Pharm II MHM - FINAL > GI Part 2 > Flashcards

GI Part 2 Flashcards

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1
Q

Goals of mild constipation IBS treatment?

A

Increase dietary fiber and fluid intake

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2
Q

Goals of moderate constipation IBS treatment?

A

Add bulk forming laxatives with or without antispasmodics

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3
Q

Goals of severe constipation IBS treatment?

A

Add chloride channel activator

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4
Q

Goals of mild diarrhea IBS treatment?

A
  • Dietary restriction

- Avoid contributing meds

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5
Q

Goals of moderate diarrhea IBS treatment?

A

-Add loperamide or other antispasmodics

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6
Q

Goals of severe diarrhea IBS treatment?

A

Add 5HT3 antagonists

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7
Q

IBS diarrhea drug choices

A
  1. Loperamide
  2. Anticholinergics
  3. Serotonin receptor blockers
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8
Q

IBS constipation drug choices

A
  1. Fiber supplements
  2. Osmotic laxatives
  3. Cl Channel Activators
  4. Guanylate Agonist
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9
Q

Describe antispasmodics

A
  • Anticholinergic (anti-SLUD)
  • Used for diarrhea
  • Side effects are dry mouth, blurred vision, urinary retention, constipation
  • Dicyclomine
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10
Q

What are TCAs and what type of IBS are they used to treat?

A
  • Tricyclic Antidepressants
  • Anticholinergic action
  • Decreases GI secretion and motility
  • Used for diarrhea
  • May help chronic abdominal pain
  • Amitriptyline, desipramine
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11
Q

What are 5HT3 receptor blockers and what type of IBS are they used to treat?

A
  • Serotonin receptor blockers
  • Mediate visceral pain
  • Inhibits colonic motility
  • Used for diarrhea
  • Alosetron
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12
Q

What is Alosetron and how is it used?

A
  • Selective 5HT3 blocker

- Used for severe diarrhea IBS in women (efficacy in men not established)

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13
Q

Side effects of Alosetron?

A
  • Constipation (can be severe)

- Ischemic colitis (fatalities reported, black box warning)

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14
Q

Describe bulk forming laxatives

A
  • Anti constipation

- Form bulky emollient gel that distends colon and promotes peristalsis

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15
Q

Describe osmotic laxatives

A
  • Anti constipation

- Nonabsorbable compounds that result in increased stool liquidity (due to obligate increase in fecal fluid)

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16
Q

What are chloride channel activators?

A
  • Approved for constipation IBS in women (efficacy in men not shown)
  • Lubiprostone/Amitiza
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17
Q

What is Lubiprostone?

A
  • Chloride channel activator
  • For constipation IBS in women
  • Works on small intestine
  • Enhances Cl-rich secretions and intestinal motility
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18
Q

Contraindications of lubiprostone? Adverse effects?

A
  • Avoid in women of CBP (preg cat C)

- Nausea, diarrhea, HA

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19
Q

What is linaclotide?

A
  • Guanylate agonist-Used for constipation
  • Causes rise of cGMP leading to rise of Cl and bicarb into intestinal lumen
  • Fluid increases, transit time decreases
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20
Q

Side effects of linaclotide?

A
  • Diarrhea
  • Flatulence
  • GI upset
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21
Q

What are serotonin 5HT4 receptor blockers?

A
  • Results in release of NTs promoting peristaltic reflex
  • Proximal bowel contraction and distal bowel relaxation
  • For constipation
  • No agent available in US
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22
Q

Drug classes for IBD treatment

A
  • Aminosalicylates
  • Glucocorticoids
  • Purine analogs
  • MTX
  • Anti-TNF
  • Anti-integrins
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23
Q

Drugs for mild IBD

A
  1. 5-aminosalicylates
  2. Abx
  3. Topical corticosteroids
  4. Budesonide
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24
Q

Drugs for moderate IBD

A
  1. Azathioprine/6-mercaptopurine
  2. MTX
  3. Oral corticosteroids
  4. TNF blockers
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25
Drugs for severe IBD
1. IV corticosteroids 2. TNF blockers 3. Cyclosporine 4. Natalizumab 5. Surgery
26
What is the active compound of all aminosalicylates?
5-ASA
27
MOA of aminosalicylates?
Unclear - May affect inflamm mediators - May interfere w/cytokine production - May inhibit immune cells
28
How do aminosalicylates work in IBD treatment?
- Topically on affected areas of GI mucosa - So must get to affected site - Pure oral 5-ASA is more than 80% absorbed which means little left over to go to needed area - Formulations are made to avoid so much absorption
29
What are the different formulations of aminosalicylates?
- Azo compounds | - Mesalamine compounds
30
What are the azo aminosalicylate drugs?
- Sulfasalazine - Olsalzine - Balsalazide
31
What are the mesalamine aminosalicylate drugs?
- Pentasa - Asacol - Lialda
32
How do azo compounds work?
- N=N azo bond reduces absorption after oral absorption | - At ileum and colon, bacteria cleave the molecules and release active 5-ASA
33
How do mesalamine compounds work?
- Each is uniquely formulated to deliver 5-ASA - Pentasa is timed-release microgranules - Asacol, apriso, lialda are coated in a pH resin that dissolves in distal ileum and colon
34
Mesalamine compounds provide ___ concentrations to sites in ___ GI tract
High Lower
35
What drug class is considered first line in mild to moderate UC?
Aminosalicylates
36
Sulfasalazine limitations
- Many pts can't tolerate dosing - Many ADRs (nausea, HA, arthralgias) - Hypersensitivity reactions
37
What supplementation does sulfasalazine require?
Folic acid due to impaired absorption
38
MOA of glucocorticoids in IBD
Inhibit production of inflammatory cytokines like TNF-a, IL-1, IL-8
39
How are glucocorticoids used in IBD?
- Moderate to severe disease | - Helpful in early treatment but not to maintain remissions
40
What is the MC oral glucocorticoid used for IBD?
Prednisone
41
What is budesonide and how is it used?
- Oral prednisolone analog | - Used in mild to moderate Crohn's
42
Side effects of glucocorticoids
- Hyperglycemia - Adrenal suppression - Peptic ulcers - Immunosuppresion
43
Describe purine analogs
- Oral - Delayed onset of action of several weeks due to metabolic conversions - Azothioprine to 6-MP to 6-thioguanine
44
How do purine analogs work in IBD?
- Provide immunosuppressive action - Used to induce and maintain remissions in both UC and Crohn's - Often used with steroids to reduce steroid dose
45
ADRs of purine analogs
- NV - Bone marrow suppression - Liver toxicity - Hypersensitivity reactions
46
Which med should be avoided when taking purine analogs?
- Allopurinol | - Can cause leukopenia
47
What is methotrexate?
- Folic acid analog - Anti-inflamm in low doses (cytotoxic at high doses) - Used to induce or maintain remission in Crohn's (unknown effect in UC)
48
ADRs of MTX
- Myelosuppression, mucositis, alopecia | - Liver toxicity
49
How do anti-integrins work?
- Prevent inflamm cells from using integrins to bind to vascular cells - Used for refractory Crohn's
50
What is natalizumab and how is it used?
- Anti-integrin - Mod to severe Crohn's - Requires pt enrollment in CD touch due to adverse effects
51
What should happen if patients are on steroids and then given natalizumab?
Taper once response is observed
52
Major ADR of natalizumab
Progressive multifocal leukoencephalopathy - A/w exposure to JC virus - Occurs in IC pts - Increased duration of med increases risk
53
What are the MC causes of cirrhosis and hepatocellular carcinoma?
HBV and HCV
54
Goal of hepatitis treatments?
Suppressive rather than curative
55
HAV treatment
- NONE | - Vaccine to prevent
56
Drug classes for HBV treatments
- Nucleoside/tide analogs | - Interferons
57
How are nucleoside/tide analogs used in HBV treatment?
Usually combined with interferon
58
What is lamivudine?
- Nucleoside/tide analog - Inhibits HBV DNA pol - Requires phosphorylation to become activated
59
What is adefovir dipivoxil?
- Nucleoside analog - Inhibits HBV DNA pol - 2nd line treatment - Less toxic than other nucleosides
60
What is entecavir?
- Nucleoside analog - Inhibits HBV DNA pol - Effective in lamivudine-resistant strains - Take on EMPTY stomach
61
What is telbivudine?
- Nucleoside analog - Inhibits HBV DNA pol - Requires phosphorylation to active form - Give with or w/o food
62
What is tenofovir?
- Nucleotide analog of adenosine | - Inhibits reverse transcriptase
63
Describe interferons
- Family of cytokines, provide antiviral action | - Alfa (2a and 2b), beta, gamma available
64
IFN alfa 2a is used to treat:
HBV AND HCV
65
IFN alfa 2b is used to treat:
ONLY HCV
66
Treatment options for HCV:
- IFN alfa 2a or 2b - Ribavirin - Telapravir - Boceptrevir
67
How is treatment of HCV directed?
Based on genotype
68
Describe IFN used to treat HCV
- Genotypes 3-6 - Often used w/ribavirin - Were once cornerstone of treatment but now newer agents available
69
Describe ribavirin
- Guanosine analog for HCV - Blocks RNA dependent RNA pol - Available oral or IV - Combined with IFN
70
Describe simeprevir
- Inhibits HCV NS3/4A protease | - 1st line treatment w/other agents
71
What is currently recommended as 1st line treatment w/other agents for HCV?
Simeprevir (NS3/4A protease inhibitor)
72
Describe paritaprevir
- HCV NS3/4A protease inhibitor - Often 1st line w/other agents - E.g. viekira pak
73
What is ledipasvir and sofosbuvir?
-NS5A inhibitors for HCV tx-1st line agent
74
How are HCV genotypes 5 and 6 treated?
Peg-IFN alfa 2a WITH ribavirin for 48 weeks
75
What are the protease inhibitors used to treat HCV?
- Simeprevir - Paritaprevir - Boceprevir
76
What are the NS5A protein inhibitors used to treat HCV?
- Ledipasvir/Sofosbuvir - Ombitasvir - Sofosbuvir and Dasabuvir
77
What is 1st line to treat ascites?
Diuretics
78
Meds for variceal bleeding prophylaxis?
-Nonselective B blockers (propranolol, nadolol)
79
Meds for acute variceal hemorrhage?
- Vasoconstrictors (octreotide, vasopressin) | - Abx
80
Meds for spontaneous bacterial pritonitis?
-Abx (cefotaxime)
81
Treatment of hepatic encephalopathy?
- Targeted to decrease NH3 blood concentration (via abx) - Neomycin and metronidazole - Rifaximin
Pharm II MHM - FINAL
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