GI Pharmacology Flashcards Preview

Pharmacology II > GI Pharmacology > Flashcards

Flashcards in GI Pharmacology Deck (46):
1

Omeparazol (class, indication, MOA)

PPI
Indication: Peptic Ulcer
MOA: react with H/K ATPase to irreversibly inactivate the enzyme (limit gastric acid in the stomach)

2

Omeprazol ADE

Short term use: GI symptoms

Long term use: reduced plasma B12, non-heme iron, Ca2+, and Mg2+ (hypomagnesia may lead to prolonged QT) increased risk of enteric and respiratory infection

3

Omeprazole Drug-Drug interactions

Drugs who's bioavailability is affecte by intragastric activity (digoxin and ketochonazole- an antifungal)

Digoxin
Ketochonazole
Phenytoin
Diazepam
Theophylline
Clopidrogrel

4

Cimetidine (class, MOA, Indication)

H2 receptor antagonist

MOA: competitively and selectively bonds H2 receptors on parietal cells to reduce histamine induction of Acid secretion(irreversible)

Indication: PUD

5

Ranitidine (class, MOA, Indication)

H2 receptor antagonist

MOA: competitively and selectively bonds H2 receptors on parietal cells to reduce histamine induction of Acid secretion(irreversible)

Indication: PUD

6

Cimetidine ADE

extremely safe

7

Ranitidine ADE

extremely safe

8

Cimetidine Drug- Drug interaction

Inhibit first pass metabolism of alcohol - ask pt to limit use (common to all H2 antagonists)

Inhibits CYP1A2, 2D6 and weak 3A4 (Lidocaine, diazapam, and antifungal agents)

9

Ranitidine Drug-Drug interaction

Inhibit first pass metabolism of alcohol - ask pt to limit use (common to all H2 antagonists)

10

Cimetidine contraindication

alcohol use

11

Ranitidine contraindication

alcohol use

12

sodium bicarbonate, calcium carbonate, aluminum hydroxide, magnesium hydroxide (class, MOA, indication )

antacid

MOA: neutralize gastric acid

indication: short term relief of PUD symptoms

13

sodium bicarbonate, calcium carbonate, aluminum hydroxide, magnesium hydroxide AE

altered electrolytes
constipation
diarrhea

14

sodium bicarbonate, calcium carbonate, aluminum hydroxide, magnesium hydroxide Drug-Drug interactions

Affects absorption of antibiotics - require separate administration times (4-6 hours)

Remember: tetracyclines and fluorquinolones are affected by di and trivalent cations

15

Bismuth subsailacylate (class, MOA, indication)

Mucosal defense

MOA: coats ulcer and errosions, stimulate prostaglandin, mucus and bicarb secretion, some antimicrobial effects, reduces stool frequency and liquidity

Indication: Treat dyspepsia, prevent travelers diarrhea, treat H.pylori induced peptic ulcer

16

Bismuth Subsailacylate ADE

Black tongue and stools

17

Bismuth Subsailacylate contraindication

Renal insufficiency ( can bind to metal binding protein in the kidney and stay there for a long time )

18

Triple therapy for H.pylori caused peptic ulcer

PPI-CA: PPI + clarythromycin + amoxicillin
PPI-CM: PPI+ calrythromycin+ Metronidazole

19

Quad therapy for H.pylori caused peptic ulcer

triple therapy (PPI-CA or PPI-CM) + mucosal defense (Bismuth Subsailacylate)

20

Sulflasalazine (class, MOA, indication

Class: 5-ASA

MOA: Inhibit IL-1 and TNFa expression, inhibit the lipoxgygenase pathway (needed for synthesis of leukotrienes), inhibit NFkB and ROS

Indication: induce and maintain remission of mild or moderate UC

21

Mesalamine

Class: 5-ASA (inflammatory supressor)

MOA: Inhibit IL-1 and TNFa expression, inhibit the lipoxgygenase pathway (needed for synthesis of leukotrienes), inhibit NFkB and ROS

Indication: induce and maintain remission of mild or moderate UC

22

Sulfasalazine AE

common: dyspnea, skin rash, headache, abdominal pain

Rare but serious: NEPHROTOXICITY

23

Mesalamine

common: dyspnea, skin rash, headache, abdominal pain

Rare but serious: NEPHROTOXICITY

24

Sulfasalazine Drug-Drug interactions

antacids (formulations with pH sensitive coat will not reach the intestine- will get stuck on the stomach)

25

Mesalamine Drug-Drug Interactions

antacids (formulations with pH sensitive coat will not reach the intestine- will get stuck on the stomach)

26

Prednisone (class, MOA, indication)

Cortocosteroids (inflammatory suppressor)

MOA: inhibit the expression of inflammatory mediators and increase the expression of anti-inflammatory mediators

Indication: induce remission and control acute moderate to severe active IBD (more potent than 5-ASA) SHORT TERM USE ONLY

27

Budesonide (class, MOA, indication)

Cortocosteroids (inflammatory suppressor)

MOA: inhibit the expression of inflammatory mediators and increase the expression of anti-inflammatory mediators

Indication: induce remission in mild and moderate IBD (SHORT TERM USE ONLY)

28

Budesonide Drug-Drug interactions

interacts with CYP34a inhibitors and inducers

29

Prednisone AE

MANY!! Drug must be tappered gradually in order to avoid systemic effects

mood changes, fluid retention, increased appetite and glucose levels, increased change of infection, adrenal axis suppression, slow growth rate in children

30

6-mecaptopurine (class, MOA, indication)

Class: Thipurine (immunomodulators)

MOA: inhibit purine synthesis - anti-proliferation and induce apoptosis in T-cells

Indication: maintain remission of UC and CD
NOTE: can be added in tappering of corticosteroids

31

6- mecaptopurine AE

Major dose: bone marrow suppression

Most serious: pancreatitis

32

6-mecaptopurine Drug-Drug interactions

XO inhibitors (gout medications)

33

Infliximab (class, MOA, indication)

Class: anti-TNFa (Biologic)

MOA: prevent TNFa from producing inflammation by blocking activation of NFkB

Indication: moderate to severe CD and or UC that do not respond to immunosupression

34

Infliximab AE

serious infection
injection site reaction
lymphoma (when taken with immunomodilators)

35

Inflixamab Contraindications

uncontrolled infection
simultaneous administration of other biologics

36

Natalizumab (class, MOA, indication)

Class: anti-a4 integrin (Biologic)

MOA: bind to a4 integrin and prevent extravagation to prevent inflammation

Indication: moderate to severe CD for INPATIENTS WHO DO NOT RESPOND TO OR CANNOT RESPOND TO ANTI-TNF THERAPY

37

Natalizumab AE

Progressive multifocal leukoencephalopathy (PML)
severe hepatic toxicity

38

Natalizumab Drug-Drug interaction

other immunosupressants

39

Metoclopramide (class, MOA, indication)

Class: D2 dopamine receptor antagonist (Prokinetic)

MOA: Peripheral - bind to receptors to decrease motility and decrease LES pressure Central- antiemetic action (CTZ)

Indication: impaired gastric emptying (Gastroparesis, post surgical disorders), prevent emesis

40

Metoclopraminde AE

Neurpsychiatric and extrapyramidal symptoms, Taradive dyskinesia, Parkinsonism

41

Metoclopramide CI

Seizures, GI obstruction, hemorrhage, Parkinson Disease

42

Psyllium (class, MOA, indication)

class: Bulk forming laxative

MOA: absorb water into the intestines to increase fecal bulk and stimulate peristalsis (through stretch receptors)

Indications: Prevent constipation

NOTE: pt needs to drink a lot of fluids and have the strength for bowel movement (not for weak patients or young children)

43

Methylcellulose (class, MOA, indication)

class: Bulk forming laxative

MOA: absorb water into the intestines to increase fecal bulk and stimulate peristalsis (through stretch receptors)

Indications: Prevent constipation

NOTE: pt needs to drink a lot of fluids and have the strength for bowel movement (not for weak patients or young children)

44

Docusate (class, MOA, indication)

class: Stool surfactant/softener

MOA: permit water and lipids to penetrate the stool - softens it

indication: prevent constipation in patients who should avoid strain (MI and surgery)

45

Mineral oil (class, MOA, indication)

class: stool softener

MOA: lubricate stool and inhibit water absorption

indication: treat and prevent constipation in young children and dibilitated adults

46

Mineral oil AE

lipid pneumonitis (oral dose should be avoided in young children)
long term: malabsorption of lipid soluble vitamins