"SCOPE LA MINE" --> as in come scope the mine but it's shitty travel there so may need some scopolamine for the motion sickness
-anti-emetic that is an ANTIMUSCARINIC
--> is the DOC for emesis d/t MOTION SICKNESS
"A Prepitant" of that New Killer 1 shit --> makes you not feel nautious during chemo brooooo"
-anti-emetic that is an NK1-receptor blocker in the CNS (NK = NeuroKinin)
--> effective in both decreasing the EARLY + DELAYED EMESIS in CANCER CHEMO
APREPITANT = ORAL
FOSAPREPITANT = IV
ADVERSE EFFECTS: dizziness, fatigue, diarrhea, and CYP interaction may occur
CHEMOTHERAPY INDUCED NAUSEA + VOMITING TX
A) Solo DEXAMETHASONE
--> Dex DOES it by itself
B) Combo of
- METHYLPREDNISOLONE +
an ANTI-EMETIC that is a "pro" for "chlorine" vomiting... makes you not vomit --> antagonizes those dopamine receptors and the muscles)
a PHENOTHIAZINE --> an ANTAGONIST at
- D2 RECEPTORS
- MUSCARINIC RECEPTORS
- EXTRAPYRAMIDAL SYMPTOMS,
-is a PRO-MOTILITY agent and an ANTI-EMETIC
--> Antagonist at D2 receptors and muscarinic receptors
-effective at HIGH DOSES against the highly emetogenic CISPLATIN
AEs: has ANTIDOPAMINERGIC SIDE EFFECTS
--> TARDIVE DYSKINESIA
--> sedation, diarrhea, extrapyramidal symptoms, limit its high-dose use
-the antiemetic potency of lorazepam, alprazolam, and diazepam is low
-their beneficial effects may be d/t their sedative, anxiolytic, and amnesic properties
-useful in ANTICIPATORY NAUSEA/VOMITING
INFLAMMATORY BOWEL DISEASE DRUGS
2) glucocorticoids (Budesonide),
6) Infliximab and
DRUG FOR IBD
• MOA: inhibits the pro-inflammatory mediators –IL1, and TNF-α
• It is a sulfa derivative. So, it should be avoided in patients with sulfa allergy.
• In the GIT,
- sulfapyridine (antibacterial) and
- 5- Aminosalicylic acid (5-ASA) (anti-inflammatory) released from sulfasalazine by colonic bacteria.
• It is used in mild to moderate Crohn’s disease or ulcerative colitis
ADVERSE EFFECTS: Nausea, vomiting, diarrhea, hypersensitivity, and reversible oligospermia. Bone morrow suppression is related to the sulfapyridine release from sulfasalazine.
NOTE: MESALAMINE (5-ASA) = "metabolite"
• Balsalazide: releases mesalamine (5-ASA) in the large intestine at the active site of ulcerative colitis.
--> B for BIG BOWEL --> LARGE INTESTINE --> more for UC (the LARGE INTESTINE)
• Sulfasalazine: Proximal, distal colon and rectum.
- 6-MP may promote apoptosis of immune response. --> Me-Cap'd (ie getting shot... promoting apoptosis)
- MTX blocks dihydrofolate reductase (DHFR)
They cause generalized immune suppression
They are used in moderately severe to severe Crohn’s disease and ulcerative colitis.
6-MP: mucositis, myelosupression.
--> Hepatotoxicity can occur with 6-MP.
-MTX: Toxicities are rare at low doses.
MAB --> can think monoclonal antibody --> MAB the MOBSTER that helps with ACUTE FISTS(ULA's) and FLARES --> fight That New Fuck ALPHA (TNF-alpha) in town. Test these mobsters for TB before you give them the MAB
MOA: is a MONOCLONAL ANTIBODY that targets TNF-alpha, a principal mediator in Crohns disease
-used in conditions associated with FLARE UP of IBD; particularly in Crohn's related FISTULAS + ACUTE FLARES
Note: it is also used in RHEUMATOID ARTHRITIS
AEs: reactivationof latent tuberculosis and other infections. It is given IV – fever, chills, urticarial reaction, hypotension may occur. Antibodies to infliximab may develop.
Note: Adalimumab: (HUMIRA) - TNF-α inhibitor
"nat" LIZ "MAB" --> blocks that integration
blocks leukocyte integrins
- can produce multifocal leukoencephalopathy.
-are gneralized anti-inflammatory drugs used in acute cases
- Inhibit TNF-α, IL-1, IL-8
Age you can start "corting" at is 18 (IL1, IL-8... can be the ALPHA male for TNF-alpha)
-controlled release formation in the distal ileum and colon
IBS (Irritable Bowel Syndrome)
IBS Characterized by
- diarrhea (D) or
- constipation (C) or
- alternating (A)
Chronic symptoms with no structural abnormalities
Frequent abdominal pain correlated with following:
- Altered stool frequency
- Pain gets better with defecation
- Alteration in stool appearance
Al! Set (up) RON for the 3!
5-HT3 antagonist with long duration of action, has high potency
MOA: Reduces smooth muscle activity in the gut (For IBS-D).
USES: Recommended for severe diarrhea associated IBS.
AE: Rare, serious constipation; ischemic colitis and infarction may occur.
non-selective action on the gut (IBS-D)
USES: IBS: diarrhea
-Chronic symptoms with no structural abnormality
CHLORIDE CHANNEL ACTIVATOR in IBS
"lubey up my prostone" bro, i need to shit"
-used in CONSTIPATION-associated IBS (IBS-C)
ANTI-DIARRHEAL, OPIOID AGONISTS
-are both opiate derivatives that SLOW GUT MOTILITY with NEGLIGABLE CNS EFFECTS
--> acts via GI mu-opioid receptors
- INHIBITS ACH release + decreases perstalsis!!
DIPHENOXYLATE: is formulated with ATROPINE to REDUCE ABUSE POTENTIAL --> High doses can cause CNS EFFECTS
AE: risk of TOXIC MEGACOLON in children or patients with severe colitis
-prevent diarrhea of IBS + IBS by blocking osmotic and irriating actions of bile salts (ie PREVENT SECRETORY DIARRHEA)
--> BILE SALTS stimulate Cl- secretion in the colon (cAMP) --> Resins form insoluble complexes with bile acids that are no longer able to stimulate this excess secretion
-they form INSOLUBLE COMPLEXES with BILE ACIDS in the intestine
-also used in LOWERING CHOLESTEROL
-classified by mechanism of action as
2) OSMOTIC AGENT
3) BULK FOMRING AGENTS
4) STOOL SOFTENERS
--> can thing SENNA for STIMULANT, and that CODYL which kind of soudns like CASTOR OIL which casts off the poop (b/c is a laxative)
-may cause cramping
-chronic use may lead to habit of perceived need for laxitives
Note: Senna is used with docusate for opioid induced constipation
BULK FORMING AGENT LAXITIVES
-if pack cells full of methyl will get bulky, as well if you go to a psyllium, you get bulky as well, and we all know bran makes bulk occur too
-these are insolube indigestible derivatives form fruits and vegetables (are hydrophilic colloids)
-they are NON-ABSORBABLE ---> increase water retention and stool becomes BULKY
-the distention of bowel leads to peristaltic stimulation of the gut
OSMOTIC AGENTS used as LAXATIVES
-the magnesium ones are "magnetic" --> help draw the water out (as does the lactose)
-Magnesium citrate, Magnesium hydroxide = SALINE CATHARTICS
-Lactulose + Sorbitol = NON-DIGESTIBLE SUGARS
-they OSMOTICALLY DRAW WATER into the lumen of GIT, which then stimulate motility
1) SIMPLE CONSTIPATION
2) BOWEL PREP FOR ENDOSCOPE
-is a semi-synthetic disaccharid sugar that acts as an OSMOTIC LAXITIVE
-large doses are degraded by colonic bacteria to form lactic, formic, and acetic acid --> this increases osmotic effect too
-is also used in HEPATIC ENCEPHALOPATHY: it helps to "draw out" ammonia (NH3) from the body and is useful for PREVENTING HYPERAMMONIA
PEG (Polyethylene glycol)
-"draws you out" like a "PIG" (for peg)
-used for COLONIC LAVAGE for ENDOSCOPIC and RADIOLOGICAL PROCEDURES
-mineral oil + docusate sodium --> together they EMULSIFY STOOL and SOFTEN IT --> lubricate it and make it wasy to pass
SENNA --> is used in combo with a DOCUSATE (make stools softer and easier to pass) --> used to treat cases of OPIOID-INDUCED CONSTIPATION
CL- CHANNEL ACTIVATOR LAXATIVE
-prostanoic acid derivative
-stimulate chloride secretion into GI --> increases fluid content
-blocks GI mu-receptors but do not enter CNS
--> useful in OPIOID INDUCED CONSTIPATION
DRUGS FOR IBS: PANCREATIC ENZYME
-a replacement enzyme from animal pancreatic extract
-improve the digestion of dietary fat, protein, and carbs (increases A, D, E, K vit absorption)
1) Patients with CHRONIC PANCREATITIS
2) AFTER PANCREATECTOMY
4) CYSTIC FIBROSIS associated insufficiences
BILE ACID THERAPY FOR GALLSTONES
-has enterohepatic circulation
-it reduces cholesterol absorption by breaking up micelles containing cholesterol
-used in patient who refuses or not eligible for surgery