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GI Drugs Flashcards

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1
Q

What is reflux esophagitis and what factors contribute?

A

Heartburn

When esophageal sphincter opens and it shouldnt

Larger meal→More relfux

Factors that decrease esophageal closure:

  • Alcohol
  • Peppermint
  • Chocolate
  • Fats
  • Acidic beverages
  • Red Wine
  • Carbonated drinks
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2
Q

-tidine

A

GI drug

Decrease acid secretion

Mech: H2 receptor blockers

SE:

  • Confusion in elderly
  • Bradycardia

Cimetidine:

  • Inh. P450
    • Prevent synth of test.
    • Anti-androgenic
      • Cause gynecomastia
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3
Q

-prazole

A

GI drug

Decrease acid formation

Mech: ATPase inhibitor

Known as proton pump inhibitor (PPI) but actually irreversibly inhibit ATPase required to drive H+ pump

Best available class of GI drugs

Prodrug-activated by acid

They are weak bases though→ stay in parietal cell

SE:

  • Hypochlorhydria-lack of H+ production
  • Decrease Ca absorption→osteoporosis
  • Decrease Vit B12 absorption
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4
Q

Systemic vs non-systemic antacids

So, what is the order of cation absorption and why does this matter?

A

Na>>Ca>Mg>Al

More readily the cation is absorbed the more the anion is absorbed→ systemic alkylation

Particularly important for kidney dysfunction

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5
Q

Sodium Bicarbonate

NaHCO3

A

Antacid

Speed-rapid

Duration-short

Neutralizing-high

SE:

  • CO2 production
  • Belching
  • Na may compromise low sodium diets
  • Systemic absorption
    • Contains Na
    • Important in those w/ kidney dysfunction
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6
Q

Calcium carbonate

CaCO3

A

Antacid

Speed-rapid

Duration-medium

Neutralizing-high

SE:

  • Constipating
  • Hypercalcemia
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7
Q

Aluminum hydroxide

Al(OH)3

A

Antacid

Speed-slow

Duration-long

Neutralizing-low

SE:

  • Constipation
  • Adsorbs drugs
  • Loss of phosphate
  • Al toxicity
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8
Q

Magnesium hydroxide

Milk of magnesia

A

Antacid

Speed-slow

Duration-medium

Neutralizing-high

SE:

  • Laxative
  • Some Mg toxicity
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9
Q

Sucralfate

A

GI drug-Enhance mucosal defense

Aluminum salt

Tx: Ulcers

Mech: Complex that becomes viscous and binds to damaged mucosa when exposed to acid

SE:

  • Constipation
  • Excess Al absorption

Contraindication: H+ depleters (PPI or antacids)

SucrALfate=ALuminum salt→Excess Al

Sucralfate=sucrose=sticky…so this sticks to damaged mucosa

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10
Q

Bismuth subsalicylate

A

GI drug-Enhance mucosal defense

Anti-diarrheal agent–absorbing agent

Mech: Increase mucous production in stomach

Inh. growth of H. pylori

Unpleasant taste+odor

SE:

  • Long term use→Darkening of feces, tongue, and teeth
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11
Q

Misoprostole

A

GI drug-Enhance mucosal defense

Tx: Ulcers

Drop in PGs→Ulcer

Asprin (NSAIDs) and GCs can decrease PGs

Mech: Prostaglandin analog

SE:

  • Uterine contractility (abortifacient)
  • You eat miso soup when you have a stomach ache because it is prostagrandin anarog (say that w/ a strong asian accent)*
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12
Q

Antibiotic combo for H pylori infection

A

GI drug-Enhance mucosal defense

Metronidazole

+/-

Amoxicillin

+/-

Clarithromycin

+/-

Tetracycline

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13
Q

Metoclopramide

A

Tx: Gastroparesis

prokinetic agent–agents that increase stomach emptying rate

Also used for hiccups

Mech: DA and possible 5HT antagonist

Route: Oral or IV

Increase motility w/o secretion (of H or gastrin)

SE:

  • Sedation
  • Depression
  • Parkinson like symptoms

Metoclopramide increases motility

  • All that motility→shakes (parkinson like symptoms)*
  • All those shakes →sedation *
  • All that sedation→depression *
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14
Q

Erythromycin

A

Tx: Gastroparesis

prokinetic agents–agents that increase stomach emptying rate

Mech: Acts directly on motilin receptor

Route: Oral but IV possible if oral is not

SE:

  • ototoxicity
  • pseudomemb. colitis
  • cardiac arrythmia
    • Especially if metabolism is inh by P450
  • Remember erythro is a macrolide*
  • Motiliy*
  • Arrythmias*
  • Cholesteric toxicity (liver tox)/Colitis*
  • Restricts P450*
  • Ototoxicity*
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15
Q

Alvimopan

A

Tx: Gastroparesis

prokinetic agents–agents that increase stomach emptying rate

Mech: Blocks opiate receptor in gut but not anywhere else

Blocks constipation due to post op opioid use

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16
Q

Dioctal sodium sulfosuccinate

A

GI Drug

Cathartic–Stool softener

Detergent

Mech: Emulsifies contents of colon

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17
Q

Mineral oil

A

GI Drug

Cathartic–Stool softener

Mech: Acts like a lubricant

Why mineral oil should NOT be used:

  • Prevents fat soluble vitamin absorption
  • Aspiration pnemonia →may damage lungs
  • May contain carcinogens
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18
Q

What are the bulk adding agents?

A

Bran

Methylcellulose

Polycarbophil

Psyllium

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19
Q

Bran

A

GI Drug

Cathartic–Bulk adding agent

Mech: Like eating fiber

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20
Q

Methylcellulose

A

GI Drug

Cathartic–Bulk adding agent

Mech: Like eating fiber

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21
Q

Polycarbophil

A

GI Drug

Cathartic–Bulk adding agent

Mech: Like eating fiber

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22
Q

Psyllium

A

GI Drug

Cathartic–Bulk adding agent

Mech: Like eating fiber

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23
Q

Cascara

A

GI Drug

Cathartic–Gastric Irritants

Mech: Stimulate gastric nn

Increase motility

Increase electrolyte secretion into gut

SE:

  • Nephritis
  • Liver damage
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24
Q

Senna

A

GI Drug

Cathartic–Gastric Irritants

Mech: Stimulate gastric nn

Increase motility

Increase electrolyte secretion into gut

SE:

  • Nephritis
  • Liver damage
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25
Castor oil
GI Drug Cathartic--Gastric Irritants **Mech**: Stimulate gastric nn Increase motility Increase electrolyte secretion into gut SE: * Nephritis * Liver damage
26
Bisacodyl
GI Drug Cathartic--Gastric Irritants **Mech**: Stimulate gastric nn Increase motility Increase electrolyte secretion into gut SE: * Nephritis * Liver damage
27
MgSO4
GI Drug Cathartic--Osmotic agent
28
Mg(OH)2
GI Drug Cathartic--Osmotic agent AKA Milk of Magnesia
29
Polyethylene glycol
GI Drug Cathartic--Osmotic agent **DOC** for colonoscopy
30
Lubiprostone
GI Drug Cathartic--Secretion enhancer **Mech:** Acts on PGE receptor PGE1 derivative Also acts on Cl channel in intestine
31
Linaclotide
GI Drug Cathartic--Secretion enhancer **Mech:** Activate guanylate cyclase Increase Cl secretion in stomach
32
What are the stool softeners?
Dioctal sodium sulfosuccinate Mineral oil
33
What are the gastric irritants used as cathartics?
Cascara Senna Castor oil Bisacodyl
34
What are the osmotic cathartics?
MgSO4 Mg(OH)2 Polyethylene glycol
35
Adverse effects of cathartics
* Fluid imbalances * K+ loss, etc * Mucosal injury * Malabsorption of nutrients * Suppress reflex fxns
36
What is essential to treat diarrhea? What do we have to be careful about?
Rehydration Diarrhea is a process to rid bacteria so we must be careful if we are stopping this process
37
Codeine
Tx: Diarrhea *Narcotic agent* Mech: act a specific receptor Not generally used for obvious reasons
38
Diphenoxylate
Tx: Diarrhea *Narcotic agent* Mech: act a specific receptor Acts primarily in gut Opiate like effects in CNS though too Given in comb w/ atropine to avoid abuse
39
Difenoxin
Tx: Diarrhea *Narcotic agent* **Active metabolite of diphenoxylate** Mech: act a specific receptor Acts primarily in gut Opiate like effects in CNS though too Given in comb w/ atropine to avoid abuse
40
Loperamide
Tx: Diarrhea *Narcotic agent* **Narcotic DOC for diarrhea** Mech: act a specific receptor Acts ONLY in gut--no CNS effects
41
Atropine
Tx: Diarrhea *Anti-cholinergic agent* Mech: Blocks muscarinic receptor SE: Many systemic
42
Scopolamine
Tx: Diarrhea *Anti-cholinergic agent* Mech: Blocks muscarinic receptor SE: Many systemic
43
Crofelemer
Tx: Diarrhea Mech: Blocks Cl channel in gut Also decreases secretion of Na and H2O ***C**rofe**L**emer blocks **CL** channels* * or * * CROws block the CLouds* * CROfelemer blocks CL channels*
44
Simethicone
Tx: Diarrhea Mech: Changes gas surface tension of gas pocket in gut
45
Alpha galactosidase
Tx: Diarrhea Mech: Increase metab. of oligosacc.→digestible sugars Oligosacc. produce gas * Alpha **GA**lacto**S**idase inh. **GAS** production* * \*Be careful there are alpha-glucosidase inh in the diabetes section\**
46
Ulcerative colitis vs Chron's disease
Ulcerative-mucosal inflammation Chron's-mucosa and even into muscle of gut--more severe
47
-sala-
**Sulfa**_sala_**zine** **Me**_sala_**mine** **Ol**_sala_**zine** **Bal**_sala_**zide** Tx: IBS--Salicylates Mech: Decrease PG synth *Online it says mech is unclear--may not be the same as aspirin* Not systemically absorbed-like a topical drug for the stomach SE: * Diarrhea * Take 3-5 weeks to work
48
Which GCs used for IBS
**Prednisone** **Budesonide**
49
Infliximab
Tx: IBS Mech: Binds TNF alpha
50
Immunosuppressants for IBS
Methotrexate Cyclosporine
51
(Apo)morphine
Emetic--central stimulant Mech: Stimulates DA sites in CTZ
52
Digoxin
Emetic--central stimulant Mech: Stimulates DA sites in CTZ
53
Ipecac
Emetic--reflex stimulant Mech: Act. receptors in GI mucosa Instant severe vomiting SE: Cardiotoxic
54
Diphenhydramine or Dimenhydramine
Anti-emetic--Antihistamine Mech: Block H1 receptor SE: Anticholinergic effects
55
Meclizine
Anti-emetic--Antihistamine Mech: Block H1 receptor SE: Anticholinergic effects
56
Cyclizine
Anti-emetic--Antihistamine Mech: Block H1 receptor SE: Anticholinergic effects
57
Which antihistamines are used as anti-emetics?
Diphenhydramine Dimenhydramine Meclizine Cyclizine
58
What other drugs mentioned will cause emesis?
NSAIDs Anti-neoplastic Iron salts
59
Scopolamine
Anti-emetic--anti-cholinergic Mech: Block muscarinic receptor Route: Patch SE: * Dry * Drowsy * Etc.
60
Dronabinol
Anti-emetic--THC derivative Mech: Bind cannabinoid receptor SE: Increased appetite
61
Nabilone
Anti-emetic--THC derivative Mech: Bind cannabinoid receptor SE: Increased appetite
62
Compazine
Anti-emetic Mech: DA blocker *Related to anti-psychotic drugs *(phenothiazine) SE: Extrapyramidal effects
63
-setron
**Ondansetron** **Granisetron** **Dolasetron** **Palonosetron** Anti-emetic (for IBS+chemo) Mech: 5HT receptor blocker Affect CTZ +rec. in gut SE: Constipation ***_SE_**lective **_T_**e**_R_**minators **_O_**f **_N_**ausea* ***_-SETRON_*** *-setron blocks serotonin*

Pharm 6 (7 decks)

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