week 2 - GI pharm Flashcards by Jennifer Toews

what are the 6 antiemetics?

scopolamine
Dimenhydrinate - Gravol
Nabilone
Ondansetron- zofran
Dexamethazone
Metoclopramide- maxeran

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What drug class is scopolamine and what is the MOA?

muscarinic receptor antagonist
blocks ACH for PNS
- so helps with GI not signaling emetic center

blocks nerve impulses between vestibular apparatus in inner ear to the emetic center

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which antiemetic is best for motion sickness?

scopolamine

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What are the adverse effects of scopolamine?

CNS - sleep/drowsy
blurred vision & dry mouth
GU retention/GI constipation b/c PNS blocked

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What drug class is dimenhydrinate and what is the MOA?

antihistimine
it blocks muscarinic receptors in vestibuler system so stops emetic signal

blocks GI receptors (ACH) so histimine can’t be released and acid can’t be made

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What are the adverse effects of scopolamine?

CNS - drowsy
dry mouth
Gu dysuria/ GI- constipation
hypotension

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What 4 things is Dimenhydrinate contraindicated in?

other CNS depressants
Gluacoma
CKD
dysuria

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what drug class is Nabilone and what is the MOA?

cannabinoid
stops activation of receptors around vomiting centre

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What are the adverse effects of Nabilone?

CNS - drowsy, confusion
Cardiac - tachy, hypotension

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Is Nabilone a first line or 2nd line drug and why?

2nd line b/c of psycho-affect
abuse potential

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what is nabilone contraindicated in?

psychiatric disorder patients
cardiovascular disease

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What drug class is ondansetron and what is the MOA?

seratonin receptor antagonist
blocks serotonin receptors in CTZ

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What are the 2 special adverse effects of Ondansetron?

QT prolongation - EKG
Muscle pain

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Which antiemetic has no side effects when used shorter term?

dexamethasone

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what is the drug class of dexamethasone?

glucocorticoid (steroid)

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What drug class is metoclopramide (maxeran) and what is the MOA?

prokinetic - promotes gastric emptying
blocks dopamine + serotonin receptors in the CTZ
upper GI responds to ACH so peristalsis happens

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What are the adverse effects of metoclopramide - maxeran?

tardive dyskinesia (remember my restless legs in concordia) w/long term use

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What is metroclopramide (maxeran) contraindicated in?

GI obstruction
perforation
hemorrhage

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What is the one “other” antidiarrheal?

bismuth subsalicylate (pepto)

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What is the MOA of bismuth subsalicylate (pepto)?

1.coats walls of the GI tract
2. stimulates mucous production
3. binds to toxins and bacteria for excretion

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what are the adverse effects of bismuth subsalicylate (pepto)?

increased bleeding time (not for PUD)
hearing loss/tinnitus
metalic taste
blue gums
dark stool

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What are the 2 non-specific antidarrheals?

loperamide- imodium
Diphenoxylate + Atropine) - Lomotil

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What drug class is loperamide - imodium and diphenoxylate + atropine - Lomotil?

Opiod

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what antidiarrheal is good for people with iliostomy?

Imodium (note the I’s)

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Which Opioid non-specific antidiarrheal causes neuro effects and which has none?

1. diphenoxylate + atropine = lomotil - neuro effects 2. loperamide- imodium - no neuro effects

What are the 2 osmotic laxatives?

1. Magnesium hydroxide 2. poly ethylene glycol

What is magnesium hydroxide contraindicated in?

Renal disease b/c mag will already be high. Kidneys can't secrete it

What laxative helps purge poisons?

magnesium hydroxide

what laxative is commonly used pre-colonoscopy?

polyethylene glycol

What is the 1 stimulant laxative?

Bisacodyl (dulcolax)

What laxative is given with constipation from opiods?

bisacodyl (dulcolax) - think codine... type meds

when should bisacodyl (dulcolax) be taken?

at bed time

what is a commonly abused drug in bulimia nervosa and anorexia nervosa?

bisacodyl (dulcolax)

What is the MOA of bisacodyl (dulcolax) ?

stimulate motility - non systemic

What is an osmotic laxative?

lactulose

What is lactulose commonly used for when not a laxative?

hepatic encephalophathy

What is the MOA of lactulose?

it turns into lactic acid in the intestine and helps ammonia NH3 turn into ammonium NH4 and leave the body

what should we teach patients to do with psyllium?

drink LOTS of water. you don't want it stuck in esophagus

what laxative is good post MI?

docusate sodium (colace) - think sodium is a heart related thing

What medication do we give for chronic IBD? UC & crohn's

5-aminosalicylates - sulfasalazine

Is 5-aminosalicylates - sulfasalazine used for acute or chronic IBD?

chronic - to maintain remission

what are the 2 adverse effects of 5-aminosalicylates- sulfasalazine ?

1. risk for bleeding 2. arthralgia - joint pain

what do we remember about salicylates?

anti-inflammatory - like an NSAID

what medication do we give for acute UC?

budesonide - glucocordicoid

what is budesonide - glucocordicoid given for?

actue IBD - to induce remission NOT maintain remission

Do we give glucocordicoid- budesonide to UC or crohns?

UC only b/c it works in the ascending colon and illium (bottom)

What are the adverse effects of glucocordicoid - budesonide?

think steroids- adrenal suppression- cushings osteoporosis increased infection

When is Infliximab used with IBD?

moderate to severe UC and crohn's

Do not give infliximab with other immuomodulator or immunosuppresants because it can increase the risk of __________

lymphoma

what are the 3 adverse effects of Infliximab?

1. chest pain (angina) 2. HTN 3. Hypotention

what are the 4 drug classes for PUD?

1. H2 receptor antagonist - ranitadine 2. PPI - omeprazole 3. antiucler - sucralfate, misoprostol, antacids 4. antibacterial drugs

When do we administer Ranitadine?

1 hour from other meds

what are the 2 main adverse effects of ranitadine?

1. confusion 2. PN - b/c less H+= more bacteria

what are the 4 main adverse effects of omeprazole?

1. dyspepsia- rebound H+ 2. PN- b/c less H+ = more bacteria 3. fractures b/c less H+ = less cal. absorption 4. hypomagnemia b/c less H+ = less mag absorption

when do we administer omeprazole?

before meals

What is Sucralfate used to treat?

GERD duodenal ulcers

how long does sucralfate adhere to ulcers?

6 hours

when do we administer sucralfate with antacids and/or other meds?

30 min to 1 hour before or after antacids 2 hours from meds

What is the MOA of misoprostol?

suppresses gastric acid

what is misoprostol contraindicated in?

pregnancy

what is a common group of meds given for GERD, PUD and gastritis?

antacids- antiulcer

when do we administer antacids?

after meals

which two antacids go well together?

magnesium hydroxide (poop lots) + aluminum hydroxide- amajel (constipation)

Who should not receive aluminum hydroxide?

people with hypophophatemia because it loves to bind to phosphate

week 2 - GI pharm Flashcards

(64 cards)