
SE of Surfactant Laxatives
Stomach upset
Mild abdominal cramping
Diarrhea
118
First Line Therapies
Bulk Forming Agents
| Decorate derivatives Surfactant laxatives
119
Second Line Therapies
Phillips Milk of Magnesia
Magnesium sulfate (Epsom salt)
Lactulose
Sorbitol
120
MOA of Magnesium hydroxide (Milk of Magnesia)
Draws water into bowel through osmosis
| Increases intraluminal pressure & motility
121
When should you avoid magnesium hydroxide?
Renal dysfunction
| Elderly
122
SE Magnesium Hydroxide
GI upset
| Diarrhea
123
When should you use Lactulose or sorbitol?
Failed bulk forming agents & magnesium hydroxide
124
SE of Lactulose and Sorbitol
GI upset
Diarrhea
Flatulence
125
Third Line Therapies
```
Stimulant laxatives
Mineral oil
Sodium biphosphates
Magnesium citrate
Castor oil
```
126
Examples of Stimulant Laxatives
Senna (Senokot)
| Bisacodyl (Dulcolax)
127
MOA of Stimulant Laxatives
Increase peristalsis through direct effects on the smooth muscle of the intestines
Promote fluid accumulation in the colon and small intestine
128
Onset of Action of Stimulant Laxatives
15 min-2 hours
129
SE of Stimulant Laxatives
N/V
| Abdominal cramping
130
Contraindications of Stimulant Laxatives
Surgical abdomen
| Fecal impaction
131
What can be exacerbated by stimulant laxatives?
Rectal fissures
| Hemorrhoids
132
What Medications can be used for a Bowel Prep?
Sodium phosphate
Magnesium citrate (Citroma)
Polyethylene glycol electrolyte solution (Golytely)
133
SE of Golytely
```
Sleep disorder
Rigors
malaise
Increased thirst
Abdominal distention
Pain
Anorectal pain
Bloating
Nausea
```
