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GI Pharm > PUD, GERD, IBD > Flashcards

PUD, GERD, IBD Flashcards

1
Q

antacids

A

Mg-Al hydroxide (Maalox)
Mg-Al hydroxide/alginic acid
Calcium carbonate (Tums)

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2
Q

MOA of antacids

A

neutralize gastric acid in stomach (aluminum causes constipation, magnesium causes diarrhea -opposing effect) (alginic acid prevents regurgitation)

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3
Q

DDI of antacids

A

significant interaction in absorption of other drugs, do not take within 1-2 hours

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4
Q

dose timing of antacids

A

1 & 3 hr after meal & @ bedtime

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5
Q

H2 receptor antagonists used for PUD

A

cimetidine, ranitidine, nizatidine, famotidine

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6
Q

MOA of H2 receptor antagonists & effects

A

MOA: bind and block H2 receptor and inhibit basal, food stimulated & nocturnal gastric acid secretion
effects: decrease volume & H+ concentration of gastric acid

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7
Q

H2 receptor antagonists AE

A

infrequent and mild…

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8
Q

rank the H2 antagonists in order of potency

A

Famotidine 20-50x > ranitidine/nizatidine 4-10x > cimetidine 1x

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9
Q

which H2 antagonists inhibits CYP450

A

cimetidine

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10
Q

PPI’s for PUD

A

omeprazole, esomeprazole, lansoprazole, rebeprazole

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11
Q

MOA of PPI

A

enteric coating to get through stomach, absorbed to bloodstream and brought to parietal cells where acid protonates drug and traps near proton pump causing IRREVERSIBLE binding to H/K ATPase

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12
Q

PPI AE

A

single dose is safe & effective for > 2 yrs

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13
Q

PK of omeprazole & esomeprazole

A

effective orally, long duration & more powerful than H2 blockers

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14
Q

PK of lansoprazole

A

similar to omeprazole but LESS effective in severe esophagitis

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15
Q

PK of Rebeprazole

A

metabolized to much lower extent by CYP450

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16
Q

4 uses for the PPIs

A
  1. short term for active PUD
  2. zollinger-ellison
  3. refractory ulcers
  4. GERD
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17
Q

cytoprotective agents (2)

A 
bismuth subsalicylate (pepto)
sucralfate
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18
Q

MOA of bismuth subsalicylate

A
  1. enhances secretion of mucous & HCO3-
  2. inhibits pepsin activity
  3. chelates proteins and forms barrier against acid
  4. inhibits h pylori
19
Q

clinical use for pepto

A
  1. adjuct tx for ulcers, GERD, diarrhea

2. traveler’s diarrhea

20
Q

sucralfate MOA

A

forms sticky, viscous gel that adheres to gastric epithelial cells protecting them from acid and pepsis

21
Q

PK for sucralfate

A

requires acidic pH for max activity

22
Q

clinical use of sucralfate

A

value in H2 blocker or PPI induced pneumonia because alkaline environment promotes bacteria

23
Q

antibiotics for H pylori eradication

A

clarithromycin, metronidazole, amoxicillin, ampicillin, furazolidine

24
Q

clarithromycin MOA

A

macrolide - inhibits protein synthesis

25
Q

metronidazole MOA

A

synthetic antibiotic active against obligate anaerobes

26
Q

penicillin class drugs used for h pylori

A

amoxicillin & ampicillin

27
Q

furazolidine MOA

A

nitrofuran antibacterial and antiprotozoal

28
Q

which antibiotic has the highest primary resistance to h pylori

A

metronidazole (43%)

clarithromycin (8%)

29
Q

general treatment regimen for h pylori

A

2 (abx) + 1 (ppi)

30
Q

dopamine receptor blocker to treat GERD?

A

metoclopramide

31
Q

metroclopromide MOA and effects

A

GI: block D2-R and increase Ach via 5HT4 - stimulates GI smooth muscle and increases amplitude of esophageal contractions, increase gastric emptying time and increase LES pressure

32
Q

BBW for metoclopramide

A

Tardive dyskinesia - so only give for 2 weeks

33
Q

what other non-pharm tx is there for GERD

A
  1. dec gastric contents
  2. dec size of meal
  3. dec weight
  4. dec fat in diet
  5. bed elevation
  6. avoid coffee & peppermint
34
Q

treatment goals for IBD (4)

A
  1. control inflammation
  2. reduce morbidity
  3. prevent complications
  4. maintain nutritional state
35
Q

sulfasalazine MOA

A

metabolized to 2 metabolites:

  1. 5-aminosalicylic acid - anti-inflammatory
  2. sulfapyridine - causes AE
36
Q

sulfasalazine AE

A

anemia, rash, impotence

37
Q

infliximab MOA

A

monoclonal ab that is a fusion against TNF-a

38
Q

etanercept MOA

A

fusion protein of TNFa receptor linked to Fc portion of human IgG1 - binds TNFa and prevents its interaction

39
Q

lactulose MOA

A

semisynthetic disaccharide and is a fecal acidifier (forms lactic, formic and acetic acid)

40
Q

lactulose AE

A

not absorbed so causes osmotic diarrhea

41
Q

lactulose PK

A

metabolized by enteric bacteria to its organic acid

42
Q

neomycin MOA

A

antibacterial given as an enema to reduce bacteria in colon

43
Q

2 drugs for tx of portal encephalopathy

A

lactulose, neomycin

GI Pharm (6 decks)

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