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GI 2 > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Which interferon ends in a instead of b?

A

Pegylated

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2
Q

Which 2 classes of hepatitis drugs have dual MOA’s?

A

Interferons

Ribavirin

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3
Q

What are the 2 MOA’s shared by interferons and ribavirin?

A

1- anti-viral

2- immunomodulatory (upregulate inflammation)

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4
Q

Almost 100% of patients taking interferons suffer from this side effect

A

Severe myalgias and fatigue (flu-like symptoms)

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5
Q

Which hepatitis drug causes dose-related side effects of bone marrow suppression and neurotoxicity?

A

Interferons

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6
Q

Why is PEG-IFN preferred to IFN?

A

Only requires 1 infusion per week instead of 3

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7
Q

Which drug’s anti-viral effect is based on a JAK-STAT pathway terminating in formation of an ISGF3:DNA complex?

A

Interferon

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8
Q

2’5’-AAA –> Ribonuclease L: DRUG & FUNCTION

A

degrades viral RNA; interferon

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9
Q

Phospho-eIF: DRUG & FUNCTION

A

inhibits protein synthesis; interferon

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10
Q

Which inflammatory cell type is upregulated by interferons?

A

Th1

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11
Q

Which treatment is appropriate for patients with decompensated HBV?

A

NRTI’s ONLY

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12
Q

Which is better tolerated: NRTI’s or Interferons?

A

NRTI’s

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13
Q

Which hepatitis drug class inhibits (viral DNA polymerase)?

A

NRTI’s – also called reverse transcriptase

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14
Q

Which NRTI is appropriate to use in a patient with a history of MDRHBV? Why?

A

Tenofovir! It doesn’t require phosphorylation by host cell kinases.

Interferons are also a good choice if the patient isn’t decompensated

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15
Q

What is the primary deadly side effect of Tenofovir?

A

Renal tubular acidosis

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16
Q

What is the primary indication for Entecavir?

A

It is safe in renal patients

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17
Q

Lamivudine is rarely used because of its high resistance profile. What mutation confers resistance to Lamivudine?

A

YMDD –> YVDD in HBV polymerase

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18
Q

Which drug is less likely to work if the patient is resistant to Lamivudine?

A

Entacavir

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19
Q

Which 2 HBV drugs also treat HIV?

A

Tenofovir

Lamivudine

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20
Q

What are the 2 serious side effects of Ribavirin?

A

Anemia

Fetal death

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21
Q

Which drug for hepatitis C is a guanosine nucleoside analog?

A

Ribavirin

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22
Q

Which hepatitis drug requires monthly pregnancy testing up to 6 months after treatment has ended?

A

Ribavirin

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23
Q

Simeprevir, Sofosbuvir, and Ledipasvir are HCV drugs in this class.

A

Direct acting anti-virals (DAA’s)

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24
Q

Why is Simepravir used less often than Sofosbuvir and Ledipasvir?

A

It only treats HCV-I. The others treat all genotypes.

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25
Q

Which DAA targets the catalytic site of the NS3/4A protease?

A

Simepravir

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26
Q

Which DAA targets the NS5B dependent RNA polymerase?

A

Sofosbuvir

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27
Q

Which DAA requires host cell phosphorylation?

A

Sofosbuvir

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28
Q

Which DAA blocks replication and assembly at the NS5A protein?

A

Ledipasvir

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29
Q

Which DAA has the highest rate of drug resistance?

A

Ledipasvir

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30
Q

List as many of the 5 effects of Ribavirin as you can

A

1- inhibit IMP dehydrogenase (deplete nucleotide triphosphate pools)

2- inhibit 5’ cap formation

3- inhibit viral RNA polymerase

4- induce mutagenesis (as ribavirin triphosphate)

5- potentiate Th1 effects of interferon

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31
Q

Which condition predisposes a patient on Ribavirin to develop anemia?

A

Renal insufficiency

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32
Q

What is the standard drug treatment in co-existant HBV/HCV?

A

Ribavirin & PEG-IFN

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33
Q

Percentage range for “moderate emesis risk” chemotherapy

A

30-90%

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34
Q

“-etrons” are anti-emetics that block this receptor

A

5HT3

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35
Q

“-prepitants” are anti-emetics that block this receptor

A

NK1 (Substance P)

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36
Q

Most H1 blockers end in “zine.” Name the 2 that don’t.

A

Diphenhydramine

Doxylamine

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37
Q

Phenothiazines are dopamine receptor blockers that unfortunately end in “zine”. Name them.

A

Chlorperomazine
Perphenazine
Prochlorperazine

“Chlor per chlor”

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38
Q

Which dopamine antagonist is classified as a butyrphenone?

A

Haloperidol

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39
Q

Drugs that end in “amide” belong to this class.

A

Dopamine blockers (other)

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40
Q

Which receptor does Scopolamine target?

A

M1

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41
Q

Which receptor is targeted by Dronabinol and Nabilone?

A

Cannibinoid

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42
Q

Which 2 drug classes should you recognize as non-specific (off-label) anti-emetics?

A

Steroids

Benzos

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43
Q

Which classes of anti-emetics are contra-indicated with anti-arrhythmics because they can cause Long QT syndrome?

A

5HT3 blockers

D2 blockers (because of A2 blockade effects)

44
Q

What effect do SSRI’s have on 5HT3 blockers?

A

They may decrease their efficacy

45
Q

Which anti-emetic acts at vagal nerve terminals?

A

5HT3 blockers

NOTE: cannabinoids via GPCR decrease 5HT3 secretion from vagal terminals

46
Q

Which cells in the intestine secrete 5HT?

A

Enterochromaffins

47
Q

Does odansetron affect serotonin secretion in the intestine?

A

NO

48
Q

Which 2 classes of anti-emetics act directly on the CTZ?

A

NK1’s (substance P)

Dopamine blockers

49
Q

Which 2 drugs are often used as nausea prophylaxis in surgery? (hint: 1 is a prodrug of the other)

A

Aprepitant

Foseprepitant

50
Q

What is the primary concern when prescribing NK/Substance P blockers?

A

CYP interactions

51
Q

Which 3 classes of anti-emetics exhibit anti-cholinergic effects?

A

M1 blockers
Dopamine blockers
Histamine blockers

52
Q

Which 2 classes of anti-emetics act in the vestibular system?

A

M1 blockers

H1 blockers

53
Q

Which H1 blocker has the longest half life?

A

Meclizine (dramamine)

54
Q

Which drug classes are preferentially used for motion sickness?

A

H1 blockers

M1 blockers

55
Q

Which classes of anti-emetics have the strongest anti-emetic potential?

A

5HT3 blockers

Cannabinoid stimulants

56
Q

What are the 3 non-dopamine receptor types affected by D2 blockers?

A

1- M1 (anti-muscarinic)
2- H1
3- Alpha adrenergic

57
Q

Drug class: Metoclopramide

A

D2 blocker

58
Q

Which anti-emetic causes diarrhea in healthy people, but is used to treat diabetic gastroparesis and dysmotility?

A

Metoclopramide (D2 blocker)

59
Q

What are the side effects of metoclopramide (D2)?

A

1- procholinergic –> diarrhea (only one in this class)
2- achalasia (increased LES tone)
3- weak 5HT3 inhibitor
4- no impact on GI secretions

60
Q

Which D2 blocker is renally eliminated?

A

Metoclopramide

61
Q

Which anti-emetics are contraindicated with many blood pressure drugs because they can cause severe hypotension? (2 classes)

A

D2 blockers

Cannabinoids

62
Q

Which receptor type is NOT in the VC (NTS)?

A

D2

63
Q

Which receptor types are NOT in the CTZ?

A

H1, M1

64
Q

Where are the central (CB1) and peripheral (CB2) cannabinoid receptors located?

A

CTZ/VC

65
Q

Which cannabinoid is schedule 2? Which is schedule 3?

A

2- Nabilone

3- Dronabinol – less potent

66
Q

Which class of anti-emetics is sympathomimetic (increases HR and BP)?

A

Cannabinoids

67
Q

Standard of treatment: mild CINV

A

Monotherapy; steroids or 5HT3, day of

68
Q

Standard of treatment: moderate CINV

A

Dual therapy: steroids and 5HT3, day of, then just the steroid for 3 days

69
Q

Standard of treatment: severe CINV

A

Triple therapy: steroids, 5HT3, and NK/SubP for day of + 3 days

70
Q

Which drug class is indicated for vertigo (1)?

A

H1 blocker

71
Q

Which drug class may be packaged with pyridoxine?

A

H1 blocker

72
Q

What is the first line treatment for morning sickness?

A

Pyridoxine

73
Q

Which antacid classes act at the basolateral membrane of the stomach? Which act on the luminal membrane?

A

Basolateral = M3, H2

Luminal = PPI’s, Antacids, misoprostol, Pepto

74
Q

Which 2 OTC antacids are used as a treatment for hyperphosphatemia?

A

Aluminum

Calcium

75
Q

Which is the only OTC antacid that causes diarrhea?

A

Magnesium

76
Q

Which OTC antacid can cause ESRD?

A

Aluminum

77
Q

Which OTC antacid causes “Milk Alkali Syndrome” (nephropathy and alkalosis)

A

Calcium

78
Q

Which OTC antacid is contraindicated with a history of kidney stones?

A

Calcium

79
Q

Which OTC antacid causes “bicarb burp” (gas and flatulence)

A

Sodium

80
Q

Which 2 OTC antacids cause alkalosis?

A

Na, Cl

81
Q

Which 2 OTC antacids have the shortest onset and longest duration

A

Ca, Mg

82
Q

Which OTC antacid supplement eliminates gas by acting as a surfactant to decrease the surface tension in the gut?

A

Simethicone

83
Q

Which transporter is targeted (BUT NOT DIRECTLY DAMAGED) by OTC antacids?

A

H/K ATPase

84
Q

Which drug class can cause “rebound” acid production in GERD?

A

OTC Antacids

85
Q

Which drug class used in the treatment of GERD can cause achalasia (+ tone LES)?

A

OTC Antacids

86
Q

What warning should patients be given about taking their other medications with antacids?

A

Never take any other drugs with antacids!

87
Q

Which GERD drug can cause gynecomastia? What class does it belong to?

A

Cimetidine (H2 blocker)

88
Q

Which 2 drugs used in PUD are very strong CYP inhibitors?

A

Cimetidine, Omeprazole

89
Q

Which alternative to Cimetidine has fewer side effects but is contraindicated in pregnancy?

A

Ranitidine (dead baby in a car)

Omprazole would also be a correct answer

90
Q

Which surface-acting agent may be used preferentially in duodenal ulcers?

A

Sucralfate

91
Q

Which drug may be packaged with diclofenac in ulcer patients who need NSAIDs?

A

Misoprostol

92
Q

Omeprazole is more effective at eliminating acid than Cimetidine. Why, then, would you choose Cimetidine?

A

It has a much faster onset (1 hour versus several days)

93
Q

Which drug class for PUD can cause blood dyscrasia?

A

H2 blockers

94
Q

Which drug class for PUD causes these side effects:

  • increased risk of C diff
  • increased risk of MI
  • increased risk of AKI
  • increased risk of fracture
A

PPI’s

95
Q

Most PUD drugs are contraindicated in renal failure. Which is the only one contraindicated in liver failure?

A

PPI’s

96
Q

Which drug class for PUD has a cytoprotective effect – increasing the concentration of PG’s and EGF – without affecting acid concentrations?

A

surface acting (sucralfate)

97
Q

Which is the only drug class for PUD that has no effect on acid concentration?

A

surface acting (sucralfate)

98
Q

How do PG-E1 analogs treat PUD?

A

1- increase PG’s –> reduce HCl secretion

2- increase mucosal defense –> increase bicarb and bloodflow

99
Q

Which PUD drug is contraindicated in IBD?

A

Misoprostol (causes diarrhea)

100
Q

Which PUD drug cannot be taken with anticoagulants

A

Pepto

101
Q

Which PUD drug is contraindicated with active GI bleeding?

A

Pepto

102
Q

What is triple therapy for PUD? How often do you take it?

A

PPI, Clarithromycin, Amoxicillin or Metronidazole

BID

103
Q

Helidac and Pylera are quadruple therapies. What is quadruple therapy for PUD? HOw often do you take it?

A

PPI or H2, Clarithomycin, Metronidazole, Pepto

104
Q

Which 2 drug classes can cause a false negative H. pylori test, other than antibiotics? (patients need to stop taking 4 weeks prior)

A

PPI’s

Pepto

105
Q

Triple and quadruple therapy for H. pylori take about 2 weeks. Then what?

A

Give PPI or H2 blocker for at least 2 more weeks

106
Q

What are the 2 first line drugs for heartburn in pregnancy?

A

OTC anatacids
Sucralfate
(Ranitidine and Lansoprazole are only ok if very bad)

GI 2 (4 decks)

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