GI Pharm from FA Flashcards Preview

0. Step Ia > GI Pharm from FA > Flashcards

Flashcards in GI Pharm from FA Deck (46)
Loading flashcards...
1

what class?

Cimetidine

Ranitidine

Famotidine

Nizatidine

H2 blockers

Take H2 blockers before you dine: "Table for 2"

2

H2 blockers: mech?

Reversible block of histamine H2 receptors

-> decr H+ secr by parietal cells

3

H2 blockers: use?

peptic ulcers, gastritis, mild esophageal reflux

4

Which H2 blockers have the most toxicity?

what is that tox?

Cimetidine: inhibits cytochrome P-450 -> multiple drug interactions.

Also is an anti-androgen -> prolactin release, gynecomastia, impotence, decr libido in males

Crosses BBB -> confusion, dizziness, headaches

crosses placenta.

Both Cimetidine and Ranitidine decrease renal excr of creatinine (could be a reason for elevated creatinine without another cause)

5

Name the H2 blockers that have no toxic effects listed in FA? (2)

Famotidine

Nizatidine

(Ranitidine has only one tox effect: decr renal excr of creatinine. Cimetidine has a boatload.)

6

What class?

Omeprazole, Lansoprazole, Esomeprazole, Pantoprazole, Dexlansoprazole

Proton Pump Inhibitors

7

Mechanism?

Omeprazole, Lansoprazole, Esomeprazole, Pantoprazole, Dexlansoprazole

Irreversibly inhibit H/K ATPase in stomach parietal cells

(receptors on LUMEN side of the stomach)

(Proton Pump Inhibitors: inhibit "primary active transport")

8

Clinical Use?

Omeprazole, Lansoprazole, Esomeprazole, Pantoprazole, Dexlansoprazole

Peptic ulcer, gastritis, esophageal reflux, Zollinger-Ellison syndrome

9

Toxocity?

Omeprazole, Lansoprazole, Esomeprazole, Pantoprazole, Dexlansoprazole

Incr risk of C Diff infection

Pneumonia

With long term use: hip fractures, decr serum Mg2+

(I'm sure this all has something to do with acid.)

10

Bismuth, Sucralfate: Mech?

Binds to ulcer base --> physical protection, allows Bicarb secretion to re-establish pH gradient in the mucous layer.

11

Bismuth, Sucralfate: Use?

Allows ulcer healing

Traveler's diarrhea

 

12

Misoprostol

Mech?

PGE1 analog

-Incr production/secretion of gastric mucous barrier

-Decr acid production

13

Misoprostol

Use?

-Prevents peptic ulcers from NSAID use (NSAIDs block PGE1 production)

-Maintains PDA

-Ripens cervix -> induces labor

(miso soup steams things open (PDA, cervix). Also is Jen's hangover cure: aspirin + miso soup)

14

Octreotide

Mech?

Long-acting somatostatin analog

Acts on ECL cell, not parietal cell

(Endocrine connection: somatostatin from hypothal decr GH and TSH release. If hypothalamus is destroyed, Octreotide can replace somatostatin)

15

Octreotide

Use?

-Acute variceal bleeds

-Acromegaly (blocks GH release from pituitary)

-VIPoma

-carcinoid tumors

-helpful for 'secretory' diarrhea

16

Octreotide

Tox?

nausea, cramps, steatorrhea

17

What class?

Aluminum hydroxide

Calcium carbonate

Magnesium hydroxide

Antacids

18

Antacids: general tox?

-affect absorption, bioavailability, or urinary excr of other drugs by altering gastric and urinary pH or by delaying gastric emptying

-Hypokalemia

19

Aluminum hydroxide: tox?

Antacid general tox = alter gastric/urinary pH or delay gastric emptying -> affect other drugs; hypokalemia

Specific to Al hydroxide: constipation, hypophosphatemia, prox muscle weakness, osteodystrophy, seizures

"Aluminimum amount of feces"

20

Calcium carbonate: tox?

Antacid general tox = alter gastric/urinary pH or delay gastric emptying -> affect other drugs; hypokalemia

Specific to Ca carbonate: hypercalcemia, rebound acid increase.

Can chelate and decr effectiveness of other drugs (ex tetracycline)

21

Magnesium hydroxide: tox?

Antacid general tox = alter gastric/urinary pH or delay gastric emptying -> affect other drugs; hypokalemia

Specific to Mg hydroxide: diarrhea, hyporeflexia, hypotension, cardiac arrest

"Mg = Must Go to the bathroom"

22

Class?

Magnesium hydroxide

Magnesium citrate

Polyethylene glycol

Lactulose

Osmotic laxatives

23

Osmotic laxatives: mech?

(Magnesium hydroxide

Magnesium citrate

Polyethylene glycol

Lactulose)

Provide osmotic load to drive water out

Lactulose treats hepatic encephalophy (gut flora degrade it into lactic acide and acetic acid -> promotes nitrogen excretion as NH4+

24

Osmotic laxatives: use?

(Magnesium hydroxide

Magnesium citrate

Polyethylene glycol

Lactulose)

Constipation

Lactulose: hepatic encephalopathy

25

Osmotic laxatives: tox?

(Magnesium hydroxide

Magnesium citrate

Polyethylene glycol

Lactulose)

diarrhea

dehydration

abuse by bulimics

26

Infliximab: mech?

Monoclonal antibody to TNF-a

27

Infliximab: use?

Crohn's

Ulcerative colitis

rheumatoid arthritis

ank spondylitis

psoriasis

28

Infliximab: tox?

Infection (possible reactivation of latent TB)

fever

hypotension

29

sulfazalazine: mech?

combination of sulfapyridine (antibacterial) + 5-aminosalicylic acid (anti-inflammatory)

Activated by colonic bacteria

30

Sulfasalazine: use?

Ulcerative colitis

Crohn's