week 2 - GI pharm Flashcards
what are the 6 antiemetics?
- scopolamine
- Dimenhydrinate - Gravol
- Nabilone
- Ondansetron- zofran
- Dexamethazone
- Metoclopramide- maxeran
What drug class is scopolamine and what is the MOA?
muscarinic receptor antagonist
blocks ACH for PNS
- so helps with GI not signaling emetic center
blocks nerve impulses between vestibular apparatus in inner ear to the emetic center
which antiemetic is best for motion sickness?
scopolamine
What are the adverse effects of scopolamine?
- CNS - sleep/drowsy
- blurred vision & dry mouth
- GU retention/GI constipation b/c PNS blocked
What drug class is dimenhydrinate and what is the MOA?
antihistimine
it blocks muscarinic receptors in vestibuler system so stops emetic signal
blocks GI receptors (ACH) so histimine can’t be released and acid can’t be made
What are the adverse effects of scopolamine?
- CNS - drowsy
- dry mouth
- Gu dysuria/ GI- constipation
- hypotension
What 4 things is Dimenhydrinate contraindicated in?
- other CNS depressants
- Gluacoma
- CKD
- dysuria
what drug class is Nabilone and what is the MOA?
cannabinoid
stops activation of receptors around vomiting centre
What are the adverse effects of Nabilone?
- CNS - drowsy, confusion
- Cardiac - tachy, hypotension
Is Nabilone a first line or 2nd line drug and why?
2nd line b/c of psycho-affect
abuse potential
what is nabilone contraindicated in?
- psychiatric disorder patients
- cardiovascular disease
What drug class is ondansetron and what is the MOA?
seratonin receptor antagonist
blocks serotonin receptors in CTZ
What are the 2 special adverse effects of Ondansetron?
- QT prolongation - EKG
- Muscle pain
Which antiemetic has no side effects when used shorter term?
dexamethasone
what is the drug class of dexamethasone?
glucocorticoid (steroid)
What drug class is metoclopramide (maxeran) and what is the MOA?
- prokinetic - promotes gastric emptying
blocks dopamine + serotonin receptors in the CTZ
upper GI responds to ACH so peristalsis happens
What are the adverse effects of metoclopramide - maxeran?
- tardive dyskinesia (remember my restless legs in concordia) w/long term use
What is metroclopramide (maxeran) contraindicated in?
- GI obstruction
- perforation
- hemorrhage
What is the one “other” antidiarrheal?
bismuth subsalicylate (pepto)
What is the MOA of bismuth subsalicylate (pepto)?
1.coats walls of the GI tract
2. stimulates mucous production
3. binds to toxins and bacteria for excretion
what are the adverse effects of bismuth subsalicylate (pepto)?
- increased bleeding time (not for PUD)
- hearing loss/tinnitus
- metalic taste
- blue gums
- dark stool
What are the 2 non-specific antidarrheals?
- loperamide- imodium
- Diphenoxylate + Atropine) - Lomotil
What drug class is loperamide - imodium and diphenoxylate + atropine - Lomotil?
Opiod
what antidiarrheal is good for people with iliostomy?
Imodium (note the I’s)
Which Opioid non-specific antidiarrheal causes neuro effects and which has none?
- diphenoxylate + atropine = lomotil - neuro effects
- loperamide- imodium - no neuro effects
What are the 2 osmotic laxatives?
- Magnesium hydroxide
- poly ethylene glycol
What is magnesium hydroxide contraindicated in?
Renal disease b/c mag will already be high. Kidneys can’t secrete it
What laxative helps purge poisons?
magnesium hydroxide
what laxative is commonly used pre-colonoscopy?
polyethylene glycol
What is the 1 stimulant laxative?
Bisacodyl (dulcolax)
What laxative is given with constipation from opiods?
bisacodyl (dulcolax) - think codine… type meds
when should bisacodyl (dulcolax) be taken?
at bed time
what is a commonly abused drug in bulimia nervosa and anorexia nervosa?
bisacodyl (dulcolax)
What is the MOA of bisacodyl (dulcolax) ?
stimulate motility - non systemic
What is an osmotic laxative?
lactulose
What is lactulose commonly used for when not a laxative?
hepatic encephalophathy
What is the MOA of lactulose?
it turns into lactic acid in the intestine and helps ammonia NH3 turn into ammonium NH4 and leave the body
what should we teach patients to do with psyllium?
drink LOTS of water. you don’t want it stuck in esophagus
what laxative is good post MI?
docusate sodium (colace) - think sodium is a heart related thing
What medication do we give for chronic IBD?
UC & crohn’s
5-aminosalicylates - sulfasalazine
Is 5-aminosalicylates - sulfasalazine used for acute or chronic IBD?
chronic - to maintain remission
what are the 2 adverse effects of 5-aminosalicylates- sulfasalazine ?
- risk for bleeding
- arthralgia - joint pain
what do we remember about salicylates?
anti-inflammatory - like an NSAID
what medication do we give for acute UC?
budesonide - glucocordicoid
what is budesonide - glucocordicoid given for?
actue IBD - to induce remission NOT maintain remission
Do we give glucocordicoid- budesonide to UC or crohns?
UC only b/c it works in the ascending colon and illium (bottom)
What are the adverse effects of glucocordicoid - budesonide?
think steroids- adrenal suppression- cushings
osteoporosis
increased infection
When is Infliximab used with IBD?
moderate to severe UC and crohn’s
Do not give infliximab with other immuomodulator or immunosuppresants because it can increase the risk of __________
lymphoma
what are the 3 adverse effects of Infliximab?
- chest pain (angina)
- HTN
- Hypotention
what are the 4 drug classes for PUD?
- H2 receptor antagonist - ranitadine
- PPI - omeprazole
- antiucler - sucralfate, misoprostol, antacids
- antibacterial drugs
When do we administer Ranitadine?
1 hour from other meds
what are the 2 main adverse effects of ranitadine?
- confusion
- PN - b/c less H+= more bacteria
what are the 4 main adverse effects of omeprazole?
- dyspepsia- rebound H+
- PN- b/c less H+ = more bacteria
- fractures b/c less H+ = less cal. absorption
- hypomagnemia b/c less H+ = less mag absorption
when do we administer omeprazole?
before meals
What is Sucralfate used to treat?
GERD
duodenal ulcers
how long does sucralfate adhere to ulcers?
6 hours
when do we administer sucralfate with antacids and/or other meds?
30 min to 1 hour before or after antacids
2 hours from meds
What is the MOA of misoprostol?
suppresses gastric acid
what is misoprostol contraindicated in?
pregnancy
what is a common group of meds given for GERD, PUD and gastritis?
antacids- antiulcer
when do we administer antacids?
after meals
which two antacids go well together?
magnesium hydroxide (poop lots) + aluminum hydroxide- amajel (constipation)
Who should not receive aluminum hydroxide?
people with hypophophatemia because it loves to bind to phosphate
