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103 Cards in this Set

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Pepcid
H2
(Famotidine) 20-40 mg tab, 40 mg/5ml suspension. Dose 20 mg bid or 40 mg hs
Tagamet
H2
(Cimetidine) 200-300-400-800 mg tab; 300 mg/5ml; IV soln. Dose 300 mg tid, 400 mg bid or 800 mg hs; 900 mg/d IV infusion
Zantac
H2
(Ranitidine) 150-300 mg tab; 75 mg/5ml syrup. Dose 150 mg bid or 300 mg hs; 50 mg q6 8h IVPB
Axid
H2
(nizatidine) 150 mg tablet. Dose 150 mg bid or 300 mg hs
Protonix
Proton pump inhibitors bind to and inhibit the H+/K+ -adenosine triphosphatase (ATPase) pump of the parietal cell, resulting in a marked decrease in acid secretion.

(Pantoprazole ) 40 mg tab 1-2x/day PO or 80 mg q12h IV
Prilosec
PPI
(Omeprazole) 10-20 mg tab 1-2x/day
Prevacid
PPI
(Lansoprazole) 15-30 mg cap QD
Aciphex
(Rabeprazole) 20 mg tab once daily
Nexium
PPI
(Esomeprazole) capsule 20 or 40 mg cap once/day
H. Pylori triple drug therapy (Primary)
- Amoxicillin 1 gram BID (#28 x 500mg), plus
(may use Metronidazole/Flagyl 500 mg BID if amoxicillin is not tolerated)
- Clarithromycin (Biaxin) 500 mg BID (#14 x 500mg), plus
- Omeprazole (Prilosec) 20 mg BID or Pantoprazole (Protonix) 40 mg BID (#14 x 40mg)
H. Pylori triple drug therapy Alternatives
Omeprazole 20 mg + Flagyl 500 mg + Clarithromycin 250 mg BID x 10 days

Peptobismuth 2 tab qid + tetracycline 500 mg qid (or Amoxicillin 500 mg qid) + Flagyl 250 mg qid x 2 wks.
C. Difficile Infection
Metronidazole (Flagyl) 250 mg qid or 500 mg tid PO or IV for 7-10 days, or
Vancomycin 125 mg qid PO for 8-10 days
Compazine/Prochlorperazine
anti-emetic
Tigan/Trimethobenzamide
Antiemetic
Reglan/Metoclopramide
antiemetic
Vistaril/Hydroxyzine
antiemetic
Phenergan/Promethazine
antiemetic
Benadryl/Diphenhydramine
Anti-emetic; anti-histamine
Zofran/Ondansetron
Anti-emetic
Scopolamine
Anti-emetic
Kytril/Granisetron
Anti-emetic
Inapsine (Droperidol)
Anti-emetic
Anzemet (Dolasetron)
anti-emetic
Bentyl (Dicyclomine)
anti-spasmodic
Donnatal (Phenobarbital-hyoscyamine-atropine-scopolamine)
anti-spasmodic
Donnatal Extentab 1 tab bid
anti-spasmodic
Librax (Librium-chlordiazepoxide/clidinium)
anti-spasmodic
Levsin (Hyoscyamine)
anti-spasmodic
Miralax (Polyethylene glycol) powder
osmotic laxative
Lactulose
osmotic laxative
Sorbitol
osmotic laxative
Bisacodyl (Dulcolax, Correctol)
Laxatives - stimulant
Castor oil
Laxatives - stimulant
Senna
Laxatives - stimulant
Lubiprostone (Amitiza)
Laxatives - stimulant
Cascara
Laxatives - stimulant
Zelnorm (Tegaserod)
5HT4 Receptor partial agonist; stimulates peristalsis and GI secretions
Infliximab (Remicade): MOA and indication
a chimeric mouse-human monoclonal antibody to TNF. It binds free and membrane-bound TNF and thus prevents the cytokine from binding to its cell surface receptor and exerting biological activity.
Infliximab is indicated for the treatment of moderate-to-severe active ulcerative colitis in patients who have experienced inadequate response to conventional therapy. It has been shown to reduce signs and symptoms, to achieve clinical remission and mucosal healing, and to eliminate corticosteroid use
Infliximab (Remicade) dosage
5 mg/kg IV infusion at 0, 2, and 6 wk as induction therapy and followed by 5 mg/kg IV infusion q8wk as maintenance regimen
Infliximab (Remicade) major side effects
Ab pain, N, V, D, elevated ALT, HA, rash, URI, dyspepsia
Azathioprine (Imuran): MOA Usage and Dosage
Purine antimetabolite, converted to mercaptopurine

Effective as a steroid-sparing or steroid-reducing agent. Effective as maintenance agent. Can have delayed onset of action of up to 3-6 mo.

2-3 mg/kg/d PO
Cyclosporine (Neoral, Sandimmune): MOA, Usage, Dosage
Calcineurin inhibitor; suppresses cellular and humoral immunity (mainly Tcells)

Effective as a means of avoiding surgery in patients with severe ulcerative colitis refractory to intravenous corticosteroids.

2-4 mg/kg/d IV infusion (can be switched to PO qd dose doubled that of IV dose as "bridge" therapy as outpatient)
6-Mercaptopurine (Purinethol)
Purine antagonist, antineoplastic

Effective as a steroid-reducing or steroid-sparing agent. Effective in maintaining remission of UC. Can have a delayed onset of action of up to 3-6 months. Usage in Crohns

UC: 1-1.5 mg/kg/d PO
Ciprofloxacin (Cipro)
activity against pseudomonads, streptococci, MRSA, Staphylococcus epidermidis, and most gram-negative organisms but no activity against anaerobes.

Inhibits bacterial DNA synthesis and, consequently, growth.
Metronidazole (Flagyl)
Imidazole ring-based antibiotic active against various anaerobic bacteria and protozoa. Used in combination with other antimicrobial agents (except for C difficile enterocolitis).
Methylprednisolone (Solu-Medrol, Depo-Medrol, Medrol)
Used in moderate-to-severe active cases for induction of UC remission. They have no benefit in maintaining remission.

80 mg IV q8h; dose may vary
Prednisone (Deltasone, Orasone, Meticorten)
Used in moderate-to-severe active cases for induction of UC remission. They have no benefit in maintaining remission.

40-60 mg/d PO as induction for 7-14 d followed by gradual taper by 5 mg/wk of prednisone to dose of 20 mg/d and then 2.5-5 mg/wk below 20 mg/d
Sulfasalazine (Azulfidine, EN-Tabs)
Useful in treating mild-to-moderate ulcerative colitis and maintaining remission. It acts locally in the colon to reduce the inflammatory response and systemically inhibits prostaglandin synthesis.

Induction: 4-6 g/d in PO divided dose
Maintenance: 2-4 g/d PO in divided dose
Balsalazide (Colazal)
Useful in the treatment of mild-to-moderate ulcerative colitis and maintaining remission.
Prodrug converted into 5-aminosalicylic acid through bacterial azoreduction. Ninety nine percent of drug is delivered to the colon.


750 mg cap PO (induction: 6.75 g/d;
maintenance: 3-6 g/d); divided tid dosing for induction and bid dosing for maintenance
Mesalamine (Asacol, Pentasa, Lialda, Rowasa, Canasa)
Useful for the treatment of mild-to-moderate ulcerative colitis and maintaining remission. Better tolerated and less adverse effects as compared to sulfasalazine.

Topical agents (Rowasa enema & Canasa suppository) are typically used in patients with distal colitis.

Asacol: 400-mg tab (induction: 2.4-4.8 g/d; maintenance is similar to induction) PO tid dosing
Pentasa: 250 mg/500 mg cap (induction: 2-4 g/d; maintenance is similar to induction) PO qid dosing
Lialda : 1.2 g tab (induction only: 2.4-4.8 g/d) PO qd dosing
Rowasa enemas: 4 g/60 mL (induction: 4 g PR qd; maintenance can be less frequent) PR qhs dosing or less frequent for maintenance
Canasa: 500 mg/1000 mg (induction: 1 g PR qd; maintenance is similar to induction) PR bid or qd dosing
Adalimumab (Humira)
Recombinant human IgG1 monoclonal antibody specific for human TNF. Binds specifically to TNF-alpha and blocks interaction with p55 and p75 cell-surface TNF receptors. This interferes with cytokine driven inflammatory processes. It also lyses surface TNF-expressing cells in vitro in the presence of complement, but it does not bind to TNF-beta (lymphotoxin).
Crohns
Induction dose: 160 mg SC once (administer by either dividing dose into 4 injections on day 1 or over 2 days), then follow with 80 mg SC once at week 2
Maintenance: 40 mg SC q2wk beginning at week 4
Certolizumab pegol (Cimzia)
Pegylated anti–TNF-alpha blocker, which results in disruption of the inflammatory process. Indicated for moderate to severe Crohn disease in individuals whose condition has not responded to conventional therapies.

400 mg SC initially; repeat at weeks 2 and 4; if favorable response occurs, initiate maintenance dose of 400 mg SC q4wk
Administer as 2 separate 200-mg SC injections at 2 separate sites in abdomen or thigh
Methotrexate (Rheumatrex, Trexall)
Structural analogue to folic acid that inhibits binding of dihydrofolic acid to the enzyme dihydrofolate reductase.

Crohns
25 mg IM with concomitant lowering of prednisone dose; once response is achieved, may switch to PO therapy; folic acid at dose of 1 mg/d should be given during treatment
Budesonide (Entocort EC)
Alters the level of inflammation in tissue by inhibiting multiple types of inflammatory cells and decreasing the production of cytokines and other mediators involved in inflammatory reactions.

Steroid used in crohns and Collagenous colitis

9 mg (3 X 3-mg cap) qd for 8 wk
Loperamide hydrochloride (Imodium AD)
Poorly absorbable opiate that decreases colonic smooth muscle contraction and propulsive activity. Slows intestinal motility and delays colonic transit. Reduction of gastrointestinal secretion may contribute to the antidiarrheal effect.

Chronic diarrhea conditions: 2 mg (1 cap or 10 cc elixir) PO after each loose bowel movement; not to exceed 16 mg/d
Diphenoxylate hydrochloride/atropine sulfate (Lomotil)
Antidiarrheal agent chemically related to narcotic analgesic meperidine. A subtherapeutic dose of anticholinergic atropine sulfate is added to discourage overdosage, in which case diphenoxylate may clinically mimic the effects of codeine.
Each tab of Lomotil (or 5 cc of elixir) contains 2.5 mg diphenoxylate hydrochloride and 0.025 mg atropine sulfate.
Bismuth subsalicylate (Pepto-Bismol)
Controls diarrhea by reducing fluid secretion into intestinal lumen, by binding bacterial toxins, or by acting as an antimicrobial agent.

3 tab PO in morning, 2 tab PO at noon, and 3 tab PO at night for an 8-wk trial
Cholestyramine (Questran, LoCholest)
Diarrhea in patients with LC and possible bile salt malabsorption may respond to exchange resins.

Absorbs bile salts in the intestine, resulting in an insoluble complex that is excreted in feces.
Drugs used in Collagenous Colitis/LC
Lomotil
Cholestyramine
Hyoscyamine (Levsin SL)
Sulfasalazine
Mesalamine
Prednisone
Budesonide (Entocort EC)
Azathioprine (Imuran), 6-merMethotrexate captopurine (Purinethol)
Sulfasalazine (Azulfidine EN-tabs)
Prodrug complexing the active component of 5-aminosalicylic acid (5-ASA) with an inactive sulfapyridine moiety to prevent systemic absorption in upper gastrointestinal tract. In the colon, the diazo bond is cleaved by bacterial flora and active 5-ASA is released to function as a topical anti-inflammatory drug. Adverse effects typically are due to sulfapyridine rather than to 5-ASA.

Initially: 500-1000 mg PO bid/qid, with ideal dose being lowest effective dose
Dosage reduction may be required with concurrent oral anticoagulants, sulfonylurea hypoglycemic agents, and hydantoin anticonvulsants
What is Sustained Virological Response in Hep C Therapy
the persistent absence of HCV RNA in serum 6 months or more after completing antiviral treatment
What are the two goals of Hep C therapy
(1) achieve sustained virological response [SVR]) (2) prevent progression to cirrhosis, HCC, and decompensated liver disease requiring LT.
How long into treatent should HCV RNA be evaluated
12 weeks
What is the Quant HCV RNA reduction that should be acheived to indicated continuation of therapy
undetectable or >2 log fold reduction because there is a 65% chance of SVR in the future
Adverse effects of interferon therapy for Hep C
Hematological complications (ie, neutropenia, thrombocytopenia), neuropsychiatric complications (ie, memory and concentration disturbances, visual disturbances, headaches, depression, irritability), flulike symptoms, metabolic complications (ie, hypothyroidism, hyperthyroidism, low-grade fever), gastrointestinal complications (ie, nausea, vomiting, weight loss), dermatological complications (ie, alopecia), and pulmonary complications (ie, interstitial fibrosis)
Adverse effects of ribarvarin therapy for Hep C
Hematological complications (ie, hemolytic anemia), reproductive complications (ie, birth defects), and metabolic complications (ie, gout)
Interferon alfa-2b (Intron-A) dosage
3 million U SC 3 times/wk
Interferon alfa-2a (Roferon)
3 million U SC 3 times/wk
Interferon alfacon-1 (Infergens)
Synthesized by combining most common amino acid sequences from all 12 naturally occurring IFNs

9 mcg SC 3 times/wk
Pegylated interferon alfa-2b (PEG-Intron): Background and dosage
Consists of IFN alfa-2b attached to a single 12-kd PEG chain. Excreted by kidneys. Has sustained absorption, slower rate of clearance, and longer half-life than unmodified IFN. Permits more convenient once-weekly dosing. Significantly improves quality of life for patients.

1.5 mcg/kg SC qwk
Pegylated interferon alfa-2a (Pegasys)
Consists of IFN alfa-2a attached to a 40-kd branched PEG molecule. Predominantly metabolized by liver.

180 mcg SC qwk
Ribavirin (Rebetol)
10.6 mg/kg PO qd or divided bid
Amoxicillin (Amoxil, Biomox, Trimox)
Derivative of ampicillin and has similar antibacterial spectrum, namely certain gram-positive and gram-negative organisms. Superior bioavailability and stability to gastric acid and has broader spectrum of activity than penicillin. Somewhat less active than that of penicillin against Streptococcus pneumococcus. Penicillin-resistant strains also resistant to amoxicillin, but higher doses may be effective. Interferes with synthesis of cell wall mucopeptides during active multiplication resulting in bactericidal activity against susceptible bacteria. Used in combination with other antimicrobial agents.

Part of H. Pylori triple therapy
Clarithromycin (Biaxin)
Semisynthetic macrolide antibiotic that reversibly binds to P site of 50S ribosomal subunit of susceptible organisms and may inhibit RNA-dependent protein synthesis by stimulating dissociation of peptidyl t-RNA from ribosomes, causing bacterial growth inhibition.
Tetracycline (Sumycin)
Inhibits bacterial growth by binding to the 30S ribosomal unit, preventing protein synthesis.
Component of drug combination therapy that effectively treats duodenal ulcer or gastric ulcer associated with H pylori infection. Treats gram-positive and gram-negative organisms and mycoplasmal, chlamydial, and rickettsial infections. Used in combination with other antimicrobial agents.
MOA of PPI
Proton pump inhibitors bind to and inhibit the H+/K+ -adenosine triphosphatase (ATPase) pump of the parietal cell, resulting in a marked decrease in acid secretion.
Misoprostol (Cytotec): usage and dosage
Prostaglandin analog can be used to decrease incidence of peptic ulcers and complications in chronic NSAID users

200 mcg PO qid
Psyllium (Metamucil, Fiberall)
Bulk agents
Chronic prophylaxis, treatment of constipation, or both in patients without anatomic outlet obstruction

15-60 g/d PO with at least 8 glasses of water or could cause obstruction
Methylcellulose (Citrucel)
Theoretically, nonfermentable, less–gas-producing products are better tolerated than psyllium. Occasionally, patients who cannot tolerate one preparation may do well with another product.

15-60 g/d fiber PO with at least 8 glasses of water
Docusate sodium (Colace)/Docusate calcium (Surfak): Class and Usage
Emollient stool softeners

Indicated for patients who should avoid straining during defecation. Allows incorporation of water and fat into stools, causing stools to soften. Tachyphylaxis with long-term use. Effective acutely. Does not induce defecation.
Docusate sodium and casanthranol combination (Peri-Colace, Diocto-C, Silace C)
Emollient stool softeners in combination with stimulants

Docusate sodium allows incorporation of water and fat into stool causing stool to soften.
Casanthranol is an anthraquinone stimulant hydrolyzed by colonic bacteria into active compound. Usually produce action 8-12 h after administration.
Magnesium citrate (Evac-Q-Mag); magnesium hydroxide (Philips' Milk of Magnesia)
Saline laxatives

Causes osmotic retention of fluid, distending the colon and increasing peristaltic activity; promotes emptying of bowel. Works within 3 h PO or 15 min PR. May cause electrolyte imbalance, especially in young children or patients with renal insufficiency.

Magnesium citrate: 11-18 g PO
Magnesium hydroxide: 2.4-4.8 g PO
Magnesium sulfate: 10-30 g PO
Mineral oil (Fleet, Zymenol)
Lubricant laxatives

Generally works within 8 h. Long-term use is accompanied by concerns of lipid pneumonia, lymphoid hyperplasia, and foreign body reactions.

Acute or subacute management of constipation; lubricate intestine and facilitate passage of stool by decreasing water absorption from intestine.
Lubiprostone (Amitiza)
Osmotics
Useful for long-term treatment of constipated patients with slow colonic transit who are refractory to dietary fiber supplementation.

Locally acting chloride channel activator that enhances a chloride-rich intestinal fluid secretion without altering sodium and potassium concentrations in the serum. Specifically activates C1C-2, an apical membrane in the human intestine. Increases intestinal fluid secretion to assist in GI motility, thereby decreasing symptoms of chronic idiopathic constipation (eg, abdominal pain, bloating, straining, hard stools).

24 mcg PO bid with food
Lactulose (Cephulac, Cholac, Constilac, Karo Syrup [for babies])
Osmotic
Produces osmotic effect in the colon, resulting in bowel distention and stimulation of peristalsis.

20-30 g (30-45 mL) PO q1-2h; adjust dose slowly to produce 2-3 soft stools daily
Alternatively, 200 g diluted with 700 mL of water or NS via rectal balloon catheter and retain 30-60 min q4-6h
Sorbitol
Osmotic

Hyperosmotic laxative that has a cathartic action in the GI tract.

PO: 30-150 mL of a 70% solution
Enema: 120 mL as 25-30% solution
Polyethylene glycol solution (Miralax)
Osmotic

Typically used in large volumes for bowel preparation and washout prior to surgical or endoscopic procedures. Now being used in smaller volumes as an osmotic (but not hyperosmotic) agent.
In theory, less risk of dehydration or electrolyte imbalance with isotonic polyethylene glycol compared with hypertonic sugar solutions. The laxative effect is generated because polyethylene glycol is not absorbed and continues to hold water by osmotic action through the small bowel and the colon, resulting in mechanical cleansing.

17 g/d PO in 8 oz of water
Senna (Senokot, Ex-Lax, Senexon, Senna-Gen)
Stimulant laxatives

Anthraquinone is hydrolyzed by colonic bacteria into its active compound. More potent than cascara sagrada and results in considerably more abdominal pain. Usually produces its action 8-12 h after administration.
Bisacodyl (Bisac-Evac, Bisco-Lax, Dulcolax, Dacodyl)
Stimulant laxatives

Stimulates peristalsis by possibly stimulating the colonic intramural neuronal plexus. Alters water and electrolyte secretion, resulting in net intestinal fluid accumulation and laxation. Provokes defecation within 24 h and may cause abdominal cramping.
Cascara sagrada
Stimulant laxatives

Irritates the intestinal mucosa, resulting in increased colonic motility and alteration in fluid and electrolyte secretion.
Castor oil (Alphamul, Emulsoil, Neoloid, Purge)
Reduced to ricinoleic acid. It decreases net absorption of fluid and electrolytes and stimulates peristalsis. Acts on the small intestine.
Casanthranol
Anthraquinone stimulant that is hydrolyzed by colonic bacteria into its active compound. Usually produces action 8-12 h after administration.
Methylnaltrexone (Relistor)
Opioid Antagonist
Peripherally acting mu-opioid receptor antagonist. Selectively displaces opioids from mu-opioid receptors outside CNS, including those located in GI tract, thereby decreasing constipating effects. Indicated for opioid-induced constipation in patients with advanced illness receiving palliative care, when response to laxatives has not been sufficient. Available as a 12-mg/0.6 mL injectable solution for subcutaneous use.
Alvimopan (Entereg)
Opioid Antagonist

Peripherally acting mu-opioid receptor antagonist. Binds mu-opioid receptors in gut, thereby selectively inhibiting negative opioid effects on GI function and motility. Indicated for postoperative ileus following bowel resection with primary anastomosis. Five clinical studies with enrollment >2500 patients demonstrated accelerated recovery time of upper and lower tract GI function with alvimopan compared with placebo. Decrease of hospital days also observed in alvimopan group compared with placebo.
Ursodiol (Actigall)
Ursodeoxycholic acid

Decreases cholesterol content of bile and bile stones probably by reducing secretion of cholesterol from the liver and the amount reabsorbed by intestines.

Gallstone dissolution: 8-10 mg/kg/d PO divided tid
Primary biliary cirrhosis: 10-15 mg/kg/d PO divided tid
Name the three drugs that manage pruritis associated with biliary salts
1. Cholestyramine (Questran)
2. Rifampin (Rifadin)
3. Naloxone (Narcan)
Name 4 agents used in Esophageal Spasm
1. Diltiazam
2. Isosorbide dinitrate (Dilatate SR, Isordil)
3. Imipramine (Tofranil)
4. Botulinum toxin (BOTOX®)
What are the classes and names of the common antiemetics
Antiemetic Agents


Antihistamines
Buclizine (Bucladin-S)
Cyclizine (Marezine)
Dimenhydrinate (Dramamine)
Diphenhydramine (Benadryl)
Meclizine (Antivert)

Anticholinergic agent
Scopolamine (Transderm Scop)

Dopamine antagonists
Chlorpromazine (Thorazine)
Droperidol (Inapsine)
Metoclopramide (Reglan)
Prochlorperazine (Compazine)
Promethazine (Phenergan)

Serotonin antagonists
Dolasetron (Anzemet)
Granisetron (Kytril)
Ondansetron (Zofran)

Other agents
Dexamethasone
Methylprednisolone (Medrol)
Trimethobenzamide (Tigan)
First line antiemetic for gastroenteritis
First-line agents: dopamine antagonists
Second-line agents: serotonin antagonists
Belladona tincture: Type and uses
antimuscarinic, antispasmodic

PUD, IBS, diarrhea, gastric hypermotility
bismuth subsalicylate
antisecretory effect from salicylate
antimicrobial action from bismuth
Rifaximin (Xifaxan)
Binds to the beta subunit of bacterial DNA-dependent RNA polymerase resulting inihibition of transcription
Ocreotide (sandostatin)
Somatostain analog; decreases GH secretion