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Pharmacology > GI > Flashcards

GI Flashcards

1
Q

Causes of Nausea/Vomiting

A
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2
Q

Which neurotransmitters trigger Nausea/Vomiting

A
  • Histamine
  • Ach
  • Serotonin
  • Dopamine
  • CHEMO Induced N/V (CINV)
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3
Q

Types of Anti-emetics

A
  • Antihistamines
  • Anticholingerics
  • Dopamine Antagonists
  • Serotonin (5-HT3) Receptor Antagonists
  • Neurokinin 1 receptor Antagonists
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4
Q

What type of Antiemetics are these?

Dimenhydrinate (Dramamine)
Meclizine (Antivert, Bonine)
Diphenhydramine (Benadryl)

A

Antihistamines

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5
Q

What type of Antiemetics are these? (“-setron”)

Ondansetron (Zofran)
Palonosetron (Aloxi)
Dolasetron (Anzamet)
Granisetron (Kytril)

A

Serotonin (5-HT3 Receptor) Antagonists

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6
Q

What type of Antiemetic is this?

Scopolamine (Transderm-Scop)

A

Anticholinergic

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7
Q

What type of Antiemetics are these?

  • Phenothiazines -> Promethazine (Phenergan), Prochlorperazine (Compazine)
  • Metoclopramide (Reglan)
A

Dopamine Antagonists

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8
Q

What type of Antiemetics are these? (“-pitant”)

Aprepitant (Emend)
Fosaprepitant for injection (Emend)
Rolapitant (Varubi)

A

Neurokinin 1 receptor antagonists
For CHEMO Induced N/V (CINV)

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9
Q

Are Antihistamines & Anticholinergics better for prophylaxis or trmnt of N/V?

A

Prophylaxis

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10
Q

Which Antiemetic blocks the chemoreceptor trigger zone and diminishes vestibular and reticular stimulation

A

Antihistamines

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11
Q

Which Antiemetic blocks the chemoreceptor trigger zone and diminished vestibular and reticular stimulation

A

Antihistamines

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12
Q

Which antiemetics are safe for refractory N/V in pregnancy

A

Serotonin Antagonists (“-setron”)

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13
Q

Serotonin Antagonists cannot be taken with other meds thay may prolongate the QT, such as…

A

Macrolides
Antiarrhythmics
Azole Antifungals
Fluoroquinolones

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14
Q

Which antiemetic agent has these considerstions:
- DO NOT GIVE TO < 2yo for risk of resp depression
- Suppresses bone marrow if used long-term (>1-2wks)

A

Phenothiazines (Dopamine Antagonists)

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15
Q

Which dopamine antiemetic inhibits dopamine receptors in brain, Blocks histamine (H1), cholinergic, & blocks adrenergic receptors

A

Phenothiazines

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16
Q

What are Extrapyramidal Symptoms (EPS)?

A

Involuntary tics, muscle contractions, restlessness (think parkinsons like tics)

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17
Q

What Antiemetics cause Extrapyramidal Symptoms (EPS)

A

Dopamine Antagonists

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18
Q

Antiemetics

Long-term use (>8-12wks) of ______ is avoided because it can lead to Tardive Dyskinesia (an often irreversible movement disorder)

A

Metoclopramide (Reglan) - Dopamine Antagonist

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19
Q

Which Antiemetics are used for CHEMO induced N/V (CINV) & may interact with warfarin therapy?

A

Neurokinin 1 receptor antagonists
* Aprepitant (Emend)
* Fosaprepitant for injection (Emend)
* Rolapitant (Varubi)

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20
Q

Diarrhea <___wks = Acute

A

< 2 wks = Acute
> 2 wks = Chronic

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21
Q

Pt presents with diarrhea and has been taking anti-diarrheals. Labs confirm Infx ET. Wdyd?

A

Discontinue Antidiarrheals (Especially of C. diff infx -> Toxic Megacolon risk)

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22
Q

What type of agent is Pepto Bismol?

A

Anti-secretory

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23
Q

Pepto Bismol contains Salicylate and Bismuth. What are the specific MOA of these two compounds?

A

Salicylate -> anti-secretory and anti-inflammatory
Bismuth -> antimicrobial to bacteria & viruses

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24
Q

Pepto Bismol Contraindications

Salicylate may interact with _____ and lead to Salicylism (Tinnitus, N/V)

A

Anticoagulants (Aspirin)
Salicylate + Aspirin = Salicylism

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25
Q

Which GI med cannot be given to children/teens with or recovering from influenza or Zoster infection -> Reye’s Syndrome (swelling/inflammation of liver & brain -> altered mental status + Vomiting)

A

Pepto Bismol

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26
Q

Which GI meds are Gastric μ-opioid receptor agonists (μ = mu)

A

Antimotility or Opiate Derivatives
- Loperamide (Imodium)
- Diphenoxylate with atropine (Lomotil)
- Difenoxin with atropine (Motofen)

27
Q

Opiate Derivatived Anti-diarrheals

Subtherapeutic amounts of _______ are added to formulations added to discourage abuse

A

ATROPINE

28
Q

PUD

What are the aggressive and protective factors?

A
29
Q

Halitosis is more commonly associated with ____
- GERD?
- PUD?

A

GERD

30
Q

GERD & PUD Trmnt Agents

A
31
Q

Which GI med can cause Milk-Alkali Syndrome?

A

Antacids

32
Q

Antacids SE

Mg -> ________
Al & Ca -> _______

A

Mg -> diarrhea (laxative effect), renal failure
Al and Ca -> constipation, hypophosphatemia

33
Q

Caution giving Antacids to those who have ___ dysfunction

A

renal

34
Q

Which H2RA has many drug interactions, is a potent multiple CYP450 inhibitor, and is generally avoided (eg. warfarin, phenytoin, nifedipine)

A

Climetidine (Tagamet)

35
Q

How do PPIs inhibit the proton pump? What needs to happen for acid secetion to resume?

A

PPIs form covalent bond with H+K+ATPase and irreversibly inhibit proton pump
Acid secretion only resumes after new pump molecules are secreted and inserted into the luminal membrane

36
Q

When should PPIs be taken?

A

30 min BEFORE MEALS

37
Q

Caution giving PPIs if there is _____ dysfunction

A

hepatic

37
Q

You need to Rx Omeprazole/Esomeprazole (Prilosec) for GERD to a patient with a laundry list of meds. You need to see if they are already taking _____, _____, or _______ because adding this drug may increase the concentration of these other 3.

A

clopidogrel, diazepam, or warfarin

38
Q

What are the 2 different Cytoprotective Agents for GERD or PUD?

A
  • Misoprostol (Cytotec) - Prostaglandin analog
  • Sucralfate (Carafate) - fills in ulcer holes
39
Q

Which GI med is approved for NSAID induced mucosal injury but TRIGGERS IBD FLARES and is TERATOGENIC (Preg Category X)?

A

Misoprostol (Cytotec)

40
Q

Cytoprotective Agents

  • Misoprostol (Cytotec)
  • Sucralfate (Carafate)

Which ones gives you Diarrhea? Which one gives you Constipation?

A

Misoprostol (Cytotec) -> Diarrhea
Sucralfate (Carafate) -> Constipation

41
Q

Which Cytoprotective agent can treat other ulcers including:
* Canker Sores
* Radiation Induced Ulcers
* Radiation Proctitis and Rectal Ulcers (when given rectally)

A

Sucralfate (Carafate)

42
Q

Untreated H. pylori -> _______

A

Gastric Cancer

43
Q

Low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma is an indication for ____ WU

A

H. pylori

44
Q

H. pylori infx leads to:
______ Gastrin & Acid
______ Bicarb

High or Low

A

HIGH Gastrin & Acid
LOW Bicarb

H. pylori infx decr inhibition of gastrin production resulting in abundance of gastrin and subsequent increased acid production and reduced duodenal bicarbonate production
= HIGH GASTRIN & ACID; LOW BICARB

45
Q

1st line Quadruple Therapy for H. pylori

A
  1. PPI BID or Esomeprazole QD (or H2RA)
  2. Bismuth Subsalicylate (Pepto Bismol)
  3. Tetracycline
  4. Metronidazole

14 Day trmnt

46
Q

Dx of IBS

A
47
Q

IBS-D Trmnts

A
48
Q

Type of drug, MOA, & Use ?

  • Hyoscyamine (Anaspaz, Levsin, Levbid)
  • Dicyclomine (Bentyl)
A

Anticholinergic/Antisposmodics
MOA: blocks Ach at parasymp sites in smooth muscle, secretory glands, and CNS
Use: IBS-D (Diarrhea)

49
Q

Which anti-diarrheal may aggrivate diarrhea associated with E. coli, C. diff, Salmonella, and Shigella?

A

Loperamide (Imodium) - Antimotility or Opiate Derivative

50
Q

IBS-C Agents

A
  • Bulk Forming Laxatives
  • Osmotic Laxatives
  • Stimulants
  • Surfactants
  • Emollients/Lubricants
  • Chloride Channel Activators
51
Q

What type of agents are these? MOA? When to take?

Psyllium (Metamucil, others)
Methylcellulose (Citrucel)
Calcium Polycarbophil (Fibercon)

A

Bulk-forming laxatives
MOA: creates gel-like matrix in stool, soaks up fluid in loose stool and adding bulk
Take with a lot of water (2hrs before or after other meds)

52
Q

Which IBS-C agent is #1 in pregnancy?

A

Bulk-Forming Laxatives
Psyllium (Metamucil, others)
Methylcellulose (Citrucel)
Calcium Polycarbophil (Fibercon)

53
Q

What drugs are Osmotic Laxatives?

A
  • Magnesium Hydoxide/Citrate/Sulfate
  • Polyethylene Gycol (Miralax)
  • Lactulose (Enulose)
  • Na+ Phosphates (Fleets)
  • Glycerin (Pedialax)
54
Q

Which IBS-C med makes your pee pink/red?

A

Senna (Senokot) - Stimulant

55
Q

What IBS-C drug should be used when stool is HARD and DRY?

A

Docusate (Colace) - Surfactant

56
Q

Aspirating which IBS-C med can lead to Lipid Pneumonitis?

A

Mineral Oil (Emollients/Lubricants)
MOA: coats the bowel and stool mass with water repelling film, keeping moisture in the stool and make it easier to shit (slip N slide)

57
Q

Which IBS-C agents should be avoided in those with Mechanical Bowel Obstruction (MBO) or are taking Methadone?

A

Lubiprostone (Amitiza) - Chloride Channel Activator

Methadone decreases Lubiprostone’s effects

58
Q

pts with IBS-C, chronic idiopathic constipation, or opiod-induced constipation with chronic non-cancer pain should take _______

A

Lubiprostone (Amitiza) - Chloride Channel Activator

59
Q

If you are constipated and straining should be avoided, you can take ________ or _______

A

Surfactants -> Docusate (Colace)
Emollients/Lubricants (Mineral Oil)

60
Q

Chronic opiod use requires regular use of _______ laxatives

A

Stimulant
- Senna (Senokot)
- Bisacodyl (Dulcolax)

61
Q

When should Stimulant laxatives be given?

A

30 min AFTER meal

62
Q

Stimulant Laxatives for non-opiod induced IBS-C should be used <____ days to avoid dependence

A

7

Pharmacology (14 decks)

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