Toxic Substances and GI meds

Question 1

MOA of proton pump inhibitors + med names

Answer 1

lansoprazole, omeprazole, pantoprazole, esomeprazole
MOA = IRREVERSIBLE inhibition of parietal cell proton pump, which reduces acid secretion (promotes peptic ulcer healing and prevents reoccurance)

Question 2

5 indications for PPIs

Answer 2

1) . #1 PUD (very important)
2) . GERD
3) . Zollinger-ellison syndrome
4) . H. pylori tx/Gastritis
5) . OTC for acid indigestion/heartburn

Question 3

4 side effects of PPIs

Answer 3

diarrhea, headache, b12 deficiency (stopping of parietal cell fxn eventually causes B12 malabsorption probs), hypomagnesemia

Question 4

when are PPIs normally taken?

Answer 4

30 mins before meal in AM

Question 5

MOA of H2 blockers and medications

Answer 5

cimetidine, famotidine, ranitidine

MOA = binds to H2 receptor on parietal cells and inhibits gastric acid secretion

Question 6

4 indications for H2 blockers

Answer 6

PUD, GERD, Zollinger-Ellison, OTC acid indigestion/heartburn

Question 7

2 ADRs for cimetidine and 2 for Famotidine

Answer 7

C = gynecomastia, impotence
F  = blood dyscrasias, QT prolongation

Question 8

when should pts take H2 blockers? which H2 blocker is most potent?

Answer 8

usually at night

famotidine

Question 9

MOA for antacids and medications

Answer 9

aluminum hydroxide, calcium carbonate (tums), magnesium hydroxide (milk of magnesia)
MOA: neutralizes gastric acid (which raises pH)

Question 10

3 indications for antacids

Answer 10

1) . sxs relief of heartburn
2) . acid indigestion
3) . GERD

Question 11

side effects of antacics

Answer 11

Mg: diarrhea

Ca/Al: constipation

Question 12

MOA of sulcralfate

Answer 12

forms adhesive coating on ulcer surface that promotes healing

Question 13

2 indications for sulcralfate

Answer 13

1) . treats active ulcers (esp duodenal)

2) prevents recurrent ulcers (used as prophylaxis)

Question 14

3 side effects for sucralfate

Answer 14

metallic taste, constipation, nausea

Question 15

what medications should you not take with sucralfate?

Answer 15

any meds that increase stomach pH (take away stomach acid) like PPIs, H2 blockers
*needs acidic pH for activation

Question 16

MOA of misoprostol

Answer 16

MOA = prostaglandin analogue that inhibits gastrin secretion and INCREASES bicarb/mucus secretion

Question 17

GI indication for misoprostol

Answer 17

preventing NSAID-induced ulcers (can’t heal existing ulcers)

Question 18

3 side effects for misoprostol

Answer 18

abdominal cramps, diarrhea, vaginal bleeding

Question 19

MOA for bismuth subsalicylate compounds and 2 drugs

Answer 19

MOA = antibacterial and binds to ulcer to protect mucosa from acid
Pepto bismol and kaopectate

Question 20

three indications for bismuth subsalicylate agents

Answer 20

GERD, diarrhea, H. pylori

Question 21

3 side effects of bismuth products

Answer 21

BLACK stool, constipation, salicylate and neuro toxicity in high doses

Question 22

what are four classes of medications that can be used for nausea/vomiting

Answer 22

dopamine blockers, serotonin antagonists, antihistamines, anticholinergics

Question 23

MOA of dopamine blockers and 3 medications

Answer 23

Metoclopramide, prochlorperazine, promethazine

MOA = blocks CNS dopamine receptors in vomiting center (metoclopramide also increase GI motility)

Question 24

2 GI indications for dopamine blockers (and one specific for metoclopramide)

Answer 24

N/V, motion sickness, metoclopramide = GERD, gastroparesis

Question 25

4 side effects for dopamine blockers

Answer 25

QT prolongation, constipation (anticholinergic), sedation (antihistamine), Parkinsonian effects (rigidity, bradykinesia, tremor, akathisia)

Question 26

how to treat acute dystonic reaction?

Answer 26

diphenhydramine IV (side effect of dopamine blocker)

Question 27

MOA of serotonin antagonists and 3 meds

Answer 27

Dolasetron, granisetron, ondansetron | MOA = blocks serotonin receptors in medulla to suppress vomiting center

Question 28

3 GI indications for serotonin antagonists

Answer 28

1) . #1 for chemotherapy induced vomiting 2) . nausea 3) . vomiting

Question 29

3 side effects for serotonin antagonists

Answer 29

1) . Neuro: HA, fatigue, sedation 2) . GI: constipation, bloating, diarrhea 3) . Cardiac: prolonged QT, arrhythmias

Question 30

MOA and 2 medications for antihistamines used for GI

Answer 30

Diphenhydramine, Meclizine | MOA = acts at CNS centers for nausea, vomiting

Question 31

main side effect for antihistamines used for GI? uses for antihistmaines

Answer 31

ANTICHOLINERGIC (dry mouth, blurry vision, sedation, urinary retention etc) -N/V, motion sickness, vertigo

Question 32

GI antimuscarinic drug and MOA

Answer 32

Scopolamine | MOA = central muscarinic receptor blocker

Question 33

3 indications for scopolamine and side effects

Answer 33

Indications = motion sickness, vomiting, anti-GI motility (anti-diarrheal) Side effects = anticholinergic (anti-sludgeM)

Question 34

2 drug classes to use to treat diarrhea

Answer 34

1) . Bismuth subsalicylate compounds | 2) . opioid agonists

Question 35

MOA of opioid agonists used to tx diarrhea and 2 meds

Answer 35

atropine and loperamide | MOA = binds to gut wall opioid receptors to disrupt peristalsis/GI motility and intestinal transit time

Question 36

2 indications for opioid agonists in diarrhea

Answer 36

1) . noninvasive acute diarrhea | 2) . chronic diarrhea associated with bowel disease

Question 37

treatment for TCA toxicity

Answer 37

sodium bicarbonate (used for cardiotoxicity of TCA)

Question 38

treatment of cocaine toxicity

Answer 38

ammonium chloride

Question 39

treatment of severe respiratory depression of Opioids

Answer 39

Naloxone, naltrexone (maintain over 12 breaths per minute)

Question 40

treatment of severe benzo toxicity

Answer 40

flumazenil

Question 41

treatment of BB toxicity

Answer 41

glucagon

Question 42

treatment to theophylline toxicity

Answer 42

BB

Question 43

treatment of digitalis toxicty

Answer 43

digibind

Question 44

treatment for warfarin toxicity

Answer 44

vitamin K and fresh frozen plasma (esp if INR > 10)

Question 45

treatment for heparin toxicity

Answer 45

protamine sulfate

Question 46

treatment for antifreeze toxicity

Answer 46

iv ethanol infusion

Question 47

what is the main complication of tylenol toxicity? how to manage it?

Answer 47

hepatic necrosis | Tx = n-acetyl-cysteine and activated charcoal

Question 48

what happens physiologically in a salicylate toxicity?

Answer 48

``` respiratory alkalosis (respiratory stimulation) leads to high anion gap metabolic acidosis *can also get CNS signs of seizures, coma ```

Question 49

how to treat salicylate toxicity?

Answer 49

1) . ABCs/resuscitation/IV fluids 2) . GI decontamination with activated charcoal 3) . Sodium bicarbonate

Question 50

Base toxicity: substances and how it damages the body

Answer 50

i. e. Oven cleaner, drain cleaner, * LIQUEFACTIVE NECROSIS = sloughs off tissue which leads to esophageal or gastric perforation (more esophagus), respiratory distress, irritated mucous membranes

Question 51

how to treat base toxicity?

Answer 51

supportive care and ABCs *DON'T try to neutralize (worse than acids)

Question 52

acid toxicity: substances and how it damages the body

Answer 52

toilet cleaner and battery acid | *causes coagulative necrosis mostly in the stomach, which turns into an eschar

Question 53

anticholinergic toxicity: what three classes of drugs and how does it affect the body?

Answer 53

i.e. antihistamines, atropine, TCAs | Sympathetic stimulation: hyperthermia, tachy, HTN, hot flushed skin, dry mucous membranes, mydriasis

Question 54

treatment of anticholinergic toxicity

Answer 54

activated charcoal, physostigmine

Question 55

cholinergic toxicity: substances and how it damages he body

Answer 55

i. e. organophosphates, insecticides, pesticides | * SLUDGE-M side effects, children usually present with nicotinic sxs (tachy, weakness, HTN, mydriasis, fasciculations)

Question 56

treatment for cholinergic toxicity

Answer 56

atropine + pralidoxime (reactivates cholinesterase enzyme) | *remove contaminated clothes

Question 57

what are some side effects of salicylate toxicity?

Answer 57

tinnitus, nausea, vomiting, abdominal pain | *often start with respiratory alkalosis and hyperventilation