Toxic Substances and GI meds Flashcards
MOA of proton pump inhibitors + med names
lansoprazole, omeprazole, pantoprazole, esomeprazole
MOA = IRREVERSIBLE inhibition of parietal cell proton pump, which reduces acid secretion (promotes peptic ulcer healing and prevents reoccurance)
5 indications for PPIs
1) . #1 PUD (very important)
2) . GERD
3) . Zollinger-ellison syndrome
4) . H. pylori tx/Gastritis
5) . OTC for acid indigestion/heartburn
4 side effects of PPIs
diarrhea, headache, b12 deficiency (stopping of parietal cell fxn eventually causes B12 malabsorption probs), hypomagnesemia
when are PPIs normally taken?
30 mins before meal in AM
MOA of H2 blockers and medications
cimetidine, famotidine, ranitidine
MOA = binds to H2 receptor on parietal cells and inhibits gastric acid secretion
4 indications for H2 blockers
PUD, GERD, Zollinger-Ellison, OTC acid indigestion/heartburn
2 ADRs for cimetidine and 2 for Famotidine
C = gynecomastia, impotence F = blood dyscrasias, QT prolongation
when should pts take H2 blockers? which H2 blocker is most potent?
usually at night
famotidine
MOA for antacids and medications
aluminum hydroxide, calcium carbonate (tums), magnesium hydroxide (milk of magnesia)
MOA: neutralizes gastric acid (which raises pH)
3 indications for antacids
1) . sxs relief of heartburn
2) . acid indigestion
3) . GERD
side effects of antacics
Mg: diarrhea
Ca/Al: constipation
MOA of sulcralfate
forms adhesive coating on ulcer surface that promotes healing
2 indications for sulcralfate
1) . treats active ulcers (esp duodenal)
2) prevents recurrent ulcers (used as prophylaxis)
3 side effects for sucralfate
metallic taste, constipation, nausea
what medications should you not take with sucralfate?
any meds that increase stomach pH (take away stomach acid) like PPIs, H2 blockers
*needs acidic pH for activation
MOA of misoprostol
MOA = prostaglandin analogue that inhibits gastrin secretion and INCREASES bicarb/mucus secretion
GI indication for misoprostol
preventing NSAID-induced ulcers (can’t heal existing ulcers)
3 side effects for misoprostol
abdominal cramps, diarrhea, vaginal bleeding
MOA for bismuth subsalicylate compounds and 2 drugs
MOA = antibacterial and binds to ulcer to protect mucosa from acid
Pepto bismol and kaopectate
three indications for bismuth subsalicylate agents
GERD, diarrhea, H. pylori
3 side effects of bismuth products
BLACK stool, constipation, salicylate and neuro toxicity in high doses
what are four classes of medications that can be used for nausea/vomiting
dopamine blockers, serotonin antagonists, antihistamines, anticholinergics
MOA of dopamine blockers and 3 medications
Metoclopramide, prochlorperazine, promethazine
MOA = blocks CNS dopamine receptors in vomiting center (metoclopramide also increase GI motility)
2 GI indications for dopamine blockers (and one specific for metoclopramide)
N/V, motion sickness, metoclopramide = GERD, gastroparesis
4 side effects for dopamine blockers
QT prolongation, constipation (anticholinergic), sedation (antihistamine), Parkinsonian effects (rigidity, bradykinesia, tremor, akathisia)
how to treat acute dystonic reaction?
diphenhydramine IV (side effect of dopamine blocker)
MOA of serotonin antagonists and 3 meds
Dolasetron, granisetron, ondansetron
MOA = blocks serotonin receptors in medulla to suppress vomiting center
3 GI indications for serotonin antagonists
1) . #1 for chemotherapy induced vomiting
2) . nausea
3) . vomiting
3 side effects for serotonin antagonists
1) . Neuro: HA, fatigue, sedation
2) . GI: constipation, bloating, diarrhea
3) . Cardiac: prolonged QT, arrhythmias
MOA and 2 medications for antihistamines used for GI
Diphenhydramine, Meclizine
MOA = acts at CNS centers for nausea, vomiting
main side effect for antihistamines used for GI? uses for antihistmaines
ANTICHOLINERGIC (dry mouth, blurry vision, sedation, urinary retention etc)
-N/V, motion sickness, vertigo
GI antimuscarinic drug and MOA
Scopolamine
MOA = central muscarinic receptor blocker
3 indications for scopolamine and side effects
Indications = motion sickness, vomiting, anti-GI motility (anti-diarrheal)
Side effects = anticholinergic (anti-sludgeM)
2 drug classes to use to treat diarrhea
1) . Bismuth subsalicylate compounds
2) . opioid agonists
MOA of opioid agonists used to tx diarrhea and 2 meds
atropine and loperamide
MOA = binds to gut wall opioid receptors to disrupt peristalsis/GI motility and intestinal transit time
2 indications for opioid agonists in diarrhea
1) . noninvasive acute diarrhea
2) . chronic diarrhea associated with bowel disease
treatment for TCA toxicity
sodium bicarbonate (used for cardiotoxicity of TCA)
treatment of cocaine toxicity
ammonium chloride
treatment of severe respiratory depression of Opioids
Naloxone, naltrexone (maintain over 12 breaths per minute)
treatment of severe benzo toxicity
flumazenil
treatment of BB toxicity
glucagon
treatment to theophylline toxicity
BB
treatment of digitalis toxicty
digibind
treatment for warfarin toxicity
vitamin K and fresh frozen plasma (esp if INR > 10)
treatment for heparin toxicity
protamine sulfate
treatment for antifreeze toxicity
iv ethanol infusion
what is the main complication of tylenol toxicity? how to manage it?
hepatic necrosis
Tx = n-acetyl-cysteine and activated charcoal
what happens physiologically in a salicylate toxicity?
respiratory alkalosis (respiratory stimulation) leads to high anion gap metabolic acidosis *can also get CNS signs of seizures, coma
how to treat salicylate toxicity?
1) . ABCs/resuscitation/IV fluids
2) . GI decontamination with activated charcoal
3) . Sodium bicarbonate
Base toxicity: substances and how it damages the body
i. e. Oven cleaner, drain cleaner,
* LIQUEFACTIVE NECROSIS = sloughs off tissue which leads to esophageal or gastric perforation (more esophagus), respiratory distress, irritated mucous membranes
how to treat base toxicity?
supportive care and ABCs
*DON’T try to neutralize
(worse than acids)
acid toxicity: substances and how it damages the body
toilet cleaner and battery acid
*causes coagulative necrosis mostly in the stomach, which turns into an eschar
anticholinergic toxicity: what three classes of drugs and how does it affect the body?
i.e. antihistamines, atropine, TCAs
Sympathetic stimulation: hyperthermia, tachy, HTN, hot flushed skin, dry mucous membranes, mydriasis
treatment of anticholinergic toxicity
activated charcoal, physostigmine
cholinergic toxicity: substances and how it damages he body
i. e. organophosphates, insecticides, pesticides
* SLUDGE-M side effects, children usually present with nicotinic sxs (tachy, weakness, HTN, mydriasis, fasciculations)
treatment for cholinergic toxicity
atropine + pralidoxime (reactivates cholinesterase enzyme)
*remove contaminated clothes
what are some side effects of salicylate toxicity?
tinnitus, nausea, vomiting, abdominal pain
*often start with respiratory alkalosis and hyperventilation
