Fa: Gastrointestinal - Pharmacology

Front 1

What drugs are Histamine H2 receptor blockers?

Back 1

- Cimetidine
- Ranitidine
- Famotidine
- Nizatidine

"Take H2 blockers before you DINE. Think "table for 2" to remember H2"

Front 2

What is the mechanism of Cimetidine, Ranitidine, Famotidine, and Nizatidine?

Back 2

Reversible block of histamine H2 receptors → ↓ H+ secretion by parietal cells

Front 3

What are the clinical uses of Cimetidine, Ranitidine, Famotidine, and Nizatidine?

Back 3

- Peptic ulcer
- Gastritis
- Mild esophageal reflux

Front 4

What are the side effects of Cimetidine, Ranitidine, Famotidine, and Nizatidine?

Back 4

- Potent inhibitor of cytochrome P450 (multiple drug interactions)
- Anti-androgenic effects
- Crosses blood-brain barrier and placenta
- Cimetidine and Ranitidine ↓ renal excretion of creatinine

Front 5

What are the effects of Cimetidine, Ranitidine, Famotidine, and Nizatidine on androgens?

Back 5

Anti-androgenic effects:
- Releases prolactin
- Gynecomastia
- Impotence
- ↓ Libido in males

Front 6

What are the implications of Cimetidine, Ranitidine, Famotidine, and Nizatidine crossing the blood-brain barrier?

Back 6

- Confusion
- Dizziness
- Headaches

Front 7

Which H2 blockers have effects on the kidneys? What effect?

Back 7

Cimetidine and Ranitidine decrease renal excretion of creatinine

Front 8

What are the proton pump inhibitors?

Back 8

- Omeprazole
- Lansoprazole
- Esomeprazole
- Pantoprazole
- Dexlansoprazole

Front 9

What is the mechanism of Omeprazole, Lansoprazole, Esomeprazole, Pantoprazole, Dexlansoprazole?

Back 9

Irreversibly inhibits H+/K+ ATPase in stomach parietal cells

Front 10

What are the clinical uses of the proton pump inhibitors?

Back 10

- Peptic ulcer
- Gastritis
- Esophageal reflux
- Zollinger-Ellison syndrome

Front 11

What are the toxic effects of Omeprazole, Lansoprazole, Esomeprazole, Pantoprazole, Dexlansoprazole?

Back 11

- Increased risk of C. difficile infection
- Increased risk of pneumonia
- Hip fractures
- ↓ serum Mg2+ with long-term use

Front 12

What drugs bind to the ulcer base providing a physical protection and allow HCO3- secretion to reestablish the pH gradient in the mucus layer? Clinical use?

Back 12

Bismuth and Sucralfate
- Used to increase ulcer healing and travelers' diarrhea

Front 13

What is the mechanism of Bismuth and Sucralfate?

Back 13

- Binds to ulcer base, providing a physical protection
- Allows HCO3- secretion to reestablish pH gradient in the mucus layer

Front 14

Which drug is a PGE1 analog? Effect?

Back 14

Misoprostol - ↑ production and secretion of gastric mucus barrier and ↓ acid production

Front 15

What kind of drug is Misoprostol? Clinical use?

Back 15

PGE1 analog
- Used for prevention of NSAID-induced peptic ulcers (NSAIDs block PGE1 production)
- Maintenance of PDA
- Also used to induce labor (ripens cervix)

Front 16

What are the toxic effects of Misoprostol?

Back 16

- Diarrhea
- Contraindicated in women of child-bearing potential (abortifacient)

Front 17

What drug is a long-acting somatostatin analog?

Back 17

Octreotide

Front 18

What is the mechanism and uses of Octreotide?

Back 18

- Long-acting somatostatin analog
- Acute variceal bleeds
- Acromegaly
- VIPoma
- Carcinoid tumors

Front 19

What are the toxic effects of Octreotide?

Back 19

- Nausea
- Cramps
- Steatorrhea

Front 20

What are the types of antacids?

Back 20

- Aluminum hydroxide
- Calcium carbonate
- Magnesium hydroxide

Front 21

What are the general effects of antacids?

Back 21

- Can affect absorption, bioavailability, or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying
- All can cause hypokalemia
- All have their own specific problems

Front 22

What are the negative side effects of Aluminum Hydroxide?

Back 22

- Constipation and hypophosphatemia (aluMINIMUM amount of feces)

- Proximal muscle weakness
- Osteodystrophy
- Seizures

Front 23

What are the negative side effects of Calcium Carbonate?

Back 23

- Hypercalcemia
- Rebound acid ↑
- Can chelate and ↓ effectiveness of other drugs (eg, tetracycline)

Front 24

What are the negative side effects of Magnesium Hydroxide?

Back 24

- Diarrhea (Mg = Must Go to the bathroom)
- Hyporeflexia
- Hypotension
- Cardiac arrest

Front 25

What are the types of osmotic laxatives?

Back 25

- Magnesium Hydroxide (Mg = Must go)
- Magnesium Citrate (Mg = Must go)
- Polyethylene glycol
- Lactulose

Front 26

What is the mechanism of Magnesium Hydroxide, Magnesium Citrate, Polyethylene Glycol, and Lactulose?

Back 26

Osmotic Laxatives:
- Provides osmotic load to draw water out

Front 27

Besides acting as an osmotic laxative, what are the other effects of Lactulose?

Back 27

Also treats hepatic encephalopathy since gut flora degrade it into metabolites (lactic acid and acetic acid) that promote nitrogen excretion as NH4+

Front 28

What are the clinical uses of Magnesium Hydroxide, Magnesium Citrate, Polyethylene Glycol, and Lactulose?

Back 28

Osmotic laxatives: used for constipation

Front 29

What are the side effects of Magnesium Hydroxide, Magnesium Citrate, Polyethylene Glycol, and Lactulose?

Back 29

Osmotic laxatives: diarrhea, dehydration, may be abused by bulimics

Front 30

What is the mechanism of Infliximab?

Back 30

Monoclonal antibody to TNF-α

Front 31

What GI disorders is Infliximab used for?

Back 31

- Ulcerative colitis
- Crohn disease

Front 32

What are the side effects of Infliximab?

Back 32

- Malaise
- Nausea
- Sulfonamide toxicity
- Reversible oligospermia

Front 33

What ist he mechanism of Ondansetron?

Back 33

5-HT3 antagonist
- ↓ Vagal stimulation
- Powerful central-acting antiemetic

Front 34

What are the clinical uses of Ondansetron?

Back 34

- Controls vomiting post-operatively
- Controls vomiting in patients undergoing cancer chemotherapy

- At a party but feeling queasy? Keep ON DANCing with ONDANSetron!

Front 35

What are the side effects of Ondansetron?

Back 35

- Headache
- Constipation

Front 36

What is the mechanism of Metoclopramide?

Back 36

D2 receptor antagonist:
- ↑ Resting tone, contractility, LES tone, and motility
- Does not influence colon transport time

Front 37

What are the clinical uses of Metoclopramide?

Back 37

- Diabetic and post-surgery gastroparesis (delayed gastric emptying)
- Anti-emetic

Front 38

What are the side effects of Metoclopramide?

Back 38

- ↑ Parkinsonian effects
- Restlessness, drowsiness, fatigue, depression
- Nausea, diarrhea

- Interacts with Digoxin and Diabetic agents
- Contraindicated in patients with small bowel obstruction of Parkinson disease (D1-receptor blockade)