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Pharmacology > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

describe peptic ulcer disease

A

upper gastrointestinal disorders characterized by varying degrees of erosion of the gut wall.
Can be classified as Duodenal or Gastric

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2
Q

what is an ulcer

A

open sore in the lining of the stomach or intestine, much like mouth or skin ulcers.

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3
Q

signs and symptoms of peptic ulcer disease

A

gnawing, burning pain in the upper abdomen
occur several hours after the food leaves the stomach but while acid production is still high.
some experience pain, while others experience intense hunger or bloating.
some have BLACK STOOLS indicating that the ulcer is bleeding (very serious complication of ulcers)

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4
Q

diagnosis of a peptic ulcer disease

A

upper intestinal endoscopy that allows viewing by barium X-ray.
Ulcers are rarely malignant. biopsy specimen can be taken to determine

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5
Q

drug treatment for ulcers

A 
antacids
H2 blockers (H2R antagonists)
Proton pump inhibitors
cytoprotective agents
H.Pylori treatment
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6
Q

Antacids

A 
neutralize stomach acids
1. Na-bicarbonate (alka-seltzer)
2. Ca-carbonate (Tums)
3. Mg-hydroxide (milk of magnesia)
4. Aluminum hydroxide (amphojel)
5. Combination (Maalox, Mylanta)
A/E - diarrhea or constipation, hypokalemia, hypercalcemia
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7
Q

histamine 2 (H2) blockers

A 
block H2 receptors
a. cimetidine (prescription)
b. famotidine
c. nizatidine
d. ranitidine
BCD - all over the counter
A/E - cimetidine, not for older adults - causes dizziness
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8
Q

proton pump inhibitors

A 
inhibits acid production parietal cells of stomach
a. OMEprazole
b. LANSOprazole
c. ESOMEprazole
d. RABEprazole
e. PANTOprazole
A/E - nausea, diarrhea, colic belching
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9
Q

miscellaneous anti-ulcer drugs

A

A. Sucralfate - coats ulcer from further acid attack. A/E drowsiness, constipation
B. Bismuth Subsalicylate (pepto-bismal) - coats esophagus and acts as barrier to gastric acids. Tetracycline & Metronidazole (eradicates H.Pylori)
C. Misoprostrol - secretes a gastric mucous barrier which prevent NSAID-induced peptic ulcers. A/E - diarrhea and CAN ABORT A FETUS!!!

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10
Q

treatment strategy for the eradication of helocobacter pylori

A

3-4 drugs for about 2 weeks
1st LINE - PPI, Clarithromycin, and Amoxicillin (penecillin). - Amoxicillin can be replaced with Metronidazole if allergic to penecillin
2nd LINE - PPI, Bismuth, Metronidazole & Tetracycline
3rd LINE - Empiric rescue therapy OR treatment tailored to individual antibiotic sensitivity.

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11
Q

What is GERD

A

Gastroesophageal Reflux disease
A condition in which stomach contents, including acid, back up into the esophagus, causing inflammation and damage to esophagus. Presents as heartburn! broken sphincter!!

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12
Q

Symptoms of GERD

A

COMMON: heartburn, regurgitation, dyspepsia, “sour stomach”
ATYPICAL symptoms - cough, hoarseness, sore throat, shortness of breath
ALARM symptoms - dysphagia, GI bleeding, weight loss, sensation of choking

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13
Q

name some foods that worsen GERD

A 
alcohol
carbonated beverages, citrus fruit drinks
chocolate
coffee
peppermint
spicy foods
Tomato products
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14
Q

Name some medications that worsen GERD symptoms

A 
Anticholinergics
 Calcium channel blocker's
nicotine
caffeine
NSAIDS
Theophylline
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15
Q

GERD drug treatment

A

stepwise treatment to empirc therapy with acid suppressants
1. Any symptoms - lifestyle modifications. avoid drugs that worsen sypmtoms
2. Empiric therapy for mild/moderate heartburn - antacids for two weeks with or w/o OTC H2RA
3. empiric therapy for typical symptoms of GERD - Standard H2RA dose x 6-12 weeks. moderate/extreme + PPI 4-8 weeks
4. for Pt’s who fail standard treatments above. High dose H2RA x 8-12 weeks or PPI for 8-12 weeks
NOTE: high dose required for BARRETT’S ESOPHAGUS

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16
Q

common causes of constipation

A 
not enough fiber in diet
not enough liquids
lack of exercise
IBS
abuse of laxatives
ignoring the urge to have a bowel movement
MEDICATIONS (Narcotics)
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17
Q

medications commonly associated with econdary constipation

A

antacids, anticholinergics, antidepressants, antihistamines
calcium channel blockers, diuretics, Iron
Narcotics, non steroidal anti-inflammatory, opiods

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18
Q

categories of anti-constipatory agents

A
  1. Bulk-producing agents (Metamucil)
  2. Stool softeners (Docusate)
  3. Lubricants or emollients (Mineral Oil)
  4. Hydrating Agents (polyethylene glycol, phosphosoda, and Lactulose)
  5. Stimulants (Bisacodyl & Sennosides)
  6. prostaglandins and prokinetics (Metaclopromide)
19
Q

nausea and vomiting key points

A

N/V is a biological defense mechanism
effective management is important, especially in cnacer therapy and post operatively.
Multiple causes of central and peripheral neurotransmitter pathways. drugs are effective against N/V of different origins

20
Q

vomiting can be caused by these multiple factors

A 
medical interventions
poison ingestion
gastroenteritis
motion
surgery (post op n/v)
pregnancy
various drugs and radiation
sights, smells, memories
21
Q

antinausea agents category and indication

A
  1. Anticholinergic agents - motion sickness
  2. anti-histamine agents - motion sickness, non-producive cough, sedation
  3. Neuroleptic agents - phychotic disorders, intracable hiccups
  4. Pro-Kinetic agents - delayed gastric emptying, gastroesophageal reflux
  5. Serotonin blockers - N/V associated with chemotherapy and post operative N/V
  6. Tetrahydrocannabinoids - chemotherapy and anorexia
22
Q

Antihistamines and Anticholinergics mechanism of action and A/E

A

Dimenhydrinate (gravol), Scopolamine, Meclizine
blocks histamine and acetylcholine receptors in the brain
primarily used for motion sickness
administered orally or as patch behind the ear (scopolamine)
A/E: sedation, dry mouth, confusion, urinary retention

23
Q

Neuroleptic agents

drugs, mechanism and A/E

A

Prochlorperazine, haloperidol, droperidol
blocks dopamine receptors in the brain and GI tract. mainly used for PONV, chemotherapy
A/E: sedation, movement disorders (stiffness)

24
Q

Prokinetic agents

drugs, mechanism, and A/E

A

Metoclopramide
blocks dopamine in the trigger chemoreceptor zone which desensitizes the impulse it receives from GI tract
enhances peristalsis

25
Q

Serotonin antagonists

drugs, mechanism, and A/E

A

Ondansetron, Granisetron, Dolasetron
blocks serotonin (5-HT) type 3 receptors. primarily used for chemotherapy and PONV
A/E: headaches, diarrhea

26
Q

Cannabinoids

drugs, mechanism, and A/E

A

Dronabinol, Nabilone
similar to marijuana, inhibits brain function, alters mood and perception, which may be beneficial to N/V. primarily used for chemotherapy induced N/V
A/E: dissociation, dysphoria

27
Q

corticosteroids for N/V

drugs, mechanism, and A/E

A

Dexamethasone
mechanism not fully understood. primarily used for chemotherapy induced N/V
A/E: psychosis, edema, increase risk of infection

28
Q

benzodiazepine for N/V

drugs, mechanism, and A/E

A

Lorazepam (ativan)
mechanism not fully understood. suppresion of anticipatory emesis, retrograde amnesia
A/E: sedation

29
Q

what causes diarrhea

A
  1. Bacterial/Viral/Parasitic infection (traveler’s diarrhea)
  2. reaction to drugs: antibiotics, BP meds, and antacids containing megnesium
  3. intestinal diseases. like inflammatory bowel disease or celiac disease
  4. functional bowel disorders, such as IBS, in which the intestines do not work normally
30
Q

drug treatment for diarrhea

A

diphenoxylate. opiod related. high doses = euphoria. used in combination with atropine to discourage abuse. A/E: dry mouth, confusion

Loperamide (imodium). non-prescription, opiod related. no potential for abuse as its poorly absorbed

31
Q

travellers diarrhea causes and symptoms

A

usually caused by infection (E.Coli). 50% of canadians get it when on a two week vacation
can cause serious dehydration
severe cases require antibiotics: ciprofloxacin / Azithromycin
Note: limit the use of antidiarrheas as you want to pass the pathogen out of your body. keeping it in there longer can fester into complications

32
Q

ways to prevent travellers diarrhea

A

Dukoral vaccine
introduces a small dead amount to cholera so the body can make antibodies. Similar toxin as E.Coli so body will defense against it.
immunization requires 2 doses - 1 week apart, with last dose taken at least 1 week before travel

33
Q

Inflammatory bowel disease (IBD) desription and two types

A

idiopathic chronic inflammatory disorders of the GI tract. Etiology unknown - (genetics, environment, autoimmune)

  1. Ulcerative Colitis
  2. Crohn’s disease
34
Q

what is ulcerative colitis

A

ulcerative process of the rectal mucosa/submucosa which may spread proximally from the rectum in a CONTINUOUS manner to involve part or all of the colon. Mural = just within the colon
Symptoms: rectal bleeding

35
Q

what is Crohn’s disease

A

transmural (through the thickness of wall) inflammation involving any part of the intestine, but primarily the distal part of the small intestine and colon
symptoms: rectal bleeding (sometimes), rectum and Ileum involved, abdominal mass, perianal disease

36
Q

therapeutic goals for IBD (inflammatory bowel disease

A
  1. resolution of acute exacerbation
  2. prevent relapse (induce remission)
  3. control intestinal and extra-intestinal complications
37
Q

treatment for IBD

A 
mild = antibiotics and aminosalicylates
moderate = corticosteroids and immunomodulators
severe = biologics, then surgery
38
Q

Aminosalicylates

drugs, and mechanism

A
  1. 5-Aminosalicylic acid (5-ASA, mesalamine) - blocks production of prostaglandins and leukotrienes and reduces inflammation
  2. Sulfasalazine - delayed absorption by combining with a sulfa compound. causes many A/E (nausea, dyspepsia, headache)
  3. Olsalazine - complex that combines 2x 5-ASA which causes fewer side effects
    All have been RARELY associated with Pacreatitis
39
Q

aminosalicylates A/E’s

A
  1. 5-ASA - abdominal pain, cramps, diarrhea, gas, hair loss, headache, dizziness. Pt’s with kidney disease should use caution on this drug
  2. Sulfasalazine - headache, nausea, loss of appetite, vomiting, rash, fever, DECREASED WBC’s and sperm count
  3. Olsalazine - diahhrea!, headache, rash, fatigue.
40
Q

Corticosteroids mechanism of action and use

A

Reduces inflammation and reduces the immune response

Used for acute flare-ups, not for maintenance therapy

41
Q

Oral, Rectal, and IV corticosteroids

A

Oral - Prednisone
Rectal - Hydrocortisone, Budesonide
IV - Hydrocortisone, Methylprednisolone
A/E: chronic use watch for edema, ulcers, delayed healing

42
Q

when are immunosuppresives used and key points

A 
2nd or 3rd line therapy
to avoid colectomy
steroid sparing properties
-onset can take 6 months
-high relapse rate after cessation of treatment
43
Q

Immunosuppressive drugs, mechanism of action and A/E

A
  1. Azathioprine - may prevent relapse in Crohn’s. A/E:Pacreatitis, arthralgia’s (sore joint)
  2. Cyclosporine - mechanism unclear. A/E: parathesias (tingling), tremor, hypertension, hyperkalemia.
  3. Methotrexate - mechanism unclear but may be beneficial in those with refractory disease. A/E: blood dyscrasias (wacky counts), nausea, hepatotoxicity
44
Q 
Biologic drugs (anti-tumor necrosis Factor)
drugs, mechanism of action, and A/E
A
  1. Infliximab
  2. Adalimumab
    Mechansim - antibodies against tumor necrosis factor (TNF)
    useful in Crohn’s disease and Ulcerative Collitis for refractory or steroid dependant disease. decreases inflammatory response
    A/E: heart failure, infections, Pancytopenia (decreased blood counts), hypotension, hepatotoxicity (failure), seizures, MS, lymphoma.

Pharmacology (7 decks)

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