Pharm Flashcards by Aly Wurster

receptors that trigger N/V

5HT3, H1, M1, D2, NK1 (substance P)

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what kind of receptor might we agonize to alleviate N/V

cannabinoid

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what do we use to help with anticipatory N/V

benzodiazepines

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-setron medications (ondansetron, dolasetron, granisetron, palonosetron) antagonize what receptor to help with N/V

5HT3

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-pitant medications (aprepitant, fosaprepitant, netupitant, rolapitant) antagonize what receptor to help with N/V

NK1 (substance P)

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what are H1 antagonists that alleviate N/V

diphenhydramine, dimenhydrinate, hydroxyzine, promethazine, meclizine, cyclizine

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which M1-R antagonist is used to help control N/V

scopolamine

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what are the cannabinoid receptor AGONISTS used to treat NV

dronabinol, nabilone

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what are serotonin receptor antagonists indicated for

strong antiemetic- chemotherapy, radiation, post operative, or pregnancy induced NV

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most worrisome adverse affect of 5HT3 antagonists (especially dolasetron)

dose dependent QT prolongation / torsades

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QT prolonging agents and antiarrythmics are interactions with 5HT3R blockers because why

they all use cyp450

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the only IV NK1 inhibitor

fosaprepitant

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what are NK1 receptor antagonists indicated for

moderate antiemetic: chemotherapy or prophylaxis post operation

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H1-R antagonists are weak anti emetics originally designed for other purposes but found to exhibit varying levels of central _____

anticholinergic at CTZ

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what are H1 receptor antagonists indicated for use in NV related to motion sickness or vertigo

meclizine, cyclizine

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H1-R, M1, and D2-R antagonists have what adverse side effects

typical anticholinergic (drowsy, dry mouth, constipation, urinary retention, blurred vision, low BP)

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what are the 2 families of D2 R antagonists used in NV tx

phenothiazine, metoclopramide

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when is a D2 inhibitor indicated

weak to moderate antiemetic: also enhances GI motility (especially metoclopramide)

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when are cannabinoids indicated for use

strong antiemetic only indicated after a patient has tried other anti emetics that are not effective (chemotherapy), appetite stimulation

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cannabinoids have interactions with what kinds of drugs

CNS depressants, CV agents, sympathomimetics

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high emetogenic (severe NV due to chemotherapy) regimen

3 drugs (NK antagonist, 5HT3 antagonist, corticosteroid) ((add cannabinoid if tx resistant))

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moderate emetogenic (NV due to chemotherapy) regimen

2 drugs (5HT3 R antagonist, corticosteroid)

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this med is given for diabetic gastroparesis which helps with NV and dysmotility

metoclopramide

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antacids do not affect the amount of acid produced, they simply neutralize whatever is in the lumen. what else do they do

increase LES tone

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what are the two preferred OTC antacids

calcium, magnesium

dose related side effects of using aluminum as an antacid

constipation, hypophosphatemia

what are the side effects of using calcium as antacid

constipation, hypercalcemia, hypophosphatemia

antacids have what unique risk when it comes to drug interactions

ALL meds should be taken 1-2 hr after or 2-4 hr before antacids (messes with absorption otherwise)

-tidine meds (cimetidine, famotidine, nizatidine, rinitidine) antagonize what receptor to help fix ulcers

-prazole meds (lansoprazole, dexlansoprazole, omeprazole, esomeprazole, pantoprazole, rabeprazole) antagonize what receptor to help with ulcers

PPI's

how does sucralafate (sucrose + aluminum) help with ulcers

surface acting agent (a bandaid)

how does misoprostol help with ulcers

PGE1 analog

which H2 blocker (used for ulcers) is the prototypical inhibitor of several CYP450 enzymes

cimetidine

which class of anti-ulcer drug can potentially block ALL formation of acid in the stomach

PPI's (block H/K ATPase of parietal cells)

PPI's and H2 blockers can help to heal an ulcer in 4-8 weeks EXCEPT under what circumstance

H pylori ulcers: these require an antibiotic also!

why must we stop PPI use in a patient who develops diarrhea

CDAD (C diff associated diarrhea -- can lead to death)

which PPI (used for ulcers) is the prototypical inhibitor of several CYP450 enzymes

omeprazole

PGE2 analog that protects from ulcer by increases mucosal defenses and decreases acid production

misoprostol (diclofenac is misoprostol + NSAID = protection from NSAID induced ulceration)

this all around champ of a drug was developed as anti diarrheal but also helps with ulcers, antimicrobial, reflux, indigestion, stimulates production of prostaglandins and probably so much more

bismuth compound

adverse effect of bismuth compounds (pep to bismol)

constipation, black or dark stools

how do you treat ulcers caused by h pylori

2 antibiotics and a PPI / H2 blocker | BID 14 days PPI + clarithromycin + amoxicillin or metronidazole) (10 days if you add bismuth

what do you give pregnant lady with PUD (no h pylori)

short course of antacid (ranitidine or if severe lansoprazole) or sucralafate

what classes of drugs might be used to alleviate symptoms caused by UC

5 ASA, corticosteroids, TNF alpha inhibitors, alpha 4 integrin inhibitors

what classes of drugs might be used to alleviate symptoms caused by CD

IL12/23 inhibitor, corticosteroid, TNF alpha inhibitor, alpha 4 integrin inhibitor

sulfasalazine, mesalamine, olsalazine, and balasalazinde are all what family of drug

5 ASA drugs used in UC

5 ASA drugs have what MOA

inhibit prostaglandin / leukotriene synthesis and decrease chemotaxis of macrophage and PMN

who should never be prescribed a 5 ASA drug

allergies! (to 5ASA and no sulfasalazine for sulfonamide allergic people)

at what severity of UC should you prescribe 5 ASA agents

mild to moderate active disease or for maintenance of remission

IBD can benefit from TNF alpha inhibitors which are anti inflammatory and all share what suffix

-mab (adalimumab, infliximab, golimumab, certolizumab)

what is unique about certolizumab compared to the rest of the TNF alpha inhibitors

made from Fab of Ab. does not fix complement or cause ADCC

TNF alpha inhibitors carry risk for what kind of infection

which TNF alpha inhibitor is used in CD and not UC

certolizumab

which TNF alpha inhibitor is used in UC and not CD

golimumab

patients who are on alpha 4 integrin inhibitor drugs (used in IBD) for more than 2 years, who have prior immunosuppressant treatment, or who have anti JC virus Ab's are at increased risk for developing what condition

PML (brain infection)

this alpha 4 integrin inhibitor is indicated to treat moderate to severe CD and as maintenance therapy only after other drugs have failed

natalizumab

this alpha 4 integrin inhibitor is indicated to treat moderate to severe CD or UC and as maintenance therapy only after other drugs have failed

vedolizumab

what is the MOA for ustekinumab (for treating CD)

IL12/23 inhibitor

what infection is common with use of IL12/23 inhibitor drugs

which class of IBD treatment causes increased glucose, BP, and lipid profile, fluid retention, increased appetite, anxiety / insomnia, and bone defects

corticoteroids

when should we use corticosteroids for IBD

only after conventional therapy fails (not for maintenance -- these are potent immunosuppressant meds)

Loperamide

for diarrhea- opioid agonist without the analgesia

there is a small quantity of atropine added to what drug

diphenoxylate (lomotil -- antidiarrheal)

indicated for use in IBS-D (diarrheal subtype)

eluxadoline

main side effect of eluxadoline (used for IBS-D)

pancreatits that can lead to death (esp if pt has no gallbladder)

alosteron

for IBS-D in women if other therapies have failed

this rare anti-diarrheal has a black box warning for ischemic collitis

alosteron

cl channel inh for diarrhea in HIV patients

crofelemer

what can we give for abdominal pain / spasm

anti muscarinic (hyoscyamine, dicyclomine, clidinium, chlordiazepoxide)

linaclotide

for IBS-C and idiopathic constipation, GCC agonist

lubiprostone

for IBS-C and chronic idiopathic constipation and opioid induced constipation (no cancer pt), PGE derivative

when do you prescribe the osmotic agent prepopik (PEG3350)

before colonoscopy only

lactulose is a sugar that helps draw fluid into the GI tract and is used in what scenario

severe liver disease (change in pH traps ammonia in GI to be excreted)

interferon alpha injections (which revs up the body's immune response to virus while inhibiting viral replication) can be used in treating HBV patients under what conditions

well compensated liver disease (decompensated cirrhosis is dangerous)

first line agent to treat HBV infection

nucleosides/tides (inh reverse transcriptase, viral polymerase, and they are oral) lamivudine, telbivudine, entecavir, tenofovir, adefovir

nucleotide adenosine analog used to treat wtHBV when patients are resistant to other nucleoside agents (rarely is a virus resistant to this guy)

tenofovir (nephrotoxic)

whats an effective anti-HBV drug that you can use in pt with renal insufficiency

entecavir

for HCV infection we still use INF alpha but we add what nucleoside agent

ribavirin (contraindicated in anemic or pregnant pts)

what NS5B inhibitor is useful in eradicating an HCV infection (RNA pol inh)

sofobuvir

HCV drugs simeprevire, telaprevir, boceprevir, grazoprevir have what MOA

protease inh

vancomycin (used to treat c diff) has what adverse affect

red man syndrome

this antibiotic should not be used with alcohol, has a metallic taste and can cause nausea or peripheral neuropathy

metronidazole

this drug is useful if c diff recurs after eradicated by vancomycin. it spares anaerobic flora and inhibits bacterial RNA pol

fidaxomicin

what drug is used to treat entamoeba histolytic infection (kills trophozoites but not cysts)

metronidazole (or tinidazole) AND luminal amebicide (like paromomycin or iodoquinol)

this infection presents as greasy fatty smelly diarrhea with NO BLOOD in the stool after drinking from creek

giardia lamblia

treat giardia infxn

supportive care plus nitazoxanide

side effect of nitazoxanide (treats giardia, cryptosporidium)

yellow eyes and bright yellow urine

itchy toes, anemia, diarrhea, abdominal pain, weight loss

necator americanus, ancylostoma duodenale

how do strongyloides stercoralis infections exit the human body (before we get rid of them with IVERMECTIN)

eggs hatch into larvae and are excreted in feces

this is diagnosed with football shaped EGGS in the feces causing abdominal pain and diarrhea

trichuric trichiura / whip worm

severe perianal itching can lead to hand to mouth transmission of the enterobius vermicularis (pinworm) which is detected by what in the lab

scotch tape test (no eosinophilia)

while they should not be used in cirrhotic or pregnant patients, most nematodes can be eradicated by what

albendazole, mebendazole

schistosomas (blood flukes) are treated with

praziquantel

Pharm Flashcards

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