Diarrhea Bugs > Pharm Gi > Flashcards

Pharm Gi Flashcards

(53 cards)

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0
Q

Active comonent is 5- aminosalicylic acid . Thought to inhibit prostaglandin synthesis, block neutrophil migration.

A

Sulfasalazine and active metabolite mesalamine

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1
Q

Dicyclomine

A

Anti-spasmodic by blocking muscarinic receptors on enteric plexus and smooth muscle.

At high doses it will have anti- chollinergic side effects like dry mouth blurred vision

Not used freq

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2
Q

Side effects and administration of sulfasalazine and mesalamine respectfully

A

Side effects due to sulfa pyridine component - nausea GI upset arthralgias myalgias bone marrow suppression hypersentivitiy rxn

Mesalalamine can be administered as rectal suppository

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3
Q

Other drugs used

A

Azathioprine and 6- mercaptopurine - immunosuppressive drugs
Metronidazole
Methotrexate - crohns not uc
Anti TNF drugs

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4
Q

MOA of metronidazole a s tinidazole

A

The nitro gourd is reduced in anaerobic bacteria and protozoan
The reactive products are responsible for its anti microbial activity

Works against gut anaerobes and is cidal against obligate anaerobes

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5
Q

C. Diff, giardia lamblia, entamoeba histolytica

A

Metronidazole and tinidazole

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6
Q

Bacteriodes , fusobacterium , trichomonoas

A

Metronidazole and tinidazole

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7
Q

Moderately active against h. Pylori

A

Metronidazole and tinidazole

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8
Q

Side effects of metronidazole

A

Nausea, headache, anorexia,band metallic taste

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9
Q

Drug rxns with metro and tinidazole

A

Tin has fewer side effects

Abstain from etoh bc of disulfiram rxn - m-24hrs t-72 hr
Inhibit warfarin metabolism potentiating it’s effects

Met class b
Tin class c for pregnancy
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10
Q

Salmonella , shigella , E. coli and campylobacter

A

Tmp/smx and fluoroquinolones

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11
Q

Severe campylobacter

A

Erythromycin

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12
Q

Amebic infections

A

Iodoquinol and metronidazole - iod remains in lumen and may cause diarrhea and rash

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13
Q

Ending - tidine

A

Histamine H2 receptor antagonist

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14
Q

Only h2 receptor antagonist that causes issues

A

Cimetidine - anti androgenic - causes gynecomastia

And potent p450 inhibitor

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15
Q

Ending - prazole

A

Proton pump inhibitors - omeprazole and lansoprazole an esomeprazole

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16
Q

Moa of proton pump inhibitors

A

Acid labile prodrugs administered in enteric coated tablets. The uncharged form enters the cytoplasm of the partial cell. In the acidic caniculus it’s converted to active sulfonamide form. Which forms a covalent disulfide link with cysteinyl residue in the proton pump on luminal side of parietal cell. This depends on the conformational change of the active H/K-ATPase pump. So it’s taken 30-60 min before meals. Irreversible and better than h2 blockers

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17
Q

Use of h2 antagonist

A

Dyspepsia - give 30 min befor meals
Peptic ulcer disease - at night on empty stomach - relapse need to treat h. Pylori
Gerd and lpr

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18
Q

Use of ppis

A

Peptic ulcer diseas - more effective ths. H2 blockers

NSAID associated ulcers , gerd, lpr, zollinger- Ellison syndrome

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19
Q

Adverse effects of PPIs

A

Lack of acidic environment in stomach will lead to poor absorption of some nutrients like calcium. And can increase c. Diff

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20
Q

Drug interactions of PPIs

A

Metabolized by CYP 450 . Pts with polymorphism in 2c19 will clear them more slowly.

Omeprazole can inhibit met of warfarin, diazepam, phenytoin, and carbamazepine

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21
Q

Adverse effects of Antacids - aluminum, magnesium hydroxides and calcium carbonate

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A

Aluminum- constipation
Magnesium - diarrhea
So give together
Calcium- lead go greater absorption of sodium bicarbonate - transient metabolic alkalosis

22
Q

Sucralfate

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A

Sulfated polysaccharide that adheres to ulcer creators and epithelial cells, inhibit pepsin- catalyze hydrolysis of mucosal proteins and stim prostaglandin synthesis. This forms a protective barrier that allows the ulcer to heal.

PUD but elf effective than h blockers and PPIs
Inhibit absorption of digoxin

23
Q

Bismuth sub salicylate

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A

Anti secretory anti inflammatory and anti microbial effects

  • pepto-bismol
  • nausea and cramps relieved by thus

Dark stools and black tongue.

24
H. Pylori treatment
Combos | PPIs and amoxicillin and then switch to ppi clarithromycin and metronidazole
25
Entecavir
Nucleoside analogue used in primary treatment of hep b. Inhibits all three functions of hbv polymerase. Low drug resistance, excellent choice for patients not exposed to lamivudine but resistance mat develop in pts resistant to lamivudine
26
Tenofovir
Treat hbv low rate of resistance. Effective against lamivudine resistant hbv . Possible renal impairment
27
Telbivudine
nucleoside analogue. Tx hbv . Dose resistance emerging
28
Interferon alpha or pegylated interferon
Treatment hbv - May be associated with severe flare up often precluded to HBeAg clearance but in pts with cirrhosis in pts it can lead to liver failure. Needs to be injected so limits it's use
29
Adefovir
Nucleoside analogue - hbv | Not first line bc takes too long may cause Renal impairment, and resistance develops
30
Lamivudine
Nucleoside analogue . Hbv Resistance is a problem. Can be used in pregnant pts
31
Side effects of nucleoside and tides
Headache, fatigue , nausea , lactic acidosis, hepatotoxicity
32
Treatment genotype 2 hep c
Pegylated interferon Alpha + ribavarin
33
Treatment genotype 1 hep c
Boceprevir or telaprevir in combo with pegylated interferon alpha and ribavirin. Inhibit replication of hcv in host cells by binding to NS3/4 protease of HCV
34
MOA of the bendazoles ( al, me, thia)
Bind beta tubulin and thereby inhibit the production of tubulin dimers which then impairs glucose uptake and depletes glycogen stores Contra for pregnant ppl
35
Pyrantel
MOA: activated cholinergic nicotine receptors in nematode so causing a depolarization blockade Alternative to bendazoles
36
Ivermectin
MOA : increase chloride permeability, which hyper polarizes the cell membrane resulting in paralysis of pharyngeal muscles Use: scabies , pediculus humanus, strongyloiadiasis, ancylostoma braziliense, onchocerca volvulus One dose a yr can prevent river blindness
37
Treatment of Cestodes and schistomiasis
Praziquantel
38
Praziquantel
MOA : outer surface of schistosomes is unique double membrane suture that protects it from host immune system. Praziquantel increases calcium per eabitiy in the tegumentnleading to its breakdown, allowing the host immune cells access to the worm antigens.
39
MOA methylphenidate
Dopamine uptake inhibitor ( dopamine motivation and reward) ADHD
40
Side effects of methylphenidate
Anorexia , insomnia , nervousness, GI distress, irritability, tachy, dose depending motor and vocal tics ADHD
41
Types of methylphenidate
Ritalin, methylin, concerta, the patch , dexamethypheindate ADHD
42
Concerta
Triphasic release duration 10-12 hrs ADHD
43
Dexamethypheindate
Can be sprinkled duration 12 hrs ADHD
44
MOA amphetamines
Enhances release and blocks reuptake of dopamine and ne. ( ne alert, attending, orienting) ADHD
45
Adverse effects amphetamine / contraindications
Anxiety, motor tics, MAOI , cardiac abnormalities, hs drug abuse , seizure disorders glaucoma ADHD
46
Types of amphetamines
Dextroamphetamine Mixed amphetamine salts ( adderall) Lisdexamfetamine ADHD
47
Adderall
Cardiac abnormalities contraindicated ADHD
48
Lisdexamfetamine
Amphetamine prodrug. Activated in the gut less potential for abuse ADHD
49
Atomoxetine
ADHD Norepi reuptake inhibitor Ae- nausea, anorexia,increase pulse/ BP, constipation hepatotoxic May take 1-2 weeks to work
50
Bupropion
ADHD Dopamine and ne reuptake inhibitor Ae: bulimia/ anorexia, seizure disorder, he substance abuse, head trauma Improvement hyperactivity, hospitality and sleep
51
Clonidine
Central alpha 2 adrenergic agonist ( post synaptic for ADHD ) Sedation big side effect , orthostatic hypotension, dry mouth More Effective for impulsivity and hyperactivity than in attentiveness. No worsen tics.
52
Guanfacine
Central alpha 2 Adrenergic agonist ( post synaptic for ADHD) Sedation ( less than clonidine) orthostatic hypotension, dry mouth More Effective for impulsivity and hyperactivity than in attentiveness. No worsen tics.
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