Quiz 12 Flashcards
(47 cards)
1
Q
H. Pylori treatment options
A
A: x 7 days
1. PPI or H2 antagonist
2. Amoxicillin
3. Clarithromycin or Metronidazole
B: x 7 days
1. PPI
2. Tetracycline
3. Bismuth
4. Metronidazole
2
Q
Domperidone
A
Prokinetic - enhance GI motility
- Dopamine antagonist, enhances Ach release
- inhibit emesis via CTZ (chemoreceptor trigger zone)
- no extrapyramidal effects, but can increase prolactin release
3
Q
Metoclopramide
A
Prokinetic AND Antiemetic
- Dopamine antagonist
- doesn’t affect lower GI motility
- also a 5-HT3 antagonist/5-HT4 agonist (increase ACh)
- extrapyramidal effects –> tardive dyskinesia
4
Q
Dicyclomine
A
Antispasmodic - decrease GI motility
- block M2 cholinergic receptor in enteric plexus to inhibit motility
- limited side effects at low dose
- high doses cause dry mouth, visual disturbance, constipation, urinary retention
5
Q
Hycosamine
A
Antispasmodic - inhibits GI motility
- block M2 cholinergic receptor in enteric plexus to inhibit motility
- limited side effects at low dose
- high doses cause dry mouth, visual disturbance, constipation, urinary retention
6
Q
Meclizine
A
Antiemetic - Antihistamine (H1R Antagonist)
- depress labyrinth excitability in ear
- can cause CNS depression
- good for motion sickness
7
Q
Doxylamine (+ pyridoxine)
A
Antiemetic - Antihistamine (H1R Antagonist)
- depress labyrinth excitability in ear
- can cause CNS depression
- good for motion sickness
8
Q
Diphenhydramine
A
Antiemetic - Antihistamine (H1R Antagonist)
- depress labyrinth excitability in ear
- can cause CNS depression
- good for motion sickness
9
Q
Promethazine
A
Antiemetic - Antihistamine (H1R Antagonist)
- ALSO BLOCKS D2 RECEPTORS
- depress labyrinth excitability in ear
- can cause CNS depression
- good for motion sickness
10
Q
Scopolamine
A
Antimuscarinic Antiemetic
- block M2 receptors in CTZ
- anti-muscarinic side effects (dry mouth, constipation, hallucination, fever)
11
Q
Prochlorperazine
A
Antimuscarinic Antiemetic
- block M2 receptors in CTZ
- anti-muscarinic side effects (dry mouth, constipation, hallucination, fever)
12
Q
Ondansetron
A
5-HT Receptor Antagonist (Antiemetic)
- treats N/V post-op or in chemo
- selective 5-HT3 antagonist
- itch, rash, constipation, fever
13
Q
Bismuth
A
Antidiarrheal
- forms salicylic acid and a bismuth clay in stomach acid to absorb water and protect stomach
- treats Traveler’s diarrhea
- blackens stool and may darken tongue
14
Q
Loperamide
A
Antidiarrheal
- Mu opioid receptor agonist (decrease intestinal motility and increase absorption)
- low abuse potential, low CNS penetration
- use for less than 48 hrs, can cause CNS depression
- don’t use with inflammatory bowel disease
15
Q
Anthraquinone
A
Laxative
- causes cramping and inflammation
- can get into breast milk
- can cause “Lazy Bowel Syndrome” with abuse
16
Q
Diphenylmethane
A
Laxative
- can cause bowel inflammation
17
Q
Aspirin
A
NSAID (Anti-inflammatory)
- irreversible COX1 and COX2 inhibitor
- inhibits COX1 at low dose, both at high dose
- platelet inhibition and vasodilation at low doses
- causes gastric ulcers, bleeding, Reyes syndrome, hepatotoxicity
- no for kids with viral infections (Reyes / CNS)
- no in pregnancy (decrease placental volume) or gout
- no tolerance
18
Q
Ibuprofen
A
NSAID (Anti-inflammatory)
- nonselective COX1 and COX2 reversible inhibitor
- causes gastric ulcers, MI, stroke, HF, bleeding, renal impairment
- no in pregnancy or gout
- no tolerance
19
Q
Naproxen
A
NSAID (Anti-inflammatory)
- nonselective COX1 and COX2 reversible inhibitor
- longer duration of action
- causes gastric ulcers, MI, stroke, HF, bleeding, renal impairment
- no in pregnancy or gout
- no tolerance
20
Q
Diclofenac
A
NSAID (Anti-inflammatory)
- nonselective COX1 and COX2 reversible inhibitor
- causes gastric ulcers, MI, stroke, HF, bleeding, renal impairment
- no in pregnancy or gout
- no tolerance
21
Q
Meloxicam
A
NSAID (Anti-inflammatory)
- predominant COX2 reversible inhibitor
- causes gastric ulcers, MI, stroke, HF, bleeding, renal impairment
- no in pregnancy or gout
- no tolerance
22
Q
Celecoxib
A
NSAID (Anti-inflammatory)
- selective COX2 reversible inhibitor
- more CV risks due to platelet aggregation and vasoconstriction via TXA2
- little GI or renal effects
- no in pregnancy or gout
- no tolerance
23
Q
Acetaminophen
A
Anti-inflammatory
- treats pain and fever but NOT inflammation
- little platelet effects, little GI effects
- overdose causes fatal hepatic necrosis
24
Q
N-Acetylcysteine
A
antidote to acetaminophen poisoning
25
Azathioprine
Antimetabolite (Anti-Inflammatory and Immunosuppressant)
- purine analog inhibits gene translation of immune cells
- bone marrow suppression, increased infection risk
- contraindicated in pregnancy
- targets inflammation and its destructive process
26
Methotrexate
Antimetabolite (Anti-Inflammatory and Immunosuppressant)
- folate analog inhibits gene translation of immune cells via dihydrofolate reductase inhibition
- cytotoxic
- contraindicated in pregnancy
- targets inflammation and its destructive process
27
Infliximab
DMARD - TNF-alpha Inhibitor
- can cause anaphylaxis or lupus like syndrome
- increased risk for malignancies and infection
- used for RA or Crohns
28
Etanercept
DMARD - TNF-alpha Inhibitor
- increased risk for malignancies and infection
29
Abatacept
DMARD - T-Cell Modulation
- increased risk for malignancies and infection
30
Rituximab
DMARD - B-Cell Cytotoxic Agent
- increased risk for malignancies and infection
31
Colchicine
Gout (Anti-Inflammatory)
- mitotic inhibitor
- used when NSAIDs ineffective
- not uricosuric
- GI distress, myopathy, neuropathy
32
Anakinra
DMARD - IL-1 Inhibition
- increased risk for malignancies and infection
33
Probenecid
Gout (Anti-Inflammatory)
- uricosuric
- precipitate uric acid crystals in renal tubules
- GI irritation with peptic ulcers, hypersensitivity
34
Allopurinol
Gout (Anti-Inflammatory)
- inhibit xanthine oxidase
- decrease uric acid production
- fever, malaise, muscle aches
35
Sumatriptan
Migraine - 5HT1 Agonist
- acute migraine treatment
- direct vasoconstriction intracranially, inhibits sensory neurons presynaptically
- serious CV complications
- contraindicated in heart disease, MAOi, or SSRI/SNRI
36
Rimegepant
Migraine - CGRP Antagonist
- inhibit the CGRP receptor
- acute migraine treatment
(CGRP are small molecules tied directly to migraine activity)
37
Fremanezumab
Migraine - CGRP Antibody
- monoclonal Ab to the CGRP receptor
- MIGRAINE PROPHYLAXIS
- no current contraindications
- causes URIs and injection site reactions
38
Cortisone
Glucocorticoid (Immunosuppressant)
- must be activated by IIB-hydroxysteroid dehydrogenase I
- toxic in long term use
- reduce cytokine release, decrease inflammation
- increase blood glucose, increase muscle catabolism (amino acids in blood), increase lipolysis (Trigs in blood)
- major side effect profile: Cushing disease, osteoporosis/bone growth suppression, myopathy
39
Prednisone
Glucocorticoid (Immunosuppressant)
- must be activated by IIB-hydroxysteroid dehydrogenase I
- toxic in long term use
- reduce cytokine release, decrease inflammation
- increase blood glucose, increase muscle catabolism (amino acids in blood), increase lipolysis (Trigs in blood)
- major side effect profile: Cushing disease, osteoporosis/bone growth suppression, myopathy
40
Dexamethasone
Glucocorticoid (Immunosuppressant)
- no mineralocorticoid activity, about 18x more potent than cortisol
- toxic in long term use
- reduce cytokine release, decrease inflammation
- increase blood glucose, increase muscle catabolism (amino acids in blood), increase lipolysis (Trigs in blood)
- major side effect profile: Cushing disease, osteoporosis/bone growth suppression, myopathy
41
Cyclosporine A
IL-2 Synthesis Inhibition (Immunosuppressant)
- binds to cyclophilin and then to calcineurin to inhibit IL-2 production via NFAT inactivation
- metabolized by CYP3A
- NEPHROTOXIC, hepatotoxic, neurotoxic
- for severe RA or organ transplants
42
Tacrolimus
IL-2 Synthesis Inhibition (Immunosuppressant)
- binds FK Binding Protein (FKBP) and then to calcineurin to inhibit IL-2 production via NFAT inactivation
- metabolized by CYP3A
- NEPHROTOXIC, neurotoxic
- for sever RA or organ transplants
43
Sirolimus (Rapamycin)
IL-2 Signaling Inhibition (Immunosuppressant)
- binds FK Binding Protein (FKBP) and then blocks IL-2 receptor signaling by blocking mTOR
- metabolized by CYP3A
- USED FOR PT AT RISK FOR NEPHROTOXICITY
- leukopenia, thrombocytopenia
44
Mycophenolic Acid
Antimetabolite (Immunosuppressant)
- inhibits IMPDH, the rate limiting enzyme for guanosine formation
- preferentially affects lymphocytes because of their high IMPDH expression
- can't use with Azathioprine
- causes vomiting, diarrhea, leukopenia
45
Anti-Thymocyte Globulin (ATG)
Antibodies (Immunosuppressant)
- polyclonal Ab from rabbits injected with thymocytes
- Ab to T-cell antigens (CDs), depletes circulating lymphocytes
- causes cytokine release syndrome (fever, HA, tremor, N/V, weakness)
- used for renal rejection and transplants
46
Muronomab-CD3 (OKT3)
Antibodies (Immunosuppressant)
- mouse monoclonal Ab against human CD3
- depletes available T cells
- causes cytokine release syndrome (fever, HA, tremor, N/V, weakness)
- potentially fatal pulmonary edema, CV collapse, or arrhythmias
- used for organ rejection
47
Basiliximab
Antibodies (Immunosuppressant)
- humanized anti-CD25 mouse monoclonal Ab
- bind to IL-2 on activated T cells
- causes anaphylaxis
- PROPHYLAXIS FOR RENAL TRANSPLANT
