Pharmacology - GI Drugs I & II - Patsy Iannolo Flashcards Preview

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Flashcards in Pharmacology - GI Drugs I & II - Patsy Iannolo Deck (106):
1

Class: Calcium carbonate (Rolaids, Tums)

Antacid

2

Class: Sodium bicarbonate

Antacid

Rarely used due to causing systemic alkalosis

3

Class: Magnesium hydroxide, magnesium carbonate (Maalox, Mylanta)

Antacid

4

Class: Aluminum hydroxide (Alternagel)

Antacid

5

Use: Calcium carbonate (Rolaids, Tums)

Ulcer tx, GERD

6

Use: Sodium bicarbonate

Ulcer tx, GERD

Rarely used due to causing systemic alkalosis

7

Use: Magnesium hydroxide, magnesium carbonate (Maalox, Mylanta)

Ulcer tx, GERD

8

Use: Aluminum hydroxide (Alternagel)

Ulcer tx, GERD

9

Side Effects: Calcium carbonate (Rolaids, Tums)

Milk-alkali syndrome, nephrocalcinosis,
"rebound" acidity,
digitalis antagonism,
constipation

10

Side Effects: Sodium bicarbonate

Systemic alkalosis;
Enhanced effects of amphetamine, quinidine, and cinchophen

Rarely used due to causing systemic alkalosis

11

Side effects: Magnesium hydroxide, magnesium carbonate (Maalox, Mylanta)

Diarrhea;
Hypokalemia,
hypermagnesemia,
iron deficiency

Magnesium toxicity mostly in presence of renal disease; liquid-based, so act fast

12

Side effects: Aluminum hydroxide (Alternagel)

Phosphate depletion and sequelae (weakness, anemia, tetany, apnea);
Constipation

13

What antacid is safe for use in patients with renal failure?

Aluminum hydroxide

also eliminates phosphate

14

What antacid should not be used in patients that have renal failure?

Magnesium hydroxide, magnesium carbonate (Maalox, Mylanta)

15

Class: Cimetidine

Histamine (H2) receptor blocker

16

Class: Famotidine

Histamine (H2) receptor blocker

17

Class: Ranitidine

Histamine (H2) receptor blocker

18

Class: Nizatidine

Histamine (H2) receptor blocker

19

MOA: Histamine (H2) receptor blockers - Cimiidine, Ranitidine, Famotidine, Nizatidine

Inhibits 50-80% of 24 hour acid production

20

Use: Histamine (H2) receptor blockers - Cimiidine, Ranitidine, Famotidine, Nizatidine

Ulcer treatment (satisfy all 4 requirements); prophylactically for stress ulcers; GERD

21

Side Effects: Ulcer treatment (satisfy all 4 requirements); prophylactically for stress ulcers; GERD

Rebound acidity if stopped;
Uncommon; headache, lethargy, confusion, depression, and hallucination

22

Class: Omeprazole

H/K/ATPase inhibitor

23

Class: Lansoprazole

H/K/ATPase inhibitor

24

Class: Rabeprazole

H/K/ATPase inhibitor

25

Class: Pantoprazole

H/K/ATPase inhibitor

26

Class: Esomeprazole

H/K/ATPase inhibitor

27

MOA: H/K/ATPase inhibitors:
Omeprazole, Lansoprazole, Rabeprazole, Pantoprazole, Esomeprazole

Inhibit >90% of 24 hour acid secretion (better than H2 antagonists);
requires acid environment to activate, selectively diffuse to acidic environments (don't take with antacids)

**noncompetitive inhibitors

28

Uses: Omeprazole and Lansorazole

Ulcer treatment,
treatment for H. pylori;
GERD

29

Uses: Rabeprazole, Pantoprazole, Esomeprazole

Ulcer treatment; GERD

30

Side Effects: H/K/ATPase inhibitors:
Omeprazole, Lansoprazole, Rabeprazole, Pantoprazole, Esomeprazole

Headache, gynecomastia, gastric hyperplasia in humans and carcinoid tumors in rats long term (do not use long-term)

31

What is Dexlansoprazole?

A rapid-formulation of slow release Lansoprazole

32

What is the only H/K ATPase inhibitor available for IV administration?

Pantoprazole

33

T/F: H/K ATPase inhibitors will heal H2 antagonist refractory ulcers.

True

Also, better pain relief and faster healing rates than with H2 antagonists.

34

What H/K ATPase inhibitor has no P450 interaction?

Pantoprazole

35

What is the only drug that is FDA approved for the prevention of NSAID-induced gastric ulcers?

Misoprostol

H2 antagonists and sucralfate are ineffective if NSAID
therapy is being continued.

36

Class: Misoprostol

Prostaglandin E analog

37

MOA: Misoprostol

Decrease acid production, increase mucous and bicarbonate secretion

38

Use: Misoprostol

Ulcer treatment when prostaglandin production decreased (RA patients taking lots of NSAIDs)

39

What antacid should not be used in pregnancy?

Misoprostol

40

Side effects: Misoprostol

Transient diarrhea

41

What is the therapy for H. Pylori infection?

Quadruple therapy:
A PPI twice a day
Tetracycline HCl 500 mg 4 times a day
Bismuth subsalicylate or subcitrate 4 times a day Metronidazole 500 mg 3 times a day

42

Class: Atropine sulfate

Anticholinergics

43

Class: Probantheline;
Metantheline bromide

Anticholinergics

44

MOA: Anticholinergics -
Atropine sulfate;
Probantheline;
Metantheline bromide

Reduce acid secretion;
reduce spasm

45

Use: Atropine sulfate

Ulcer treatment

46

Side effects: Anticholinergics -
Atropine sulfate;
Probantheline;
Metantheline bromide

Anticholinergic effects

47

What are the contraindications for Probantheline;
Metantheline bromide

Known pyloric obstruction, hiatal hernia, or peptic esophagitis (not used much)

48

What are the contraindications for Atropine sulfate?

Aspirin;
Belladonna;
known pyloric obstruction, hiatal hernia, or peptic esophagitis (not used much)

49

Use: Probantheline;
Metantheline bromide

Ulcer treatment (taken 15-30 minutes before meals, and before bed)

50

Class: Sucralfate (Carafate)

Mechanical protector

51

Class: Bismuth salts

Mechanical protector

52

MOA: Sucralfate

Coat the ulcer crater, increase mucosal resistance (requires acid environment)

53

MOA: Bismuth salts

Coat the ulcer crater, increase mucosal resistance

54

Side effects: Sucralfate

Aluminum toxicity possible in renal failure

55

Use: Sucralfate, Bismuth salts

Ulcer treatment, treatment for H. pylori

56

Side effects: Bismuth salts

Aluminum toxicity possible in renal failure; turns bowel movements (and sometimes tongues) black

57

Class: Ondansetron

Serotonin (5HT3) receptor antagonists

58

Class: Granesitron

Serotonin (5HT3) receptor antagonists

59

Class: Dolasetron

Serotonin (5HT3) receptor antagonists

60

Class: Promethazine

Phenothiazines (neuroleptic class)

61

Class: Prochlorperazine

Phenothiazines (neuroleptic class)

62

MOA: Prochlorperazine

Probable CNS interaction with dopaminergic receptor-antagonist (leading to reduction of stimulation in the CRTZ in the medulla)

63

Use:
Prochlorperazine;
Promethazine

Anti-emetic

64

MOA: Promethazine

Antihistamine (H1 receptor);
anticholinergic

65

Side effects: Prochlorperazine

Largely extra-pyramidal (torticollis!)

66

Side effects: Promethazine

Somnolence (esp in elderly)

67

MOA:
Ondansetron;
Granesitron;
Dolasetron

Blocks serotonin at 5HT3 receptor (in central CRTZ)

68

Use:
Ondansetron;

Anti-emetic

69

Use:
Granesitron;
Dolasetron

Post-op anti-emetic

70

Class: Metochlopramide

Promotility agent (dopamine antagonist)

71

MOA: Metochlopramide

Increase motor tone in lower esophageal sphincter (prevent reflux) and stomch (esp. antrum: improves gastric emptying); peripheral (stomach) and CNS (vomiting, via CRTZ) dopamine antagonist

72

Use: Metochlopramide

GERD, anti-emetic, gastroparesis

73

Side effects: Metochlopramide

Hand tremor if used 4X/day (optimum use); possible extra-pyramidal symptoms, but not so severe

74

Class: Domperidone

Promotility agent

75

MOA: Domperidone

Improves gastric tone

76

Use: Domperidone

Gastroparesis

77

An important complication of Cisparide is:

possibility of sudden cardiac death

78

Class: Cisparide

Promotility agent (dopamine agonist)

79

MOA: Cisparide

Increase motor tone in lower esophageal sphincter and stomach

80

Use: Cisparide

GERD, gastroparesis

81

Class: Lubiprostone

...

82

Class: Linaclotide

...

83

Class: Naloxegol

Mu receptor antagonist

84

MOA: Lubiprostone

acts on chloride channel

85

MOA: Linaclotide

cGMP

86

Use: Lubiprostone

Anti-constipation

87

MOA: Naloxegol

...

88

Use: Naloxegol

Anti-constipation;
effective in opioid addicted population

89

Class: Sulfasalazine

Anti-inflammatory

90

Class: Olsalazine

Anti-inflammatory

91

Class: Mesalamine

Anti-inflammatory

92

Class: Prednisone

Corticosteroid

93

Class: Azathioprine

Immunosuppressive

94

Class: Cyclosporine

Immunosuppressive

95

Class: Infliximab

MAb Immunisuppressive

96

MOA: Sulfasalazine

Work from lumen to reduce inflammation

97

MOA: Olsalazine

Work from lumen to reduce inflammation; 5-ASA dimer

Broken down into bowel by bacteria into 2 moleules of 5-ASA

98

MOA: Mesalamine

Work from lumen to reduce inflammation

Delayed release 5-ASA, for terminal ileum, colon

99

MOA: Azathioprine

Purine antimetabolite; interferes with DNA synthesis

100

MOA: Cyclosporine

Suppresses T helper and T suppressor lymphocytes

101

MOA: Infliximab

Binds and neutralized TNFa

102

Use:
Sulfasalazine;
Olsalazine;
Mesalamine

Acute IBD (UC)

103

Use: Prednisone

Acute and chronic IBD

Can be given systemically or as enemas

104

Use:
Azathioprine;
Cyclosporine;
Infliximab

Chronic IBD

105

Side Effects: Sulfasalazine

Toxicity coming from systemic absorption of sulfapyridine

106

T/F: Olsalazine has less toxicity that Sulfasalazine

True