Pharmocology

Front 1

Histamine H2 blockers

Back 1

1- Cinetidine, Ranitidine, Famotidine, Nizatidine

2- Reversible block histamine H2 reception - decrease H release by parietal cells

3- Use 1- Peptic ulcer

2- GERD

3- Gastritis

4- Adverse effect 1- Cimetidine inhibits cytochrome P450 - 1- adrogenic effects (prolactin release, Gynecomastia, impotence, decrease libido)

2- Cross blood brain barrier (confusion, dizziness, headache) and placenta

3- Cimetidine and Ranitidine decrease renal clearance of creatinine

Front 2

Antacid

Back 2

1- Can alter absorption, bioavailability and urinary excretion of other drugs by altering gastric and urinary pH or delaying gastric emptying

2- Cause Hypokalemia

3- Examples 1- aluminum hydroxide

2- Calcium carbonate

3- Magnesium hydroxide

Front 3

Proton pump inhibitor

Back 3

1- Pantaprozole, Lansoprazole, esomeorozole, dextansoprozole

2- Irreversibly inhibit H/K ATPase in stomach parietal cells

3- Use 1- Peptic ulcer

2- GERD

3- Gastritis

4- Zollinger Ellison syndrome

4- Adverse effect 1- C. Difficle infection

2- Pneumonia

3- Acute interstitial nephritis

4- Vitamin B12 malabsorption

5- Decrease Mg and Ca

Front 4

Aluminum hydroxide side effect

Back 4

1- Constipation

2- Hypophosphatemia - bind to phosphate in the gut

3- Osteodystrophy

4- Proximal muscle weakness

5- Seizures

Front 5

Calcium carbonate side effect

Back 5

1- Hypercalcemia

2- Rebound acid increase

Front 6

Magnesium hydroxide side effect

Back 6

1- Cardiac arrest

2- Hypotension

3- Hyporeflexia

4- Diarrhea

Front 7

Bismuth, sucralfate

Back 7

1- Bind to ulcer base

2- Provide physical protection and allow HCO secretion to reestablish pH gradient in mucosal layer

3- Sucralfate require acidic environment

4- Use 1- Peptic ulcer (quadruple therapy in H.pylori gastritis)

2- Travelers diarrhea

5- Side effect 1- Black stool

Front 8

Misoprostol

Back 8

1- PGE1 analog 1- Increase production and secretion of gastric mucous barrier

2- Decrease acid production

2- Use- 1- NSAID induced peptic ulcer

2- Induce labour

3- Side effect 1- Diarrhea

2- Abortion

Front 9

Octreotide side effect

Back 9

1- Cramps

2- Increase risk of cholelithiasis due to CCK inhibition

3- Nausea

4- Steatorrhea

Front 10

Sulfasalazine

Back 10

1- Combination of sulfapyridine (antibiotic) and 5 aminosalicylic acid (anti-inflammatory)

2- Activated by colonic bacteria

2- Use 1- Ulcerative colitis

2- Crohn’s disease (colitis component)

3- Adverse effect 1- Malaise

2- Nausea

3- Sulfa toxicity

4- Reversible oligospermia

Front 11

Loperamide

Back 11

1- M.O.A 1- Agonist at u-opioid receptor

2- Slow gut motility

3- Poor CNS penetration ( low addictive potential)

2- Use 1- Diarrhea

3- Adverse effect 1- Constipation

2- Nausea

Front 12

Ondonsetron

Back 12

1- M.O.A 1- 5 HT3 (serotonin) antagonist

2- Decrease vagal stimulation

3- Powerful central acting antiemetic

2- Use 1- Vomiting

3- Adverse effect 1- Constipation

2- Headache

3- Serotonin syndrome

4- QT interval prolongation

Front 13

Ondonsetron is used to control vomiting primarily in which 2 settings

Back 13

1- Post operative y

2- Chemotherapy

Front 14

Metocloperamide

Back 14

1- M.O.A 1- D2 receptor antagonist

2- Increase resting tone, Contractility and LES

3- Promote gastric emptying

2- Use 1- Diabetic and postoperative gastrioaresis

2- Vomiting

3- Persistent GERD

3- Adverse effect 1- Increase Parkinson effect (tardive dyskinesia)

2- Depression

3- Drowsiness

4- Diarrhea

5- Fatigue

6- Restlessness

4- Drug interaction with digoxin and diabetic drugs

5- Decrease seizure threshold

6- Contraindicated in patients with small bowel obstruction and Parkinson disease

Front 15

Orlistat

Back 15

1- M.O.A 1- Inhibit gastric and pancreatic lipase

2- Decrease breakdown and absorption of dietary fat

3- Taken with fat containing Mets

2- Use Weight loss

3- Adverse effect 1- Abdominal pain

2- Flatulance

3- Frequent bowel movement

4- Steatorrhea

5- Fat soluble vitamins deficiency

Front 16

Aprepitant

Back 16

1- M.O.A 1- Substance P antagonist

2- Blocks NK1 (neurkinin - 1) receptors in the brain

2- Use 1- Antiemetic in chemotherapy induced nausea and vomiting

Front 17

Bulk forming laxatives

Back 17

1- Psyllium, methyl cellulose

2- Soluble fibers draw water into gut lumen forming a viscous liquid that promotes peristalsis

3- Adverse effect 1- Bloating

Front 18

Osmotic laxative

Back 18

1- Magnesium hydroxide, Magnesium citrate, polyethylene glycol, Lactulose

2- M.O.A 1- Provide osmotic load that draw water into GI lumen

2- Lactulose is use to treat hepatic encephalopathy - Gut flora degrade Lactulose into metabolites (lactic acid, acetic acid) promoting nitrogen excretion as ammonia

3- Adverse effect 1- Diarrhea

2- Dehydration

3- Abused in Bulimia

Front 19

Stimulants laxatives

Back 19

1- Senna

2- Enteric nerve stimulation- colonic contraction

3- Adverse effect 1- Diarrhea

2- Melanesia coli

Front 20

Emollient laxatives

Back 20

1- Docimusate

2- Promotes in-cooperation of water and fat in stool

3- Adverse effect 1- Diarrhea

Front 21

Indication of laxative

Back 21

1- Constipation

2- Patients on opioid require a bowel regimen