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Flashcards in GI DISEASES Deck (65)
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31

SCOPOLAMINE

"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

32

APREPITANT

FOSAPREPITANT

"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 

33

CHEMOTHERAPY INDUCED NAUSEA + VOMITING TX

A) Solo DEXAMETHASONE

--> Dex DOES it by itself

OR

B) Combo of

  • METHYLPREDNISOLONE +
  • ONDANSETRON/APREPITANT 

 

34

PROCHLORPERAZINE

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

SIDE EFFECTS:

  • EXTRAPYRAMIDAL SYMPTOMS,
  • HYPOTENSION,
  • SEDATION 

35

METOCLOPRAMIDE (MCP)

-PHENOTHIAZINE

-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 

36

LORAZEPAM

ALPRAZOLAM

DIAZEPAM

 

-are BENZO'S

-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

37

INFLAMMATORY BOWEL DISEASE DRUGS

1) Sulfasalzine,

2) glucocorticoids (Budesonide),

3) azathioprine,

4) Methotrexate,

5) Cyclosporine,

6) Infliximab and

7) Natalizumab

38

SULFASALAZINE

 

MESALAMINE (5-ASA)

  • BALSALAZIDE
  • SULFASALAZINE

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,

  1. sulfapyridine (antibacterial) and
  2. 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.

 

 

 

 

39

6-mercaptopurine(6-MP)

Methotrexate (MTX)

-IMMUNOMODULATORS 

  • 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.

AE:

6-MP: mucositis, myelosupression.

--> Hepatotoxicity can occur with 6-MP.

-MTX: Toxicities are rare at low doses.

40

INFLIXIMAB

 

ADALIMUMAB

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

41

NATALIZUMAB

"nat" LIZ "MAB" --> blocks that integration 

blocks leukocyte integrins

  • can produce multifocal leukoencephalopathy.

42

HYDROCORTISONE

PREDNISONE

PREDNISOLONE

CORTICOSTEROIDS

-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)

43

BUDESONIDE

CORTICOSTEROID

-controlled release formation in the distal ileum and colon 

44

 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

Treatment: symptomatic

45

ALOSETRON

5-HT3 BLOCKER

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.

 

46

DICYCLOMINE

HYOSCYAMINE

GLYCOPYRROLATE

METHSCOPALAMINE

ANTICHOLINERGICS

non-selective action on the gut (IBS-D) 

USES: IBS: diarrhea 

-Chronic symptoms with no structural abnormality 

47

LUBIPROSTONE

CHLORIDE CHANNEL ACTIVATOR in IBS

"lubey up my prostone" bro, i need to shit"

-used in CONSTIPATION-associated IBS (IBS-C)

48

LOPERAMIDE

DIPHENOXYLATE

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

 

49

CHOLESTYRAMINE

COLESTIPOL

COLESEVELAM

-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 

50

LAXATIVES

-classified by mechanism of action as

1) STIMULANTS

2) OSMOTIC AGENT

3) BULK FOMRING AGENTS

4) STOOL SOFTENERS

51

SENNA

BISACODYL

CASTOR OIL

LAXATIVE STIMULANT

--> 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

52

METHYCELLULOSE

PSYLLIUM

BRAN 

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 

53

MAGNESIUM CITRATE

MAGNESIUM HYDROXIDE

 

LACTULOSE

POLYETHYLENE GLYCOL

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 

USES:

1) SIMPLE CONSTIPATION

2) BOWEL PREP FOR ENDOSCOPE

54

LACTULOSE

OSMOTIC LAXATIVE

-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

55

PEG (Polyethylene glycol)

OSMOTIC LAXATIVE

-"draws you out" like a "PIG" (for peg)

-used for COLONIC LAVAGE for ENDOSCOPIC and RADIOLOGICAL PROCEDURES

56

MINERAL OIL

DOCUSATE SODIUM

STOOL SOFTENERS

-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

57

LUBIPROSTONE

CL- CHANNEL ACTIVATOR LAXATIVE

-prostanoic acid derivative

-stimulate chloride secretion into GI --> increases fluid content 

58

ALVIMOPAN

METHYLNATREXONE

-blocks GI mu-receptors but do not enter CNS

--> useful in OPIOID INDUCED CONSTIPATION 

59

PANCRELIPASE

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)

USE: 

1) Patients with CHRONIC PANCREATITIS

2) AFTER PANCREATECTOMY

3) STEATORRHEA

4) CYSTIC FIBROSIS associated insufficiences

 

60

URSODIOL

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

AE: DIARRHEA