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51 Cards in this Set

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  • Back
What are some H2 blockers?
What is the mechanism of cimetidine?
reversible block of histamine H2 RECEPTORS on parietal cells, and this prevents H2 secretion by parietal cells.

What are the clinical usage for cimetidine (H2 blocker)?
Peptid ulcer, gastritis, mild esophageal reflux, ZE syndrome, stress ulcers.
What is the toxicity of cimetidine?
Is a potentnt INHIBITOR of P450 and has antiandrogenic effect (leads to gynecomastia and galactorrhea)
What are some examples of proton pump inhibitors?
1) Omeprazole
2) Lansoprazole
What is the action of omeprazole?
IRREVERSIBLY inhibits H+/K+ ATPase in stomach parietal cells.
What are some side effects of omeprazole?
Interferes with oxidation of warfarin, phenytoin, and diazepam.
What is the mechanism of action of bismuth and sucralfate?
Interacts with gastric mucosa to form a COMPLEX GEL creating a physical barrier that impairs HCL diffusion and pepsin-mediated degradation of mucosa.
What is mechanism of bismuth and sucralfate?
Bind to ulcer base, providing physical protection through COMPLEX GEL, and allow bicarbonate secretion to re-establish pH gradient.
What is bismuth and sucralfate used for?
Increase ulcer healing and traveler's diarrhea, and peptid ulcer disease.
What is the triple therapy of H. pylori ulcers?
metronidazole, bismuth/sucralfate, amoxicillin (or tetracycline).
What drug requires an acidic pH for activation and not be given with H2 antagonists or antacids?
What is misoprostol?
A PGE1 analog. It increases the production and secretion of gasric mucous barrier.
What is misoprostol used for?
Prevention of NSAID induced peptic ulcers

2) Maintenance of a patent ductus arteriosus

3) Induce labor
What is the toxicity of misopristol?
1) Diarrhea
2) abortifactent in women of childbearing potential.
3) produce uterine contractions.
Where is the chemoreceptor trigger zone located?
At caudal end of 4th ventricle (area postrema)
What is pirenzipine and propantheline?
muscarinic antagonists
What is the action of pirenzipine?
Block M1 receptors on ECL cells (decrease histamine secretion) AND M3 receptors on parietal cells (decrease H+ secretion)
What is the toxicity of pirenzipine and propantheline?
1) Bradycardia
2) dry mouth
3) difficulty focusing eyes.
What is infliximab?
A monoclonal antibody to TNF-alpha, a pro-inflammatory cytokine.
What are the uses for infliximab (a monoclonal antibody to TNF-alpha)
Crohns disease, rheumatoid arthritis
What is the toxicity of infliximab?
Respiratory infection
What is sulfasalazine?
A combination of sulfapyridine (antibacterial) and mesalamine (anti-inflammatory): activated by colonic bacteria.
What is sulfasalazine used for?
Ulcerative colitis, Crohns disease
What is the toxicity of sulfasalazine?
malaise, nausea, sulfa allergy, reversible oligospermia!
What is ondansetron?
5HT-3 antagonist. Selective blocker of 5HT3 receptors in the CTZ.
What is ondansetron used for?
Control vomiting postoperatively and in patients undergoing chemotherapy.
What is toxicity of ondansetron a 5HT-3 antagonist?
Note: drugs used to treat migraines (sumatripan) are 5HT agonists, so use caution when treating migrane patients with ondansetron!
What is a possible problem with antacid overuse?
Can affect absorption, bioavailability, or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.
What is the mechanism of action of antacids?
These agents (aluminum hydroxide, magnesium hydroxide, and calcium carbonate) are weak bases capable of neutralizng gastric acid.
What are some side effects of alumnium hydroxide?
Constipation and hypophosphatemia

What are the side effects of magnesium hydroxide?
Mg = Must Go to the bathroom

What are the side effects of calcium carbonate?
1) Hypercalcemia which can lead to rebound hyperacidity.

Remember: calcium salts can stimulate gastrin release.
What are antacids effect on other drugs?
They can chelate and decrease absorption of certain drugs like tetracycline and levodopa.

All can cause hypokalemia!
What is the action of metoclopramide?
Blocks dopamine and seretonin receptors in CTZ.

Used to treat emesis.
What is the side effect of metoclopramide?
Diarrhea, extra-pyramidal symptoms (since its blocking DA and 5HT at CTZ).
What is action of Mg OH2?
Osmotic laxative (as well as antacid) that is non absorbable, so this substance attracts water into the intestinal lumen, thus distending the intestinal wall and increasing peristalsis.
What is the action of cannabinoids?
Used to treat emesis.
What is the mechanism of action of loperamide?
Activates opioid receptors that decrease peristalsis
What is the mechanism of action of diphenoxylate?
Activate opioid receptors that decrease peristalsis.
Does loperamide cross the BBB?
No, so it doesnt produce euphoria or respiratory depression characteristic of other opioids.
what is the toxicity of diphenoxylate and loperamide?
Toxic megacolon

They are antimotility agents.
What drugs can be used to treat diarrhea?
1) Loperamide
2) Diphenoxylate

They activate opioid receptors that decrease peristalsis.
What is the other class of drugs besides (diphenoxylate or loperamide) that can treat diarrhea?
What are the different types of adsorbants?
Kaolin, pectin, methylcellulose
What is the action of kaolin, pectin, and methylcellulose?
Adsorption of intestinal toxins and increases stool viscosity.
What is the mechanism of action of castor oil, senna, bisacodyl?
irritates mucosal lining leading to hypermotility.
What is the major side effect of castor oil, senna, phenolphthalein, and bisacodyl?
Rebound intestinal hypomotility after discontinued
What is the mechanism of action of stool softeners?
Creates a hyperosmotic agent which draws water into the lumen of the intestines, and they lubricate the feces to ease transit.
What are some examples of stool softeners?
Mineral oil, glycerin, and docusate (NOT Castor OIL).

Castor oil is an irritant!
What are some examples of bulking agents?
psyllium and methylcellulose

1) Draw water into intestinal lumen.