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PHARM 2 > GI > Flashcards

GI Flashcards

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1
Q

AE of antacids

A

decreases oral absorption of tetracyclines with milk (Ca), antacids (Ca/Mg) or iron containing meds (via chleation)

increaes oral absorption of weak bases (quinidine)

decreases oral absorption of weak acids (warfarin)

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2
Q

enhancement of gastric acid secretion

A

1) histamine
2) acetylcholine
3) gastrin

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3
Q

MgOH AE

A

produces Mg salt - poor absorption –> diarrhea

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4
Q

AlOH AE

A

reacts with HCL –> AlCl = insoluble and causes constipation and hypophosphatemia

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5
Q

CaCO3 AE

A

hypercalcemia
nephrolithiasis
constipation –> fecal compaction

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6
Q

Reversible H2 blockers

A

1) cimetidine
2) ranitidine
3) famotidine
3) nizatidine

cimetidine = shortest acting, and least potent

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7
Q

H2 blocker use in ICU pt

A

prophylaxis for acute stress ulcers

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8
Q

H2 AE

A

nausea, HA, dizzy

cimetidine: anti-androgenic effects - newer H2’s don’t do this and don’t inhibit CYP450

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9
Q

Cimetidine AE

A

1) gynecomastia
2) inc prolactin
3) dec libido
4) confusion in elderly

crosses BBB and placenta

cimetidine+ranitidine = dec renal excretion of creatinine

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10
Q

Cimetidine contraindicated with

A

CYP 450 inhib - AE with warfarin, procainamide, phenytoin, benzo, theophylline, imipramine, quinidine

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11
Q

Omeprazole contraindicated with

A

warfarin, clopidogrel, phenytoin, diazepam, cyclosporine

  • omeprazole inhibits their metabolism
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12
Q

PPI AE

A

inc in respiratory and GI infection

dec Mg serum levels – hip fractures

prolonged use with H2 blockers = dec avail of B12, digoxin, and ketoconzaole

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13
Q

1st lines for h pylori

A

macrolides: clarithromycin
B-lactam: amoxicillin
antiprotozoals: metronidazole
broad spec: tetracycline

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14
Q

clarithromycin MOA

A

bacteriostatic

binds 23S rRNA of 50s = prevents translocation

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15
Q

clarithromycin uses

A 
h pylori
atypical PNA
CAPNA
pertussis
corneybacteria
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16
Q

clarithromycin AE

A

binds motilin receptors - GI upset: n/v
prolonged QT = arrhythmias
hepatitis
eosinophilia
affect oral anticoagulants via CYP450 inhibition
**resistance: methylation of 23s binding site - no binding of drug

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17
Q

Amoxicillin MOA

A

bactericidal - bind transpeptidase = prevent cross linking of PTGN - autolytic enzymes activated

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18
Q

amoxicilin use

A

h pylori

G+ and some G(-)’s

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19
Q

amoxicilin AE

A

rash, hypersensitivity, pseuomembranous colitis

resisitance = b-lactamase cleaves b-lactam ring

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20
Q

metronidazole MOA

A

bactericidal

inhib. electron transport system - toxic metabolites that damage DNA

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21
Q

metronidazole use

A

h pylori
c diff
bacteroides
antiprotozoal

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22
Q

metronidazole AE

A

flushing
tachycardia
low BP with alcohol (like disulfiram)
metallic taste

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23
Q

tetracycline MOA

A

binds 30s and prevents aminoacyl-tRNA attachment

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24
Q

tetracycline AE

A

GI upset, discolored teeth, inhibited bone growth in kids, photosensitivity

resistance: reduced uptake/inc efflux out of bacterial cells by plasmid encoded transp pumps

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25
metoclopramide MOA
5HT3 and D2 blocker = anti-emetic | 5HT4 agonist - muscarinic activity = prokinetic
26
metoclopramide use
diabetic, post op gastroparesis, relief GERD sxs
27
prokinetics (4)
1) metoclopramide 2) 5HT4 agonists 3) cholinomimetics 4) macrolides
28
metoclopramide AE
anti-dopaminergic: sedation, diarrhea, parkinsonian possib inc prolactin = infertility
29
cisapride MOA
5HT4
30
cisapride use
gastroparesis, GERD, constipation via Ach stimulation - not a first line b/c of AE
31
cisapride AE
arrhythmias
32
Cholinomimetics types
1) neostimgine - colonic pseudoobstruction | 2) bethanechol - resistance to cholesterase: long duration for post op bladder/bowel atony
33
erythromycin MOA
acts on motilin receptors
34
erythromycin use
gastric emptying before endoscopic procedures - if used for extended period, develops tolerance
35
anti-emetic agents
1) 5HT3 inhib 2) H1 antihistamine and anti-muscarinic 3) NK1 blocker 4) corticosteroids 5) D2 blocker 6) metoclopramide 7) cannabinoids
36
Ondansetron MOA
5HT3 blocker
37
Ondansetron AE
QT prolongation/arrhtyhmias
38
H1 antihistamines MOA
block peripheral and CNS H1 | block alpha and muscarinic
39
HI antihistamine uses
hay fever, angioedema, motion sickness
40
NK1 drugs
1) arepitant = PO | 2) fosaprepitant = IV
41
NK1 use
decreasing early and delayed emesis in cancer chemo
42
glucocorticoid agonists AE
``` adrenal suppression growth inhibition muscle wasting osteoporosis salt retention glucose intolerance behavior changes ```
43
glucocorticoid agonists (2)
1) dexamethasone | 2) methylprednisolone
44
first line chemo induced nausa/vomiting
dexamethasone Or methylprednisolone + ondansetron or combination of both
45
D2 blockers (3)
1) phenothiazines: D2 and M blockers 2) promethazine: anti-dop and anticholinergic 3) droperidol: anti-dopaminergic, antiemetic, antipsychotic, neuroleptic analgesic
46
Benzodiazepines (3)
lorazepam alprazolam diazepam
47
Dronabinol
acts on CB1 as agonist - cannabinoid
48
anti-diarrheals
1) opoid agonist (loperamide, diphenoxylate) 2) somatostatin analog (octreotide) 3) bismuth
49
Methotrexate - be sure to give (high/low) doses
LOW doses when not for cancer treatment
50
IBS tx (4)
1) anticholinergics: hyoscyamine, dicyclomine, glycopyrrolate, methscopalamine 2) 5HT3 blockers: alosetron 3) opioid agonists: loperamide 4) chloride channel activators: lubiprostone
51
PPI MOA
PPIs once in parietal cell - converted to active form, react with cysteine residue of H/K ATPase = stable covalent bond forms = IRREVERSIBLE inactivation of enzyme
52
Mucosal protective agents (3)
sucralfate bismuth subsalicylate misoprostol
53
sucralfate MOA
selectively binds to necrotic tissue = barrier to acid stimulates PG synthesis mucosal protective
54
sucralfate contraindications
ineffective if given with H2 blockers or PPI = requires acidic environment for activation
55
bismuth subsalicylate MOA
selectively binds ulcer and forms coating = protect from acid and pepsin
56
misoprostol MOA
prevent gastric ulcers induced by NSAIDs: activate EP receptors = inc HCO3 and mucus PGE1 also ineffective with PPI or H2
57
misoprostol AE
diarrhea uterine cramping abortifacient exacerbate IBD
58
loperamide
antidiarrheal opiate derivate
59
diphenoxylate
antidiarrheal opiate derivative
60
Opiate derivates for antidiarrheal MOA
act at GI mu opioid receptors: inhib Ach and dec peristalsis
61
Diphenoxylate AE
high doses can cause CNS effects formulated with atropine to reduce abuse
62
octreotide
somatostatin analog - anti-diarrheal
63
somatostain analog use
diarrhea carcinoid syndrome associated flushing VIP secreting tumors control bleeding from esophageal varices and acromegaly
64
ocreotide AE
GI disturbance gall stones bradycardia cardiac conduction anomalies
65
Laxative mechanisms
1) stimulants 2) bulk forming agents 3) osmotic agents 4) stool softeners 5) chloride channel activator 6) opioid receptor antagonist
66
senna
laxative - stimulant
67
bisacodyl
laxative - stimulant
68
methylcellulose
laxative - bulk forming agent
69
psyllium
laxative - bulk forming agent
70
bran
laxative - bulk forming agent
71
magnesium oxide
laxative - osmotic agent
72
magnesium hydroxide
laxative - osmotic agent
73
lactulose
laxative - osmotic agent
74
polyethylene glycol
laxative - osmotic agent
75
osmotic agents as laxatives AE
Mg may be absorbed and cause toxicity in renal impairment
76
lactulose USE
hepatic encephalopathy - draws out NH3 from body to prevent hyperammonia
77
glycerin
stool softening laxative
78
docusate
stool softening laxative
79
lubiprostone
chloride channel activator laxative
80
tx for IBS associated constipation
lubipristone
81
tx for opioid induced constipation
senna + docusate OR opioid receptor antagonists (alvimopan/methylnaltrexone)
82
alvimopan
opioid receptor antagonist laxative
83
methylnaltrexone
opioid receptor antagonist laxative
84
Drugs used in IBD
1) aminosalicylates 2) glucocorticoids 3) immunosuppressants 4) anti-TNFalpha 5) anti-integrins
85
sulfasalazine
aminosalicylate used for IBD
86
sulfasalazine MOA
inhibits eicosanoid inflam mediators
87
sulfasalazine contraindications/AE
avoid in pt with sulfa allergy HS. reversible oligospermia. BM suppression
88
mesalamine
aminosalicylate used for crohns and UC
89
mesalamine target
distal ileum and colon
90
Balsalazide
aminosalicylate used for UC
91
balsalazide target
large intestine - targets site of UC
92
glucocorticoids used for IBD
1) hydrocortisone 2) prednisone 3) prednisolone 4) budesonide
93
budesonide target
glucocorticoid used for IBD = distal ileum and colon
94
immunosuppressant used to treat IBD
MTX
95
MTX AE
``` nausea mucosal ulcers hematotoxicity hepatotoxicity teratogen ```
96
6 mercaptopurine
immunosuppressant tx UC and CD
97
azathioprine
immunosuppressant tx UC and CD
98
6-MP AE
myelosuppression, immunosuppresion, hepatotoxicity
99
infliximab
anti-TNF alpha drug for UC and CD
100
adalimumab
anti-TNF alpha drug for UC and CD
101
anti-TNF alpha AE
reactivation of latent TB
102
natalizumab
anti-integrin: blocks leukocyte integrins and can cause PML
103
IBS tx (4)
1) anticholinergic 2) 5HT3 antagonists 3) opioid agonist 4) chloride channel activators
104
anticholinergics for IBS
1) hyoscyamine 2) dicyclomine 3) glycopyrrolate 4) methscopalamine
105
anticholinergic IBS drugs AE
delirium, hallucinations, coma, tachy, HTN, hyperthermia
106
Alosteron
5 HT3 antagonist tx IBS
107
alosteron AE
ischemic colitis
108
loperamide
opioid agonist in IBS - diarrhea!
109
lubiprostone
chloride channel activator in IBS - constipation
110
ursodiol
bile acid therapy for gallstones

PHARM 2 (18 decks)

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