GI Flashcards
(155 cards)
1
Q
What is the most commonly used class of antiemetics and their MOA?
A
metoclopromide is a dopamine antagonists that can cause tardive dyskinesia
2
Q
5-HT3 receptor antagonists are also called what?
A
serotonin receptor antagonists or serotonin blockers, by inhibiting serotonin from binding to the 5-HT3 receptors aka ZOFRAN
3
Q
What is the MOA of 5-HT3 antagonists?
A
works on the vagal nerve terminals in the GI system and centrally in the chemoreceptor trigger zone
4
Q
What is tardive dyskinesia?
A
It is a constant, involuntary rhythmic movement that like the movement of perioral muscles that results in smacking or pursing of lips. can progress over months to years
5
Q
The most common side effect of Mg is what?
A
diarrhea
6
Q
The most common side effect of Al is what?
A
constipation
7
Q
Which medication is an abortifacient and cervical ripening?
A
misoprostol
8
Q
What are the most potent suppressors of gastric acid secretion?
A
Proton Pump Inhibitors (PPIs)
9
Q
What are the clinical use of PPIs?
A
Red is normal. PPIs lower it the most. GERD, Peptic ulcer disease, H pylori-associated ulcers, NSAID-associated ulcers, prevention of rebleeding from peptic ulcers, non-ulcer dyspepsia, prevention or stress-related mucosal bleeding, gastrinoma and other hypersecretory conditions.
10
Q
What is the treatment of H. pylori?
A
Combination of two antibiotics and a PPI.
Two 14-day treatment regimen.
Triple therapy x 10-14 days:
1. PPI
2. Clarithromycin
3. Amoxcilin (or metronidazole)
Quadruple Therapy x 10-14 days:
1. PPI
2. Bismuth subsalicylate
3. Metronidazole
4. Tetracycline
The PPI should be continued once daily for a total of 4-6 weeks to ensure complete ulcer healing. TOTAL after you stop the other meds.
11
Q
In regards to the escalation of therapy for chronic diseases, what are the goals?
A
find a regimen that reduces the use of steroids while still being therapeutic
12
Q
What areas of the colon does Crohn’s disease affect?
A
colon and distal ileum
13
Q
What area of the colon does UC affect?
A
sigmoid colon
14
Q
How is obesity diagnosed?
A
15
Q
What are anti-hepatic agents?
A
acute hepatitis care is primarily supportive. Likelihood progression to chronic HBV infection is less than 5%. Antiviril agent for chronic HBV include: Pegays and nucleotide analogs.
16
Q
How long does a patient have to have chronic viral hepatitis to be considered for diagnosis?
A
longer than 3-6 months
17
Q
How do you diagnosis chronic viral hepatitis?
A
antibody tests and viral nucleic acid serum
18
Q
What are the potential side effects of Lamivudine?
A
lactic acidosis
19
Q
What are the potential side effects of Pegasys?
A
flu-like sx, fatigue, mood disturbances, cytopenias
20
Q
What are the disadvantages of Interfern as an anti-hepatitis agent?
A
less than 50% of persons treated will respond
21
Q
What treatment regimen is recommended for HCV infections?
A
Sofosbuvir and Ledipavir
Genotypes 1, 4, 5 and 6
22
Q
What are the various combinations of hemorrhoidal suppositories and rectal ointments made from?
A
emollients, topical anesthetics, vasoconstrictors, astringents, and corticosteroids
23
Q
What are some patient education tips about flatus?
A
avoid gun chewing and carbonated beverages (#1 way to reduce)
Avoid FODMAPS
Beano is supposed to reduce gas, but it is not very effective.
Simethicone has no proven benefits, but is known to reduce pain
24
Q
Define FODMAPS
A
fermentable, oligosaccharides, disaccharides, monosaccharides, and polypols
25
What is the MOA of ondansetron?
5-HT3 antagonist
works on intestinal vagal and spinal afferent nerves
26
What is the important patient education associated with ondansetron?
Apomorphine (Parkinson's drug) and non selctive dopamine agonists are contraindicated due to risks of QT prolongation and cardiac arrhythmias
27
What are the safety concerns for ondansetron?
ECG for electrolyte abnormalities, CHF, bradyarrhythmias, or other medicines
28
What is the MOA of metoclopramide?
dopamine receptor blockade
29
What are the uses of metoclopramide?
no longer the drug of choice for chemotherapy induced N/V, but IS USEFUL for gastric emptying
Prokinetic: GERD, diabetic gastroparesis, small bowel intubation
30
What is the patient education in relation to metoclopramide?
never use in larger amount sthan recommended or for longer than 12 weeks
31
What is the safety warning for metoclopramide?
BB WARNING for IRREVERSIBLE tardive dyskinesia
contraindicated in GI blockage perforation or bleeding
32
What is the MOA of prochlorperazine?
blocking H1 receptors can have sedative effects
33
What are the uses of prochlorperazine?
N/V, anxiety, and schizophrenia
34
What is the patient education in relation to prochlorperazine?
tablets, IM injection, suppository
35
What is the safety warning for prochlorperazine?
BEERS CRITERIA for dementia-related psychosis is not approved. Increases mortality risk in elderly dementia patients on conventional or atypical antipsychotics. BB WARNING for tardive dyskinesia
36
What is the MOA of Chlorpromazine?
antagonizes dopamine D2 receptors
37
What are the uses of chlorpromazine?
Intractable hiccups and psychosis (antipsychotics)
38
What is the patient education in relation to chlorpromazine?
tablets, injection (IM/IV)
39
What is the safety warning for Chlorpromazine?
BEERS CRITERIA for dementia-related psychosis is not approved. Increases mortality risk in elderly dementia patients on conventional or atypical antipsychotics. BB WARNING for tardive dyskinesia
40
What is the MOA of promethazine?
anatagonizes central and peripheral histamine H1 receptors
41
What is the patient education in relation to promethazine?
extrapyridamal sx like tremor. Contraindicated in kids younger than 2 years. Can cause Reye's syndrome
42
What is the safety warning for promethazine?
Can cause severe tissue damage if IV extravasates or given IM. BB WARNING for tissue damage and gas gangrene
43
What is the MOA of scopolamine?
anticholinergic, muscarinic receptor antagonist and works onthe vestibular system, but has weak antiemetic activity
44
What are the uses of scopolamine?
patch for motion sickness
45
What is the patient education in relation to scopolamine?
dry mouth, visual disturbances, drowsiness
46
What is the safety warning for scopolamine?
BB WARNING for angle closure glaucoma
47
What is the MOA of NK-1 antagonists?
inhibit NK-1 receptors to prevent nausea nin patients receiving chemo
48
What is the patient education in relation to NK-1 antagonists?
given in conjunction with steroid and 5-HT3 antagonist
49
What is the MOA of Aluminum Hydroxide, Magnesium Hydroxide?
directly reduces intragastric acidity through chemical neutralization
50
What are the uses of Aluminum Hydroxide, Magnesium Hydroxide?
relieves heartburn and upset stomach
51
What is the MOA of Calcium Carbonate?
directly reduces intragastric acidity through chemical neutralization
52
What are the uses of Calcium Carbonate?
relieves heartburn and upset stomach. calcium for dietary supplementation and reducing the risk of osteoporosis.
53
What is the patient education in relation to Calcium Carbonate?
hypomagnesia
54
What is the MOA of sucralfate?
tenacious paste that binds selectively to ulcers or erosions and "coats" the mucosa. Stimulates prostaglandin production
55
What are the uses of sucralfate?
duodenal ulcer
gastric erosion due to aspirin
56
What is the patient education in relation to sucralfate?
not systemically absorbed
4x daily on EMPTY stomach
57
What is the safety warning for sucralfate?
should not be used for prolonged periods in patients with renal insufficiency
58
What is the MOA of Misoprostol?
prostaglandin analog (E1)
59
What are the uses of Misoprostol?
NSAID GI ulcer prevention, cervical ripening, early pregnancy termination
60
What is the safety warning for Misoprostol?
BB WARNING
Use in pregnant women can cause birth defects, abortion, premature birth, or uterine rupture. Women of childbearing age potential do not use to decrease the risk of NSAID-induced ulcers unless HIGH-risk gastric ulcer
61
What is the MOA of Famotidine?
selectively antagonizes H2 receptors in parietal cells
62
What are the uses of Famotidine?
GERD
63
What is the safety warning for Famotidine?
adjust for renal failure
64
What is the MOA of PPIs?
inhibits gastric parietal cell hydrogen pump ATPase (proton pump inhibitor)
65
What two PPIs are the most potent and irreversible?
Omeprazole and Lansoprazole
66
What are the uses for PPIs?
GERD, gastric ulcer, H pylori, hypersecretory conditions
67
What is the saftey warning for PPIs?
consider Mg at baseline
68
What is the safety warning for protonix?
no renal/hepatic adjustments
69
What is the MOA of loperamide?
binds gut opioid receptors, inhibiting peristalsis, increases sphincter tone
70
What are the uses for loperamide?
diarrhea, does not cross the blood-brain barrier. No analgesic properties
71
What is the patient education in relation to loperamide?
should not use if you have bloody diarrhea. Safe when used as directed, but taking too much can cause serious heart problems or death.
72
What is the safety warning for loperamide?
BB WARNING for Torsades De Point and sudden death. contraindicated in patients under 2 YO
73
What is the MOA of diphenoxylate/atropine?
binds gut wall opioid receptors inhibiting peristalsis, subtherapeutic atropine discourages overdose
74
What are the uses for diphenoxylate/atropine?
prescription only
75
What is the patient education in relation to diphenoxylate/atropine?
pts can develop dependence with prolonged use
76
What is the safety warning for diphenoxylate/atropine?
do not use if you have diarrhea that is caused by bacteria or by taking an abx. Do not use if you have a bile duct disorder causing jaundice. Keep this medication out of the reach of children, as it can cause overdose and fatality
77
What is the MOA of bismuth subsalicylate?
possesses topical mucosal effects, reduces secretions, binds to bacterial toxins, antimicrobial effects
78
What are the uses for bismuth subsalicylate?
diarrhea, H pylori infection, traveler's diarrhea prophylaxis
79
What is the patient education in relation to bismuth subsalicylate?
You should not use this medication if you have a bleeding issue or are allergic to aspirin
80
What is the safety warning for bismuth subsalicylate?
reyes syndrome
black fecal discoloration, black tongue discoloration
may lead to salicylate toxicity
81
What is the MOA of octreotide?
man-made. acts like somatostatin, inhibits multiple hormones including growth hormone, glucagon, insulin, LH, VIP and inhibits portal and splanchnic blood flow
82
What are the uses for octreotide?
acromeagly
secretory diarrhea, especially in patients with HIV
esophageal varices
83
What is the MOA of docusate?
facilitate a mixture of stool fat and water. STOOL SOFTNER
84
What are the uses for docusate?
prevent constipation
decrease straining during defecation
85
What is the patient education in relation to docusate?
diarrhea due to increased fluid and electrolyte secretion
86
What is the MOA of psyllium?
increases stool bulk
BULK FORMING LAXATIVE
87
What are the uses for psyllium?
relieving constipation
supplementing fiber intake
88
What is the patient education in relation to psyllium?
swallow one at a time and separate form other drugs by >2 hrs
89
What is the MOA of methylcellulose?
increases stool bulk
BULK FORMING LAXATIVE
90
What are the uses for methylcellulose?
relieving constipation
91
What are the uses for bisacodyl?
constipation and bowel prep
92
What is the MOA of bisacodyl?
stimulant laxative promotes peristalsis
93
What is the patient education in relation to bisacodyl?
do not crush, chew, or break. Swallow with a full glass of water
taken PO should produce a BM in 6-12 hrs
94
What is the safety warning for bisacodyl?
do not use for more than 1 wk. DO NOT chronically use for constipation. Electrolyte imbalances and cathartic colon
95
What is the MOA of polyethylene glycol?
causes water retention in stool, producing a laxative effect
OSMOTIC LAXATIVE
96
What are the uses for polyethylene glycol?
relieving constipation
97
What is the safety warning for polyethylene glycol?
electrolyte imbalance
laxative dependence
98
What is the MOA of Polyethylene glycol/ Electrolytes?
causes water retention in the stool, producing a laxative effect
99
What are the uses for Polyethylene glycol/ Electrolytes?
bowel prep
100
What is the patient education in relation to Polyethylene glycol/ Electrolytes?
this medication can be abused by bulimics
100
What is the safety warning for Polyethylene glycol/ Electrolytes?
Monitor BUN/Cr., Ca, K, Na at baseline and post colonoscopy if seizures hx
101
What is the MOA of sodium phosphate rectal?
bowel cleansing
CONSTIPATION OSMOTIC LAXATIVE
102
What are the uses for sodium phosphate rectal?
constipation
bowel prep for enemas
103
What is the safety warning for sodium phosphate rectal?
for best results, stay lying down and hold in the enema until you feel the urge to have a BM
104
What is the MOA of Linaclotide?
activates guanylate cyclase-C stimulation cGMP production
105
What are the uses for Linaclotide?
chronic idiopathic constipation
IBS
106
What is the safety warning for Linaclotide?
contraindicated in patients < 6 years old and deaths have occurred due to dehydration within 24 hours in nonclinical studies
107
What is the MOA of Methylnaltrexone?
selectively antagonizes peripheral mucoid receptors, inhibiting opioid-inducing GI hypermotility
108
What are the uses for Methylnaltrexone?
opioid-induced constipation
109
What is the patient education in relation to Methylnaltrexone?
avoid use if concern for bowel obstruction perforation
110
What is the safety warning for Methylnaltrexone?
opioid withdrawal (only if the blood-brain barrier is disrupted)
111
What is the MOA of Dicyclomine?
antagonizes Ach at muscarinic receptors (anticholinergic), relaxes smooth muscle, inhibits bradykinin and histamine-induced spasms
112
What are the uses for Dicyclomine?
IBS
113
What is the patient education in relation to Dicyclomine?
Stop using and call right away of you have side effects such as confusion, hallucinations, unusual thoughts, fast or uneven heart rate, or urinate less than usual or not at all.
114
What is the MOA of Hyoscyamine?
antagonizes Ach receptors (anticholinergic)
115
What are the uses for Hyoscyamine?
IBS, bladder spasms
116
What is the MOA of Sulfasalazine?
blocks COX and inhibits prostaglandin production, producing anti-inflammatory effects
117
What are the uses for Sulfasalazine?
UC
Crohn's
118
What is the MOA of Mesalamine?
blocks COX and inhibits prostaglandin production, producing anti-inflammatory effects
119
What are the uses for Mesalamine?
UC
Crohn's
120
What is the patient education in relation to Mesalamine?
renal toxicity
121
What is the safety warning for Mesalamine?
caution in patients over 65
122
What is the MOA of 6-Mercaptopurine?
inhibits DNA synthesis
123
What are the uses for 6-Mercaptopurine?
ALL
Crohn's
UC
124
What are the uses for Adalimumab?
Crohn's
UC
HS
uveitis
125
What is the safety warning for 6-Mercaptopurine?
pregnancy avoid in 1st trimester
125
What is the MOA of Adalimumab?
binds and inhibits TNF-a, reducing inflammation and altering immune response
126
What is the patient education in relation to Adalimumab?
sub-Q, every 6 weeks, Expensive
127
What are the uses for orlistate?
diet needs to be less than 30% fat. fat-soluble vitamin supplement is recommended
128
What is the MOA of orlistate?
inhibits lipases reducing fat absorption
128
What is the safety warning for Adalimumab?
Malignancy: lymphoma and other malignancies, some fatal reported in children and adolescents treated w/ TNF blockers
129
What is the patient education in relation to orlistate?
steatorrhea
130
What is the safety warning for orlistate?
pregnancy contraindicated
131
What is the MOA of pancreatic enzymes?
disintegrates into trypsin, amylase, and lipase which break down proteins, carbs, and fat
132
What are the uses for pancreatic enzymes?
exocrin pancreatic insufficiency
133
What is the patient education in relation to pancreatic enzymes?
the number on the capsule is the umber of thousands of units
134
What is the safety warning for pancreatic enzymes?
you should not take pancrelipase if you are allergic to pork protiens
135
What is the MOA of Urodiol?
decreased cholesterol synthesis, secretion, and absorption, alters bile cholesterol and composition
136
What is the safety warning for Urodiol?
capsules are not for treating gallstones that are calcified
137
What is the MOA of Pegylated Interferon Alfa 2A?
inhibits viral replication, various antivirals, antiproliferative, and immunomodulatory effects. attached to polyethylene glycol leads to longer half-life.
138
What are the uses for Pegylated Interferon Alfa 2A?
chronic Hep B
139
What is the safety warning for Pegylated Interferon Alfa 2A?
aggravate fatl or life threatening neuropsychiatric, autoimmune, ischemic, and infectious disorders,
140
What is the MOA of Lamivudine?
nucleoside reverse transciptase inhibitor
141
What is the patient education in relation to Lamivudine?
higher dose for HIV infection
142
What are the uses for Lamivudine?
chronic Hep B
143
What is the safety warning for Lamivudine?
1. HIV testing: rapid emergences of HIV resistance
2. Hep B exacerbation
144
What is the MOA of Lepidasvir/sofosbuvir?
inhibits non-structural protein 5A (NS5A), limiting viral replication. inhibits non structural protein 5B RNA-dependent RNA polymerase, terminating viral replication
145
What are the uses for Lepidasvir/sofosbuvir?
Hep C
146
What is the safety warning for Lepidasvir/sofosbuvir?
BB WARNING for Hep B reactivation. Screen all patients for HBV co-infection
147
What is the MOA of hydrocortisone/pramoxine topical?
corticosteroid and topical anesthetic
148
What are the uses for hydrocortisone/pramoxine topical?
hemorrhoids
149
What is the patient education in relation to hydrocortisone/pramoxine topical?
apply after BM for external use
no systemic med, hemorrhoids common in pregnant women
150
What is the safety warning for hydrocortisone/pramoxine topical?
HPA axis suppression (prolonged use)
caution advised during pregnancy especially if long term use
151
What is the MOA of Simethicone (Gas-X)?
alters bubble surface tension
152
What are the uses for Simethicone (Gas-X)?
silicone based antifoaming agents for relieving gas
