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Pharmacology > Unit 6: GI > Flashcards

Unit 6: GI Flashcards

1
Q

Vomiting center is rich in

A

Dopamine, histamine, serotonin, and Ach receptors

Can also be effected by binding to opiate/benzo receptors

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2
Q

Stimulatory nausea center

A

Chemo trigger zone
most important for sensing noxious stimuli–it is exposed to both the blood and the CSF
Rich in neurotransmitter receptors for dopamine, serotonin, histamine, ACh, and NK (Anti emetic effect occurs when these receptors are blocked)

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3
Q

Phenothiazines

A

Prochlorperazine + Promethazine
Dopamine receptor blockade in chemo trigger zone
Also has anticholinergic activity
Used as monotherapy for mild-moderate N/V

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4
Q

SE of phenothiazines

A

EPS may occur due to dopamine blockage

Drowsiness and sedation

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5
Q

Antihistamines and anticholinergics for N/V

A

Hydroxyzine, meclizine, dimenhydrinate, scopolamine
Used for mild nausea such as motion sickness
Interruption of visceral afferent pathways that are responsible for N/V
Can be used in pregnancy but not breastfeeding

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6
Q

Benzodiazepines for nausea

A

Prevent and treat emesis as well as anti anxiety and amnesia
Helpful for anticipatory nausea and vomiting with chemo
Lorazepam (ativan) most frequently used

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7
Q

Serotonin antagonists for nausea

A

Ondansetron (zofran), granisetron, palonesetron, dolasetron
Antagonist 5HT-3 receptors centrally in CTZ and peripherally at vagal and splanchnic afferent fibers
Usually used for chemo N/V

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8
Q

Metoclopramide

A

Reglan
Highly useful in treatment of diabetic gastric stasis, postsurgical stasis and GERD
Increase motility and gastric emptying by increasing duration and extent of esophageal contractions, resting tone of LES, and gastric contractions
Dopamine receptor inhibition
Used for prevention/tx of chemo N/V

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9
Q

SE of metoclopramide

A

Can cause increased EPS

Can cause hypertensive crisis when used with MAOI

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10
Q

Corticosteroids for nausea

A

Reserves for chemo induced N/V
Inhibits prostaglandins
Dexamethasone + Methylprednisolone most common
Usually used in combo with other anti emetics

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11
Q

Cannabinoids for nausea

A

Only indicated for chemo N/V
Dronabinol is available agent
Effects on vomiting center, opiate receptors in CNS and cerebral cortex

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12
Q

Antacids for nausea

A

Mild N/V
Coats stomach with neutralizing agent
CaCO3, MgOH, AlOH, AlCO3

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13
Q

First line treatment for non-chemo induced N//V

A

Phenothiazine

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14
Q

First line treatment for chemo acute emesis

A

Combo of serotonin antagonist and corticosteroid 30 minute prior to chemo

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15
Q

First line treatment for chemo delayed emesis

A

Metoclopramide + Dexamethasone

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16
Q

Drug choices for GERD

A

Antacids, histamine 2 receptor antagonists, proton pump inhibitors

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17
Q

What stimulates parietal cells to release acid

A

Histamine, ACh, gastrin

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18
Q

What decreases gastric acid production

A

Prostaglandins and bicarb

Also increase mucus production–GI protective

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19
Q

H Pylori cause of PUD

A

Increases acid production, increases gastrin secretion and releases its own noxious enzymes and toxins

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20
Q

NSAIDs cause of PUD

A

Inhibit COX which decreases production of prostaglandins

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21
Q

Antacids

A

CaCO3, Mg salts, Al salts
Used for mild and intermittent symptoms
Partially neutralize HCl in stomach; pepsin is inhibited

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22
Q

H2 receptor antagonists

A

Cimetidine, famotidine, nizatidine, ranitidine
Effective in mild GERD, ulcer healing, H pylori eradication
Reversibly inhibits histamine 2 receptors on gastric parietal cells causing decreased acid secretion and pepsin activation

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23
Q

Proton pump inhibitor

A

Most potent acid-suppressing agents available
-Prazole
Inhibit gastric proton pumps located on parietal cells; produces long suppression of acid secretion

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24
Q

Tx to eradicate H Pylori induced PUD

A

Antibiotics + acid suppressing medication

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25
Q

Most common antibiotics for H Pylori

A

Amoxicillin, Carithromycin, Metronidazole, Tetracycline, Misoprostol, Sucralfate, Bismuth Subsalicylate

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26
Q

Algorithm for GERD tx

A

Lifestyle changes –> H2 receptor antagonist –> if no improvement Proton pump inhibitor–> if no improvement, refer to gastroenterologist

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27
Q

First line therapy for H Pylori eradication

A

Triple therapy:

  • PPI
  • Amoxicillin
  • Clarithromycin

OR

  • PPI
  • Metronidazole
  • Clarithromycin
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28
Q

Sequential therapy for H Pylori eradication

A

-PPI
-Amoxicilln
Followed by
-PPI
-Clarithromycin
-Metronidazole

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29
Q

What drugs have shown efficacy for preventing NSAID induced ulcers

A

PPIs and misoprostol

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30
Q

Bulk forming laxatives

A

Methylcellulose, psyllium, polycarbophil, malt soup extract, wheat dextrin
Bind to fecal contents and pull water into stool–softens and lubricates stool
Preferred treatment of constipation

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31
Q

Hyperosmotic laxatives

A

Lactulose, sorbitol, polyethylene glycol, glycerine

Increase concentration of solutes which creates osmotic pressure and draws fluid into intestinal lumen

32
Q

Saline laxatives

A

MgOH, Mg citrate, Mg sulfate, Na phosphate, Na biphosphate
Draw water into the intestines through osmosis
May cause dehydration

33
Q

Stimulant laxatives

A

Bisacodyl + Senna concentrates
Increase peristalsis through direct effects on smooth muscle of intestines + promote fluid accumulation in colon and small intestines
Avoid long term

34
Q

Surfactant laxatives

A

Docusate sodium + Docusate calcium
Decrease surface tension of liquid contents of bowel–promotes incorporation of additional liquid into the stool (stool softener)
DOC in patients who should not strain

35
Q

Lubricant laxatives

A

Mineral oil coats and softens the stool and prevents reabsorption of water from the stool by the colon

36
Q

Lubiprostone

A

Secretagogues
Derivative from prostaglandin
Increases chloride rich intestinal fluid without altering serum sodium and potassium concentrations

37
Q

Naloxegol

A

Peripherally acting mu-opioid receptor antagonists
Decrease constipation of opioids
Does not cross bbb

38
Q

First line therapy for all forms of constipation

A

bulk forming laxative

39
Q

First line therapy if straining should be avoided

A

Stool softener

40
Q

First line therapy for constipation in infants

A

Glycerin

41
Q

Second line therapy for constipation

A

Milk of magnesia, lactulose, sorbitol

42
Q

Third line therapy for constipation

A

Stimulant laxatives

43
Q

Meds that might cause diarrhea

A

Antacids containing Mg, antibiotics, SSRIs, cholinergic agents, cholchicine, digoxin, metoclopramide, laxatives, metformin, prostaglandins, quinidine

44
Q

Osmotic diarrhea

A

Nonabsorbed solutes retained in the lumen of intestinal tract–pulls water and ions into intestinal lumen

45
Q

Secretory diarrhea

A

Colonic absorption of fluid is secondary to active transport of Na+ through Na/K ATpase

46
Q

Exudative diarrhea

A

Inflammation of mucosa

Due to enteritis, UC, carcinoma

47
Q

Prophylactic agents for travellers diarrhea

A

Bismuth subsalicylate (pepto bismol) or quinolone antibiotic or rifaximin

48
Q

Antimotility drug for diarrhea

A

Loperamide (immodium) and Diphenoxylate
Opioid receptor agonist acting on mu receptors of large intestine
Avoid in patients with infectious diarrhea–fever, bloody stools, fecal leukocytes

49
Q

Atypical antidiarrheals

A 
Bismuth subsalicylate (Pepto Bismol)
Stimulates prostaglandin, mucous and bicarb secretion in stomach and inhibits prostaglandin and chloride secretion in large intestine
50
Q

Rifaximin

A

Semi synthetic antibiotic
Only active against noninvasive strains of E. Coli
Blocks transcription of bacteria–alters growth of bacteria
Used for travellers diarrhea

51
Q

First line tx for diarrhea

A

Loperamide or rifaximin

52
Q

Second line tx for dirrhea

A

Adsorbents/anti secretory

53
Q

Third line tx for diarrhea

A

Diphenoxylate

54
Q

Drug therapy for IBS

A

Depends on if it is constipation predominant or diarrhea

55
Q

Antispasmodics for IBS

A

Dicyclomide Hcl and Hyosycamine sulfate

Direct relaxation of smooth muscle component of GI tract

56
Q

Serotonin 3 receptor antagonists for IBS

A

Alosetron
Decrease abdominal pain, slow colonic transit time, increase rectal compliance and improve stool consistence
Used for severe diarrhea with no constipation

57
Q

First line IBS tx for constipation

A

Linaclotide or lubiprostone

58
Q

First line IBS tx for diarrhea

A

Loperamide

59
Q

First line IBS tx for bloating and pain

A

Dicyclomine

60
Q

Treatments for inflammatory bowel disease

A

aminosalicylates, corticosteroids, immunosuppressive agents, antibiotics, and biological agents

61
Q

Aminosalicylates

A

Sulfasalazine, mesalamine, olsalazine, balsalazide
Gold standard for tx of mild to moderate CD or UC
Decrease inflammation in GI tract by inhibiting prostaglandin synthesis which decreases inflammatory mediators

62
Q

Aminosalicylates CI in

A

Patients with aspirin allergy or G6PD deficiency

63
Q

Corticosteroids for IBD

A

Prednisone, methylprednisolone, hydrocortisone, dexamethasone, budesonide
Used to treat acute IBD exacerbations only

64
Q

Immunosuppressive agents for IBD

A

Azathioprine, 6-mercaptopurine, methotrexate, cyclosporine

Used as adjunct tx to induce or maintain remission

65
Q

What antibiotics are desirable for IBD

A

Acts against G- and mycobacterium with low SE profile and poor systemic absorption

66
Q

Mild to moderate active CD responds to what antibiotics

A

Metronidazole and Ciprofloxacin

67
Q

Long term use of metronidazole is associated with

A

Neurotoxic effects

68
Q

Biologic agents for IBD

A

TNF-alpha inhibitors: infliximab, adalimumab, certolizumab

Selective adhesion molecule inhibitors: natalizumab, vedolizumab

69
Q

First line tx for mild to moderate active luminal CD

A

Oral aminosalicylates alone or in combo with antibiotic

Oral preferred over rectal

70
Q

First line tx for moderate to severe CD

A

Combo of aminosalicylates and corticosteroids

71
Q

First line tx for mild UC

A

Aminosalicylates (oral + rectal combo)

72
Q

First line tx for moderate UC

A

Add in a corticosteroid to aminosalicylates

73
Q

Aminosalicylate of choice for IBD

A

Mesalamine

74
Q

Corticosteroid of choice for IBD

A

Oral budesonide

75
Q

Cyclosporine for IBD

A

Reserved for acute treatment of severe UC exacerbations

Pharmacology (56 decks)

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