PPTs Flashcards
Drug class? Block the action of histamine by binding to H1 receptors
antihistamines
effect of antihistamines on capillary permeability?
Decreased
what receptors do antihistamines bind to?
H1 receptors
effect of antihistamines on respiratory muscle constriction?
decrease
effect of antihistamines on vascular muscle constriction?
decrease
effect of antihistamines on GI smooth muscle constriction?
decrease
which generation of antihistamines bind non-selectively to central H1 receptors?
1st generation
which generation of antihistamines bind selectively for peripheral H1 receptors?
2nd generation
what receptors do 1st generation H1 receptors bind to?
central H1 receptors
which generation of antihistamines binds to central H1 receptors?
1st generation
which generation of antihistamines bind to peripheral H1 receptors?
2nd generation
do 1st generation antihistamines bind non-selectively or selectively?
non-selectively
do 2nd generation antihistamines bind non-selectively or selectively?
selective
which generation of antihistamines bind to central H1 receptors?
1st generation
which generation of antihistamines bind to peripheral receptors?
2nd generation
where are antihistamines metabolized?
in the liver
where are antihistamines excreted?
in the urine
which generation of antihistamines is on the Beer’s criteria list?
1st generation
1st generation antihistmines and BPH?
contraindicated
1st generation antihistamines in narrow angle glaucoma?
contraindicated
1st generation antihistamines in newborns and premature infants?
contraindicated
why are 1st generation antihistamines contraindicated in newborns and premature infants?
convulsions
which generation of antihistamines can cause paradoxical CNS stimulation in young children?
1st generation
which generation of antihistamines is diphenhydramine?
1st generation
which generation of antihistamines is chlorpheniramine?
1st generation
which generation of antihistamines is hydroxyzine?
1st generation
three examples of 1st generation antihistamines?
diphenhydrame, chlorpheniramine, hydroxyzine
which generation of antihistamine is cetirizine?
2nd generation
which generation of antihistamine is levocetirizine?
2nd generation
which generation of antihistamine is loratidine?
2nd generation
which generation of antihistamine is desloratadine?
2nd generation
which generation of antihistamine is fexofenadine?
2nd generation
brand name of diphenhydramine?
benadryl
brand name of chlorpheniramine?
chlor-trimeton
brand name of hydroxyzine?
atarax
brand name of cetirizine?
zyrtec
brand name of levocetirizine?
xyzal
brand name of loratadine?
claritin
brand name of desloratadine?
clarinex
brand name of fexofenadine?
allegra
5 examples of 2nd generation antihistamines?
cetirizine, levocetirizine, loratadine, desloratadine, fexofenadine
drug class? Used for the treatment of seasonal allergic rhinitis and vasomotor rhinitis
intranasal antihistamines
what are two indications for intranasal antihistamines?
seasonal allergic rhinitis & vasomotor rhinitis
what is the systemic oral bioavailability of intranasal antihistamines?
0.4
describe protein binding of intranasal antihistamines?
high levels
metabolism of intranasal antihistamines?
metabolized into active metabolites
excretion of intranasal antihistamines?
excreted in the feces
three side effects of intranasal antihistamines?
somnolence, nasal irritation, bitter taste
two examples of intranasal antihistamines?
azelastine & olopatadine
class? Azelastine
intranasal antihistamines
class? Olopatadine
intranasal antihistamines
what is the MOA of nasal corticosteroids?
same as inhaled corticosteroids
class? Fluticasone
nasal corticosteroids
class? Budesonide
nasal corticosteroids
class? Triamcinolone
nasal corticosteroids
class? Ciclesonide
nasal corticosteroids
class? Mometasone
nasal corticosteroids
brand name? fluticasone
flonase
brand name? budesonide
rhinocort aqua
brand name? Triamcinolone
nasacort AQ
brand name? ciclesonide
omnaris
brand name? mometsone
nasonex
what class are these? Fluticasone, budesonide, triamcinolone, ciclesonide, mometasone
nasal corticosteroids
specific class? Kaolin & pectin, bismuth subsalicylate
absorbent antidiarrheals
two examples of absorbent drugs?
kaolin and pectin; bismuth subsalicylate
specific class? Kaolin & pectin
absorbent antidiarrheals
specific class? Bismuth subsalicylate
absorbent antidiarrheals
specific class? Diphenoxylate w/ atropine
opiate antidiarrheals
specific class? Difenoxin with atropine
opiate antidiarrheals
specific class? Loperamide
opiate antidiarrheals
general class? Kaolin and pectin
antidiarrheals
general class? Bismuth subsalicylate
antidiarrheals
general class? Diphenoxylate with atropine
antidiarrheals
general class? Loperamide
antidiarrheals
two classes of antidiarrheal drugs used in crohn’s and ulcerative colitis?
loperamide & anticholinergices
what is the action of pectin?
absorbs liquid in the stool and thickens the stool
when are kaolin/pectin usually used?
uncomplicated acute diarrhea
what antidiarrheal has antisecretory, antiinflammatory, and antimicrobial actions?
bismuth subsalicylate
what portion of bismuth subsalicylate is antisecretory?
salicylate portion
what portion of bismuth subsalicylate is antimicrobial?
bismuth portion
what antidiarrheal causes discoloration of stool and tongue?
bismuth
what antidiarrheal should not be given in febrile viral conditions?
bismuth subsalicylate
what antidiarrheal can precipitate Reye syndrome in febrile viral conditions?
bismuth subsalicylate
what color does bismuth subsalicylate change stools?
gray
what can stool discoloration with bismuth make patients think?
GIB
do diphenoxylate and difenoxin cause analgesia?
no
diphenoxylate- specific class?
opiate antidiarrheals
difenoxin- specific class?
opiate antidiarrheals
what is the second ingredient of diphenoxylate?
atropine
what is the second ingredient of difenoxin?
atropine
what is the main active metabolite of diphenoxylate?
difenoxin
what is the role of atropine with diphenoxylate or difenoxin?
antisecretory and slows peristalsis
drug? Slowing of peristalsis by binding of the drug to opioid receptors in the intestines
loperamide
what does loperamide do to the stool?
bulking & increased thickness; reduction in fecal volume
effect of loperamide on fecal volume?
reduction in fecal volume
drug? Used in mild cases of Crohn disease that is without any serious complications
loperamide
what class of antidiarrheals can cause toxic megacolon?
opiate antidiarrheals
children are especially prone to anticholinergic effects of what class of antidiarrheals?
opiate antidiarrheals
opiate antidiarrheals and narrow angle glaucoma?
contraindicated
opiate antidiarrheals and urinary obstruction?
contraindicated
why shouldn’t diphenoxylate and difenoxin not be used in intestinal infections?
can worsen the condition
brand name for olodaterol?
striverdi respimat
brand name for vilanterol?
breo ellipta
specific class? Block muscarinic cholinergic receptors by antagonizing acetylcholine
inhaled anticholinergics
what receptors do inhaled anticholinergics block?
muscarinic cholinergic receptors
what do inhaled anticholinergics antagonize?
acetylcholine
what respiratory med class decreases the formation of cyclic GMP?
inhaled anticholinergics
what respiratory class decreases the formation of cyclic GMP?
inhaled anticholinergics
what respiratory class causes decreased contractility of smooth muscle in the lungs?
inhaled anticholinergics
what do inhaled anticholinergics do to contractility of smooth muscle in the lungs?
decreased contractility
what muscle do inhaled anticholinergics act on?
smooth muscle of the lungs
describe absorption of inhaled anticholinergics?
poorly absorbed from lungs and GIT
what percentage of inhaled anticholinergic dose is swallowed?
0.9
where are inhaled anticholinergics excreted from?
feces
10% of inhaled anticholinergics are metabolized by WHAT?
hydrolysis
what drug class involves metabolism via hydrolysis?
inhaled anticholinergics
what do inhaled anticholinergics decrease the formation of?
cyclic GMP
what specific class involves cyclic GMP with MOA?
inhaled anticholinergics
what does the decreased formation of cyclic GMP cause with inhaled anticholinergics?
decreased contractility of smooth muscle in the lungs
three common side effects of inhaled anticholinergics?
dry mouth, cough, headache
which glaucoma needs to be avoided with inhaled anticholinergics?
closed-angle glaucoma
what specific drug class should not be used for acute bronchospasm unless in combination with albuterol?
inhaled anticholinergics
inhaled anticholinergics in urinary retention?
no
inhaled anticholinergics in BPH?
no
inhaled anticholinergics in closed-angle glaucoma?
no
what must you combine inhaled anticholinergics with in order to use for acute bronchospasm?
albuterol
can you use inhaled anticholinergics on their own for acute bronchospasm?
no
what does SAMA stand for?
short acting muscarinic antagonists
what does LAMA stand for?
long acting muscarinic antagonists
how long do SAMAs last?
4-6 hours
specific class? Ipratropium bromide
short acting muscarinic antagonists
ipratropium bromide/albuterol- specific class?
short acting muscarinic antagonists
tiotropium bromide-specific class?
long acting muscarinic antagonists
aclidinium bromide- specific class?
long acting muscarinic antagonists
umeclidinium bromide- specific class?
long acting muscarinic antagonists
revefenacin- specific class?
long acting muscarinic antagonists
which LAMA is the only one that can be nebulized?
revefenacin
what is the brand name for revefenacin?
yupelri
how long does revefenacin (yupelri) last?
24 hours
how long does umeclidinium bromide (incruse ellipta) last?
24 hours
how long does aclidinium bromide (tudorza pressair) last?
12 hours
how long does tiotropium bromide (spiriva) last?
24 hours
what is the brand name for ipratropium bromide?
atrovent
what is the brand name for ipratropium bromide/albuterol?
combivent
what is the brand name for tiotropium bromide?
spiriva handihaler/spiriva respimat
what is the brane name for aclidinium bromide?
tudorza pressair
what is the brand name for umeclidinium bromide?
incruse ellipta
what is the first long acting nebulized LAMA?
revefenacin
specific class? Preferentially bind to M3 receptors which are the primary muscarinic receptor involving bronchoconstriction in COPD
glycopyrrolates (LAMAs)
two examples of glycopyrronium bromide?
seebri neohaler & breztri (in combination with LABA and ICS)
which receptors are the primary muscarinic receptor involving bronchoconstriction in COPD?
M3 receptors
broad class of glycopyrrolates?
inhaled anticholinergics
specific class of glycopyrrolates?
long acting muscarinic antagonists
how long does seebri neohaler last?
12 hours
example of methylxanthine drug?
theophylline
theophylline- specific class?
methylxanthine
class? Inhibit phosphodiesterases that lead to an increase in cyclic AMP
methylxanthine
effect of theophylline on bronchial smooth muscle?
relaxation
effect of theophylline on pulmonary vessels?
relaxation
what does theophylline inhibit?
phosphodiesterases
inhibition of phosphodiesterases lead to an increase of what?
cyclic AMP
describe absorption of theophylline?
well and fully absorbed orally
describe first pass with theophylline?
very little
where is theophylline metabolized?
in the liver
four common side effects of methylxanthines?
headache, irritability, gastric irritation, N/V
describe drug interactions with methylxanthines?
multiple
what respiratory drug requires monitoring with serum drug levels to prevent toxicity?
theophylline
what are decongestants used for?
used to relieve nasal congestion
what two forms do decongestants come in?
oral and topical (nasal spray) forms
class? Alpha-adrenergic receptor agonists
decongestants
class? Stimulate alpha receptors of vascular smooth muscle, constricting dilated arterioles within the nasal mucosa
decongestants
what receptors do decongestants simulate?
alpha receptors
where do decongestants stimulate alpha receptors?
vascular smooth muscle
where do decongestants constrict dilated arterioles?
within the nasal mucosa
general class? Pseudoephedrine
decongestants
specific class? Pseudoephedrine
alpha-adrenergic receptor agonists
describe absorption of pseudoephedrine?
well absorbed from GI tract
describe distribution of pseudoephedrine?
widely distributed
does pseudoephedrine cross the BBB?
yes
describe metabolism of pseudoephedrine?
partially metabolized in the liver
describe excretion of pseudoephedrine?
excreted in urine with up to 75% as an active metabolite
what is pseudoephedrine used for?
to relieve nasal congestion
what are three adverse effects with oral decongestants?
anxiety, restlessness, tremors
what are four adverse effects with topical decongestants?
burning, stinging, dryness, sneezing
oral decongestants in severe HTN?
contraindicated
oral decongestants in cardiovascular disease?
contraindicated
what is the absolute contraindication to oral decongestants?
patients on MAOIs
can you take MAOIs with oral decongestants?
no (absolute contraindication)
can kids younger than 4 years take oral decongestants?
no
what age of children should not take topical decongestants?
younger than 6 years
what age of children should not take oral decongestants?
younger than 4 years
two examples of oral decongestants?
pseudoephedrine & phenylephrine
pseudoephedrine & phenylephrine are what type of drugs?
oral decongestants
does phenylephrine have an oral form?
yes
does phenylephrine have a topical form?
yes
does phenylephrine come in oral and topical forms?
yes
does pseudoephedrine have a topical form?
no
is oxymetazoline an oral or topical decongestant?
topical
is tetrahydrozoline an oral or topical decongestant?
topical
how is oxymetazoline given?
topical
how is tetrahydrozoline given?
topical
what are antitussives used for?
to suppress cough
general class? Used to suppress cough- but should be used judiciously
antitussives
two examples of nonopioid antitussives?
benzonatate and dextromethorphan
benzonatate- specific class?
nonopioid antitussive
dextromethorphan- specific class?
nonopioid antitussive
drug? D isomer of codeine analogue that acts in medulla to increase cough threshold
dextromethorphan
drug? Chemically related to tetracaine that acts by anesthetizing the cough receptors in the lungs
benzonatate
drug? Directly acts on receptors in the cough center of the medulla
codeine
example of opioid antitussive drug?
codeine
codeine-specific class?
opioid antitussive
where does dextromethorphan act?
in the medulla
what does dextromethorphan do in the medulla?
increase cough threshold
what does dextromethorphan do to the cough threshold?
increase cough threshold
what antitussive is chemically related to tetracaine?
benzonatate
what receptors does benzonatate act on?
cough receptors in the lungs
what does benzonatate do to cough receptors in the lungs?
anesthetizes them
what receptors does codeine act on?
receptors in cough center of the medulla
describe absorption of antitussives?
all well absorbed from GIT
describe distribution of codeine?
widely distributed including CNS
where is dextromethorphan metabolized?
liver
where is dextromethorphan excreted?
in the urine
where is codeine metabolized?
liver
where is codeine excreted?
in the urine
metabolism of benzonatate?
unknown
excretion of benzonatate?
unknown
can codeine cause dependence?
yes
can dextromethorphan cause dependence?
yes
when is benzonatate contraindicated?
patients who are allergic to any “caine” compound
patients who are allergic to any “caine” compound should not take what drug?
benzonatate
should antitussives be used in patients with respiratory disease with chronic cough?
no
what two antitussive drugs can cause dependence?
codeine and dextromethorphan
three side effects of antitussives?
drowsiness, dizziness, nausea
class? Used to reduce the viscosity of thick sputum in the symptomatic treatment of cough due to respiratory infections
what is the only FDA approved expectorant?
guaifenesin
thick bronchial secretions are composed of what?
mucins
what cells produce mucins?
goblet cells
what glands produce mucins?
submucosal glands
where are the submucosal glands located?
in the airways
what drug decreases mucin production from goblet cells?
guaifenesin
what drug indirectly stimulates GI vagal afferent nerves
guaifenesin
drug? Decreases mucin production from goblet cells and indirectly stimulates GI vagal afferent nerves that trigger reflex parasympathetic glandular secretion from submucosal cells and goblet cells increasing hydration of mucus layer for more effective mucociliary clearance
guaifenesin
what are the potential GI side effects of guaifenesin?
GI upset- N/V/D
should guaifenesin be taken with asthma?
no
should guaifenesin be taken with COPD?
no
should guaifenesin be taken with HF?
no
should guaifenesin be taken with ACE inhibitor therapy?
no
class? Inhibit IgE and mast cell mediated migration of inflammatory cells into bronchial mucosa
inhaled corticosteroids
which immunoglobulin is affected with inhaled corticosteroids?
IgE
what phase of allergic reaction is affected by inhaled corticosteroids?
late-phase allergic reaction
in what two places are inhaled corticosteroids absorbed?
lungs and GI tract
describe speed of absorption of inhaled corticosteroids?
rapid
how much of inhaled corticosteroid dose is deposited in the lungs?
less than one-fourth
less than one-fourth of dose of what class is deposited in the lungs?
inhaled corticosteroids
what happens to swallowed portion of inhaled corticosteroid dose?
undergoes extensive first-pass metabolism
where are inhaled corticosteroids excreted?
in urine and feces
migration of inflammatory cells with inhaled corticosteroids are mediated by what?
mast cells
how do inhaled corticosteroids come?
in multiple forms and delivery systems
what are five potential adverse effects of inhaled corticosteroids?
xerostomia; hoarseness; mouth irritation; dysgeusia; oral candidiasis
oral candiasis can occur with what class of respiratory medication?
inhaled corticosteroids
HPA suppression is a risk with what class of respiratory medication?
inhaled corticosteroids
can inhaled corticosteroids be given in status asthmaticus?
no
high-dose of what class of respiratory medication in children may inhibit growth?
inhaled corticosteroids
highest potency inhaled corticosteroid?
fluticasone furoate
what is the brand name for fluticasone furoate?
arnuity ellipta
specific class? Fluticasone furoate
inhaled corticosteroids
specific class? Mometasone furoate DIP
inhaled corticosteroids
specific class? Fluticasone propionate DIP
inhaled corticosteroids
specific class? Beclomethasone dipropioate
inhaled corticosteroids
specific class? Ciclesonide MDI
inhaled corticosteroids
specific class? Budesonide DPI
inhaled corticosteroids
what is the brand name of mometasone furoate DPI?
asmanex twisthaler
what is the brand name for fluticasone propionate DPI?
armonair digihaler
what is the brand name for beclomethasone dipropionate?
QVAR redihaler
four examples of stimulant laxatives?
cascara, senna, bisacodyl, castor oil
specific class- cascara?
stimulant laxative
specific class- senna?
stimulant laxative
specific class- bisacodyl?
stimulant laxative
specific class- castor oil?
stimulant laxative
four examples of osmotic laxatives?
magnesium hydroxide, magnesium citrate, sodium phosphate, PEG 3350
specific class- magnesium hydroxide?
osmotic laxative
specific class- magnesium citrate?
osmotic laxative
specific class- sodium phosphate?
osmotic laxative
specific class- polyethylene glycol 3350?
osmotic laxative
three examples of bulk-producing laxatives?
psyllium, methylcellulose, polycarbophil
specific class- psyllium?
bulk-producing laxative
specific class- methylcellulose?
bulk-producing laxative
specific class- polycarbophil?
bulk-producing laxative
example of lubricant laxative?
mineral oil
specific class- mineral oil?
lubricant laxative
example of surfactant laxative?
docusate
specific class- docusate sodium?
surfactant laxative
specific class- docusate calcium?
surfactant laxative
specific class- docusate potassium?
surfactant laxative
what are the three types of docusate?
docusate sodium, docusate calcium, docusate potassium
two examples of hyperosmolar laxatives?
glycerin and lactulose
specific class- glycerin?
hyperosmolar laxative
specific class- lactulose?
hyperosmolar laxative
example of chloride channel activator laxative?
lubiprostone
specific class- lubiprostone?
chloride channel activator laxative
example of opioid receptor antagonist laxative?
methylnaltrexone
specific class- methylnaltrexone?
opioid receptor antagonist laxative
what is the one class of laxatives that does not have abuse/dependency potential?
bulk-producing laxative
do stimulant laxatives have abuse/dependency potential?
yes
do osmotic laxatives have abuse/dependency potential?
yes
do bulk-producing laxatives have abuse/dependency potential?
no
do lubricant laxatives have abuse/dependency potential?
yes
do surfactant laxatives have abuse/dependency potential?
yes
do hyperosmolar laxatives have abuse/dependence potential?
yes
do chloride channel activator laxatives have abuse/dependency potential?
yes
do opioid receptor antagonist laxatives have abuse/dependency potential?
yes
electrolyte alterations, fluid alterations, steatorrhea, osteomalacia, vitamin/nutrient deficiences- can occur with what general class?
laxatives
tartrazine sensitivity can occur with what general class?
laxatives
what is an example of a tartrazine sensitivity reaction?
bronchospasm
tartrazine sensitivity is associated with sensitivity to what?
aspirin
can you give laxatives when nausea, vomiting, and/or abdominal pain of unknown cause are present?
no
when might you especially want to avoid giving laxatives?
n/v or abdominal pain of unknown cause, especially if may have bowel obstruction
can all laxatives be given in pregnancy?
no
specific class? Thought to possible cause stimulation/irritation of the myenteric nerves
stimulant laxative
specific class? Irritation of intestinal smooth muscle
stimulant laxative
effect of stimulant laxatives on peristalsis?
increased
do stimulant laxatives affect peristalsis?
yes
specific laxative class? Increased prostaglanding release and an increase in cAMP concentration?
stimulant laxative
what nerves are effected by stimulant laxatives?
myenteric nerves
effect of stimulant laxatives on prostaglandin release?
increased
effect of stimulant laxatives on cAMP concentration?
increased
effect of stimulant laxatives on electrolyte secretion?
increased
why do stimulant laxatives cause increased electrolyte secretion?
increased prostaglandin release and an increase in cAMP concentration
four adverse effects of stimulant laxatives?
diarrhea, flatulence, abdominal cramping, bloating
why should castor oil not be used in pregnancy?
can stimulate uterine contractions
which stimulant laxative can stimulate uterine contractions?
castor oil
which stimulant laxative can cause diarrhea in lactating infants?
cascara
cascara can cause what in lactating infants?
diarrhea
cardiovascular disease is a relative contraindication to which stimulant laxative?
bisacodyl
cascara should not be used if the patient cannot ingest WHAT?
alcohol
why should cascara not be used if the patient cannot ingest some alcohol?
cascara contains some alcohol
can bisacodyl be used in pregnancy?
yes
which stimulant laxative can be used in pregnancy?
bisacodyl
can castor oil be used in pregnancy?
no
what are two indications for osmotic laxatives?
constipation and bowel prep
specific class? Increased intraluminal pressure due to water being drawn more inside the intestines
osmotic laxative
effect of osmotic laxatives on peristalsis?
increased
do osmotic laxatives affect peristalsis?
yes
four side effects of osmotic laxatives?
diarrhea, flatulence, abdominal cramping, bloating
why should magnesium-containing laxatives be avoided in renal dysfunction?
kidneys may not be able to excrete the magnesium adequately
what effect on magnesium happens if magnesium-containing laxatives are used in renal dysfunction?
hypermagnesemia
magnesium-containing laxatives should not be used in patients with what calcium imbalance?
hypocalcemia
what cardiac issues contraindicate magnesium-containing laxatives?
cardiac dysrhythmias or conduction disturbances
cardiac dysrhythmias or conduction disturbance contraindicate laxatives containing what?
magnesium hydroxide, magnesium citrate, sodium phosphate, PEG 3350
pediatric use of PEG 3350?
caution
why do osmotic laxatives cause increased intraluminal pressure?
water being drawn more inside the intestines
what laxative class can be used in chronic, watery diarrhea?
bulk-producing laxative
why are bulk-producing laxatives used in chronic, watery diarrhea?
to bulk the stool
specific class? Act physiologically like increased fiber in the diet would by combining with water in the intestines
bulk-producing laxative
specific class? Mechanical distention of the intestinal wall
bulk-producing laxative
do bulk-producing laxatives affect peristalsis?
yes
effect of bulk-producing laxatives on peristalsis?
increased
do side effects of bulk-producing laxatives dissipate with time?
usually
can bulk-producing laxatives be used in pregnancy?
yes
can bulk-producing laxatives be used if a bowel impaction?
no
why should bulk-producing laxatives not be used in a bowel impaction?
feces cannot get around impacted stool
specific class? Some may be contraindicated in clinical settings where either salt or sugar is restricted
bulk-producing laxative
what specific class of laxatives may contain salt or sugar?
bulk-producing laxative
what specific class of laxatives should be used cautiously when patient may have strictures or other narrowing of esophagus or intestine?
bulk-producing laxative
what specific class of laxatives may be used long-term for simple, chronic constipation?
bulk-producing laxative
what are four potential adverse effects of bulk-producing laxatives?
diarrhea, flatulence, abdominal cramping, bloating
specific class? Used to soften impacted stool
lubricant laxative
what is the main component of lubrican laxatives?
mineral oil
MOA of lubricant laxatives?
used to soften impacted stool
what is the purpose of lubrication with these laxatives?
to help stool move more easily via the presence of mineral oil
what are four potential adverse effects of lubricant laxatives?
diarrhea, flatulence, abdominal cramping, bloating
which specific laxative class can cause decreased absorption of fat-soluble vitamins if used chronically?
lubricant laxative
decreased absorption of what can occur with chronic use of lubricant laxatives?
fat-soluble vitamins
which specific laxative class can cause lipid pneumonia if aspirated?
lubricant laxative
who is at risk for lipid pneumonia with lubricant laxatives?
very young and any patient at risk for aspiration
which class of laxatives would you not want to give in someone with impaired swallowing?
lubricant laxative
can lubricant laxatives be taken in pregnancy?
no
why shouldn’t lubricant laxatives be taken in pregnancy?
fat-soluble vitamins may not be absorbed as well
which class of laxatives can cause vitamin K deficiency in newborns?
lubricant laxative
which class of laxatives can cause hypoprothrombinemia in newborns?
lubricant laxative
what is another name for surfactant laxatives?
stool softeners
what is the class name for stool softeners?
surfactant laxative
specific class? Used to soften stool and prevent constipation, especially stool that is dry and difficult to evacuate and when straining at stool must be stopped
surfactant laxative
which laxative class is useful when stool is dry and difficult to evacuate?
surfactant laxative
which laxative class is useful when straining at stool must be stopped?
surfactant laxative
specific class? Assist with lipids and water being mixed into stool
surfactant laxative
what is the MOA of surfactant laxatives?
assist with lipids and water being mixed into stool
do surfactant laxatives have precautions?
no
do surfactant laxatives have contraindications?
no
which class of laxatives? Usually well-tolerated and without precautions or contraindications
surfactant laxative
can surfactant laxatives be used in pregnancy?
yes
which class of laxatives are used for fecal impaction and neurogenic bowel?
hyperosmolar laxative
which class of laxatives is indicated with neurogenic bowel?
hyperosmolar laxative
which class of laxatives is used with chronic constipation and increased excretion of ammonia in the stool?
hyperosmolar laxative
specific class? Glycerin
hyperosmolar laxative
specific class? Lactulose
hyperosmolar laxative
drug? Bacteria in the gut transform this dissarchide into lactic, acetic, and formic acids
lactulose
drug? Local colonic irritation and more water drawn into the stool
glycerin
what are the four adverse effects of hyperosmolar laxatives?
diarrhea, flatulence, abdominal cramping, bloating
what patient population is at risk for dehydration with hyperosmolar laxatives?
older adults
what laxative class is associated with dehydration risk in older adults?
hyperosmolar laxative
when should you monitor blood glucose with lactulose?
those taking lactulose chronically and acutely in patients with diabetes mellitus
which laxative drug involves blood glucose monitoring?
lactulose
hyperosmolar laxatives in lactation?
avoid
lactulose in pregnancy?
only when benefits > risks
glycerin in pregnancy?
no
why do older adults get dehydration with hyperosmolar laxatives?
intravascular volume depletion
specific class? Activation of CIC-2 chloride channels in the intestinal epithelium
chloride channel activator laxative
effect of chloride channel activators on chloride secretion?
more chloride is secreted
what helps soften the stool and improve intestinal movement with chloride channel activators?
increased chloride
three indications for chloride channel activators?
chronic constipation d/t unknokwn cause; chronic constipation d/t IBS; opioid-induced constipation
these are indications for what laxative class? Chronic constipation d/t unknown cause; chronic constipation d/t IBS; opioid-induced constipation
chloride channel activator laxative
what channels do chloride channel activators activate?
CIC-2
what part of GIT do chloride channel activators work in?
intestinal epithelium
four potential adverse effects of chloride channel activators?
diarrhea, flatulence, abdominal cramping, bloating
how can you avoid nausea with chloride channel activators?
avoid by giving the drug with a meal
which laxative class is associated with dyspnea?
chloride channel activator laxative
chloride channel activators in pregnancy?
avoid
indication for opioid receptor antagonist laxatives?
chronic constipation due to opioids
this is an indication for which laxative class? Chronic constipation due to opioids
opioid receptor antagonist laxative
what receptors do opioid receptor antagonists act on?
mu opioid receptors
where are the mu opioid receptors located that opioid antagonist laxatives act on?
in the gut
effect of opioid receptor antagonist laxatives on peristalsis?
increased
do opioid receptor antagonist laxatives cross the BBB?
no
do opioid receptor antagonist laxatives cause analgesia?
no
four adverse effects of opioid receptor antagonist laxatives?
diarrhea, flatulence, abdominal cramping, bloating
can opioid receptor antagonists induce opioid withdrawal?
yes
what is the concern with abdominal pain and constipation?
concern for bowel rupture
when is opioid withdrawal syndrome more likely with opioid receptor antagonist laxatives?
if alterations of the BBB have occurred
specific class? Antagonist at the mu-opioid receptors in the gut– speeds up peristalsis
opioid receptor antagonist laxative
why shouldn’t diphenoxylate and difenoxin not be used in intestinal infections?
can worsen the condition
which two drugs should not be used with intestinal infection? (antidiarrheals)
diphenoxylate and difenoxin
children with Down syndrome are especially prone to anticholinergic adverse effects of what antidiarrheals?
opiate antidiarrheals
what type of glaucoma is a contraindication for opiate antidiarrheals?
narrow angle glaucoma
loss of WHAT in the GIT is prevented by loperamide?
fluid and electrolyte loss
what effect does loperamide have on peristalsis?
slowing
rebound constipation can progress to what?
serious impaction
what population is especially prone to serious impaction with rebound constipation?
older adults
general class? Eluxadoline
antidiarrheals
general class? Alosetron
antidiarrheals
drug? Mu and kappa opioid receptor agonist
eluxadoline
drug? Delta opioid receptor antagonist
eluxadoline
drug? Mu and kappa opioid receptor agonist and delta opioid receptor antagonist
eluxadoline
what antidiarrheal drug should be avoided in: hx of biliary disorders, pancreatitis, severe liver impairment, and heavy alcohol use?
eluxadoline
drug? Selective 5-HT3 receptor antagonist
alosetron
describe MOA of alosetron?
selective 5-HT3 receptor antagonist
drug? Decreased intestinal motility and secretions and a decrease in any associated abdominal pain
alosetron
what drug is used for females with diarrhea-predominant IBS not responsive to other therapies?
alosetron
when is alosetron used?
diarrhea-predominant IBS not responsive to other therapies
four examples of antihistamines used as antiemetics?
dimenhydrinate, diphenhydramine, hydroxyzine, meclizine
three examples of phenothiazine antiemetics?
prochlorperazine, perphenazine, promethazine
specific class? Prochlorperazine
phenothiazine antiemetics
specific class? Perphenazine
phenothiazine antiemetics
specific class? Promethazine
phenothiazine antiemetics
general class? Prochlorperazine
antiemetics
general class? Perphenazine
antiemetics
general class? Promethazine
antiemetics
can sedative-hypnotics be used as antiemetics?
antiemetics
general class? Dronabinol
cannabinoids
example of cannabinoid antiemetics?
dronabinol
specific class? Dronabinol
cannabinoid antiemetics
four examples of 5HT3 receptor antagonists? (antiemetics)
palonosetron, ondansetron, dolasetron mesylate, granisetron
general class? Palonosetron
antiemetics
general class? Ondansetron
antiemetics
general class? Dolasetron mesylate
antiemetics
general class? Granisetron
antiemetics
specific class? Palonosetron
5-HT3 receptor antagonists
specific class? Ondansetron
5-HT3 receptor antagonists
specific class? Dolasetron mesylate
5-HT3 receptor antagonists
specific class? Granisetron
5-HT3 receptor antagonists
example drug of anticholinergic antiemetic?
scopolamine
general class? Scopolamine
antiemetics
specific class? Scopolamine
anticholinergic antiemetics
general class? Aprepitant
antiemetic
specific class? Aprepitant
substance P/neurokinin 1 receptor antagonist
example of substance P/neurokinin 1 receptor antagonist?
aprepitant
example of a miscellaneous antiemetic?
trimetobenzamide
specific class? Most useful for motion sickness N/V due to slowing of neuronal communication in the vestibulocerebellar areas
antihistamine antiemetics
what class of antiemetics bind to histamine-1 receptors?
antihistamine antiemetics
antihistamine antiemetics; binding to histamine-1 receptors causes decreased what?
secretions in mouth and eyes
antihistamine antiemetics- binding to central cholinergic receptors causes what?
decreased nausea and vomiting
do antihistamine antiemetics cause anticholinergic effects?
yes
why should antihistamine antiemetics be avoided in the older adult population?
because of anticholinergic effects
what class of antiemetics can cause unexpected agitation in the pediatric population as opposed to sedation in adults?
antihistamine antiemetics
antihistamine antiemetics in hepatic dysfunction?
avoid
why should antihistamine antiemetics be avoided in hepatic dysfunction
because of liver metabolism
use of antiemetics in pregnancy and lactation?
weight risk benefit ration
which class of antiemetics is most useful for motion sickness?
antihistamine antiemetics
what class of antiemetics slows neuronal communication in the vestibulocerebellar areas
antihistamine antiemetics
where do antihistamine antiemetics slow neuronal communication?
vestibulocerebellar areas
indication for phenothiazine antiemetics?
prevent and treat N/V
what is the MOA of phenothiazine antiemetics?
antagonist at dopamine receptors in the chemoreceptor trigger zone (CTZ) (bind at multiple other receptors as well)
where are phenothiazines an antagonist?
dopamine receptors
where do phenothiazines antagonize dopamine receptors?
in the chemoreceptor trigger zone
what is the ultimate action of phenothiazine antiemetics?
decreased nausea and vomiting
extrapyramidal side effects are associated with what class of antiemetics?
phenothiazine antiemetics
who is at highest risk for EPS with phenothiazine antiemetics?
pediatric population
what is the pediatric population at risk for with phenothiazine antiemetics?
EPS
what is the black box warning with phenothiazine antiemetics?
respiratory depression in the pediatric population
which specific class of antiemetics has black box warning for respiratory depression in the pediatric population?
phenothiazine antiemetics
what class of antiemetics can cause agranulocytosis with long term use?
phenothiazine antiemetics
how many months does it take to see agranulocytosis with phenothiazine antiemetics?
four months or more
phenothiazines and Parkinson disease?
contraindicated
phenothiazines and narrow-angle glaucoma?
contraindicated
phenothiazines and bone marrow depression?
contraindicated
phenothiazines and cardiovascular disease?
contraindicated
what reflex is decreased with phenothiazine antiemetics?
cough reflex
what class of antiemetics can decrease the cough reflex?
phenothiazine antiemetics
what patients are at risk due to decreased cough reflex with phenothiazine antiemetics?
COPD or those prone to aspiration
phenothiazines and pregnancy?
avoid
what class of antiemetics can cause changes to urine color?
phenothiazine antiemetics
what color can phenothiazines antiemetics change urine?
pink to reddish brown
most adverse effects of phenothiazine antiemetics are not likely with only what?
short term use
what kind of glaucoma is contraindicated with phenothiazine antiemetics?
narrow-angle glaucoma
specific class? Used to treat N/V due to chemotherapy when other agents have failed; appetite stimulation
cannabinoid antiemetics
where do cannabinoid antiemetics act?
at cannabinoid receptors centrally
are cannabinoid receptors involved centrally or peripherally?
centrally
describe adverse effects of cannabinoid antiemetics
THC-like adverse effects
two possible mood changes with cannabinoid antiemetics?
euphoria; depression
dronabinol may cause what effect on sensory experience/level?
increase
describe changes to thoughts with dronabinol?
unusual
effect of dronabinol on concentration?
problems with concentration
effect of dronabinol on memory?
memory alterations
effect of dronabinol on time?
loss of time
what antiemetic can cause seizures?
cannabinoid antiemetics
why can dronabinol cause seizures?
lowering of the seizure threshold
three CV adverse effects with dronabinol?
palpitations, tachycardia, hypotension
effect of dronabinol on BP?
decreased blood pressure (hypotension)
effect of dronabinol on heart rate?
increased heart rate (tachycardia)
patients with a hx of an allergy to sesame oil should not take which antiemetic?
dronabinol
what drug class is first-line therapy in the management of HTN and HF?
diuretics
are diuretics first-line therapy in HTN?
yes
are diuretics first-line therapy in HF?
yes
pathophysiologic effects of HTN and HF?
increased sodium and water retention
pathophysiologic effect of HTN and HF on ECF volume?
increased
effect of diuretics on cardiac output?
decreased
effect of diuretics on plasma volume?
decreased
how do diuretics reduce cardiac output?
by decreasing plasma volume
do the effects of diuretics stay the same over time?
no- they are reduced
do diuretics always decrease peripheral resistance?
yes
effect of diuretics on peripheral resistance?
decreased
effect of diuretics on afterload?
decreased
effect of diuretics on BP?
decreased
general class? Carbonic anhydrase inhibitors
diuretics
general class? Osmotic diuretics
diuretics
general class? Aldosterone antagonists
diuretics
general class? Loop diuretics
diuretics
general class? Thiazides
diuretics
risk with diuretics re: potassium?
hypokalemia
risk with diuretics re: calcium?
hypercalcemia
risk with diuretics re: sodium?
hyponatremia
risk with diuretics re: magnesium?
hypomagnesemia
hypo or hyperkalemia with diuretics?
hypokalemia
hypo or hypercalcemia with diuretics?
hypercalcemia
hypo or hypernatremia with diuretics?
hyponatremia
hypo or hypermagnesemia with diuretics?
hypomagnesemia
what kind of diet exacerbates potassium loss with diuretics?
high sodium diet
what happens with a high sodium diet on diuretics?
exacerbates potassium loss
adverse effect associated with hypokalemia on diuretics?
metabolic alkalosis
what causes metabolic alkalosis with diuretics?
hypokalemia
effect of diuretics on uric acid?
elevated
what two diuretic classes are most likely to cause glucose intolerance?
loop and thiazide
glucose intolerance on diuretics is directly linked to what?
potassium level
potassium level is directly linked to what with diuretics?
glucose intolerance
what causes hypotension with diuretics?
decreased fluid volume
decreased fluid volume causes what adverse effect with diuretics?
hypotension
describe drug interactions with diuretics?
multiple
what is the MOA of loop diuretics?
inhibit sodium reabsorption in the ascending loop of Henle
where do loop diuretics act?
the ascending loop of Henle
what do loop diuretics inhibit in the ascending loop of Henle?
sodium reabsorption
which loop do diuretics act on?
ascending loop of Henle
class? Inhibit sodium reabsorption in the ascending loop of Henle
loop diuretics
what is the effect of loop diuretics on potassium?
increase potassium excretion
are loop diuretics short or long-acting?
short acting
are loop diuretics weak or powerful?
powerful
do loop diuretics cause small or large natriuresis?
large natriuresis
describe absorption of oral loop diuretics?
well-absorbed orally
describe distribution of loop diuretics?
widely distributed
where are loop diuretics metabolized?
liver
describe excretion of loop diuretics?
excreted unchanged in the urine
class? Inhibit sodium reabsorption in the distal renal tubule
thiazide diuretics
describe the MOA of thiazide diuretics?
inhibit sodium reabsorption in the distal renal tubule
where do thiazide diuretics act in the kidney?
distal renal tubule
effect of thiazide diuretics on potassium?
increase potassium excretion
do loop diuretics effect potassium?
yes
do thiazide diuretics effect potassium?
yes
are thiazide diuretics short or long-acting?
longer lasting
describe diuresis with thiazide diuretics?
less diuresis
describe thiazide diuretic absorption?
well-absorbed orally
what is the only diuretic to enter intracellular spaces?
thiazide diuretics
which diuretic class can be used in refractory edema?
thiazide diuretics
describe distribution of thiazide diuretics?
widely distributed
why can you use thiazide diuretics in refractory edema?
only diuretic to enter intracellular spaces
where are thiazide diuretics metabolized?
liver
where are thiazide diuretics excreted?
unchanged in urine
which diuretic class can cause hyperlipidemia?
thiazide diuretics
which diuretic class can cause photosensitive reactions?
thiazide diuretics
how long can photosensitivity secondary to thiazide diuretics last?
years after discontinuing the drug
are increased lipid levels permanent with thiazide diuretics?
elevations are transient
class? Inhibit excretion in the distal tubule of the kidney
aldosterone antagonists
describe MOA of aldosterone antagonists?
inhibit excretion in the distal tubule of the kidney
are aldosterone antagonists weak or strong diuretics?
weak diuretics
where do aldosterone antagonists act in the kidney?
distal tubule of the kidney
what class of diuretics are most often used with thiazide diuretics?
aldosterone antagonists
why are thiazide diuretics and aldosterone antagonists used together?
decrease potassium loss
aldosterone antagonists are most often used with what class of diuretics to decrease potassium loss?
thiazide diuretics
describe absorption of aldosterone antagonists?
absorption rates vary
describe distribution of aldosterone antagonists?
widely distributed
where are aldosterone antagonists metabolized?
liver
where are aldosterone antagonists excreted?
unchanged in urine
gynecomastia is associated with what class of diuretics?
aldosterone antagonists
gynecomastia occurs in 50% of patients taking what drug?
spironolactone
spironolactone- specific class?
aldosterone antagonists
impotence is a side effect of what specific class?
aldosterone antagonists
furosemide- specific class?
loop diuretics
furosemide- general class?
diuretic
bumetanide- specific class?
loop diuretics
chlorthalidone- specific class?
thiazide diuretics
hydrochlorothiazide- specific class?
thiazide diuretics
indapamide- specific class?
thiazide diuretics
metolazone- specific class?
thiazide diuretics
spironolactone- specific class?
aldosterone antagonists
triamterene- specific class?
aldosterone antagonists
amiloride- specific class?
aldosterone antagonists
eplerenone- specific class?
aldosterone antagonists
what are the four goals of GERD therapy?
prevent/decrease symptoms; heal esophagitis or any erosive esophageal lesions; prevent complications; prevent recurrent symptoms
esophageal carcinoma is a potential complication of what condition?
GERD
smoking cessation is what?
a nonpharmacologic intervention for GERD
weight loss to ideal body weight is what?
a nonpharmacologic intervention for GERD
when should HOB be elevated with GERD?
at night or if lying down
how long should patients remain supine after eating or drinking?
three hours
do not overeat- is what?
a nonpharmacologic intervention for GERD
how long should bending over be avoided after eating?
three hours
how long should strenuous exercise be avoided after eating?
three hours
class? Can be used as adjunctive therapy for frequent symptoms, as needed, and for non-frequent symptoms as needed
antacids
class? Considered first line therapy for most patients with frequent GERD symptoms or other serious complications
proton pump inhibitors
are PPIs first line therapy?
yes
are histamine-2 receptor antagonists first line for GERD?
not first line in most cases
when are drugs that improve the LES tone used?
adjunctively with a drug that is suppressing the production of HCL
when are prokinetic agents used?
reserved for use in those who still experience symptoms after maximal acid suppression therapy and max lifestyle modifications
why are cytoprotective agents mostly used only in PUD?
since they affect the gastric mucosa
which GERD drugs have serious potential adverse effects?
prokinetic agents
what do H2RAs stand for?
histamine-2 receptor antagonists
can antacids be used in GERD?
yes
can antacids be used in PUD?
yes
can antacids be used in hypersecretory states?
yes
can antacids be used in calcium deficiency?
yes
can antacids be used in hyperphosphatemia?
yes
what are the five indications for antacids?
GERD, PUD, hypersecretory states, hyperphosphatemia, calcium deficiency
class? Weak bases that form salt and water when they interact with HCL
antacids
what do antacids do to HCL?
neutralize
what do antacids do to gastric ph?
increase
what do antacids do to duodenal bulb ph?
increase
what are the components of antacids?
metallic cation plus basic anion
what effect do antacids have on pepsin?
inhibit pepsin’s proteolytic activity
do antacids affect the LES tone?
yes
what effect do antacids have on LES tone?
improve
do aluminum based antacids affect gastric motility?
yes
what is the effect of aluminum based antacids on gastric motility?
slowed
how do aluminum based antacids affect gastric motlity?
via inhibition of smooth muscle contraction locally in the stomach
which type of antacid is the only type that affects gastric motility?
aluminum-based
which two types of antacids are used in renal failure?
calcium-based and aluminum-based antacids
why are antacids used in renal failure?
to bind phosphates and lower blood phosphate levels
which two types of antacids can cause constipation?
aluminum-based and calcium-based
diarrhea is caused by which type of antacids?
magnesium-based antacids
when might alkalosis occur with antacids?
usually only in patients with renal failure
patients with renal failure are at risk for what adverse effect of antacids?
alkalosis
are antacids used as monotherapy for signficant disease?
no
are antacids used as monotherapy for esophagitis?
no
are antacids used as monotherapy for frequent symptoms?
no
antacids can be used as needed in concert with what?
an acid suppressive drug
can you use antacids without knowing the cause of abdominal pain?
no
can you use antacids in the setting of severe abdominal pain of undetermined cause?
no
can you use calcium-based antacids if a patient has hypercalcemia?
no
can you use calcium-based antacids if a patient has a history of renal stones?
no
hypercalcemia is a contraindication to what type of antacids?
calcium-based
renal stones are a contraindication to what type of antacid?
calcium-based
what two types of antacids should not be used in renal failure?
magnesium or aluminum-based antacids
why should you not use magnesium-based antacids in renal failure?
hypermagnesemia
why should you not use aluminum-based antacids in renal failure?
worsened osteomalacia
worsened osteomalacia in patients with renal failure can occur with use of which type of antacid?
aluminum-based
when should high sodium-containing antacids NOT be used?
in settings where fluid overload will exacerbate a condition
describe drug interactions with antacids?
many drug interactions re: absorption- check drug information
when should a patient call provider re: antacids?
if symptoms continue or worsen within two weeks; if new symptoms arise
are PPIs used with GERD?
yes
are PPIs used with PUD?
yes
are PPIs used with hypersecretory states?
yes
Zollinger-Ellison syndrome is an example of what?
hypersecretory state
are PPIs used with Zollinger-Ellison syndrome?
yes
what are three indications for PPIs?
GERD, PUD, hypersecretory states (e.g. Zollinger-Ellison syndrome)
specific class? Suppression of gastric acid secretion by parietal cells by preventing the H+/K+ATPase enzyme system from secreting hydrogen ion needed to form hydrochloric acid
PPIs
what do PPIs suppress?
gastric acid secretion by parietal cells
what cells do PPI suppress?
parietal cells
what system is involved in PPIs?
H+K+ATPase enzyme system
what class of GERD medications can result in achlorhydria?
proton pump inhibitors
term? No gastric acid
achlorhydria
less gastric acid results in decreased/increased blood flow to gastric antrum?
decreased
less gastric acid results in decreased/increased blood flow to the pylorus?
decreased
less gastric acid results in decreased/increased blood flow to the duodenal bulb?
decreased
what effect does decreased gastric acid have on pepsinogen levels?
increased
less gastric acid results in decreased/increased pepsinogen levels?
increased
less gastric acid results in decreased/increased pepsin activity?
decreased
what effect does less gastric acid have on pepsin activity?
decreased
less gastric acid results in a compensatory increase in what?
gastrin levels
are there any clinically significant effects with compensatory increase in gastric levels?
no
what are four GI adverse effects with PPIs?
nausea, abdominal pain, flatulence, constipation/diarrhea
what are two CNS type adverse effects with PPIs?
dizziness and drowsiness
acute interstitial nephritis is associated with what GERD class?
proton pump inhibitors
deficiences of what four nutrients can occur with PPIs?
iron, magnesium, vitamin B12, calcium
what GERD medication has potential risk for hip fracture?
proton pump inhibitors
acute kidney injury and chronic kidney disease can occur with long-term use of what GERD class?
proton pump inhibitors
even short-term use increases the risk of pneumonia with what GERD drug class?
proton pump inhibitors
what is the potentially respiratory consequence with even short-term use of PPIs?
pneumonia
C diff infection can occur with what GERD class?
proton pump inhibitors
what GERD class may pose a risk for gastric cancer?
proton pump inhibitors
what GERD class is associated with chronic atrophic gastritis?
proton pump inhibitors
chronic atrophic gastritis with PPIs may increase risk for what?
gastric cancer
what GERD class has concern re: development of dementia?
proton pump inhibitors
PPI effect on overall mortality?
potential increased risk
PPIs in hepatic dysfunction?
cautious use
PPIs in older patients?
cautious use
PPIs in pregnancy?
avoid in pregnancy unless needed (requires favorable risk/benefit)
PPIs in lactation?
cautious use only
are any PPIs safe and effective in pediatrics?
some drugs in class
any drug therapy for GERD must be combined with what?
ongoing lifestyle modifications
if PPI response is not adequate, what should I do?
check for compliance with medication and with lifestyle modifications
what class is almost always preferred over H2RAs?
proton pump inhibitors
what are three indications for H2RAs?
GERD (w/ or w/o erosive esophagitis); PUD; hypersecretory states
can H2RAs be used for GERD?
yes
can H2RASs be used for GERD with erosive esophagitis?
yes
can H2RAs be used for GERD without erosive esophagitis?
yes
can H2RAs be used for PUD?
yes
can H2RAs be used for hypersecretory states
yes
is ranitidine still used?
no
why is ranitidine no longer used in the USA?
due to nitrosodimethylamine being found in the formulations
what does NDMA stand for?
nitrosodimethylamine
what is the problem with nitrosodimethylamine?
likely a human carcinogen
specific class? Blockade of the histamine-2 receptor on gastric parietal cells
histamine-2 receptor antagonists
less/more HCL is produced with H2RAs?
less
effect of H2RAs on gastric PH?
increased
do H2RAs have effect on LES pressure?
yes- varied
do H2RAs have effect on speed of gastric emptying?
yes-varied
do H2RAs have effect on volume of gastric secretion?
yes-varied
do H2RAs have effect on hydrogen ion concentration?
yes-varied
which H2RA medication is the most potent at lowering gastric acid secretion?
famotidine
is there any clinical benefit of famotidine’s potency at lowering gastric acid secretion?
unclear
famotidine is the most potent at doing what?
lowering gastric acid secretion
what GERD class can cause gynecomastia and erectile dysfunction?
histamine-2 receptor antagonists
what GERD medication can cause gynecomastia and erectile dysfunction?
cimetidine
what are two antiandrogenic side effects of cimetidine?
gynecomastia and erectile dysfunction
oral and IV forms of what GERD drug class can cause potential rhythm and conduction abnormalities?
histamine-2 receptor antagonists
can oral H2RAs cause rhythm and conduction abnormalities?
yes
can IV H2RAs cause rhythm and conduction abnormalities?
yes
the following are CNS ADEs with what drug class (GERD)? Alterations of cognitive function, agitation, psychosis, depression, headache, seizures
histamine-2 receptor antagonists
CNS adverse effects with H2RAs are more likely to occur in who?
renal and/or hepatic dysfunction
why should H2RAs be avoided in older population?
due to cognitive effects
what is the hematologic adverse reaction to H2RAs?
individual cell line deficiencies to pancytopenia
individual cell line deficiencies to pancytopenia can occur with what GERD drug class?
histamine-2 receptor antagonists
why should we monitor CBC with H2RAs?
risk for individual cell line deficiencies to pancytopenia
hepatic cell injury can occur with what GERD medication?
nizatidine
why should we monitor LFTs with H2RAs?
hepatic cell injury (nizatidine)
nizatidine is associated with what?
hepatic cell injury
what is the vitamin deficiency that can occur with long-term use of H2RAs?
vitamin B12
what can happen to vitamin B12 with long-term use of H2RAs?
deficiency
vitamin B12 deficiency can cause what two consequences? (H2RAs)
anemia and neurologic deficits
neurologic deficits with H2RAs can be due to what?
vitamin B12 deficiency
three immune-related adverse effects with H2RAs?
polymyositis, nephritis, immune-related rashes
immune-related rashes can occur with what GERD class?
histamine-2 receptor antagonists
polymyositis can occur with what GERD class?
histamine-2 receptor antagonists
nephritis can occur with what GERD class?
histamine-2 receptor antagonists
fever can occur with what GERD class?
histamine-2 receptor antagonists
do H2RAs block histamine-1 receptors?
no
why are H2RAs not anticholinergic?
they do not block the histamine-1 receptors
are H2RAs anticholinergic drugs?
no
H2RA use in pregnancy?
not well studied, avoid (weigh risk benefit)
H2RA use in lactation?
avoid (weight risk benefit)
H2RA use in pediatrics?
yes
drug? Used for lower tiers of therapy due to serious adverse effects possible
metoclopramide
EPS are possible with what GERD medication?
metoclopramide
pediatric patients taking metoclopramide are at higher risk for what?
EPS
is metoclopramide used as monotherapy for GERD?
no
does metoclopramide have prokinetic properties?
yes
does metoclopramide affect LES tone?
improves LES tone
does metoclopramide help heal esophageal lesions?
no
is bethanechol used as GERD monotherapy?
no
what two drugs are mostly used for gastroparesis therapy re: GI disorders?
metoclopramide and bethanechol
what is the primary use for metoclopramide?
gastroparesis therapy re: GI disorders
what is the primary use for bethanechol?
gastroparesis therapy re: GI disorders
does bethanechol have prokinetic properties?
yes
does bethanechol help heal esophageal lesions?
no
these are the goals of what? Eliminate H pylori (main cause of PUD); reduction/elimination of any symptoms; healing of ulcer; avoid complications; prevent recurrent disease
PUD
what is the main cause of PUD?
H pylori
what organism causes PUD?
H pylori
what are three potential complications of PUD?
bleeding, perforation, carcinoma
why are H2RAs rarely used for PUD?
because the PPIs are much more effective at gastric acid suppression
what is the main class of antisecretory medication used in PUD treatment?
proton pump inhibitors
what are the seven antimicrobials used for H pylori?
clarithromycin; amoxicillin; metronidazole; tetracycline; doxycycline; nitazoxanide; levofloxacin
is bismuth subsalicylate used in PUD treatment?
yes
is clarithromycin used in PUD treatment?
yes
is amoxicillin used in PUD treatment?
yes
is metronidazole used in PUD treatment?
yes
is tetracycline used in PUD treatment?
yes
is doxycycline used in PUD treatment?
yes
is nitazoxanide used in PUD treatment?
yes
is levofloxacine used in PUD treatment?
yes
is vancomycin used in PUD treatment?
no
is erythromycin used in PUD treatment?
no
why might treatment failure occur in H pylori treatment?
microbial resistance to antibiotics
what is the treatment regimen for H pylori?
various three and four-drug combinations with PPIs
drug? Binds to the ulcer site to shield the area from HCL, pepsin, and bile salts
sucralfate
can you use sucralfate in children?
safety not established
what three things does sucralfate shield from?
HCL, pepsin, and bile salts
drug? Inhibits formation of cAMP that occurs due to histamine stimulation?
misoprostol
misoprostol MOA?
inhibits formation of cAMP that occurs due to histamine stimulation
what does misoprostol do to gastric acid secretion?
inhibits
what effect does misoprostol have on gastric mucus?
promotes formation
what effect does misoprostol have on bicarbonate?
promotes production
does misoprostol protect mucosa?
yes
what PUD medication can induce uterine contractions?
misoprostol
what PUD medication is absolutely contraindicated in pregnancy?
misoprostol
why is misoprostol absolutely contraindicated in pregnancy?
can induce uterine contractions
misoprostol in renal dysfunction?
cautious use
misoprostol in pediatrics?
safety not established in < 18 years of age
indication for misoprostol?
primarily used for prevention of NSAID-induced PUD
what drug is primarily used for prevention of NSAID-induced PUD?
misoprostol
class? Inhibit IgE and mast cell mediated migration of inflammatory cells into bronchial mucosa
inhaled corticosteroids
which immunoglobulin is affected with inhaled corticosteroids?
IgE
what phase of allergic reaction is affected by inhaled corticosteroids?
late-phase allergic reaction
in what two places are inhaled corticosteroids absorbed?
lungs and GI tract
describe speed of absorption of inhaled corticosteroids?
rapid
how much of inhaled corticosteroid dose is deposited in the lungs?
less than one-fourth
less than one-fourth of dose of what class is deposited in the lungs?
inhaled corticosteroids
what happens to swallowed portion of inhaled corticosteroid dose?
undergoes extensive first-pass metabolism
where are inhaled corticosteroids excreted?
in urine and feces
migration of inflammatory cells with inhaled corticosteroids are mediated by what?
mast cells
how do inhaled corticosteroids come?
in multiple forms and delivery systems
what are five potential adverse effects of inhaled corticosteroids?
xerostomia; hoarseness; mouth irritation; dysgeusia; oral candidiasis
oral candiasis can occur with what class of respiratory medication?
inhaled corticosteroids
HPA suppression is a risk with what class of respiratory medication?
inhaled corticosteroids
can inhaled corticosteroids be given in status asthmaticus?
no
high-dose of what class of respiratory medication in children may inhibit growth?
inhaled corticosteroids
highest potency inhaled corticosteroid?
fluticasone furoate
what is the brand name for fluticasone furoate?
arnuity ellipta
specific class? Fluticasone furoate
inhaled corticosteroids
specific class? Mometasone furoate DIP
inhaled corticosteroids
specific class? Fluticasone propionate DIP
inhaled corticosteroids
specific class? Beclomethasone dipropioate
inhaled corticosteroids
specific class? Ciclesonide MDI
inhaled corticosteroids
specific class? Budesonide DPI
inhaled corticosteroids
what is the brand name of mometasone furoate DPI?
asmanex twisthaler
what is the brand name for fluticasone propionate DPI?
armonair digihaler
what is the brand name for beclomethasone dipropionate?
QVAR redihaler
four examples of stimulant laxatives?
cascara, senna, bisacodyl, castor oil
specific class- cascara?
stimulant laxative
specific class- senna?
stimulant laxative
specific class- bisacodyl?
stimulant laxative
specific class- castor oil?
stimulant laxative
four examples of osmotic laxatives?
magnesium hydroxide, magnesium citrate, sodium phosphate, PEG 3350
specific class- magnesium hydroxide?
osmotic laxative
specific class- magnesium citrate?
osmotic laxative
specific class- sodium phosphate?
osmotic laxative
specific class- polyethylene glycol 3350?
osmotic laxative
three examples of bulk-producing laxatives?
psyllium, methylcellulose, polycarbophil
specific class- psyllium?
bulk-producing laxative
specific class- methylcellulose?
bulk-producing laxative
specific class- polycarbophil?
bulk-producing laxative
example of lubricant laxative?
mineral oil
specific class- mineral oil?
lubricant laxative
example of surfactant laxative?
docusate
specific class- docusate sodium?
surfactant laxative
specific class- docusate calcium?
surfactant laxative
specific class- docusate potassium?
surfactant laxative
what are the three types of docusate?
docusate sodium, docusate calcium, docusate potassium
two examples of hyperosmolar laxatives?
glycerin and lactulose
specific class- glycerin?
hyperosmolar laxative
specific class- lactulose?
hyperosmolar laxative
example of chloride channel activator laxative?
lubiprostone
specific class- lubiprostone?
chloride channel activator laxative
example of opioid receptor antagonist laxative?
methylnaltrexone
specific class- methylnaltrexone?
opioid receptor antagonist laxative
what is the one class of laxatives that does not have abuse/dependency potential?
bulk-producing laxative
do stimulant laxatives have abuse/dependency potential?
yes
do osmotic laxatives have abuse/dependency potential?
yes
do bulk-producing laxatives have abuse/dependency potential?
no
do lubricant laxatives have abuse/dependency potential?
yes
do surfactant laxatives have abuse/dependency potential?
yes
do hyperosmolar laxatives have abuse/dependence potential?
yes
do chloride channel activator laxatives have abuse/dependency potential?
yes
do opioid receptor antagonist laxatives have abuse/dependency potential?
yes
electrolyte alterations, fluid alterations, steatorrhea, osteomalacia, vitamin/nutrient deficiences- can occur with what general class?
laxatives
tartrazine sensitivity can occur with what general class?
laxatives
what is an example of a tartrazine sensitivity reaction?
bronchospasm
tartrazine sensitivity is associated with sensitivity to what?
aspirin
can you give laxatives when nausea, vomiting, and/or abdominal pain of unknown cause are present?
no
when might you especially want to avoid giving laxatives?
n/v or abdominal pain of unknown cause, especially if may have bowel obstruction
can all laxatives be given in pregnancy?
no
specific class? Thought to possible cause stimulation/irritation of the myenteric nerves
stimulant laxative
specific class? Irritation of intestinal smooth muscle
stimulant laxative
effect of stimulant laxatives on peristalsis?
increased
do stimulant laxatives affect peristalsis?
yes
specific laxative class? Increased prostaglanding release and an increase in cAMP concentration?
stimulant laxative
what nerves are effected by stimulant laxatives?
myenteric nerves
effect of stimulant laxatives on prostaglandin release?
increased
effect of stimulant laxatives on cAMP concentration?
increased
effect of stimulant laxatives on electrolyte secretion?
increased
why do stimulant laxatives cause increased electrolyte secretion?
increased prostaglandin release and an increase in cAMP concentration
four adverse effects of stimulant laxatives?
diarrhea, flatulence, abdominal cramping, bloating
why should castor oil not be used in pregnancy?
can stimulate uterine contractions
which stimulant laxative can stimulate uterine contractions?
castor oil
which stimulant laxative can cause diarrhea in lactating infants?
cascara
cascara can cause what in lactating infants?
diarrhea
cardiovascular disease is a relative contraindication to which stimulant laxative?
bisacodyl
cascara should not be used if the patient cannot ingest WHAT?
alcohol
why should cascara not be used if the patient cannot ingest some alcohol?
cascara contains some alcohol
can bisacodyl be used in pregnancy?
yes
which stimulant laxative can be used in pregnancy?
bisacodyl
can castor oil be used in pregnancy?
no
what are two indications for osmotic laxatives?
constipation and bowel prep
specific class? Increased intraluminal pressure due to water being drawn more inside the intestines
osmotic laxative
effect of osmotic laxatives on peristalsis?
increased
do osmotic laxatives affect peristalsis?
yes
four side effects of osmotic laxatives?
diarrhea, flatulence, abdominal cramping, bloating
why should magnesium-containing laxatives be avoided in renal dysfunction?
kidneys may not be able to excrete the magnesium adequately
what effect on magnesium happens if magnesium-containing laxatives are used in renal dysfunction?
hypermagnesemia
magnesium-containing laxatives should not be used in patients with what calcium imbalance?
hypocalcemia
what cardiac issues contraindicate magnesium-containing laxatives?
cardiac dysrhythmias or conduction disturbances
cardiac dysrhythmias or conduction disturbance contraindicate laxatives containing what?
magnesium hydroxide, magnesium citrate, sodium phosphate, PEG 3350
pediatric use of PEG 3350?
caution
why do osmotic laxatives cause increased intraluminal pressure?
water being drawn more inside the intestines
what laxative class can be used in chronic, watery diarrhea?
bulk-producing laxative
why are bulk-producing laxatives used in chronic, watery diarrhea?
to bulk the stool
specific class? Act physiologically like increased fiber in the diet would by combining with water in the intestines
bulk-producing laxative
specific class? Mechanical distention of the intestinal wall
bulk-producing laxative
do bulk-producing laxatives affect peristalsis?
yes
effect of bulk-producing laxatives on peristalsis?
increased
do side effects of bulk-producing laxatives dissipate with time?
usually
can bulk-producing laxatives be used in pregnancy?
yes
can bulk-producing laxatives be used if a bowel impaction?
no
why should bulk-producing laxatives not be used in a bowel impaction?
feces cannot get around impacted stool
specific class? Some may be contraindicated in clinical settings where either salt or sugar is restricted
bulk-producing laxative
what specific class of laxatives may contain salt or sugar?
bulk-producing laxative
what specific class of laxatives should be used cautiously when patient may have strictures or other narrowing of esophagus or intestine?
bulk-producing laxative
what specific class of laxatives may be used long-term for simple, chronic constipation?
bulk-producing laxative
what are four potential adverse effects of bulk-producing laxatives?
diarrhea, flatulence, abdominal cramping, bloating
specific class? Used to soften impacted stool
lubricant laxative
what is the main component of lubrican laxatives?
mineral oil
MOA of lubricant laxatives?
used to soften impacted stool
what is the purpose of lubrication with these laxatives?
to help stool move more easily via the presence of mineral oil
what are four potential adverse effects of lubricant laxatives?
diarrhea, flatulence, abdominal cramping, bloating
which specific laxative class can cause decreased absorption of fat-soluble vitamins if used chronically?
lubricant laxative
decreased absorption of what can occur with chronic use of lubricant laxatives?
fat-soluble vitamins
which specific laxative class can cause lipid pneumonia if aspirated?
lubricant laxative
who is at risk for lipid pneumonia with lubricant laxatives?
very young and any patient at risk for aspiration
which class of laxatives would you not want to give in someone with impaired swallowing?
lubricant laxative
can lubricant laxatives be taken in pregnancy?
no
why shouldn’t lubricant laxatives be taken in pregnancy?
fat-soluble vitamins may not be absorbed as well
which class of laxatives can cause vitamin K deficiency in newborns?
lubricant laxative
which class of laxatives can cause hypoprothrombinemia in newborns?
lubricant laxative
what is another name for surfactant laxatives?
stool softeners
what is the class name for stool softeners?
surfactant laxative
specific class? Used to soften stool and prevent constipation, especially stool that is dry and difficult to evacuate and when straining at stool must be stopped
surfactant laxative
which laxative class is useful when stool is dry and difficult to evacuate?
surfactant laxative
which laxative class is useful when straining at stool must be stopped?
surfactant laxative
specific class? Assist with lipids and water being mixed into stool
surfactant laxative
what is the MOA of surfactant laxatives?
assist with lipids and water being mixed into stool
do surfactant laxatives have precautions?
no
do surfactant laxatives have contraindications?
no
which class of laxatives? Usually well-tolerated and without precautions or contraindications
surfactant laxative
can surfactant laxatives be used in pregnancy?
yes
which class of laxatives are used for fecal impaction and neurogenic bowel?
hyperosmolar laxative
which class of laxatives is indicated with neurogenic bowel?
hyperosmolar laxative
which class of laxatives is used with chronic constipation and increased excretion of ammonia in the stool?
hyperosmolar laxative
specific class? Glycerin
hyperosmolar laxative
specific class? Lactulose
hyperosmolar laxative
drug? Bacteria in the gut transform this dissarchide into lactic, acetic, and formic acids
lactulose
drug? Local colonic irritation and more water drawn into the stool
glycerin
what are the four adverse effects of hyperosmolar laxatives?
diarrhea, flatulence, abdominal cramping, bloating
what patient population is at risk for dehydration with hyperosmolar laxatives?
older adults
what laxative class is associated with dehydration risk in older adults?
hyperosmolar laxative
when should you monitor blood glucose with lactulose?
those taking lactulose chronically and acutely in patients with diabetes mellitus
which laxative drug involves blood glucose monitoring?
lactulose
hyperosmolar laxatives in lactation?
avoid
lactulose in pregnancy?
only when benefits > risks
glycerin in pregnancy?
no
why do older adults get dehydration with hyperosmolar laxatives?
intravascular volume depletion
specific class? Activation of CIC-2 chloride channels in the intestinal epithelium
chloride channel activator laxative
effect of chloride channel activators on chloride secretion?
more chloride is secreted
what helps soften the stool and improve intestinal movement with chloride channel activators?
increased chloride
three indications for chloride channel activators?
chronic constipation d/t unknokwn cause; chronic constipation d/t IBS; opioid-induced constipation
these are indications for what laxative class? Chronic constipation d/t unknown cause; chronic constipation d/t IBS; opioid-induced constipation
chloride channel activator laxative
what channels do chloride channel activators activate?
CIC-2
what part of GIT do chloride channel activators work in?
intestinal epithelium
four potential adverse effects of chloride channel activators?
diarrhea, flatulence, abdominal cramping, bloating
how can you avoid nausea with chloride channel activators?
avoid by giving the drug with a meal
which laxative class is associated with dyspnea?
chloride channel activator laxative
chloride channel activators in pregnancy?
avoid
indication for opioid receptor antagonist laxatives?
chronic constipation due to opioids
this is an indication for which laxative class? Chronic constipation due to opioids
opioid receptor antagonist laxative
what receptors do opioid receptor antagonists act on?
mu opioid receptors
where are the mu opioid receptors located that opioid antagonist laxatives act on?
in the gut
effect of opioid receptor antagonist laxatives on peristalsis?
increased
do opioid receptor antagonist laxatives cross the BBB?
no
do opioid receptor antagonist laxatives cause analgesia?
no
four adverse effects of opioid receptor antagonist laxatives?
diarrhea, flatulence, abdominal cramping, bloating
can opioid receptor antagonists induce opioid withdrawal?
yes
what is the concern with abdominal pain and constipation?
concern for bowel rupture
when is opioid withdrawal syndrome more likely with opioid receptor antagonist laxatives?
if alterations of the BBB have occurred
specific class? Antagonist at the mu-opioid receptors in the gut– speeds up peristalsis
opioid receptor antagonist laxative
class? Inhibit IgE and mast cell mediated migration of inflammatory cells into bronchial mucosa
inhaled corticosteroids
which immunoglobulin is affected with inhaled corticosteroids?
IgE
what phase of allergic reaction is affected by inhaled corticosteroids?
late-phase allergic reaction
in what two places are inhaled corticosteroids absorbed?
lungs and GI tract
describe speed of absorption of inhaled corticosteroids?
rapid
how much of inhaled corticosteroid dose is deposited in the lungs?
less than one-fourth
less than one-fourth of dose of what class is deposited in the lungs?
inhaled corticosteroids
what happens to swallowed portion of inhaled corticosteroid dose?
undergoes extensive first-pass metabolism
where are inhaled corticosteroids excreted?
in urine and feces
migration of inflammatory cells with inhaled corticosteroids are mediated by what?
mast cells
how do inhaled corticosteroids come?
in multiple forms and delivery systems
what are five potential adverse effects of inhaled corticosteroids?
xerostomia; hoarseness; mouth irritation; dysgeusia; oral candidiasis
oral candiasis can occur with what class of respiratory medication?
inhaled corticosteroids
HPA suppression is a risk with what class of respiratory medication?
inhaled corticosteroids
can inhaled corticosteroids be given in status asthmaticus?
no
high-dose of what class of respiratory medication in children may inhibit growth?
inhaled corticosteroids
highest potency inhaled corticosteroid?
fluticasone furoate
what is the brand name for fluticasone furoate?
arnuity ellipta
specific class? Fluticasone furoate
inhaled corticosteroids
specific class? Mometasone furoate DIP
inhaled corticosteroids
specific class? Fluticasone propionate DIP
inhaled corticosteroids
specific class? Beclomethasone dipropioate
inhaled corticosteroids
specific class? Ciclesonide MDI
inhaled corticosteroids
specific class? Budesonide DPI
inhaled corticosteroids
what is the brand name of mometasone furoate DPI?
asmanex twisthaler
what is the brand name for fluticasone propionate DPI?
armonair digihaler
what is the brand name for beclomethasone dipropionate?
QVAR redihaler
four examples of stimulant laxatives?
cascara, senna, bisacodyl, castor oil
specific class- cascara?
stimulant laxative
specific class- senna?
stimulant laxative
specific class- bisacodyl?
stimulant laxative
specific class- castor oil?
stimulant laxative
four examples of osmotic laxatives?
magnesium hydroxide, magnesium citrate, sodium phosphate, PEG 3350
specific class- magnesium hydroxide?
osmotic laxative
specific class- magnesium citrate?
osmotic laxative
specific class- sodium phosphate?
osmotic laxative
specific class- polyethylene glycol 3350?
osmotic laxative
three examples of bulk-producing laxatives?
psyllium, methylcellulose, polycarbophil
specific class- psyllium?
bulk-producing laxative
specific class- methylcellulose?
bulk-producing laxative
specific class- polycarbophil?
bulk-producing laxative
example of lubricant laxative?
mineral oil
specific class- mineral oil?
lubricant laxative
example of surfactant laxative?
docusate
specific class- docusate sodium?
surfactant laxative
specific class- docusate calcium?
surfactant laxative
specific class- docusate potassium?
surfactant laxative
what are the three types of docusate?
docusate sodium, docusate calcium, docusate potassium
two examples of hyperosmolar laxatives?
glycerin and lactulose
specific class- glycerin?
hyperosmolar laxative
specific class- lactulose?
hyperosmolar laxative
example of chloride channel activator laxative?
lubiprostone
specific class- lubiprostone?
chloride channel activator laxative
example of opioid receptor antagonist laxative?
methylnaltrexone
specific class- methylnaltrexone?
opioid receptor antagonist laxative
what is the one class of laxatives that does not have abuse/dependency potential?
bulk-producing laxative
do stimulant laxatives have abuse/dependency potential?
yes
do osmotic laxatives have abuse/dependency potential?
yes
do bulk-producing laxatives have abuse/dependency potential?
no
do lubricant laxatives have abuse/dependency potential?
yes
do surfactant laxatives have abuse/dependency potential?
yes
do hyperosmolar laxatives have abuse/dependence potential?
yes
do chloride channel activator laxatives have abuse/dependency potential?
yes
do opioid receptor antagonist laxatives have abuse/dependency potential?
yes
electrolyte alterations, fluid alterations, steatorrhea, osteomalacia, vitamin/nutrient deficiences- can occur with what general class?
laxatives
tartrazine sensitivity can occur with what general class?
laxatives
what is an example of a tartrazine sensitivity reaction?
bronchospasm
tartrazine sensitivity is associated with sensitivity to what?
aspirin
can you give laxatives when nausea, vomiting, and/or abdominal pain of unknown cause are present?
no
when might you especially want to avoid giving laxatives?
n/v or abdominal pain of unknown cause, especially if may have bowel obstruction
can all laxatives be given in pregnancy?
no
specific class? Thought to possible cause stimulation/irritation of the myenteric nerves
stimulant laxative
specific class? Irritation of intestinal smooth muscle
stimulant laxative
effect of stimulant laxatives on peristalsis?
increased
do stimulant laxatives affect peristalsis?
yes
specific laxative class? Increased prostaglanding release and an increase in cAMP concentration?
stimulant laxative
what nerves are effected by stimulant laxatives?
myenteric nerves
effect of stimulant laxatives on prostaglandin release?
increased
effect of stimulant laxatives on cAMP concentration?
increased
effect of stimulant laxatives on electrolyte secretion?
increased
why do stimulant laxatives cause increased electrolyte secretion?
increased prostaglandin release and an increase in cAMP concentration
four adverse effects of stimulant laxatives?
diarrhea, flatulence, abdominal cramping, bloating
why should castor oil not be used in pregnancy?
can stimulate uterine contractions
which stimulant laxative can stimulate uterine contractions?
castor oil
which stimulant laxative can cause diarrhea in lactating infants?
cascara
cascara can cause what in lactating infants?
diarrhea
cardiovascular disease is a relative contraindication to which stimulant laxative?
bisacodyl
cascara should not be used if the patient cannot ingest WHAT?
alcohol
why should cascara not be used if the patient cannot ingest some alcohol?
cascara contains some alcohol
can bisacodyl be used in pregnancy?
yes
which stimulant laxative can be used in pregnancy?
bisacodyl
can castor oil be used in pregnancy?
no
what are two indications for osmotic laxatives?
constipation and bowel prep
specific class? Increased intraluminal pressure due to water being drawn more inside the intestines
osmotic laxative
effect of osmotic laxatives on peristalsis?
increased
do osmotic laxatives affect peristalsis?
yes
four side effects of osmotic laxatives?
diarrhea, flatulence, abdominal cramping, bloating
why should magnesium-containing laxatives be avoided in renal dysfunction?
kidneys may not be able to excrete the magnesium adequately
what effect on magnesium happens if magnesium-containing laxatives are used in renal dysfunction?
hypermagnesemia
magnesium-containing laxatives should not be used in patients with what calcium imbalance?
hypocalcemia
what cardiac issues contraindicate magnesium-containing laxatives?
cardiac dysrhythmias or conduction disturbances
cardiac dysrhythmias or conduction disturbance contraindicate laxatives containing what?
magnesium hydroxide, magnesium citrate, sodium phosphate, PEG 3350
pediatric use of PEG 3350?
caution
why do osmotic laxatives cause increased intraluminal pressure?
water being drawn more inside the intestines
what laxative class can be used in chronic, watery diarrhea?
bulk-producing laxative
why are bulk-producing laxatives used in chronic, watery diarrhea?
to bulk the stool
specific class? Act physiologically like increased fiber in the diet would by combining with water in the intestines
bulk-producing laxative
specific class? Mechanical distention of the intestinal wall
bulk-producing laxative
do bulk-producing laxatives affect peristalsis?
yes
effect of bulk-producing laxatives on peristalsis?
increased
do side effects of bulk-producing laxatives dissipate with time?
usually
can bulk-producing laxatives be used in pregnancy?
yes
can bulk-producing laxatives be used if a bowel impaction?
no
why should bulk-producing laxatives not be used in a bowel impaction?
feces cannot get around impacted stool
specific class? Some may be contraindicated in clinical settings where either salt or sugar is restricted
bulk-producing laxative
what specific class of laxatives may contain salt or sugar?
bulk-producing laxative
what specific class of laxatives should be used cautiously when patient may have strictures or other narrowing of esophagus or intestine?
bulk-producing laxative
what specific class of laxatives may be used long-term for simple, chronic constipation?
bulk-producing laxative
what are four potential adverse effects of bulk-producing laxatives?
diarrhea, flatulence, abdominal cramping, bloating
specific class? Used to soften impacted stool
lubricant laxative
what is the main component of lubrican laxatives?
mineral oil
MOA of lubricant laxatives?
used to soften impacted stool
what is the purpose of lubrication with these laxatives?
to help stool move more easily via the presence of mineral oil
what are four potential adverse effects of lubricant laxatives?
diarrhea, flatulence, abdominal cramping, bloating
which specific laxative class can cause decreased absorption of fat-soluble vitamins if used chronically?
lubricant laxative
decreased absorption of what can occur with chronic use of lubricant laxatives?
fat-soluble vitamins
which specific laxative class can cause lipid pneumonia if aspirated?
lubricant laxative
who is at risk for lipid pneumonia with lubricant laxatives?
very young and any patient at risk for aspiration
which class of laxatives would you not want to give in someone with impaired swallowing?
lubricant laxative
can lubricant laxatives be taken in pregnancy?
no
why shouldn’t lubricant laxatives be taken in pregnancy?
fat-soluble vitamins may not be absorbed as well
which class of laxatives can cause vitamin K deficiency in newborns?
lubricant laxative
which class of laxatives can cause hypoprothrombinemia in newborns?
lubricant laxative
what is another name for surfactant laxatives?
stool softeners
what is the class name for stool softeners?
surfactant laxative
specific class? Used to soften stool and prevent constipation, especially stool that is dry and difficult to evacuate and when straining at stool must be stopped
surfactant laxative
which laxative class is useful when stool is dry and difficult to evacuate?
surfactant laxative
which laxative class is useful when straining at stool must be stopped?
surfactant laxative
specific class? Assist with lipids and water being mixed into stool
surfactant laxative
what is the MOA of surfactant laxatives?
assist with lipids and water being mixed into stool
do surfactant laxatives have precautions?
no
do surfactant laxatives have contraindications?
no
which class of laxatives? Usually well-tolerated and without precautions or contraindications
surfactant laxative
can surfactant laxatives be used in pregnancy?
yes
which class of laxatives are used for fecal impaction and neurogenic bowel?
hyperosmolar laxative
which class of laxatives is indicated with neurogenic bowel?
hyperosmolar laxative
which class of laxatives is used with chronic constipation and increased excretion of ammonia in the stool?
hyperosmolar laxative
specific class? Glycerin
hyperosmolar laxative
specific class? Lactulose
hyperosmolar laxative
drug? Bacteria in the gut transform this dissarchide into lactic, acetic, and formic acids
lactulose
drug? Local colonic irritation and more water drawn into the stool
glycerin
what are the four adverse effects of hyperosmolar laxatives?
diarrhea, flatulence, abdominal cramping, bloating
what patient population is at risk for dehydration with hyperosmolar laxatives?
older adults
what laxative class is associated with dehydration risk in older adults?
hyperosmolar laxative
when should you monitor blood glucose with lactulose?
those taking lactulose chronically and acutely in patients with diabetes mellitus
which laxative drug involves blood glucose monitoring?
lactulose
hyperosmolar laxatives in lactation?
avoid
lactulose in pregnancy?
only when benefits > risks
glycerin in pregnancy?
no
why do older adults get dehydration with hyperosmolar laxatives?
intravascular volume depletion
specific class? Activation of CIC-2 chloride channels in the intestinal epithelium
chloride channel activator laxative
effect of chloride channel activators on chloride secretion?
more chloride is secreted
what helps soften the stool and improve intestinal movement with chloride channel activators?
increased chloride
three indications for chloride channel activators?
chronic constipation d/t unknokwn cause; chronic constipation d/t IBS; opioid-induced constipation
these are indications for what laxative class? Chronic constipation d/t unknown cause; chronic constipation d/t IBS; opioid-induced constipation
chloride channel activator laxative
what channels do chloride channel activators activate?
CIC-2
what part of GIT do chloride channel activators work in?
intestinal epithelium
four potential adverse effects of chloride channel activators?
diarrhea, flatulence, abdominal cramping, bloating
how can you avoid nausea with chloride channel activators?
avoid by giving the drug with a meal
which laxative class is associated with dyspnea?
chloride channel activator laxative
chloride channel activators in pregnancy?
avoid
indication for opioid receptor antagonist laxatives?
chronic constipation due to opioids
this is an indication for which laxative class? Chronic constipation due to opioids
opioid receptor antagonist laxative
what receptors do opioid receptor antagonists act on?
mu opioid receptors
where are the mu opioid receptors located that opioid antagonist laxatives act on?
in the gut
effect of opioid receptor antagonist laxatives on peristalsis?
increased
do opioid receptor antagonist laxatives cross the BBB?
no
do opioid receptor antagonist laxatives cause analgesia?
no
four adverse effects of opioid receptor antagonist laxatives?
diarrhea, flatulence, abdominal cramping, bloating
can opioid receptor antagonists induce opioid withdrawal?
yes
what is the concern with abdominal pain and constipation?
concern for bowel rupture
when is opioid withdrawal syndrome more likely with opioid receptor antagonist laxatives?
if alterations of the BBB have occurred
specific class? Antagonist at the mu-opioid receptors in the gut– speeds up peristalsis
opioid receptor antagonist laxative
what are leukotrienes?
inflammatory mediators
a type of inflammatory mediator?
leukotrienes
what two types of cells produce leukotrienes?
eosinophils and mast cells
what are the three potential effects of leukotrienes?
bronchospasm, airway hyperresponsiveness, and vascular leakage
what substance can cause bronchospasm, airway hyperresponsiveness, and vascular leakage?
leukotrienes
specific class? Montelukast
leukotriene receptor antagonists
drug? Inhibits the cysteinyl leukotriene receptor
montelukast
drug? Blocks action of LTD4
montelukast
what is a component of SRS-A?
LTD4
what is the MOA of montelukast?
inhibits the cysteinyl leukotriene receptor- blocks action of LTD4
what does montelukast block the action of?
LTD4
what is LTD4?
a component of SRS-A
drug? Inhibits 5-lipoxygenase
zileuton
what is 5-lipoxygenase?
enzyme responsible for the formation of leukotrienes from arachidonic acid
name? enzyme responsible for the formation of leukotrienes from arachidonic acid
5-lipoxygenase
what does zileuton inhibit?
5-lipoxygenase
specific class? Zileuton
5-lipoxygenase pathway inhibitors
example of 5-lipoxygenase pathway inhibitor?
zileuton
example of leukotriene receptor antagonist?
montelukast
general class? Montelukast
leukotriene modifiers
general class? Zileuton
leukotriene modifiers
what are two examples of leukotriene modifiers?
montelukast and zileuton
describe absorption of the leukotriene modifiers?
rapidly from the GI tract
describe the protein binding of the leukotriene modifiers?
highly protein bound
describe the metabolism of the leukotriene modifiers?
extensively metabolized in the liver
describe the excretion of the leukotriene modifiers?
in the urine
what two enzyme systems metabolize montelukast?
CYP3A4 & CYP2C9
what three enzyme systems metabolize zileuton?
CYP1A2, CYP2C9, CYP3A4
which leukotriene modifier is metabolized by CYP3A4 and CYP2C9?
montelukast
which leukotriene modifier is metabolized by CYP1A2, CYP2C9, & CYP3A4?
zileuton
two side effects of montelukast?
headache, sore throat
one side effect of zileuton?
dyspepsia
what respiratory drug class is associated with post-marketing neuropsychiatric events?
leukotriene modifiers
these are symptoms of what type of adverse effect? Irritability, agitation, tremors, insomnia, depression, suicidality
neuropsychiatric events
leukotriene receptor antagonists and severe liver disease?
avoid
can montelukast chewable tabs be given in PKU?
no
why shouldn’t montelukast chewable tablets be given in PKU?
they contain phenylalanine
which leukotriene modifier (chewable form) shouldn’t be given in PKU?
montelukast
can 5-lipoxygenase pathway inhibitors be given in active liver disease?
no, contraindicated
examples of neuropsychiatric event symptoms associated with leukotriene modifiers?
irritability, agitation, tremors, insomnia, depression, suicidality
