Session 3 Pharm -1- Anti-Emetics

Front 1

How can emesis be stimulated

Back 1

caused by stimulation of chemoreceptor trigger zone (CTZ) and the vomiting center. Affected by chemical stimuli and afferent input from vestibular system. Activation of dopamine and serotonin receptors

Front 2

If you want to prevent and tx vomiting or chemotherapy-induced vomiting what type of drug do you likely prescribe

Back 2

antiemetic

Front 3

What is the #1 choice for antiemetic

Back 3

5HT3 inhibitors

Front 4

This antiemetic can also cause movement disorders

Back 4

metoclopramide

Front 5

What are the following drugs phenothiazine, 5HT3 inhibitors, metoclopramide, butyrophenones, H1-antihistamines, dronabinol

Back 5

Antiemetics

Front 6

what is prochlorperazine(compazine)

Back 6

a Phenothiazine- blockade of dopamine receptors, moderate action against chemo agents, increased dose improves antiemetic effect but limited due to s/e of sedation and extrapyramidal symptoms

Front 7

What are the s/e of phenothiazines such as Prochlorperazine (Compazine)

Back 7

sedation, extrapyramidal symptoms.

Front 8

What type of drug are Ondansetron (Zofran), Granisetron (Kytril), Dolasetron (Anzemet)

Back 8

5-HT3 inhibitors (1st line drug in antiemetics) they cause a receptor blockade in the vomiting center and chemoreceptor trigger zone

Front 9

This drug has a long duration of action, is highly effective for preventing chemo induced emesis (give if prior to chemo) and needs a dosage adjustment for hepatic insufficiency

Back 9

5-HT3 inhibitors; Ondansetron, Granisetron, Dolasetron (setron's)

Front 10

This drug is a dopamine antagonist and elevates the CTZ threshold. Indicated in gastroparesis and prevention of chemo induced emesis. It has extrapyramidal s/e (muscle rigidity biggest complaint)

Back 10

metoclopramide

Front 11

What type of drug are diphenhydramine (Benadryl), Meclizine (atarax), Hyoscine (scopolamine)

Back 11

H1 antihistamines

Front 12

you usually combine this drug with other antiemetics especially to control motion sickness, but is limited by sedation, dizziness, confusion, dry mouth, and urinary retention; Don't give with BPH

Back 12

H1 antihistamines; diphenhydramine (Benadryl), Meclizine (atarax), Hyoscine (scopolamine)

Front 13

this drug inhibits the vomiting control mechanism the metabolite is excreted slowly over days to weeks in feces and urine but has serious s/e that limit its use. Usually combined with other antiemetics w/ phenothiazines has synergistic effect

Back 13

cannabinoids- dronabinol (Marinol)

Front 14

What are the s/e of cannabinoids; dronabinol (Marinol)

Back 14

euphoria, dysphoria, sedation, hallucinations, dry mouth, and increased appetite

Front 15

What are the 4 types of laxatives

Back 15

Bulk-forming laxatives, stool surfactant agents (softeners), osmotic laxatives, stimulant laxatives

Front 16

What should you always prescribe w/ long term opiods

Back 16

a laxative

Front 17

This type of laxative act on the stool and causes reflex contraction of the bowel

Back 17

bulk-forming

Front 18

This type of laxative works on hard impacted stool

Back 18

stool softening

Front 19

this type of laxative works by easing passage of stool through the rectum

Back 19

lubricating agents

Front 20

What is the result of increased GI tract motility and reduced fluid absorption often due to infection

Back 20

Diarrhea

Front 21

If you are trying to reduce peristalsis, have an adsorbent effect to modify fluid and electrolyte transport in the GI tract what type of drug are you going to prescribe

Back 21

Antidiarrheal agents

Front 22

What are the most effective antidiarrheal agents

Back 22

opioids and their derivatives.

Front 23

What two opioid class drugs should be selected as antidiarrheal because they have minimal CNS effects

Back 23

Diphenoxylate(lomotil) and Loperamide (Imodium-no CNS effects)

Front 24

This drug inhibits mucosal peristaltic reflex reducing GI motility. It is metabolized to difenoxin. Usually formulated w/ antimuscarinic alkaloid (atropine) to keep it from being addicted

Back 24

Diphenoxylate- antidiarrheal agent

Front 25

This drug inhibits peristaltic activity of GI tract, prolongs transit time of intestinal contents, reduce fluid and electrolyte loss. Indicated for non-specific diarrhea and IBD

Back 25

loperamide- antidiarrheal agents

Front 26

Antidiarrheal agent that is an antisecretory agent

Back 26

Bismuth subsalicylate

Front 27

This drug has antisecretory, anti-inflammatory and antibacterial effects. Inhibits prostaglandin synthesis and reduces hypermotility and inflammation

Back 27

Bismuth subsalicylate

Front 28

What is the therapeutic approach to treating inflammatory bowel disease

Back 28

suppress inflammation and alleviate sx- using aminosalicylates, corticosteroids, immunosuppressive antimetabolites, monoclonal antibodies

Front 29

What is the 1st line choice for treating IBD

Back 29

Aminosalicylates

Front 30

What drugs are the aminosalicylates

Back 30

sulfasalazine (Azulfidine), Olsalazine (Dipentum) and Balsalazide (Colazal) release 5-ASA in the large intestine which inhibit synthesis of prostaglandins and inflammatory leukotrienes

Front 31

What is the MOA of aminosalicylates in treating IBD

Back 31

release 5-aminosalicyclic acid in the large intestines, inhibits the synthesis of prostaglandins and inflammatory leukotrienes

Front 32

What are the mesalamine compounds

Back 32

Pentasa, Asacol, Rowasa, Canasa- they modulate local chemical mediators of inflammatory response especially leukotrienes. Free radical scavenger or an inhibitor of TNF (tumor necrosis factor)

Front 33

What drug type would you prescribe for pt w/ IBD when you want anti-inflammatory effect for short term management of the disease hoping it will rapidly improve the sx and severity of the IBD

Back 33

Corticosteroids

Front 34

What corticosteroids are you likely to use for IBD

Back 34

prednisone/ Prednisolone, methylprednisolone, hydrocortisone

Front 35

What is the 1st line immunosuppressant for treating IBD

Back 35

methotrexate (Rheumatrex)

Front 36

What type of drug are the following; methotrexate(rheumatrex), Azathioprine(imuran), 6-mercaptopurine (Purinethol), Cyclosporine (Sandimmune) Infliximab (Remicade)

Back 36

immunosuppressants

Front 37

How do the immunosuppressants work

Back 37

inhibit purine synthesis, reduce GI inflammation, maintenance of remission, slow onset of action, reduce need for long-term corticosteroid use

Front 38

What drug would you give to target TNF-alpha but could have injection site rxn and flu like s/e. Give for symptomatic tx of severe Crohn's disease

Back 38

Infliximab- (biological response modifier)

Front 39

What is IBS

Back 39

irritable bowel syndrome marked by lower abdominal pain, disturbed defecation, bloating that is not explained by structural or known biochemical abnormalities

Front 40

What are the two types of IBS

Back 40

Constipation predominant and Diarrheal Predominant

Front 41

What do you want to do for constipation predominant IBS

Back 41

increase Fiber and psyllium

Front 42

What do you want to do for diarrhea-predominant IBS

Back 42

dietary modifications, loperamide, alosetron (5HT3 antagonist), modulate visceral afferent activity from the GI tract and may improve abdominal pain, reduces hypersensitivity and hyperactivity of larger intestine

Front 43

Why would you prescribe antidepressants TCA's (amitriptyline or doxepin) in IBS

Back 43

For modulation of pain via effects of neurotransmitter reuptake

Front 44

Why would you possible prescribe SSRI antidepressants in IBS (paroxetine, fluoxetine, sertraline)

Back 44

action on 5HT1 and 5HT2 receptors reduces visceral hypersensitivity

Front 45

What is the ROME II diagnostic criteria for IBS

Back 45

12 weeks or more in the past, 12 months of abdominal discomfort of pain with 2 of 3 features; 1 relieved w/ defecation, 2 onset associated w/ change in frequency of stool, 3 onset associated w/ change in form of stool

Front 46

This is retrograde movement of gastric contents from stomach into esophagus causing heartburn, esophageal inflammation, erosive esophagitis, that can lead to barrettes esophagitis

Back 46

GERD

Front 47

What are the common tx for GERD

Back 47

lifestyle changes, Antacids, H2 antagonists, Proton Pump Inhibitors

Front 48

This syndrome is caused by hypersecretion due to gastric secreting tumor

Back 48

Zollinger-Ellison syndrome

Front 49

What are some causes of PUD

Back 49

NSAID use, EtOH, smoking, stress, acid hypersecretion, H. Pylori (#1 cause)

Front 50

What are the sx of PUD

Back 50

epigastric pain, dyspepsia, perforation and bleeding, abdominal/nocturnal pain, nausea, vomiting and anorexia

Front 51

How do you dx H. Pylori infection

Back 51

upper endoscopy, serologic antibody detection test, urea breath test, stool antigen test

Front 52

What are your goals in tx PUD

Back 52

1. get rid of H. Pylori, 2 Reduce gastric acid secretion and acid neutralization 3 protect gastric mucosa from further damage

Front 53

What drugs can be used to tx PUD

Back 53

antacids, H2 blockers, Cytoprotective agents, Proton Pump inhibitors (1st line most effective), antimicrobial agents, Triple therapy (PPI + 2antimicrobials)

Front 54

What is the 1st line most effective tx for PUD

Back 54

Proton Pump Inhibitor

Front 55

What problem can result from prolonged use of antacids

Back 55

systemic alkalosis, diarrhea, Magnesium based antacids should be avoided in renal impairment

Front 56

Why should patients avoid antacids when taking digoxin, ketoconazole, isoniazid, tetracycline, Cipro floxacillin

Back 56

may interfere with drug absorption

Front 57

What ist he MOA of H2 blockers

Back 57

competitively and reversibly bind to H2 receptor on parietal cells, lower cAMP lowering Gastric acid secretion. Complete inhibition of gastric acid secretion stimulated by histamine and gastrin and partial inhibition induced by ach

Front 58

Which of the H2 blocker has a lot of drug interactions

Back 58

Cimetidine (Tagamet)

Front 59

What are the H2 blockers

Back 59

Tidine's; Cimetidine (Tagamet, Ranitidine (zantac), Nizatidine (Axid), Famotidine (Pepcid-most potent)

Front 60

This drug has high selectivity for H2 receptor on parietal cells- suppresses all phases of daytime and nocturnal basal gastric acid secretion, but decreases hepatic metabolism of warfarin, phenobarbital, Phenytoin, diazepam, propranolol

Back 60

Cimetidine

Front 61

This drug also is competitive blocker of H2 receptor on parietal cells and reduces gastric secretion of acid in response to food and insulin used for short term treatment of duodenal ulcer and maintenance therapy- potent anti-ulcer agent

Back 61

ranitidine (zantac)

Front 62

This is the most potent H2 blocker inhibits basal, nocturnal and meal-stimulated gastric secretion of HCL

Back 62

Famotidine

Front 63

Irreversible inhibitors of H+/K+ ATPase inhibits gastric acid secretion more than H2 blockers. Indicated for short term treatment of duodenal ulcers

Back 63

Proton Pump Inhibitor

Front 64

when are PPI's most effective (when should you take them)

Back 64

most effective if taken 30 minutes before a meal

Front 65

What are the names of the PPI's

Back 65

the Prazole's; Omeprazole (Prilosec), Lansoprazole (Prevacid), Esomeprazole (Nexium), Pantoprazole (Protonix), Rabeprazole (Aciphex)

Front 66

what PPI should not be prescribed if patient is taking drugs such as Phenytoin, diazepam, and warfarin

Back 66

Omeprazole- it selectively inhibits CYP450-2C19 decreasing elimination of Phenytoin, diazepam, and warfarin; Prescribe instead rabeprazole and pantoprazole they don't interact

Front 67

If you are trying to enhance mucosal protection mechanism to prevent mucosal injury reduce inflammation and expedite healing of existing ulcers what type of drug should you order

Back 67

cytoprotective agents- bismuth subsalicylate (Pepto-Bismol)

Front 68

What is the MOA of Pepto-Bismol

Back 68

selective coating affinity for base of peptic ulcer, bactericidal against H. Pylori and may provide passive protection against acid and pepsin

Front 69

If patient tests positive for presence of H. Pylori what is the first line therapy for tx them

Back 69

Combination Triple therapy- PPI w/ metronidazole or amoxicillin and Clarithromycin = 90% eradication rate

Front 70

IF triple therapy doesn't work to eradicate H. Pylori what tx might you try next

Back 70

Bismuth based 4 drug regimen Omeprazole(or another PPI)+Bismuth Subsalicylate+metronidazole+tetracycline or clarithromycin

Front 71

If patient has peptic ulcer induced by nsaids what should be done

Back 71

stop NSAIDS, give them an anti-ulcer drug (PPI or H2 blocker) avoid NSAIDS in future. If you can't stop the NSAID prescribe them a PPI

Front 72

If pt suffers from zollinger-ellison syndrome what should you prescribe them to tx their hyperacidity

Back 72

PPI are drug of choice although many time hypersecretory tissue has to be excised

Front 73

Apart from drug therapy what non-pharmacological tx should patients with ulcers do

Back 73

reduce stress, cigarette smoking, use of NSAID's, avoid food causing dyspepsia, EtOH and Caffeine