segers meds Flashcards
antacids antiulcer N/V IBD Diarrhea, Abd pain, Constipation
indications for antacids
SHORT term use, temporary relief of PUD and GERD
low systemic antacids
aluminum based agents
Ca based agents
Mg based agents
high systemic antacids
Na based agents
how do antacids work
combine chemically with H+ to make H2O, CO2, Cl- salts
–>increease LES tone in high doses
not any reduction in acid production, in fact rebound increase in acid production can happen
which antacids work fastest and longest, and have the best neutralizing ability
Ca based agents
Mg based agents
what is the clinical use of simethicone
= an antacid
= pro-fart+burp to get rid of gas thats already been made in the body
side effects of Al based antacids
constipation, HYPOphosphatamia
side effects of Mg based antacids
dose related diarrhea, increased Mg
side effects of Ca based antacids
constipation, increase Ca (leading to stones), nephropathy, met alk, HYPOphosphatemia
side effects of Mg based antacids
dose related diarrhea, increased Mg
side effects of Na based antacids
bicarb burps, increased Na, met alk
what important considerations should be taken when considering prescribing antacids
dosage
hx of renal/heart ds
electrolyte status
hx of diarrhea/constipation
lots of drug interactions- take all antacids 1-2 hours before, or 2-4 hours after any other med
which drugs work on the H+ leaving parietal cells into the extracellular gastric content
antacids
which drugs inhibit the luminal H/K+ ATPase on parietal cells membranes
PPIs
which drugs inhibit H2 receptors on the basolateral membrane of parietal cells
H2 receptor antagonists
which drug is a PGE1 analog, working on EP3 receptors on the basolateral membrane of parietal cells and superficial epithelial cells
misprostol
which drugs directly inhibits H Pylori
bismuth clonthromycin metronidazole tetracycline amoxicillin
what drug enhances mucus and bicarb transport on the luminal membrane of superficial epithelial cells
sucralfate
“__-tidine”
group special drug notes method of action side effect contraindications
h2 receptor antagonist= antiulcer
cimetidine= decreased T binding= gynecomastia/galactorrhea, neutropenia, thrombocytopenia, DRUG INTERACTIONS SO REPLACE WITH RANITIDINE
partially inhibits acid production –> ulcer will heal in 4-8 weeks if H pylori is not present
side effects= mild and transient if at all, GI and HA
PREGNANCY= use ranitidine or famotidine
rate the speed of action of dif antiulcer+antacids
antacids > H2 block > PPI
drugs that have a lot of drug drug interactions usually affect what pathway
CYP450
with what anti-ulcer drug classes do you need to use an NSAID
PPI and PGE1 analog
“__-prazole”
group special drug notes method of action side effect contraindications
PPIs= antiulcer
takes days to create a new steady state by binding sulfhydryl group of H/K ATPase
short have life but effect lasts days, ulcers heal in 4-8 weeks if H Pylori not present
omeprazole= increased drug interactions
sideeffects= dyspepsia, myalgia, life threatening C. Dif fiarrhea (CDAD)= watery and smelly
pregnancy= only if necessary, use lansoprazole
sucralfate
group method of action indications side effect contraindications
surface acting =antiulcer
=sucrose + Al(OH)3 create viscous polymer when adheres to epithelial cells around ulcer –> stimulate PGE + mucus production
NO effect on pH
can also use for mucositis, enema, bile acid reflex
side effect= constipation
relative contra= severe renal failure
possible drug interactions->take 2 hours after any other male
misprostol
group method of action indications side effect contraindications
PGE1 analog = antiulcer
protect prostoglandin + decreased gastric acid release from parietal cell
+increased mucous+bicarb production
used to prevent NSAID-induced ulceration in pts who can’t stop taking NSAIDs
also for pregnancy termination, cervical ripening, post partum hemorrhage
side effects= diarrhea, HA, dizzy
contra= pregnancy, IBD (r)
“bismuth”, peptobismol, kaopectate
group method of action indications side effect contraindications
bismuth compounds, anti-ulcer
prevent attachment to mucosa, disrupt cell wall
use for heartburn, diarrhea
antidiarrheal and antimicrobial = can work against H Pylori (in combo w abx+acid suppressant)
side effect= constipation, black stool (norm shape)
drug interactions, take 2 hrs after other meds
relative CI= anticoag use, severe renal failure
abs CI= GI bleed, hypersensitivity to salicytes
trx for H pylori
at least 2 abs + PPI
- clorythromycin/amoxicillin
- if can’t use PPI, give H2 blocker
if failed regimen, then do triple therapy:
BID PPI+ clarythromycin + amoxicillin/metronidazole
if failed then do quadriple
BID PPI+ QID metronidazole +tetracycline + bismuth
receptors responsible for N/V
5-HT3 (seratonin) HI (histamine) MI (muscurinic) D2 (dopamine) NKI (neurokinin/substance P)
what is the vomiting center of the brain and what receptors are there
nucleus of tractus solitaris
5HT3
HI
NK1
what is the chemoreceptor trigger zone in the brain and what receptors are there
area postrema
5HT3
D2
indication for glucocorticosteroids + benzodiazepines
for N/V
“__setron”
group method of action indications side effect special drug notes contraindications
5 HT3 serotonin antagonists- strong drug for N/V
block 5ht3 receptor at vagal N terminal and block transmission to CTZ in medulla,
used in chemo and N/V of pregnancy
bc have short half life
adverse effects= serotonin syndrome [met instable, dec mood, life threatening]
QT PROLONGATION= torades des pointe
alosetron= IBS is the only indication palonesetron= longer half life
“___pitant”
group method of action indications side effect special drug notes contraindications
NKI receptor antagonist= moderate drug for N/V
block neurokinin/substance P in the medulla, vomiting center/vagal terminals in gut
used in PROPHYLAXIS of chemo induced N/V w glucosteroids+ 5HT3 antagonist
adverse effect= somnolence, drug interactions
diphenhydramine, dimenhydrinate,
group
method of action
indications
side effect
H1 histamine receptor antagonist= weak drug for N/V
mostly for allergies or motion sickness, work in medulla and vestibular system
adverse= drowsy, dry mouth, urinary retention, blurred vision, hypotension, antii-chol
hydroxyzine
group
method of action
indications
side effect
H1 histamine receptor antagonist= weak drug for N/V
mostly for allergies or motion sickness, work in medulla and vestibular system
adverse= drowsy, dry mouth, urinary retention, blurred vision, hypotension, antii-chol
promethazine
group
method of action
indications
side effect
H1 histamine receptor antagonist= weak drug for N/V
mostly for allergies or motion sickness, work in medulla and vestibular system
adverse= drowsy, dry mouth, urinary retention, blurred vision, hypotension, antii-chol
meclizine, cyclizine
group
method of action
indications
side effect
only indication is motion sickness
H1 histamine receptor antagonist= weak drug for N/V
mostly for allergies or motion sickness, work in medulla and vestibular system
adverse= drowsy, dry mouth, urinary retention, blurred vision, hypotension, antii-chol
doxylamine
group
method of action
indications
side effect
used in N/V of pregnancy
H1 histamine receptor antagonist= weak drug for N/V
mostly for allergies or motion sickness, work in medulla and vestibular system
adverse= drowsy, dry mouth, urinary retention, blurred vision, hypotension, antii-chol
metoclopramide
phenothiazines (prochloroperazine, perphenazine, chlorpromazine)
group method of action indications side effect special drug notes contraindications
D2 receptor antagonist= weak-mod drug for N/V
block D2 receptor in CTZ/medulla
metoclopramide= stimulate Ach actions in GI, enhance motility, inc LES tone
used in N/V of preg, not used alone bc is weak
adverse= drowsy, dry mouth, urinary retention, blurred vision, hypotension, antii-chol
+arrhythmia, parkinsons,
scopolamine
group method of action indications side effect special drug notes contraindications
M1 receptor antagonist= weak
a patch worn for 72 hours, mostly used for motion sickness
block Ach from vestibular nuclei in inner ear –> brainstem and reticular formation –> vomiting center
mostly palliative and end of life care
adverse= drowsy, dry mouth, urinary retention, blurred vision, hypotension, antii-chol
+drug interactions
dronabinol and nabilone
group method of action indications side effect special drug notes contraindications
cannabinoid receptor agonist
synthetic THC= v strong+effective in trx resistant N/V
stimulate CB1+CB2 receptors in vomiting center/CTZ medulla
reserved for trx-resistant chemo induced N/V +appetite stimulation in anorexic pts
adverse= emotional lability, vertigo, sedation, impaired cogn, hallucinations, dry mouth, inc HR/BP
what is the high emetogenic chemo regimen
NKI receptor ant + 5-HT3 receptor antagonist + dexamethasone
regimen on day of chemo + 3 days after
if hx of N/V with chemo–> add olanzipine
in trx resistance –> add cannaboid
what is the moderate ematogenic chemo regimen
5-HT3 receptor antagonist + dexamethasone
give regimen of day of chemo + 2 days after
if hx of N/V with chemo–> add NKI receptor or olanzipine
in trx resistance –> add cannaboid
what is the low ematogenic regimen
dexamethasone OR 5-HT3 receptor antagonist OR metoclopramide OR prochlorperazine
give med on daily chemo
what is the minimal ematogenic chemo regimen
no prophylaxis recommended
define acute N/V
less than 24 hours after chemo
trx for motion sickness
scopalimine or dymenhydrinate or meclizine
trx for vertigo
meclizine or cyclizine
trx for diabetic gatroparesis
metaclopramide
trx of pregnancy induced N/V
step 1–> vit B6 or H1 antagonist or 5-HT3 antagonist
step 2–> D2 antagonist
step 3–> steroid or dif dopamine antagonist
5 ASA Agents
names indication method special drug notes side effects
“__sala__”= for mid to moderate ulcerative colitis
inhibit PG+LT production via AA pathway= xCOX+ xLTE4
decreased Mø = xNF-kB activation
sulfasalazine= no give with sulfa allergy
olsalazine= maintain remission only
balsalazide- active ds only
mesalamine= pH dependent, time dependent, rectal enema, rectal suppositary
avoid in pts w ASA allergy
TNF inhibitors
names indication method special drug notes side effects
” ___mab”= mod to severe UC or crohn
upregulate VCAM, E selectin, MADCAM-1 for leukocyte adhesion
adallmumab+ infliximab= UC+Crohn
IgG1 recomb,
a= SQ every 2 weeks, i= IV every 8 weeks
Gollmumab= UC only
IgG4 recomb, SQ every 4 weeks
certolizumab= Crohn only
Fab recomb, SQ every 4 weeks
integrin inhibitors
names indication method special drug notes side effects
___lizumab= mod to severe active and maintain remission UC or CD
prevent leukocyte-endothelium adhesion by xα4B1, VCAM1, MadCAM1
Natalazumab= Crohn only
α4B1/7 blocker, IgG4 recomb
IV every 4 weeks
Vedolizumab= α4B7 blocker, IgG1 recomb
IV every 8 weeks
side effects= increased risk of PML (infection) w trx > 2 years, prior immunosuppression, JCV Ab present
IL12/23 inhibitors
names indication method special drug notes side effects
Ustekinumab= mod to severe, active + maintain remission of Crohn
give to pts resistant/intolerant to steroids/TNF therapy
bind and block P450 subunit of IL-12/23 –> x naive T cell activation and NK activation
IgG1 Ab, SQ every 8 weeks
side effect= occur w infection so get TB test before use
JAK inhibitor
names indication method special drug notes side effects
tofacitinib= mod-severe, active and maintain remission of UC
no use unless HAVE to
intracellularly inhibit pro-inflammatory gene via JAK 1+3 –> x cytokine release
taken orally
side effects= lymphopenia lymphocytosis: neutropenia:
describe the use of steroids in IBD
give in active IBD if absolutely need to
lowest dose, shortest duration possible
Loperamide
group, indication
MOA
special facts
side effects/contraI
opioid agonist= for diarrhea
slow peristalsis+motility, increase fluid absorb
no analgesic effect, no dependence
side effect= cardiact toxicity
diphenoxylate
group, indication
MOA
special facts
side effects/contraI
opioid agonist= for diarrhea
slow peristalsis+motility, increase fluid absorb
synthetic opiate
analgesic at HIGH doses
give with atropine to decrease dependence
eluxadoline
group, indication
MOA
special facts
side effects/contraI
opioid agonist= for diarrhea
use in IBS
slow peristalsis+motility, increase fluid absorb
opioid mu and kappa agonist
delta antagonist–> decrease secretions
side effects- hepatic and pancreatic toxicity
CONTRA- biliary duct obstruction, alc abuse, STOP IF HAVE CONSTIPATION FOR MORE THAN 4 DAYS
PG inhibitors indication?
diarrhea
alosetron
group, indication
MOA
special facts
side effects/contraI
serotonin antagonist= use in refractory IBS
block GI 5HT3 receptor
x pain, transit, secretion
side effect= ischemic colitis, no refill without f/u w PCP
CONTRAI= GI obstruct, perforation, stricture, diverticulitis, impaired intestinal circulation, constipation
crofetemer
group, indication
MOA
special facts
side effects/contraI
chloride ch blocker,
non-infectious diarrhea in HIV/AIDS
inhibit CFTR+ CaCC channel, regulate fluid secretion
CONTRA in respiratory/urinary ds
antimuscurinics
group, indication
MOA
special facts
side effects/contraI
Hyoscyamine, Dicyclomine, Clinium/chlordiazepoxide
abdominal pain
competitive inhibitors of post ganglionic cholinergic receptors
side effects= dry mouth, urinary retention, blurry vision, constipation (the effects with anti-chol)
methylnaltrexone + alvimopan
group, indication
MOA
special facts
side effects/contraI
peripheral opioid antagonist, trx constipation
work together: peripheral mu opioid receptor antagonist
prevent post op ileus after bowel resection
side effects: increased risk of MI, REMS program= use on in institutions for max 15 dose
Linoditide
group, indication
MOA
special facts
side effects/contraI
guanylate cyclase ch agonist- constipation
increase intra/extracellular cGMP
increase Cl-/HCO3 secretion via CFTR
increase intestinal fluids
*use with IBS-C + chronic idiopathic constipation
lubiprostone
group, indication
MOA
special facts
side effects/contraI
selective C2 ch activator- constipation
increased fluid secretion secondary to increased Cl in lumen
use in IBS-women, chronic idiopathic and opioid induced constipation
fiber/bran: psyllum: cellulose : Ca polycarbophil
group, indication
MOA
special facts
side effects/contraI
bulk forming laxative/cathartic agent= works in 2-4 days
increase bulk volume and water support, bacterial fermentation
side effects-
bloating, obstruction (
surfactant, emollient
group, indication
MOA
special facts
side effects/contraI
stool softener laxative/cathartic agent= works in 1-3 days
=decusate salts and mineral oils
surfactant lubricates feces, increase fluid secretion, H2O resorption, oil will penetrate the stool
senna
group, indication
MOA
special facts
side effects/contraI
stimulant- laxative/cathartic agent works in 12-36 hrs
irritate enterocyte till they make prostoglandins
side effects= pass into breast milk
urine discoloration either yellow-brown or red-pink
bisacodyl and glycerin
group, indication
MOA
special facts
side effects/contraI
stimulant- laxative/cathartic agent works in 12-36 hrs
irritate enterocyte till they make prostoglandins
only taken PR
side effects= pass into breast milk
caotoroil
group, indication
MOA
special facts
side effects/contraI
stimulant- laxative/cathartic agent works in 12-36 hrs
irritate enterocyte till they make prostoglandins
hydrolysed into rucinoleic acid
side effects= pass into breast milk
Na picosulfate
group, indication
MOA
special facts
side effects/contraI
stimulant- laxative/cathartic agent works in 12-36 hrs
irritate enterocyte till they make prostoglandins
precolonoscopy bowel prep –> lead to osmotic diarrhea
side effects= pass into breast milk
Mg salt, Na phosphate
group, indication
MOA
special facts
side effects/contraI
saline agents= laxative/cathartic agent
hyperosmolar solutions, osmotically retain water in GI
with increase volume, decrease transit time
side effect= interact with diuretics–> electrolyte imbalance
contraindications= (relative) renal ds/CHF/HTN
lactulose
group, indication
MOA
special facts
side effects/contraI
osmotic agents, laxative/cathartic agent= work in 1-3 hours but take small doses so that it takes 1-2 days?
osmotically attract and retain water in the colon
increased moisture, softness, volume
also used in liver ds (with increase ammonia)
side effect= electrolyte imbalance
PEG-3350
group, indication
MOA
special facts
side effects/contraI
osmotic agents, laxative/cathartic agent= work in 1-3 hours but take small doses so that it takes 1-2 days?
osmotically attract and retain water in the colon
increased moisture, softness, volume
increase dose for bowel prep prior to scope
side effect= electrolyte imbalance
Mg citrate, sorbitol
group, indication
MOA
special facts
side effects/contraI
osmotic agents, laxative/cathartic agent= work in 1-3 hours but take small doses so that it takes 1-2 days?
osmotically attract and retain water in the colon
increased moisture, softness, volume
side effect= electrolyte imbalance
