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GI > TBL > Flashcards

TBL Flashcards

1
Q

Complications of N/V

A 
Dehydration
Electrolyte disturbances
Malnutrition
Aspiration Pneumonia
Esophageal Tears
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2
Q

Causes of N/V

A

CNS (migraine, vestibular dysfx)
GI (viral gastroenteritis)
Radiation induced (RINV)
Post-op (PONV)

Medications:
Chemo-induced (CINV)
Can be acute (hrs) or delayed (onset w/in days)

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3
Q

Receptors that promote N/V

A 
5-HT3
D2
Neurokinin (NK1)
M1
H1
Opioid
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4
Q

Receptors that inhibit NV

A 
Cannabinoid (CB1)
Glucocorticoid receptor (GR)
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5
Q

5-HT3 Antag

A

Ondansetron

Blocks 5HT3 receptor
Enhanced effects when combo w corticosteroids &/or NK1 antag

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6
Q

5-HT3 Antag Indications

A

Acute CINV
RINV
PONV
Acute gastroenteritis

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7
Q

5-HT3 Antag AE

A

HA
GI (constip/diar)
Elevated LFTs
Inc QTc interval (from Kr channel block) –> Inc risk for TdP

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8
Q

D2 Antag examples

A

Prochlorperazine

Metoclopramide

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9
Q

Prochelorperazine MOA & Indic

A

Blocks D2 receptors
Also blocks M, H1, alpha 1, Kr channels

General purpose

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10
Q

Prochlorperazine AE

A 
Blocking D2:
Movement disorder:
resting tremor
slow movements
rigidity
involuntary movements of eyes, mouth, head, arms (tardive dyskinesia)

Hyperprolactinemia:
reproductive dysfx
galactorrhea

Antimuscarinic (blocking M)

Sedation (blocking H1)

Orthostatic HOTN (blocking alpha 1)

Inc QTc inverval (from Kr channel block) –> Inc risk for TdP

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11
Q

Metoclopramide MOA & Indic

A

MOA: blocks D2 receptors; also blocks 5-HT3 and stimulates 5-HT4

Indications: PONV
migraine NV
GI motility related NV (gastroparesis)

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12
Q

Metoclopramide AE

A 
Movement disorder from blocking D2:
resting tremor
slow movements
rigidity
involuntary movements of eyes, mouth, head, arms (tardive dyskinesia)

Black Box warning for Tardive dyskinesia (Don’t use for >3 months)

Hyperprolactinemia (from blocking D2):
reproductive dysfx, galactorrhea

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13
Q

M antag

A

Scopolamine

Blocks M receptors

Motion sickness, vertigo

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14
Q

M antag AE

A

antimuscarinic

sedation

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15
Q

H1 antag

A

Meclizine, Dimenhydrinate

Block H1 & M receptors

Motion sickness, vertigo

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16
Q

H1 antag AE

A

antimuscarinic

sedation

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17
Q

NK1 antag

A

Aprepitant

Blocks NK1 receptors

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18
Q

NK1 antag Indic

A

CINV (in combo w setron & corticosteroids)

PONV

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19
Q

NK1 antag AE

A 
elevated LFTs
HA
dizziness
fatigue
hiccups
constip
20
Q

Corticosteroid

A

Dexamethasone

Stimulates GRs

21
Q

Corticosteroid Indic

A

CINV (in combo w/ setron and NK1 antag)

PONV

22
Q

Corticosteroid AE

A

Insomnia
Inc plasma glucose

Other corticosteroid AE not normally seen bc usually acute admin

23
Q

Cannabinoids

A

Dronabinol

Stim CB1 receptors

CINV (refractory to other tx)

24
Q

Cannabinoids AE

A

CNS
INc laughing, emotional changes, hallucinations
Inc HR

25
Q

Drug Induced NV

A 
Opiods
Inc D2 activity
SSRIs
Chemotherapeutic agents
Inc ACh activity in brain
26
Q

Spironolactone MOA

A

blocks mineralocorticoid receptor (receptor for aldosterone) –> dec renal sodium retention
Also blocks the androgen receptor (AR)

27
Q

Spironolactone AE

A

Hyperkalemia

Gynecomastia, sexual dysfx (from blocking AR)

28
Q

Propranolol MOA

A

Nonselective beta blocker

Blocks B2 –> dec splanchnic vasodil –> dec portal pressure –> dec risk of variceal bleeding

29
Q

Propranolol Clin Use

A

Primary & secondary prophylaxis against variceal bleeding

30
Q

Spironolactone Clin Use

A

Treats ascites

31
Q

Propranolol AE

A

Beta blocker AE

32
Q

Octreotide MOA

A

SST-R (Gi coupled) agonist

Stim of SST-R –> dec release of vasodil –> dec splanchnic vasodil –> dec portal pressure

33
Q

Octreotide Clin Use

A

Tx acute esophageal varciceal bleeding

*Also tx a variety of hormone secreting tumor syndromes

34
Q

Octreotide AE

A

Abd pain
diarrhea
NV
gallstones

35
Q

Vasopressin MOA

A

Activates V1-R (Gq-coupled) –> splanchnic vasoconst. –> dec portal pressure

36
Q

Vasopressin Clin Use

A

Acute esophageal varciceal bleeding

37
Q

Vasopressin AE

A

HTN
Hyponatremia
(Stim V2 in kidney –> water retention)

38
Q

Lactulose MOA

A

Metabolized by colonic bacteria to formic and acetic acid –> acidifies lumen –> protonates NH3 to NH4+ –> traps in lumen

39
Q

Lactulose Clin Use

A

Tx hepatic encephalopathy, constipation

40
Q

Lactulose AE

A

Abd pain
flatulence
diarrhea

41
Q

Rifaximin MOA

A

Nonabsorbable antibiotic that kills GI bacteria that metabolize urea to NH3

42
Q

Rifaximin Clin Use

A

Tx hepatic encephalopathy

43
Q

Rifaximin AE

A

GI (abd pain, nausea)

44
Q

Miscellaneous H2-R antag AE

A

HA
Diarrhea
Dizziness
Drowsiness

Hypergastrinemia after prolonged use

45
Q

Notable PPI risks/AE

A

Inc risk of CKD and acute KDz
Hypergastrinemia (worse than H2-R antag)
Can cause hyperplasia of gastric cells

46
Q

Hyoscyamine MOA, Use

A

Block M3 on GI smooth muscle –> dec contractions

Tx spasms

47
Q

Hyoscyamine AE

A

Antimuscarinic

GI (3 decks)

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