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103 Cards in this Set

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What NT is the dominant route of acid secretion in the stomach?
histamine

(Gastrin stimulates acid secretion principally by promoting the release of histamine from ECL cells)
Name 2 common preparations of antacids
aluminum/magnesium hydroxide

calcium carbonate
How do antacids work?
neutralize gastric acidity which increased the pH - pepsin does not actively proteolyze when pH is >4
Antacids decrease absorption of which drugs?
TTC
FQs
itra/ketoconazole
Iron
Dig
Phenytoin
What electrolyte abnormality can result from large or prolonged doses of aluminum/magnesium hydroxide?
hypophosphatemia
Renal failure pts taking AL(OH)3 antacids are at risk for what?
Aluminum intoxication

(dementia, encephalopathy, seizures, confusion, coma)
What does calcium carbonate tend to cause in the elderly?
constipation
What can CaCO3 cause in renal failure pts?
milk-alkali syndrome(HA, nausea, irritability, weakness, hypercalcemia, metabolic alkalosis)

and hypophosphatemia
What two GI drugs can cause hypophosphatemia in renal failure pts?
antacids (aluminum/magnesium hydroxide, OR calcium carbonate)
Which antacid has laxative effects?
Mg(OH)2
How does sucralfate work?
Forms a complex by binding with positively charged proteins in exudates  viscous paste-like, adhesive substance
Forms a protective coating that protects the lining against peptic acid, pepsin, & bile salts
What are the common clinical uses of aluminum sucrose sulfate?
GERD/PUD
treatment of NSAID-induced mucosal damage

prevention of stress ulcers

tx of stomatitis from chemo
sucralfate
What GI drug may be used in topical form for treatment of stomatitis due to chemo?
sucralfate
Sucralfate decreases the absorption of what other drugs? How can this be overcome?
dig
phenytoin
warfarin
itra/ketoconazole
theophylline
TTC
FQ

*take meds 2 hrs prior to sucralfate (but its a QID drug!)
What is the cleanest H2 antagonist?
famotidine
Name the first generation H2 antagonists
cimetidine
ranitidine
Name the second generation H2 antagonists.
famotidine
nizatidine
How do H2 blockers work?
they inhibit secretion of acid by blocking histamine receptors on the parietal cell
WHich GI drug is more likely to lead to nosocomial pneumonia when used to prevent UGI bleed in critically ill patients?
H2 blockers
WHich other drugs do H2 blockers interfere with because of alteration of the environment of the gut?
itra/ketoconazole, iron, dig, phenytoin (b/c they need an acidic environment)
What are the CYP interactions of cimetidine?
inhibitor of 3A4, 2C9, and 2C19
Which H2 blocker may lead to anti-androgen effects?
cimetidine
which H2 blocker(s) may lead to drug fever?
all of them
If the white count drops suddenly in a patient being treated for GERD, what might you suspect they are being treated with?
H2 blocker
What drugs cause drug fever?
antiepileptics
beta lactams
H2 blockers
Which PPI has the fastest onset?
Rabeprazole
Name the PPIs.
Omeprazole
Esomeprazole
Lansoprazole
Rabeprazole
Pantoprazole
When should PPIs be taken? Why?
before the first meal of the day because they need to be activated in an acidic environment.
What are the most potent inhibitors of gastric acid secretion available?
PPIs
How do PPIs work?
they inhibit the parietal cell H+/K+ ATP pump suppressing gastric basal AND stimulated secretion of acid
Name two "gastric hypersecretory states" that PPIs or H2 blockers may be used to treat.
Zollinger-Ellison
MEN
What drug besides H2 blockers may be used for prevention of UGI bleed in critically ill pts? (this one also may inc nosocomial pneumonia)
PPIs
Which two PPIs cause moderate inhibition of 2C9?
pantoprazole
omeprazole
Just like antacids and H2 blockers and sulfracrate will reduce absorption of which drugs?
itra/ketoconazole
phenytoin
dig
Iron
WHat is the biggest side effect of PPIs? (more likely at high doses)
diarrhea
How do fiber and bulk laxatives work?
inc bulk --> inc motility --> dec transit time in the colon
What constipation meds are NOT helpful for opiate-induced constipation?
bulk laxatives/fiber
When is fiber contraindicated?
when pt has obstructive symptoms
Name 3 bulk laxatives
psyllium
Methylcellulose
Calcium polycarbophil
How do stool softeners work?
They decrease surface tension and allow stool to absorb more water
Which two constipation drugs may take up to 3 days to start working?
bulk laxatives
stool softeners
Are stool softeners primarily for tx or prevention?
prevention
Name two stool softeners.
Docusate sodium
Docusate calcium
Which constipation drug can give you hypermagnesemia (so you should avoid prescribing it in CRF pts)?
Saline laxatives (magnesium hydroxide)
How does milk of magnesia work? (magnesium hydroxide)
hyperosmolar agent - it draws fluid into the gut.
Name some stimulant laxatives.
bisacodyl
senna
senekot
castor oil
How do stimulant laxatives work?
they alter the electrolyte transport and stimulate the myenteric plexus
Which are the hyperosmolar laxatives?
Sorbitol
Lactulose
PEG
Which constipation med is used in hepatic failure because it removes ammonia?
lactulose
How do the hyperosmolar laxatives sorbitol and lactulose work?
they are disaccharides that are not metabolized by the enzymes in the intestine so water and electrolytes remain in the lumen due to the osmotic effect of the sugar (but they also lead to gas!)
sorbitol and lactulose
How does polyethylene glycol work?
increases intraluminal fluid
What constipation drug is used for bowel preps? What type of laxative is it?
PEG (Golytely); hyperosmolar
What drug is a lubricant laxative?
mineral oil
What is a side effect of long term use of mineral oil laxatives?
malabsorption of fat-soluble vitamins
In which patients should you avoid suppositories?
neutropenic or thrombocytopenic pts

(e.g. leukemia or BRCA pts undergoing chemo)
Name two suppositories for constipation
glycerin
bisadocyl
In which pts should you avoid enemas for constipation?
neutropenic or thrombocytopenic pts
same as suppositories
Which type of enema would you try first? next?
1. phosphate (Fleet)
2. tap water
Name the steps for outpatient constipation?
1. fiber (not for opiate induced)
2. MOM
3. stimulants, lactulose, or PEG if still constipated after 1 and 2.
What is the recommendation for hospitalized/opiate constipation?
stool softener plus stimulate laxative (start WITH the opiate)
What should be the first step in the treatment of urinary incontinence?
behavioral measures
What types of incontinence is pharmacologic management mainly for? What class of drugs is mainly used?
urge and mixed

antimuscarinics
What can cause urge incontinece?
neurogenic bladder (diabetes)
age
pg
UTIs
BPH
etc . . .
What is oxybutynin for?
urinary incontinence
Which oxybutynin formulation is probably best tolerated?
oxytrol (transdermal)
How do tolteradine, trospium, and oxybutynin work?
inhibits ACH on smooth muscle --> less IVS
Who should you be careful prescribing incontinence meds to?
pts with urinary retention or narrow angle glaucoma
What are the advantages to transdermal antimuscarinics for urinary incontinence?
less xerostomia and constipation
WHat urinary incontinence drug is a substrate of 2D6 and 3A4?
tolteridine
(solifenacin and darifenacin are also 3A4 substrates)
Which urinary incontinence med is available in a transdermal patch?
oxybutynin
Which will probably give you more xerostomia, tolteridine or oxybutynin?
oxybutynin
What is trospium?
anticholinergic for urinary incontinence
What is the drug interaction specific to trospium and not other incontinence meds?
cations may compete with it for renal excretion.

amiloride, dig, metformin, and vanco may interfere
Which urinary incontinence meds are more selective for the M3 receptor (in the bladder/GI tract)?
solifenacin and darifenacin

(fewer SEs)
What are the CYP interactions of solifenacin and darifenacin?
3A4 substrate
Name some drugs used to treat BPH
terazosin
doxazosin
tamsulosin
alfuzosin
finasteride
dutasteride
How do the alpha antagonists for tx of BPH? (terazosin and doxazosin)
relax smooth muscle of the bladder neck which decreases bladder outlet obstruction
Which alpha antagonist is not actually approved to treat BPH?
prazosin
What is the most significant side effect of terazosin and doxazosin and how can it be reduced?
postural hypotension; give first few doses at bedtime
BPH drugs should not be used with what other drugs?
ED drugs
Postural hypotension, drowsiness/fatigue, nasal congestion, rhinitis, and impotence may be side effects of what meds?
alpha blockers
How does tamsulosin work?
it is an alpha 1A antagonist (specific to the prostate and bladder neck) which causes smooth muscle relaxation
Which BPH drug is a 2D6 and 3A4 substrate?
tamsulosin

(alfuzosin is a 3A4 substrate also)
Which ED med might be okay with low doses of tamsulosin?
tadalafil
What are the main side effects of tamsulosin?
headache
abnormal ejaculation
Which BPH drugs cause more issues with impotence and retrograde ejaculation? why?
tamsulosin; works more specifically on the prostate
What drug works just like tamsulosin?
alfuzosin
Which BPH drug is probably the best tolerated?
alfuzosin
Which drugs "shrink" the prostate?
finasteride
dutasteride
How do the prostate shrinking drugs work?
5 alpha reductase inhibitors what inhibit the conversion of test to dihydrotestosterone
finasteride
dutasteride
In which patient population can you use finasteride for BPH?
big prostates
Why is it important that finasteride and dutasteride will lower PSA levels?
PSA not as appropriate an indicator of prostate CA in pt being treated with these meds
WHich BPH drug can be used in combination with an alpha blocker?
NOT ED meds

Can use finasteride or dutasteride
Which BPH drug takes 6-12 months for maximal effect?
finasteride or dutasteride
What are the main ADRs of the prostate shrinkers?
impotence
dec libido
ejaculation disturbances

(but usually improve after a year)
WHat are some of the main drugs that are associated with ED?
cimetidine
beta blockers
SSRIs
Opioids
ETOH/Cocaine
Name 3 drugs for ED.
Sildenafil
Vardenafil
Tadalafil
How do the ED drugs work?
PDE-5 inhibitors - they relax smooth muscle --> engorgement (in presence of sexual stimulation)
What else is sildenafil used for besides ED?
pulmonary HTN (Revatio)
What are the 3 main drug interactions of ED meds?
1. 3A4 substrate
2. if given with alpha blockers --> postural hypotension and dizziness
3. if given with nitrates --> hypotension
What is the only alpha blocker/ED med combo that is okay?
tamsulosin and tadalafil
Which ED drug may cause bluish vision?
sildenafil
ED drugs MIGHT be associated with what condition?
NAION (nonarteric ischemic optic neuropathy) - more common if PVD