PPTs Flashcards
(1231 cards)
1
Q
Drug class? Block the action of histamine by binding to H1 receptors
A
antihistamines
2
Q
effect of antihistamines on capillary permeability?
A
Decreased
3
Q
what receptors do antihistamines bind to?
A
H1 receptors
4
Q
effect of antihistamines on respiratory muscle constriction?
A
decrease
5
Q
effect of antihistamines on vascular muscle constriction?
A
decrease
6
Q
effect of antihistamines on GI smooth muscle constriction?
A
decrease
7
Q
which generation of antihistamines bind non-selectively to central H1 receptors?
A
1st generation
8
Q
which generation of antihistamines bind selectively for peripheral H1 receptors?
A
2nd generation
9
Q
what receptors do 1st generation H1 receptors bind to?
A
central H1 receptors
10
Q
which generation of antihistamines binds to central H1 receptors?
A
1st generation
11
Q
which generation of antihistamines bind to peripheral H1 receptors?
A
2nd generation
12
Q
do 1st generation antihistamines bind non-selectively or selectively?
A
non-selectively
13
Q
do 2nd generation antihistamines bind non-selectively or selectively?
A
selective
14
Q
which generation of antihistamines bind to central H1 receptors?
A
1st generation
15
Q
which generation of antihistamines bind to peripheral receptors?
A
2nd generation
16
Q
where are antihistamines metabolized?
A
in the liver
17
Q
where are antihistamines excreted?
A
in the urine
18
Q
which generation of antihistamines is on the Beer’s criteria list?
A
1st generation
19
Q
1st generation antihistmines and BPH?
A
contraindicated
20
Q
1st generation antihistamines in narrow angle glaucoma?
A
contraindicated
21
Q
1st generation antihistamines in newborns and premature infants?
A
contraindicated
22
Q
why are 1st generation antihistamines contraindicated in newborns and premature infants?
A
convulsions
23
Q
which generation of antihistamines can cause paradoxical CNS stimulation in young children?
A
1st generation
24
Q
which generation of antihistamines is diphenhydramine?
A
1st generation
25
which generation of antihistamines is chlorpheniramine?
1st generation
26
which generation of antihistamines is hydroxyzine?
1st generation
27
three examples of 1st generation antihistamines?
diphenhydrame, chlorpheniramine, hydroxyzine
28
which generation of antihistamine is cetirizine?
2nd generation
29
which generation of antihistamine is levocetirizine?
2nd generation
30
which generation of antihistamine is loratidine?
2nd generation
31
which generation of antihistamine is desloratadine?
2nd generation
32
which generation of antihistamine is fexofenadine?
2nd generation
33
brand name of diphenhydramine?
benadryl
34
brand name of chlorpheniramine?
chlor-trimeton
35
brand name of hydroxyzine?
atarax
36
brand name of cetirizine?
zyrtec
37
brand name of levocetirizine?
xyzal
38
brand name of loratadine?
claritin
39
brand name of desloratadine?
clarinex
40
brand name of fexofenadine?
allegra
41
5 examples of 2nd generation antihistamines?
cetirizine, levocetirizine, loratadine, desloratadine, fexofenadine
42
drug class? Used for the treatment of seasonal allergic rhinitis and vasomotor rhinitis
intranasal antihistamines
43
what are two indications for intranasal antihistamines?
seasonal allergic rhinitis & vasomotor rhinitis
44
what is the systemic oral bioavailability of intranasal antihistamines?
0.4
45
describe protein binding of intranasal antihistamines?
high levels
46
metabolism of intranasal antihistamines?
metabolized into active metabolites
47
excretion of intranasal antihistamines?
excreted in the feces
48
three side effects of intranasal antihistamines?
somnolence, nasal irritation, bitter taste
49
two examples of intranasal antihistamines?
azelastine & olopatadine
50
class? Azelastine
intranasal antihistamines
51
class? Olopatadine
intranasal antihistamines
52
what is the MOA of nasal corticosteroids?
same as inhaled corticosteroids
53
class? Fluticasone
nasal corticosteroids
54
class? Budesonide
nasal corticosteroids
55
class? Triamcinolone
nasal corticosteroids
56
class? Ciclesonide
nasal corticosteroids
57
class? Mometasone
nasal corticosteroids
58
brand name? fluticasone
flonase
59
brand name? budesonide
rhinocort aqua
60
brand name? Triamcinolone
nasacort AQ
61
brand name? ciclesonide
omnaris
62
brand name? mometsone
nasonex
63
what class are these? Fluticasone, budesonide, triamcinolone, ciclesonide, mometasone
nasal corticosteroids
64
specific class? Kaolin & pectin, bismuth subsalicylate
absorbent antidiarrheals
65
two examples of absorbent drugs?
kaolin and pectin; bismuth subsalicylate
66
specific class? Kaolin & pectin
absorbent antidiarrheals
67
specific class? Bismuth subsalicylate
absorbent antidiarrheals
68
specific class? Diphenoxylate w/ atropine
opiate antidiarrheals
69
specific class? Difenoxin with atropine
opiate antidiarrheals
70
specific class? Loperamide
opiate antidiarrheals
71
general class? Kaolin and pectin
antidiarrheals
72
general class? Bismuth subsalicylate
antidiarrheals
73
general class? Diphenoxylate with atropine
antidiarrheals
74
general class? Loperamide
antidiarrheals
75
two classes of antidiarrheal drugs used in crohn's and ulcerative colitis?
loperamide & anticholinergices
76
what is the action of pectin?
absorbs liquid in the stool and thickens the stool
77
when are kaolin/pectin usually used?
uncomplicated acute diarrhea
78
what antidiarrheal has antisecretory, antiinflammatory, and antimicrobial actions?
bismuth subsalicylate
79
what portion of bismuth subsalicylate is antisecretory?
salicylate portion
80
what portion of bismuth subsalicylate is antimicrobial?
bismuth portion
81
what antidiarrheal causes discoloration of stool and tongue?
bismuth
82
what antidiarrheal should not be given in febrile viral conditions?
bismuth subsalicylate
83
what antidiarrheal can precipitate Reye syndrome in febrile viral conditions?
bismuth subsalicylate
84
what color does bismuth subsalicylate change stools?
gray
85
what can stool discoloration with bismuth make patients think?
GIB
86
do diphenoxylate and difenoxin cause analgesia?
no
87
diphenoxylate- specific class?
opiate antidiarrheals
88
difenoxin- specific class?
opiate antidiarrheals
89
what is the second ingredient of diphenoxylate?
atropine
90
what is the second ingredient of difenoxin?
atropine
91
what is the main active metabolite of diphenoxylate?
difenoxin
92
what is the role of atropine with diphenoxylate or difenoxin?
antisecretory and slows peristalsis
93
drug? Slowing of peristalsis by binding of the drug to opioid receptors in the intestines
loperamide
94
what does loperamide do to the stool?
bulking & increased thickness; reduction in fecal volume
95
effect of loperamide on fecal volume?
reduction in fecal volume
96
drug? Used in mild cases of Crohn disease that is without any serious complications
loperamide
97
what class of antidiarrheals can cause toxic megacolon?
opiate antidiarrheals
98
children are especially prone to anticholinergic effects of what class of antidiarrheals?
opiate antidiarrheals
99
opiate antidiarrheals and narrow angle glaucoma?
contraindicated
100
opiate antidiarrheals and urinary obstruction?
contraindicated
101
why shouldn't diphenoxylate and difenoxin not be used in intestinal infections?
can worsen the condition
102
brand name for olodaterol?
striverdi respimat
103
brand name for vilanterol?
breo ellipta
104
specific class? Block muscarinic cholinergic receptors by antagonizing acetylcholine
inhaled anticholinergics
105
what receptors do inhaled anticholinergics block?
muscarinic cholinergic receptors
106
what do inhaled anticholinergics antagonize?
acetylcholine
107
what respiratory med class decreases the formation of cyclic GMP?
inhaled anticholinergics
108
what respiratory class decreases the formation of cyclic GMP?
inhaled anticholinergics
109
what respiratory class causes decreased contractility of smooth muscle in the lungs?
inhaled anticholinergics
110
what do inhaled anticholinergics do to contractility of smooth muscle in the lungs?
decreased contractility
111
what muscle do inhaled anticholinergics act on?
smooth muscle of the lungs
112
describe absorption of inhaled anticholinergics?
poorly absorbed from lungs and GIT
113
what percentage of inhaled anticholinergic dose is swallowed?
0.9
114
where are inhaled anticholinergics excreted from?
feces
115
10% of inhaled anticholinergics are metabolized by WHAT?
hydrolysis
116
what drug class involves metabolism via hydrolysis?
inhaled anticholinergics
117
what do inhaled anticholinergics decrease the formation of?
cyclic GMP
118
what specific class involves cyclic GMP with MOA?
inhaled anticholinergics
119
what does the decreased formation of cyclic GMP cause with inhaled anticholinergics?
decreased contractility of smooth muscle in the lungs
120
three common side effects of inhaled anticholinergics?
dry mouth, cough, headache
121
which glaucoma needs to be avoided with inhaled anticholinergics?
closed-angle glaucoma
122
what specific drug class should not be used for acute bronchospasm unless in combination with albuterol?
inhaled anticholinergics
123
inhaled anticholinergics in urinary retention?
no
124
inhaled anticholinergics in BPH?
no
125
inhaled anticholinergics in closed-angle glaucoma?
no
126
what must you combine inhaled anticholinergics with in order to use for acute bronchospasm?
albuterol
127
can you use inhaled anticholinergics on their own for acute bronchospasm?
no
128
what does SAMA stand for?
short acting muscarinic antagonists
129
what does LAMA stand for?
long acting muscarinic antagonists
130
how long do SAMAs last?
4-6 hours
131
specific class? Ipratropium bromide
short acting muscarinic antagonists
132
ipratropium bromide/albuterol- specific class?
short acting muscarinic antagonists
133
tiotropium bromide-specific class?
long acting muscarinic antagonists
134
aclidinium bromide- specific class?
long acting muscarinic antagonists
135
umeclidinium bromide- specific class?
long acting muscarinic antagonists
136
revefenacin- specific class?
long acting muscarinic antagonists
137
which LAMA is the only one that can be nebulized?
revefenacin
138
what is the brand name for revefenacin?
yupelri
139
how long does revefenacin (yupelri) last?
24 hours
140
how long does umeclidinium bromide (incruse ellipta) last?
24 hours
141
how long does aclidinium bromide (tudorza pressair) last?
12 hours
142
how long does tiotropium bromide (spiriva) last?
24 hours
143
what is the brand name for ipratropium bromide?
atrovent
144
what is the brand name for ipratropium bromide/albuterol?
combivent
145
what is the brand name for tiotropium bromide?
spiriva handihaler/spiriva respimat
146
what is the brane name for aclidinium bromide?
tudorza pressair
147
what is the brand name for umeclidinium bromide?
incruse ellipta
148
what is the first long acting nebulized LAMA?
revefenacin
149
specific class? Preferentially bind to M3 receptors which are the primary muscarinic receptor involving bronchoconstriction in COPD
glycopyrrolates (LAMAs)
150
two examples of glycopyrronium bromide?
seebri neohaler & breztri (in combination with LABA and ICS)
151
which receptors are the primary muscarinic receptor involving bronchoconstriction in COPD?
M3 receptors
152
broad class of glycopyrrolates?
inhaled anticholinergics
153
specific class of glycopyrrolates?
long acting muscarinic antagonists
154
how long does seebri neohaler last?
12 hours
155
example of methylxanthine drug?
theophylline
156
theophylline- specific class?
methylxanthine
157
class? Inhibit phosphodiesterases that lead to an increase in cyclic AMP
methylxanthine
158
effect of theophylline on bronchial smooth muscle?
relaxation
159
effect of theophylline on pulmonary vessels?
relaxation
160
what does theophylline inhibit?
phosphodiesterases
161
inhibition of phosphodiesterases lead to an increase of what?
cyclic AMP
162
describe absorption of theophylline?
well and fully absorbed orally
163
describe first pass with theophylline?
very little
164
where is theophylline metabolized?
in the liver
165
four common side effects of methylxanthines?
headache, irritability, gastric irritation, N/V
166
describe drug interactions with methylxanthines?
multiple
167
what respiratory drug requires monitoring with serum drug levels to prevent toxicity?
theophylline
168
what are decongestants used for?
used to relieve nasal congestion
169
what two forms do decongestants come in?
oral and topical (nasal spray) forms
170
class? Alpha-adrenergic receptor agonists
decongestants
171
class? Stimulate alpha receptors of vascular smooth muscle, constricting dilated arterioles within the nasal mucosa
decongestants
172
what receptors do decongestants simulate?
alpha receptors
173
where do decongestants stimulate alpha receptors?
vascular smooth muscle
174
where do decongestants constrict dilated arterioles?
within the nasal mucosa
175
general class? Pseudoephedrine
decongestants
176
specific class? Pseudoephedrine
alpha-adrenergic receptor agonists
177
describe absorption of pseudoephedrine?
well absorbed from GI tract
178
describe distribution of pseudoephedrine?
widely distributed
179
does pseudoephedrine cross the BBB?
yes
180
describe metabolism of pseudoephedrine?
partially metabolized in the liver
181
describe excretion of pseudoephedrine?
excreted in urine with up to 75% as an active metabolite
182
what is pseudoephedrine used for?
to relieve nasal congestion
183
what are three adverse effects with oral decongestants?
anxiety, restlessness, tremors
184
what are four adverse effects with topical decongestants?
burning, stinging, dryness, sneezing
185
oral decongestants in severe HTN?
contraindicated
186
oral decongestants in cardiovascular disease?
contraindicated
187
what is the absolute contraindication to oral decongestants?
patients on MAOIs
188
can you take MAOIs with oral decongestants?
no (absolute contraindication)
189
can kids younger than 4 years take oral decongestants?
no
190
what age of children should not take topical decongestants?
younger than 6 years
191
what age of children should not take oral decongestants?
younger than 4 years
192
two examples of oral decongestants?
pseudoephedrine & phenylephrine
193
pseudoephedrine & phenylephrine are what type of drugs?
oral decongestants
194
does phenylephrine have an oral form?
yes
195
does phenylephrine have a topical form?
yes
196
does phenylephrine come in oral and topical forms?
yes
197
does pseudoephedrine have a topical form?
no
198
is oxymetazoline an oral or topical decongestant?
topical
199
is tetrahydrozoline an oral or topical decongestant?
topical
200
how is oxymetazoline given?
topical
201
how is tetrahydrozoline given?
topical
202
what are antitussives used for?
to suppress cough
203
general class? Used to suppress cough- but should be used judiciously
antitussives
204
two examples of nonopioid antitussives?
benzonatate and dextromethorphan
205
benzonatate- specific class?
nonopioid antitussive
206
dextromethorphan- specific class?
nonopioid antitussive
207
drug? D isomer of codeine analogue that acts in medulla to increase cough threshold
dextromethorphan
208
drug? Chemically related to tetracaine that acts by anesthetizing the cough receptors in the lungs
benzonatate
209
drug? Directly acts on receptors in the cough center of the medulla
codeine
210
example of opioid antitussive drug?
codeine
211
codeine-specific class?
opioid antitussive
212
where does dextromethorphan act?
in the medulla
213
what does dextromethorphan do in the medulla?
increase cough threshold
214
what does dextromethorphan do to the cough threshold?
increase cough threshold
215
what antitussive is chemically related to tetracaine?
benzonatate
216
what receptors does benzonatate act on?
cough receptors in the lungs
217
what does benzonatate do to cough receptors in the lungs?
anesthetizes them
218
what receptors does codeine act on?
receptors in cough center of the medulla
219
describe absorption of antitussives?
all well absorbed from GIT
220
describe distribution of codeine?
widely distributed including CNS
221
where is dextromethorphan metabolized?
liver
222
where is dextromethorphan excreted?
in the urine
223
where is codeine metabolized?
liver
224
where is codeine excreted?
in the urine
225
metabolism of benzonatate?
unknown
226
excretion of benzonatate?
unknown
227
can codeine cause dependence?
yes
228
can dextromethorphan cause dependence?
yes
229
when is benzonatate contraindicated?
patients who are allergic to any "caine" compound
230
patients who are allergic to any "caine" compound should not take what drug?
benzonatate
231
should antitussives be used in patients with respiratory disease with chronic cough?
no
232
what two antitussive drugs can cause dependence?
codeine and dextromethorphan
233
three side effects of antitussives?
drowsiness, dizziness, nausea
234
class? Used to reduce the viscosity of thick sputum in the symptomatic treatment of cough due to respiratory infections
235
what is the only FDA approved expectorant?
guaifenesin
236
thick bronchial secretions are composed of what?
mucins
237
what cells produce mucins?
goblet cells
238
what glands produce mucins?
submucosal glands
239
where are the submucosal glands located?
in the airways
240
what drug decreases mucin production from goblet cells?
guaifenesin
241
what drug indirectly stimulates GI vagal afferent nerves
guaifenesin
242
drug? Decreases mucin production from goblet cells and indirectly stimulates GI vagal afferent nerves that trigger reflex parasympathetic glandular secretion from submucosal cells and goblet cells increasing hydration of mucus layer for more effective mucociliary clearance
guaifenesin
243
what are the potential GI side effects of guaifenesin?
GI upset- N/V/D
244
should guaifenesin be taken with asthma?
no
245
should guaifenesin be taken with COPD?
no
246
should guaifenesin be taken with HF?
no
247
should guaifenesin be taken with ACE inhibitor therapy?
no
248
class? Inhibit IgE and mast cell mediated migration of inflammatory cells into bronchial mucosa
inhaled corticosteroids
249
which immunoglobulin is affected with inhaled corticosteroids?
IgE
250
what phase of allergic reaction is affected by inhaled corticosteroids?
late-phase allergic reaction
251
in what two places are inhaled corticosteroids absorbed?
lungs and GI tract
252
describe speed of absorption of inhaled corticosteroids?
rapid
253
how much of inhaled corticosteroid dose is deposited in the lungs?
less than one-fourth
254
less than one-fourth of dose of what class is deposited in the lungs?
inhaled corticosteroids
255
what happens to swallowed portion of inhaled corticosteroid dose?
undergoes extensive first-pass metabolism
256
where are inhaled corticosteroids excreted?
in urine and feces
257
migration of inflammatory cells with inhaled corticosteroids are mediated by what?
mast cells
258
how do inhaled corticosteroids come?
in multiple forms and delivery systems
259
what are five potential adverse effects of inhaled corticosteroids?
xerostomia; hoarseness; mouth irritation; dysgeusia; oral candidiasis
260
oral candiasis can occur with what class of respiratory medication?
inhaled corticosteroids
261
HPA suppression is a risk with what class of respiratory medication?
inhaled corticosteroids
262
can inhaled corticosteroids be given in status asthmaticus?
no
263
high-dose of what class of respiratory medication in children may inhibit growth?
inhaled corticosteroids
264
highest potency inhaled corticosteroid?
fluticasone furoate
265
what is the brand name for fluticasone furoate?
arnuity ellipta
266
specific class? Fluticasone furoate
inhaled corticosteroids
267
specific class? Mometasone furoate DIP
inhaled corticosteroids
268
specific class? Fluticasone propionate DIP
inhaled corticosteroids
269
specific class? Beclomethasone dipropioate
inhaled corticosteroids
270
specific class? Ciclesonide MDI
inhaled corticosteroids
271
specific class? Budesonide DPI
inhaled corticosteroids
272
what is the brand name of mometasone furoate DPI?
asmanex twisthaler
273
what is the brand name for fluticasone propionate DPI?
armonair digihaler
274
what is the brand name for beclomethasone dipropionate?
QVAR redihaler
275
four examples of stimulant laxatives?
cascara, senna, bisacodyl, castor oil
276
specific class- cascara?
stimulant laxative
277
specific class- senna?
stimulant laxative
278
specific class- bisacodyl?
stimulant laxative
279
specific class- castor oil?
stimulant laxative
280
four examples of osmotic laxatives?
magnesium hydroxide, magnesium citrate, sodium phosphate, PEG 3350
281
specific class- magnesium hydroxide?
osmotic laxative
282
specific class- magnesium citrate?
osmotic laxative
283
specific class- sodium phosphate?
osmotic laxative
284
specific class- polyethylene glycol 3350?
osmotic laxative
285
three examples of bulk-producing laxatives?
psyllium, methylcellulose, polycarbophil
286
specific class- psyllium?
bulk-producing laxative
287
specific class- methylcellulose?
bulk-producing laxative
288
specific class- polycarbophil?
bulk-producing laxative
289
example of lubricant laxative?
mineral oil
290
specific class- mineral oil?
lubricant laxative
291
example of surfactant laxative?
docusate
292
specific class- docusate sodium?
surfactant laxative
293
specific class- docusate calcium?
surfactant laxative
294
specific class- docusate potassium?
surfactant laxative
295
what are the three types of docusate?
docusate sodium, docusate calcium, docusate potassium
296
two examples of hyperosmolar laxatives?
glycerin and lactulose
297
specific class- glycerin?
hyperosmolar laxative
298
specific class- lactulose?
hyperosmolar laxative
299
example of chloride channel activator laxative?
lubiprostone
300
specific class- lubiprostone?
chloride channel activator laxative
301
example of opioid receptor antagonist laxative?
methylnaltrexone
302
specific class- methylnaltrexone?
opioid receptor antagonist laxative
303
what is the one class of laxatives that does not have abuse/dependency potential?
bulk-producing laxative
304
do stimulant laxatives have abuse/dependency potential?
yes
305
do osmotic laxatives have abuse/dependency potential?
yes
306
do bulk-producing laxatives have abuse/dependency potential?
no
307
do lubricant laxatives have abuse/dependency potential?
yes
308
do surfactant laxatives have abuse/dependency potential?
yes
309
do hyperosmolar laxatives have abuse/dependence potential?
yes
310
do chloride channel activator laxatives have abuse/dependency potential?
yes
311
do opioid receptor antagonist laxatives have abuse/dependency potential?
yes
312
electrolyte alterations, fluid alterations, steatorrhea, osteomalacia, vitamin/nutrient deficiences- can occur with what general class?
laxatives
313
tartrazine sensitivity can occur with what general class?
laxatives
314
what is an example of a tartrazine sensitivity reaction?
bronchospasm
315
tartrazine sensitivity is associated with sensitivity to what?
aspirin
316
can you give laxatives when nausea, vomiting, and/or abdominal pain of unknown cause are present?
no
317
when might you especially want to avoid giving laxatives?
n/v or abdominal pain of unknown cause, especially if may have bowel obstruction
318
can all laxatives be given in pregnancy?
no
319
specific class? Thought to possible cause stimulation/irritation of the myenteric nerves
stimulant laxative
320
specific class? Irritation of intestinal smooth muscle
stimulant laxative
321
effect of stimulant laxatives on peristalsis?
increased
322
do stimulant laxatives affect peristalsis?
yes
323
specific laxative class? Increased prostaglanding release and an increase in cAMP concentration?
stimulant laxative
324
what nerves are effected by stimulant laxatives?
myenteric nerves
325
effect of stimulant laxatives on prostaglandin release?
increased
326
effect of stimulant laxatives on cAMP concentration?
increased
327
effect of stimulant laxatives on electrolyte secretion?
increased
328
why do stimulant laxatives cause increased electrolyte secretion?
increased prostaglandin release and an increase in cAMP concentration
329
four adverse effects of stimulant laxatives?
diarrhea, flatulence, abdominal cramping, bloating
330
why should castor oil not be used in pregnancy?
can stimulate uterine contractions
331
which stimulant laxative can stimulate uterine contractions?
castor oil
332
which stimulant laxative can cause diarrhea in lactating infants?
cascara
333
cascara can cause what in lactating infants?
diarrhea
334
cardiovascular disease is a relative contraindication to which stimulant laxative?
bisacodyl
335
cascara should not be used if the patient cannot ingest WHAT?
alcohol
336
why should cascara not be used if the patient cannot ingest some alcohol?
cascara contains some alcohol
337
can bisacodyl be used in pregnancy?
yes
338
which stimulant laxative can be used in pregnancy?
bisacodyl
339
can castor oil be used in pregnancy?
no
340
what are two indications for osmotic laxatives?
constipation and bowel prep
341
specific class? Increased intraluminal pressure due to water being drawn more inside the intestines
osmotic laxative
342
effect of osmotic laxatives on peristalsis?
increased
343
do osmotic laxatives affect peristalsis?
yes
344
four side effects of osmotic laxatives?
diarrhea, flatulence, abdominal cramping, bloating
345
why should magnesium-containing laxatives be avoided in renal dysfunction?
kidneys may not be able to excrete the magnesium adequately
346
what effect on magnesium happens if magnesium-containing laxatives are used in renal dysfunction?
hypermagnesemia
347
magnesium-containing laxatives should not be used in patients with what calcium imbalance?
hypocalcemia
348
what cardiac issues contraindicate magnesium-containing laxatives?
cardiac dysrhythmias or conduction disturbances
349
cardiac dysrhythmias or conduction disturbance contraindicate laxatives containing what?
magnesium hydroxide, magnesium citrate, sodium phosphate, PEG 3350
350
pediatric use of PEG 3350?
caution
351
why do osmotic laxatives cause increased intraluminal pressure?
water being drawn more inside the intestines
352
what laxative class can be used in chronic, watery diarrhea?
bulk-producing laxative
353
why are bulk-producing laxatives used in chronic, watery diarrhea?
to bulk the stool
354
specific class? Act physiologically like increased fiber in the diet would by combining with water in the intestines
bulk-producing laxative
355
specific class? Mechanical distention of the intestinal wall
bulk-producing laxative
356
do bulk-producing laxatives affect peristalsis?
yes
357
effect of bulk-producing laxatives on peristalsis?
increased
358
do side effects of bulk-producing laxatives dissipate with time?
usually
359
can bulk-producing laxatives be used in pregnancy?
yes
360
can bulk-producing laxatives be used if a bowel impaction?
no
361
why should bulk-producing laxatives not be used in a bowel impaction?
feces cannot get around impacted stool
362
specific class? Some may be contraindicated in clinical settings where either salt or sugar is restricted
bulk-producing laxative
363
what specific class of laxatives may contain salt or sugar?
bulk-producing laxative
364
what specific class of laxatives should be used cautiously when patient may have strictures or other narrowing of esophagus or intestine?
bulk-producing laxative
365
what specific class of laxatives may be used long-term for simple, chronic constipation?
bulk-producing laxative
366
what are four potential adverse effects of bulk-producing laxatives?
diarrhea, flatulence, abdominal cramping, bloating
367
specific class? Used to soften impacted stool
lubricant laxative
368
what is the main component of lubrican laxatives?
mineral oil
369
MOA of lubricant laxatives?
used to soften impacted stool
370
what is the purpose of lubrication with these laxatives?
to help stool move more easily via the presence of mineral oil
371
what are four potential adverse effects of lubricant laxatives?
diarrhea, flatulence, abdominal cramping, bloating
372
which specific laxative class can cause decreased absorption of fat-soluble vitamins if used chronically?
lubricant laxative
373
decreased absorption of what can occur with chronic use of lubricant laxatives?
fat-soluble vitamins
374
which specific laxative class can cause lipid pneumonia if aspirated?
lubricant laxative
375
who is at risk for lipid pneumonia with lubricant laxatives?
very young and any patient at risk for aspiration
376
which class of laxatives would you not want to give in someone with impaired swallowing?
lubricant laxative
377
can lubricant laxatives be taken in pregnancy?
no
378
why shouldn't lubricant laxatives be taken in pregnancy?
fat-soluble vitamins may not be absorbed as well
379
which class of laxatives can cause vitamin K deficiency in newborns?
lubricant laxative
380
which class of laxatives can cause hypoprothrombinemia in newborns?
lubricant laxative
381
what is another name for surfactant laxatives?
stool softeners
382
what is the class name for stool softeners?
surfactant laxative
383
specific class? Used to soften stool and prevent constipation, especially stool that is dry and difficult to evacuate and when straining at stool must be stopped
surfactant laxative
384
which laxative class is useful when stool is dry and difficult to evacuate?
surfactant laxative
385
which laxative class is useful when straining at stool must be stopped?
surfactant laxative
386
specific class? Assist with lipids and water being mixed into stool
surfactant laxative
387
what is the MOA of surfactant laxatives?
assist with lipids and water being mixed into stool
388
do surfactant laxatives have precautions?
no
389
do surfactant laxatives have contraindications?
no
390
which class of laxatives? Usually well-tolerated and without precautions or contraindications
surfactant laxative
391
can surfactant laxatives be used in pregnancy?
yes
392
which class of laxatives are used for fecal impaction and neurogenic bowel?
hyperosmolar laxative
393
which class of laxatives is indicated with neurogenic bowel?
hyperosmolar laxative
394
which class of laxatives is used with chronic constipation and increased excretion of ammonia in the stool?
hyperosmolar laxative
395
specific class? Glycerin
hyperosmolar laxative
396
specific class? Lactulose
hyperosmolar laxative
397
drug? Bacteria in the gut transform this dissarchide into lactic, acetic, and formic acids
lactulose
398
drug? Local colonic irritation and more water drawn into the stool
glycerin
399
what are the four adverse effects of hyperosmolar laxatives?
diarrhea, flatulence, abdominal cramping, bloating
400
what patient population is at risk for dehydration with hyperosmolar laxatives?
older adults
401
what laxative class is associated with dehydration risk in older adults?
hyperosmolar laxative
402
when should you monitor blood glucose with lactulose?
those taking lactulose chronically and acutely in patients with diabetes mellitus
403
which laxative drug involves blood glucose monitoring?
lactulose
404
hyperosmolar laxatives in lactation?
avoid
405
lactulose in pregnancy?
only when benefits > risks
406
glycerin in pregnancy?
no
407
why do older adults get dehydration with hyperosmolar laxatives?
intravascular volume depletion
408
specific class? Activation of CIC-2 chloride channels in the intestinal epithelium
chloride channel activator laxative
409
effect of chloride channel activators on chloride secretion?
more chloride is secreted
410
what helps soften the stool and improve intestinal movement with chloride channel activators?
increased chloride
411
three indications for chloride channel activators?
chronic constipation d/t unknokwn cause; chronic constipation d/t IBS; opioid-induced constipation
412
these are indications for what laxative class? Chronic constipation d/t unknown cause; chronic constipation d/t IBS; opioid-induced constipation
chloride channel activator laxative
413
what channels do chloride channel activators activate?
CIC-2
414
what part of GIT do chloride channel activators work in?
intestinal epithelium
415
four potential adverse effects of chloride channel activators?
diarrhea, flatulence, abdominal cramping, bloating
416
how can you avoid nausea with chloride channel activators?
avoid by giving the drug with a meal
417
which laxative class is associated with dyspnea?
chloride channel activator laxative
418
chloride channel activators in pregnancy?
avoid
419
indication for opioid receptor antagonist laxatives?
chronic constipation due to opioids
420
this is an indication for which laxative class? Chronic constipation due to opioids
opioid receptor antagonist laxative
421
what receptors do opioid receptor antagonists act on?
mu opioid receptors
422
where are the mu opioid receptors located that opioid antagonist laxatives act on?
in the gut
423
effect of opioid receptor antagonist laxatives on peristalsis?
increased
424
do opioid receptor antagonist laxatives cross the BBB?
no
425
do opioid receptor antagonist laxatives cause analgesia?
no
426
four adverse effects of opioid receptor antagonist laxatives?
diarrhea, flatulence, abdominal cramping, bloating
427
can opioid receptor antagonists induce opioid withdrawal?
yes
428
what is the concern with abdominal pain and constipation?
concern for bowel rupture
429
when is opioid withdrawal syndrome more likely with opioid receptor antagonist laxatives?
if alterations of the BBB have occurred
430
specific class? Antagonist at the mu-opioid receptors in the gut-- speeds up peristalsis
opioid receptor antagonist laxative
431
why shouldn't diphenoxylate and difenoxin not be used in intestinal infections?
can worsen the condition
432
which two drugs should not be used with intestinal infection? (antidiarrheals)
diphenoxylate and difenoxin
433
children with Down syndrome are especially prone to anticholinergic adverse effects of what antidiarrheals?
opiate antidiarrheals
434
what type of glaucoma is a contraindication for opiate antidiarrheals?
narrow angle glaucoma
435
loss of WHAT in the GIT is prevented by loperamide?
fluid and electrolyte loss
436
what effect does loperamide have on peristalsis?
slowing
437
rebound constipation can progress to what?
serious impaction
438
what population is especially prone to serious impaction with rebound constipation?
older adults
439
general class? Eluxadoline
antidiarrheals
440
general class? Alosetron
antidiarrheals
441
drug? Mu and kappa opioid receptor agonist
eluxadoline
442
drug? Delta opioid receptor antagonist
eluxadoline
443
drug? Mu and kappa opioid receptor agonist and delta opioid receptor antagonist
eluxadoline
444
what antidiarrheal drug should be avoided in: hx of biliary disorders, pancreatitis, severe liver impairment, and heavy alcohol use?
eluxadoline
445
drug? Selective 5-HT3 receptor antagonist
alosetron
446
describe MOA of alosetron?
selective 5-HT3 receptor antagonist
447
drug? Decreased intestinal motility and secretions and a decrease in any associated abdominal pain
alosetron
448
what drug is used for females with diarrhea-predominant IBS not responsive to other therapies?
alosetron
449
when is alosetron used?
diarrhea-predominant IBS not responsive to other therapies
450
four examples of antihistamines used as antiemetics?
dimenhydrinate, diphenhydramine, hydroxyzine, meclizine
451
three examples of phenothiazine antiemetics?
prochlorperazine, perphenazine, promethazine
452
specific class? Prochlorperazine
phenothiazine antiemetics
453
specific class? Perphenazine
phenothiazine antiemetics
454
specific class? Promethazine
phenothiazine antiemetics
455
general class? Prochlorperazine
antiemetics
456
general class? Perphenazine
antiemetics
457
general class? Promethazine
antiemetics
458
can sedative-hypnotics be used as antiemetics?
antiemetics
459
general class? Dronabinol
cannabinoids
460
example of cannabinoid antiemetics?
dronabinol
461
specific class? Dronabinol
cannabinoid antiemetics
462
four examples of 5HT3 receptor antagonists? (antiemetics)
palonosetron, ondansetron, dolasetron mesylate, granisetron
463
general class? Palonosetron
antiemetics
464
general class? Ondansetron
antiemetics
465
general class? Dolasetron mesylate
antiemetics
466
general class? Granisetron
antiemetics
467
specific class? Palonosetron
5-HT3 receptor antagonists
468
specific class? Ondansetron
5-HT3 receptor antagonists
469
specific class? Dolasetron mesylate
5-HT3 receptor antagonists
470
specific class? Granisetron
5-HT3 receptor antagonists
471
example drug of anticholinergic antiemetic?
scopolamine
472
general class? Scopolamine
antiemetics
473
specific class? Scopolamine
anticholinergic antiemetics
474
general class? Aprepitant
antiemetic
475
specific class? Aprepitant
substance P/neurokinin 1 receptor antagonist
476
example of substance P/neurokinin 1 receptor antagonist?
aprepitant
477
example of a miscellaneous antiemetic?
trimetobenzamide
478
specific class? Most useful for motion sickness N/V due to slowing of neuronal communication in the vestibulocerebellar areas
antihistamine antiemetics
479
what class of antiemetics bind to histamine-1 receptors?
antihistamine antiemetics
480
antihistamine antiemetics; binding to histamine-1 receptors causes decreased what?
secretions in mouth and eyes
481
antihistamine antiemetics- binding to central cholinergic receptors causes what?
decreased nausea and vomiting
482
do antihistamine antiemetics cause anticholinergic effects?
yes
483
why should antihistamine antiemetics be avoided in the older adult population?
because of anticholinergic effects
484
what class of antiemetics can cause unexpected agitation in the pediatric population as opposed to sedation in adults?
antihistamine antiemetics
485
antihistamine antiemetics in hepatic dysfunction?
avoid
486
why should antihistamine antiemetics be avoided in hepatic dysfunction
because of liver metabolism
487
use of antiemetics in pregnancy and lactation?
weight risk benefit ration
488
which class of antiemetics is most useful for motion sickness?
antihistamine antiemetics
489
what class of antiemetics slows neuronal communication in the vestibulocerebellar areas
antihistamine antiemetics
490
where do antihistamine antiemetics slow neuronal communication?
vestibulocerebellar areas
491
indication for phenothiazine antiemetics?
prevent and treat N/V
492
what is the MOA of phenothiazine antiemetics?
antagonist at dopamine receptors in the chemoreceptor trigger zone (CTZ) (bind at multiple other receptors as well)
493
where are phenothiazines an antagonist?
dopamine receptors
494
where do phenothiazines antagonize dopamine receptors?
in the chemoreceptor trigger zone
495
what is the ultimate action of phenothiazine antiemetics?
decreased nausea and vomiting
496
extrapyramidal side effects are associated with what class of antiemetics?
phenothiazine antiemetics
497
who is at highest risk for EPS with phenothiazine antiemetics?
pediatric population
498
what is the pediatric population at risk for with phenothiazine antiemetics?
EPS
499
what is the black box warning with phenothiazine antiemetics?
respiratory depression in the pediatric population
500
which specific class of antiemetics has black box warning for respiratory depression in the pediatric population?
phenothiazine antiemetics
501
what class of antiemetics can cause agranulocytosis with long term use?
phenothiazine antiemetics
502
how many months does it take to see agranulocytosis with phenothiazine antiemetics?
four months or more
503
phenothiazines and Parkinson disease?
contraindicated
504
phenothiazines and narrow-angle glaucoma?
contraindicated
505
phenothiazines and bone marrow depression?
contraindicated
506
phenothiazines and cardiovascular disease?
contraindicated
507
what reflex is decreased with phenothiazine antiemetics?
cough reflex
508
what class of antiemetics can decrease the cough reflex?
phenothiazine antiemetics
509
what patients are at risk due to decreased cough reflex with phenothiazine antiemetics?
COPD or those prone to aspiration
510
phenothiazines and pregnancy?
avoid
511
what class of antiemetics can cause changes to urine color?
phenothiazine antiemetics
512
what color can phenothiazines antiemetics change urine?
pink to reddish brown
513
most adverse effects of phenothiazine antiemetics are not likely with only what?
short term use
514
what kind of glaucoma is contraindicated with phenothiazine antiemetics?
narrow-angle glaucoma
515
specific class? Used to treat N/V due to chemotherapy when other agents have failed; appetite stimulation
cannabinoid antiemetics
516
where do cannabinoid antiemetics act?
at cannabinoid receptors centrally
517
are cannabinoid receptors involved centrally or peripherally?
centrally
518
describe adverse effects of cannabinoid antiemetics
THC-like adverse effects
519
two possible mood changes with cannabinoid antiemetics?
euphoria; depression
520
dronabinol may cause what effect on sensory experience/level?
increase
521
describe changes to thoughts with dronabinol?
unusual
522
effect of dronabinol on concentration?
problems with concentration
523
effect of dronabinol on memory?
memory alterations
524
effect of dronabinol on time?
loss of time
525
what antiemetic can cause seizures?
cannabinoid antiemetics
526
why can dronabinol cause seizures?
lowering of the seizure threshold
527
three CV adverse effects with dronabinol?
palpitations, tachycardia, hypotension
528
effect of dronabinol on BP?
decreased blood pressure (hypotension)
529
effect of dronabinol on heart rate?
increased heart rate (tachycardia)
530
patients with a hx of an allergy to sesame oil should not take which antiemetic?
dronabinol
531
what drug class is first-line therapy in the management of HTN and HF?
diuretics
532
are diuretics first-line therapy in HTN?
yes
533
are diuretics first-line therapy in HF?
yes
534
pathophysiologic effects of HTN and HF?
increased sodium and water retention
535
pathophysiologic effect of HTN and HF on ECF volume?
increased
536
effect of diuretics on cardiac output?
decreased
537
effect of diuretics on plasma volume?
decreased
538
how do diuretics reduce cardiac output?
by decreasing plasma volume
539
do the effects of diuretics stay the same over time?
no- they are reduced
540
do diuretics always decrease peripheral resistance?
yes
541
effect of diuretics on peripheral resistance?
decreased
542
effect of diuretics on afterload?
decreased
543
effect of diuretics on BP?
decreased
544
general class? Carbonic anhydrase inhibitors
diuretics
545
general class? Osmotic diuretics
diuretics
546
general class? Aldosterone antagonists
diuretics
547
general class? Loop diuretics
diuretics
548
general class? Thiazides
diuretics
549
risk with diuretics re: potassium?
hypokalemia
550
risk with diuretics re: calcium?
hypercalcemia
551
risk with diuretics re: sodium?
hyponatremia
552
risk with diuretics re: magnesium?
hypomagnesemia
553
hypo or hyperkalemia with diuretics?
hypokalemia
554
hypo or hypercalcemia with diuretics?
hypercalcemia
555
hypo or hypernatremia with diuretics?
hyponatremia
556
hypo or hypermagnesemia with diuretics?
hypomagnesemia
557
what kind of diet exacerbates potassium loss with diuretics?
high sodium diet
558
what happens with a high sodium diet on diuretics?
exacerbates potassium loss
559
adverse effect associated with hypokalemia on diuretics?
metabolic alkalosis
560
what causes metabolic alkalosis with diuretics?
hypokalemia
561
effect of diuretics on uric acid?
elevated
562
what two diuretic classes are most likely to cause glucose intolerance?
loop and thiazide
563
glucose intolerance on diuretics is directly linked to what?
potassium level
564
potassium level is directly linked to what with diuretics?
glucose intolerance
565
what causes hypotension with diuretics?
decreased fluid volume
566
decreased fluid volume causes what adverse effect with diuretics?
hypotension
567
describe drug interactions with diuretics?
multiple
568
what is the MOA of loop diuretics?
inhibit sodium reabsorption in the ascending loop of Henle
569
where do loop diuretics act?
the ascending loop of Henle
570
what do loop diuretics inhibit in the ascending loop of Henle?
sodium reabsorption
571
which loop do diuretics act on?
ascending loop of Henle
572
class? Inhibit sodium reabsorption in the ascending loop of Henle
loop diuretics
573
what is the effect of loop diuretics on potassium?
increase potassium excretion
574
are loop diuretics short or long-acting?
short acting
575
are loop diuretics weak or powerful?
powerful
576
do loop diuretics cause small or large natriuresis?
large natriuresis
577
describe absorption of oral loop diuretics?
well-absorbed orally
578
describe distribution of loop diuretics?
widely distributed
579
where are loop diuretics metabolized?
liver
580
describe excretion of loop diuretics?
excreted unchanged in the urine
581
class? Inhibit sodium reabsorption in the distal renal tubule
thiazide diuretics
582
describe the MOA of thiazide diuretics?
inhibit sodium reabsorption in the distal renal tubule
583
where do thiazide diuretics act in the kidney?
distal renal tubule
584
effect of thiazide diuretics on potassium?
increase potassium excretion
585
do loop diuretics effect potassium?
yes
586
do thiazide diuretics effect potassium?
yes
587
are thiazide diuretics short or long-acting?
longer lasting
588
describe diuresis with thiazide diuretics?
less diuresis
589
describe thiazide diuretic absorption?
well-absorbed orally
590
what is the only diuretic to enter intracellular spaces?
thiazide diuretics
591
which diuretic class can be used in refractory edema?
thiazide diuretics
592
describe distribution of thiazide diuretics?
widely distributed
593
why can you use thiazide diuretics in refractory edema?
only diuretic to enter intracellular spaces
594
where are thiazide diuretics metabolized?
liver
595
where are thiazide diuretics excreted?
unchanged in urine
596
which diuretic class can cause hyperlipidemia?
thiazide diuretics
597
which diuretic class can cause photosensitive reactions?
thiazide diuretics
598
how long can photosensitivity secondary to thiazide diuretics last?
years after discontinuing the drug
599
are increased lipid levels permanent with thiazide diuretics?
elevations are transient
600
class? Inhibit excretion in the distal tubule of the kidney
aldosterone antagonists
601
describe MOA of aldosterone antagonists?
inhibit excretion in the distal tubule of the kidney
602
are aldosterone antagonists weak or strong diuretics?
weak diuretics
603
where do aldosterone antagonists act in the kidney?
distal tubule of the kidney
604
what class of diuretics are most often used with thiazide diuretics?
aldosterone antagonists
605
why are thiazide diuretics and aldosterone antagonists used together?
decrease potassium loss
606
aldosterone antagonists are most often used with what class of diuretics to decrease potassium loss?
thiazide diuretics
607
describe absorption of aldosterone antagonists?
absorption rates vary
608
describe distribution of aldosterone antagonists?
widely distributed
609
where are aldosterone antagonists metabolized?
liver
610
where are aldosterone antagonists excreted?
unchanged in urine
611
gynecomastia is associated with what class of diuretics?
aldosterone antagonists
612
gynecomastia occurs in 50% of patients taking what drug?
spironolactone
613
spironolactone- specific class?
aldosterone antagonists
614
impotence is a side effect of what specific class?
aldosterone antagonists
615
furosemide- specific class?
loop diuretics
616
furosemide- general class?
diuretic
617
bumetanide- specific class?
loop diuretics
618
chlorthalidone- specific class?
thiazide diuretics
619
hydrochlorothiazide- specific class?
thiazide diuretics
620
indapamide- specific class?
thiazide diuretics
621
metolazone- specific class?
thiazide diuretics
622
spironolactone- specific class?
aldosterone antagonists
623
triamterene- specific class?
aldosterone antagonists
624
amiloride- specific class?
aldosterone antagonists
625
eplerenone- specific class?
aldosterone antagonists
626
what are the four goals of GERD therapy?
prevent/decrease symptoms; heal esophagitis or any erosive esophageal lesions; prevent complications; prevent recurrent symptoms
627
esophageal carcinoma is a potential complication of what condition?
GERD
628
smoking cessation is what?
a nonpharmacologic intervention for GERD
629
weight loss to ideal body weight is what?
a nonpharmacologic intervention for GERD
630
when should HOB be elevated with GERD?
at night or if lying down
631
how long should patients remain supine after eating or drinking?
three hours
632
do not overeat- is what?
a nonpharmacologic intervention for GERD
633
how long should bending over be avoided after eating?
three hours
634
how long should strenuous exercise be avoided after eating?
three hours
635
class? Can be used as adjunctive therapy for frequent symptoms, as needed, and for non-frequent symptoms as needed
antacids
636
class? Considered first line therapy for most patients with frequent GERD symptoms or other serious complications
proton pump inhibitors
637
are PPIs first line therapy?
yes
638
are histamine-2 receptor antagonists first line for GERD?
not first line in most cases
639
when are drugs that improve the LES tone used?
adjunctively with a drug that is suppressing the production of HCL
640
when are prokinetic agents used?
reserved for use in those who still experience symptoms after maximal acid suppression therapy and max lifestyle modifications
641
why are cytoprotective agents mostly used only in PUD?
since they affect the gastric mucosa
642
which GERD drugs have serious potential adverse effects?
prokinetic agents
643
what do H2RAs stand for?
histamine-2 receptor antagonists
644
can antacids be used in GERD?
yes
645
can antacids be used in PUD?
yes
646
can antacids be used in hypersecretory states?
yes
647
can antacids be used in calcium deficiency?
yes
648
can antacids be used in hyperphosphatemia?
yes
649
what are the five indications for antacids?
GERD, PUD, hypersecretory states, hyperphosphatemia, calcium deficiency
650
class? Weak bases that form salt and water when they interact with HCL
antacids
651
what do antacids do to HCL?
neutralize
652
what do antacids do to gastric ph?
increase
653
what do antacids do to duodenal bulb ph?
increase
654
what are the components of antacids?
metallic cation plus basic anion
655
what effect do antacids have on pepsin?
inhibit pepsin's proteolytic activity
656
do antacids affect the LES tone?
yes
657
what effect do antacids have on LES tone?
improve
658
do aluminum based antacids affect gastric motility?
yes
659
what is the effect of aluminum based antacids on gastric motility?
slowed
660
how do aluminum based antacids affect gastric motlity?
via inhibition of smooth muscle contraction locally in the stomach
661
which type of antacid is the only type that affects gastric motility?
aluminum-based
662
which two types of antacids are used in renal failure?
calcium-based and aluminum-based antacids
663
why are antacids used in renal failure?
to bind phosphates and lower blood phosphate levels
664
which two types of antacids can cause constipation?
aluminum-based and calcium-based
665
diarrhea is caused by which type of antacids?
magnesium-based antacids
666
when might alkalosis occur with antacids?
usually only in patients with renal failure
667
patients with renal failure are at risk for what adverse effect of antacids?
alkalosis
668
are antacids used as monotherapy for signficant disease?
no
669
are antacids used as monotherapy for esophagitis?
no
670
are antacids used as monotherapy for frequent symptoms?
no
671
antacids can be used as needed in concert with what?
an acid suppressive drug
672
can you use antacids without knowing the cause of abdominal pain?
no
673
can you use antacids in the setting of severe abdominal pain of undetermined cause?
no
674
can you use calcium-based antacids if a patient has hypercalcemia?
no
675
can you use calcium-based antacids if a patient has a history of renal stones?
no
676
hypercalcemia is a contraindication to what type of antacids?
calcium-based
677
renal stones are a contraindication to what type of antacid?
calcium-based
678
what two types of antacids should not be used in renal failure?
magnesium or aluminum-based antacids
679
why should you not use magnesium-based antacids in renal failure?
hypermagnesemia
680
why should you not use aluminum-based antacids in renal failure?
worsened osteomalacia
681
worsened osteomalacia in patients with renal failure can occur with use of which type of antacid?
aluminum-based
682
when should high sodium-containing antacids NOT be used?
in settings where fluid overload will exacerbate a condition
683
describe drug interactions with antacids?
many drug interactions re: absorption- check drug information
684
when should a patient call provider re: antacids?
if symptoms continue or worsen within two weeks; if new symptoms arise
685
are PPIs used with GERD?
yes
686
are PPIs used with PUD?
yes
687
are PPIs used with hypersecretory states?
yes
688
Zollinger-Ellison syndrome is an example of what?
hypersecretory state
689
are PPIs used with Zollinger-Ellison syndrome?
yes
690
what are three indications for PPIs?
GERD, PUD, hypersecretory states (e.g. Zollinger-Ellison syndrome)
691
specific class? Suppression of gastric acid secretion by parietal cells by preventing the H+/K+ATPase enzyme system from secreting hydrogen ion needed to form hydrochloric acid
PPIs
692
what do PPIs suppress?
gastric acid secretion by parietal cells
693
what cells do PPI suppress?
parietal cells
694
what system is involved in PPIs?
H+K+ATPase enzyme system
695
what class of GERD medications can result in achlorhydria?
proton pump inhibitors
696
term? No gastric acid
achlorhydria
697
less gastric acid results in decreased/increased blood flow to gastric antrum?
decreased
698
less gastric acid results in decreased/increased blood flow to the pylorus?
decreased
699
less gastric acid results in decreased/increased blood flow to the duodenal bulb?
decreased
700
what effect does decreased gastric acid have on pepsinogen levels?
increased
701
less gastric acid results in decreased/increased pepsinogen levels?
increased
702
less gastric acid results in decreased/increased pepsin activity?
decreased
703
what effect does less gastric acid have on pepsin activity?
decreased
704
less gastric acid results in a compensatory increase in what?
gastrin levels
705
are there any clinically significant effects with compensatory increase in gastric levels?
no
706
what are four GI adverse effects with PPIs?
nausea, abdominal pain, flatulence, constipation/diarrhea
707
what are two CNS type adverse effects with PPIs?
dizziness and drowsiness
708
acute interstitial nephritis is associated with what GERD class?
proton pump inhibitors
709
deficiences of what four nutrients can occur with PPIs?
iron, magnesium, vitamin B12, calcium
710
what GERD medication has potential risk for hip fracture?
proton pump inhibitors
711
acute kidney injury and chronic kidney disease can occur with long-term use of what GERD class?
proton pump inhibitors
712
even short-term use increases the risk of pneumonia with what GERD drug class?
proton pump inhibitors
713
what is the potentially respiratory consequence with even short-term use of PPIs?
pneumonia
714
C diff infection can occur with what GERD class?
proton pump inhibitors
715
what GERD class may pose a risk for gastric cancer?
proton pump inhibitors
716
what GERD class is associated with chronic atrophic gastritis?
proton pump inhibitors
717
chronic atrophic gastritis with PPIs may increase risk for what?
gastric cancer
718
what GERD class has concern re: development of dementia?
proton pump inhibitors
719
PPI effect on overall mortality?
potential increased risk
720
PPIs in hepatic dysfunction?
cautious use
721
PPIs in older patients?
cautious use
722
PPIs in pregnancy?
avoid in pregnancy unless needed (requires favorable risk/benefit)
723
PPIs in lactation?
cautious use only
724
are any PPIs safe and effective in pediatrics?
some drugs in class
725
any drug therapy for GERD must be combined with what?
ongoing lifestyle modifications
726
if PPI response is not adequate, what should I do?
check for compliance with medication and with lifestyle modifications
727
what class is almost always preferred over H2RAs?
proton pump inhibitors
728
what are three indications for H2RAs?
GERD (w/ or w/o erosive esophagitis); PUD; hypersecretory states
729
can H2RAs be used for GERD?
yes
730
can H2RASs be used for GERD with erosive esophagitis?
yes
731
can H2RAs be used for GERD without erosive esophagitis?
yes
732
can H2RAs be used for PUD?
yes
733
can H2RAs be used for hypersecretory states
yes
734
is ranitidine still used?
no
735
why is ranitidine no longer used in the USA?
due to nitrosodimethylamine being found in the formulations
736
what does NDMA stand for?
nitrosodimethylamine
737
what is the problem with nitrosodimethylamine?
likely a human carcinogen
738
specific class? Blockade of the histamine-2 receptor on gastric parietal cells
histamine-2 receptor antagonists
739
less/more HCL is produced with H2RAs?
less
740
effect of H2RAs on gastric PH?
increased
741
do H2RAs have effect on LES pressure?
yes- varied
742
do H2RAs have effect on speed of gastric emptying?
yes-varied
743
do H2RAs have effect on volume of gastric secretion?
yes-varied
744
do H2RAs have effect on hydrogen ion concentration?
yes-varied
745
which H2RA medication is the most potent at lowering gastric acid secretion?
famotidine
746
is there any clinical benefit of famotidine's potency at lowering gastric acid secretion?
unclear
747
famotidine is the most potent at doing what?
lowering gastric acid secretion
748
what GERD class can cause gynecomastia and erectile dysfunction?
histamine-2 receptor antagonists
749
what GERD medication can cause gynecomastia and erectile dysfunction?
cimetidine
750
what are two antiandrogenic side effects of cimetidine?
gynecomastia and erectile dysfunction
751
oral and IV forms of what GERD drug class can cause potential rhythm and conduction abnormalities?
histamine-2 receptor antagonists
752
can oral H2RAs cause rhythm and conduction abnormalities?
yes
753
can IV H2RAs cause rhythm and conduction abnormalities?
yes
754
the following are CNS ADEs with what drug class (GERD)? Alterations of cognitive function, agitation, psychosis, depression, headache, seizures
histamine-2 receptor antagonists
755
CNS adverse effects with H2RAs are more likely to occur in who?
renal and/or hepatic dysfunction
756
why should H2RAs be avoided in older population?
due to cognitive effects
757
what is the hematologic adverse reaction to H2RAs?
individual cell line deficiencies to pancytopenia
758
individual cell line deficiencies to pancytopenia can occur with what GERD drug class?
histamine-2 receptor antagonists
759
why should we monitor CBC with H2RAs?
risk for individual cell line deficiencies to pancytopenia
760
hepatic cell injury can occur with what GERD medication?
nizatidine
761
why should we monitor LFTs with H2RAs?
hepatic cell injury (nizatidine)
762
nizatidine is associated with what?
hepatic cell injury
763
what is the vitamin deficiency that can occur with long-term use of H2RAs?
vitamin B12
764
what can happen to vitamin B12 with long-term use of H2RAs?
deficiency
765
vitamin B12 deficiency can cause what two consequences? (H2RAs)
anemia and neurologic deficits
766
neurologic deficits with H2RAs can be due to what?
vitamin B12 deficiency
767
three immune-related adverse effects with H2RAs?
polymyositis, nephritis, immune-related rashes
768
immune-related rashes can occur with what GERD class?
histamine-2 receptor antagonists
769
polymyositis can occur with what GERD class?
histamine-2 receptor antagonists
770
nephritis can occur with what GERD class?
histamine-2 receptor antagonists
771
fever can occur with what GERD class?
histamine-2 receptor antagonists
772
do H2RAs block histamine-1 receptors?
no
773
why are H2RAs not anticholinergic?
they do not block the histamine-1 receptors
774
are H2RAs anticholinergic drugs?
no
775
H2RA use in pregnancy?
not well studied, avoid (weigh risk benefit)
776
H2RA use in lactation?
avoid (weight risk benefit)
777
H2RA use in pediatrics?
yes
778
drug? Used for lower tiers of therapy due to serious adverse effects possible
metoclopramide
779
EPS are possible with what GERD medication?
metoclopramide
780
pediatric patients taking metoclopramide are at higher risk for what?
EPS
781
is metoclopramide used as monotherapy for GERD?
no
782
does metoclopramide have prokinetic properties?
yes
783
does metoclopramide affect LES tone?
improves LES tone
784
does metoclopramide help heal esophageal lesions?
no
785
is bethanechol used as GERD monotherapy?
no
786
what two drugs are mostly used for gastroparesis therapy re: GI disorders?
metoclopramide and bethanechol
787
what is the primary use for metoclopramide?
gastroparesis therapy re: GI disorders
788
what is the primary use for bethanechol?
gastroparesis therapy re: GI disorders
789
does bethanechol have prokinetic properties?
yes
790
does bethanechol help heal esophageal lesions?
no
791
these are the goals of what? Eliminate H pylori (main cause of PUD); reduction/elimination of any symptoms; healing of ulcer; avoid complications; prevent recurrent disease
PUD
792
what is the main cause of PUD?
H pylori
793
what organism causes PUD?
H pylori
794
what are three potential complications of PUD?
bleeding, perforation, carcinoma
795
why are H2RAs rarely used for PUD?
because the PPIs are much more effective at gastric acid suppression
796
what is the main class of antisecretory medication used in PUD treatment?
proton pump inhibitors
797
what are the seven antimicrobials used for H pylori?
clarithromycin; amoxicillin; metronidazole; tetracycline; doxycycline; nitazoxanide; levofloxacin
798
is bismuth subsalicylate used in PUD treatment?
yes
799
is clarithromycin used in PUD treatment?
yes
800
is amoxicillin used in PUD treatment?
yes
801
is metronidazole used in PUD treatment?
yes
802
is tetracycline used in PUD treatment?
yes
803
is doxycycline used in PUD treatment?
yes
804
is nitazoxanide used in PUD treatment?
yes
805
is levofloxacine used in PUD treatment?
yes
806
is vancomycin used in PUD treatment?
no
807
is erythromycin used in PUD treatment?
no
808
why might treatment failure occur in H pylori treatment?
microbial resistance to antibiotics
809
what is the treatment regimen for H pylori?
various three and four-drug combinations with PPIs
810
drug? Binds to the ulcer site to shield the area from HCL, pepsin, and bile salts
sucralfate
811
can you use sucralfate in children?
safety not established
812
what three things does sucralfate shield from?
HCL, pepsin, and bile salts
813
drug? Inhibits formation of cAMP that occurs due to histamine stimulation?
misoprostol
814
misoprostol MOA?
inhibits formation of cAMP that occurs due to histamine stimulation
815
what does misoprostol do to gastric acid secretion?
inhibits
816
what effect does misoprostol have on gastric mucus?
promotes formation
817
what effect does misoprostol have on bicarbonate?
promotes production
818
does misoprostol protect mucosa?
yes
819
what PUD medication can induce uterine contractions?
misoprostol
820
what PUD medication is absolutely contraindicated in pregnancy?
misoprostol
821
why is misoprostol absolutely contraindicated in pregnancy?
can induce uterine contractions
822
misoprostol in renal dysfunction?
cautious use
823
misoprostol in pediatrics?
safety not established in < 18 years of age
824
indication for misoprostol?
primarily used for prevention of NSAID-induced PUD
825
what drug is primarily used for prevention of NSAID-induced PUD?
misoprostol
826
class? Inhibit IgE and mast cell mediated migration of inflammatory cells into bronchial mucosa
inhaled corticosteroids
827
which immunoglobulin is affected with inhaled corticosteroids?
IgE
828
what phase of allergic reaction is affected by inhaled corticosteroids?
late-phase allergic reaction
829
in what two places are inhaled corticosteroids absorbed?
lungs and GI tract
830
describe speed of absorption of inhaled corticosteroids?
rapid
831
how much of inhaled corticosteroid dose is deposited in the lungs?
less than one-fourth
832
less than one-fourth of dose of what class is deposited in the lungs?
inhaled corticosteroids
833
what happens to swallowed portion of inhaled corticosteroid dose?
undergoes extensive first-pass metabolism
834
where are inhaled corticosteroids excreted?
in urine and feces
835
migration of inflammatory cells with inhaled corticosteroids are mediated by what?
mast cells
836
how do inhaled corticosteroids come?
in multiple forms and delivery systems
837
what are five potential adverse effects of inhaled corticosteroids?
xerostomia; hoarseness; mouth irritation; dysgeusia; oral candidiasis
838
oral candiasis can occur with what class of respiratory medication?
inhaled corticosteroids
839
HPA suppression is a risk with what class of respiratory medication?
inhaled corticosteroids
840
can inhaled corticosteroids be given in status asthmaticus?
no
841
high-dose of what class of respiratory medication in children may inhibit growth?
inhaled corticosteroids
842
highest potency inhaled corticosteroid?
fluticasone furoate
843
what is the brand name for fluticasone furoate?
arnuity ellipta
844
specific class? Fluticasone furoate
inhaled corticosteroids
845
specific class? Mometasone furoate DIP
inhaled corticosteroids
846
specific class? Fluticasone propionate DIP
inhaled corticosteroids
847
specific class? Beclomethasone dipropioate
inhaled corticosteroids
848
specific class? Ciclesonide MDI
inhaled corticosteroids
849
specific class? Budesonide DPI
inhaled corticosteroids
850
what is the brand name of mometasone furoate DPI?
asmanex twisthaler
851
what is the brand name for fluticasone propionate DPI?
armonair digihaler
852
what is the brand name for beclomethasone dipropionate?
QVAR redihaler
853
four examples of stimulant laxatives?
cascara, senna, bisacodyl, castor oil
854
specific class- cascara?
stimulant laxative
855
specific class- senna?
stimulant laxative
856
specific class- bisacodyl?
stimulant laxative
857
specific class- castor oil?
stimulant laxative
858
four examples of osmotic laxatives?
magnesium hydroxide, magnesium citrate, sodium phosphate, PEG 3350
859
specific class- magnesium hydroxide?
osmotic laxative
860
specific class- magnesium citrate?
osmotic laxative
861
specific class- sodium phosphate?
osmotic laxative
862
specific class- polyethylene glycol 3350?
osmotic laxative
863
three examples of bulk-producing laxatives?
psyllium, methylcellulose, polycarbophil
864
specific class- psyllium?
bulk-producing laxative
865
specific class- methylcellulose?
bulk-producing laxative
866
specific class- polycarbophil?
bulk-producing laxative
867
example of lubricant laxative?
mineral oil
868
specific class- mineral oil?
lubricant laxative
869
example of surfactant laxative?
docusate
870
specific class- docusate sodium?
surfactant laxative
871
specific class- docusate calcium?
surfactant laxative
872
specific class- docusate potassium?
surfactant laxative
873
what are the three types of docusate?
docusate sodium, docusate calcium, docusate potassium
874
two examples of hyperosmolar laxatives?
glycerin and lactulose
875
specific class- glycerin?
hyperosmolar laxative
876
specific class- lactulose?
hyperosmolar laxative
877
example of chloride channel activator laxative?
lubiprostone
878
specific class- lubiprostone?
chloride channel activator laxative
879
example of opioid receptor antagonist laxative?
methylnaltrexone
880
specific class- methylnaltrexone?
opioid receptor antagonist laxative
881
what is the one class of laxatives that does not have abuse/dependency potential?
bulk-producing laxative
882
do stimulant laxatives have abuse/dependency potential?
yes
883
do osmotic laxatives have abuse/dependency potential?
yes
884
do bulk-producing laxatives have abuse/dependency potential?
no
885
do lubricant laxatives have abuse/dependency potential?
yes
886
do surfactant laxatives have abuse/dependency potential?
yes
887
do hyperosmolar laxatives have abuse/dependence potential?
yes
888
do chloride channel activator laxatives have abuse/dependency potential?
yes
889
do opioid receptor antagonist laxatives have abuse/dependency potential?
yes
890
electrolyte alterations, fluid alterations, steatorrhea, osteomalacia, vitamin/nutrient deficiences- can occur with what general class?
laxatives
891
tartrazine sensitivity can occur with what general class?
laxatives
892
what is an example of a tartrazine sensitivity reaction?
bronchospasm
893
tartrazine sensitivity is associated with sensitivity to what?
aspirin
894
can you give laxatives when nausea, vomiting, and/or abdominal pain of unknown cause are present?
no
895
when might you especially want to avoid giving laxatives?
n/v or abdominal pain of unknown cause, especially if may have bowel obstruction
896
can all laxatives be given in pregnancy?
no
897
specific class? Thought to possible cause stimulation/irritation of the myenteric nerves
stimulant laxative
898
specific class? Irritation of intestinal smooth muscle
stimulant laxative
899
effect of stimulant laxatives on peristalsis?
increased
900
do stimulant laxatives affect peristalsis?
yes
901
specific laxative class? Increased prostaglanding release and an increase in cAMP concentration?
stimulant laxative
902
what nerves are effected by stimulant laxatives?
myenteric nerves
903
effect of stimulant laxatives on prostaglandin release?
increased
904
effect of stimulant laxatives on cAMP concentration?
increased
905
effect of stimulant laxatives on electrolyte secretion?
increased
906
why do stimulant laxatives cause increased electrolyte secretion?
increased prostaglandin release and an increase in cAMP concentration
907
four adverse effects of stimulant laxatives?
diarrhea, flatulence, abdominal cramping, bloating
908
why should castor oil not be used in pregnancy?
can stimulate uterine contractions
909
which stimulant laxative can stimulate uterine contractions?
castor oil
910
which stimulant laxative can cause diarrhea in lactating infants?
cascara
911
cascara can cause what in lactating infants?
diarrhea
912
cardiovascular disease is a relative contraindication to which stimulant laxative?
bisacodyl
913
cascara should not be used if the patient cannot ingest WHAT?
alcohol
914
why should cascara not be used if the patient cannot ingest some alcohol?
cascara contains some alcohol
915
can bisacodyl be used in pregnancy?
yes
916
which stimulant laxative can be used in pregnancy?
bisacodyl
917
can castor oil be used in pregnancy?
no
918
what are two indications for osmotic laxatives?
constipation and bowel prep
919
specific class? Increased intraluminal pressure due to water being drawn more inside the intestines
osmotic laxative
920
effect of osmotic laxatives on peristalsis?
increased
921
do osmotic laxatives affect peristalsis?
yes
922
four side effects of osmotic laxatives?
diarrhea, flatulence, abdominal cramping, bloating
923
why should magnesium-containing laxatives be avoided in renal dysfunction?
kidneys may not be able to excrete the magnesium adequately
924
what effect on magnesium happens if magnesium-containing laxatives are used in renal dysfunction?
hypermagnesemia
925
magnesium-containing laxatives should not be used in patients with what calcium imbalance?
hypocalcemia
926
what cardiac issues contraindicate magnesium-containing laxatives?
cardiac dysrhythmias or conduction disturbances
927
cardiac dysrhythmias or conduction disturbance contraindicate laxatives containing what?
magnesium hydroxide, magnesium citrate, sodium phosphate, PEG 3350
928
pediatric use of PEG 3350?
caution
929
why do osmotic laxatives cause increased intraluminal pressure?
water being drawn more inside the intestines
930
what laxative class can be used in chronic, watery diarrhea?
bulk-producing laxative
931
why are bulk-producing laxatives used in chronic, watery diarrhea?
to bulk the stool
932
specific class? Act physiologically like increased fiber in the diet would by combining with water in the intestines
bulk-producing laxative
933
specific class? Mechanical distention of the intestinal wall
bulk-producing laxative
934
do bulk-producing laxatives affect peristalsis?
yes
935
effect of bulk-producing laxatives on peristalsis?
increased
936
do side effects of bulk-producing laxatives dissipate with time?
usually
937
can bulk-producing laxatives be used in pregnancy?
yes
938
can bulk-producing laxatives be used if a bowel impaction?
no
939
why should bulk-producing laxatives not be used in a bowel impaction?
feces cannot get around impacted stool
940
specific class? Some may be contraindicated in clinical settings where either salt or sugar is restricted
bulk-producing laxative
941
what specific class of laxatives may contain salt or sugar?
bulk-producing laxative
942
what specific class of laxatives should be used cautiously when patient may have strictures or other narrowing of esophagus or intestine?
bulk-producing laxative
943
what specific class of laxatives may be used long-term for simple, chronic constipation?
bulk-producing laxative
944
what are four potential adverse effects of bulk-producing laxatives?
diarrhea, flatulence, abdominal cramping, bloating
945
specific class? Used to soften impacted stool
lubricant laxative
946
what is the main component of lubrican laxatives?
mineral oil
947
MOA of lubricant laxatives?
used to soften impacted stool
948
what is the purpose of lubrication with these laxatives?
to help stool move more easily via the presence of mineral oil
949
what are four potential adverse effects of lubricant laxatives?
diarrhea, flatulence, abdominal cramping, bloating
950
which specific laxative class can cause decreased absorption of fat-soluble vitamins if used chronically?
lubricant laxative
951
decreased absorption of what can occur with chronic use of lubricant laxatives?
fat-soluble vitamins
952
which specific laxative class can cause lipid pneumonia if aspirated?
lubricant laxative
953
who is at risk for lipid pneumonia with lubricant laxatives?
very young and any patient at risk for aspiration
954
which class of laxatives would you not want to give in someone with impaired swallowing?
lubricant laxative
955
can lubricant laxatives be taken in pregnancy?
no
956
why shouldn't lubricant laxatives be taken in pregnancy?
fat-soluble vitamins may not be absorbed as well
957
which class of laxatives can cause vitamin K deficiency in newborns?
lubricant laxative
958
which class of laxatives can cause hypoprothrombinemia in newborns?
lubricant laxative
959
what is another name for surfactant laxatives?
stool softeners
960
what is the class name for stool softeners?
surfactant laxative
961
specific class? Used to soften stool and prevent constipation, especially stool that is dry and difficult to evacuate and when straining at stool must be stopped
surfactant laxative
962
which laxative class is useful when stool is dry and difficult to evacuate?
surfactant laxative
963
which laxative class is useful when straining at stool must be stopped?
surfactant laxative
964
specific class? Assist with lipids and water being mixed into stool
surfactant laxative
965
what is the MOA of surfactant laxatives?
assist with lipids and water being mixed into stool
966
do surfactant laxatives have precautions?
no
967
do surfactant laxatives have contraindications?
no
968
which class of laxatives? Usually well-tolerated and without precautions or contraindications
surfactant laxative
969
can surfactant laxatives be used in pregnancy?
yes
970
which class of laxatives are used for fecal impaction and neurogenic bowel?
hyperosmolar laxative
971
which class of laxatives is indicated with neurogenic bowel?
hyperosmolar laxative
972
which class of laxatives is used with chronic constipation and increased excretion of ammonia in the stool?
hyperosmolar laxative
973
specific class? Glycerin
hyperosmolar laxative
974
specific class? Lactulose
hyperosmolar laxative
975
drug? Bacteria in the gut transform this dissarchide into lactic, acetic, and formic acids
lactulose
976
drug? Local colonic irritation and more water drawn into the stool
glycerin
977
what are the four adverse effects of hyperosmolar laxatives?
diarrhea, flatulence, abdominal cramping, bloating
978
what patient population is at risk for dehydration with hyperosmolar laxatives?
older adults
979
what laxative class is associated with dehydration risk in older adults?
hyperosmolar laxative
980
when should you monitor blood glucose with lactulose?
those taking lactulose chronically and acutely in patients with diabetes mellitus
981
which laxative drug involves blood glucose monitoring?
lactulose
982
hyperosmolar laxatives in lactation?
avoid
983
lactulose in pregnancy?
only when benefits > risks
984
glycerin in pregnancy?
no
985
why do older adults get dehydration with hyperosmolar laxatives?
intravascular volume depletion
986
specific class? Activation of CIC-2 chloride channels in the intestinal epithelium
chloride channel activator laxative
987
effect of chloride channel activators on chloride secretion?
more chloride is secreted
988
what helps soften the stool and improve intestinal movement with chloride channel activators?
increased chloride
989
three indications for chloride channel activators?
chronic constipation d/t unknokwn cause; chronic constipation d/t IBS; opioid-induced constipation
990
these are indications for what laxative class? Chronic constipation d/t unknown cause; chronic constipation d/t IBS; opioid-induced constipation
chloride channel activator laxative
991
what channels do chloride channel activators activate?
CIC-2
992
what part of GIT do chloride channel activators work in?
intestinal epithelium
993
four potential adverse effects of chloride channel activators?
diarrhea, flatulence, abdominal cramping, bloating
994
how can you avoid nausea with chloride channel activators?
avoid by giving the drug with a meal
995
which laxative class is associated with dyspnea?
chloride channel activator laxative
996
chloride channel activators in pregnancy?
avoid
997
indication for opioid receptor antagonist laxatives?
chronic constipation due to opioids
998
this is an indication for which laxative class? Chronic constipation due to opioids
opioid receptor antagonist laxative
999
what receptors do opioid receptor antagonists act on?
mu opioid receptors
1000
where are the mu opioid receptors located that opioid antagonist laxatives act on?
in the gut
1001
effect of opioid receptor antagonist laxatives on peristalsis?
increased
1002
do opioid receptor antagonist laxatives cross the BBB?
no
1003
do opioid receptor antagonist laxatives cause analgesia?
no
1004
four adverse effects of opioid receptor antagonist laxatives?
diarrhea, flatulence, abdominal cramping, bloating
1005
can opioid receptor antagonists induce opioid withdrawal?
yes
1006
what is the concern with abdominal pain and constipation?
concern for bowel rupture
1007
when is opioid withdrawal syndrome more likely with opioid receptor antagonist laxatives?
if alterations of the BBB have occurred
1008
specific class? Antagonist at the mu-opioid receptors in the gut-- speeds up peristalsis
opioid receptor antagonist laxative
1009
class? Inhibit IgE and mast cell mediated migration of inflammatory cells into bronchial mucosa
inhaled corticosteroids
1010
which immunoglobulin is affected with inhaled corticosteroids?
IgE
1011
what phase of allergic reaction is affected by inhaled corticosteroids?
late-phase allergic reaction
1012
in what two places are inhaled corticosteroids absorbed?
lungs and GI tract
1013
describe speed of absorption of inhaled corticosteroids?
rapid
1014
how much of inhaled corticosteroid dose is deposited in the lungs?
less than one-fourth
1015
less than one-fourth of dose of what class is deposited in the lungs?
inhaled corticosteroids
1016
what happens to swallowed portion of inhaled corticosteroid dose?
undergoes extensive first-pass metabolism
1017
where are inhaled corticosteroids excreted?
in urine and feces
1018
migration of inflammatory cells with inhaled corticosteroids are mediated by what?
mast cells
1019
how do inhaled corticosteroids come?
in multiple forms and delivery systems
1020
what are five potential adverse effects of inhaled corticosteroids?
xerostomia; hoarseness; mouth irritation; dysgeusia; oral candidiasis
1021
oral candiasis can occur with what class of respiratory medication?
inhaled corticosteroids
1022
HPA suppression is a risk with what class of respiratory medication?
inhaled corticosteroids
1023
can inhaled corticosteroids be given in status asthmaticus?
no
1024
high-dose of what class of respiratory medication in children may inhibit growth?
inhaled corticosteroids
1025
highest potency inhaled corticosteroid?
fluticasone furoate
1026
what is the brand name for fluticasone furoate?
arnuity ellipta
1027
specific class? Fluticasone furoate
inhaled corticosteroids
1028
specific class? Mometasone furoate DIP
inhaled corticosteroids
1029
specific class? Fluticasone propionate DIP
inhaled corticosteroids
1030
specific class? Beclomethasone dipropioate
inhaled corticosteroids
1031
specific class? Ciclesonide MDI
inhaled corticosteroids
1032
specific class? Budesonide DPI
inhaled corticosteroids
1033
what is the brand name of mometasone furoate DPI?
asmanex twisthaler
1034
what is the brand name for fluticasone propionate DPI?
armonair digihaler
1035
what is the brand name for beclomethasone dipropionate?
QVAR redihaler
1036
four examples of stimulant laxatives?
cascara, senna, bisacodyl, castor oil
1037
specific class- cascara?
stimulant laxative
1038
specific class- senna?
stimulant laxative
1039
specific class- bisacodyl?
stimulant laxative
1040
specific class- castor oil?
stimulant laxative
1041
four examples of osmotic laxatives?
magnesium hydroxide, magnesium citrate, sodium phosphate, PEG 3350
1042
specific class- magnesium hydroxide?
osmotic laxative
1043
specific class- magnesium citrate?
osmotic laxative
1044
specific class- sodium phosphate?
osmotic laxative
1045
specific class- polyethylene glycol 3350?
osmotic laxative
1046
three examples of bulk-producing laxatives?
psyllium, methylcellulose, polycarbophil
1047
specific class- psyllium?
bulk-producing laxative
1048
specific class- methylcellulose?
bulk-producing laxative
1049
specific class- polycarbophil?
bulk-producing laxative
1050
example of lubricant laxative?
mineral oil
1051
specific class- mineral oil?
lubricant laxative
1052
example of surfactant laxative?
docusate
1053
specific class- docusate sodium?
surfactant laxative
1054
specific class- docusate calcium?
surfactant laxative
1055
specific class- docusate potassium?
surfactant laxative
1056
what are the three types of docusate?
docusate sodium, docusate calcium, docusate potassium
1057
two examples of hyperosmolar laxatives?
glycerin and lactulose
1058
specific class- glycerin?
hyperosmolar laxative
1059
specific class- lactulose?
hyperosmolar laxative
1060
example of chloride channel activator laxative?
lubiprostone
1061
specific class- lubiprostone?
chloride channel activator laxative
1062
example of opioid receptor antagonist laxative?
methylnaltrexone
1063
specific class- methylnaltrexone?
opioid receptor antagonist laxative
1064
what is the one class of laxatives that does not have abuse/dependency potential?
bulk-producing laxative
1065
do stimulant laxatives have abuse/dependency potential?
yes
1066
do osmotic laxatives have abuse/dependency potential?
yes
1067
do bulk-producing laxatives have abuse/dependency potential?
no
1068
do lubricant laxatives have abuse/dependency potential?
yes
1069
do surfactant laxatives have abuse/dependency potential?
yes
1070
do hyperosmolar laxatives have abuse/dependence potential?
yes
1071
do chloride channel activator laxatives have abuse/dependency potential?
yes
1072
do opioid receptor antagonist laxatives have abuse/dependency potential?
yes
1073
electrolyte alterations, fluid alterations, steatorrhea, osteomalacia, vitamin/nutrient deficiences- can occur with what general class?
laxatives
1074
tartrazine sensitivity can occur with what general class?
laxatives
1075
what is an example of a tartrazine sensitivity reaction?
bronchospasm
1076
tartrazine sensitivity is associated with sensitivity to what?
aspirin
1077
can you give laxatives when nausea, vomiting, and/or abdominal pain of unknown cause are present?
no
1078
when might you especially want to avoid giving laxatives?
n/v or abdominal pain of unknown cause, especially if may have bowel obstruction
1079
can all laxatives be given in pregnancy?
no
1080
specific class? Thought to possible cause stimulation/irritation of the myenteric nerves
stimulant laxative
1081
specific class? Irritation of intestinal smooth muscle
stimulant laxative
1082
effect of stimulant laxatives on peristalsis?
increased
1083
do stimulant laxatives affect peristalsis?
yes
1084
specific laxative class? Increased prostaglanding release and an increase in cAMP concentration?
stimulant laxative
1085
what nerves are effected by stimulant laxatives?
myenteric nerves
1086
effect of stimulant laxatives on prostaglandin release?
increased
1087
effect of stimulant laxatives on cAMP concentration?
increased
1088
effect of stimulant laxatives on electrolyte secretion?
increased
1089
why do stimulant laxatives cause increased electrolyte secretion?
increased prostaglandin release and an increase in cAMP concentration
1090
four adverse effects of stimulant laxatives?
diarrhea, flatulence, abdominal cramping, bloating
1091
why should castor oil not be used in pregnancy?
can stimulate uterine contractions
1092
which stimulant laxative can stimulate uterine contractions?
castor oil
1093
which stimulant laxative can cause diarrhea in lactating infants?
cascara
1094
cascara can cause what in lactating infants?
diarrhea
1095
cardiovascular disease is a relative contraindication to which stimulant laxative?
bisacodyl
1096
cascara should not be used if the patient cannot ingest WHAT?
alcohol
1097
why should cascara not be used if the patient cannot ingest some alcohol?
cascara contains some alcohol
1098
can bisacodyl be used in pregnancy?
yes
1099
which stimulant laxative can be used in pregnancy?
bisacodyl
1100
can castor oil be used in pregnancy?
no
1101
what are two indications for osmotic laxatives?
constipation and bowel prep
1102
specific class? Increased intraluminal pressure due to water being drawn more inside the intestines
osmotic laxative
1103
effect of osmotic laxatives on peristalsis?
increased
1104
do osmotic laxatives affect peristalsis?
yes
1105
four side effects of osmotic laxatives?
diarrhea, flatulence, abdominal cramping, bloating
1106
why should magnesium-containing laxatives be avoided in renal dysfunction?
kidneys may not be able to excrete the magnesium adequately
1107
what effect on magnesium happens if magnesium-containing laxatives are used in renal dysfunction?
hypermagnesemia
1108
magnesium-containing laxatives should not be used in patients with what calcium imbalance?
hypocalcemia
1109
what cardiac issues contraindicate magnesium-containing laxatives?
cardiac dysrhythmias or conduction disturbances
1110
cardiac dysrhythmias or conduction disturbance contraindicate laxatives containing what?
magnesium hydroxide, magnesium citrate, sodium phosphate, PEG 3350
1111
pediatric use of PEG 3350?
caution
1112
why do osmotic laxatives cause increased intraluminal pressure?
water being drawn more inside the intestines
1113
what laxative class can be used in chronic, watery diarrhea?
bulk-producing laxative
1114
why are bulk-producing laxatives used in chronic, watery diarrhea?
to bulk the stool
1115
specific class? Act physiologically like increased fiber in the diet would by combining with water in the intestines
bulk-producing laxative
1116
specific class? Mechanical distention of the intestinal wall
bulk-producing laxative
1117
do bulk-producing laxatives affect peristalsis?
yes
1118
effect of bulk-producing laxatives on peristalsis?
increased
1119
do side effects of bulk-producing laxatives dissipate with time?
usually
1120
can bulk-producing laxatives be used in pregnancy?
yes
1121
can bulk-producing laxatives be used if a bowel impaction?
no
1122
why should bulk-producing laxatives not be used in a bowel impaction?
feces cannot get around impacted stool
1123
specific class? Some may be contraindicated in clinical settings where either salt or sugar is restricted
bulk-producing laxative
1124
what specific class of laxatives may contain salt or sugar?
bulk-producing laxative
1125
what specific class of laxatives should be used cautiously when patient may have strictures or other narrowing of esophagus or intestine?
bulk-producing laxative
1126
what specific class of laxatives may be used long-term for simple, chronic constipation?
bulk-producing laxative
1127
what are four potential adverse effects of bulk-producing laxatives?
diarrhea, flatulence, abdominal cramping, bloating
1128
specific class? Used to soften impacted stool
lubricant laxative
1129
what is the main component of lubrican laxatives?
mineral oil
1130
MOA of lubricant laxatives?
used to soften impacted stool
1131
what is the purpose of lubrication with these laxatives?
to help stool move more easily via the presence of mineral oil
1132
what are four potential adverse effects of lubricant laxatives?
diarrhea, flatulence, abdominal cramping, bloating
1133
which specific laxative class can cause decreased absorption of fat-soluble vitamins if used chronically?
lubricant laxative
1134
decreased absorption of what can occur with chronic use of lubricant laxatives?
fat-soluble vitamins
1135
which specific laxative class can cause lipid pneumonia if aspirated?
lubricant laxative
1136
who is at risk for lipid pneumonia with lubricant laxatives?
very young and any patient at risk for aspiration
1137
which class of laxatives would you not want to give in someone with impaired swallowing?
lubricant laxative
1138
can lubricant laxatives be taken in pregnancy?
no
1139
why shouldn't lubricant laxatives be taken in pregnancy?
fat-soluble vitamins may not be absorbed as well
1140
which class of laxatives can cause vitamin K deficiency in newborns?
lubricant laxative
1141
which class of laxatives can cause hypoprothrombinemia in newborns?
lubricant laxative
1142
what is another name for surfactant laxatives?
stool softeners
1143
what is the class name for stool softeners?
surfactant laxative
1144
specific class? Used to soften stool and prevent constipation, especially stool that is dry and difficult to evacuate and when straining at stool must be stopped
surfactant laxative
1145
which laxative class is useful when stool is dry and difficult to evacuate?
surfactant laxative
1146
which laxative class is useful when straining at stool must be stopped?
surfactant laxative
1147
specific class? Assist with lipids and water being mixed into stool
surfactant laxative
1148
what is the MOA of surfactant laxatives?
assist with lipids and water being mixed into stool
1149
do surfactant laxatives have precautions?
no
1150
do surfactant laxatives have contraindications?
no
1151
which class of laxatives? Usually well-tolerated and without precautions or contraindications
surfactant laxative
1152
can surfactant laxatives be used in pregnancy?
yes
1153
which class of laxatives are used for fecal impaction and neurogenic bowel?
hyperosmolar laxative
1154
which class of laxatives is indicated with neurogenic bowel?
hyperosmolar laxative
1155
which class of laxatives is used with chronic constipation and increased excretion of ammonia in the stool?
hyperosmolar laxative
1156
specific class? Glycerin
hyperosmolar laxative
1157
specific class? Lactulose
hyperosmolar laxative
1158
drug? Bacteria in the gut transform this dissarchide into lactic, acetic, and formic acids
lactulose
1159
drug? Local colonic irritation and more water drawn into the stool
glycerin
1160
what are the four adverse effects of hyperosmolar laxatives?
diarrhea, flatulence, abdominal cramping, bloating
1161
what patient population is at risk for dehydration with hyperosmolar laxatives?
older adults
1162
what laxative class is associated with dehydration risk in older adults?
hyperosmolar laxative
1163
when should you monitor blood glucose with lactulose?
those taking lactulose chronically and acutely in patients with diabetes mellitus
1164
which laxative drug involves blood glucose monitoring?
lactulose
1165
hyperosmolar laxatives in lactation?
avoid
1166
lactulose in pregnancy?
only when benefits > risks
1167
glycerin in pregnancy?
no
1168
why do older adults get dehydration with hyperosmolar laxatives?
intravascular volume depletion
1169
specific class? Activation of CIC-2 chloride channels in the intestinal epithelium
chloride channel activator laxative
1170
effect of chloride channel activators on chloride secretion?
more chloride is secreted
1171
what helps soften the stool and improve intestinal movement with chloride channel activators?
increased chloride
1172
three indications for chloride channel activators?
chronic constipation d/t unknokwn cause; chronic constipation d/t IBS; opioid-induced constipation
1173
these are indications for what laxative class? Chronic constipation d/t unknown cause; chronic constipation d/t IBS; opioid-induced constipation
chloride channel activator laxative
1174
what channels do chloride channel activators activate?
CIC-2
1175
what part of GIT do chloride channel activators work in?
intestinal epithelium
1176
four potential adverse effects of chloride channel activators?
diarrhea, flatulence, abdominal cramping, bloating
1177
how can you avoid nausea with chloride channel activators?
avoid by giving the drug with a meal
1178
which laxative class is associated with dyspnea?
chloride channel activator laxative
1179
chloride channel activators in pregnancy?
avoid
1180
indication for opioid receptor antagonist laxatives?
chronic constipation due to opioids
1181
this is an indication for which laxative class? Chronic constipation due to opioids
opioid receptor antagonist laxative
1182
what receptors do opioid receptor antagonists act on?
mu opioid receptors
1183
where are the mu opioid receptors located that opioid antagonist laxatives act on?
in the gut
1184
effect of opioid receptor antagonist laxatives on peristalsis?
increased
1185
do opioid receptor antagonist laxatives cross the BBB?
no
1186
do opioid receptor antagonist laxatives cause analgesia?
no
1187
four adverse effects of opioid receptor antagonist laxatives?
diarrhea, flatulence, abdominal cramping, bloating
1188
can opioid receptor antagonists induce opioid withdrawal?
yes
1189
what is the concern with abdominal pain and constipation?
concern for bowel rupture
1190
when is opioid withdrawal syndrome more likely with opioid receptor antagonist laxatives?
if alterations of the BBB have occurred
1191
specific class? Antagonist at the mu-opioid receptors in the gut-- speeds up peristalsis
opioid receptor antagonist laxative
1192
what are leukotrienes?
inflammatory mediators
1193
a type of inflammatory mediator?
leukotrienes
1194
what two types of cells produce leukotrienes?
eosinophils and mast cells
1195
what are the three potential effects of leukotrienes?
bronchospasm, airway hyperresponsiveness, and vascular leakage
1196
what substance can cause bronchospasm, airway hyperresponsiveness, and vascular leakage?
leukotrienes
1197
specific class? Montelukast
leukotriene receptor antagonists
1198
drug? Inhibits the cysteinyl leukotriene receptor
montelukast
1199
drug? Blocks action of LTD4
montelukast
1200
what is a component of SRS-A?
LTD4
1201
what is the MOA of montelukast?
inhibits the cysteinyl leukotriene receptor- blocks action of LTD4
1202
what does montelukast block the action of?
LTD4
1203
what is LTD4?
a component of SRS-A
1204
drug? Inhibits 5-lipoxygenase
zileuton
1205
what is 5-lipoxygenase?
enzyme responsible for the formation of leukotrienes from arachidonic acid
1206
name? enzyme responsible for the formation of leukotrienes from arachidonic acid
5-lipoxygenase
1207
what does zileuton inhibit?
5-lipoxygenase
1208
specific class? Zileuton
5-lipoxygenase pathway inhibitors
1209
example of 5-lipoxygenase pathway inhibitor?
zileuton
1210
example of leukotriene receptor antagonist?
montelukast
1211
general class? Montelukast
leukotriene modifiers
1212
general class? Zileuton
leukotriene modifiers
1213
what are two examples of leukotriene modifiers?
montelukast and zileuton
1214
describe absorption of the leukotriene modifiers?
rapidly from the GI tract
1215
describe the protein binding of the leukotriene modifiers?
highly protein bound
1216
describe the metabolism of the leukotriene modifiers?
extensively metabolized in the liver
1217
describe the excretion of the leukotriene modifiers?
in the urine
1218
what two enzyme systems metabolize montelukast?
CYP3A4 & CYP2C9
1219
what three enzyme systems metabolize zileuton?
CYP1A2, CYP2C9, CYP3A4
1220
which leukotriene modifier is metabolized by CYP3A4 and CYP2C9?
montelukast
1221
which leukotriene modifier is metabolized by CYP1A2, CYP2C9, & CYP3A4?
zileuton
1222
two side effects of montelukast?
headache, sore throat
1223
one side effect of zileuton?
dyspepsia
1224
what respiratory drug class is associated with post-marketing neuropsychiatric events?
leukotriene modifiers
1225
these are symptoms of what type of adverse effect? Irritability, agitation, tremors, insomnia, depression, suicidality
neuropsychiatric events
1226
leukotriene receptor antagonists and severe liver disease?
avoid
1227
can montelukast chewable tabs be given in PKU?
no
1228
why shouldn't montelukast chewable tablets be given in PKU?
they contain phenylalanine
1229
which leukotriene modifier (chewable form) shouldn't be given in PKU?
montelukast
1230
can 5-lipoxygenase pathway inhibitors be given in active liver disease?
no, contraindicated
1231
examples of neuropsychiatric event symptoms associated with leukotriene modifiers?
irritability, agitation, tremors, insomnia, depression, suicidality
