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GI Flashcards

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1
Q

Bismuth Subsalicylate (Pepto-Bismol)

A
  • NV
  • SUBSALICYLATE=BLEEDING
  • NO MORE THAN 4 G IN 24 HR
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2
Q 
Bismuth Subsalicylate (Pepto-Bismol) 
Pharm
A
  • Salicylate well absorbed in stomach, 80%
  • bismuth poor absorb, but coats ulcers well
  • Subsalicylate hydrolized in stomach into salicylate
  • sali excret in urine
  • bismuth excret in stool
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3
Q 
Bismuth Subsalicylate (Pepto-Bismol) 
SE
A
  • discolored tongue

- black stools

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4
Q 
Bismuth Subsalicylate (Pepto-Bismol) 
Contra
A
  • Peds (Reyes Syndrome)

- ALLERGY TO ASPRIN

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5
Q

Phenothiazines

A
  • NV
  • Promethazine (Phenergan), Prochlorperazine (Compazine)
  • NOT 1ST CHOICE
  • ANTIDOPAMINERGIC (BLOCKS DOPAMINE RECEPTERS)
  • SEDATION, DIZZINESS
  • no under 2 (resp depress)
  • mood changes
  • constipation
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6
Q

Phenothiazines
-Promethazine (Phenergan), Prochlorperazine (Compazine)
MOA

A

-ANTIDOPAMINERGIC (BLOCKS DOPAMINE RECEPTERS)
blocks vagus nerve in gi tract
-phenergan antihistamine to H1 recepters

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7
Q

Phenothiazines
-Promethazine (Phenergan), Prochlorperazine (Compazine)
Pharm

A
  • metab liver

- excret stool

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8
Q

Phenothiazines
-Promethazine (Phenergan), Prochlorperazine (Compazine)
SE

A
  • SEDATION
  • DIZZINESS
  • mood changes
  • constipation
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9
Q

Phenothiazines
-Promethazine (Phenergan), Prochlorperazine (Compazine)
Contra

A
  • bad HTN
  • no under 2 (resp depress)
  • BPH
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10
Q

Serotonin 5-HT Receptor Antagonists

A
  • NV
  • Ondansetron (Zofran), Palonosetron (Aloxi)
  • Selective 5-HT3 Receptor Antagonist binds in CNS and periphery, reducing vagal nerve stim
  • not clear if effects are from CNS or periphery
  • SE=QT Prolongation
  • Contra=Congenital Long QT Syndrome, Any Meds that prolong QT
  • well absorb po, especially w/ food
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11
Q

Serotonin 5-HT Receptor Antagonists
-Ondansetron (Zofran), Palonosetron (Aloxi)
MOA

A
  • Selective 5-HT3 Receptor Antagonist binds in CNS & periphery, reducing vagal nerve stim
  • not clear if effects are from CNS or periphery
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12
Q

Serotonin 5-HT Receptor Antagonists
-Ondansetron (Zofran), Palonosetron (Aloxi)
PHARM

A
  • well absorb PO, best with food
  • metab liver
  • 70% protein bound
  • excret urine
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13
Q

Serotonin 5-HT Receptor Antagonists
-Ondansetron (Zofran), Palonosetron (Aloxi)
SE

A
  • headache
  • dizziness
  • QT Prolongation
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14
Q

Serotonin 5-HT Receptor Antagonists
-Ondansetron (Zofran), Palonosetron (Aloxi)
Contra

A
  • allergy
  • Congenital Long QT Syndrome
  • No meds that prolong QT
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15
Q

Acid Reflux/ Gastritis

A
  • very common, 10%
  • No ONE CAUSE
  • transient lower esophageal sphinter relaxation
  • low resting esophag sphinc
  • bad esophag acid clearance
  • esophag motility defect
  • impaired mucosal resistance & other protective defenses
  • burning sensation, chest pain, globus sensation
  • acidic or spicy foods
  • lifestyle modification first
  • common in pregnancy
  • Kids can take anything for GERD
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16
Q

Antacids

A
  • Acid Reflex/Gastritis
  • Sodium Bicarbonate (Baking Soda), Calcium Carbonate, Magnesium Hydroxide, Aluminum Hydrozide
  • Alkalizing Agent
  • Bad Kidney=Don’t Give
  • Contra=Renal Failure for meds with Aluminum and Magnesium
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17
Q

Antacids
-Sodium Bicarbonate (Baking Soda), Calcium Carbonate, Magnesium Hydroxide, Aluminum Hydroxide
MOA

A
  • weak bases react w/ gastric acid to form a salt and water, which decreases gastric acidity
  • Alkalizing agent
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18
Q

Antacids
-Sodium Bicarbonate (Baking Soda), Calcium Carbonate, Magnesium Hydroxide, Aluminum Hydroxide
PHARM

A
  • bicarbonate some po absorb, better with food
  • hydroxide poor po
  • carbonate excret stool
  • aluminum and magnesium excret in urine
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19
Q

Antacids
-Sodium Bicarbonate (Baking Soda), Calcium Carbonate, Magnesium Hydroxide, Aluminum Hydroxide
SE

A

-dependence

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20
Q

Antacids
-Sodium Bicarbonate (Baking Soda), Calcium Carbonate, Magnesium Hydroxide, Aluminum Hydroxide
Contra

A
  • Renal Failure for those with Aluminum or Magnesium

- Bad Kidney, Don’t give!

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21
Q

Sucralfate (Carafate)

A
  • Acid Reflux/Gastritis
  • can change other meds
  • paste coats ulcers
  • post gastric bypass
  • dissolve in H2O for 30 mins
    • joins - to form protective barrier
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22
Q

Sucralfate (Carafate)

MOA

A
    • charged sucrose sulfate binds to - charged proteins in base of ulcers, forms adherent protective barrier from gatric acid and bile salts (+ joins - to form protective barrier)
  • dissolve in H2O for 30 mins
  • paste coats ulcers
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23
Q

Sucralfate (Carafate)

PHARM

A
  • little absorb

- excret in stool

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24
Q

Sucralfate (Carafate)

SE

A

-constipation

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25
Sucralfate (Carafate) | Contra
- allergy | - may affect absorb of other meds!
26
H-2 Receptor Antagonists
- Acid Reflux/ Gastritis - Ranitdine (Zantac), Famotidine (pepcid), Cimetidine (Tagamet) - 1st line! - competitive inhibitors of H-2 Receptors in gastric parietal cells cause decrease gastric acid - No H1 or H3 efficacy, so no sedation - Gynecomastia - decrease ETOH, don't take w/ wine - food in belly=wait 3 hrs - lay down
27
H-2 Receptor Antagonists -Ranitdine (Zantac), Famotidine (pepcid), Cimetidine (Tagamet) MOA
- competitive inhibitors of H-2 Receptors in gastric parietal cells cause decrease gastric acid - No H1 or H3 efficacy, so no sedation - decrease ETOH, don't take w/ wine - food in belly=wait 3 hrs - lay down
28
H-2 Receptor Antagonists -Ranitdine (Zantac), Famotidine (pepcid), Cimetidine (Tagamet) PHARM
- good po - bioavail 50% - metab liver - excret urine
29
H-2 Receptor Antagonists -Ranitdine (Zantac), Famotidine (pepcid), Cimetidine (Tagamet) SE
- headache - dizziness - confusion in elderly - gynecomastia
30
H-2 Receptor Antagonists -Ranitdine (Zantac), Famotidine (pepcid), Cimetidine (Tagamet) CONTRA
- confusion in elderly | - potent P450 inhibitor
31
``` Bismuth Subsalicylate (Pepto-Bismol) PTS ```
-no peds (Reyes Syndrome)
32
Phenothiazines -Promethazine (Phenergan), Prochlorperazine (Compazine) PTS
- bad HTN - no under 2 (resp depress) - BPH
33
Antacids -Sodium Bicarbonate (Baking Soda), Calcium Carbonate, Magnesium Hydroxide, Aluminum Hydroxide PTS
- Preg B | - BF OK
34
Serotonin 5-HT Receptor Antagonists -Ondansetron (Zofran), Palonosetron (Aloxi) PTS
- allergy - Congenital Long QT Syndrome - No meds that prolong QT
35
Antacids -Sodium Bicarbonate (Baking Soda), Calcium Carbonate, Magnesium Hydroxide, Aluminum Hydroxide PTS
- Bad Kidney, Don't give! - Preg B - BF OK
36
Sucralfate (Carafate) | PTS
- Preg B - Off label peds - allergy - can change absorb of other meds
37
H-2 Receptor Antagonists -Ranitdine (Zantac), Famotidine (pepcid), Cimetidine (Tagamet) PTS
- Preg B - Peds OK - confusion in elderly
38
Proton Pump Inhibitors (PPIs)
- Acid Reflux/ Gastritis - Omeprazole (Prilosec), Lansoprazole (Prevacid), Pantoprazole (Protonix), Esomeprazole (Nexium) - Good for Renal (mostly liver) - take on an empty stomach 1st thing in AM - low B12 increases pernicious anemia (long term take supplements) - Protein bound - 4-8 wks then diagnostics - ulcers - lower CA absorb - short half life - lower Clopidogrel activation - Prodrug, must survu=ive acidic environment to be absorb in small bowel - SE=increased risk of osteoporosis related fractures w/ prolonged use
39
Proton Pump Inhibitors (PPIs) -Omeprazole (Prilosec), Lansoprazole (Prevacid), Pantoprazole (Protonix), Esomeprazole (Nexium) MOA
- binds irreversibly to H+/K+ exchanging ATPase pumps (Proton Pumps) in gastric parietal cells - decreases basal and stimulated acid secretion
40
Proton Pump Inhibitors (PPIs) -Omeprazole (Prilosec), Lansoprazole (Prevacid), Pantoprazole (Protonix), Esomeprazole (Nexium) PHARM
- take on an empty stomach 1st thing in AM - low B12 increases pernicious anemia (long term take supplements) - Protein bound - short half life - lower Clopidogrel activation - Prodrug, must survu=ive acidic environment to be absorb in small bowel - good po avail, decreased w/ food - metab in liver - inhibits CYP2C19 - excret in stool - adjust dose for hepatic disease - little renal excret
41
Proton Pump Inhibitors (PPIs) -Omeprazole (Prilosec), Lansoprazole (Prevacid), Pantoprazole (Protonix), Esomeprazole (Nexium) SE
-headache -increase risk of C. Diff infection -low Mg w/ prolonged use increased risk of osteoporosis related fractures w/ prolonged use
42
Proton Pump Inhibitors (PPIs) -Omeprazole (Prilosec), Lansoprazole (Prevacid), Pantoprazole (Protonix), Esomeprazole (Nexium) CONTRA
-allergy
43
Proton Pump Inhibitors (PPIs) -Omeprazole (Prilosec), Lansoprazole (Prevacid), Pantoprazole (Protonix), Esomeprazole (Nexium) PTS
- osteoporosis - hepatic pt adjust dose - Good for Renal (mostly liver)
44
Gastric Motility Agents
- Metclopromide (Reglan) - gi motility caused by D2 Antagonism - emotion - concurrent use of drugs capable of causing EPS/TD (involuntary face movements) - no more than 8-12 wks
45
Gastric Motility Agents -Metclopromide (Reglan) MOA
- binds to dopamine D2 Receptors in CNS and some 5-HT3 antagonism - gi motility caused by D2 Antagonism
46
Gastric Motility Agents -Metclopromide (Reglan) PHARM
- well absorb po - bioavail 65-90% - metab liver - excret in urine - decrease dose in renal insuff
47
Gastric Motility Agents -Metclopromide (Reglan) SE
- EPS secondary to dopamine blockade - high prolactin - gynemastia - galactorrhea - irreversible tardive dyskinesia (involun face movements)
48
Gastric Motility Agents -Metclopromide (Reglan) Contra
- allergy | - concurrent use of drugs capable of causing EPS/TD (involuntary face movements)
49
Gastric Motility Agents -Metclopromide (Reglan) PTS
- Safe Preg - No BF - Off-label in Peds - decrease dose in renal insuff - concurrent use of drugs capable of causing EPS/TD (involuntary face movements)
50
Constipation
- ask what their normal pattern is - decreased stool passage - straining, hard pellet stools - Causes: potty training (control), meds, diet, tumors, kids w/ developmental delays (frequent small mushy stools, Encropresis) - 1st line always Osmotic Laxative, Polyethylene Glycol (Miralax) always 1st line med (doesn't alter glucose or electrolyes like colace)
51
Osmotic Laxatives | -Magnesium hydroxide (Milk of magnesia), Lactulose, Magnesium Citrate, Polythylene glycol (Miralax)
- constipation - “1st line treatment” - Polythylene glycol (Miralax) used first line medication - great option for long term treatment - 12 hours to work
52
Osmotic Laxatives -Magnesium hydroxide (Milk of magnesia), Lactulose, Magnesium Citrate, Polythylene glycol (Miralax) MOA
- Causes water retention in stool | - Soluble but not nonabsorbable compounds
53
Osmotic Laxatives -Magnesium hydroxide (Milk of magnesia), Lactulose, Magnesium Citrate, Polythylene glycol (Miralax) PHARM
- No PO absorption | - Eliminated in stool as unchanged drug
54
Osmotic Laxatives -Magnesium hydroxide (Milk of magnesia), Lactulose, Magnesium Citrate, Polythylene glycol (Miralax) SE
- Diarrhea | - Abdominal complaints
55
Osmotic Laxatives -Magnesium hydroxide (Milk of magnesia), Lactulose, Magnesium Citrate, Polythylene glycol (Miralax) CONTRA
- Existing electrolyte abnormalities | - Under 2 years of age
56
Osmotic Laxatives -Magnesium hydroxide (Milk of magnesia), Lactulose, Magnesium Citrate, Polythylene glycol (Miralax) PTS
- no Existing electrolyte abnormalities | - no Under 2 years of age
57
Bulk Laxatives
- constipation | - Metamucil, Fibercon
58
Bulk Laxatives -Metamucil, Fibercon MOA
- Absorb water and enlarge stools | - Stimulates propulsive movements of lower GI tract
59
Bulk Laxatives -Metamucil, Fibercon PHARM
- No PO absorption | - Excreted in stool as unchanged drug
60
Bulk Laxatives -Metamucil, Fibercon SE
- Nausea - Vomiting - Abdominal fullness
61
Bulk Laxatives -Metamucil, Fibercon CONTRA
- Bowel obstruction | - Use under 6 years old
62
Bulk Laxatives -Metamucil, Fibercon PTS
- Preg OK - BF OK- - Peds: not under 6
63
Stimulant Laxatives
- ,constipation - Senna (Sennakot, Exlax) - most common perscription - irritates intestinal lining - do not give w/ fecal impaction - hide from kids, looks like candy - 2nd degree burns in kids from exlax poop - dependence w/ reg use - 12 hrs
64
Stimulant Laxatives -Senna (Sennakot, Exlax) MOA
-Irritates intestinal lining causing increased peristalsis and propulsion of intestinal contents
65
Stimulant Laxatives -Senna (Sennakot, Exlax) PHARM
- Minimal PO absorption | - Excreted in stool as unchanged drug
66
Stimulant Laxatives -Senna (Sennakot, Exlax) SE
- Diarrhea - Nausea - Dependence with Regular Use
67
Stimulant Laxatives -Senna (Sennakot, Exlax) CONTRA
- BF | - fecal impaction
68
Stimulant Laxatives -Senna (Sennakot, Exlax) PTS
- NO BF | - NO impaction
69
Diarhea
- 3 OR MORE A DAY - CHECK FLUIDS AND ELECTROLYTES - IDENTIFY CAUSE AND TREAT THE CAUSE. - kids: too much fruit - gum or candy sweetened w/ sorbital
70
Opioid Agonist
- diarhea - Loperamide - DOSE NOT CROSS BBB - SIGNIFICANT FIRST PASS METABOLISM - BF unknown - slows motility by opiod receptor activation - reduce volume and increase viscosity
71
Opiod Agonist -Loperamide MOA
- slows motility by opiod receptor activation | - reduce volume and increase viscosity
72
Opioid Agonist -Loperamide PHARM
- Little PO absorption - DOSE NOT CROSS BBB - SIGNIFICANT FIRST PASS METABOLISM - Excreted in stool
73
Opioid Agonist -Loperamide SE
- Fatigue - Dizziness - Constipation - Nausea - toxic mega colon
74
Opioid Agonist -Loperamide CONTRA
- High Fever - Bloody Diarrhea - Acute UC Flare - Age Less than 2 - C Diff
75
Opioid Agonist -Loperamide PTS
- Safe in Pregnancy - UNKNOWN if distributed in breastmilk - High Fever - Bloody Diarrhea - Acute UC Flare - Age Less than 2 - C Diff
76
IRRITABLE BOWEL SYNDROME
- DIAGNOSIS OF EXCLUSION! Lifestyle | - lifestyle changes/modifications then medication
77
Antispasmodics
- IBS | - Dicyclomine, hyoscyamine
78
Antispasmodics -Dicyclomine, hyoscyamine MOA
- Inhibit cholinergic receptors on smooth muscle | - not specific to GI smooth muscle
79
Antispasmodics -Dicyclomine, hyoscyamine PHARM
- Inhibit cholinergic receptors on smooth muscle | - not specific to GI smooth muscle
80
Antispasmodics -Dicyclomine, hyoscyamine SE
-anticholergic
81
Antispasmodics -Dicyclomine, hyoscyamine PTS
- PREG OK - BF NO - No Infants less than six month
82
5HT3 antagonist
- IBS - Alosetron (Lotronex) - (Always remember: NO LONGER PRESCRIBED BY PRIMARY CARE) - for diarrhea
83
5HT3 antagonist -Alosetron (Lotronex) MOA
- Modulates enteric nervous system, slows GI activity | - Primarily for diarrhea predominant IBS
84
Chloride Channel Activators
- Lubiprostone (Amitiza) - IBS-C - empty stomach - only women
85
Chloride Channel Activators -Lubiprostone (Amitiza) SE
- diarhea | - nausea
86
Chloride Channel Activators -Lubiprostone (Amitiza) CONTRA
-no pts with potential for chronic obstruction
87
Chloride Channel Activators -Lubiprostone (Amitiza) PTS
- only women IBS-C - Preg C - No BF - No Peds - No Men
88
Chloride Channel Activators
- IBS - Linaclotide, Linzess - FLATULENCE - FECAL INCONTINENCE - take on empty stomach 30 mins before meal
89
Chloride Channel Activators -Linaclotide, Linzess MOA
- Guanylate cyclase-C (GC) agonist - Binds to receptors in intestine activates CGMP which stimulates secretion of chloride and bicarbonate results in increased intestinal fluid
90
Chloride Channel Activators -Linaclotide, Linzess PHARM
- Minimal systemic availability; take 30 minutes prior to first meal of day on empty stomach - Metabolized within GI tract - Excretion primarily stool
91
Chloride Channel Activators -Linaclotide, Linzess SE
- Diarrhea - Dyspepsia - FLATULENCE - FECAL INCONTINENCE
92
Chloride Channel Activators -Linaclotide, Linzess CONTRA
Patients with known obstruction
93
Chloride Channel Activators -Linaclotide, Linzess PTS
- No risk with hepatic or renal impairment - Only Adults - No Preg - NO BF - No Peds - Geri-unknown
94
Inflammatory Bowel Disease
- 1st line treatment for acute flare is steroid, then send to GI dr - Chrohns (mouth to anus) (Skip Lesions) (1st steroid, 2nd aminosalicylates) - UC (only colon) - immunomodulaters more popular, may allow pts to avoid steroids
95
Aminosalicylates
- Inflammatory Bowel Disease - Sulfasalazine (Azulfidine), Mesalamine (Asacol), Balsalazide (Cozaal) - mesalamine good for unclompicated UC - 2nd line for Crohns - metab liver - bone marrow suppression (R/T Reyes Syndrome) - blood disorders - liver function tests, CBC - decrese CBC - “REMISSION TX” - Children with Varicella or Flulike symptoms – R/T REYE SYNDROME (REMEMBER THIS MED IS A SALICYLATE just like the BISMUTH SUBSALICYLATE
96
Aminosalicylates -Sulfasalazine (Azulfidine), Mesalamine (Asacol), Balsalazide (Cozaal) MOA
- Not certain, likely blocks prostaglandin synthesis | - May inhibit cellular function of NK cells, mucosal lymphocytes and macrophages
97
Aminosalicylates -Sulfasalazine (Azulfidine), Mesalamine (Asacol), Balsalazide (Cozaal) PHARM
- Well absorbed in small intestine, but minimal colonic absorption - Up to 78% PROTEIN bound - Metabolized in liver - Excreted in stool
98
Aminosalicylates -Sulfasalazine (Azulfidine), Mesalamine (Asacol), Balsalazide (Cozaal) SE
- Nausea - GI upset - Headaches - Bone Marrow Suppression can be r/t Reye Syndrome
99
Aminosalicylates -Sulfasalazine (Azulfidine), Mesalamine (Asacol), Balsalazide (Cozaal) CONTRA
- Breastfeeding - Children with Varicella or Flulike symptoms – R/T REYE SYNDROME (REMEMBER THIS MED IS A SALICYLATE just like the BISMUTH SUBSALICYLATE)
100
Aminosalicylates -Sulfasalazine (Azulfidine), Mesalamine (Asacol), Balsalazide (Cozaal) PTS
- NO BF - -Children with Varicella or Flulike symptoms – R/T REYE SYNDROME (REMEMBER THIS MED IS A SALICYLATE just like the BISMUTH SUBSALICYLATE)
101
Glucocorticoids
- IBD - Budesonide (Entocort) - Metaolized EXTENSIBLY in liver - NOT FOR MAINTAINING DISEASE - HIGH FAT MEAL WILL DELAY ENTOCORT ABSORPTION - RECTAL PREPARATION FIST LINE FOR UC FLARE (reduce inflamation) - EVALUATE: Glucose, Electrolytes, and Bone Density
102
Glucocorticoids -Budesonide (Entocort) MOA
-Antiinflammatory corticosteroids, reduce inflammation by suppressing migration of polymophonuclear leukocytes, decreases protoglandin synthesis
103
Glucocorticoids -Budesonide (Entocort) PHARM
- “FIRST LINE TREATMENT” - Not well absorbed - Entocort has max 21% BIOAVAILABILITY - Metaolized EXTENSIBLY in liver - Excreted in urine
104
Glucocorticoids -Budesonide (Entocort) SE
- Headache | - Nausea/Vomiting
105
Glucocorticoids -Budesonide (Entocort) CONTRA
- NOT FOR MAINTAINING DISEASE - Allergy - HIGH FAT MEAL WILL DELAY ENTOCORT ABSORPTION
106
Glucocorticoids -Budesonide (Entocort) PTS
- RECTAL PREPARATION FIST LINE FO UC FLARE | - NOT FOR MAINTAINING DISEASE
107
Purine Analogs
- IBD - Azathioprine (Imuran), 6-MP (Purinethol) - Azathioprine refractury UC - reducing immune response - Active malignancy (LONG TERM USE CAN INCREASE RISK OF MALIGNANCIES ESP LYMPHOMA) - check labs
108
Purine Analogs -Azathioprine (Imuran), 6-MP (Purinethol) MOA
-Blocks Synthesis of purine which hinders DNA, RNA and protein synthesis in fast growing cells like lymphocytes, reducing immune response
109
Purine Analogs -Azathioprine (Imuran), 6-MP (Purinethol) PHARM
- Azathioprine has better absorption than 6-MP - 30% protein bound - Metabolized in liver - Excreted in urine
110
Purine Analogs -Azathioprine (Imuran), 6-MP (Purinethol) SE
- Pancytepenia - Infection - Hepatotoxicity - Pancreatitis - Active malignancies (Lymphoma) (long term)
111
Purine Analogs -Azathioprine (Imuran), 6-MP (Purinethol) CONTRA
-Active malignancy (LONG TERM USE CAN INCREASE RISK OF MALIGNANCIES ESP LYMPHOMA)
112
Purine Analogs -Azathioprine (Imuran), 6-MP (Purinethol) PTS
- Preg No - BF No - Active malignancy (LONG TERM USE CAN INCREASE RISK OF MALIGNANCIES ESP LYMPHOMA)
113
Immunosuppresive
- IBD - Azathioprine (Imuran) - Methotrexate (Rheumatrex) - Cyclosporine (Sandimmune) - Evaluate: CBC, Serum Creatinine, Amylase, LFT
114
Immunosuppresive -Azathioprine (Imuran) MOA
-Decrease inflammatory mediators
115
Immunosuppresive -Azathioprine (Imuran) PHARM
- Absorption- Oral well absorbed - Protein binding – 30% - Metabolism – Hepatic - Excretion – Urine
116
Immunosuppresive -Azathioprine (Imuran) SE
- Dependent on dosing - Hepatotoxic - Increased susceptibility to infection - Leukopenia
117
Immunosuppresive -Azathioprine (Imuran) PTS
- AVOID USE IN PREGNANCY | - AVOID IN BF
118
Immunosuppresive -Methotrexate (Rheumatrex) MOA
- Suppresses interleukin 1 | - Folate antimetabolite
119
Immunosuppresive -Methotrexate (Rheumatrex) PHARM
-Dose based on Renal function
120
Immunosuppresive -Methotrexate (Rheumatrex) PTS
-No Preg
121
Immunosuppresive -Cyclosporine (Sandimmune) MOA
- Acute Exacerbations | - Suppresses Cell mediated Immunity
122
Immunosuppresive -Cyclosporine (Sandimmune) PHARM
- IV - Oral is INEFFECTIVE - decrease bone marrow - pancreatic and joint pain
123
Immunosuppresive | -Cyclosporine (Sandimmune)
- decrease bone marrow | - pancreatic and joint pain
124
Biological Agents
- IBD - TNF Inhibitors (Humira, Remicaide, Cimzia) - resistant Crohns Disease
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Biological Agents -TNF Inhibitors (Humira, Remicaide, Cimzia) SE
- opportunistic infections - TB - Hep B reactivation
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Monitor for Toxicity
- Aminosalicylates (CBC, LFT) - Corticosteroids (Glucose levels, Electrolytes, Bone Density) - Immunosuppressive (
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H2 Blockers: CimetiDINE, RanitiDINE, FamotiDINE, NizatiDINE
- Clinical Use: decrease acid: peptic ulcer disease, gastritis, mild GERD - MOA: reversibly (competitive) block histamine H2; decrease H+ from parietal cells - **Cimetdine: crosses BBB--lipophilic, uncharged (confusion, dizziness, headaches) - P450 inhibitor - Antiandrogenic effects (prolactin release, gynecomastia, decrease male libido) - **Cimetidine & Ranitidine: decrease renal creatinine excretion
128
PPI Proton Pump Inhibitor: OmePRAZOLE, LansoPRAZOLE, EsomePRAZOLE, PantoPRAZOLE, DexlansoPRAZOLE
- Clinical Use: decrease acid: peptic ulcer, gastritis, GERD, Zollinger-Ellison Syndrome - MOA: Irreversibly (noncompetitive) block H+/K+ ATPace in parietal cells of stomach - SE: Increased risk of C.diff, pneumonia, hip fractures, decreased serum magnesium (long-term)
129
Bismuth, Sulcralfate:
- MOA: provides physical protection (coating) by binding to the GI ulcer - Allows HCO3 to promote mucous layer production - Clinical Use: Promote ulcer healing, traveler’s diarrhea
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Misoprostol:
- MOA: PGE-1 analog - Stimulates production and secretion of gastric mucus - Decreased acid production - SE: Diarrhea, contraindicated in pregnancy (can cause abortion due to vasoconstriction) - Clinical Use: Prevent NSAID induced gastritis, traveler’s diarrhea
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Octreotide:
MOA: long-acting somatostatin analog - SE: (slows things down) nausea, cramps, steatorrhea (fat in stool due to system slowed down) - Clinical Use: acute variceal bleeding (painless, hematemesis, dilation), acromegaly (inhibits growth hormone), VIPoma (vasoactive intestinal peptide), Carcinoid tumors - Mallory-Weiss-painful hematemesis (alcoholics)
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Antacids:
- MOA: drop the base - SE: can cause changes in absorption, bioavailability, urinary excretion - Clinical Use: decrease stomach acid - *Aluminum hydroxide-constipation - *Magnesium hydroxide-diarrhea, hyporeflexia (magnesium competes with sodium and creates a traffic jam…magnesium gets through but sodium can’t) - *Calcium carbonate-hypercalcemia
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Osmotic Laxatives: Magnesium hydroxide, lactulose, magnesium citrate, polyethylene glycol
- SE: diarrhea, dehydration | - Clinical Use: constipation
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Sulfasalazine:
-MOA: Combination of 5-ASA anti-inflammatory; Sulfapyridine-antibacterial SE: Malaise, nausea, sulfonamide poisoning, reversible oligospermia -Clinical Use: Crohn’s disease (RLQ pain), Ulcerative colitis (LLQ pain) -Loperimide –LOWERS mortality in IBD
135
Ondansetron:
- MOA: 5-HT3 antagonist; antiemetic especially in cancer patients - SE: headache, constipation (decreased motility) - Clinical Use: post-op vomiting, cancer chemotherapy
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Metoclopramide:
- MOA: D2 (dopamine) receptor antagonist; increased gastric motility/tone - SE: Increased Parkinsonian effects, depression-like symptoms, interaction with digoxin and diabetes drugs - Clinical Use: gastroparesis (post-op, diabetics); antiemetic - Contraindications: SBO, Parkinson’s Disease
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RENAL FAILURE
NO MAGNESIUM OR ALLUMINUM
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PPIs
OSTEOPEROSIS | TAKE ON EMPTY STOMACH
139
SEROTONIN 5-HT RECEPTOR ANTAGONISTS
CONSTIPATION
140
REGLAN
TARDIVE KINESIA
141
KIDS AND GERD
EVERYTHING!
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1ST LINE TREATMENT FOR IBC
GLUCOSTEROID
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CONSTIPATION
POLYTHENE GLYCOL/MIRALAX
144
IBS-C
CHLORIDE CHANNEL ACTIVATORS LUBIPROSTONE (AMITZIA) WOMEN ONLY
145
PHENERGAN
CONSTIPATION | MOOD CHANGES

Pharmacology Test 3 (5 decks)

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