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97 Cards in this Set
- Front
- Back
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What is used to treat upper GI disease?
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PPIs (1st line of therapy), antacids, H2 antagonists, prostaglandins, sulcralfate, colloidal bismuth and H. pylori therapy
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what GI symptom is associated with almuinum antacids?
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constipation
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what about calcium antacids decreases patient compliance?
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chalky taste
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what GI symptom is associated with magnesium antacids?
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diarrhea
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which antacids are absorbed slowly and which ones are absorbed quickly?
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slow - aluminum and magnesium compounds; fast - sodium compoundsa nd clacium compounds;
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What are the adverse effects of aluminum antacids?
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constipation, intestinal obstruction, osteomalacia
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What are the adverse effects of magnesium antacids?
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diarrhea, electrolyte abnormalities, dehydration
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what is the first line of therapy for reflux esophagitis?
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ranitidine
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what is the action of cimetidine on ulcers?
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accelerates healing and reduces rate or relapse
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what are the adverse effects of cimetidine?
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anti-androgenic, CNS distrubances, binds to P450, increases blood alcohol levels, may reduce hepatic blood flow, may produce cardiotoxic effects
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how long does cimetidine last?
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6-8 hours
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is ranitidine more or less potent than cimetidine?
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more, given at 1/2 the dose; longer effects with fewer adverse effects
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what is cimetidine?
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H2 angatonist
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What is ranitidine?
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H2 angatonist
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What is nizatidine?
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H2 angatonist
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what are the adverse effects of ranitidine?
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may reduce hepatic flow, headaches, increase blood alcohol levels, may have cardiotoxic effects DOES NOT bind to androgen receptors or elevate prolactin, little effects on drug metabolism and CNS function
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what is omeprazole?
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PPI
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what is iansoprazole?
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ppi
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what is pantoprazole?
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ppi
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what is rabeprazole?
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ppi
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what is esomeprazole?
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ppi
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what is the M.O. of ppi's?
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non-competitive irreversible inhibitor that covalently binds to the proton pump, acts at the final step; it is a lipophilic weak base that diffuse into parietal cell canaliculi where they become protonated and concentrated
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how long does it take ppi's to become effective?
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3-4 days
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what decreases the bioavilability of ppi's?
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food - must take ppi 30-60 minutes before eating
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what is the maintanence dose of ppi's?
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half of the healing dose
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what are the adverse effects of PPI's?
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infrequent - diarrhea, abdominal pain and headache; increased risk of food poisoning and C. difficil infections; long term use increases cardiac events
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what is misoprostol?
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PGE1 analog - gastric antisecretory and mucosal protective properties
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what is required to activate sulcralfate?
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an acidic pH = DON'T give with H2 antagonists!!
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how does sulcralfate aid in healing of ulcers?
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it polymerizes in the stomach and attachs to injured tissue which forms a protective coat
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how often must sulcralfate be taken?
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4 times/day
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what are the adverse effects of sulcralfate?
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constipation - espeically in the elderly; nausea, indigestion, abdominal discomfort, diarrhea, headaches, dizziness, drowsiness
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what does colloidal bismuth do?
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forms a protective coating on ulcerated tissue, sitmulates mucosal protective mechanisms and has direct antimicrobial effect and sequestration or enterotoxins
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what does colloidal bismuth do to stool?
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reduces stool frequency and liquidity in infectious diarrhea, turns the stools black
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what is the regimen for H. pylori treatment?
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at least 2 antibiotics and a PPI - there is a problem with compliance
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what is bethanechol?
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a muscarinic agonist that is a prokinetic
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what type of motility does bethanechol promote?
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uncoordinated motility due to stimulation of all muscarinic receptors on the muscle at once
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what is metoclopramide?
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D2 antagonist that is a prokinetic
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what are the actions of bethanechol?
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it increases tone of the LES and stimulates gastric acid secretoin
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what is the action of metoclopramide?
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increases LES tone and esophageal acid clearance; promotes gastric emptying, increases ACh release, no effect on acid or gastrin secrtion, central antiemetic action
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what type of motility does metoclopramide produce?
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parastaltic - due to stimulation at the ENS
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what are the adverse effects of metoclopramide?
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drowsiness, extrapyramidal effects; chronic use can cause parkinsonism, other extrapyramidal effects and hyperprolactinemia
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what is domperidone?
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D2 antagonist that is peripherally restricted that is a prokinetic
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what is cisapride?
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prpkinetic
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what is the action of cisapride?
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increases gastric emptying
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what is the M.O. of cisapride?
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5HT4 agonist = prokinetic and some 5HT3 antagonist acitivty; works at the level of the ENS to cause post-ganglionic release of ACh
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what are the side effects of cisapride?
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ventricular arrhythmias - potentially fatal
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what is tegaserod?
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a peripherally restricted prokinetic
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when is tegaserod used?
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restricted use for women >55 yoa with constipation IBS and for chronic constipation
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what is the M.O. of tegaserod?
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5HT4 agonist and 5HT2b antagonist - causes side effects; augments intestinal peristalsis; NO CNS activity
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what are the toxicities of tegaserod?
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CV - increased stroke, unstable angina and heart attacks
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what is erythromycin?
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prokinetic
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what is the M.O. of erythromycin?
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motilin agonist, increases LES tone, sppeds up upper GI transit, efficacy best with IV
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when is erythromycin used?
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in diabetic gastroparesis to enhance gastric emptying
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what are the side effects of erythromycin?
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abdominal cramping and diarrhea, liver toxicity
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what are the 6 stimulant laxatives?
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castor oil, cascara, senna, phenolphalein, bisacodyl, magnesium hydroxide
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what is the action of senna and cascara
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they are anthrquinones that stimulate ENS to increase motility
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what is the action of phenolphalein and bisacodyl?
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diphenylmethane derivates that stimulate water and electrolyte accumulation and enchance colonic motility
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what are the 5 dietary and bulk forming laxatives?
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bran, lactulose, sorbitol, pysllium, metamucil
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what is the action of bulk forming laxatives?
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bind water and ions int eh colonic lumen, softens feces, increases fecal mass and increases rate of colonic transit - effects occur in 24 hours
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what are the adverse effects of bulk forming laxatives?
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faltulence, borborygmi, reduced intestinal absorption of drugs, intestinal obstruciton/impaction, abdominal distension
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what are the 5 lubricating laxatives?
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magnesium salts, lactulose, glycerin, mineral oil, sorbitol
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what is the M.O. of lubricating laxatives?
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they are poorly absorbed, osmotic properties retain water in the intestinal lumen
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what are lubricating laxatives used for?
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bowel prep prior to surgery
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what are the adverse effects of lubricating laxatives?
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lactulose: cramping flatuelnce, discomfort; Mg: effects on renal funciton; phosphate: severe effects on kidneys; PEG: fewer cramps
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what are the 3 stool softeners/
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mineral oil, glycerin, docusate
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what is lubiprostone?
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PGE1 metabolite that is a chloride channel activator that is used to treat constipation
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what is lubiprostone used for?
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chronic idiopathic constipation
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what are the side effects of lubiprostone?
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nausea and diarrhea
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what is methylnaltrexone?
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peripherally restricted mu opioid antagonist
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when is methylnaltrexone used?
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in opioid induced bowel dysfunciton
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what are the side effects of methylnaltrexone?
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abdominal pain and flatuence BUT NO symptoms of opioid withdrawal
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what is alvimopan?
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peripherally restricted mu opioid antagonist
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when is alvimopan used?
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to treat post operative ilius
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what is the adverse effect of alvimopan?
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high number of Mis reported
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what is loperamide?
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opioid agonist used to treat diarrhea
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when should loperamide not be used?
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contraindicated in IBD - will lead to toxic megacolon
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what is diphenoxylate?
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opioid agonist used to treat diarrhea
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when is diphenoxylate used?
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for travelers diarrhea
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what is clonidine?
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sympathetic agonist used to treat diarrhea
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when is clonidine used?
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in patients refractory to everything else
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where does clonidine act?
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at both the neuron to inhibit release of secretory NT and at the epithelial alpha 2 recetpors to stimulate absorption
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what is budesonide?
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a corticosteroid used to treat IBD - low systemic bioavilability
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what is sulfasalasine?
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a IBD drug used to treat mild disease and for the maintance of remssion
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what are the side effects of sulfasalasine?
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dyspepsia, nausea, anorexia, headache, allergic reactions, mild to severe hymolysis, neutropenia, folate deficiency, male infertility
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where can severe toxic reactions to sulfasalasine occur?
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lung, liver, pancreas, skin or nerves
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what is olsalazine?
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5ASA derivative, a dimer; used to treat IBD
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what is balsaladie?
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5ASA derivative, an inert carrier; used to treat IBD
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what is pentasa?
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mesalamine (5ASA derivative) used to treat IBD in the small intestine
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what is asacol?
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mesalamine (5ASA derivative) used to treat IBD in the distal ileum/proximal colon
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what is rowasa?
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mesalamine (5ASA derivative) used to treat IBD in the rectum
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what is infliximab?
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anti-TNF alpha therapy used to treat IBD
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what is certolizumab?
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anti-TNF alpha therapy used to treat IBD
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What is natalizumab and adalimumab?
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anti-TNF alpha therapy used to treat IBD
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what are the side effects of infliximab?
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lymphoma esepcially in children, sereious infection - sepsis, TB, histo
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what is used to treat IBS?
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anticholinergics, alosteron (diarrhea IBS) and teraserod (constipation IBS)
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what is used to treat motion sickness?
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scopolamine (anticholinergic) and H1 antihistamines - diphenhydramine and meclizine
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what is used to treat chemo induced vomiting?
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5HT3 antagonists: ondansetron, granisteron and dolasteron; dopamine antagonists: metoclopramide, doperidone; cannabinoids
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