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GI Flashcards

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1
Q

3 Ways to Tx PUD

A
  • Decrease acid
  • Eliminate H. pylori
  • Protect mucosa
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2
Q

Antacids (4)

A
  • Aluminum
  • Mg
  • Calcium
  • Sodium bicarbonate
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3
Q

Causes diarrhea

A

Mg

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4
Q

Causes constipation

A

Aluminum

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5
Q

Often combined to cancel each other’s effect on GI motility out

A
  • Aluminum

- Magnesium

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6
Q

Considered “candy”

A
  • Antacids, Tums
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7
Q

Drug interactions with antacids common because ______, (4 drugs affected)

A

They form insoluble complexes with drugs like

  • Theophylline
  • Ketoconazole
  • Quinolone antibiotics
  • Tetracycline
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8
Q

Antacids decrease absorption of _______ (3 drugs)

A
  • Digoxin
  • Phenytoin
  • Propranolol
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9
Q

Antacids increase elimination of _____ (2 drugs)

A
  • Phenobarbital

- Salicylates

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10
Q

What do antacids do to urine?

A

Alkalinalize

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11
Q

Uses of Antacids (3)

A
  • Relief of heart burn, gastritis
  • Temporary fix
  • Adjunct to other drugs, because effect is quick
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12
Q

Systemic effects of antacids

A
  • Rare
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13
Q

Antacids affect (2)

A
  • Renal function

- CHF (watch Na)

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14
Q

H2 Antagonists (4)

A
  • Cimetidine
  • Ranitidine
  • Famotidine
  • Nizatidine
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15
Q

H2 Antagonists MOA

A
  • Decrease GI acid formation through H2 receptor blockade
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16
Q

H2 Blockers Tx

A
  • Ulcers
  • Most effective at night
  • GERD (as adjuncts)
  • Pre-anesthesia
  • With H1 antagonists for severe allergic rxn
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17
Q

H2 blocker metabolism (3)

A
  • Metabolized by liver, excreted by kidney
  • Usually oral
  • t 1/2 = 12 hrs
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18
Q

H2 blocker SE

A
  • Few, but worse in elderly
  • HA, dizziness, N
  • Rash, itch
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19
Q

Cimetidine SE

A
  • Anti-testosterone effect
  • May be useful in women (treat hirsutisim)
  • Chronic, high doses may cause gynecomastia, loss libido, impotence in men
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20
Q

Cimetidine Drug Interactions (2)

A
  • Inhibits CYP3A

- Warfarin, phenytoin, theophylline, digoxin

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21
Q

Proton Pump Inhibitors (4)

A
  • Omeprazole
  • Esomeprazole
  • Lansoprazole
  • Rabeprazole
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22
Q

Proton Pump Inhibitor MOA (2)

A
  • Activated in gastric parietal cell

- Irreversible block of acid formation

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23
Q

DOC for GERD

A

PPI

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24
Q

Proton Pump Inhibitor MOA (2)

A
  • Activated in gastric parietal cell to sulfenamide
  • Irreversible block of acid formation
  • Administered as pro-drugs
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25
PPI SE (6)
- N/D/Colic - Osteoporosis (decrease Ca absorption) - Dec Mg absorption (leg cramps) - HA, dizziness, sleepiness uncommon - Increase ALT, AST - Skin rash, bacterial overgrowth possible
26
May inhibit CYP2C19 --> phenytoin, warfarin, diazepam, clopidogrel possible interactions
Omeprazole
27
PPI Uses (4)
- Ulcers that haven't responded to H2 antagonists - Heal duodenal ulcer or gastric ulcer - Pts on NSAID - ZE syndrome
28
Cytoprotective Agents
- Sucralfate
29
Cytoprotective MOA
- Polymerizes to provide protective barrier cells in ulcer base
30
Sucralfate SE
- Constipation (contains aluminum) - Upset stomach - Drug interactions
31
- Prostaglandin E1 analogue
Misoprostol
32
Misoprostol Tx
- Prevent or reduce NSAID - induced damage
33
NOT used in pregnancy, can induce abortion
Misoprostol
34
D2 Antagonist
Metocloropramide
35
Metocloropramide MOA
- D2 antagonists --> increases ACh release
36
Metocloropramide SE (3)
- Parkinson's like symptoms - Increase prolactin - Methemoglobinemia in infants (NOT to be used in pregnancy)
37
Bethanechol MOA
- M agonist
38
Used in diabetic gastroparesis
Erythromycin
39
Prokinetic agents
- Metoclopramide - Bethanechol - Erythromycin
40
IBS Tx
- Glycopyrrolate - Dicyclomine - TCA (good for pain)
41
Proton Pump Inhibitors (5)
"Prazole" - Omeprazole - Esomeprazole - Lansoprazole - Rabeprazole - Pantoprazole
42
IBS due to ______ (4)
- Stimulation of 5HT4 receptors on nerve terminal increases ACh release - Increases peristalsis - Release of 5 HT from EC stimulates 5HT3 receptors - Sends pain signal to CNS
43
Alosetron MOA
- 5HT3 receptor antagonist
44
Alosetron Tx
- IBS with severe diarrhea in women
45
Alosetron SE (3)
- Constipation - GI obstruction, perforation - MANY contraindications --> risk benefit statement required
46
Taken off market due to cardiac events
Tegaserod
47
Tegaserod MOA
5 HT4 partial agonist
48
5 HT3 Antagonists (4)
"Setron" - Ondansetron - Granisetron - Dolasetron - Palonosetron
49
Very effective for N/V induced by chemo, radiation, gastric dz
5 HT3 antagonists ("Setron")
50
Prochlorperazine, Promethazinen MOA
Block DA, muscarinic, histamine receptors
51
Prochlorperazine, Promethazinen Tx (4)
- Post op - Gastroenteritis - Chemo - Motion sickness (not DOC though)
52
Prochlorperazine, Promethazinen SE
- Highly sedating
53
Used for chemo induced N/V, stimulates appetite
- Dronabinol, Medical marijuana, Nabilone
54
Laxative MOA (4)
- Increase GI motility - Prevent reabsorption of water/electrolytes - Enhance secretion of water/electrolytes - Dissolve or lubricate feces
55
Bulk forming agents
- Fiber (dietary, methylcellulose, psyllium, polycarbophil) | - High fiber diet best
56
Fiber SE
- Bloating and flatulence common
57
Osmotic laxatives (3)
- Mg Hydroxide (stimulate GI tract, increase peristalsis) - Na Salts (oral, enema) - Sorbitol, Mannitol, Sucralose (sweeteners)
58
Polyethylene glycol MOA
- Insoluble, holds water in intestine
59
Polyethylene glycol Tx
- Prep for colonoscopy
60
OTC for ocassional constipation
Miralax used for up to 7 days
61
Lactulose Tx
- Used in cirrhosis and liver dz to decrease blood ammonia levels
62
Lactulose MOA (2)
- Conversion to lactic acid, decrease pH in gut lumen | - Traps ammonium in gut lumen
63
Lactulose SE (2)
- Flatulence | - Diarrhea
64
Mucosal Agents (3)
- Bisacodyl - Senna - Castor oil
65
Mucosal Agent MOA
- Stimulate peristalsis | - Enhance secretion/inhibit absorption H2O
66
Intense Mucosal agent that is not recommended
Castor oil
67
Mucosal Agent Tx (2)
- Surgery | - Diagnostics
68
Mucosal Agent requires _____
Bile
69
Mucosal Agents CI
- Pregnancy (stimulates uterus)
70
Lubricants/Softeners MOA
- Increase bulk | - Soften and lubricate stool
71
Lubricants/Softeners (3)
- Mineral Oil - Docusate - Glycerin - -- Not very effective
72
Mineral Oil MOA
Fat soluble vitamins, inhalation orally (aspiration PNA), leaking (need to wear depends)
73
Docusate MOA
Emulsifies, softens, may incraese water
74
Glycerin MOA
Lubricate
75
Lubiprostone MOA
- Prostaglandin E1 analogue | - Activates CIC-2 Cl channels in luminal cells to increase fluid secretion
76
Lubiprostone Features (6)
- Softer stool, better motility - Fewer symptoms of constipation - No effect on electrolytes - No lax dependence - N/D, HA - Not absorbed systemically
77
Use of Laxatives (7)
- Reduce straining - Maintain soft stools - Empty bowel for dx or surgical procedures - Decrease bowel tone - Geriatrics, preg - Get rid of pathogens/toxins - Constipation
78
Contraindications of Laxatives
- N/V - Abd cramps - Undx abd pain - Appendicitis - Intestinal obstruction
79
Over use of laxatives can lead to (4)
- Dependence - Fluid/electrolyte imbalance - Spastic colitis - Ulcerative colitis
80
Diarrhea drugs MOA (3)
- Absorb excess water (Fiber, Al salts) - Inhibit secretion - Decrease motility (opioids, anticholinergics)
81
Absorbents MOA (3)
- Absorb water, form gel-like mass - Increase bulk - Dietary (bananas, applesauce) - Not very effective
82
Opioids in Diarrhea
- Loperamide (Imodium) | - Diphenoxylate/ atropine (Lomotil)
83
Loperamide (Imodium) Features (2)
- Does NOT enter CNS (low abuse) | - May cause abd pain/constipation
84
Diphenoxylate/ atropine (Lomotil)
- With atropine, decreases abuse, increase effectiveness | - Anticholinergic SE
85
Opioid CI
- Infections (dec expulsion of pathogens) - Ulcerative colitis (toxic megacolon) - Recovering drug addicts (some abuse potential)
86
Bismuth subsalicylate MOA
- Absorb water | - Absorb pathogens
87
Bismuth subsalicylate Tx
- Traveller's diarrhea
88
Black tongue, mouth and stool
Bismuth subsalicylate
89
Bismuth subsalicylate CI
- Pts allergic to aspirin - Childrens (reyes) - Caution in asthmatics
90
Simethicone MOA (FYI)
- Coats gas, dissipates | - Decreases bloating flatulence
91
Sulfsalazine (FYI)
- Antiinflamm - 5 aminosalicylic acid plus sulfapyridine - Bacteria in GI tract activate it - Used in Inflamm bowel dz - Allergic rxn possible - Avoid in children (reyes)

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