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Flashcards in Foregut pharmacology Deck (34):
1

List medical conditions in which gastric acid may play a role

Gastrointestinal reflux disease (GERD)
Benign peptic ulcers of the stomach and duodenum
Ulcers secondary to the use of NSAIDs
Ulcers due to the rare Zollinger-Ellison syndrome

2

Describe the mechanism of action of PPIs

Irreversibly bind to H/K ATPase on parietal cells

3

List side effects of PPIs

Nausea
Abdominal pain
Constipation
Flatulence
Decreased absorption of calcium and drugs that require acid
C diff
GI infections
Bronchitis and pneumonia

4

List therapeutic uses of PPIs

Healing of gastric and duodenal ulcers, reduce risk of ulcers and their complications, ameliorate effects of NSAIDs, treatment of gastrinoma

5

What is the mechanism of action of ranitidine?

Histamine H2 receptor blocker
Inhibits acid secretion by reversibly competing with histamine H2 receptors on parietal cells
others: cimetidine, famotidine, nizatidine

6

H2 blockers are more effective at suppressing ______ acid secretion than PPIs

nocturnal

7

List side effects of H2 blockers

Rare
diarrhea
headache
drowsiness, fatigue
muscular pain
constipation

8

Cimetidine can cause _____ in men and ____ in women

gynecomastia, galactorrhea

9

List therapeutic uses of H2 blockers

Dyspepsia, heartburn, uncomplicated GERD, used to tx ulcers

10

What is the mechanism of action of misoprostol?

Prostaglandin analog
Inhibits gastric acid production by binding to the EP3 receptor on parietal cells, has cytoprotective effects by stimulating secretion of mucin and bicarbonate and improves mucosal blood flow

11

What are side effects of misoprostol?

Diarrhea (great for tx of constipation)
Contraindicated in pregnancy, counsel if giving to women of childbearing age

12

Sucralfate binds ____ AND ______

hydrochloric acid and bile salts

13

What is the mechanism of action of sucralfate

Cross links and polymerizes to form a viscous liquid that adheres to ulcer crates and creates a protective barrier
May stimulate local PG and EGF production

14

What are side effects of sucralfate?

Constipation, aluminum poisoning if renal failure, can inhibit absorption of other drugs

15

_____ work fastest and their effects dissipate most quickly

Antacids

16

What is sucralfate?

Octasulfate of sucrose with aluminum hydroxide functional group
Used to treat ulcers

17

What are side effects of antacids?

Altered absorption of other drugs
Alkalosis from NaHCO3
Release of CO2--> belching
Nausea
Abdominal distension

18

Antacids bind ____ and ____

hydrochloric acid and bile salts

19

Omeprazole interferes with the effects of _____ in some patients

clopidegrel

20

Cimetidine interferes with the effects of ____ in some pateints

warfarin

21

_____ in antacids can cause constipation, whereas _____ can cause diarrhea

aluminum= constipation
magnesium= diarrhea

22

What is appropriate therapy for peptic ulcers

acid suppression for 8 weeks
document healing only if gastric ulcer, not duodenal

23

Describe helicobacter plyori treatment

PPI + amoxicillin and clarithromycin (or metronidazole)

PPI, bismuth, tetracycline, metronidazole

24

What is the mechanism of action of metoclopride

Facilitates release of ACh from enteric neurons: Activates 5-HT4 receptors on cholinergic neurons and acts as an antagonist at D2 receptors
Results in increased gastric motility, enhanced transit

25

There is a black box warning on metoclopramide for _________

neurological side effects- Parkinsons like symptoms, tardive dyskinesia

26

Ondansetron is a ______ antagonist that is used as an antiemetic

5-HT3 receptor antagonist

27

Describe the mechanism of action of ondansetron (oterhs are granisetron, dolasetron, alosetron)

5-HT3 receptor blockers, antiemetic properties
highest 5-HT3 receptor concentration in nucleus tractus solitarius of vagus nerve

28

What are adverse reactions to 5-HT3 receptor blockers

constipation, diarrhea, headache, and light-headedness

29

What is the mechanism of action of prochlorperazine

D2 blocker in the chemoreceptor trigger zone, useful in motion sickness
Useful "general purpose" anti-nausea and anti-emetics

30

What is the mechanism of action of promethazine and meclizine

H1 receptor blocker
acts on vestibular afferents within the brainstem, useful for motion sickness and post-operative emesis

31

What is the mechanism of action of scopolamine

Anticholinergic used to treat motion sickness, no role in chemotherapy induced nausea

32

What is the ONLY cause of reversible cyclic vomiting syndrome?

THC
Relieved by hot shower

33

Dronabinol is useful for _______ properties in patients receiving cancer chemotherapy for which other medications are not effective

anti-emetic

34

Scopolamine is a ______ that is ONLY useful for motion sickness

anticholinergic