GI Drugs Flashcards by Britney Gomer

Q

Aluminum salts

A

Class: Low-systemic antacid
MOA: binds luminal H+ to produce H2O, CO2, or Cl- salts
Adverse Effects: Constipation, Hypophospatemia

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Q

Calcium salts

A

Class: Low-systemic antacid
MOA: binds luminal H+ to produce H2O, CO2, or Cl- salts
Adverse Effects: Constipation, hypercalcemia, hypophosphatemia, calcium-based kidney stones

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Q

Magnesium salts

A

Class: Low-systemic antacid
MOA: binds luminal H+ to produce H2O, CO2, or Cl- salts
Adverse Effects: Diarrhea, hypermagnesemia

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Q

Sodium salts

A

Class: high-systemic antacid
MOA: Binds luminal H+ to produce H2O, CO2, or Cl- salts
Adverse Effects: Gas/flatulence, hypernatremia, metabolic alkalosis

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Q

Simethicone

A

Class: Supplemental antacid
MOA: surfactant that decreases surface tension of gas bubbles in the GI tract to create one, easily passable gas bubble
Adverse Effects: none listed

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Q

Cimetidine

A

Class: H2 receptor antagonist
MOA: Reversibly inhibits H2-receptors on the basolateral membrane of parietal cells
Adverse Effects: Nausea, diarrhea, constipation, headache
Unique characteristics: gynechomastia in men, galactorrhea in women, neutropenia, thrombocytopenia, prototypical CYP450 inhibitor

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Q

Famotidine

A

Class: H2 receptor antagonist
MOA: Reversibly inhibits H2-receptors on the basolateral membrane of parietal cells
Adverse Effects: Nausea, diarrhea, constipation, headache

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Q

Nizatidine

A

Class: H2 receptor antagonist
MOA: Reversibly inhibits H2-receptors on the basolateral membrane of parietal cells
Adverse Effects: Nausea, diarrhea, constipation, headache

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Q

Ranitidine

A

Class: H2 receptor antagonist
MOA: Reversibly inhibits H2-receptors on the basolateral membrane of parietal cells
Adverse Effects: Nausea, diarrhea, constipation, headache

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Q

Lansoprazole

A

Class: Proton pump inhibitors
MOA: irreversibly binds sulfhydryl groups of H/K-ATPase at parietal cell secretory sites, inhibiting gastric acid secretion
Adverse Effects: Nausea, diarrhea, dyspepsia, increased risk for C diff infection, HA, dizziness

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Q

Dexlansoprazole

A

Class: Proton pump inhibitors
MOA: irreversibly binds sulfhydryl groups of H/K-ATPase at parietal cell secretory sites, inhibiting gastric acid secretion
Adverse Effects: Nausea, diarrhea, dyspepsia, increased risk for C diff infection, HA, dizziness

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Q

Omeprazole

A

Class: Proton pump inhibitors
MOA: irreversibly binds sulfhydryl groups of H/K-ATPase at parietal cell secretory sites, inhibiting gastric acid secretion
Adverse Effects: Nausea, diarrhea, dyspepsia, increased risk for C diff infection, HA, dizziness
Unique Characteristics: prototypical CYP450 inhibitor

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Q

Esomeprazole

A

Class: Proton pump inhibitors
MOA: irreversibly binds sulfhydryl groups of H/K-ATPase at parietal cell secretory sites, inhibiting gastric acid secretion
Adverse Effects: Nausea, diarrhea, dyspepsia, increased risk for C diff infection, HA, dizziness

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Q

Pantoprazole

A

Class: Proton pump inhibitors
MOA: irreversibly binds sulfhydryl groups of H/K-ATPase at parietal cell secretory sites, inhibiting gastric acid secretion
Adverse Effects: Nausea, diarrhea, dyspepsia, increased risk for C diff infection, HA, dizziness

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Q

Rabeprazole

A

Class: Proton pump inhibitors
MOA: irreversibly binds sulfhydryl groups of H/K-ATPase at parietal cell secretory sites, inhibiting gastric acid secretion
Adverse Effects: Nausea, diarrhea, dyspepsia, increased risk for C diff infection, HA, dizziness

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Q

Sucralfate

A

Class: Surface acting anti-ulcer agent
MOA: cross-links w/ itself in response to stomach acid to create a sticky polymer that adheres to epithelial cells around the ulcer’s crater
Adverse Effects: Constipation d/t conjugated Al(OH)3

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Q

Misoprostol

A

Class: misoprostol
MOA: reduces gastric acid release from parietal cells and stimulates cytoprotective actions of gastric mucosa
Adverse Effects: diarrhea, cramping, HA, dizziness

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Q

Bismuth subsalicylate

A

Class: bismuth antiulcer agents
MOA: prevents microbial attachment to mucosa, inactivates enterotoxins, disrupts bacterial cell wall
Adverse Effects: constipation, black regularly formed stools

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Q

Dolasetron

A

Class: Serotonin Receptor Antagonist
MOA: blocks serotonin receptors at vagal nerve terminals and block signal transmission to CTZ
Adverse Effects: HA, constipation/diarrhea, serotonin syndrome, QT prolongation, Torsade de pointes

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Q

Granisetron

A

Class: Serotonin Receptor Antagonist
MOA: blocks serotonin receptors at vagal nerve terminals and block signal transmission to CTZ
Adverse Effects: HA, constipation/diarrhea, serotonin syndrome, QT prolongation, Torsade de pointes
Unique characteristic: sustained-release allows for once daily administration

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Q

Ondansetron

A

Class: Serotonin Receptor Antagonist
MOA: blocks serotonin receptors at vagal nerve terminals and block signal transmission to CTZ
Adverse Effects: HA, constipation/diarrhea, serotonin syndrome, QT prolongation, Torsade de pointes

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Q

Palonosetron

A

Class: Serotonin Receptor Antagonist
MOA: blocks serotonin receptors at vagal nerve terminals and block signal transmission to CTZ
Adverse Effects: HA, constipation/diarrhea, serotonin syndrome, QT prolongation, Torsade de pointes
Unique Characteristic: sustained-release allows for once daily administration

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Q

Aprepitant

A

Class: neurokinin-1 receptor antagonist
MOA: blocks NK1 receptors in the CTZ and vomit center
Adverse effects: dyspepsia, constipation, diarrhea, dizziness, fatigue, somnolence
Unique Characteristic: given up to 3 hours prior to anesthesia induction to control vomiting

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Q

Fosaprepitant

A

Class: neurokinin-1 receptor antagonist
MOA: blocks NK1 receptors in the CTZ and vomit center
Adverse effects: dyspepsia, constipation, diarrhea, dizziness, fatigue, somnolence

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Netupitant

Class: neurokinin-1 receptor antagonist MOA: blocks NK1 receptors in the CTZ and vomit center Adverse effects: dyspepsia, constipation, diarrhea, dizziness, fatigue, somnolence Unique characteristic: longer half-life

Fosnetupitant

Class: neurokinin-1 receptor antagonist MOA: blocks NK1 receptors in the CTZ and vomit center Adverse effects: dyspepsia, constipation, diarrhea, dizziness, fatigue, somnolence Unique characteristic: longer half-life

Rolapitant

Class: neurokinin-1 receptor antagonist MOA: blocks NK1 receptors in the CTZ and vomit center Adverse effects: dyspepsia, constipation, diarrhea, dizziness, fatigue, somnolence

Diphenhydramine

Class: Histamine-1 Receptor Antagonist MOA: blocks H1 receptors in the VC and vestibular system Adverse effects: Drowsiness, dry mouth, constipation, urinary retention, blurred vision, decreased BP

Dimenhydrinate

Class: Histamine-1 Receptor Antagonist MOA: blocks H1 receptors in the VC and vestibular system Adverse effects: Drowsiness, dry mouth, constipation, urinary retention, blurred vision, decreased BP

Hydroxyzine

Class: Histamine-1 Receptor Antagonist MOA: blocks H1 receptors in the VC and vestibular system Adverse effects: Drowsiness, dry mouth, constipation, urinary retention, blurred vision, decreased BP

Promethazine

Class: Histamine-1 Receptor Antagonist MOA: blocks H1 receptors in the VC and vestibular system Adverse effects: Drowsiness, dry mouth, constipation, urinary retention, blurred vision, decreased BP

Meclizine

Class: Histamine-1 Receptor Antagonist MOA: blocks H1 receptors in the VC and vestibular system Adverse effects: Drowsiness, dry mouth, constipation, urinary retention, blurred vision, decreased BP

Cyclizine

Class: Histamine-1 Receptor Antagonist MOA: blocks H1 receptors in the VC and vestibular system Adverse effects: Drowsiness, dry mouth, constipation, urinary retention, blurred vision, decreased BP

Doxylamine

Class: Histamine-1 Receptor Antagonist MOA: blocks H1 receptors in the VC and vestibular system Adverse effects: Drowsiness, dry mouth, constipation, urinary retention, blurred vision, decreased BP

Chlorpromazine

Class: Phenothiazine Dopamine-2 receptor antagonist MOA: blocks D2 receptors in the CTZ Adverse Effects: Drowsiness, dry mouth, constipation, urinary retention, blurred vision, arrhythmias

Perphenazine

Class: Phenothiazine Dopamine-2 receptor antagonist MOA: blocks D2 receptors in the CTZ Adverse Effects: Drowsiness, dry mouth, constipation, urinary retention, blurred vision, arrhythmias

Prochlorperazine

Class: Phenothiazine Dopamine-2 receptor antagonist MOA: blocks D2 receptors in the CTZ Adverse Effects: Drowsiness, dry mouth, constipation, urinary retention, blurred vision, arrhythmias

Metoclopramide

Class: Dopamine-2 receptor antagonist MOA: blocks D2 receptors in the CTZ Adverse Effects: Drowsiness, dry mouth, constipation, urinary retention, blurred vision, arrhythmias

Scopolamine

Class: Muscarinic-1 receptor antagonist MOA: blocks M1 receptors in neural pathways from the vestibular nuclei in the inner ear to the brain stem and from the reticular formation to the VC Adverse effects: Drowsiness, dry mouth, constipation, urinary retention, blurred vision

Dronabinol

Class: Cannabinoids MOA: stimulation of CB1 and CB2 receptors in VC/CTZ to minimize release of serotonin from vagal afferent terminals Adverse effects: euphoria, irritability, vertigo, sedation, drowsiness, impaired cognition, memory, hallucinations, distorted sense of time, xerostomia, increased HR and BP, appetite stimulation Unique Characteristic: schedule III drug, large first-pass effect

Nabilone

Class: Cannabinoids MOA: stimulation of CB1 and CB2 receptors in VC/CTZ to minimize release of serotonin from vagal afferent terminals Adverse effects: euphoria, irritability, vertigo, sedation, drowsiness, impaired cognition, memory, hallucinations, distorted sense of time, xerostomia, increased HR and BP, appetite stimulation Unique characteristic: schedule II drug, metabolized to several active metabolites

Sulfasalzine

Class: 5-ASA MOA: inhibition of prostaglandin and leukotriene formation via arachidonic acid pathway, reduction in macrophage chemotaxis Adverse effects: aspirin allergy Unique characteristic: sulfa drug

Mesalamine

Class: 5-ASA MOA: inhibition of prostaglandin and leukotriene formation via arachidonic acid pathway, reduction in macrophage chemotaxis Adverse effects: aspirin allergy Unique characteristic: single 5-ASA molecule

Olsalazine

Class: 5-ASA MOA: inhibition of prostaglandin and leukotriene formation via arachidonic acid pathway, reduction in macrophage chemotaxis Adverse effects: aspirin allergy Unique characteristic: 2 5-ASA molecules

Balsalazine

Class: 5-ASA MOA: inhibition of prostaglandin and leukotriene formation via arachidonic acid pathway, reduction in macrophage chemotaxis Adverse effects: aspirin allergy Unique characteristic: inert carrier + 5-ASA

Tofacitinib

Class: JAK inhibitor MOA: sequestration of free-floating and bound JAK-1 and JAK-3 to inhibit gene transcription and cytokine release Adverse Effects: lymphopenia, neutropenia, anemia, fatigue, increased LDL and HDL

Adalimumab

Class: TNF-α inhibitor MOA: binds and neutralizes membrane-associated and soluble TNF-α to block leukocyte migration Adverse Effects: reactivation of TB, liver injury, HA, arthralgia, fatigue

Golimumab

Class: TNF-α inhibitor MOA: binds and neutralizes membrane-associated and soluble TNF-α to block leukocyte migration Adverse Effects: reactivation of TB, liver injury, HA, arthralgia, fatigue Unique Characteristic: only indicated for ulcerative colitis

Certolizumab

Class: TNF-α inhibitor MOA: binds and neutralizes membrane-associated and soluble TNF-α to block leukocyte migration Adverse Effects: reactivation of TB, liver injury, HA, arthralgia, fatigue Unique Characteristic: only indicated for Crohn disease

Infliximab

Class: TNF-α inhibitor MOA: binds and neutralizes membrane-associated and soluble TNF-α to block leukocyte migration Adverse Effects: reactivation of TB, liver injury, HA, arthralgia, fatigue

Vedolizumab

Class: α4 Integrin inhibitor MOA: limits integrin-associated cell adhesion and subsequent trans-endothelial migration of leukocytes Adverse Effects: Infusion-related side effects, anti-medication antibody formation Unique characteristics: increased risk for malignancies

Natalizumab

Class: α4 Integrin inhibitor MOA: limits integrin-associated cell adhesion and subsequent trans-endothelial migration of leukocytes Adverse Effects: Infusion-related side effects, anti-medication antibody formation Unique characteristics: progressive multifocal leukoencephalopathy (infection w/ JC virus)

Ustekinumab

Class: IL-12/-23 Inhibitors MOA: Binds to p40 subunit of IL-12/-23 to block activation and differentiation of naive T cells and NK cell activation Adverse Effects: reactivation of TB, infusion/injection-related allergic reactions, HA, arthralgia, fatigue

Loperamide

Class: opioid agonist MOA: interferes w/ peristalsis via direct action on circular and longitudinal muscles of intestinal wall Adverse Effects: dizziness, fatigue, drowsiness, urinary retention Unique characteristics: cardiac toxicities that can lead to death

Diphenoxylate

Class: opioid agonist MOA: exerts local and central effect on GI smooth muscle cells to inhibit GI motility and slow excess GI propulsion Adverse Effects: dizziness, fatigue, drowsiness, urinary retention Unique characteristic: opioid agonist + atropine (to curb abuse)

Eluxadoline

Class: opioid agonist MOA: mu and kappa receptor agonist in GI tract to slow peristalsis, delta receptor antagonist to decrease stomach/pancreas/biliary secretions Adverse Effects: dizziness, fatigue, drowsiness, urinary retention Unique Characteristic: hepatic/pancreatic toxicity

Alosetron

Class: Serotonin receptor antagonist MOA: selective blockade of GI serotonin receptors to regulate visceral pain, colonic transit, and GI secretions Adverse Effects: Ischemic colitis Unique characteristics: requires special prescriber program, only indicated in chronic severe IBS-D that is not responsive to other conventional therapies

Crofelemer

Class: Chloride channel inhibitor MOA: inhibition of chloride anion secretion by blocking CFTR and calcium-activated chloride channels Adverse Effects: abd distention, elevated AST/ALT/bilirubin, respiratory/urinary infections Unique characteristics: indicated in non-infectious diarrhea for HIV/AIDS pts

Methylnaltrexone

Class: peripheral opioid antagonist MOA: peripheral mu receptor blockade increases GI motility Adverse Effects: abd pain, diarrhea, N/V

Naloxegol

Class: peripheral opioid antagonist MOA: peripheral mu receptor blockade increases GI motility Adverse Effects: abd pain, diarrhea, N/V

Alvimopan

Class: peripheral opioid antagonist MOA: peripheral mu receptor blockade increases GI motility Adverse Effects: abd pain, diarrhea, N/V Unique Characteristics: increased risk for MI w/ use; only used in post-op ileus prevention

Linaclotide

Class: Guanylate Cyclase-C agonists MOA: binds GC-C on luminal surface of intestinal epithelium to increase cGMP stimulation of chloride/bicarb secretion Adverse Effects: diarrhea, GERD, dyspepsia, N/V Unique characteristic: indicated in IBS-C and chronic idiopathic constipation

Lubiprostone

Class: selective chloride channel activators MOA: PGE-1 analog that increases activation of GI specific chloride channels (CIC-2) in luminal cells of intestinal epithelium Adverse Effects: Nausea, dyspepsia, dizziness

Bisacodyl

Class: stimulant laxative MOA: irritates enterocytes, GI smooth muscle cells to promote water and electrolyte accumulation in the lumen, prompting peristalsis to remove irritants Adverse Effects: abdominal cramping, urine discoloration, fluid/electrolyte disturbances, perforated bowel (in GI obstruction) Unique characteristics: faster onset (0.5 - 2 hours)

Castor oil

Class: stimulant laxative MOA: irritates enterocytes, GI smooth muscle cells to promote water and electrolyte accumulation in the lumen, prompting peristalsis to remove irritants Adverse Effects: abdominal cramping, urine discoloration, fluid/electrolyte disturbances, perforated bowel (in GI obstruction)

Glycerin

Class: stimulant laxative MOA: irritates enterocytes, GI smooth muscle cells to promote water and electrolyte accumulation in the lumen, prompting peristalsis to remove irritants Adverse Effects: abdominal cramping, urine discoloration, fluid/electrolyte disturbances, perforated bowel (in GI obstruction) Unique characteristics: faster onset (0.5 - 2 hours)

Senna

Class: stimulant laxative MOA: irritates enterocytes, GI smooth muscle cells to promote water and electrolyte accumulation in the lumen, prompting peristalsis to remove irritants Adverse Effects: abdominal cramping, urine discoloration, fluid/electrolyte disturbances, perforated bowel (in GI obstruction)

Na+ picosulfate

Class: stimulant laxative MOA: irritates enterocytes, GI smooth muscle cells to promote water and electrolyte accumulation in the lumen, prompting peristalsis to remove irritants Adverse Effects: abdominal cramping, urine discoloration, fluid/electrolyte disturbances, perforated bowel (in GI obstruction)

Lactulose

Class: Osmotic laxative MOA: osmotically attracts and retains water in the colon to increase moisture, softness, and volume/bulk of stools Adverse effects: electrolyte disturbances, N/V, diarrhea Unique characteristic: used to trap ammonia in liver disease

Magnesium citrate

Class: Osmotic laxative MOA: osmotically attracts and retains water in the colon to increase moisture, softness, and volume/bulk of stools Adverse effects: electrolyte disturbances, N/V, diarrhea

Polyethylene glycol (PEG)

Class: Osmotic laxative MOA: osmotically attracts and retains water in the colon to increase moisture, softness, and volume/bulk of stools Adverse effects: electrolyte disturbances, N/V, diarrhea Unique Characteristics: used as pre-surgical bowel prep

Sorbitol

Class: Osmotic laxative MOA: osmotically attracts and retains water in the colon to increase moisture, softness, and volume/bulk of stools Adverse effects: electrolyte disturbances, N/V, diarrhea

Magnesium Hydroxide

Class: Saline cathartic MOA: create hyperosmolar solutions that pull fluid into the stool and inhibits reabsorption of water in the GI tract to increase stool volume, shortening transit time Adverse Effects: electrolyte imbalance, hypernatremia

Na+ phosphate

Class: Saline cathartic MOA: create hyperosmolar solutions that pull fluid into the stool and inhibits reabsorption of water in the GI tract to increase stool volume, shortening transit time Adverse Effects: electrolyte imbalance, hypernatremia

Dietary fiber

Class: bulk forming cathartic MOA: increase bulk volume and water content to increase GI motility, supports colonic bacteria fermentation and digestion Adverse effects: bloating, obstruction

Psyllium

Class: bulk forming cathartic MOA: increase bulk volume and water content to increase GI motility, supports colonic bacteria fermentation and digestion Adverse effects: bloating, obstruction Unique characteristics: many drug interactions

Methylcellulose/carboxymethylcellulose

Class: bulk forming cathartic MOA: increase bulk volume and water content to increase GI motility, supports colonic bacteria fermentation and digestion Adverse effects: bloating, obstruction Unique characteristics: many drug interactions

Calcium polycarbophil

Class: bulk forming cathartic MOA: increase bulk volume and water content to increase GI motility, supports colonic bacteria fermentation and digestion Adverse effects: bloating, obstruction

Docusate

Class: stool softener MOA: increases fluid secretion and inhibits water reabsorption to soften and lubricate already formed stool Adverse Effects: N/V/D

Mineral Oil

Class: stool softener MOA: increases fluid secretion and inhibits water reabsorption to soften and lubricate already formed stool Adverse Effects: N/V/D

Hyoscyamine

Class: antimuscarinic agents MOA: competitive inhibition of muscarinic receptors to decrease GI motility and spasms Adverse Effects: dry mouth, urinary retention, constipation, drowsiness, mental confusion, blurred vision

Dicyclomine

Class: antimuscarinic agents MOA: competitive inhibition of muscarinic receptors to decrease GI motility and spasms Adverse Effects: dry mouth, urinary retention, constipation, drowsiness, mental confusion, blurred vision

Clidinium/chlordiazepoxide

Class: antimuscarinic agents MOA: competitive inhibition of muscarinic receptors to decrease GI motility and spasms Adverse Effects: dry mouth, urinary retention, constipation, drowsiness, mental confusion, blurred vision

Drugs to treat CDI

Vancomycin Metronidazole Fidaxomicin

H. Pylori Treatments

Bismuth subsalicylate Metronidazole Tetracycline Omeprazole

E. histolytica treatment

Metronidazole Tinidazole Paromomycin Iodoquinol

Giardia lamblia treatment

Tinidazole Metronidazole Nitazoxanide

C. parvum treatment

Nitazoxanide

Nematodes treatment

``` Albendazole Mebendazole Ivermectin Thiabendazole Pyrantel pamoate ```

Schistosoma treatment

Praziquantel

Cestode treatments

Praziquantel Niclosamide Albendazole