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Pharm Unit 6 > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

What are the 3 receptor types of the parietal cell that act to stimulate acid secretion through K+/H+ ATPase?

A

Histamine
Gastrin
Acetylcholine

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2
Q

What are 3 ways gastric epithelial cells protect themselves from the acidic environment?

A

Secrete mucus
secrete bicarb
mucosal blood flow

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3
Q

Which class acts to neutralize acid and promote healing in the treatment of ulcers and GERD? What are 4 agents in this class?

A 
Antacids:
Calcium carbonate (Rolaids, Tums)
Sodium bicarbonate
Magnesium hydroxide, magnesium carbonate (Maalox, Mylanta)
Aluminum hydroxide
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4
Q

Which antacid is rarely used due to induced systemic alkalosis?

A

Sodium Bicarbonate

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5
Q

Which antacid agent can produce intoxication in the presence of renal disease? What agent should be used instead for pts with renal failure?

A

Magnesium hydroxide - Mg intoxication in renal disease

Aluminum hydroxide - useful in renal failure pts (not absorbed)

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6
Q

Which antacid agent can cause “rebound” acidity? What are its other adverse effects?

A

Calcium carbonate

–> Milk-alkali syndrome, nephrocalcinosis, digitalis antagonism, constipation

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7
Q

What are some adverse effects of aluminum hydroxide?

A

Phosphate depletion and sequelae (weakness, anemia, tetany, apnea); constipation

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8
Q

What are the 3 classes of agents that decrease gastric acid production?

A

H2 blockers
Anticholinergic agents
H+/K+ proton pump inhibitors

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9
Q

What are 3 anticholinergic agents that reduce acid secretion and prevent spasms? Contraindications?

A

Atropine sulfate
Propantheline (Pro-Banthine)
Metantheline bromide
–>Contraindications: known pyloric obstruction, hiatal hernia, or peptic esophagitis=reflux esophagitis (not used much)

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10
Q

Name 4 H2 blockers. Mechanism and use?

A

Cimetidine (Tagamet)
Ranitidine (Zantac)
Famotidine (Pepcid)
Nizatidine (Axid)

  • -> decrease basal and meal acid secretion (doesn’t need to be administered with meals)
  • -> Inhibit 50-80% of 24 hour acid production
  • -> Ulcer treatment; prophylactically for stress ulcers; GERD
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11
Q

What is a concern if Famotidine is stopped suddenly after prolonged use?

A

Rebound acidity
–>exaggerated response to histamine
(need to reduce dose slowly)

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12
Q

Cimetidine and ranitidine will do what to warfarin and lidocaine plasma levels?

A

increase

inhibits P450

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13
Q

What class of drugs will not work if taken with antacid or H2-blocker?

A

Proton Pump Inhibitors

require acidic environment to activate

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14
Q

What is the mechanism, use and side effects of Lansoprazole?

A

(H+/K+ ATPase inhibitor)
MECH: Non-competitive Inhibition >90% of 24 hour acid secretion (better than H2 antagonists)
USE: Ulcer treatment, H. pylori; GERD
SE: Headache, gynecomastia, gastric hyperplasia in humans and carcinoid tumors in rats long term (do not use long-term)

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15
Q

Which proton-pump inhibitor has the most P450 inhibition. Which has moderate? Which has NO P450 inhibition?

A

Most - Omeprazole
Moderate - Rabeprazol
None - Pantoprazole

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16
Q

What are 3 factors that impair mucosal defense?

A

NSAIDs;
H. pylori;
Zollinger-Ellison syndrome(↑Gastrin)

17
Q

What is Sucralfate?

A

Sucrose Sulfate Aluminum Complex

  • adjunct to ulcer treatment
  • Mechanical protector –> Coats the ulcer crater to promote healing, increases mucosal resistance (requires acid environment)

[Chosen over bismuth salts since it doesn’t turn stool black]

18
Q

What is the treatment for H. pylori infections?

A

Triple Therapy:

  • PPI or ranitidine 2x a day
  • plus 2 of: amoxicillin, clarithromycin, metronidazole
19
Q

What is the only FDA approved drug for the prevention of NSAID induced gastric ulcers? Mechanism? Use? Contraindications?

A

Misoprostol (PGE2 analog)

MECH: Decrease acid production, increase mucous and bicarbonate secretion
USE: Ulcer treatment when prostaglandin production decreased (RA patients taking lots of NSAIDs)
CONTRAINDICATION: pregnancy

20
Q

What is the mechanism and use of Metoclopramide and Cisapride? Which one requires special FDA approval and may cause sudden cardiac death?

A

MECH: Increase motor tone in lower esophageal sphincter and stomach (promotility/Dopa-blocker)
USE: GERD (w/o esophagitis), gastroparesis, Metoclopramide- anti-emetic

Cisapride- FDA approval/ sudden death (removed from market in July 2000)

21
Q

What class are Prochlorperazine and Promethazine? Mechanism? Use? SE?

A 
(Phenothiazines)- anti-emetics
MECH:
Prochlorperazine- Dopamine antagonist
Promethazine- H1-blocker, Anticholinergic
SE: 
Prochlorperazine- torticollis
Promethazine- somnolence
22
Q

What is a Benzamide derivate that has an anti-cholinergic mechanism to suppress CRTZ and is given in oral form. SE?

A

Tetrahydro Cannabinol (THC)

SE- munchies

CRTZ=Chemoreceptor trigger zone

23
Q

What is the use, mechanism and side effect profile of Ondansetron, Granesitron & Dolasetron? Which one is safe enough for use in infants?

A

Anti-emetics
5HT3-blockers (serotonin antagonists)
SE: headache, dizziness, somnolence

Ondansetron- very safe

24
Q

What agent would be used for gastroparesis?

A

Metoclopramide

taken before each meal to stimulate upper GI motility [no effect on gastric, biliary or pancreatic secretions]

25
Q

What are 3 classes of drugs used to treat diarrhea? Mechanism of each?

A
  • Anticholinergics- relax bowel smooth muscle
  • Opioid Agonists- stimulates μ receptors in GI tract; increased rectal tone leading to segmentation of colon and disruption of peristalsis–> increased absorption time
  • Colloids/Pectins- absorb water to bulk stool (do NOT prevent dehydration)
26
Q

What is the use of atropine sulfate for GI disorders?

A

Anti-cholinergic - treatment of diarrhea

can be combined with opioid agonists

27
Q

Name 3 opioid agonists used in the treatment of diarrhea. Contraindication?

A

Loperamide (Immodium)
Diphenoxylate (Lomotil)
Codeine sulfate
-The last 2 are contraindicated in children (respiratory suppression)

28
Q

Name a colloid. Name a pectin.

A

Metamucil - colloid

Kaopectate (Bismuth subsalicylate) - pectin

29
Q 
What is the use and mechanism of:
Castor oil
Cascara sagrada
senna extract
Bisacodyl
phenolphthalein
A
  • irritant/stimulant used for constipation

- Irritate lumen of the colon, causes peristaltic contractions

30
Q

What is the mechanism and 2 uses of:

Magnesium citrate; Magnesium sulfate (Epsom salt); sodium sulfate (Glauber salt); Milk of Magnesia

A

-Osmotic cathartics–> Draw water into the colon

USE: Constipation; clean bowel prior to colonoscopy

31
Q 
What is the use and mechanism of:
Psyllium seed (Metamucil); methylcellulose (Hydrolose); sodium carboxymethylcellulose
A

Bulk-forming hydrophilic colloid

USE: Constipation (especially small, hard stools)

32
Q

What is the use and mechanism of:

Mineral oil; Dioctyl sodium sulfo-succinate (Colace); poloxalkol

A

Stool softening, lubrication for constipation

33
Q

Name 3 agents used to treat Ulcerative Colitis. Mechanism?

A

Sulfasalazine
Olsalazine
Mesalamine

Work from lumen to reduce inflammation

34
Q

Name 4 agents used for chronic treatment of Ulcerative Colitis. Mechanism of each?

A

Prednisone- Corticosteroid
Azathioprine- Purine antimetabolite
Cyclosporine- suppresses T cells
Infliximab (Remicade)- Binds and neutralizes TNFa

35
Q

What is the use and mechanism of Dicyclomine HCl & Hyoscyamine sulfate

A

Anticholinergic (antispasmodic)

Reduce spasm in irritable bowel syndrome

36
Q

Alosetron and Tegaserod maleate are 2 agents whose approval has been withdrawn by the FDA. What are they used to treat and what’s the difference between them?

A

-Irritable Bowel Syndrome

Alosetron- diarrhea predominant symptoms
Tegaserod maleate- constipation predominant

Pharm Unit 6 (5 decks)

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