GI Flashcards

Question

Ranatidine (2 things)

Answer 1

- H2 receptor antagonist (4x more potent) | - ADRs: Hepatitis

Answer 2

- H2 receptor antagonist (40-60x more potent) - Decreases cardiac output - ADRs: increases LFTs

Answer 3

- H2 receptor antagonist (2-3x more potent) - Decreases cardiac output and heart rate - ADRs: increases LFTs

Answer 4

- Most commonly used antacid - Most effect on lower esophageal sphincter pressure (TQ) - Potent, reversible, rapid, prolonged - Increases fecal bulk, excretion of fatty acids, bile salts - Less chance of systemic alkalosis than sodium bicarb - Does not alter transit time - ADRs: acid rebound, pancreatic enzyme secretion, gallbladder emptying

Answer 5

- Noncompetitive, irreversible inhibitors of intracellular acid pump - Takes a week to be effective (NOT immediate) - Inhibits daytime/nighttime secretion with once a day dosing (long DOA) - Prodrugs: omeprazole and lansoprazole - Esomeprazole: active S-isomer of omeprazole - Uses: peptic ulcer, reflux esophagitis, antimicrobial activity (against H. pylori) - ADRs: headache, diarrhea, rebound (take 7.5 days for full restoration), CYP interactions (omeprazole lowers phenytoin and warfarin), pH changes (increase digoxin, nifedipin, ASA, midazolam, DDI, methadone), decrease ketoconazole/itraconazole

Answer 6

- Reversibly compete with histamine at H2 receptor on parietal cells (external receptor) - Does NOT affect H1 receptor - Decreases acid secretion/gastric motility, little effect on smooth muscle function - Uses: peptic duodenal ulcer, benign gastric ulcer, erosive esophagitis (GERD), hypersecretory conditions (zolinger-ellison) - ADRs: Cimetidine is associated with most ADRs (inhibits CYP450)

Answer 7

- Noncompetitive, irreversible inhibitors of intracellular acid pump - Takes a week to be effective (NOT immediate) - Inhibits daytime/nighttime secretion with once a day dosing (long DOA) - Prodrugs: omeprazole and lansoprazole - Esomeprazole: active S-isomer of omeprazole - Uses: peptic ulcer, reflux esophagitis, antimicrobial activity (against H. pylori) - ADRs: headache, diarrhea, rebound (take 7.5 days for full restoration), CYP interactions (omeprazole lowers phenytoin and warfarin), pH changes (increase digoxin, nifedipin, ASA, midazolam, DDI, methadone and decrease ketoconazole/itraconazole) - Long term effects: malabsorptions of calcium and magnesium (esp in sedentary lifestyles, thiazides, HRT, corticosteroids), may increas infection of enteric bacteria (C. diff and CA-pneumonia)

Answer 8

- Not readily absorbed, especially short term - Uses: promotes healing of gastric/duodenal ulcers by coating them, antimicrobial to H. pylori - ADRs: encephalopathy (chronic use), contains salicylates (may cause Reye's Syndrome in children)

Answer 9

- Dopamine antagonist (blocks central and periphery) - Direct inhibitor of chemoreceptor trigger zone, blocks serotonin receptors at high doses - Improves gastric emptying, no effect on biliary, gastric or pancreatic enzymes - Uses: GERD and diabetic gastroparesis (also to control chemo-induced vomiting) - ADRs: sedation, extra-pyramidal symptoms (TQ), prolactin secretion

Answer 10

- Increase bulk of feces, which stretches the GI tract and stimulates peristalsis - Drink extra water - 2-3 days time to action - Methylcellulose, Carboxymethylcellulose, Psyllium Seed, Bran

Answer 11

- Osmotic laxative - As colonic ostomotic osmolality increases, fluid movement occurs - 1-3 days time to action - ADRs: contraindicated in patients who are galactose sensitive

Answer 12

- Analogue of PGE-1 - Well absorbed, metabolized to active compound - Approved for prevention of NSAID-induced ulcer - ADRs: cramps, abdominal pain, diarrhea, uterine contractions (spontaneous abortions)

Answer 13

- Help retain fluid in gut through osmotic effect - Drink extra water - 2-6 hours time to action - Soluble, inorganic salts (magnesium, sodium, potassium) - Given as liquids, powders or enemas - Milk of magnesiam (MOM), sodium phosphates

Answer 14

- Not absorbed from alimentary canal - Act by increasing bulk of feces and softening stool - 1-2 day times time to action - ADRs: chronic use may cause vitamin deficiencies - Mineral oil (dissolves and prevents absorption of fat-soluble vitamins [TQ]), Docusate (surfactant)

Answer 15

- Act on gut mucosa to stimulate peristalsis - ADRs: GI pain - Phenolphtalein, Castor Oil, Bisacodyl (causes colonic contraction and inhibits water absorption), Cascara

Answer 16

- Chloride channel activator - Uses: chronic constipation in adults (for patients when nothing else works) - ADRs: nausea, diarrhea, headache, abdominal pain/distension, flatulence

Answer 17

- Block emetic stimuli of vestibular origin - Meclozine: DOC for vestibular issues - Uses: motion sickness, nausea/vomiting in children (diphenhydramine) and after operation (hydroxyzine) - ADRs: anticholinergic effects (dry mouth, sedation, blurred vision, urinary retention) - Diphenhydramine, Hydroxyzine, Scopolamine (patch), Meclozine

Answer 18

- Direct inhibitor of chemoreceptor trigger zone, blocks serotonin recepetors at high doses - Blocks central and peripheral dompanine and sensitizes GI receptors to ACh - Structurally related to procainamide - Better efficacy as an anti-emetic with a corticosteroid (dexamethasone or methylprednisolone) - Uses: control chemo-induced vomiting (also GERD and diabetic gastroparesis) - ADRs: extra-pyramidal symptoms, sedation, diarrhea, hypotension

Answer 19

- Widely prescribed, practical for long-term use - Uses: control morning sickness, nausea, vomiting, mildly emetogenic chemotherapy - ADRs: extrapyramidal symptoms (reversible with antihistamines), allergic reactions, sedation, blurred vision - Prochlorperazine, promethazine, thiethylperazine

Answer 20

- Very potent antidopaminergic inhibitors of chemoreceptor trigger zone (CTZ) - Uses: effective against emetogenic chemo, usually used in combo with other agents - ADRs: extra-pyramidal symptoms, sedation, restlessness, hypotension, hallucinations - Haloperidol, Droperidol

Answer 21

- Inhibits prostaglandin synthesis - Anticholinergic activity, may exert action through opiate receptors - Uses: refractory chemo-related emesis (TQ), esp in patients with previous marijuana use - ADRs: mood changes, memory loss, hunger, motor incoordination, euphoria, relaxation (so basically being high haha) - Nabilone, Dronabinol

Answer 22

- 5-HT-3 Antagonists - Uses: control chemo-related emesis, even highly emetogentic chemo (best on 1st round), post-op nausea and vomiting (PONV) - Does NOT interact with dopamine receptors, therefore no extra-pyramidal symptoms - ADRs: headache, constipation, lightheadness, abdominal pain/cramping, sedation, potentially fatal abnormal heart rhythms - Caution in those who are predisposed to low levels of K and Mg in blood and those received other meds that may lead to QT prolongation

Answer 23

- Serotonin receptor antagonist | - Pure (5HT3), long T1/2, QD dosing

Answer 24

- Serotonin receptor antagonist | - Pure (5HT3), long T1/2, QD dosing

Answer 25

- Serotonin receptor antagonist - Binds at 5HT3, 5HT1b, 5HT1c, a-adrenergic and mu opioid receptors - Shorter T1/2, dose 3-4 times daily

Answer 26

- Serotonin receptor antagonist - Binds at 5HT3, 5HT4 - Long T1/2, QD dosing

Answer 27

- 5-ASA is active metabolite that inhibits the synthesis of inflammatory mediators - Composed of sulfapyridine and 5-aminosalicylate linked by an azo bond - Uses: part of primary mode of therapy for inflammatory bowel disease - ADRs: nausea/vomiting/headache (due to sulfa), inhibits absorption of folate, decreases bioavailability of digoxin

Answer 28

- AZA is a prodrug (TQ) that is converted to 6-MP - Steroid sparing, reduces amount needed to maintain remission - Monitor CBC every 3 months - ADRs: allergic (pancreatitis, fever, rash, arthralgias, malaise), non-allergic (bone marrow depression, infections, hepatitis, malignancy)

Answer 29

- Inhibits T-helper cell production of IL-2 and IFN-y (alters T and B cell function) - Uses: indicated for refractory patients - ADRs: renal dysfunction, hypertension, infection, paresthesias, tremor, hirsutism, gingival hyperplasia

Answer 30

- Folate analogue - Gold standard, PO or IM - Inhibits purine synthesis (needed to make DNA, RNA, protein) - Monitor levels - Antidote/"rescue": leucovorine (TQ) - ADRs: increases LFTs, hepatic fibrosis, mucositis, headache, nausea, rash, bone marrow suppression, lymphoma

Answer 31

- Anti-TNFa antibody mediator, monoclonal - IV only - Uses: Crohn's, RA, rapid relief of symptoms - ADRs: fevers, chills, itching, chest pain, BP changes, dyspnea

Answer 32

- Selective 5HT4 (5-hydroxytryptamine-4) partial agonist (TQ) - Accelerates gastric empyting and small bowel and colonic transit time - Uses: treatment of abnominal pain/discomfort and constipation, chronic constipation, gastroparesis, GERD - ADRs: inhibits CYP1A2 and CYP2D6, diarrhea, headache, don't use longer than 12 weeks

Answer 33

- Selective 5HT3 antagonist - 10x as potent as ondansetron - Increases fluid absorption in SI, slows colonic contraction by 8 hours - Does NOT affect gastric emptying time, LESP, esophageal motility or small bowel transit time - Absorption decreased by food - Uses: patients (women) with severe diarrhea predominant IBS - ADRs: contipation, ischemic colitis, decreases concentration of levonorgestrel and ethinyl estradiol (decreases effectiveness of BC)

Answer 34

- Inhibits the cystic fibrosis transmembrane conductance regulator (CFTR) chloride channels and calcium-activated Cl channels at luminal membrane of enterocytes, which blocks Cl secretion and high water loss through the gut that results in diarrhea - Acts locally on enterocytes - Uses: for ymptomatic relief of non-infectious diarrhea in adults HIV/AIDS on anti-retroviral therapy (TQ) - No dose modifications recommended with respect to CD4 count - ADRs: may inhibit absorption of drugs

Answer 35

- Anorexia - Weight loss - Malaise - Dehydration - Esophagastric tears - Electrolyte imbalances - Aspiration pneumonia

Answer 36

- Coordinated in the emetic center in the medulla - Chemoreceptor trigger zone (CTZ) is responsive to chemical stimulation (serotonin and dopamine) - Begins with nausea, increased salivation, pupillary dilation, sweating, pallor, retching and vomiting

Answer 37

- Includes: ulcerative colitis, Crohn's - Symptoms: bleeding, urgency, diarrhea, tenesmus - Primary mode of therapy involves corticosteroids and sulfasalazine - Immunomodifiers (AZA/6-MP, cyclosporine, MTX)are also used

Answer 38

- Causes cramping, bloating, gas, diarrhea or constipation - Pain occurs during/after meal - No damage to the bowel - IBS is a chronic relapsing disorder

Answer 39

- Live microorganisms administered to improve "microbial balance" - Saccharomyces boulardii and Lactobacillus rhamnosus, strain GG shown to prevent antimicrobial associated diarrhea - I. acidophilus, bifidobacterium longum, enterococcus faecium are others - Problems (TQ): unknown if organisms still living when administered, may cause infection, not regulated/ approved by FSA - Align (IBS), Activia (irregularity due to slow GI motility), VSL #3 (may reduce pain/bloating), Culturelle/Florastor (reduce stool frequency with antibiotic treatment)

Answer 40

- Cholinergic agent - Increases resting LESP, therefore decreasing reflux and improving esophageal clearing - Decreases symptoms and need for antacid use, also promotes healing - Uses: reflux esophagitis with H2 antagonists or proton pump inhibitors - ADRs: gastric acid production, cholinergic effects (cramps, diarrhea, urinary frequency, blurred vision)

Answer 41

- Purge by excess volume (TQ) - Ingestion of 4 liters of iso-osmotic fluid over 3-4 hours - Uses: prior to procedures or post-poisonings - ADRs: not for patients with bowel obstruction or impaired gag reflex, tastes bad (mix with chicken bouillon) - GoLYTELY, Colyte, Miralax (common)

GI Flashcards

(65 cards)