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Pharmacology 2 > GI > Flashcards

GI Flashcards

1
Q

what causes most peptic ulcer disease?

A

h. pylori

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2
Q

in a patient with peptic ulcer disease, which pain and fever reducer should we use?

A

acetaminophen (tylenol)

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3
Q

what are the 3 steps in H. pylori that results in destruction of the mucosal layer?

A

H. pylor produces urease
urease converts to ammonia
ammonia destroys mucosal layer

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4
Q

what 6 antibiotics can help eradicate H. pylori?

A

Clarithromycin
Amoxicillin
Levofloxacin
Metronidazole
Tetracycline

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5
Q

how does bismuth subsalicylate help with h. pylori?

A

it is a heavy metal that is toxic to bacteria

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6
Q

2 MOAs of bismuth subsalicylate?

A

inhibits protein synthesis
disrupts bacterial cell wall

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7
Q

which PUD drug class being used with an antibiotic can exacerbate diarrhea and C. difficile,?

A

proton pump inhibitors

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8
Q

what is the typical triple regimen for PUD?

A

proton pump inhibitor
+
clarithromycin/amoxicillin/levofloxacin/metronidazole

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9
Q

what is the quadruple regimen to treat PUD?

A

proton pump inhibitor
+
bismuth subsalicylate
metronidazole
tetracycline

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10
Q

what is a metronidazole alternative to treat PUD?

A

tinidazole

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11
Q

-tidine

A

H2 receptor antagonists

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12
Q

MOA of H2 receptor antagonists

A

inhibit histamine at H2 receptors on parietal cells = decrease gastric acid production

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13
Q

what are the uses of H2 receptor antagonists? (2)

A

heart burn/acid indigestion
active duodenal ulcers

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14
Q

what can H2 receptor antagonists treat when given IV? (2)

A

stress ulcer
acute GI bleed

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15
Q

ADR of H2 receptor antagonists (2)

A

diarrhea
CNS (dizzy, drowsy, headache)

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16
Q

what are 2 instances when H2 receptor antagonists can cause confusion and hallucinations?

A

in elderly
cimetidine given IV

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17
Q

what are 3 ADR specific to oral cimetidine?

A

gynecomastia
galactorrhea
impotence

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18
Q

when are H2 receptor antagonists most effective?

A

at night

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19
Q

which H2 receptor antagonist has the most DDI with P450 since they are all metabolized by the liver?

A

cimetidine

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20
Q

what drugs must we stay away from if giving a patient an H2 receptor antagonist? (7)

A

macrolides
NSAIDS
codeine
oxycodone
anticoagulants
phenytoin
antidepressants

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21
Q

which H2 receptor antagonist is best used in patients with hepatic dysfunction? why?

A

Nizatidine

renal elimination

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22
Q

-prazole

A

proton pump inhibitors

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23
Q

MOA of proton pump inhibitors

A

inhibit H/K-ATPase pump on surface of gastric parietal cells

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24
Q

what are the uses of proton pump inhibitors? (2)

A

ulcers
GERD

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25
Q

what are 4 ADR of proton pump inhibitors?

A

GI pain
constipation
C. difficile
acid-rebound

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26
Q

what is an ADR specific to omeprazole?

A

dry mouth

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27
Q

what 2 drugs have DDI with proton pump inhibitors? what’s the enzyme?

A

clopidogrel
diazepam

CYP2C19

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28
Q

how does a PPI affect Pazopanib when they are used together?

A

PPI increases PH
Pazopanib becomes insoluble (no effect on body)

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29
Q

-prazan

A

acid pump antagonists

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30
Q

MOA of acid pump antagonists

A

inhibit K binding to parietal cell gastric H/K ATPase

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31
Q

which drug class does not require activation or an acidic environment to become active form?

A

acid pump antagonists

32
Q

which acid pump antagonist can be used in combination with amoxicillin and clarithromycin, or amoxicillin monotherapy?

A

vonoprazan

33
Q

MOA of anticholinergic agents

A

block Acetylcholine at muscarinic receptors

34
Q

which anticholinergic agents block both M1 and M3 receptors?

A

dicyclomine
propantheline

35
Q

which anticholinergic agents block only the M1 receptor?

A

pirenzepine
telenzepine

36
Q

synthetic prostaglandin analogue that binds to EP3 receptor on parietal cells

A

misoprostol

37
Q

what are the uses for misoprostol (a synthetic prostaglandin analogue)? (2)

A

prevent NSAID ulcers
3rd line for duodenal ulcers

38
Q

what are the ADR of misoprostol (a synthetic prostaglandin analogue)? (5)

A

abortifacient
N/V/D
cramps (abd/uterine)
uterine bleeding

39
Q

what must be used with misoprostol therapy?

A

contraceptive

40
Q

what are the 2 cytoprotectants?

A

sucralfate
bismuth subsalicylate

41
Q

MOA of sucralfate

A

forms sticky gel that adheres to ulcer and prevents mucosal sites from further damage

42
Q

what is sucralfate made up of?

A

aluminum hydroxide + sucrose

43
Q

what are the uses of sucralfate and bismuth subsalicylate? (2)

A

heal peptic ulcers
prevent ulcer relapse

44
Q

what are the 2 ADR of sucralfate?

A

constipation
hypophosphatemia

45
Q

what must be the pH in order for sucralfate to be activated?

A

pH < 4

46
Q

why must sucralfate be taken at least 30 mins before or after PPI, H2RA, or antacids?

A

sucralfate is not absorbed

47
Q

DOA of sucralfate?

A

6 hours

48
Q

name the 3 antacids

A

maalox
mylanta
sodium bicarb

49
Q

MOA of antacids?

A

neutralize acid locally

50
Q

what is the use of antacids?

A

relieve symptoms of PUD and GERD

51
Q

5 ADR of antacids?

A

hypercalcemia
diarrhea
hypermagnesemia
constipation
hypophosphatemia

52
Q

using antacids decreases the drug absorption of which 2 antibiotic classes?

A

tetracyclines
fluoroquinolones

53
Q

which 2 antacids have a rapid onset?

A

sodium bicarb
magnesium

54
Q

what can be used for GERD to decrease acid content in the mouth?

A

sodium bicarb mouth rinse

55
Q

-chol

A

cholinomimetics

56
Q

MOA of cholinomimetics

A

M2 receptor agonist to increase cholinergic stimulation

57
Q

what are the 2 uses for cholinomimetics?

A

reduce reflux
increase LES tone

58
Q

ADR of cholinomimetics?

A

Diarrhea
Urination
Miosis
Bradycardia
Bronchoconstriction
Emesis
Lacrimation
Sweat
Salivation

59
Q

dopamine antagonist that stimulates cholinergic activity in gut walls via D2 receptor antagonism

A

metoclopramide

60
Q

what are the 2 uses for metoclopramide? (dopamine antagonist)

A

gastroparesis in diabetics
increase gastric emptying

61
Q

what are 5 ADR of metoclopramide? (dopamine antagonist)

A

dystonia
restlessness
sedation
galactorrhea
gynecomastia

62
Q

what is the #1 cause of constipation?

A

laxatives

63
Q

why should patients be careful with laxatives? (2)

A

promote K loss = lyte + fluid imbalance
decreased peristalsis = longer time to refill rectum

64
Q

bulk-forming laxative that retains water, increases colonic mass, and increases reflex contraction of bowel

A

methylcellulose bran

65
Q

stool softener that eases passage and prevents straining

A

docusate

66
Q

which patients should use docusate? (3)

A

+ hemorrhoids
+ hernia
prior MI

67
Q

osmotic laxative that increases fluid content of stools

A

lactulose

68
Q

what are 3 enemas?

A

Mg citrate
MgOH (mg hydroxide)
NaPO4 (sodium phosphate)

69
Q

cathartic agent that purges intestine of rapid water evacuation

A

SUTAB

70
Q

cathartic agent that stimulates smooth muscle contraction to promote defecation

A

bisacodyl

71
Q

ADR of bisacodyl

A

local irritation of GI mucosa

72
Q

when would we want to use cathartic agents to stimulate defecation?

A

prior to radiological/sigmoidoscopic exam

73
Q

chloride channel activators that cause Cl to enter the lumen, Na and water follow. (2)

A

lubiprostone
linaclotide

74
Q

what are 3 ADR of chloride channel activators?

A

headache
nausea
diarrhea

75
Q

which GI medications have the least effect on electrolytes, including K?

A

chloride channel activators

Pharmacology 2 (22 decks)

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