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Flashcards in GI Deck (110):
1

AE of antacids

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)

2

enhancement of gastric acid secretion

1) histamine
2) acetylcholine
3) gastrin

3

MgOH AE

produces Mg salt - poor absorption --> diarrhea

4

AlOH AE

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

5

CaCO3 AE

hypercalcemia
nephrolithiasis
constipation --> fecal compaction

6

Reversible H2 blockers

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

cimetidine = shortest acting, and least potent

7

H2 blocker use in ICU pt

prophylaxis for acute stress ulcers

8

H2 AE

nausea, HA, dizzy
cimetidine: anti-androgenic effects - newer H2's don't do this and don't inhibit CYP450

9

Cimetidine AE

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

crosses BBB and placenta

cimetidine+ranitidine = dec renal excretion of creatinine

10

Cimetidine contraindicated with

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

11

Omeprazole contraindicated with

warfarin, clopidogrel, phenytoin, diazepam, cyclosporine

- omeprazole inhibits their metabolism

12

PPI AE

inc in respiratory and GI infection

dec Mg serum levels -- hip fractures

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

13

1st lines for h pylori

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

14

clarithromycin MOA

bacteriostatic
binds 23S rRNA of 50s = prevents translocation

15

clarithromycin uses

h pylori
atypical PNA
CAPNA
pertussis
corneybacteria

16

clarithromycin AE

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

17

Amoxicillin MOA

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

18

amoxicilin use

h pylori
G+ and some G(-)'s

19

amoxicilin AE

rash, hypersensitivity, pseuomembranous colitis

resisitance = b-lactamase cleaves b-lactam ring

20

metronidazole MOA

bactericidal
inhib. electron transport system - toxic metabolites that damage DNA

21

metronidazole use

h pylori
c diff
bacteroides
antiprotozoal

22

metronidazole AE

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

23

tetracycline MOA

binds 30s and prevents aminoacyl-tRNA attachment

24

tetracycline AE

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

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

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