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Pharmacology > Unit 6: GI > Flashcards

Unit 6: GI Flashcards

1
Q

Vomiting center is rich in

A

Dopamine, histamine, serotonin, and Ach receptors

Can also be effected by binding to opiate/benzo receptors

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2
Q

Stimulatory nausea center

A

Chemo trigger zone
most important for sensing noxious stimuli–it is exposed to both the blood and the CSF
Rich in neurotransmitter receptors for dopamine, serotonin, histamine, ACh, and NK (Anti emetic effect occurs when these receptors are blocked)

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3
Q

Phenothiazines

A

Prochlorperazine + Promethazine
Dopamine receptor blockade in chemo trigger zone
Also has anticholinergic activity
Used as monotherapy for mild-moderate N/V

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4
Q

SE of phenothiazines

A

EPS may occur due to dopamine blockage

Drowsiness and sedation

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5
Q

Antihistamines and anticholinergics for N/V

A

Hydroxyzine, meclizine, dimenhydrinate, scopolamine
Used for mild nausea such as motion sickness
Interruption of visceral afferent pathways that are responsible for N/V
Can be used in pregnancy but not breastfeeding

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6
Q

Benzodiazepines for nausea

A

Prevent and treat emesis as well as anti anxiety and amnesia
Helpful for anticipatory nausea and vomiting with chemo
Lorazepam (ativan) most frequently used

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7
Q

Serotonin antagonists for nausea

A

Ondansetron (zofran), granisetron, palonesetron, dolasetron
Antagonist 5HT-3 receptors centrally in CTZ and peripherally at vagal and splanchnic afferent fibers
Usually used for chemo N/V

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8
Q

Metoclopramide

A

Reglan
Highly useful in treatment of diabetic gastric stasis, postsurgical stasis and GERD
Increase motility and gastric emptying by increasing duration and extent of esophageal contractions, resting tone of LES, and gastric contractions
Dopamine receptor inhibition
Used for prevention/tx of chemo N/V

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9
Q

SE of metoclopramide

A

Can cause increased EPS

Can cause hypertensive crisis when used with MAOI

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10
Q

Corticosteroids for nausea

A

Reserves for chemo induced N/V
Inhibits prostaglandins
Dexamethasone + Methylprednisolone most common
Usually used in combo with other anti emetics

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11
Q

Cannabinoids for nausea

A

Only indicated for chemo N/V
Dronabinol is available agent
Effects on vomiting center, opiate receptors in CNS and cerebral cortex

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12
Q

Antacids for nausea

A

Mild N/V
Coats stomach with neutralizing agent
CaCO3, MgOH, AlOH, AlCO3

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13
Q

First line treatment for non-chemo induced N//V

A

Phenothiazine

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14
Q

First line treatment for chemo acute emesis

A

Combo of serotonin antagonist and corticosteroid 30 minute prior to chemo

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15
Q

First line treatment for chemo delayed emesis

A

Metoclopramide + Dexamethasone

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16
Q

Drug choices for GERD

A

Antacids, histamine 2 receptor antagonists, proton pump inhibitors

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17
Q

What stimulates parietal cells to release acid

A

Histamine, ACh, gastrin

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18
Q

What decreases gastric acid production

A

Prostaglandins and bicarb

Also increase mucus production–GI protective

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19
Q

H Pylori cause of PUD

A

Increases acid production, increases gastrin secretion and releases its own noxious enzymes and toxins

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20
Q

NSAIDs cause of PUD

A

Inhibit COX which decreases production of prostaglandins

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21
Q

Antacids

A

CaCO3, Mg salts, Al salts
Used for mild and intermittent symptoms
Partially neutralize HCl in stomach; pepsin is inhibited

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22
Q

H2 receptor antagonists

A

Cimetidine, famotidine, nizatidine, ranitidine
Effective in mild GERD, ulcer healing, H pylori eradication
Reversibly inhibits histamine 2 receptors on gastric parietal cells causing decreased acid secretion and pepsin activation

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23
Q

Proton pump inhibitor

A

Most potent acid-suppressing agents available
-Prazole
Inhibit gastric proton pumps located on parietal cells; produces long suppression of acid secretion

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24
Q

Tx to eradicate H Pylori induced PUD

A

Antibiotics + acid suppressing medication

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25
Most common antibiotics for H Pylori
Amoxicillin, Carithromycin, Metronidazole, Tetracycline, Misoprostol, Sucralfate, Bismuth Subsalicylate
26
Algorithm for GERD tx
Lifestyle changes --> H2 receptor antagonist --> if no improvement Proton pump inhibitor--> if no improvement, refer to gastroenterologist
27
First line therapy for H Pylori eradication
Triple therapy: - PPI - Amoxicillin - Clarithromycin OR - PPI - Metronidazole - Clarithromycin
28
Sequential therapy for H Pylori eradication
-PPI -Amoxicilln Followed by -PPI -Clarithromycin -Metronidazole
29
What drugs have shown efficacy for preventing NSAID induced ulcers
PPIs and misoprostol
30
Bulk forming laxatives
Methylcellulose, psyllium, polycarbophil, malt soup extract, wheat dextrin Bind to fecal contents and pull water into stool--softens and lubricates stool Preferred treatment of constipation
31
Hyperosmotic laxatives
Lactulose, sorbitol, polyethylene glycol, glycerine | Increase concentration of solutes which creates osmotic pressure and draws fluid into intestinal lumen
32
Saline laxatives
MgOH, Mg citrate, Mg sulfate, Na phosphate, Na biphosphate Draw water into the intestines through osmosis May cause dehydration
33
Stimulant laxatives
Bisacodyl + Senna concentrates Increase peristalsis through direct effects on smooth muscle of intestines + promote fluid accumulation in colon and small intestines Avoid long term
34
Surfactant laxatives
Docusate sodium + Docusate calcium Decrease surface tension of liquid contents of bowel--promotes incorporation of additional liquid into the stool (stool softener) DOC in patients who should not strain
35
Lubricant laxatives
Mineral oil coats and softens the stool and prevents reabsorption of water from the stool by the colon
36
Lubiprostone
Secretagogues Derivative from prostaglandin Increases chloride rich intestinal fluid without altering serum sodium and potassium concentrations
37
Naloxegol
Peripherally acting mu-opioid receptor antagonists Decrease constipation of opioids Does not cross bbb
38
First line therapy for all forms of constipation
bulk forming laxative
39
First line therapy if straining should be avoided
Stool softener
40
First line therapy for constipation in infants
Glycerin
41
Second line therapy for constipation
Milk of magnesia, lactulose, sorbitol
42
Third line therapy for constipation
Stimulant laxatives
43
Meds that might cause diarrhea
Antacids containing Mg, antibiotics, SSRIs, cholinergic agents, cholchicine, digoxin, metoclopramide, laxatives, metformin, prostaglandins, quinidine
44
Osmotic diarrhea
Nonabsorbed solutes retained in the lumen of intestinal tract--pulls water and ions into intestinal lumen
45
Secretory diarrhea
Colonic absorption of fluid is secondary to active transport of Na+ through Na/K ATpase
46
Exudative diarrhea
Inflammation of mucosa | Due to enteritis, UC, carcinoma
47
Prophylactic agents for travellers diarrhea
Bismuth subsalicylate (pepto bismol) or quinolone antibiotic or rifaximin
48
Antimotility drug for diarrhea
Loperamide (immodium) and Diphenoxylate Opioid receptor agonist acting on mu receptors of large intestine Avoid in patients with infectious diarrhea--fever, bloody stools, fecal leukocytes
49
Atypical antidiarrheals
``` Bismuth subsalicylate (Pepto Bismol) Stimulates prostaglandin, mucous and bicarb secretion in stomach and inhibits prostaglandin and chloride secretion in large intestine ```
50
Rifaximin
Semi synthetic antibiotic Only active against noninvasive strains of E. Coli Blocks transcription of bacteria--alters growth of bacteria Used for travellers diarrhea
51
First line tx for diarrhea
Loperamide or rifaximin
52
Second line tx for dirrhea
Adsorbents/anti secretory
53
Third line tx for diarrhea
Diphenoxylate
54
Drug therapy for IBS
Depends on if it is constipation predominant or diarrhea
55
Antispasmodics for IBS
Dicyclomide Hcl and Hyosycamine sulfate | Direct relaxation of smooth muscle component of GI tract
56
Serotonin 3 receptor antagonists for IBS
Alosetron Decrease abdominal pain, slow colonic transit time, increase rectal compliance and improve stool consistence Used for severe diarrhea with no constipation
57
First line IBS tx for constipation
Linaclotide or lubiprostone
58
First line IBS tx for diarrhea
Loperamide
59
First line IBS tx for bloating and pain
Dicyclomine
60
Treatments for inflammatory bowel disease
aminosalicylates, corticosteroids, immunosuppressive agents, antibiotics, and biological agents
61
Aminosalicylates
Sulfasalazine, mesalamine, olsalazine, balsalazide Gold standard for tx of mild to moderate CD or UC Decrease inflammation in GI tract by inhibiting prostaglandin synthesis which decreases inflammatory mediators
62
Aminosalicylates CI in
Patients with aspirin allergy or G6PD deficiency
63
Corticosteroids for IBD
Prednisone, methylprednisolone, hydrocortisone, dexamethasone, budesonide Used to treat acute IBD exacerbations only
64
Immunosuppressive agents for IBD
Azathioprine, 6-mercaptopurine, methotrexate, cyclosporine | Used as adjunct tx to induce or maintain remission
65
What antibiotics are desirable for IBD
Acts against G- and mycobacterium with low SE profile and poor systemic absorption
66
Mild to moderate active CD responds to what antibiotics
Metronidazole and Ciprofloxacin
67
Long term use of metronidazole is associated with
Neurotoxic effects
68
Biologic agents for IBD
TNF-alpha inhibitors: infliximab, adalimumab, certolizumab | Selective adhesion molecule inhibitors: natalizumab, vedolizumab
69
First line tx for mild to moderate active luminal CD
Oral aminosalicylates alone or in combo with antibiotic | Oral preferred over rectal
70
First line tx for moderate to severe CD
Combo of aminosalicylates and corticosteroids
71
First line tx for mild UC
Aminosalicylates (oral + rectal combo)
72
First line tx for moderate UC
Add in a corticosteroid to aminosalicylates
73
Aminosalicylate of choice for IBD
Mesalamine
74
Corticosteroid of choice for IBD
Oral budesonide
75
Cyclosporine for IBD
Reserved for acute treatment of severe UC exacerbations

Pharmacology (56 decks)

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