GI Part 2 Flashcards Preview

Pharm II MHM - FINAL > GI Part 2 > Flashcards

Flashcards in GI Part 2 Deck (81):
1

Goals of mild constipation IBS treatment?

Increase dietary fiber and fluid intake

2

Goals of moderate constipation IBS treatment?

Add bulk forming laxatives with or without antispasmodics

3

Goals of severe constipation IBS treatment?

Add chloride channel activator

4

Goals of mild diarrhea IBS treatment?

-Dietary restriction
-Avoid contributing meds

5

Goals of moderate diarrhea IBS treatment?

-Add loperamide or other antispasmodics

6

Goals of severe diarrhea IBS treatment?

Add 5HT3 antagonists

7

IBS diarrhea drug choices

1. Loperamide
2. Anticholinergics
3. Serotonin receptor blockers

8

IBS constipation drug choices

1. Fiber supplements
2. Osmotic laxatives
3. Cl Channel Activators
4. Guanylate Agonist

9

Describe antispasmodics

-Anticholinergic (anti-SLUD)
-Used for diarrhea
-Side effects are dry mouth, blurred vision, urinary retention, constipation
-Dicyclomine

10

What are TCAs and what type of IBS are they used to treat?

-Tricyclic Antidepressants
-Anticholinergic action
-Decreases GI secretion and motility
-Used for diarrhea
-May help chronic abdominal pain
-Amitriptyline, desipramine

11

What are 5HT3 receptor blockers and what type of IBS are they used to treat?

-Serotonin receptor blockers
-Mediate visceral pain
-Inhibits colonic motility
-Used for diarrhea
-Alosetron

12

What is Alosetron and how is it used?

-Selective 5HT3 blocker
-Used for severe diarrhea IBS in women (efficacy in men not established)

13

Side effects of Alosetron?

-Constipation (can be severe)
-Ischemic colitis (fatalities reported, black box warning)

14

Describe bulk forming laxatives

-Anti constipation
-Form bulky emollient gel that distends colon and promotes peristalsis

15

Describe osmotic laxatives

-Anti constipation
-Nonabsorbable compounds that result in increased stool liquidity (due to obligate increase in fecal fluid)

16

What are chloride channel activators?

-Approved for constipation IBS in women (efficacy in men not shown)
-Lubiprostone/Amitiza

17

What is Lubiprostone?

-Chloride channel activator
-For constipation IBS in women
-Works on small intestine
-Enhances Cl-rich secretions and intestinal motility

18

Contraindications of lubiprostone? Adverse effects?

-Avoid in women of CBP (preg cat C)
-Nausea, diarrhea, HA

19

What is linaclotide?

-Guanylate agonist-Used for constipation
-Causes rise of cGMP leading to rise of Cl and bicarb into intestinal lumen
-Fluid increases, transit time decreases

20

Side effects of linaclotide?

-Diarrhea
-Flatulence
-GI upset

21

What are serotonin 5HT4 receptor blockers?

-Results in release of NTs promoting peristaltic reflex
-Proximal bowel contraction and distal bowel relaxation
-For constipation
-No agent available in US

22

Drug classes for IBD treatment

-Aminosalicylates
-Glucocorticoids
-Purine analogs
-MTX
-Anti-TNF
-Anti-integrins

23

Drugs for mild IBD

1. 5-aminosalicylates
2. Abx
3. Topical corticosteroids
4. Budesonide

24

Drugs for moderate IBD

1. Azathioprine/6-mercaptopurine
2. MTX
3. Oral corticosteroids
4. TNF blockers

25

Drugs for severe IBD

1. IV corticosteroids
2. TNF blockers
3. Cyclosporine
4. Natalizumab
5. Surgery

26

What is the active compound of all aminosalicylates?

5-ASA

27

MOA of aminosalicylates?

Unclear
-May affect inflamm mediators
-May interfere w/cytokine production
-May inhibit immune cells

28

How do aminosalicylates work in IBD treatment?

-Topically on affected areas of GI mucosa
-So must get to affected site
-Pure oral 5-ASA is more than 80% absorbed which means little left over to go to needed area
-Formulations are made to avoid so much absorption

29

What are the different formulations of aminosalicylates?

-Azo compounds
-Mesalamine compounds

30

What are the azo aminosalicylate drugs?

-Sulfasalazine
-Olsalzine
-Balsalazide

31

What are the mesalamine aminosalicylate drugs?

-Pentasa
-Asacol
-Lialda

32

How do azo compounds work?

-N=N azo bond reduces absorption after oral absorption
-At ileum and colon, bacteria cleave the molecules and release active 5-ASA

33

How do mesalamine compounds work?

-Each is uniquely formulated to deliver 5-ASA
-Pentasa is timed-release microgranules
-Asacol, apriso, lialda are coated in a pH resin that dissolves in distal ileum and colon

34

Mesalamine compounds provide ___ concentrations to sites in ___ GI tract

High Lower

35

What drug class is considered first line in mild to moderate UC?

Aminosalicylates

36

Sulfasalazine limitations

-Many pts can't tolerate dosing
-Many ADRs (nausea, HA, arthralgias)
-Hypersensitivity reactions

37

What supplementation does sulfasalazine require?

Folic acid due to impaired absorption

38

MOA of glucocorticoids in IBD

Inhibit production of inflammatory cytokines like TNF-a, IL-1, IL-8

39

How are glucocorticoids used in IBD?

-Moderate to severe disease
-Helpful in early treatment but not to maintain remissions

40

What is the MC oral glucocorticoid used for IBD?

Prednisone

41

What is budesonide and how is it used?

-Oral prednisolone analog
-Used in mild to moderate Crohn's

42

Side effects of glucocorticoids

-Hyperglycemia
-Adrenal suppression
-Peptic ulcers
-Immunosuppresion

43

Describe purine analogs

-Oral
-Delayed onset of action of several weeks due to metabolic conversions
-Azothioprine to 6-MP to 6-thioguanine

44

How do purine analogs work in IBD?

-Provide immunosuppressive action
-Used to induce and maintain remissions in both UC and Crohn's
-Often used with steroids to reduce steroid dose

45

ADRs of purine analogs

-NV
-Bone marrow suppression
-Liver toxicity
-Hypersensitivity reactions

46

Which med should be avoided when taking purine analogs?

-Allopurinol
-Can cause leukopenia

47

What is methotrexate?

-Folic acid analog
-Anti-inflamm in low doses (cytotoxic at high doses)
-Used to induce or maintain remission in Crohn's (unknown effect in UC)

48

ADRs of MTX

-Myelosuppression, mucositis, alopecia
-Liver toxicity

49

How do anti-integrins work?

-Prevent inflamm cells from using integrins to bind to vascular cells
-Used for refractory Crohn's

50

What is natalizumab and how is it used?

-Anti-integrin
-Mod to severe Crohn's
-Requires pt enrollment in CD touch due to adverse effects

51

What should happen if patients are on steroids and then given natalizumab?

Taper once response is observed

52

Major ADR of natalizumab

Progressive multifocal leukoencephalopathy
-A/w exposure to JC virus
-Occurs in IC pts
-Increased duration of med increases risk

53

What are the MC causes of cirrhosis and hepatocellular carcinoma?

HBV and HCV

54

Goal of hepatitis treatments?

Suppressive rather than curative

55

HAV treatment

-NONE
-Vaccine to prevent

56

Drug classes for HBV treatments

-Nucleoside/tide analogs
-Interferons

57

How are nucleoside/tide analogs used in HBV treatment?

Usually combined with interferon

58

What is lamivudine?

-Nucleoside/tide analog
-Inhibits HBV DNA pol
-Requires phosphorylation to become activated

59

What is adefovir dipivoxil?

-Nucleoside analog
-Inhibits HBV DNA pol
-2nd line treatment
-Less toxic than other nucleosides

60

What is entecavir?

-Nucleoside analog
-Inhibits HBV DNA pol
-Effective in lamivudine-resistant strains
-Take on EMPTY stomach

61

What is telbivudine?

-Nucleoside analog
-Inhibits HBV DNA pol
-Requires phosphorylation to active form
-Give with or w/o food

62

What is tenofovir?

-Nucleotide analog of adenosine
-Inhibits reverse transcriptase

63

Describe interferons

-Family of cytokines, provide antiviral action
-Alfa (2a and 2b), beta, gamma available

64

IFN alfa 2a is used to treat:

HBV AND HCV

65

IFN alfa 2b is used to treat:

ONLY HCV

66

Treatment options for HCV:

-IFN alfa 2a or 2b
-Ribavirin
-Telapravir
-Boceptrevir

67

How is treatment of HCV directed?

Based on genotype

68

Describe IFN used to treat HCV

-Genotypes 3-6
-Often used w/ribavirin
-Were once cornerstone of treatment but now newer agents available

69

Describe ribavirin

-Guanosine analog for HCV
-Blocks RNA dependent RNA pol
-Available oral or IV
-Combined with IFN

70

Describe simeprevir

-Inhibits HCV NS3/4A protease
-1st line treatment w/other agents

71

What is currently recommended as 1st line treatment w/other agents for HCV?

Simeprevir (NS3/4A protease inhibitor)

72

Describe paritaprevir

-HCV NS3/4A protease inhibitor
-Often 1st line w/other agents
-E.g. viekira pak

73

What is ledipasvir and sofosbuvir?

-NS5A inhibitors for HCV tx-1st line agent

74

How are HCV genotypes 5 and 6 treated?

Peg-IFN alfa 2a WITH ribavirin for 48 weeks

75

What are the protease inhibitors used to treat HCV?

-Simeprevir
-Paritaprevir
-Boceprevir

76

What are the NS5A protein inhibitors used to treat HCV?

-Ledipasvir/Sofosbuvir
-Ombitasvir
-Sofosbuvir and Dasabuvir

77

What is 1st line to treat ascites?

Diuretics

78

Meds for variceal bleeding prophylaxis?

-Nonselective B blockers (propranolol, nadolol)

79

Meds for acute variceal hemorrhage?

-Vasoconstrictors (octreotide, vasopressin)
-Abx

80

Meds for spontaneous bacterial pritonitis?

-Abx (cefotaxime)

81

Treatment of hepatic encephalopathy?

-Targeted to decrease NH3 blood concentration (via abx)
-Neomycin and metronidazole
-Rifaximin