Rx Files Gastrointestinal Flashcards by Alexis Elliott

Ulcer types

gastric and duodenal

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In what patient populations are stress ulcers commonly seen?

critically ill
mechanically ventilated
head trauma
burn trauma

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What is the most common cause of medication induced ulcers?

NSAIDs

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What is the indication for PrevPac?

H. pylori eradication

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What drugs does the PrevPac contain?

Amoxicillin
Lansoprazole
Clarithromycin

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What is Zollinger-Ellison syndrome?

A condition where tumors cause the stomach to secrete too much acid.

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Describe the pathology of gastrointestinal ulcers.

Mismatch between destructive and protective gastrointestinal factors.

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What is the general treatment path for gastrointestinal ulcers?

increase mucus

decrease acid

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What is GERD?

gastroesophageal reflux disease: phenomenon where gastric acid backs up or refluxes into the esophagus

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How is GERD treated?

decreasing acid
coating and protecting esophagus
improving LES tone
lowering abdominal pressure

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What is LES?

lower esophageal sphincter

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Sucralfate brand

Carafate

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Sucralfate undergoes (extensive/minimal) absorption from the gut.

minimal

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Sucralfate exerts a (local/ systemic) effect.

local

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Sucralfate mechanism of action

“band-aid effect”

coats areas of ulceration so that healing may occur

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Sucralfate dosing

1 gram 4 times daily
empty stomach
chelates aluminum

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What are the H2 receptor blockers?

Cimetidine
Famotidine
Nizatidine
Ranitidine

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Cimetidine brand

Tagamet

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Famotidine brand

Pepcid

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Nizatidine brand

Axid

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Ranitidine brand

Zantac

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What H2 receptor blockers are available IV?

Cimetidine
Famotidine
Ranitidine

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H2 receptor blockers mechanism of action?

Inhibits the binding of histamine to H2 receptors, preventing parietal cells from releasing H+ into the lumen of the gut.

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Common adverse effects of H2 receptor blockers

CNS alterations
confusion
thrombocytopenia

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Which H2 receptor blocker may have the least thrombocytopenic potential?

Famotidine

Cimetidine has been associated with anti-_________ effects.

androgenic: gynocomastia

H2 receptor blockers elimination

renal

At what CrCl must H2 receptor blockers be adjusted?

CrCl < 50 mL/min

Examples of common drugs that depend on acid for absorption and therefore would have a negative interaction with acid reducers.

itraconazole digoxin iron

Why does cimetidine have so many drug interactions?

hepatic metabolism via CYP450 3A4

What are the proton pump inhibitors?

- omeprazole - esomeprazole - lansoprazole - rabeprazole - pantoprazole

Omeprazole brand

Prilosec

Esomeprazole brand

Nexium

Lansoprazole

Prevacid

Rabeprazole

Aciphex

Pantoprazole

Protonix

Which PPIs are available IV?

- esomeprazole - lansoprazole - pantoprazole

PPI mechanism of action

Inhibiting H+/K+ ATPase pump

Where are proton pumps located?

surface of parietal cells

Proton pump inhibition is (permanent/reversible).

permanent - parietal cells must generate new functional pumps

(T/F) Acid secretion returns to normal within a couple of days of discontinuation of PPIs.

False, acid secretion may continue to be inhibited after discontinuation of PPI

PPIs are considered to be the (least/most) potent acid reducer.

most

PPIs are _________ eliminated.

hepatically

How do you make a PPI suspension?

sodium bicarb and triturate for 15 - 30 minutes

What are the prokinetic agents?

- metoclopramide | - cisapride

Metoclopramide brand

Reglan

Cisapride brand

Propulsid

What are the indications of prokinetic agents?

- anti-emetics - GERD - gastroparesis - facilitate feeding tube placement

Metoclopramide mechanism of action

enhances upper GI smooth muscle response to Ach - this results in increased GI motility and accelerated gastric emptying, also blocks DA receptors in the CTZ

Cisapride mechanism of action

increases LES tone and GI motility also accelerates GI emptying time, works by enhancing GI response to Ach at the mysenteric plexus of the GI smooth muscle

How do cisapride and metoclopramide differ?

Cisapride affects the whole GI tract whereas metoclopramide only acts on the upper GI tract.

What are some common side effects of prokinetic agents?

- diarrhea - dizziness - confusion

What are some serious side effects of cisapride?

- QT interval prolongation -> Torsades de pointes - significant drug interaction with medications that inhibit CYP450 ( causes cisapride levels to rise and increase risk of TDP)

Cisapride caveat

Cisapride is no longer marketed in the US and is only available through limited access program.

What prokinetic agent is available IV?

metoclopramide

What are ADRs of aluminum antacids?

constipation

What are ADRs of magnesium antacids?

diarrhea

What are some precautions to take with antacid use?

- monitor sodium load | - chelations

What drug is used to prevent NSAID induced ulcers?

Misoprostol

Misoprostol brand

- Cytotec | - Arthrotec

Misoprostol ADRs

``` diarrhea uterine contractions (also used as abortifacient) ```

What is a common reason for misuse of laxatives?

weight loss

Examples of laxative agents

- magnesium sulfate - lactulose - polyethylene glycol - docusate sodium - bisacodyl - castor oil - SENA - Sorbitol

Treatment of flatulence

simethicone

Explain avoidance of antimotility agents in C.diff

can predispose to ileus (toxic megacolon)

Examples of anti-motility agents

- codiene - Diphenoxylate/ Atropine (Lomotil) - Loperamide (Immodium)

Common causes of traveller's diarrhea

- E.coli - Salmonella - Norwalk virus - Giardia - C.diff

Sulfasalazine brand

Sulfazine

Sulfasalazine indications

- UC | - RA

Mesalamine brand

- Ascol | - Pentasa

What are treatment options for UC?

- sulfasalazine - mesalamine - corticosteroids

Dicyclomine brand

Bentyl

Dicyclomine use

anti-spasmotic and anticholinergic specific to the intestinal musculature

What are the antiemetic antihistamines?

- meclizine | - dimenhydrinate

Meclizine brand

Antivert

Dimenhydrinate brand

Dramimine

What are the antiemetic phenothiazides?

Prochlorperazine

Prochlorperazine brand

Compazine

What are the antiemetic 5-HT3 receptor blockers?

ondansetron

Ondansetron brand

Zofran

What are the antiemetic prokinetics?

metoclopramide

What are the antiemetic BZDs?

lorazepam

Lorazepam brand

Ativan

What are the antiemetic cannabinoids?

Dronabinol

Dronabinol brand

Marinol

What are the antiemetic corticosteroids?

Dexamethazone

Dexamethasone brand

Decadron

What are the antiemetic substance P receptor blockers?

Aprepitant

Aprepitant brand

Emend