GI (Annie👵🏻) Flashcards by Shelby SK

What is milk-alkali Syndrome and what class of medications is it associated with?

It is a hypercalcemia with renal insufficiency and metabolic ALKALOSIS******

From taking a TON of antacids plus eating a lot of dairy

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Magnesium causes (constipation/diarrhea).

Aluminum causes (constipation/diarrhea).

What do we do about this?

Mg = diarrhea

Al = constipation

Give em together to even it all out!

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Antacids are inorganic _____ that neutralize ____ to form salts and H2O.

Bases

HCl

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What are the commonly used compounds in antacids?

Aluminum

Calcium carbonate******

Sodium bicarb

Magnesium

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What happens if you give magnesium to renal patients?

Possible toxicity

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What could be a bad effect of patients not telling you they are taking antacids because they just think they are “candy”?

Lots of drug interactions!!

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What class of drugs are the -tidines?

Cimetidine (Tagamet)
Ranitidine (Zantac)
Famotidine (Pepsid)
Nizatidine (Axid)

H2 histamine receptor antagonists

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Which GI drug can be used in anaphylaxis also?

Why?

H2 blockers

Because they decrease the H2-mediated vasodilation that occurs with anaphylaxis

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What side effect happens with chronic cimetidine at high doses?

Who is this bad for an who is it good for?

Antiandrogen effect

Men can get moobs

Women can use it for treating masculinization

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Which GI drug can cause an antiandrogen effect with chronic use at high doses?

Cimetidine (Tagamet)

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What is another use for H2 blockers besides GERD/ulcers/ZES?

In anaphylaxis used with H1 blockers

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Which H2 blocker has a LOT of drug interactions?

Does it induce or inhibit CYP3A4?

Cimetidine

Inhibits

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Which drugs will cimetidine interact with?

Any drug with a narrow therapeutic range!!

Warfarin 
Phenytoin
Theophylline
BZs
Digoxin
TCAs
Etc.

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Do all H2 blockers inhibit CYP3A4?

NOPE

Just cimetidine

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What is the MOA of proton pump inhibitors?

IRREVERSIBLE binding to the HK-ATPase in the parietal cells

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What is the DOC in GERD with esophagitis?

PPIs

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Do PPIs have a lot of side effect?

Why or why not?

NOPE

They are activated within the parietal cells so they don’t effect other cells?

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If someone does have side effects from PPIs, what will it be?

Some GI upset

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Why do PPIs take a few days to take full effect?

Because not all proton pumps are always active

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What happens if you stop taking a proton pump inhibitor?

You’ll still get the benefit of the drug for 24-48 hours after because of the IRREVERSIBLE action of the drug

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What drug class is associated with an increased risk of pneumonia and other upper respiratory infections?

PPIs

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What is a side effect of long term PPI use?

Reduced absorption of calcium, magnesium and B12

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What diseases can long term PPI use put you at risk for?

Pneumonia

Osteoporosis (from calcium deficiency)

Chronic kidney disease

Macrocytic anemia (from B12 deficiency)

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What PPI inhibits CYP2C19?

Omeprazole (Prilosec)

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What drugs can omeprazole interact with?

It can decrease the metabolism of: Phenytoin Diazepam Warfarin

What is the MOA of Misoprostol (Cytotec)?

It’s a Prostaglandin E1 analogue It increases the secretion of mucus and decreases acid secretion

What does Misoprostol (Cytotec) do to mucus and acid in the stomach?

Increases mucus (cytoprotective) Decreases acid

Who can ABSOLUTELY NEVER NEVER EVER HAVE MISOPROSTOL (CYTOTEC)?

PREGGOS YOU WILL KILL THE BABY AND GET FIRED

What is the MOA at metoclopramide (Reglan)?

It’s a D2 receptor antagonist It enhances motility and tone of smooth muscle in the upper GI

What GI drug has the big side effect of EXTRAPYRAMIDAL SYMPTOMS?? ***************

Metoclopramide (Reglan)

What is the main use for Metoclopramide (Reglan)?

Decreases nausea and gets the GI tract moving again after surgery

What are the possible side effects of metoclopramide (Reglan)?

GI cramping Diarrhea

Can metoclopramide (Reglan) be used in preggos?

What is the MOA of bethanechol (Urecholine)?

Muscarinic agonist It increases tone and motility of GI tract

What are the side effects of dicyclomine (Bentyl)?

All things antimuscarinic: Dry mouth Constipation Sedation

What is the use for dicyclomine (Bentyl)?

Reduce abdominal cramping and spasms

What is the MOA of dicyclomine (Bentyl)?

Muscarinic blocker

What is the MOA of amitriptyline (Elavil)?

Muscarinic blocker a2 stimulator/NE increaser (It’s a TCA)

What is the use for Amitriptyline (elavil) in GI?

IBS-D | Muscarinic blockers decrease spasticity and diarrhea

What is the MOA of eluxadoline (Viberzi)?

Peripherally acting opioid agonist at the mu and kappa receptors

What is the main side effect of eluxadoline (Viberzi)?

Severe constipation Get ready

What is the use for eluxadoline (VIberzi)?

IBS-D

What are a couple options for treating severe IBS-D?

Amitriptyline (Elavil) Eluxadoline (Viberzi)

Is ondansetron (Zofran) a good option for motions sickness?

No That would require muscarinic and histamine blockade. Zofran is 5HT3 only.

What is the MOA of ondansetron (Zofran)?

Selective 5HT3 blockade

What is the use for ondansetron (Zofran)?

Nausea/vomiting

Adverse side effects of ondansetron (Zofran)?

Headache Constipation Dizziness

What is the MOA of prochlorperazine (Compazine)?

D2, muscarinic, and H1 blocker

What is the MOA of promethazine (Phenergan)?

D2, muscarinic, and H1 blocker

What is the main side effect of prochlorperazine (Compazine) and promethazin (Phenergan)?

Major sedation

Are prochlorperazine (Compazine) and promethazine (Phenergan) good for motion sickness?

Yes!!

What drug is a cannabinoid and a form of THC?

Dronabinol

What is Dronabinol used for?

Chemo-induced nausea, vomiting, weight loss

What is the MOA of aprepitant (Emend)?

NK1 receptor blocker

What is aprepitant (Emend) usually combined with?

A 5HT3 antagonist | Like zofran

Is laxative use in intestinal blockage, perforation or toxic megacolon a good idea?

What is the BEST WAY to prevent constipation and diverticulitis?

Dietary fiber

What are 2 supplemental forms of dietary fiber?

Methylcellulose Psyllium

What are the most common side effects of adding in some dietary fiber?

Bloating Gas 🐑💨

What piece of patient education should be given when a patient begins fiber?

Drink a looot of water!! “So you dont get a basketball in there” 🏀

What osmotic laxative should NOT be given to patients with congestive heart failure?

Sodium Salts (Fleet) oral or enema

What osmotic laxative is given long term to people with cirrhosis?

Lactulose

Why is lactulose given to people with cirrhosis?

It traps the ammonia in the colon so you poop it out instead of it going to your liver and making things worse

Should osmotic laxatives be used long term?

NO Exception: lactulose in people with cirrhosis

What type of laxative is magnesium hydroxide (Milk of Mag)?

Osmotic laxative

What type of laxative are sorbitol and mannitol?

Osmotic laxative

What osmotic laxative is most commonly used in colonoscopy prep?

Polyethylene glycol (miralax)

What are 2 *mild* constipation drugs that act on the mucosa?

Bisacodyl (Dulcolax) Senna (Senokot)

What is the MOA of Bisacodyl (Dulcolax)?

Inhibits water absorption and can stimulate peristalsis by irritation of the mucosa

Contraindication of castor oil

Biliary obstruction

What is the MOA of docusate sodium (Colace)?

Emulsifying agent that allows water to penetrate the colonic contents and soften them

Contraindications of laxative use

Nausea and vomiting Abdominal cramps Undiagnosed abdominal pain Appendicitis Intestinal obstruction

What is the main effect of laxative overuse?

Electrolyte imbalance***

What are the ONLY ONLY ONLY TWO constipation drugs that can be used chronically?

Lubiprostone (Amitiza) Linaclotide (Linzess)

What 2 drugs are used for IBS-C?

Lubiprostone (Amitiza) Linaclotide (Linzess)

What is the MOA of lubiprostone (Amitiza)?

Activates ClC-2 chloride channels within the intestinal lumen cells

What is the MOA of linaclotide (Linzess)?

Activates cGMP which activates cystic fibrosis transmembrane conductor (CFTR) This increases chloride secretion

Does Loperamide (Imodium) have abuse potential? Why or why not?

Not really At therapeutic doses it doesn’t affect the CNS

Cholinergic inputs ____ the GI tract and opioids _____ the GI tract.

Stimulate Inhibit

Why is diphenoxylate plus atropine (Lomotil) mixed like it is?

The diphenoxylate is the opioid derivative which stope the runs but has abuse potential due to its CNS effect The atropine lowers intestinal spasm AND lowers the abuse potential of the diphenoxylate

In whom in pesto bismol contraindicated?

ASPIRIN ALLERGY And kids due to Reyes

What is a side effect of Pepto bismol? 💩

Black poops

In whom in sulfasalazine (Azulfidine) contraindicated?

Aspirin allergy

What is sulfasalazine (Azulidine) made of? Why is this combo important?

5-aminosalicylic acid linked to sulfapyridine This linkage prevents GI absorption of the drug until the gut bacteria break that linkage. This means it can be delivered locally.

In whom is sulfasalazine (Azulfidine) most effective?

Ulcerative colitis

What is the med used for gas? 🐋💨

Simethicone (Gas-X)

GI (Annie👵🏻) Flashcards

(86 cards)