Year 1: Patho/Pharm > GI PHARM > Flashcards

GI PHARM Flashcards

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1
Q

MOA of Serotonin receptor antagonists

A

Prevent nausea and vomitting by blocking serotonin receptors at two sites

  1. chemoreceptor trigger zone
  2. afferent vagal nerves
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2
Q

Example Sertoninin receptor antagonists

A

OndanSETRON
ganiSETRON
dolaSETRON
palonoSETRON

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3
Q

Indication for serotonin receptor antagonists

A

Nausea and vomiting

  • post operative
  • chemotherapy induced
  • pregnancy
  • gastritis
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4
Q

Contraindications
Serotonin receptor antagonists

A

Prolonged QT interval

Cardiac abnormalities:
Bradydysrhythmias
heart failure

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5
Q

MOA
Antihistamines H1 receptor antagonists

A

Block H1 receptor in the vomiting centre

Prevent signal from inner ear to vomiting centre

Prevention of N/V/motion sickness

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6
Q

SE
H1 receptor antagonists

A

Muscarinic blockade: dry mouth, constipation, urinary retention, glaucoma, blurred vision, sedation, delirium/paradoxical reaction

H1 receptor blockade: hypertension

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7
Q

Contraindications
H1 receptor antagonists

A

Third trimester pregnancy - neonatal sedation

breast feeding - neonatal sedation

Conditions made worse by muscarinic blockade: asthma, BPH, constipation, elderly, children

Infants < 6 months

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8
Q

Examples of H1 receptor antagonists

A

Dimenhydramine (benadryll)
Dimenhydrinate (gravel)
Meclizine
Cyclizine

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9
Q

MOA
Glucocorticoids (for N/V)

A

unknown mechanism of action

synergistic for N/V if given with other anti-emetics

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10
Q

SE
Glucocorticoids

A

Bones: osteoporosis, growth suppression, fractures

Skin: infections, striation, poor wound healing

GI: ulcers, perforations, hemorrhages

Cushingoid appearance: central fat, degradation muscles, moon face, hump back; adrenal suppression

Electrolytes: hyperglycaemia, hypernatremia, hypokalemia, FVO, weight gain

Eyes: glaucoma, cataracts

CSN: mania, depression

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11
Q

Contraindications
Glucocorticoids

A

pregnancy / breastfeeding - teratogenic

Caution: children and elderly, growth suppression, fractures, adrenal insufficiency

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12
Q

Example
Antacids

A

magnesium hydroxide
aluminum hydroxide
calcium carbonate
sodium bicarbonate

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13
Q

MOA
Ant-acids

A
  1. neutralize HCl –> rise in pH
  2. prevent activation pepsinogen to pepsin
  3. activation prostaglandin –> increase mucous, bicarb, blood flow mucosa barrier
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14
Q

SE
antacids

A

calcium carbonate - constipation, acid rebound

magnesium hydroxide - magnesium toxicity, diarrhea

sodium bicarbonate - metabolic alkalosis, hypernatremia

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15
Q

Contraindications
ant-acids

A

sodium bicarbonate
- metabolic alkalosis, hypernatremia, heart failure or kidney disease

Increase clearance of acidic drugs in urine

prevent absorption of drugs - give 1 hour apart

Magnesium hydroxide
Kidney failure or disease

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16
Q

MOA
H2 receptor antagonists

A

Prevents gastric acid secretion

Blocks H2 receptors on parietal cells. Prevents cAMP signal which H/K ATPase excretes H+ into gastric lumen (blocked)

increase pH stomach

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17
Q

SE
H2 receptor antagonists

A

CNS: depression, hallucinations, agitation

pneumonia: increase bacterial colonization stomach, secondary respiratory infections (aspiration)

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18
Q

Contraindications
H2 receptor antagonists

A

Caution: pregnancy, breast feeding (sedation)

Caution: kidney and hepatic impairment (dose adjustment)

Drug interactions: CYP450 inhibitor (increase warfarin, phenytoin) ; antacids prevent H2 receptor antagonist absorption

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19
Q

Examples
H2 receptor antagonists

A

raniTIDINE
cimeTIDINE
famoTIDINE
nizaTIDINE

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20
Q

Indication
H2 receptor antagonists

A
  1. Treatment PUD
  2. Ulcer healing
    Duration 8-12 weeks gastric
    Duration 4-6 weeks duodenal
  3. GERD
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21
Q

MOA
proton pump inhibitors

A

Prevent secretion and synthesis of HCl

Block H/K ATPase in the parietal cells. Irreversible inhibition. Lasts lifetime of cell (3-5 days)

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22
Q

Indications
PPIs

A
  1. Prophylaxis and treatment of PUD
  2. GERD
  3. erosive esophagitis
  4. Zollinger-Ellison syndrome
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23
Q

SE
PPIs

A

Hypomagnesium - cramps, dysrhythmias, tremors

Hypocalcemia - fractures (convulsions, reflex hyperactive, anorexia, muscle spasms/tetany, positive trauseau, chvostek, parenthesia)

Pneumonia

C. Diff diarrhea

Acid rebound - wean, do not D/C abruptly, PRN H2 receptor antagonist

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24
Q

Contraindications
PPI

A

pneumonia

osteoporosis

hypomagnesemia, hypocalcemia

C. diff diarrhea

DRUG INTERACTIONS
clopidogrel - decrease conversion to active form (PRN PPI for gastric protection)

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25
Example PPIs
OmePRAZOLE lansoPRAZOLE
26
Patient education PPI
Don't D/C abruptly - hyperacid secretion Report - diarrhea (c. diff) Report - dry cough, fatigue, fever (pneumonia) Report - leg cramps, palpitations, tremors (hypo magnesium) Take PRN vitamin D and calcium
27
MOA metoclopromide
1. block HT and DA receptors in CTZ = prevention N/V 2. Increase Ach in GI = increase GI motility "Pro-kinetic agent"
28
Indications Metoclopromide
GERD Diabetic gastroparesis N/V chemotherapy, 1st trimester pregnancy hiccups
29
SE Metoclopromide
Diarrhea Tardive dyskinesia (DA blockade): involuntary movement legs, arms, face
30
Contraindications Metoclopromide
GI obstruction, perforation, hemorrhage 2nd and 3rd trimester of pregnancy Start low, go slow (Tardive dyskinesia), shortest duration
31
MOA Sucrafalate
Forms a protective gel that coats an ulcer crater at low pH aluminum hydroxide + sulphated sucrose + low pH = protective gel
32
SE and contraindications Sucrafalate
prevention drug absorption administer 2 hours apart No systemic SE No contraindications
33
Indicaiton Sucrafalate
PUD gastric or duodenal ulcers Protective coating for the ulcers
34
MOA Misoprostol
Prostaglandin E1 analog Binds Prostaglandin E1 receptor on parietal cells 1. prevents cAMP signal which prevents H+ secretion into lumen (H/K ATPase) 2. promotes mucous , bicarbonate secretion, and blood flow
35
Indications Misoprostol
1. PUD secondary to NSAID therapy 2. Induce labour / abortions
36
SE Misoprostol
abdominal pain, diarrhea dysmenorrhea, spotting induction labour, abortions
37
Contraindication Misoprostol
Pregnancy Written and oral dangers birth control HCG negative start on 2nd day of period
38
MOA Clarithromycin
Macrolide antibiotic Prevent protein synthesis by blocking Ribosome 50S inhibitor Bacteriostatic Active against Gram positive Some gram negative Atypicals
39
Indication Clarithromycin
H. pylori infections PUD Triples: Clarithromycin + amoxicillin/metronidazole + PPI
40
SE Clarithromycin
GI: N/V/D, metallic taste Cardio: Sudden cardiac death, prolonged QT interval Ottotoxic
41
Contraindications Clarithromycin
Drugs that prolong QT interval Long QT syndrome, ventricular dysrhythmias CYP3A4 inhibitors (5x cardiac sudden death) Azole anti fungals CCB (verapamil, diltiazem) HIV medications
42
MOA Metronidazole
Kills anaerobic bacteria Anaerobic bacteria convert to active form; causes DNA breaks, prevents nucleic acid synthesis, results in cell death
43
SE Metronidazole
N/V/HA
44
Contraindications Metronidazole
Alcohol Disulfram reaction Wait 3 days before drinking
45
Indication Metronidazole
H. pylori infection Quadruple therapy (Metronidazole + bismuth + tetracycline + PPI) Triple therapy (Metronidazole + clarithromycin + PPI)
46
MOA Bismuth Subsalicylate
1. Bacterial cell wall lysis 2. inhibits H. pylori urease - preventing adhesion to gastric epithelial cells
47
SE Bismuth subsalicylate
Black colour on tongue and in stool (false positive melena stool) Constipation Bleeds, acidosis
48
AE Bismuth Subsalicylate
Neurotoxicity (high dosage, long term use): tinnitus, loss of hearing Melena stools (GI bleeds): salicylate Reye’s syndrome and acidosis Decreased kidney perfusion, hypertension
49
Contraindications Bismuth Subsalicylate
Salicylate: pregnancy, breast feeding, children (Reyes syndrome), acidosis
50
MOA Tetracycline
bacteriocidal Blocks 30S Ribosome preventing protein synthesis Broad spectrum antibiotic gram postive, gram negative, MRSA
51
SE Tetracycline
Deposition in teeth and long bones Yellow teeth Hypoenamel Fractures Diarrhea - C. Diff Phototoxicity Teratogenic
52
AE Tetracycline
C. diff infections hepatotoxicity (post partum) phototoxicity Teratogenic
53
Contraindications Tetracycline
pregnancy post partum (caution) children < 8 years liver and kidney disease
54
Indication Tetracycline
H. pylori infections Quadruple therapy Tetracycline + bismuth subsalicylate + metronidazole + PPI Can also use for CAP Monotherapy, dual therapy
55
Indication Bismuth Subsalicylate
H. pylori infection Quadruple therapy Bismuth subsalicylate + tetracycline + metronidazole + PPI Travellers diarrhea first line with imodium
56
MOA Amoxicillin
1. prevent cell wall peptidoglycan cross linking 2. promote increase autolysin activity - cell wall degredation Destruction bacterial cell wall resulting in cell lysis gram positive, some gram negative infections
57
SE Amoxicillin
GI: N/V/D allergic reactions IgE mediated 7% people (1% cross reactivity with 1st generation cephalosporins) Neuropsych SE when toxicity (renal impairment)
58
Contraindications Amoxicillin
renal impairment hypersensitivity reactions
59
MOA Fluroquinolones
Block DNA gyrase (prevent supercoiling DNA) Block DNA topoisomerase (prevent separation daughter strands) Broad spectrum anaerobic, gram positive, gram negative, pseudomonas
60
SE Fluroquinolones
Cardiac: prolonged QT interval GI: N/V/D/C. diff MSK: tendon ruptures SKIN: phototoxicity Teratogenic
61
Contraindications Fluroquinolones
Pregnancy - teratogenic Children < 18 years Long QT intervals Myasthenia Gravis Caution: Adults > 60 years transplants glucocorticoids
62
Indication Levofloxacin
H. Pylori infection Triples Amoxicillin + levofloxacin + PPI Back up for CAP resistant
Year 1: Patho/Pharm
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