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Pharmacology (Dale Turley) > GastroIntestinal > Flashcards

GastroIntestinal Flashcards

1
Q

Idiopathic disease involving an immune reaction of the body to its own intestinal tract

A

Inflammatory Bowel Disease (IBS)

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2
Q

IBS major types?

A

UC

Crohns

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3
Q

UC is limited to the ?

A

colon

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4
Q

Crohns disease can involve ________ of the gastrointestinal tract

A

any part

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5
Q

IBS: goal of therapy?

A

Goal of therapy: Reduce inflammation and control flare-ups

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6
Q

IBS tx step wide approach ?

A

Benign drugs first

5-ASA’s first

Crohns, peri-anal disease and inflammatory mass

Corticosteroids 2nd

Immune modifying agents 3rd

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7
Q

______ oral aminosalicylate agents in the United States

A

Six

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8
Q

Two most common 5-ASAs?

A

Sulfasalazine (Azulfidine)

Mesalamine ( Asacol, Pentasa, Lialda)

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9
Q

_________ was originally proposed as a treatment for rheumatoid arthritis.

A

Sulfasalazine

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10
Q

It was subsequently discovered that sulfasalazine was also efficacious in treating ?

A

inflammatory bowel disease, particularly ulcerative colitis.

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11
Q

The 5-aminosalicylic acid (5-ASA) medications were developed because many patients were intolerant of or allergic to _________.

A

sulfasalazine

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12
Q

____________ is a prodrug composed of 5-aminosalicylic acid (5-ASA) linked to __________.

A

Sulfasalazine

sulfapyridine

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13
Q

___________ accounts for many of its side effects

A

Sulfapyridine

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14
Q

5-ASA MOA?

A

exact mechanism of action unknown

blocks cyclooxygenase and inhibits prostaglandin
production

producing anti-inflammatory effects

ASA also black cyclooxygenase

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15
Q

Also known as “DMARDS” (disease-modifying antirheumatic drugs)?

A

5-ASA

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16
Q

Compounds are broken up by ____________ releasing active compound 5-ASA

A

colonic bactreria

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17
Q

Indications for Sulfasalazine (Azulfidine)?

A

Ulcerative Colitis
Crohn’s Disease
Rheumatoid Arthritis

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18
Q

Sulfasalazine trade?

A

Azulfidine

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19
Q

Side effects can occur with both sulfasalazine and 5-ASA, but are more common with ____________

A

sulfasalazine

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20
Q

Approximately ______ percent of patients discontinue sulfasalazine due to side effects.

A

20 to 25

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21
Q

Adverse reactions and interactions to Sulfasalazine (Azulfidine)?

A

Pruritus

abnormal LFTs

leukopenia

urticaria, anemia

hemolytic anemia

TTP

cyanosis

anorexia

N/V, HA and dizziness

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22
Q

Sulfasalazine (Azulfidine) monitoring?

A

CBC w/ diff, LFTs at baseline, then q2wk x3mo, then

BUN/Cr, urinalysis w/ microscopic exam

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23
Q

Sulfasalazine (Azulfidine) decreases?

A

Decreases the effects of

Iron supplement, Digoxin and Folic Acid

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24
Q

Sulfasalazine (Azulfidine) increases the effects of?

A

oral anticoagulants,

hypoglycemic agents

methotrexate

**check INR and glucose*

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25
Contraindications to Sulfasalazine (Azulfidine)?
Hypersensitivities to sulfonamides and salicylates (ASA, Bactrim) GI obstruction caution if renal impairment caution if hepatic impairment **it will slow motility so you get GI obstruction *
26
Sulfasalazine (Azulfidine) is Preg. Cat?
Pregnancy Cat B (trimester specific due to folate metabolism) ** cause what it does to the folic acid synthesis *
27
Sulfasalazine (Azulfidine) dosing?
Dosing Crohns: Dz 500 mg PO q 6hr - give with food RA: 1 Gm PO q 12 hr UC: 500 mg q 6 hr
28
mesalamine three trade name?
Asacol Pentasa Lialda
29
Mesalamine indications?
Indicated for Crohns Disease and Ulcerative Colitis
30
Mesalamine is a derivative of?
derivative of salicylic acid (anti-inflammatory effects)
31
The release of 5-ASA is ____________
pH-dependent ** pH dependent is the key to the drug especially when it comes to prescribing it *
32
Oesophagus pH?
7.0
33
Stomach pH?
1-2.5 (5 when fed)
34
Proximal small intestine pH?
6.16-7.35
35
Distal small intestine pH?
6.8-7.88
36
Ascending colon pH?
5.26-6.72
37
Descending colon pH?
5.02-7.02
38
Mesalamine targets location depending on ?
pH
39
_______- drug released at a pH of 7 (typically at the terminal ileum)
Asacol **more for UC*
40
_______ – time release coating begins at pylorus (pH 4), used proximal colonic disease ( more acidic)
Pentasa **more for crohns*
41
______ indicated to induce remission of active UC
Lialida
42
_________ of release mechanism of Asacol and Pentasa
Combination
43
Mesalamine has a ____ relapse
high
44
__________ high concentration of mesalamine to descending colon (enema or suppository for proctitis)
Rectal dosage
45
Mesalamine: UC tx?
Oral: Usual course of therapy is 6 to 8 weeks: Asacol HD: 1.6 g 3 times daily for 6 weeks Delzicol: 800 mg 3 times daily for 6 weeks Lialda: 2.4 or 4.8 g once daily Pentasa: 1 g 4 times daily
46
Mesalamine: UC remission maintenance?
Oral: Apriso: 1.5 g once daily in the morning Delzicol: 1.6 g in 2 to 4 divided doses Lialda: 2.4 g once daily Pentasa: 1 g 4 times daily **GOUT people get an additional high dose and then a maintenance dose *
47
Anti-diarrhea Meds: Absorbent preparations | ?
Bismuth subsalicylate (Pepto-Bismal, Kaopectate)
48
Anti-diarrhea Meds: Opiates?
Diphenoxylate with atropine (Lomotil)
49
Anti-diarrhea Meds: Anticholinergics (IBS)?
Belladonna Scopalamine remember glaucoma effects of anticholenigerics - closed canal of schlemm which would increase IOP.
50
Biological Therapies are ?
Immune Modifying Agents or Biologicals
51
When are Biological Therapies indicated?
When corticosteroids fail or require long term therapy Biologicals not used in acute flare-ups - cause onset of action is not until 2-3 months
52
BT: Class: Tumor Necrosis Factor (TNF) Inhibitors | examples?
Infliximab (Remicade) Etanercept (Embrel) Adalimumab (Humira)
53
TNF Inhibitors BBW?
Chronic or recurrent infection Pulmonary and extrapulmonary tuberculosis (TB) Invasive fungal infections and other opportunistic infections incl. Legionella and Listeria ( especially w/ PNA) **these really suppress immune system and open you up for opportunistic infections, CXR and basic lab work for monitoring and before you give them treatment with these guys *
54
TNF Inhibitors indications?
``` Crohns Ulcerative Colitis Rheumatoid Arthritis Ankylosing Spondylitis Psoriasis ```
55
TNF inhibitors contrindications?
Contraindicated in co-morbid active infections and disease: DM hepatitis restrictive lung disease
56
TNF Inhibitor facts?
Peds under >6 yo Many drug-drug interactions
57
TNF inhibitor reactions?
serum sickness anaphylactoid rxn ``` hypersensitivity rxn ( rashes preload with prednisone and benadryl ( premedicate)) ``` Opportunistic infections, sepsis, pneumonia, opportunistic infection, tuberculosis, malignancy, lymphoma, hepatosplenic T-cell lymphoma (peds pts), leukemia, HBV reactivation, hepatotoxicity, CHF
58
TNFI are administered _________ and repeated at _ week and _ week intervals
Administered IV infusion and repeated at 2 week and 6 week intervals
59
How long do you observe for post infusion signs of infections when taking TNFI?
Observed for post infusion signs of infections (3-12 days)
60
Lipase Inhibitor?
Orlistat
61
Orlistat is the only drug in class?
Lipase Inhibitors FDA approval in 1999
62
What is commonly used for obesity management?
Orlistat: Commonly used for obesity management Weight loss Weight maintenance Reduce the risk of weight gain following weight loss **reduces absorbing of fat , potato chip*
63
What is Orlistat used with ?
calorie diet
64
Orlistat trade name?
Orlistat (Alli, Xenical)
65
Orlistat indications Obesity?
BMI greater than 30 BMI greater than 27 with co-morbidities (HTN, DM, HLP)
66
Orlistat MOA?
reversible inhibitor of gastric and pancreatic lipases, thus inhibiting absorption of dietary fats by 30% Binds sites stomach and small intestines Does not break down dietary fat Undigested triglycerides not absorbed causing reduced caloric intake
67
Orlistat availability?
OTC 60 mg capsule PO tid Reduced calorie diet and exercise
68
Orlistat adverse reactions?
Fatty / oily stools Fecal urgency, flatulence, increased stools
69
Contraindications to Orlistat?
Malabsorption disorders, vitamin deficiency and cholestasis **short gut sycnrome or gastroparesis or GB disease - avoid this medication in these people *
70
Zofran is Preg. Cat ?
C it used to be B
71
What is a Reverse Lipase Inhibitor?
Binds sites stomach and small intestines Does not break down dietary fat Undigested triglycerides not absorbed causing reduced caloric intake

Pharmacology (Dale Turley) (31 decks)

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