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54 Cards in this Set
- Front
- Back
Drugs for acid related disorders
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H2RA, PPI, Prostaglandin E analogue, Cytoprotective agents, anti H. pylori regimens
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Drugs for nausea/vomiting
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5HT antagonist, histamine H1 antagonist, Dopaminergic D2 antagonist, Benzodiazepines, corticosteroids, cannabinoids
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drugs for variceal hemorrhage
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somatostatin, octreotide, vasopressin
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list H2RAs (4)
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cemitidine (tagamet), ranitidine (Zantac), famotidine (pepcid), nizatidine (axid)
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H2RA MOA
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reversible, competitive inhibition of histamine-2 receptor
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which H2RA interferes with Cyt P450?
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cimetidine
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rare, serious side effects of H2RA?
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leukopenia, thrombocytopenia, anemia, bradycardia, hypotension
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clinical uses of H2RAs
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GERD, PUD, non-ulcer dyspepsia, stress gastritis prevention
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PPI agents available
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omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), pantoprazole (Protonix), esomeprazole (Nexium)
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PPI MOA
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prodrugs, irreversibly bind H+/K+ atpase, concentrated 1000x in acidic canaliculi
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PPI pkinetics
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short serum t 1/2 ~1.5 hrs, but duration of action is 24h, takes 3-4 days before full potential is reached
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which PPI inhibits Cyt P450?
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omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), pantoprazole (Protonix), esomeprazole (Nexium)
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Clinical uses of PPIs
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GERD, PUD, non-ulcer dyspepsia, stress gastritis prevention, Zollinger Ellison Sydrome
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what is the prostaglandin E analogue?
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misoprostol (Cytotec)
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how does misoprostol work?
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stims mucus and bicarb secretion and enhances mucosal blood flow
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problem with misoprostol?
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lots of side affects: diarrhea, uterine bleeding, abortion
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prokinetic agents?
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meoclopramide (Reglan), bethanechol, macrolides (erythromycin)
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metoclopramide MOA
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stims release of ach from myenteric neurons, increases LES pressure and enhances gastric emptying
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metoclopramide Side Effects:
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neuropsychiatric side effects in 10-20%, EPS
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uses of metoclopramide
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Gastroparesis, anti-emetic, GERD, non-ulcer dyspepsia
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where is the brainstem vomiting center?
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lateral medullary reticular formation
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what provides input into brainstem vomiting center?
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CTZ, vestibular system, pharynx, GI tract, cerebral cortex
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5HT3 serotonin antagonists
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ondansetron (zofran), granisetron (Kytril), dolasetron
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five types of laxatives
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bulk forming, stool surfactant, osmotics, PEGs, Stimulants
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what is a bulk forming laxative?
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indigestible substance that swells w/ water. Fiber: metamucil
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what is a stool surfactant agent?
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Colace: acts as detergent to soften stool
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what is an osmotic laxative?
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non-absorbable osmotically active agent: milk of magnesia
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list some stimulant laxatives:
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bisacodyl (ducolax), phenolphthalein (ExLax)
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list 3 anti-diarrheal agents
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loperamide (Immodium), diphenoxylate, octreotide
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mechanism of loperamide?
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slows motility through direct action on intestinal nerves
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diphenoxylate mechanism?
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opioid agonist
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Octreotide mechanism?
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synthetic peptide, mimics somatostatin
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Drugs used for IBS?
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antispasmodics and antidepressants, alosetron and tegaserod
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list some antispasmodics?
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Bentyl (dicylomine HCl), Levsin (hyocyamine sulfate)
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Mech of alosetron?
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selective 5ht3 antagonist, decreases visceral sensitivity
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mech of Tegaserod?
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5HT4 agonist, prokinetic effect
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5-ASA drugs
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pentasa, asacol, rowasa
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5-ASA mech?
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inhibits NFkB, transcription factor for pro-inflammatory cytokines
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key to 5-ASA delivery/bioavailability?
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works topically, so need to deliver high concentration
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when to use 5-ASA?
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first line against UC and CD
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which glucocorticoids used for IBD?
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prednisone and prednisolone
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glucorticoid MOA?
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anti-inflammatory and immunosuppresive: block TNF-a, IL-1, IL-8, NOS, phospholipase A2, cox2
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side effects of glucocorticoids?
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petechiae, bruising, striae, moon face, acne, HTN, ifxn
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how do you dose glucocorticoids?
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use high dose to induce remission, after stabilization, slowly taper dose
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Azathioprine MOA
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intracellular accumulation of 6-thioguanine tns inhibts pathways of purine synthesis/repair, causing inhibition of cell division
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p-kinetics of AZA/6MP
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AZA quickly metabolized to 6MP, 6MP inactivated by TPMT, converted to active 6TG by HGPRT
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problem with giving AZA?
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if px has TPMT deficiency, get toxic levels of drug
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adverse effects of AZA:
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allergic, dose related: BMS, anemia, leukocytopenia, thrombocytopenia
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methotrexate MOA
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inhibits DHFR, which is critical for production of thymidylate and purines
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MTX toxicities
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BMS, GI ulcer, stomatitis, alopecia, rescue with tetrahydrofolate
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which IBD benefits from MTX?
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CD, not UC
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what is infliximab?
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monoclonal anti-TNFa
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which IBD benefits from infliximab?
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UC and CD
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Drugs for IBD?
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5-ASA, prednisone, AZA, MTX, infliximab, abx, cyclosporine
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