GI Flashcards
exam 4 (107 cards)
1
Q
what 5 classes of drugs can be used for PUD?
A
- ABX
- anti-secretory agents
- mucosal protectants / enhance mucosal defenses
- prostaglandin agent
- antacids
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
3
Q
what is a barrier to treatment for H. pylori? (patient-specific)
A
adherence b/c of SE, cost + large # of pills
4
Q
how often are H2 blockers given?
A
BID
5
Q
MOA of H2 blockers
A
block H2 (histamine parietal cells in stomach) to suppress acid secretion
6
Q
what are the 2 prototypes for H2 blockers?
A
famotidine + cimetidine
7
Q
SE of cimetidine (3)
A
- androgen blockage –> gynecomastia, dec. libido + impotence
- CNS effects (elderly)
- PNA
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
9
Q
H2 blockers + antacids…. what do we do?
A
separate admin by 1 hour
10
Q
what are the 2 types of drugs that fall into anti-secretory agents?
A
- H2 blockers
2. PPIs
11
Q
what is the prototype for PPIs?
A
omeprazole
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)
13
Q
what drug class is used for stress ulcer prophylaxis?
A
PPIs
omeprazole
14
Q
SE of PPIs (2; one is broad) - short term
A
- HA
2. GI: N/V/D
15
Q
long term PPI use can lead to….. (7)
A
- OP + fractures (decreased calcium absorption)
- C. diff (decreased acid in gut)
- PNA (decreased acid in gut –> aspirate)
- acid rebound
- kidney issues
- liver issues
- 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.
16
Q
what’s a strategy to prevent acid rebound with long term PPI use ?
A
wean off PPIs + use H2 blockers
17
Q
how can we recognize PPIs by their name?
A
“_____prazole”
18
Q
what PPI do we often see in acute care b/c of it’s IV formulation?
A
pantoprazole (Protonix)
19
Q
what is the prototype for mucosal protectants?
A
sucralfate
20
Q
MOA of sucralfate
A
creates a protective coating on gastric surfaces to protect ulcer from acid + pepsin
21
Q
SE of sucralfate
A
constipation
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
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
24
Q
what is prototype for prostaglandin agent for PUD?
A
misoPROSTol (Cytotec)
25
what is misoprostol?
synthetic prostaglandin
misoPROSTol = PROSTaglandin
26
what drug is used for gastric ulcers caused by NSAIDs?
misoprostol
27
what is interaction between misoprostol + pregnancy?
CATEGORY X!!!!
prostaglandins cause contractions of the uterus / cervical ripeninggggg
28
SE of misoprostol (4)
1. spotting
2. dysmenorrhea
3. abd pain
4. diarrhea
29
what are antacids?
what conditions are they used for?
alkaline agents --> neutralize stomach acid
used for: PUD + GERD
30
what should you know about antacids and other drugs? (interactions)
separate 1 hour from other drugs
| many drugs require an acidic stomach environment to be absorbed + this interferes
31
re: antacids, aluminum compounds often cause what ?
constipation
32
re: antacids, magnesium compounds often cause what ?
diarrhea
33
what is DOC for antacids? why?
milk of mag ◡̈
rapid-acting + long lasting ◡̈
34
re: antacids, magnesium compounds are contraindicated with which patients? why?
renal patients - b/c mag is excreted by the kidneys
35
re: antacids, sodium compounds are contraindicated with which patients? why?
HF + HTN patients - can cause fluid retention
36
re: antacids, calcium + sodium compounds share which SE? which drug can be added to decrease this SE?
gas !!
simethicone to reduce gas
37
what are the 5 types of laxatives we discuss?
1. bulk-forming
2. surfactant
3. stimulant
4. osmotic
5. miscellaneous
38
what is the prototype for bulk-forming laxatives?
psyllium (Metamucil)
39
MOA of psyllium + 5 positive outcomes
pulls H2O into stool
1. increases mass
2. softens stool
3. feels colonic bacteria
4. increases peristalsis
5. decreases cholesterol
40
what is risk of psyllium use?
intestinal obstruction
41
how should psyllium be taken?
with a FULL glass of H2O
42
onset for psyllium
1-3 days
43
what is the prototype for surfactant laxatives?
docusate sodium (Colace)
44
MOA of docusate sodium
increased H2O in stool --> softens stool
*doesn't make people go, but makes it easier to go*
45
onset for docusate sodium
1-3 days
46
how should docusate sodium be taken?
with a FULL glass of H2O
47
what is prototype for stimulant laxatives?
bisacodyl (Dulcolax)
senna (Senokot) is another
48
what laxatives produce a KICK!!!???
1. bisacodyl or senna (stimulant): 6-12 hrs
| 2. high dose osmotic laxatives: 2-6 hrs
49
MOA of bisacodyl (2)
1. pulls H2O into stool --> softens stool
| 2. stimulates peristalsis
50
what laxative has a potential for abuse?
stimulant laxatives
| bisacodyl or senna
51
onset of bisacodyl
6-12 hours
52
how should bisacodyl be taken in regards to food + antacids?
separate 1 hour from milk or antacids
53
what is prototype for low dose osmotic laxatives?
polyethylene glycol (Miralax)
also....
milk of mag
54
onset for polyethylene glycol
2-4 days (low dose)
55
what is MOA for polyethylene glycol?
1. pulls H2O into intestinal lumen --> fecal mass swells
| 2. stimulates peristalsis
56
SE of polyethylene glycol (4)
GI =
1. nausea
2. abd bloating
3. cramping
4. flatulence
57
what drug class is used for bowel prep for colonoscopy or GI surgery?
high dose osmotic laxatives
| ex: polyethylene glycol w/electrolytes = GoLytely
58
high dose osmotic laxatives are contraindicated in which population of patients? why?
renal: Mg elimination
cardiac: electrolyte imbalances
59
what is major risk with high dose osmotic laxatives?
dehydration risk
60
what is onset for high dose osmotic laxatives?
2-6 hrs!!!
61
what are the high dose osmotic laxatives?
*no true prototype just ones she says we should know*
1. polyethylene glycol electrolyte solution (Golytely)
2. sodium phosphate (Fleets phosphosoda)
3. magnesium citrate
4. lactulose
"Please Save My Laxatives"
62
what is administration notes for polyethylene glycol electrolyte solution? (Golytely)
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
why is lactulose often used?
to lower ammonia levels (often in liver disease patients)
64
what is the prototype for miscellaneous laxatives?
lubiprostone
65
what is MOA of lubiprostone?
Cl channel activator: secretion of Cl-rich fluid into intestine which increases motility
66
SE of lubiprostone + how can we mitigate this?
nausea --> take with food + H2O
67
onset of lubiprostone
24 hrs
68
what are the 7 classes of antiemetic drugs?
1. serotonin receptor antagonists
2. dopamine antagonists
3. substance P neurokinin antagonists
4. anticholinergics / antihistamines
5. benzos
6. glucocorticoids
7. cannabinoids
69
re: antiemetic drugs, what is the prototype for serotonin receptor antagonists?
ondanSETRON (SEROTONIN)
70
what is MOA of ondansetron?
block serotonin receptors on vagal neurons in the chemo-receptor-trigger zone (CTZ)
71
what is the most efficacious antiemetic available?
ondansetron
72
SE of ondansetron (3)
1. CNS (HA + dizzy)
2. diarrhea
3. QT prolongation
73
re: antiemetic drugs, what is the prototype for substance P neurokinin antagonists?
aprepitant
74
what is MOA of aprepitant?
blocks neurokinin receptors in the CTZ (chemo-receptor-trigger zone)
75
what is the combination of drugs that is identified as the most efficacious for managing n/v?
1. ondansetron
2. aprepitant
3. dexamethasone
76
SE of aprepitant (2)
1. fatigue
| 2. weakness
77
re: antiemetic drugs, what is the prototype for glucocorticoids?
dexamethasone
78
what are SE of dexamethasone?
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
re: antiemetic drugs, what is prototype for benzodiazepines?
lorazepam (Ativan)
80
SE of lorazepam (2)
CNS =
1. sedation
2. retrograde amnesia
81
re: antiemetic drugs, what are the prototypes for dopamine antagonist? (2 prototypes + 1 class)
1. promethazine (Phenergan)
2. metoclopramide (Reglan)
3. butyrophenones (no prototype)
"metoclo, pro and butyro"
82
MOA of promethazine
block dopamine receptors in the CTZ
| this can help with knowing the SE. blocking dopamine = parkinson's effects
83
SE of promethazine (4 - 3 specific + 1 broad)
1. dyskinesia
2. hypotension
3. sedation
4. anticholinergic effects
84
what is important to know about IV administration of promethazine?
dilute + push SLOWLY!!!
85
AE of promethazine (2)
1. tissue extravasation --> injury/gangrene
| 2. respiratory depression
86
if someone receiving promethazine via IV and experiences burning at injection site, what should you do?
STOP!!!!! (AE is tissue extravasation and this can cause gangrene!)
87
b/c of one of the AE of promethazine, what population should this drug not be given to?
children under 2 yrs (respiratory depression)
88
what is the MOA of metoclopramide?
blocks dopamine + serotonin in the CTZ
MOTILITY MOTILITY MOTILITY!!!
89
what is a long term SE of metoclopramide?
tardive dyskinesia
90
re: antiemetic drugs, what is the prototype for cannabinoids?
dronabiol (Marinol)
91
re: antiemetic drugs, what is prototype for anticholinergic/antihistamine?
hydroxyzine
92
what antiemetic can be used for motion sickness and CINV?
hydroxyzine
| dulls the inner ear's ability to sense motion....cool◡̈
93
what is the MOA of hydroxyzine?
blocks histamine
94
SE of hydroxyzine
anticholinergic + sedation
"can't pee, can't see, can't spit, can't shit"
95
what are our prototypes for anti-diarrheal agents?
| 1 opioid + 1 mu opioid, OTC + 1 "other"
1. diphenoxylate + atropine
2. loperamide (Imodium)
3. bismuth-subsalicylate (Pepto Bismol)
96
re: anti-diarrheal agents, why is atropine combined with diphenoxylate ?
atropine prevents abuse
97
what is a unique fact about bismuth-subsalycilate that Knowlton said we should know? and is good patient education?
can turn your stool and tongue black
98
what are the 5 drug classes for Inflammatory Bowel Disease?
1. 5-aminosalicylates
2. glucocorticoids
3. immunosuppressants
4. targeted therapy
5. ABX
99
re: IBD drugs, what is the prototype for 5-aminosalicylates?
sulfasalazine
100
what is the MOA of sulfasalazine?
inhibits prostaglandins --> reduce inflammation
101
what are the SE of sulfasalazine? (4)
1. nausea
2. fever
3. rash
4. arthralgia
102
what should we check for before administration of sulfasalazine? (patient)
"SULFA" ALLERGY
103
what dosing would you see with glucocorticoid therapy for acute exacerbation of IBD?
HIGH DOSES!
104
re: IBD drugs, what is prototype for targeted therapy?
infliximab
105
what is MOA of infliximab?
inhibits TNF
106
what is SE of infliximab (2)?
1. injection site rxns
| 2. infections
107
re: IBD drugs, what are the 2 prototypes for ABX treatment?
1. metronidazole
| 2. ciprofloxacin
