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97 Cards in this Set

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