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Module 9: Mali: GI > pharm chart > Flashcards

Flashcards in pharm chart Deck (170):
1

Anti-diarrheals Opioid

Loperamide [Imodium]

2

MOA of Loperamide [Imodium]

Inhibition of presynaptic cholinergic nerves in colonic submucosal and myenteric plexus slows transit time

3

Indications of Loperamide [Imodium]

Mild to moderate diarrhea w/o obstruction,
IBD, IBS

4

Anti-diarrheals Non- Opioid

Kaolin-Pectin

5

MOA of Kaolin-Pectin

A clay (Kaolin) and a plant polysaccride (Pectin) combination that absorbs fluids & bacterial toxins

6

indications of Kaolin-Pectin

Mild diarrhea

7

Anti-diarrheals Laxative

Dietary Fiber
[Metamucil, Citrucel, Fibercon]

8

MOA of Dietary Fiber
[Metamucil, Citrucel, Fibercon]

Absorb and bind fluids, provides stool bulk

9

Indications of Dietary Fiber
[Metamucil, Citrucel, Fibercon]

Mild to moderate diarrhea,
constipation

10

Anti-Diarrheal
Synthetic Somatostatin Analogue

Octreotide [Sandostatin]

11

MOA of Octreotide [Sandostatin]

Synthetic analogue of somatostatin with longer half-life;
inhibits bowel secretion;
dose related impact on motility;
splanchnic arteriole constriction

12

Indications of Octreotide [Sandostatin]

Diarrhea sec to bowel dysmotility, carcinoid,
VIP-oma, pancreatic fistulas,
vagotomy, dumping syndrome,
short bowel syndrome,
HIV diarrhea; GI bleeding

13

Anti-diarrheals

Bismuth Subsalicylate [Pepto- Bismol]

14

MOA of Bismuth Subsalicylate [Pepto- Bismol]

Anti-secretory (salicylate) and anti-microbial (bismuth) action

15

Indications of Bismuth Subsalicylate [Pepto- Bismol]

sxs treatment of mild, nonspecific diarrhea,
traveler’s diarrhea,
as part of multi- drug regimen for H. pylori

16

what are the 2 
5ASA Anti- Inflammatories

1. Mesalamine or 5-ASA [Asacol]

2. Sulfasalazine [Azulfadine]
5-ASA + sulfapyridine

17

what is the MOA of the 5ASA Anti- Inflammatories

Local colon anti- inflammatory action and systemic prostaglandin inhibition

18

Inidacation of Mesalamine or 5-ASA [Asacol]

Ulcerative colitis, proctosigmoiditis, proctitis

19

Indication of Sulfasalazine [Azulfadine]
5-ASA + sulfapyridine

Ulcerative colitis,
rheumatoid arthritis,
Crohn’s disease, psoriasis

20

Purine Analogues Immunosuppressant

Azathioprine [Imuran]

21

MOA of Azathioprine [Imuran]

Inhibits synthesis of DNA, RNA, proteins

22

Indications of Azathioprine [Imuran]

Steroid sparing for steroid dependent Crohn’s Disease, Ulcerative colitis;
maintain remission in CD;
fistulizing CD;
kidney transplant, rheumatoid arthritis

23

Purine Analogues Anti-Inflammatory

Methotrexate [Rheumatriex]

24

MOA of Methotrexate [Rheumatriex]

Decreases protein synthesis via inhibition of dihydrofolate reductase;
inhibits interleukin-1;
incr release of anti- inflammatory adenosine

25

Indications of Methotrexate [Rheumatriex]

Crohn’s Disease;
+/- Ulcerative colitis;
psoriasis, rheumatoid arthritis

26

Anti-TNF Alfa Compounds

Infliximab [Remicade]

27

MOA of Infliximab [Remicade]

Decr TH1-cell activation/proliferation;
block TNF alfa receptor (TNFR) & decr cytokine (IL-12) release;
decr leukocyte migration, fibroblast collagen production, & hepatic acute phase reactants;
incr apoptosis of activated cells

28

Indications of Infliximab [Remicade]

Acute and maintenance Tx mod to severe Crohn’s Disease & Ulcerative colitis

29

Anti-integrin

Natalizumab

30

MOA of Natalizumab

Inhibit integrins on leukocyte surface and inhibit their adhesion to vascular endothelium and their migration into tissue

31

Indications of Natalizumab

Subset of patients with mod to severe Crohn’s ds who have failed other therapies

32

Ursodeoxycholic Acid Gallstone Dissolution Agent

Ursodiol [Actigall]

33

MOA of Ursodiol [Actigall]

Reduces hepatic secretion of cholesterol reducing enterohepatic circulation of cholesterol, reduces hepatic absorption of cholesterol;
metabolized to lithocolic acid by colonic bacteria; excreted in stool and bile

34

Indications of Ursodiol [Actigall]

Gallstones;
prevention of stones in rapid weight loss,;
primary billiary cirrhosis

35

Laxative Stimulant

Senokot [Senna]

36

MOA of Senokot [Senna]

stimulate enterocytes, enteric neurons,
GI smooth muscle inducing low-grade inflammation, fluid accumulation and
stimulate intestinal motility

37

INdications of Senokot [Senna]

constipation (without bowel obstruction)

38

Laxative Calcium Channel Activator

Lubiprostone [Amitiza]

39

MOA of Lubiprostone [Amitiza]

Activates calcium channels to increase bowel fluid secretion and motility

40

Indications of Lubiprostone [Amitiza]

Chronic idiopathic constipation;
IBS constipation- dominant in women >18yo;
opioid induced constipation

41

Laxative cGMP agonist

Linaclotide [Linzess]

42

MOA of Linaclotide [Linzess]

Agonizes guanylate cyclase-C (cGMP) on luminal surface of bowel epithilium, increases cGMP resulting in chloride and bicarbonate secretion into intestinal lumen

43

Indications of Linaclotide [Linzess]

IBS-C (in adults not responsive to PEG); or, Chronic Idiopathic Constipation (CIC) in adults

44

Osmotic Laxative; PEG

Polyethylene Glycol (PEG) 3350
Electrolyte Solution [GoLYTELY] [MiraLax]

45

MOA of Polyethylene Glycol (PEG) 3350
Electrolyte Solution [GoLYTELY] [MiraLax]

Causes water retention in stool and incr stool frequency

46

Indications of Polyethylene Glycol (PEG) 3350
Electrolyte Solution [GoLYTELY] [MiraLax]

Occasional Constipation
Short Term Use

47

Osmotic Laxative

Lactulose [Enulose]

48

MOA of Lactulose [Enulose]

a) synthetic disaccharide (osmotic) laxative;
b) bacterial digestion of lactulose produces acid pH converting NH3 to NH4+ which can’t cross gut wall;
c) enhances diffusion NH3 from serum into gut lumen

49

Indications of Lactulose [Enulose]

Px & Tx portal- systemic encephalopathy (PSE)

50

Magnesium Laxative

MgCitrate [Citroma]

51

MOA of MgCitrate [Citroma]

Osmotic retention of bowel fluid distending colon and increasing peristalsis

52

INdications of MgCitrate [Citroma]

Occasional constipation, study prep

53

Stool Softener

Docusate Na [Colase]

54

MOA of Docusate Na [Colase]

....

55

Indications of Docusate Na [Colase]

.....

56

Anticholinergic, Anti-emetic & anti-vertigo
(dermal patch)

Scopolamine [Transderm Scop]

57

MOA of Scopolamine [Transderm Scop]

Blocks activity of acetylcholine at PSNS sites in smooth muscle, secretory glands, and CNS
Fast onset, short duration

58

INdications of Scopolamine [Transderm Scop]

Nausea, vertigo

59

H1 Antagonist Antihistamine

Meclizine [Antivert]

60

MOA of Meclizine [Antivert]

Central anticholinergic blockage in chemoreceptor trigger zone and decreases excitability of vestibular- cerebellar pathways

61

Indications of Meclizine [Antivert]

Prevention & treatment of motion sickness

62

Phenothiazines

Promethazine [sPhenergan]

63

MOA of Promethazine [sPhenergan]

Blocks CNS dopamine receptors (D2); competes for H1 receptors in brain and systemically
(anti-histamine and anti-dopaminergic)

64

Indications of Promethazine [sPhenergan]

Anti-emetic, motion sickness,
sedative

65

Butyrophenones
Typical anti- psychotic

Haloperidol [Haldol]

66

MOA of Haloperidol [Haldol]

Blocks post-synaptic mesolimbic D1 & D2 receptors; also suppresses the reticular activating system (RAS) thereby reducing emesis

67

Indications of Haloperidol [Haldol]

Anti-emetic; schizophrenia Tourette’s disorder;
emergency sedation of agitated- aggressive patients (off label)

68

Benzamides

some refer to as pro kinetic

Metoclopromide [Reglan]

69

MOA of Metoclopromide [Reglan]

Blocks D and 5-HT receptors in CRTZ; overcomes inappropriate direction of peristalsis experienced with vomiting

70

Indications of Metoclopromide [Reglan]

Anti-emetic;
diabetic gastroparesis (decreased stomach emptying d/t inadequate peristalsis),
GERD
cancer chemo-induced emesis & radiation sickness

71

Corticosteroid

Dexamethasone [Maxidex]

72

MOA of Dexamethasone [Maxidex]

Enhance effect of 5- HT3-receptor (in heart, stomach, brain: area postrema & nucleus of tractus solitarius) antagonists CRTZ

73

Indications of Dexamethasone [Maxidex]

Anti-emetic pre- chemo;
immune modulation

74

Cannaboids
Tetrahydrocanna binol (THC)
Dopamine antagonist

Dronabinol [Marinol]

75

MOA of Dronabinol [Marinol]

Unknown

76

INidcations of Dronabinol [Marinol]

Appetite stimulant;
anti-emetic (Chemo related);
adjunct to surgical anesthesia

77

Serotonin Antagonists

Ondansetron [Zofran]

78

MOA of Ondansetron [Zofran]

Peripheral and CRTZ 5-HT3 receptor blockade

79

Indications of Ondansetron [Zofran]

ONLY for post- op, radiation & chemotherapy induced N/V

80

Neurokinin-1 Antagonist

Aprepitant [Emend]

81

MOA of Aprepitant [Emend]

Blocks central NK1 receptors
Augments anti- emetic effect of 5- HT3 receptor antagonism & corticosteroids

82

Indications of Aprepitant [Emend]

Prevention chemo induced N/V;
post-op N/V

83

Peripherally- acting Opioid Antagonist

Naloxegol [Movantik]

84

MOA of Naloxegol [Movantik]

Mu-opioid receptor antagonist (conjugated with PEG reducing its ability to cross BBB) so acts peripherally in GI tract

85

Indications of Naloxegol [Movantik]

Opioid Induced Constipation

86


H Pylori Combo- Triple Drug and 4 drug combo

1. Omeprazole Amoxicillin Clarithromycin

2. Omeprazole Metronidazole Tetracycline Bismuth SS

87

MOA of H Pylori Combos

Raise gastric pH and antibiotic action on H pylori

88

Indications of H Pylori Combos

Eradication of H pylori-associated ulcers

89

H2R Antagonists

in another drug table this is under: Gastric Acid Suppressants and it is a H2 Receptor blocker

Ranitidine [Zantac]

90

MOA of Ranitidine [Zantac]

Competitive inhibition of H2-receptors of gastric parietal cells reduce basal and stimulated acid production

91

Indications of Ranitidine [Zantac]

Peptic ulcer disease, GERD

92

2 drugs that are in the class:
Proton Pump Inhibitors (PPI)

1. Omeprazole [Prilosec]

2. Pantoprazole [Protonix]

93

mOA of Proton Pump Inhibitors (PPI)

Inhibits basal and stimulated parietal cell proton pump acid secretion

94

Indications of Proton Pump Inhibitors (PPI)

Peptic ulcer disease, GERD;
prevention of NSAID ulcers;
stress ulcer prophylaxis in critically ill

95

Mucosal Surfactants

Sucralfate [Carafate]

96

MOA of Sucralfate [Carafate]

In water or acidic solutions, forms a paste that forms barrier by binding selectively to gastric mucosal ulcers and erosions; stimulates mucosal prostaglandin & bicarb secretion

97

Indications of Sucralfate [Carafate]

Duodenal or gastric ulcers or erosions, stomatitis (off label)

98

Muscarinic Antagonists
Anti- Spasmodic

Dicyclomine [Bentyl]

99

MOA of Dicyclomine [Bentyl]

M receptor anticholinergic drug

100

Indications of Dicyclomine [Bentyl]

Irritable Bowel Syndrome (cramps)

101

Antacids

AlOH [Alternagel]
(Aluminum Hydroxide)

102

MOA of AlOH [Alternagel]
(Aluminum Hydroxide)

Neutralizes HCl in stomach to form Al(Cl)3 & H20

103

Indications of AlOH [Alternagel]
(Aluminum Hydroxide)

hyperacidity, hyperphosphatemia

104

Antacids Laxative

MgOH [MOM]

105

MOA of MgOH [MOM]

reacts with HCl acid to form MgCl;
osmotic absorption of fluids distends colon and increases peristaltic activity

106

Indications of MgOH [MOM]

dyspepsia; constipation

107

Mucosal, NSAID Protectants
Prostaglandin

Misoprostol [Cytotec]

108

MOA of Misoprostol [Cytotec]

synthetic prostaglandin E1 analog replaces protective PG inhibited by NSAID therapy

109

Indications of Misoprostol [Cytotec]

NSAID-induced gastric ulcers;
people at high risk for NSAID induced bleeding

110

GLP-1 Receptor Agonist

Liraglutide [Saxenda]

111

MOA of Liraglutide [Saxenda]

incr glucose dependent insulin secretion;
decr inappropriate glucagon secretion;
incr Beta-cell growth & replicaton;
decr gastric emptying; decr food intake

112

Indications of Liraglutide [Saxenda]

T2DM adjunct therapy;
weight loss

113

Lipase Inhibitor

Orlistat [Xenical]

114

MOA of Orlistat [Xenical]

Reversible inhibitor of gastric and pancreatic lipase resulting in ~30% reduction in fat absorption

115

Indications of Orlistat [Xenical]

Management of obesity in individuals w/ BMI >30 or >27 with other risk factors (diabetes, HTN, dyslipidemia)

116

Anorexiant
5HT2c Receptor Agonist

Lorcasarin [Belviq]

117

MOA of Lorcasarin [Belviq]

Preferentially activates 5HT2C receptor initiating hormonal cascade resulting in decreased appetite, early satiety

118

Indications of Lorcasarin [Belviq]

Wt management in individuals w/ BMI > 30 or > 27 with other risk factors (diabetes, HTN, dyslipidemia)

119

what are the 3 weight loss agents?

1. Liraglutide [Saxenda]

2. Orlistat [Xenical]

3. Lorcasarin [Belviq]

120

Pancreatic Enzymes

Pancrelipase [Viokase]

121

MOA of Pancrelipase [Viokase]

Supplemental enzymes (Lipase, Amylase, Protease)

122

Indications of Pancrelipase [Viokase]

Chronic pancreatitis

123

Opioid Analgesics Synthetic

Meperidine [Demerol]

124

MOA of Meperidine [Demerol]

Binds to mu opioid receptors in CNS & inhibits ascending pain pathways

125

INdications of Meperidine [Demerol]

Short-term use peri-op and acute pancreatitis
(??less sphincter of Oddi spasm??)

126

Somatostatin Analogue

Octreotide [Sandostatin]

127

MOA of Octreotide [Sandostatin]

Synthetic analogue of somatostatin with longer half-life;
inhibits bowel secretion;
dose related impact on motility;
splanchnic arteriole constriction

128

Indications of Octreotide [Sandostatin]

Diarrhea sec to bowel dysmotility, carcinoid,
VIP-oma, pancreatic fistulas,
vagotomy,
dumping syndrome,
short bowel syndrome,
HIV diarrhea; GI bleeding

129

Antibiotic
Anti- Pseudomonas
Anti-Anerobes

Imipenem- cilastin [Primaxin]

130

MOA of Imipenem- cilastin [Primaxin]

Inhibits bacterial cell wall synthesis with lyses of bacterial cells

131

Indications of Imipenem- cilastin [Primaxin]

Intra-abdominal infxns,
liver abcess,
lower respiratory tract and GYN organ infxns

132

Antibiotic
Fluoroquinol one

Ciprofloxacin [Cipro]

133

MOA of Ciprofloxacin [Cipro]

Inhibits DNA gyrase

134

Indications of Ciprofloxacin [Cipro]

Diverticulitis, mild;
traveler’s diarrhea;
UTIs,
Anthrax (inhalational, cutaneous, GI),
chlamydial infections,
cholera, salmonosis, shigella

135

Misc ABX

Metronidazole [Flagyl]

136

MOA of Metronidazole [Flagyl]

Disrupts DNA structure inhibiting protein synthesis producing cell death

137

Indications of Metronidazole [Flagyl]

Anaerobic bacterial and protozoal infections:
Diverticulitis; C Diff; vaginitis;
brain abcess; rosacea, amebiasis,
giardiasis, trichomonas

138

Glycopeptide Antibiotic

Vancomycin [Vancocin]

139

MOA of Vancomycin [Vancocin]

Inhibits bacterial cell wall synthesis by blocking glycopeptide polymerization

140

Indications of Vancomycin [Vancocin]

PO treatment of staph enterocolitis or antibiotic- associated pseudomembra nous (C. Diff) colitis:
IV MRSA, HAP , meningitis,
pre-op Px infective endocarditis

141

Synthetic Somatastatin Analogue
Anti-Diarrheal

Octreotide [Sandostatin]

142

MOA of Octreotide [Sandostatin]

Synthetic analogue of somatostatin with longer half- life;
inhibits bowel secretion;
dose related impact on motility; splanchnic arteriole constriction

143

Indications of Octreotide [Sandostatin]

Diarrhea sec to bowel dysmotility, carcinoid,
VIP-oma, pancreatic fistulas,
vagotomy, dumping syndrome,
short bowel syndrome,
HIV diarrhea; GI bleeding

144

Interferon

Interferon-alpha & Pegylated Interferon- alpha

145

MOA of Interferon-alpha & Pegylated Interferon-alpha

Multiple anti-viral, immune modulating, & viral anti- proliferative

146

Indications of Interferon-alpha & Pegylated Interferon-alpha

Hepatitis B, Hepatitis C

147

Quinolone Abx

Ofloxacin Floxin]

148

MOA of Ofloxacin Floxin]

Inhibits bacterial DNA replication by binding to DNA gyrase & topoisomerase

149

Indications of Ofloxacin Floxin]

Infections with susceptible GI, GU bacteria &
traveler’s diarrhea (off label)

150

Cytosine Analogue Anti-Viral (NRTI)

Lamivudine [Epivir]

151

MOA of Lamivudine [Epivir]

Inhibits HBV DNA polymerase (& HIV reverse transcriptase); suppresses HBV replication

152

Indications of Lamivudine [Epivir]

HBV
HIV

153

Guanosine Analogue Anti-viral

Ribavarin [Virazole]

154

MOA of Ribavarin [Virazole]

Inhibits replication of wide range of DNA & RNA viruses
(influenza A & B, RSV, parainfluenza virus)

155

Indications of Ribavarin [Virazole]

HCV, HIV;
goal is eradication of HCV

156

Direct Acting Antiviral
Polymerase Inhibitor

Sofosbuvir [Sovaldi]

157

MOA of Sofosbuvir [Sovaldi]

Inhibits HCV RNA-dependent RNA polymerase preventing HCV replication

158

Indications of Sofosbuvir [Sovaldi]

Acute or Chronic Hepatitis C

159

the other Direct Acting Antiviral
Polymerase Inhibitor
that is just one pill for it all!!!!

Ledipasvir/ Sofosbuvir [Harvoni]

160

MOA of Ledipasvir/ Sofosbuvir [Harvoni]

Ledipsavir inhibits HCV protein needed for replication;
sofosbuvir inhibits RNA- dependent polymerase preventing replication

161

Indications of Ledipasvir/ Sofosbuvir [Harvoni]

Chronic Hepatitis C, genotype 1

162

Misc Antibiotic from Hepatic disorders drug table

Rifaximin [Xifaxan]

163

MOA of Rifaximin [Xifaxan]

Inhibits bacterial RNA-synthesis by binding to bacterial RNA- polymerase

164

Indications of Rifaximin [Xifaxan]

Hepatic encephalopathy,
IBS-Diarrhea predominant, Traveler’s diarrhea;
Off-label: C Diff associated diarrhea (CDAD)

165

Hepatitis Vaccines:

Inactivated Vaccine

Hep A Vaccine [Havrix]

166

MOA of Hep A Vaccine [Havrix]

Stimulates HAV antibody response

167

Indications of Hep A Vaccine [Havrix]

Active HAV prophylaxis;
Pre- and post- exposure;
2 doses

168

Hepatitis Vaccines:

Recombinant Vaccine

Hep B Vaccine [Engerix-B]

169

MOA of Hep B Vaccine [Engerix-B]

Stimulates anti-HBV antibody formation

170

Indications of Hep B Vaccine [Engerix-B]

Active HBV prophylaxis
(3 doses)