GI drugs Flashcards by Ben Harris

What is the MOA of Bismuth?

Two MOAs:

1) Disrupts cell wall, prevents adhesion, inhibits urease
2) Coats ulcer, stimulates PGE, Mucus and Bicarb release

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What are three regimens for PUD treatment?

1) PPI + Amoxacillin followed by Clarithromycin and Tinidazole
2) PPI + Tetracyclin+ metronidazole + ciprofloxacin
3) PPI + Amoxacillin + rifabutin +ciprofloxacin

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1st line treatment for GERD?

Lifestyle modification

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2nd line treatment for GERD?

H2 blockers

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3rd line treatment for GERD?

PPIs, esomeprazone

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Name PPIs

Esomeprazole/

Omeprazole, Lansoprazole, Pantoprazole, Rabeprazole

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What is the MOA of PPIs? (Esomeprazole/

Omeprazole, Lansoprazole, Pantoprazole, Rabeprazole)

Irreversibly inhibit H/K ATPase

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Name common antacids

Aluminum hydroxide, calcium carbonate, magnesium hydroxide, sodium bicarbonate

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Name AEs of aluminum hydroxide

Constipation, decreased PO4 absorption (osteomalacia)

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Name AEs of Magnesium hydroxide

Osmotic diarrhea

In pts with renal insufficiency –> hypermagnesemia –> cardiotoxicity

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Name AE of calcium carbonate

Metabolic alkalosis when systemically absorbed

Hypercalcemia if taken w/ dairy products

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Name AEs of sodium bicarbonate

Systemically absorbed: metabolic alkalosis, hypercalcemia

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What are AEs of PPI use?

ECL hyperplasia due to decreased negative feedback of gastrin from somatostatin

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What are CCK effects on gastric mucosa?

Increased pepsinogen (chief cell), increased somatostatin (D cell)

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What are Gastrin effects on Gastric mucosa?

Increased acid secretion (direct)
Increased histamine release (ECL cell)
Increased pepsinogen (chief cell)
Increased growht
Decreased somatostatin (D cell)

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Name H2 blockers?

Cimetidine, Famotidine, Nizatine, Ranitidine

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What is the MOA of H2 blockers? (Cimetidine, Famotidine, Nizatine, Ranitidine)

competitive H2 antagonists that decrease all forms of gastric acid secretion

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What do H2 blockers compete with for elimination?

weak bases (i.e. metronidazole)

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What are AEs of cimetidine?

Inhbitor of CYP450
Androgenic effects (gynecomastia, galactorrhea)

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What is the MOA of misoprostol?

PGE1 analog

Used to treat NSAID-induced ulcers- reverses action of NSAIDs at ulcer

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AEs of misoprostol?

Diarrhea and severe nausea

Stimulate uterine contractions (abortafactant)

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MOA of sucralfate

sucrose sulfate aluminum hydroxide complex that attaches to the basement membrane of the ulcer
May stimulate mucosal PGE and bicarb secretion

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What are the pharmacokinetics of sucralfate?

Requires an acidic environment to be activated

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What are AEs of sucralfate?

Study These Flashcards

constipation due to aluminum salt

may bind to other meds decreasing absorption

What is the MOA of bismuth subsalicylate?

Bismuth: stimulate PG release | Disrupts cell wall, prevents adhesion, inhibits urease

AEs of bismuth subsalicylate?

Blackening of stool and tongue | High doses of subsalicylate may lead to salicylate toxicity: vomiting, tinnitus, metabolic acidosis/alkalosis

MOA of pancrelipase?

Enriched extract of hog pancreatic enzymes to supplement a pt's lack of

AE of pancrelipase?

Diarrhea, abdominal pain | Hyperuricosuria --> renal stone

MOA of orlistat?

lipase inhibitor- pancreatic and gastric lipase and phospholipase A2, decreasing digestion and absorption of fat

AEs of orlistat?

Decreased fat absorption --> increased flatus, fecal urgency | Decreased fat soluble vitamins ADEK

MOA of ursodiol?

Secondary acid ursodeoxycholic acid, conjugates w/ glycine and taurine in liver decreasing CE in bile decreasing CE gallstones

Action of CCK on pancreatic acini

Increase enzyme secretion in intestinal phase | Increase growth

Action of Gastrin on Pancreatic acini

Increase enzyme secretion (gastric phase)

What is the MOA of lubipristone?

CIC-2 activator, increase Cl excretion, retain H2O in lumen

What are AEs of Lubipristone?

Increased fetal loss, diarrhea in infants (found in milk)

What is the MOA of Linaclotide?

GC-C activator, increasing cGMP, activationg CFTR channel

What are AEs of linaclotide?

Increased maternal death in animals, mortality of juvenile mice

What is MOA of Crofelemer?

voltage-independent inhibition of CFTR, decreasing Cl- secretion

What is AE of crofelemer?

Constipation

What is MOA of octreotide?

Somatostatin analogue, decreases 5HT stimulation, decrease hormone release. Low dose increases motility, High does decreases motility

What are the uses for octreotide?

treatment of tumors, severe diarrhea due to dumping syndrome, short bowel syndrome, vagotomy

what are AEs of octreotide?

Decrease in GI motility, impaired pancreatic secretion

What is the use of lactulose?

Decreases plasma ammonia levels due to alkalinizing lumen, also increases H2O retention due to osmotic forces

What are the AEs of lactulose?

When metabolized by gut bacteria, severe cramps and flatulence

What are MOA of sodium phosphate?

Increase osmotic pressure in lumen, creating looser stools

What are AEs of sodium phosphate?

Intracellular volume depletion and electrolyte imbalances

What are MOA od cholestyramine and colestipol?

Decrease reabsorption of bile salts

What are AEs of cholestyramine and colestipol?

Bloating, flatulence, constipation, fecal impaction

What is MOA of Alosetron?

5HT3 antagonist, decreasing motility (decreasing afferent stimulation)

What are AE of alosetron?

Constipation in 30% of patients ischemic cholitis.

What are MOA of tegaserod and cisapride?

Activation of 5HT4 presynaptic receptors, increasing gastric motility

what are AEs of tegaserod and cisapride?

Arrhythmias, long QT

What is the MOA of Diphenoxylate and Loparimide?

u-agonists, decrease motility and secretion

What are AEs of diphenoxylate and loparimide?

Constipation, abdominal cramps, TOXIC MEGACOLON They can make people high, too

What is MOA of Alvimopan, methylnaloxone?

u-receptor antagonists; increase gastric motility

What are AEs of alvimopam and methynaloxone?

Alvimopam: increased risk of MI

What is MOA of domperidone and metaclopramide?

Inhibits dopamine inhibition, increasing ACh in gut, increasing motility

Whar are AEs of domperidone and metaclopramide?

Domperidone: Sudden cardiac death Metoclopramide: dystonia, parkinsonism, tardive dyskinesia

How do they decrease the risk of abuse with domperidone?

D2 receptor antagonist, Add atropine

GI drugs Flashcards

(59 cards)