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Pharmacology (Dale Turley) > H2, PPI, Prokinetics, Anti (emetics, diarrhea's, constipation), IBS > Flashcards

H2, PPI, Prokinetics, Anti (emetics, diarrhea's, constipation), IBS Flashcards

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1
Q

GERD stepwise approach ?

A

Sleep head bed elevated 6-8 inches

Avoid lying down within 3 hours eating

No exercise within 3 hours after eating

No excessive squatting or bending within 3 hours after eating

Body weight

Avoid foods acidic, spicy, excessive fat

Avoid chocolate, peppermint, citric acids

Avoid alcohol, coffee, tea

Overeating

Stop smoking

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2
Q

H2 receptor antagonist Blockers MOA?

A

Inhibit acid secretion by gastric parietal cells through reverse blockade of histamine at the H2 receptor

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3
Q

H2 examples?

A

cimetidine (Tagament)

ranitidine (Zantac)

famotidine (Pepcid)

nizatidine (Axid)

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4
Q

H2 pharmacokinetics?

A

Metabolized Cytochrome P450 enzymes liver

Half-life 3-4 hours

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5
Q

Indications for H2?

A

GERD

Duodenal and PUD

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6
Q

H2 interactions?

A

May increase blood alcohol levels

Antacids and anticholinergics may decrease absorption of cimetidine

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7
Q

H2 contraindications?

A

-

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8
Q

Adverse reactions H2?

A

Arrhythmias, rash, nausea, vomiting, diarrhea, pancreatitis, granulocyte leukemia, thrombocytopenia, confusion, agitation, depression

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9
Q

H2 education for patients?

A

Taken after meals and before bed
Avoid drugs that interact or lowered pH affects activity
Smoking affects absorption of histamine blockers

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10
Q

PPI MOA?

A

Inhibition of the H+/K+/ATPase enzyme at the surface of the parietal cell

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11
Q

PPI examples?

A

Omeprazole (Prilosec)

Lansoprazole (Prevacid)

Esomeprazole (Nexium)

Pantoprazole (Protonix)

Rabeprazole (Aciphex)

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12
Q

PPI pharmacokinetics?

A

Metabolizeed by liver
Half-life 2 hours
Rapid absorption

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13
Q

PPI Indications?

A 
GERD
Erosive gastritis
Hyper-secretory states
Zollinger-Ellison syndrome
Short term treatment of PUD caused by H.pylori
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14
Q

PPI interactions?

A

Drugs cytochrome P450 enzymes

Drugs that require higher pH (digoxin, ketoconazole, ampicillin)

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15
Q

PPI adverse reactions?

A

Long term use may result in increased fracture risk (believed to be result of calcium absorption decrease)

Rash

Abd. pain, N/V diarrhea,

constipation

Flatulence

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16
Q

PPI patient education?

A

Taken before meals / AM

Avoid taking with antacids

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17
Q

Contraindications for PPIs?

A

Older adults - cause osteopuritic, and renal disease

Liver and renal disease

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18
Q

PPI Tx for moderate to severe disease: step 1?

A

Lifestyle modifications and PPIs are used initially

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19
Q

PPI Tx for moderate to severe disease: step 2?

A

If sxs. do not improve, increase the dose of PPIs

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20
Q

PPI Tx for moderate to severe disease: step 3?

A

Add H2 blockers or pro kinetic agent

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21
Q

PPI Tx for moderate to severe disease: step 4?

A

Step down the proton pump inhibitor dose once the initial symptoms have resolved

In addition, the patient may be stepped down to an H2 blocker
Failure of results within a 3-month span requires a gastroenterologist referral

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22
Q

Prokinetic Agents/Gastrointestinal Stimulants MOA?

A

Stimulate the motility

Does not stimulate gastric, biliary, or pancreatic secretions

Sensitizes tissues to the action of ACH

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23
Q

Metoclopramide (Reglan) pharmokinetics?

A

Increases resting tone of the LES

Increases tone and amplitude of gastric secretions

Increases peristalsis of the duodenum and jejunum

Accelerated gastric emptying

**settles down nausea, they get a little less GERD; adjunct to GERD , it increases resting tone of the LES*

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24
Q

Indications for Metoclopramide?

A

Acute and recurrent diabetic gastroparesis

Antiemetic properties

Adjunct therapy migraines

Short term therapy GERD with failure H2 and PPI

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25
Adverse reactions and indications with Metoclopramide?
Restless, drowsiness, mental depression which may include SI Extrapyramidal symptoms 1 in 500 patients, especially pediatric and older patients Include Tardive dyskinesia Hypotension, hypertension, tachycardia Bowel disturbance, diarrhea Neutropenia, leukopenia **if on SSRi’s make sure to use caution with this medication cause it can cause dyskinesia especially if they have had it before with same type of medication or ar eat high risk of getting this side effect then just avoid this drug*
26
Contraindications to Metoclopramide?
GI hemorrhage, obstruction, perforation Pheochromocytoma (HTN crisis) Renal disease Patients with epilepsy or history of medication induced extrapyramidal
27
Metoclopramide patient education?
Impair / sedate ( not great for GERD but can be used if failure of H2’s) Take 30 min before meals Watch for extrapyramidal symptoms
28
is Metoclopramide pregnancy safe?
this medicine is safe in pregnancy ( once of the few that is indicated in pregnancy especially for hyperemesis)
29
Antiemetics facts?
Nausea and vomiting common in the primary care setting Treatment is often nonpharmacological
30
Antiemetics MOA?
Provide symptom relief - to get fluids in them - so they stop puking etc. Prevent fluid and electrolyte disturbances Consider treatment of cancer patients
31
Antiemetics: Seritonin blocker agents?
Palonosetron (Aloxi) Dolasetron (Anzamet)
32
Antiemetics: Phenoththiazines?
Prochlorperazine (Compazine) Promethazine (Phenergan)
33
Antiemetics: 5-HT3 receptor antagnist ?
Ondansetron (Zofran) * 5HT3’s - was used for hyperemesis in pregnancy until we started seeing birth defects **
34
Antiemetics pharmacokinetics?
Rapid absorbed (Zofran 100% IV or IM, 50% oral) Crosses blood brain barrier and placenta Metabolized liver Half life: Promethazine 9-16 hr - longer HF Prochlorperazine 3-5 hr Ondansetron 3-6 hr
35
Adverse reactions with Antiemetics?
Arrhythmias ( Zofran prolonged QT) Rash Watch ANC / WBC Compazine Aplastic anemia Agitation extrapyramidal systems - BBW-Dementia related psychosis Compazine - ( watch for it if they are taking serotonin) Current concern pregnancy Zofran Phenothiazine's - Watch small children and older adults - more extrapyramidal sxs in our elderly
36
Meclizine ( Antivert) subclass?
Subclass: Antihistamines, 1st generation; Nausea/Vomiting; Vertigo/Motion Sickness
37
Meclizine ( antivert) MOA?

non-selectively antagonizes central and peripheral histamine H1 receptors; antagonizes cholinergic receptors, producing antiemetic effects
38
Dose of Antivert?
non selectie H1 like benadryl 25 mg PO to start 12.5 mg for PEDS dosing **only PO , may need to start with another antiemetic if they are N/V, maybe zofran first to relax them and chill them out so the can take the anti vert *
39
Practical Pharmacology of Antidiarrheal’s are used?
acute versus chronic
40
Using Antidiarrheal’s pay attention in children and the elderly cause?
Quickly experience dehydration Usually self limited
41
Antidiarrheals three main classes of drugs?
Absorbent preparations Opiates Anticholinergics
42
Antidiarrheal’s: absorbent preparations?
Bismuth subsalicylate (Pepto-Bismal, Kaopectate)
43
Antidiarrheal’s: Opiates?
Diphenoxylate with atropine (Lomotil)
44
Antidiarrheals: Anticholinergics (IBS)?
Belladonna Scopalamine
45
Antidiarrheal’s MOA of absorbent preparations??
Bismuth subsalicylate (Pepto-Bismal, Kaopectate Absorb moisture in stool without effecting total water loss Bismuth has anti-secretory and antimicrobial effect Mucosal protectant - good for erosive bacteria etc
46
Antidiarrheal’s MOA of opiates?
Diphenoxylate with atropine (Lomotil) Constipating effect atropine is anticholinergic slows peristalsis no used if C.diff cause you do not want to encapsulate it and keep it in slowing down peristalsis can keep bacteria in the gut an cause more problems
47
Antidiarrheal’s MOA of Anticholinergics (IBS)
Belladonna, scopolamine Inhibits peristalsis direct effect on smooth muscle intestinal wall Diminishes loss fluids and electrolytes No direct opioid effect
48
Adverse reactions and interactions with Bismuth?
Pg. 181 ASA TCL Coumadin Tongue and stools gray-black
49
Adverse reactions and interactions with Lomotil?
CNS Alcohol Antihistamines Opioids **remember contents of lomotil *
50
Adverse reactions and interactions with Pectin?
Digitalis will be extremely elevated yellow vision if dig is to high in a lot of the anti-diarrheal
51
Adverse reactions and interactions with Imodium?
CNS Alcohol Antihistamines opioids
52
Antidiarrheal’s contrindications?
Atropine ( ACH) with glaucoma Children with Downs hypersensitive to atropine Atropine can cause urinary retention in older people
53
Use all _____________ with caution in elderly
antidiarrheal’s
54
antidiarrheal’s are not used in children under _ years old, under _ they have more supportive care.
2 2
55
Antidiarrheal’s (cont’d) make sure to use caution in?
Caution in digoxin, cephalosporins, warfarin, heparin, CND depressants
56
Antidiarrheal’s patient education?
Hand washing BRAT diet bananas, rice, apple sauce, toast = bulk agents Stop Milk / lactose
57
Causes of constipation?
what drugs? Pg 190
58
Non-pharmacological intervention for constipation?
Fiber intake Hydration Physical activity
59
Constipation treatment categories?
Bulk forming agents Emollient stool softeners Rapidly acting lubricants and laxatives
60
Constipation: bulk producing laxatives?
Metamucil Fiberall FiberCon Citracel
61
Constipation: emollient stool softeners?
Mineral oil - slow colonic fecal water absorption
62
Constipation: rapidly acting lubricants and laxatives?
Magnesium citrate
63
Constipation: GI stimulant?
Reglan
64
Constipation: stool softeners?
MiraLax Lactulose Ducusate / Colace - degeneration of nerve plexus
65
Adverse reactions and interactions with constipation meds?
Nausea, vomiting, anal irritation, flatulence Obstruction
66
Contraindications with constipation meds?
Signs of appendicitis Obstruction Undiagnosed abd pain - work up further
67
Saline enemas MOA?
draw water into the colon.
68
Mineral oil enemas MOA?
ease passage of stool, lubricating passage moisten and soften the hardened stool.
69
Emollient enemas MOA?
reduces tension in the lumen - allows easier passage contain substances that soften the stool. Examples are Microenema and Colace.
70
Phosphate enemas MOA?
cause contractions of the muscle in the colon cause contractions in the muscles of the colon. Examples are Fleet phosphosoda
71
What is one of the most common gastric pathogens?
H. Pylroi
72
H. Pylori has an important role in the pathogenesis of?
Peptic ulcer disease Gastric malignancy Chronic gastritis
73
Tx of H. Pylori?
Clarithromycin-based triple therapy Bismuth quadruple therapy
74
Clarithromycin-based triple therapy contains?
a PPI, clarithromycin, and amoxicillin, or metronidazole for 14 days ( usually 2 times a day )
75
Bismuth quadruple therapy | contains?
H2 or PPI blocker , bismuth, metronidazole, and tetracycline for 10–14 days to eradicate used first line in clindamycin resistant area or active infections
76
Cytoprotective Agents combats ulcers bot by reducing gastric acid but by increasing _______________
mucosal protection
77
Prostaglandins physiology?
protect the stomach mucosa against injury by increasing gastric mucus secretion commonly utilized agents: sucralfate, misoprostol **more of a bandaid over the area , long tern NSAIDs medications nd need to promote healing *
78
Cytoprotective Agents examples?
Sucralfate Misoprostol (Cytotec)
79
Sucralfate is what ?
sucrose sulfate-aluminium complex - alumni covers the ulcer and acts as a barrier - prevent degradation fo the mucosa
80
Sucralfate MOA?
binds to the ulcer, creating a physical barrier that protects the gastrointestinal tract from stomach acid and prevents the degradation of mucus promotes bicarbonate production and acts like an acid buffer **used main in pregs and non- NSAIDS induced treatment more for local treatment take on empty stomach *
81
Misoprostol (Cytotec) is what?
Prostaglandin analog - mucosa protective quality
82
Misoprostol (Cytotec) MOA?
use in the prevention of NSAID-induced gastric inhibiting the secretion of gastric acid decreased intracellular cyclic AMP levels **used more in NSAID - induced ulcers it is systemically absorbed take on full stomach *
83
Misoprostol is a prostaglandin _______?
analog
84
what cytoprotective agent is used to initiate labor in pregnancy?
Misoprostol (Cytotec)
85
Misoprostol (Cytotec) | uses?
Used to initiate labor in pregnancy Post-partum bleeding contraction uterus Used in other countries to produce abortion Decrease the effects of Warfarin - make sure to watch INR
86
Misoprostol (Cytotec) pregnancy category?
X
87
What is IBS?
Chronic functional bowel disorder characterized by abdominal pain and altered bowel habits in the absence of specific and unique organic pathology
88
IBS treatment drugs?
IBS-A- alternating IBS-C- constipation dominant IBS-D- diarrhea IBS-M- mixed
89
What are the two drugs used to treat IBS and both agents decrease GI motility?
Anticholinergics Antispasmodics **act on smooth muscle *
90
Anticholinergics example?
Glycopyrrolate (Robinul)
91
Glycopyrrolate (Robinul) | MOA?
Mechanism of Action
antagonizes acetylcholine receptors (anticholinergic) relieves smooth muscle spasms GI tract
92
Glycopyrrolate (Robinul) | adverse reactions and interactions?
hypersensitivity rxn anaphylaxis intestinal obstruction seizures arrhythmias
93
Glycopyrrolate (Robinul) | contraindications?
neonates (benzyl alcohol-containing INJ forms) “Gasping Syndrome” - causing death in neonates - so avoid in any neonate - significant catastrophic events glaucoma, angle-closure obstructive uropathy GI obstruction
94
Glycopyrrolate (Robinul) | pregnancy cat?
B
95
Glycopyrrolate (Robinul) | Lactation and dose?
Lactation: Safety Unknown Dose - 1 mg TID
96
Antispasmodics example?
Dicyclomine (Bentyl)
97
Dicyclomine (Bentyl) | MOA?
antagonizes acetylcholine at muscarinic receptors (anticholinergic) relaxes smooth muscle inhibits bradykinin- and histamine-induced spasms
98
Dicyclomine (Bentyl) | adverse reactions and interactions?
psychosis Hallucinations, delirium paralytic ileus dizziness, blurred vision, nausea, somnolence
99
Dicyclomine (Bentyl) | pregnancy cat?
B
100
Dicyclomine (Bentyl) | lactation and dose?
Lactation: Possibly Unsafe Dose- 20 mg QID , can be used PO / IM
101
Anticholinergic/Belladonna Alkaloids | examples?
Atropine sulfate (Donnatal) | atropine, hyoscamine, scopolamine
102
Anticholinergic/Belladonna Alkaloids MOA?
antagonize acetylcholine at muscarinic receptors relaxing GI smooth muscle decreasing GI motility and gastric secretion (anticholinergic) Sedating effect affect CNS sites and does cross BBB so it cause sedating affects in patients
103
``` Atropine sulfate (Donnatal) interactions and cautions? ```
urinary hesitancy/retention blurred vision palpitations/tachycardia Mydriasis, cycloplegia, IOP incr. ( glaucoma) loss of taste Headache, nervousness, drowsiness, weakness
104
``` atropine sulfate (Donnatal) Pregnancy category? ```
C
105
``` atropine sulfate (Donnatal) lactation and dose? ```
Lactation: Possibly Unsafe Dose - 0.4 mgs PO q4-6

Pharmacology (Dale Turley) (31 decks)

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