Block 3 material simplified (GIT meds) Flashcards by isabelle courtney

H2 Blockers

MOA:

Clinical uses:

Adverse effects:

Cimetidine, Famotidine, & Nizatidine

MOA:
Inhibit H2 receptors to reduce H+ secretion from gastric parietal cells

Clinical uses:
Peptic ulcers
Gastritis
Mild esophageal reflux

Adverse effects: mostly Cimetidine
1) Inhibits CYP450 (drug interactions)

2) Antiandrogenic
(prolactin release, gynecomastia, impotence, low libido)

3) Cross BBB & placenta
(confusion, headaches, & dizziness)

4) Elevated CK (reduced renal clearance)

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Cimetidine, Famotidine, & Nizatidine

MOA:
Inhibit H2 receptors to reduce H+ secretion from gastric parietal cells

Clinical uses:
Peptic ulcers
Gastritis
Mild esophageal reflux

Adverse effects: mostly Cimetidine
1) Inhibits CYP450 (drug interactions)

2) Antiandrogenic
(prolactin release, gynecomastia, impotence, low libido)

3) Cross BBB & placenta
(confusion, headaches, & dizziness)

4) Elevated CK (reduced renal clearance)

H2 Blockers

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Proton Pump Inhibitors

MOA:

Clinical uses:

Adverse effects:

Omeprazole, Lansoprazole, Esomeprazole, Pantoprazole, & Dexlansoprazole

MOA:
Irreversibly inhibits H+/K+ ATPase in gastric parietal cells
(needs acidic pH take before food)

Clinical uses:
Peptic ulcers
Gastritis
GERD
Zollinger Ellison syndrome
H. pylori
Prophylaxis for stress-induced ulcers

Adverse effects:
1) High risk of C.diff infection
2) Pneumonia
3) Acute interstitial nephritis
4) Vit B12, Mg2+, & Ca2+ malabsorption (higher fracture risk in elderly)

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Omeprazole, Lansoprazole, Esomeprazole, Pantoprazole, & Dexlansoprazole

MOA:
Irreversibly inhibits H+/K+ ATPase in gastric parietal cells
(needs acidic pH take before food)

Clinical uses:
Peptic ulcers
Gastritis
GERD
Zollinger Ellison syndrome
H. pylori
Prophylaxis for stress-induced ulcers

Adverse effects:
1) High risk of C.diff infection
2) Pneumonia
3) Acute interstitial nephritis
4) Vit B12, Mg2+, & Ca2+ malabsorption (higher fracture risk in elderly)

Proton Pump Inhibitors

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What are the effects of overuse of Aluminum hydroxide (antacid)?

Constipation
Hypophosphatemia/Hypokalemia
Osteodystrophy
Proximal muscle weakness
Seizures

“CHOPS”

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Constipation
Hypophosphatemia/Hypokalemia
Osteodystrophy
Proximal muscle weakness
Seizures

“CHOPS”

Are overuse of which antacid?

Aluminum hydroxide

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What are the effects of overuse of Calcium carbonate (antacid)?

Hypercalcemia (milk-alkali syndrome)
Hypokalemia
Rebound acid increase

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Hypercalcemia (milk-alkali syndrome)
Hypokalemia
Rebound acid increase

Are overuse of which antacid?

Calcium carbonate

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What are the effects of overuse of Magnesium hydroxide (antacid)?

Diarrhea
Hyporeflexia
Hypokalemia
Hypotension
Cardiac arrest

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Diarrhea
Hyporeflexia
Hypokalemia
Hypotension
Cardiac arrest

Are overuse of which antacid?

Magnesium hydroxide

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Bismuth & Sucralfate

MOA:

Clinical uses:

MOA:
They bind to the ulcers base to protect it from further damage & they allow HC0-3 secretion to reestablish the pH gradient in the mucous layer

Note:
Sucralfate needs acidic pH (give before meals) & AVOID PPI’S & H2 inhibitors

Clinical uses:
1) Improve ulcer healing
2) Travelers diarrhea (Bismuth)
3) H.pylori-induced gastritis (Bismuth)

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MOA:
They bind to the ulcers base to protect it from further damage & they allow HC0-3 secretion to reestablish the pH gradient in the mucous layer

Note:
_______ needs acidic pH (give before meals) & AVOID PPI’S & H2 inhibitors

Clinical uses:
1) Improve ulcer healing
2) Travelers diarrhea (_______)
3) H.pylori-induced gastritis (________)

Bismuth & Sucralfate

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Misoprostol

MOA:

Clinical uses:

Adverse effects:

MOA:
PGE1 analog that increases the production/secretion of bicarbonate from the gastric mucosa & reduces the secretion of acid to protect the lining

Clinical uses:
1) Prevent NSAID-induced peptic ulcers
2) Off label labor inducer (ripens the cervix)

Adverse effects:
Diarrhea

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MOA:
PGE1 analog that increases the production/secretion of bicarbonate from the gastric mucosa & reduces the secretion of acid to protect the lining

Clinical uses:
1) Prevent NSAID-induced peptic ulcers
2) Off label labor inducer (ripens the cervix)

Adverse effects:
Diarrhea

Misoprostol

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Octreotide

MOA:

Clinical uses:

Adverse effects:

MOA:
Long-acting somatostatin analog that inhibits the release of various splanchnic vasodilatory hormones

Clinical uses:
1) Acute varicocele bleeds
2) Acromegaly
3) VIPoma
4) Carcinoid tumor

Adverse effects:
1) Nausea/Cramps
2) Steatorrhea
3) Higher risk of cholelithiasis (due to CCK inhibition)

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MOA:
Long-acting somatostatin analog that inhibits the release of various splanchnic vasodilatory hormones

Clinical uses:
1) Acute varicocele bleeds
2) Acromegaly
3) VIPoma
4) Carcinoid tumor

Adverse effects:
1) Nausea/Cramps
2) Steatorrhea
3) Higher risk of cholelithiasis (due to CCK inhibition)

Octreotide

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Sulfasalazine

MOA:

Clinical uses:

Adverse effects:

MOA:
A combination of sulfapyridine (antibacterial) & 5-aminosalicylic acid (anti-inflammatory) that is activated by colonic bacteria

Clinical uses:
Ulcerative colitis
The ulcerative component of Chron’s

Adverse effects:
1) Malaise/Nausea
2) Sulfonamides toxicity
3) Reversible oligospermia

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MOA:
A combination of sulfapyridine (antibacterial) & 5-aminosalicylic acid (anti-inflammatory) that is activated by colonic bacteria

Clinical uses:
Ulcerative colitis
The ulcerative component of Chron’s

Adverse effects:
1) Malaise/Nausea
2) Sulfonamides toxicity
3) Reversible oligospermia

Sulfasalazine

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Loperamide

MOA:

Clinical uses:

Adverse effects:

MOA:
An agonist at μ-opioid receptors in the myenteric plexus to slow gut motility & increase electrolyte resorption (hardens poop & reduces frequency)

Clinical uses:
Diarrhea

Adverse effects:
Constipation
Nausea/Cramping

MOA:
An agonist at μ-opioid receptors in the myenteric plexus to slow gut motility & increase electrolyte resorption (hardens poop & reduces frequency)

Clinical uses:
Diarrhea

Adverse effects:
Constipation
Nausea

Loperamide

Ondansetron & Granisetron

MOA:

Clinical uses:

Adverse effects:

MOA:
5-HT3 antagonist that acts peripherally to reduce vagal stimulation & centrally as an antiemetic

Clinical uses:
Control post-op vomiting in chemo patients

Adverse effects:
1) Headache
2) Constipation
3) QT prolongation
4) Serotonin syndrome

MOA:
5-HT3 antagonist that acts peripherally to reduce vagal stimulation & centrally as an antiemetic

Clinical uses:
Control post-op vomiting in chemo patients

Adverse effects:
1) Headache
2) Constipation
3) QT prolongation
4) Serotonin syndrome

Ondansetron & Granisetron

Aprepitant

MOA:

Clinical uses:

Adverse effects:

MOA:
Substance P antagonists that blocks NK1 (neurokinin-1) brain receptors

Clinical uses:
Antiemetic to reduce nausea/vomiting in chemo patients

MOA:
Substance P antagonists that blocks NK1 (neurokinin-1) brain receptors

Clinical uses:
Antiemetic to reduce nausea/vomiting in chemo patients

Aprepitant

Prochlorperazine & Metoclopramide MOA: Clinical uses: Adverse effects:

MOA: D2 receptor antagonist that increase acetylcholine's response in the upper Gi tract to promote gastric emptying (prokinetic effect) and reducing nausea and vomiting (antiemetic effect). AVOID in patients with a small bowel obstruction Clinical uses: Diabetic & post op gastroparesis Antiemetic Adverse effects: 1) Extrapyramidal symptoms (tardive dyskinesia & lower seizure threshold) 2) Drowsiness/Fatigue 3) Depression 4) Diarrhea 5) Drug interactions with digoxin & diabetic drugs

Prochlorperazine & Metoclopramide

Orlistat MOA: Clinical uses: Adverse effects:

Lipid lowering agent MOA: Inhibits gastric & pancreatic lipase to reduce breakdown & absorption of dietary fats (take with a fatty meal) Clinical use: Weight loss Adverse effects: 1) Abdominal pain 2) Flatulence 3) Bowel urgency/frequency 4) Steatorrhea (fat-soluble vitamin def)

MOA: Inhibits gastric & pancreatic lipase to reduce breakdown & absorption of dietary fats (take with a fatty meal) Clinical use: Weight loss Adverse effects: 1) Abdominal pain 2) Flatulence 3) Bowel urgency/frequency 4) Steatorrhea (fat-soluble vitamin def)

Orlistat

Bulk-forming laxatives MOA: Clinical uses: Adverse effects:

Psyllium & Methylcellulose MOA: Soluble fibers draw water into the gut's lumen to form a viscous liquid to trigger peristalsis Adverse effects: Bloating

Bulk-forming laxatives

Osmotic laxatives MOA: Clinical uses: Adverse effects:

Magnesium hydroxide, Magnesium citrate, Polyethylene glycol, & Lactulose MOA: They are osmotic loads that draw water into the Gi lumen to trigger peristalsis Clinical uses: Constipation (all) Hepatic encephalopathy (Lactulose) Adverse effects: 1) Diarrhea 2) Dehydration 3) Metabolic alkalosis (overuse)

Osmotic laxatives

Lactulose MOA: Clinical uses:

MOA: A synthetic disaccharide that's not absorbed in the gut that is metabolized by gut flora to activate an osmotic effect to soften stool and promote bowel movements Clinical uses: 1) Constipation 2) Hepatic encephalopathy (It reduces ammonia absorption)

Lactulose

Stimulants (laxatives) MOA: Clinical uses: Adverse effects:

Senna & Bisacodyl MOA: Stimulate the enteric nerves to contract the colon (induce pooping) Clinical uses: Constipation Adverse effects: 1) Diarrhea 2) Melanosis coli 3) Metabolic alkalosis (overuse)

Stimulants (laxatives)

Emollients (laxative) MOA: Clinical uses: Adverse effects:

Docusate MOA: Promotes the incorporation of water & fat into poop (more pooping) Clinical uses: Constipation Adverse effects: 1) Diarrhea 2) Metabolic alkalosis (overuse)

Emollients (laxative)

Lubiprostone MOA: Clinical uses: Adverse effects:

Cl- channel activator MOA: It activates the type 2 Cl- channels in the small intestine to increase the amount of Cl- rich fluid into the intestine to stimulate intestinal motility and shortens intestinal transit time Clinical uses: women with IBS (predominantly constipation) Adverse effects: Category C (pregnancy)

Lubiprostone

infliximab, adalimumab, and certolizumab MOA: Clinical uses: Adverse effects:

MOA: anti-TNF monoclonal antibody Clinical uses: 1) IBD 2) Rheumatoid arthritis 3) Ankylosing spondylitis 4) Psoriasis Adverse effects: 1) predisposing to infection (reactivation of latent TB) 2) drug-induced lupus

infliximab, adalimumab, and certolizumab

_______ IDB treatment options includes: 1) Anti-TNF antibodies like infliximab, adalimumab, and certolizumab 2) Natalizumab 3) Cyclosporine 4) IV corticosteroids 5) Surgery

Severe

______IDB treatment options includes: 1) Anti-TNF antibodies like infliximab, adalimumab, and certolizumab 2) Oral corticosteroids 3) Methotrexate 4) Azathioprine/6 Mercaptopurine

Moderate

_______IBD treatment options includes: Budesonide (ileitis) Topical corticosteroids Antibiotics 5-Aminosalicylate

Mild

Liraglutide MOA: Clinical uses: Adverse effects:

GLP-1 agonist MOA: decrease glucagon release, decrease gastric emptying, increase glucose-dependent insulin release Clinical uses: Weight loss Adverse effects: 1) N/V 2) headache 3) nasopharyngitis 4) increase satiety

Liraglutide