GI Drugs Flashcards Preview

pharm 516 > GI Drugs > Flashcards

Flashcards in GI Drugs Deck (48):
1

Meds that cause GERD,

calcium channel blockers, glucocorticoids, muscle relaxants, theophylline, oral bronchodialators, diazepam, nicotine, etoh, coffee, chocolate, mint, fatty foods

2

risk factors for ulcers

H. pylori, OTC pain meds (aspirin and ibu)
Etoh
Smoing
Family Hx

3

4 types of antacids

aluminum salts
magnesium salts
calcium salts
sodium bicarbonate
don't use antacids chronically

4

Aluminum Salts

constipating
mag can counteract constipation
aluminum toxicity
aluminum carbonate (basaljel), hydroxide salt:AlternaGEL, combination with mag: Gaviscon, Maalox, Mylanta, Di-Gel

5

Magnesium salts

often cause diarrhea
dangerous with renal failure, can result in mag accumulation

6

Calcium Salts

may cause kidney stones
long duration of acid action can cause rebound hyperacidity
TUMS
stay away from it

7

Sodium bicarbonate

high solubility
buffers acidic properties of HCL
quick onset, short duration
may cause metabolic alkalosis
high sodium content (CHF, HTN, renal insuf)

8

ppi therapy should

elinimate symptoms
heal erosive esophagitis
prevent the relapse of erosive esophagitis

9

PPI

wait 2-6 weeks before increasing dose
OTC is more expensive than rx
hates esomeprazole
give 1h before meals

10

H2 receptor antagonist

reversible competitive inhibitor of H2 receptor
highly selective
effective in inhibiting nocturnal acid secretion
modest impact on meal stimulated acid secretion
ranitidine and famotidine are good,
cimetidine is bad P450 inhibitor, gynecomastia, impotence, decreased levels of other drugs (warfarin, theophylline, phentoin, ethanol)
take 1h before or after antacids
assess for allergies, imp renal or liver function

11

H2 antagonist SE

HA, lethargy, confusion, diarrhea, urticaria, sweating, flushing, other effects, may decrease absorption of drugs that need acidic GI env

12

kaolin and pectin

absorbent antidiarrheal, clay like powder attracts and holds onto bacteria, then thickens.for simple diarrhea, act locally in bowel

13

bismuth subsalicylate

antisecretory and antibacterial, possibly anti-inflammatory, part of h.pylori tx, contains aspirin, CI in kids and teenagers, gray/black stools and black tongue are normal

14

diphenoxylate with atropine

constipating, opioid activity at high doses, anticholinergic properties, slows peristalsis, d/c if abd distension, caution in older adults, hepatorenal disease

15

loperamide

binds to opiate receptors of the intenstinal wall, slow gastric motility, diminishes fluid loss, d/c if abd distension

16

oral rehydration solution

8 oz water, 1/4 tsp baking soda, alternate with water with salt and honey. for severe diarrhea, more salt is needed

17

IBD diarrhea control

steroids and sulfasalazine, loperamide first

18

traveler's diarrhea

bismuth subsalicylate, oral antimicrobials, loperamide (immodium)

19

cytoprotective agents

sucralfate (basic aluminum salt)- viscous gel adheres to ulcer's crater, stress ulcer prevention and duodenal ulcer, taken on empty stomach, avoid concurrent antacid, and misoprostol - stimulates mucous and bicarb secretion(caution in renal impairment) for NSAID induced problems, cat X, GI sx, with food

20

5 classes of antiemetics

antihistamines, phenothiazines, sedative hypnotics, cannabinoids, and 5_HT receptor antagonists

21

antihistamines

good for motion sickness, dimenhydrinate, diphenhydramine, hydroxyzine, and meclizine, strong anticholinergic effects, CI in severe liver disease, better for long term applications

22

phenothiazines

block dopamine receptors, sedating, have extrapyramidal effects (limiting), prochlorperazine and promethazine (fatal resp dep younger than 2, bone marrow depression)), metoclopramide (prokinetic), CI in Parkinson's, narrow-angle glaucoma, bone marrow depression, severe CV or hepatic disease. some anticholinergic effects. may discolor urine pink/reddish-brown. additive hypontensive effects. CBC prior to initiating therapy, blood dyscrasias 4 to 10 weeks after therapy starts

23

cannabinoids

decrease n/v/appetite stimulant, works in the CNS, may lower seizure threshold, palpitations, tachycardia, hypotension, interacts with other CNS depressants

24

5-HT receptor antagonists

block serotonin on the peripheral vagal nerve terminals and centrally, used with chemotherapy, may mask progressive ileus, constipation, HA, fatigue

25

drugs that cause peptic ulcers

NSAID, glucocorticoids, cytotoxic agents

26

colloidal bismuth compounds

coats ulcer, stimulates mucus and bicaarb, direct action against H. pylori, blackening of tongue and stool, not for long term use - bismuth toxicity

27

IBD therapy

sulfasalazine and 5-ASA, (mesalamine, active molecule) 2 moeity's, mild to moderate CD/UC

28

5-ASA delivery systems

Pentasa - esop-rectum, for Chrons', slow release
Asacol-ileum and colon effected, 60-70%
Rowasa-if only rectal, avoids systemic
Colazal-very expensive, colon

29

antibiotics

CD only, not UC, metronidazole has anti-fistula properties, cipro, pouchitis biologics if metronidazole doesn't work

30

steroids

for flare-ups, not long-term, hospitalize if can't tolerate PO, if unable to taper, try antimetabolite or infliximab, topical can be used in rectum

31

azathioprine and 6 MP

for steroid dependent IBD, measure CBC q2w, takes months to work, major durg-drug ALLOPURINOL

32

methotrexate

IV for active CD or maitenance of CD remission, induction with steroid withdrawal, weekly IM, monitor CBC, LFT, renal function

33

cyclosporine

induction in UC, CD in high doses (toxicity), steroid refractory UC, used to bridge to AZA as maintenance

34

infliximab

tnf alpha antibody - CD and UC with inadequate response to conventional tx, withdrawal concomitant steroids. avoid infection, demyelinating d/o, CHF, malignancy, screen for

35

metoclopramide

stimulates motility in GI, postprandial and daytime heartburn, 30 min prior to meal, r/f tardive dyskinesia, don't use more than 12 weeks or when GI motility is CI (obstruction), used for GERD and diabetic gastroparesis

36

PPI's interfere with absorption of...

Warfarin, ketoconazole, digoxin, esters of ampicillin, iron salts. inc monitoring of INR. clopidogrel efficacy dec. by 50%. lansoprazole does not interfere with warfarin

37

tx of duodenal and gastric ulcers

PPI for 12 weeks, once daily in the am before meals, also test for H. pylori

38

GERD management

lifestyle and antacid PRN, then H2RA, then PPI. If refractory after 4-8 weeks, inc. PPI. if symptoms gone, decrease PPI after 4 weeks. if no relief after BID, referral to gastroenterologist or if endoscopy shows erosive disease. failure to achieve symptom relief after 3 months, gastroenterology referral.

39

alarm symptoms that require endoscopy

dysphagia, painful swallowing, noncardiac chest pain, weight loss, hematemesis, and choking. PPI may mask gastric CA.

40

stimulant laxatives

release of prostaglandins
inc cAMP concentration
increases secretion of electrolytes
stimulates peristalsis
rapid response, short term
cascara (has etoh, CI pregnancy), senna, bisacodyl, and castor oil
used for reduced mobility, constipating drugs, reduced motility, ibs, neurogenic bowel
caution with severe CV disease

41

osmotic laxatives

draw water into intestinal lumen to inc pressure
hypertonic salt-based solutions
cause diffucion of fluid from the plasma inot the intestine
most powerful
mag hydroxide, mag citrate, PEG (CI in kids d/t electrolyte probs), used for bowel prep
CI in renal insufficiency, hyper mag, hypocalcemia, heart block

42

bulk producing laxatives

most physiological, safest,
natural and semisynthetic polysaccharides and cellulose
mechanical distention that increases peristalsis
long-term management of simple, chronic const
useful in avoiding straining to stool
mgt of chronic, watery diarrhea
CI narrowed esophageal or intestinal lumen and impaction
watch for sugar or salt

43

lubricants

mineral oil, retards colonic absorption of fecal water and softens stool
used with fecal impaction
lubricates intestines
may decrease absorption of fat soluble vitamins, avoid in pregnancy
r/f aspiration under 4 y.o.

44

surfactants

stool softeners, emollient action, good for hard, dry stool, anorectal conditions, painful stool, avoiding straining, safe for all ages.
no specific CI

45

CI of all laxatives

presence of n/v or undiagnosed abd pain or bowel obstruction.

46

miscellaneous

glycerin is local irritant, hyperosmotic, draws water. lactulose, hyperosmotic transformed to lactic acid and acetic and formic acid, lowers pH of colon. glycerin, for fecal impaction, neurogenic bowel.

47

hyperosmolar considerations

lactulose causes hyperglycemia, caution in presence of volume depletion,

48

chronic use of laxatives

r/f abuse and dependency, fluid and electrolyte imbalances, steatorrhea, osteomalacia, and vit and min deficiencies.