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Pharm 323 Spring 22 > GI > Flashcards

GI Flashcards

exam 4

1
Q

what 5 classes of drugs can be used for PUD?

A
  1. ABX
  2. anti-secretory agents
  3. mucosal protectants / enhance mucosal defenses
  4. prostaglandin agent
  5. antacids
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2
Q

what is preferential tx for H. pylori + for how long? + why do we treat it?

A

3 ABX + PPI or H2 blocker

10-14 days (longer abx tx than usual)

to cure symptoms of PUD

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3
Q

what is a barrier to treatment for H. pylori? (patient-specific)

A

adherence b/c of SE, cost + large # of pills

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4
Q

how often are H2 blockers given?

A

BID

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5
Q

MOA of H2 blockers

A

block H2 (histamine parietal cells in stomach) to suppress acid secretion

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6
Q

what are the 2 prototypes for H2 blockers?

A

famotidine + cimetidine

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7
Q

SE of cimetidine (3)

A
  1. androgen blockage –> gynecomastia, dec. libido + impotence
  2. CNS effects (elderly)
  3. PNA
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8
Q

all H2 blockers have this SE related to respiratory system…….. why?

A

PNA - b/c decreasing acid in stomach leads to bacterial growth + if aspirated can cause bacterial PNA

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9
Q

H2 blockers + antacids…. what do we do?

A

separate admin by 1 hour

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10
Q

what are the 2 types of drugs that fall into anti-secretory agents?

A
  1. H2 blockers

2. PPIs

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11
Q

what is the prototype for PPIs?

A

omeprazole

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12
Q

what drug class is most effective at acid suppression? + why?

A

PPIs
(omeprazole)

b/c it works the life of the enzyme (90% reduction in acid)

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13
Q

what drug class is used for stress ulcer prophylaxis?

A

PPIs

omeprazole

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14
Q

SE of PPIs (2; one is broad) - short term

A
  1. HA

2. GI: N/V/D

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15
Q

long term PPI use can lead to….. (7)

A
  1. OP + fractures (decreased calcium absorption)
  2. C. diff (decreased acid in gut)
  3. PNA (decreased acid in gut –> aspirate)
  4. acid rebound
  5. kidney issues
  6. liver issues
  7. B12 + Mag deficiencies

….lots. not sure how in depth she will get, but if we think of the MOA and doing this long term, i think we can figure it out.

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16
Q

what’s a strategy to prevent acid rebound with long term PPI use ?

A

wean off PPIs + use H2 blockers

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17
Q

how can we recognize PPIs by their name?

A

“_____prazole”

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18
Q

what PPI do we often see in acute care b/c of it’s IV formulation?

A

pantoprazole (Protonix)

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19
Q

what is the prototype for mucosal protectants?

A

sucralfate

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20
Q

MOA of sucralfate

A

creates a protective coating on gastric surfaces to protect ulcer from acid + pepsin

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21
Q

SE of sucralfate

A

constipation

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22
Q

administration for sucralfate (re: meals, other meds + time of day)

A
  • 1 hour BEFORE meals
  • 2 hours separated from other meds (b/c coating interferes with absorption
  • at bedtime
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23
Q

how should sucralfate be given/taken if there are:

  • esophageal ulcerations:
  • gastric ulcerations:
A

esophageal: put in H2O + create slurry and take by mouth to coat upper GI tract
gastric: swallow pill whole is OK

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24
Q

what is prototype for prostaglandin agent for PUD?

A

misoPROSTol (Cytotec)

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25
Q

what is misoprostol?

A

synthetic prostaglandin

misoPROSTol = PROSTaglandin

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26
Q

what drug is used for gastric ulcers caused by NSAIDs?

A

misoprostol

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27
Q

what is interaction between misoprostol + pregnancy?

A

CATEGORY X!!!!

prostaglandins cause contractions of the uterus / cervical ripeninggggg

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28
Q

SE of misoprostol (4)

A
  1. spotting
  2. dysmenorrhea
  3. abd pain
  4. diarrhea
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29
Q

what are antacids?

what conditions are they used for?

A

alkaline agents –> neutralize stomach acid

used for: PUD + GERD

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30
Q

what should you know about antacids and other drugs? (interactions)

A

separate 1 hour from other drugs

many drugs require an acidic stomach environment to be absorbed + this interferes

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31
Q

re: antacids, aluminum compounds often cause what ?

A

constipation

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32
Q

re: antacids, magnesium compounds often cause what ?

A

diarrhea

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33
Q

what is DOC for antacids? why?

A

milk of mag ◡̈

rapid-acting + long lasting ◡̈

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34
Q

re: antacids, magnesium compounds are contraindicated with which patients? why?

A

renal patients - b/c mag is excreted by the kidneys

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35
Q

re: antacids, sodium compounds are contraindicated with which patients? why?

A

HF + HTN patients - can cause fluid retention

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36
Q

re: antacids, calcium + sodium compounds share which SE? which drug can be added to decrease this SE?

A

gas !!

simethicone to reduce gas

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37
Q

what are the 5 types of laxatives we discuss?

A
  1. bulk-forming
  2. surfactant
  3. stimulant
  4. osmotic
  5. miscellaneous
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38
Q

what is the prototype for bulk-forming laxatives?

A

psyllium (Metamucil)

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39
Q

MOA of psyllium + 5 positive outcomes

A

pulls H2O into stool

  1. increases mass
  2. softens stool
  3. feels colonic bacteria
  4. increases peristalsis
  5. decreases cholesterol
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40
Q

what is risk of psyllium use?

A

intestinal obstruction

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41
Q

how should psyllium be taken?

A

with a FULL glass of H2O

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42
Q

onset for psyllium

A

1-3 days

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43
Q

what is the prototype for surfactant laxatives?

A

docusate sodium (Colace)

44
Q

MOA of docusate sodium

A

increased H2O in stool –> softens stool

doesn’t make people go, but makes it easier to go

45
Q

onset for docusate sodium

A

1-3 days

46
Q

how should docusate sodium be taken?

A

with a FULL glass of H2O

47
Q

what is prototype for stimulant laxatives?

A

bisacodyl (Dulcolax)

senna (Senokot) is another

48
Q

what laxatives produce a KICK!!!???

A
  1. bisacodyl or senna (stimulant): 6-12 hrs

2. high dose osmotic laxatives: 2-6 hrs

49
Q

MOA of bisacodyl (2)

A
  1. pulls H2O into stool –> softens stool

2. stimulates peristalsis

50
Q

what laxative has a potential for abuse?

A

stimulant laxatives

bisacodyl or senna

51
Q

onset of bisacodyl

A

6-12 hours

52
Q

how should bisacodyl be taken in regards to food + antacids?

A

separate 1 hour from milk or antacids

53
Q

what is prototype for low dose osmotic laxatives?

A

polyethylene glycol (Miralax)

also….
milk of mag

54
Q

onset for polyethylene glycol

A

2-4 days (low dose)

55
Q

what is MOA for polyethylene glycol?

A
  1. pulls H2O into intestinal lumen –> fecal mass swells

2. stimulates peristalsis

56
Q

SE of polyethylene glycol (4)

A

GI =

  1. nausea
  2. abd bloating
  3. cramping
  4. flatulence
57
Q

what drug class is used for bowel prep for colonoscopy or GI surgery?

A

high dose osmotic laxatives

ex: polyethylene glycol w/electrolytes = GoLytely

58
Q

high dose osmotic laxatives are contraindicated in which population of patients? why?

A

renal: Mg elimination
cardiac: electrolyte imbalances

59
Q

what is major risk with high dose osmotic laxatives?

A

dehydration risk

60
Q

what is onset for high dose osmotic laxatives?

A

2-6 hrs!!!

61
Q

what are the high dose osmotic laxatives?

no true prototype just ones she says we should know

A
  1. polyethylene glycol electrolyte solution (Golytely)
  2. sodium phosphate (Fleets phosphosoda)
  3. magnesium citrate
  4. lactulose

“Please Save My Laxatives”

62
Q

what is administration notes for polyethylene glycol electrolyte solution? (Golytely)

A
  1. add H2O or juice to the 4L jug
  2. drink 250-300mL every 10 minutes for 2-3 hrs
  3. poop until clear
63
Q

why is lactulose often used?

A

to lower ammonia levels (often in liver disease patients)

64
Q

what is the prototype for miscellaneous laxatives?

A

lubiprostone

65
Q

what is MOA of lubiprostone?

A

Cl channel activator: secretion of Cl-rich fluid into intestine which increases motility

66
Q

SE of lubiprostone + how can we mitigate this?

A

nausea –> take with food + H2O

67
Q

onset of lubiprostone

A

24 hrs

68
Q

what are the 7 classes of antiemetic drugs?

A
  1. serotonin receptor antagonists
  2. dopamine antagonists
  3. substance P neurokinin antagonists
  4. anticholinergics / antihistamines
  5. benzos
  6. glucocorticoids
  7. cannabinoids
69
Q

re: antiemetic drugs, what is the prototype for serotonin receptor antagonists?

A

ondanSETRON (SEROTONIN)

70
Q

what is MOA of ondansetron?

A

block serotonin receptors on vagal neurons in the chemo-receptor-trigger zone (CTZ)

71
Q

what is the most efficacious antiemetic available?

A

ondansetron

72
Q

SE of ondansetron (3)

A
  1. CNS (HA + dizzy)
  2. diarrhea
  3. QT prolongation
73
Q

re: antiemetic drugs, what is the prototype for substance P neurokinin antagonists?

A

aprepitant

74
Q

what is MOA of aprepitant?

A

blocks neurokinin receptors in the CTZ (chemo-receptor-trigger zone)

75
Q

what is the combination of drugs that is identified as the most efficacious for managing n/v?

A
  1. ondansetron
  2. aprepitant
  3. dexamethasone
76
Q

SE of aprepitant (2)

A
  1. fatigue

2. weakness

77
Q

re: antiemetic drugs, what is the prototype for glucocorticoids?

A

dexamethasone

78
Q

what are SE of dexamethasone?

A

no real SE when using short term, but long term use are same as usual steroid therapy……

(OP, adrenal insufficiency, gastric ulcers, weight gain, insomnia)

79
Q

re: antiemetic drugs, what is prototype for benzodiazepines?

A

lorazepam (Ativan)

80
Q

SE of lorazepam (2)

A

CNS =

  1. sedation
  2. retrograde amnesia
81
Q

re: antiemetic drugs, what are the prototypes for dopamine antagonist? (2 prototypes + 1 class)

A
  1. promethazine (Phenergan)
  2. metoclopramide (Reglan)
  3. butyrophenones (no prototype)

“metoclo, pro and butyro”

82
Q

MOA of promethazine

A

block dopamine receptors in the CTZ

this can help with knowing the SE. blocking dopamine = parkinson’s effects

83
Q

SE of promethazine (4 - 3 specific + 1 broad)

A
  1. dyskinesia
  2. hypotension
  3. sedation
  4. anticholinergic effects
84
Q

what is important to know about IV administration of promethazine?

A

dilute + push SLOWLY!!!

85
Q

AE of promethazine (2)

A
  1. tissue extravasation –> injury/gangrene

2. respiratory depression

86
Q

if someone receiving promethazine via IV and experiences burning at injection site, what should you do?

A

STOP!!!!! (AE is tissue extravasation and this can cause gangrene!)

87
Q

b/c of one of the AE of promethazine, what population should this drug not be given to?

A

children under 2 yrs (respiratory depression)

88
Q

what is the MOA of metoclopramide?

A

blocks dopamine + serotonin in the CTZ

MOTILITY MOTILITY MOTILITY!!!

89
Q

what is a long term SE of metoclopramide?

A

tardive dyskinesia

90
Q

re: antiemetic drugs, what is the prototype for cannabinoids?

A

dronabiol (Marinol)

91
Q

re: antiemetic drugs, what is prototype for anticholinergic/antihistamine?

A

hydroxyzine

92
Q

what antiemetic can be used for motion sickness and CINV?

A

hydroxyzine

dulls the inner ear’s ability to sense motion….cool◡̈

93
Q

what is the MOA of hydroxyzine?

A

blocks histamine

94
Q

SE of hydroxyzine

A

anticholinergic + sedation

“can’t pee, can’t see, can’t spit, can’t shit”

95
Q

what are our prototypes for anti-diarrheal agents?

1 opioid + 1 mu opioid, OTC + 1 “other”

A
  1. diphenoxylate + atropine
  2. loperamide (Imodium)
  3. bismuth-subsalicylate (Pepto Bismol)
96
Q

re: anti-diarrheal agents, why is atropine combined with diphenoxylate ?

A

atropine prevents abuse

97
Q

what is a unique fact about bismuth-subsalycilate that Knowlton said we should know? and is good patient education?

A

can turn your stool and tongue black

98
Q

what are the 5 drug classes for Inflammatory Bowel Disease?

A
  1. 5-aminosalicylates
  2. glucocorticoids
  3. immunosuppressants
  4. targeted therapy
  5. ABX
99
Q

re: IBD drugs, what is the prototype for 5-aminosalicylates?

A

sulfasalazine

100
Q

what is the MOA of sulfasalazine?

A

inhibits prostaglandins –> reduce inflammation

101
Q

what are the SE of sulfasalazine? (4)

A
  1. nausea
  2. fever
  3. rash
  4. arthralgia
102
Q

what should we check for before administration of sulfasalazine? (patient)

A

“SULFA” ALLERGY

103
Q

what dosing would you see with glucocorticoid therapy for acute exacerbation of IBD?

A

HIGH DOSES!

104
Q

re: IBD drugs, what is prototype for targeted therapy?

A

infliximab

105
Q

what is MOA of infliximab?

A

inhibits TNF

106
Q

what is SE of infliximab (2)?

A
  1. injection site rxns

2. infections

107
Q

re: IBD drugs, what are the 2 prototypes for ABX treatment?

A
  1. metronidazole

2. ciprofloxacin

Pharm 323 Spring 22 (18 decks)

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