Usmle Step 1 High Yield Systems Gi Pharmacology 2013

Front 1

H2 blockers

Back 1

Cimetidine, ranitidine, famotidine, nizatidine

-dine

Take H2 blockers before you dine. "Table for 2"

Front 2

H2 blockers MOA

Back 2

REVERSIBLE block of histamine H2 receptors
=
DEC H secretion by parietal cells

Front 3

H2 blockers clinical use

Back 3

Peptic ulcer
Gastritis
Mild esophageal reflux

Front 4

H2 blockers TOX

Back 4

Cimetidine:
potent INHIBITOR of P-450 (DDI)
Anti-androgenic effects (prolactin release, gynecomastia, impotence, DEC libido in males)
Cross BBB (confusion, dizziness, headaches)
Cross placenta

Both CIMETIDINE and RANITIDINE DEC renal excretion of creatinine

Front 5

PPIs

Back 5

Omeprazole, lansoprazole, esomeprazole, pantoprazole, dexlansoprazole

-prazole

More effective than H2 blockers

Front 6

PPIs MOA

Back 6

IRREVERSIBLY inhibit H/K ATPase in stomach parietal cells

Front 7

PPIs clinical use

Back 7

Peptic ulcer
Gastritis
Esophageal reflux
Zollinger-Ellison syndrome (Gastrinoma of pancreas)

Front 8

PPIs TOX

Back 8

Inreased risk of C. difficle infection!
Pneumonia
Hip fractures due to DEC Mg after long term use

Front 9

Bismuth, Sucralfate MOA

Back 9

Bind to ulcer base, providing physical protection and allowing HCO3 secretion to reestablish pH gradient in the mucous layer

Front 10

Bismuth, sucralfate Clinical use

Back 10

INC ulcer healing

Traveler's diarrhea (ETEC, Labile/Stable toxin, no inflammation or invasion)

Front 11

Misoprostol MOA

Back 11

PGE1 analong

INC production and secretion of gastric mucous barrier
DEC acid production

Front 12

Misoprostol clinical use

Back 12

Prevention of NSAID-induced peptic ulcers
Maintenance of PDA
Induce labor (ripens cervix)

Front 13

Misoprostol TOX

Back 13

Diarrhea
CONTRA in women of childbearing potential (abortifaceint)

Front 14

Octreotide MOA

Back 14

Long-acting somatostatin analog

Front 15

Octreotide clinical use

Back 15

Acute variceal bleeds
Acromegaly
VIPoma
Carcinoid tumors

Front 16

Octreotide TOX

Back 16

Nausea
Cramps
Steatorrhea

Front 17

Antacid use

Back 17

Affects: absorption, bioavaliability, or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying

All can cause hypokalemia

Front 18

Antacid: Aluminum hydroxide TOX

Back 18

Constipation and HYPOphosphatemia
Proximal mm weakness
Osteodystrophy
seizures

AluMINIMUM amount of feces

Front 19

Antacid: Magnesium hydroxide TOX

Back 19

Diarrhea
HYPOreflexia
HYPOtension
Cardiac arrest

Mg= Must Go to bathroom

Front 20

Antacid: Calcium carbonate TOX

Back 20

HYPERcalcemia
rebound acid INC (stimulates G cells to make gastrin)

Divalent ion can chelate and DEC effectiveness of other drugs (tetracyclines)

Front 21

Osmotic laxatives

Back 21

Mg hydroxide (Milk of Magnesia), Mg citrate, polyethylene glycol, LACTULOSE

Front 22

Osmotic lax MOA

Back 22

Provide osmotic load to draw out water

LACTULOSE also treats HEPATIC ENCEPHALOPATHY since gut flora degrade it into metabolites that promote nitrogen excretion as NH4

Front 23

Osmotic Lax clinical use

Back 23

Constipation

Front 24

Osmotic lax TOX

Back 24

Diarrhea
Dehydration

*may be abused by bulimics

Front 25

Infliximab MOA

Back 25

Monoclonal ab to TNF-a

Front 26

Infliximab clinical use

Back 26

Crohn's
UC
Rheumatoid arthritis

Front 27

Inflixmab TOX

Back 27

Infection (including reactivation of latent TB)
Fever
HYPOtension

Front 28

Sulfasalazine MOA

Back 28

Sulfapyridine (antibacterial) + 5-aminosalicyclic acid (anti-inflammatory)

activated by colonic bacteria

Front 29

Sulfasalazine clinical use

Back 29

UC
Crohn's

Front 30

Sulfasalazine TOX

Back 30

Malaise
Nausea

SULFONAMIDE TOX (urinary tract disorders, haemopoietic disorders, porphyria, and hypersensitivity reactions, SJS/TEN)

REVERSIBLE oligospermia

Front 31

Ondansetron MOA

Back 31

5-HT3 antagonist

Powerful central acting antiemetic (against N/V)

"At a party but feeling queasy? Keep ON DANCing with ONDANSetron!"

Front 32

Ondansetron clinical use

Back 32

Control vomiting post-operatively and in patients undergoing cancer chemo

Front 33

Ondansetron TOX

Back 33

Headache (due to vasodilation)
Constipation (too much 5-HT-->diarrhea)

Front 34

Metoclopramide MOA

Back 34

D2 receptor antagonist
INC resting tone, contractility, LES tone, motility

Does NOT influence colon transport time

Front 35

Metoclopramide clinical use

Back 35

Diabetic and post-surgery gastroparesis
Antiemetic

Front 36

Metoclopramide TOX

Back 36

INC PARKINSONIAN EFFECTS!
Restlessness, drowsiness, fatigue, depression N/D

DDI with Digoxin and diabetic agents

CONTRA in patients with small bowel obstruction or Parkinson's