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Naplex > Rx Files Gastrointestinal > Flashcards

Rx Files Gastrointestinal Flashcards

1
Q

Ulcer types

A

gastric and duodenal

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2
Q

In what patient populations are stress ulcers commonly seen?

A
  • critically ill
  • mechanically ventilated
  • head trauma
  • burn trauma
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3
Q

What is the most common cause of medication induced ulcers?

A

NSAIDs

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4
Q

What is the indication for PrevPac?

A

H. pylori eradication

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5
Q

What drugs does the PrevPac contain?

A
  • Amoxicillin
  • Lansoprazole
  • Clarithromycin
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6
Q

What is Zollinger-Ellison syndrome?

A

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

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7
Q

Describe the pathology of gastrointestinal ulcers.

A

Mismatch between destructive and protective gastrointestinal factors.

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8
Q

What is the general treatment path for gastrointestinal ulcers?

A

increase mucus

decrease acid

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9
Q

What is GERD?

A

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

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10
Q

How is GERD treated?

A

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

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11
Q

What is LES?

A

lower esophageal sphincter

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12
Q

Sucralfate brand

A

Carafate

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13
Q

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

A

minimal

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14
Q

Sucralfate exerts a (local/ systemic) effect.

A

local

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15
Q

Sucralfate mechanism of action

A

“band-aid effect”

coats areas of ulceration so that healing may occur

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16
Q

Sucralfate dosing

A

1 gram 4 times daily
empty stomach
chelates aluminum

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17
Q

What are the H2 receptor blockers?

A

Cimetidine
Famotidine
Nizatidine
Ranitidine

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18
Q

Cimetidine brand

A

Tagamet

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19
Q

Famotidine brand

A

Pepcid

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20
Q

Nizatidine brand

A

Axid

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21
Q

Ranitidine brand

A

Zantac

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22
Q

What H2 receptor blockers are available IV?

A

Cimetidine
Famotidine
Ranitidine

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23
Q

H2 receptor blockers mechanism of action?

A

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

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24
Q

Common adverse effects of H2 receptor blockers

A
  • CNS alterations
  • confusion
  • thrombocytopenia
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25
Q

Which H2 receptor blocker may have the least thrombocytopenic potential?

A

Famotidine

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26
Q

Cimetidine has been associated with anti-_________ effects.

A

androgenic: gynocomastia

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27
Q

H2 receptor blockers elimination

A

renal

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28
Q

At what CrCl must H2 receptor blockers be adjusted?

A

CrCl < 50 mL/min

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29
Q

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

A

itraconazole
digoxin
iron

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30
Q

Why does cimetidine have so many drug interactions?

A

hepatic metabolism via CYP450 3A4

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31
Q

What are the proton pump inhibitors?

A
  • omeprazole
  • esomeprazole
  • lansoprazole
  • rabeprazole
  • pantoprazole
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32
Q

Omeprazole brand

A

Prilosec

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33
Q

Esomeprazole brand

A

Nexium

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34
Q

Lansoprazole

A

Prevacid

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35
Q

Rabeprazole

A

Aciphex

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36
Q

Pantoprazole

37
Q

Which PPIs are available IV?

A
  • esomeprazole
  • lansoprazole
  • pantoprazole
38
Q

PPI mechanism of action

A

Inhibiting H+/K+ ATPase pump

39
Q

Where are proton pumps located?

A

surface of parietal cells

40
Q

Proton pump inhibition is (permanent/reversible).

A

permanent - parietal cells must generate new functional pumps

41
Q

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

A

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

42
Q

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

43
Q

PPIs are _________ eliminated.

A

hepatically

44
Q

How do you make a PPI suspension?

A

sodium bicarb and triturate for 15 - 30 minutes

45
Q

What are the prokinetic agents?

A
  • metoclopramide

- cisapride

46
Q

Metoclopramide brand

47
Q

Cisapride brand

48
Q

What are the indications of prokinetic agents?

A
  • anti-emetics
  • GERD
  • gastroparesis
  • facilitate feeding tube placement
49
Q

Metoclopramide mechanism of action

A

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

50
Q

Cisapride mechanism of action

A

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

51
Q

How do cisapride and metoclopramide differ?

A

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

52
Q

What are some common side effects of prokinetic agents?

A
  • diarrhea
  • dizziness
  • confusion
53
Q

What are some serious side effects of cisapride?

A
  • QT interval prolongation -> Torsades de pointes
  • significant drug interaction with medications that inhibit CYP450 ( causes cisapride levels to rise and increase risk of TDP)
54
Q

Cisapride caveat

A

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

55
Q

What prokinetic agent is available IV?

A

metoclopramide

56
Q

What are ADRs of aluminum antacids?

A

constipation

57
Q

What are ADRs of magnesium antacids?

58
Q

What are some precautions to take with antacid use?

A
  • monitor sodium load

- chelations

59
Q

What drug is used to prevent NSAID induced ulcers?

A

Misoprostol

60
Q

Misoprostol brand

A
  • Cytotec

- Arthrotec

61
Q

Misoprostol ADRs

A 
diarrhea
uterine contractions (also used as abortifacient)
62
Q

What is a common reason for misuse of laxatives?

A

weight loss

63
Q

Examples of laxative agents

A
  • magnesium sulfate
  • lactulose
  • polyethylene glycol
  • docusate sodium
  • bisacodyl
  • castor oil
  • SENA
  • Sorbitol
64
Q

Treatment of flatulence

A

simethicone

65
Q

Explain avoidance of antimotility agents in C.diff

A

can predispose to ileus (toxic megacolon)

66
Q

Examples of anti-motility agents

A
  • codiene
  • Diphenoxylate/ Atropine (Lomotil)
  • Loperamide (Immodium)
67
Q

Common causes of traveller’s diarrhea

A
  • E.coli
  • Salmonella
  • Norwalk virus
  • Giardia
  • C.diff
68
Q

Sulfasalazine brand

69
Q

Sulfasalazine indications

70
Q

Mesalamine brand

A
  • Ascol

- Pentasa

71
Q

What are treatment options for UC?

A
  • sulfasalazine
  • mesalamine
  • corticosteroids
72
Q

Dicyclomine brand

73
Q

Dicyclomine use

A

anti-spasmotic and anticholinergic specific to the intestinal musculature

74
Q

What are the antiemetic antihistamines?

A
  • meclizine

- dimenhydrinate

75
Q

Meclizine brand

76
Q

Dimenhydrinate brand

77
Q

What are the antiemetic phenothiazides?

A

Prochlorperazine

78
Q

Prochlorperazine brand

79
Q

What are the antiemetic 5-HT3 receptor blockers?

A

ondansetron

80
Q

Ondansetron brand

81
Q

What are the antiemetic prokinetics?

A

metoclopramide

82
Q

What are the antiemetic BZDs?

83
Q

Lorazepam brand

84
Q

What are the antiemetic cannabinoids?

A

Dronabinol

85
Q

Dronabinol brand

86
Q

What are the antiemetic corticosteroids?

A

Dexamethazone

87
Q

Dexamethasone brand

88
Q

What are the antiemetic substance P receptor blockers?

A

Aprepitant

89
Q

Aprepitant brand

Naplex (8 decks)

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