Cne Etp Pharmacology: Gastrointestinal

Front 1

What maintains the acidity of the stomach?

Back 1

The H+/K+ protein pump

Front 2

What drugs are used to treat Gastroesophageal Reflux disease?

Back 2

1. Histamine Receptor Antagonists
2. Proton Pump Inhibitors
3. Antacids
4. GIi Protectant
5. Prostaglandin

Front 3

What is the common suffix for Histamine Receptor Antagonists?

Back 3

"Tidine"

Front 4

Describe the MOA of Histamine Antagonists.

Back 4

REVERSIBLY inhibit gastric acid secretion by competitively antagonizing H2 receptors on parietal cells

Front 5

Why are histamine antagonists only good for moderate control?

Back 5

They only block 1 of 3 receptors

Front 6

What is the one Histamine Antagonist that is excreted by the kidneys?

Back 6

Nizatidine

Front 7

Which drug causes delirium, sedation and male breasts to grow?

Back 7

Histamine Antagonists

Front 8

Which of the Histamine antagonist inhibit CYP 450 enzymes?

Back 8

Cimetidine

Front 9

Azole antifungals (require acid) have a drug interaction with which reflux drug?

Back 9

Histamine Antagonists, PPIs, Antacids

Front 10

MOA of proton pump inhibitors

Back 10

proton pump inhibitors IRREVERSIBLY bind to proton pumps and inhibit ACTIVE pumps --> stop the "pumping" or release of gastric acid

1st drug of choice in most cases (much more effective than H2 blockers)

Front 11

Are PPIs active upon ingestion?

Back 11

NO, activate in the presence of food

Front 12

What is the advantage of perscribing PPIs?

Back 12

- short half life but are long lasting (24 hours)
- better for compliance
- most effective GI med
- can be used for a longer course of therapy than other GI meds (8-12 weeks)
- absorbed well PO

Front 13

prototype & variations of PPIs

Back 13

PROTOTYPE: prilosec

also: omeprazole (generic name), prevacid, nexium, protonix

Front 14

Which GERD drugs are safe for children?

Back 14

PPIs

Front 15

ADEs of PPIs

Back 15

- nausea/diarrhea
- headache
- increase in bone fractures (interferes with Ca2+ absorption
- higher risk of developing C. diff
- may decrease absorption of some nutrients & vitamins
- can effect absorption of some long-term meds
- rebound acid production if stopped after long-term use

Front 16

How should PPIs be taken?

Back 16

PO w/ meal

Front 17

Which reflux drugs are used for symptom relief only?

Back 17

Antacids

Front 18

Na, Ca, Mg and Al are examples of what GERD drugs?

Back 18

Antacids

Front 19

What are the most frequently used antacids?

Back 19

MgOH and AlOH compounds (aka hydroxides)

Front 20

Which antacids causes constipation? How is it counteracted?

Back 20

Ca and Aluminum

counteracted by giving these drugs in combo with Magnesium (which itself causes diarrhea) --> balance each other out

Front 21

What are some drug interactions for Antacids?

Back 21

Fluoroquinolone and tetracylines --> bind w/ them and inactivate

anti-fungal drugs (need acidic stomach enviro to work)

Front 22

How should antacids be administered?

Back 22

PO and 1-2 hours before tetracyclines and fluoroquinolines

Front 23

What is the one GI protectant?

Back 23

Sucralfate

Front 24

How is Sucralfate administered?

Back 24

Orally: viscous paste in water or acid

Front 25

What is the MOA of Sucralfate?

Back 25

bind to damaged, ulcerated tissue forming a protective barrier

Front 26

Which GERD drug is NOT absorbed and excreted in the feces?

Back 26

Sucralfate

Front 27

What prostaglandin drug is used to treat GERD?

Back 27

Misoprostol

Front 28

which drug is only FDA approved to treat GERD in patients on long term NSAIDs?

Back 28

Misoprostol

Front 29

What is the WORST adverse effect of Misoprostol?

Back 29

Causes uterine contractions! ABORTION!

Front 30

Which GERD drug is a pregnancy category X?

Back 30

Misoprostol

Front 31

What are adverse effects of Prostaglandin drugs?

Back 31

Spontaneous abortion
-Stomach Pain
-Diarrhea

Front 32

How do indirect acting stimuli work to bring about emesis?

Back 32

They first activate chemoreceptor trigger zone

Front 33

What receptors are involved in emesis?

Back 33

Seretonin, Dopamine, Ach, Histamine

Front 34

What are the drugs for Nausea and Vomiting?

Back 34

Phenothiazines
-Nonphenothiazines
-Seretonin 5HT3 antagonists

Front 35

What class of antiemetics are antipsychotic?

Back 35

Phenothiazines

Front 36

Which drugs inhibit dopamine and muscarinic receptors (CTZ) and cause sedation by blocking histamine?

Back 36

Phenothiazines

Front 37

What are the 3 routes of admin for Phenothiazines?

Back 37

PO, IV and PR!!

Front 38

Does Rectal or oral admin have a longer duration in phenothaizines?

Back 38

RECTAL

Front 39

Which Antiemetics cause both extrapyramidal and anticholinergic effects?

Back 39

Phenothizines

Front 40

Metoclopramide (Reglan) is under what class?

Back 40

Nonphenothiazine…Antiemetic

Front 41

What is the MOA of Metoclopramide?

Back 41

inhibits Dopamine and SERETONIN in the CTZ

Front 42

Pts with Obstructions of the GI should not take?

Back 42

Metoclopramides

Front 43

What are the adverse effects of Metoclopramide?

Back 43

CNS (sedation, confusion, extrapyramidal, seizures) crosses the BBB
-Diarrhea

Front 44

Which antiemetics are used to treat chemotherapy induced nausea?

Back 44

Seretonin Antagonists

Front 45

When are Seretonin Antagonists administered>?

Back 45

30 -60 mins prior to chemotherapy

Front 46

Which drugs block both the peripheral and central stimulation of vomiting?

Back 46

Seretonin Antagonists

Front 47

Which Seretonin Antagonist is dosed ONCE WEEKLY?

Back 47

Palonosetron

Front 48

What are the adverse effects of Seretonin Antagonists? How often do they occur?

Back 48

Do not occur often
-headache
-sedation
-dizziness
-constipation

Front 49

What is constipation determined by?

Back 49

Stool consistency, not frequency

Front 50

What are the laxative classes?

Back 50

Chemical Stimulants
-Bulk Stimulants
-Lubricants

Front 51

Which laxative increase the amount of fluid in the stool and increase peristalsis?

Back 51

Chemical Stimulants

Front 52

What drug causes pink, yellowish-brown urine?

Back 52

Senna

Front 53

What can long term use of chemical stimulants cause?

Back 53

Laxative dependence

Front 54

What are some of the common adverse effects of laxatives?

Back 54

Nausea, vomitting, cramping flatulence

Front 55

Which laxatives most resemble fiber and are safe to take normally?

Back 55

Bulk Stimulants

Front 56

What is the predominant use of Bulk stimulants?

Back 56

Prevention of constipation

Front 57

What is the MOA of bulk stimulants?

Back 57

Mechanical Distention of the Bowel (expands the stool)

Front 58

What type of bulk stimulant should DM pts take?

Back 58

One that is sugar free

Front 59

What is the prototype Lubricant?

Back 59

Docusate (Colase)

Front 60

What is the outcome of using Docusate?

Back 60

Stool Softening

Front 61

Which type of pts are often perscribed colase?

Back 61

Cardiac pts, post operatively, or pts on opioids (prevent straining)

Front 62

What are the antidiarrheal agents?

Back 62

2. Diphenoxylate/atropine (Lomotil)
3. Bismuth-subsalicylate (Pepto-bismol)

Front 63

What antidiarrheal is Rx ONLY?

Back 63

Diphenoxylate/atropine

Front 64

Which antidiarreal acts directly on the MUSCLES of the GI tract to slow motility?

Back 64

Loperamide (Imodium)

Front 65

List some common side effects for antidiarrheals.

Back 65

Nausea, vomiting, constipation, abdominal discomfort

Front 66

State the antidiarrheal that acts on the opioid receptors to decresase motility

Back 66

Diphenoxylate/atropine

Front 67

Why is atropine added to Diphenoxylate?

Back 67

To prevent pts from abusing the medication because of opioid effects

Front 68

What affects are seen with high doses of Diphenoxylate/atropine?

Back 68

Morphine-like effects, light headedness, hallucinations

Front 69

Which antidiarrheal turns the stool and tongue black?

Back 69

Bismuth Subsalicylate

Front 70

Which antidiarrheal can cause tinnitus?

Back 70

Pepto-Bismol

Front 71

Which patients cannot take pepto-bismol?

Back 71

Warfarin and those with asaprin allergy

Front 72

What causes peptic ulcer disease?

Back 72

exposure to HCl acid & pepsin

Front 73

What are the main causes of ulcers?

Back 73

- stress
- smoking
- certain meds (ASA, NSAID, coumadin/heparin)
- heliobacter pylori

Front 74

Anti-ulcer meds?

Back 74

- antacids
- ulcer adherents
- histamine-2 receptor blockers
- proton pump inhibitors
- h. pylori agents

Front 75

antacids (prototype)

Back 75

AlOH + MgOH (maalox, mylanta gelusel, di-gel)

Front 76

sodium bicarbonate prototype & category

Back 76

alka-selter/bromo-seltzer --> antacids

Front 77

calcium carbonate prototype & category

Back 77

tums --> antacids

Front 78

simethicone

Back 78

decreases GI gas (antacid)

Front 79

antacids (types & names)

Back 79

aluminum + magnesium:
- maalox
- mylanta gelusel
- di-gel

sodium bi-carbonate:
- alka-seltzer
- bromo-seltzer

calcium carbonate:
- tums

- simethicone (decreases GI gas)

Front 80

therapeutic effects of antacids

Back 80

- chemical neutralization
- decreased pain

Front 81

ulcer adherents (prototype & drug use)

Back 81

sucralfate (carafate)

use/activity:
- anti-peptic activity
- non-absorbant paste forms in acidic environment of stomach and sticks to the lining of the stomach/ulcer
- requires acidic environment to work
- minimal antacid effects

Front 82

ADEs & contraindications for sucralfate

Back 82

- cumbersome schedule --> 1-2 hours AC (before a meal) & HS (before bedtime)
- patient compliance may be difficult
- constipation
- dry mouth
- metallic taste
- interferes w/ absorption of other meds --> can't be taken w/ H2 blockers or PPI or antacids

Front 83

How should sucralfate be taken?

Back 83

should be taken before meals to protect lining of stomach from food & HCl

should only be used for 4-8 weeks

Front 84

mechanism of action for antacids

Back 84

- increase pH of stomach contents
- increases tone of lower esophageal sphincter
- slows gastric emptying (contents stay in stomach for longer)
- improves absorption of meds that are harmed by acid
(impairs absorption of meds that need acid)

Front 85

amphogel (class/type of drug & ADEs)

Back 85

AlOH antacid

can cause constipation

can be used to treat hyperphosphatemia from renal disease (but can also have the ADE of causing hypophosphatemia --> muscle dysfunction, mental status change

Front 86

MOM (class/type of drug & ADEs)

Back 86

MgOH antacid

can cause diarrhea

can cause hypermagnesemia from decreased clearance --> weakness, bradycardia, bradypnea

Front 87

What is one major contraindication for amphogel & MOM?

Back 87

do NOT use MgOH (MOM) or AlOH (amphogel) antacids with GI bleed

Front 88

Indications for use of hydroxides?

Back 88

- tx of stomach pain
- maintenance of duodenal ulcers

***should only be used for up to 2 weeks!! NOT meant for long term use

Front 89

carbonates (prototypes, uses)

Back 89

alka seltzer & tums

- have a better ANC than hydroxides
- have a more systemic absorption
- calcium carbonate can be used for people with hypocalcemia (but only should be used for people with osteoporosis, not prophylactically)

Front 90

carbonates nursing interventions

Back 90

- monitor electrolyte levels!!!!
- take 2 hours after other drugs
- take 1-3 hours after meals & at bedtime
- taken PO (solution & chewable tablets)
- tablets taken w/ water
- solution must be shaken

Front 91

ADEs & contraindications for sodium bicarbonate

Back 91

sodium bicarbonate: careful w/ low-sodium diet (for people with HTN, CHF, RF)

metabolic alkalosis

Calcium carbonates: bind with tetracyclines & fluoroquinalones and make them inactive. Also there's a potential for altered fluid/electrolyte balance.

all carbonates use CYP 450 --> lots of drug interactions (give 1-2 hours before after other drugs)

carbonates can't be taken w/ antifungals

Front 92

Uses for H2 receptor blockers?

Back 92

- treatment of PUD
- prevent & treat ulcers
- treat GERD/acid reflux

Front 93

How frequently is Tagamet used in the hospital setting?

Back 93

not very frequently at all:
- interferes with the metabolism of lots of drugs
- should only be taken for a short period of time (OTC drug)

Front 94

ADEs of H2 receptor blockers

Back 94

- nausea
- diarrhea
- headaches
- dizziness
- confusion in elderly pts

Front 95

How should H2 receptor blockers & antacids be administered together?

Back 95

should be taken at least 2 hours apart

Front 96

How is H. pylori treated?

Back 96

treated with:
1. a combo of 2 antibiotics (there are 4 that can be used)
2. a PPI or H2 receptor blocker

often comes packaged in "Previpak" (somewhat expensive)

Front 97

Which antibiotics can be used as part of H. pylori treatment?

Back 97

usually amoxicillin and biaxin

Front 98

Differences b/w laxatives & cathartics?

Back 98

laxatives are more mild & make soft, semi-hard stool

cathartics have stronger effect & make liquid-y & more rapid stools --> for rapid bowel clearing

Front 99

prototype, action, and timing of laxatives

Back 99

lubricant laxatives -- mineral oil, castor oil

lubricate intestines

works within 8 hours

Front 100

2 types of cathartics

Back 100

1. saline cathartics
2. irritant/stimulant cathartics

Front 101

prototypes, action, and timing of saline cathartics

Back 101

prototypes: MOM, fleets enema, goLYTELY

action: increases osmotic pressure; bowel cleansing/rapid bowel cleaning

timing: rapid

assess patients & never give more than 3 times in a row --> could throw off electrolyte balance

Front 102

prototypes, action, and timing of irritant/stimulant cathartics

Back 102

prototypes: cascara, senekot, dulcolax

action: irritates the GI mucosa; eliminates toxic substances from colon

timing: quicker than bulk forming
**most abused**

Front 103

surfactant/stool softeners (action, prototypes)

Back 103

action: don't cause stool, just soften it. prevents straining. (good for pts w/ increased ICP or MI --> don't want them to be straining to poo)

prototypes: colace

Front 104

bulk forming (action, prototypes, timing)

Back 104

action: adds bulk to increase peristalsis; treats constipation --> acts the same as increasing fiber & fluids in diet

prototypes: metamucil, fibercon

timing: acts within 24 hours

Front 105

types of anti-diarrheal meds & prototypes

Back 105

- opiate derivatives (lomotil, imodium)

- misc: pepto-bismol, kaopectate

- specific therapy (antibiotics for intestinal infections, supplemental digestive enzymes)

Front 106

drugs that can be used as anti-emetics

Back 106

- phenothiazines
- antihistamines
- serotonin receptor antagonists
- benzodiazapines (part of a multi-drug regimen --> reduce N/V when caused by anxiety)

Front 107

Drugs used for motion sickness? (and class)

Back 107

dramamine, vistaril, antivert

antihistamines

take 30 minutes before