Block 12 > Pharm: GI > Flashcards

Pharm: GI Flashcards

(86 cards)

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1
Q

GERD affects what part of the body?

A

Lower esophageal sphincter

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2
Q

What are the symptoms of GERD?

A

heartburn, hypersalivation, regurgitation of acid contents, chest pain

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3
Q

GERD treatment two methods

A

Acid suppression

Promotility therapy

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4
Q

Lifestyle modifications for GERD

A

Elevate head end of bed while sleeping
Weight loss

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5
Q

What is first-line treatment in acid suppression for GERD?

A

PPIs

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6
Q

PPIs have been shown to be more effective than ______ blockers are in healing esophagitis and maintaining healing

A

H2

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7
Q

______ receptor antagonists are used for milder symptoms

A

H2-

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8
Q

In pregnancy what medications can be used in acid suppression in GERD treatment?

A

H2-antagonist (Ranitidine)

Lansoprazole (PPI)

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9
Q

Pro-motility therapy drug used in GERD

A

Metoclopramide - dopamine antagonist

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10
Q

Is Metoclopramide (Reglan) recommended as first-line or mono therapy?

A

Not recommended

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11
Q

MOA of Metoclopramide (Reglan)

A

D2 receptor antagonist

Promotes gastric emptying

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12
Q

Black Box Warning: Metoclopramide (Reglan) can cause what?

A

Tardive dyskinesia

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13
Q

Metoclopramide Contraindications

A

Parkinson’s disease, bowel obstruction

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14
Q

Peptic ulcer disease four common causes

A
  1. NSAID
  2. H. Pylori
  3. Stress-related mucosal disease
  4. Disease-related (cirrhosis, Chronic renal failure, CVD, Organ transplant)
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15
Q

How does peptic ulcer disease present?

A

Pain usually 1-3 hours after meals that is relieved by food

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16
Q

How do NSAIDs cause ulcers?

A
  • Inhibit prostaglandin synthesis and cause damage to the lining
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17
Q

How can H. Pylori cause peptic ulcer disease?

A

Infects the mucosal lining leading to PUD and shows greater incidence of GI bleeding

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18
Q

H. Pylori combination therapy

A

2 antibiotics and a PPI

Amoxicillin, Clarithromycin, and a PPI

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19
Q

If the patient has an amoxicillin allergy, what can be used instead of amoxicillin in H. Pylori combination treatment?

A

Metronidazole

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20
Q

PPI drugs

A

Omeprazole (Prilosec)
Esomeprazole (Nexium)
Lansoprazole (Prevacid)
Pantoprazole (Protonix)
Rabeprazole (Aciphex)

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21
Q

MOA of PPIs

A

irreversibly inhibit H/K ATPase of parietal cells and suppresses acid secretion

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22
Q

PPIs are most effective taken when?

A

30-60 mins before a meal

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23
Q

PPIs are the DOC in ___________ conditions and _____________

A

Hypersecretory conditions and H. Pylori

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24
Q

Long-term adverse effects of PPIs

A

Hypomagnesemia
Bone Fractures, Vitamin D deficiency
Vitamin B12 deficiency

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25
H2 antagonist drugs
Cimetidine Ranitidine Famotidine Nizatidine
26
MOA of H2 antagonists
Competitively block the H2 receptor of acid-producing parietal cells
27
Which H2 antagonist is associated with greatest risk of CYP enzyme inhibition?
Cimetidine
28
Cimetidine inhibits multiple ________ enzymes and can cause what?
CYP enzymes and can cause gynecomastia and loss of libido
29
Side effects of H2 antagonists
Agranulocytosis and thrombocytopenia Blurred vision
30
Sucralfate (Carafate) MOA
forms a physical barrier over an open ulcer
31
Sucralfate can block ___________ of medications So when should meds that are taken alongside Sucralfate be taken?
Absorption Taken meds 2 hours before Sucralfate
32
What can occur in chronic users of Sucralfate?
Hypophosphatemia Hypovitaminosis
33
What types of drugs are the last line for H. Pylori treatment?
Antacid and anti-diarrheal
34
How does bismuth (Pepto-Bismol) work? What are two common side effects?
Neutralizes gastric acid and has antibacterial effect Black tongue and stools
35
Bismuth subsalicylate (Pepto-Bismol) is not used for who?
It is a salicylate so not for children or teens recovering from chicken pox. Flu, or fever
36
Recurrent abdominal pain or discomfort due to visceral hypersensitivity (no inflammation)
IBS
37
Three types of IBS
IBS-C (constipation) IBS-D (diarrhea) IBS-M (mixed)
38
Receptor involved in IBS: 5-HT3 receptor antagonists help in _________ and _________
Diarrhea and nausea
39
Receptor involved in IBS: 5-HT4 agonist promotes __________ and _________
Motility and secretion
40
What are the 4 Rx Laxatives
i Lube the Lines To Move Lubiprostone Linaclotide Tegaserod Methylnaltrexone
41
Lubiprostone MOA
chloride channel activator
42
Side effects of lubiprostone
nausea, diarrhea, headache
43
Linaclotide (Linzess) MOA
Increase cGMP
44
Tegaserod (Zelnorm) MOA
-5-HT4 receptor partial agonist increases intestinal secretions
45
Methylnaltrexone (Relistor) MOA
Mu-opioid receptor antagonist
46
Use of Methylnaltrexone
Specific for opioid induced constipation
47
Methynaltrexone has a limited ability to cross the _______
BBB
48
4 diarrhea treatment drugs
Loperamide (Imodium) Diphenoxylate and Atropine Dicyclomine Alosetron
49
Loperamide MOA
Mu-opioid receptor agonist that slows down gut transit time
50
What is the US box warning with Loperamide?
Torsades de Pointes
51
Loperamide is contraindicated in patients less than ________
2 years old
52
diphenoxylate/atropine (Lomotil) MOA
Mu opioid receptor agonist
53
diphenoxylate/atropine (Lomotil) are always together for what reason?
To discourage abuse
54
Dicylomine MOA
Block Muscarinic receptors in the gut to decrease motility
55
Alosetron MOA
5HT3 antagonist
56
Who Alosetron only approved for?
Women with severe diarrhea predominant IBS who have chronic IBS symptoms > 6 months
57
Two types of IBD
Ulcerative colitis and Crohn's disease
58
ulcerative colitis is inflammation and ulceration of the lining in the __________
Colon
59
Crohn's disease can affect any part of the ____________
Intestines
60
6 treatment options for UC
5-ASA Corticosteroids Azthioprine Cyclosporine Infliximab Surgery
61
5-ASA drugs
sulfasalazine and mesalamine
62
MOA: 5-amino salicylic acid (5-ASA)
NSAID-like blocks the inflammatory response, especially leukotrienes, cytokines and TNF
63
Corticosteroids are used for ____________ UC
Moderate-severe
64
Budesonide is a _________
Corticosteroid
65
Budesonide is indicated for what?
The induction of remission of active, mild-to-moderate UC
66
Azathioprine MOA
purine antimetabolite that is converted to 6-MP and inhibits the synthesis of DNA, RNA and proteins
67
Cyclosporine MOA
Calcineurin inhibitor
68
Cyclosporine Box warning
Nephrotoxicity
69
Infliximab MOA
Anti-TNF-a
70
Infliximab can cause an increased risk of infection such as ________, ________, and _______
TB, fungal, and viral
71
Infliximab is often used for what?
Fistula closures
72
What test must be performed before being given Infliximab?
Tb test
73
What are the 6 treatment options for Crohn's Disease?
1. Mesalamine or Sulfasalazine (if mild) 2. Corticosteroids (moderate to severe) 3. Immunosuppressants 4. Anti-TNF agent: Infliximab 5. Anti-integrin 6. Surgery
74
What are the two anti-integrin drugs used in treatment of Crohn's Disease?
Natalizumab and Vedolizumab
75
How do anti-integrins act to treat Crohn's disease?
Block T-lymphocyte migration
76
Adverse effects of Anti-integrin drugs
Increase risk of PML: viral infection of the brain
77
What is Emesis?
vomiting
78
What are the 5 antiemetic drug classes used?
5-HT3 receptor antagonists Muscarinic blocker D2 receptor blockers First generation H1 Blockers NK1 antagonist and Substance P antagonist
79
5-HT3 receptor antagonist drugs
Ondansetron
80
5-HT3 receptor antagonists MOA
Slows intestinal secretions and motility
81
Muscarinic blocker used as an antiemetic?
Scopolamine
82
D2 receptor blocker used as an antiemetic?
Promethazine (also an anti histamine)
83
First generation H1 blocker used as an antiemetic?
Diphenhydramine
84
Aprepitant MOA and Use
Substance P antagonist, blocks NK1 receptors in brain Clinical use: antiemetic for chemo induced nausea and vomiting
85
What is the most emetic chemotherapy agent?
Cisplatin
86
CINV treatment when using Cisplatin
5HT3 antagonist + NK1 antagonist + Dexamethasone
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