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GI Pharm
| Question | Answer |
|---|---|
| Aggressive Factors in PUD | Acid and Pepsin Secretion |
| Protective Factors in PUD | Mucus, Bicarbonate, Mucosal blood flow, cell restitution, prostaglandins |
| ____ percent of patients infected with H. pylori will develop an ulcer | 15-20% |
| Two mechanisms of injury with NSAIDs | Direct action on the mucosa, Inhibition of prostaglandins |
| Big difference between Gastric and duodenal ulcer | Gastric - food worsens pain; Duodenal Ulcer - pain relieved by food. |
| ___ ulcers are harder to heal | Gastric. Biggest compication is gastric carcinoma. Most gastric ulcers are biopsied to rule out cancer. Most duodenal ulcers are not biopsied (duodenal ulcers are more common and easier to treat) |
| Neutralizes acid, inhibiting pepsinogen to pepsin, and may bind bile salts | Antacids. When used at proper doses (8oz bottle/day), they are equally efficacious as H2 blockers. Tablets are not as potent as suspensions |
| Onset of action of Antacids | 5-15 minutes after administration. Short duration (1-2 hours). Often used in combo w/ other agents |
| Non-systemic antacids | Aluminum Hydroxide, Magnesium Hydroxide, Calcium Carbonate, Al/Mg combinations |
| Systemic Antacids | Sodium Bicarbonate (Alka-Seltzer) |
| AE of Aluminum Hydroxide (Amphojel) | Constipation and aluminum toxicity in renal pts |
| Major AE of Magnesium Hydroxide -Milk of Magnesia | Diarrhea. Magnesium can also accumulate in renal pts |
| ___ Is an antacid that binds dietary phosphate and causes constipation (also a good source of calcium) | Calcium Carbonate - Tums |
| Alka Seltzer | come back to |
| Efficacy of H2 Blockers | heals 90% of DU at 8 weeks and 80% of GU at 12 weeks |
| H2 requires dose adjustment in which populations? | renal insufficiency |
| Block gastric acid secretion by inhibiting gastric H/K ATPase in gastric parietal cells. | Proton Pump Inhibitors. Produces profound, long-lasting antisecretory effect. Knocks out all three acid production pathways |
| PPI and Plavix | decreased acidity with PPI decreases efficacy of Plavix (Omeprazole is the worst) |
| PPI advantage over H2 blockers | Heals faster and they are part of the H. pylori treatment regiment. |
| Comparative efficacy between PPIs | Same; no head to head studies. But patients will prefer one over another. |
| Forms cytoprotective complex that covers ulcer site. Mucosal PG synthesis and inhibit pepsin. Has lots of drug interactions. | Sucralfate (carafate). Indicated for tx of and maintenance of DU only. Causes constipation |
| This drug is preferred in ventilated patients (especially over H2blockers which has been associated with more aspiration pneumonia). PILL IS HUGE | Sucralfate. Useful in patients with H2Blocker thrombocytopenia |
| A synthetic prostaglandin that increases mucus production and mucosal bicarb. Indicated for NSAID induced gastric ulcers | Misoprostol (cytotec) |
| AE's of Misoprostol | Diarrhea (40% or higher, but this is dose related)!!! Abdominal Pain, flatulence abortifacient |
| Antiulcer agent/Prostaglandin that induces abortion | Misoprostol |
| PPI in tx of H. pylori | BID, 2-4 weeks longer than abx (can use once a day after end of abx) |
| Tx of H. pylori | MOC AOCMetronidazole, Omeprazole, Clarithromycin, Amoxicillin, Omeprazole, Clarithromycin. All regimens are 10-14 days |
| Which tx regimen should be taken for H. pylori infection in penicillin allergic patients? | Metronidazole, Clarithromycin and a PPI (ex: omeprazole) |
| Protective Forces in GERD | LES pressure, Esophageal clearance, Esophageal mucosal defense, Gastric emptying |
| Complications of GERD | Esophageal ulceration, Esophageal stricture, hemorrhage, Barett's esophagus, Pulmonary Complications (bronchoconstriction, cough) |
| Cisapride AEs and cause of withdrawl from the market | Drug interactions, torsades de pointe |
| Meds to increase LES pressure | Bethanechol, metoclopramide |
| Med used to increase gastric emptying in GERD | Metoclopramide |
| Med Used to increase esophageal clearance | Bethanechol |
| Esophageal healing in GERD with PPI compared to H2blockers | Esophageal healing is about double with PPI compared to H2blockers |
| Combination therapy in GERD | PPI plus a promotility agent, or H2blocker plus a promotility agent |
| Tx Key in GERD | Maintenance therapy is key. Up to 90% of pts with severe esophagitis will relapse after stopping meds |
| Causes of N/V | Fluid and electrolyte abnormalities, Drug-induced (chemo, abx, etc), GI obstruction, Metabolic disorders (DM, Uremia), Neurological process, Drug withdrawal, Pregnancy, Anxiety |
| Neuropharmacology of Emesis | Visceral Stimuli, Chemoreceptor Trigger zone, Vestibular Input |
| Protective Factor in Chemo Induced N/V | Past or current heavy EtOH use. Risk factor: female>male |
| Risk factors for N/V Post-Operative | Female, children, obese, non-smoker, hx of motion sickness |
| Treatment for simple N/V | Antacids, H2 antagonists, antihistaminic-cholinergics, phosphorated carbohydrate solution, Phenothiazines (prescription required) |
| Tx for Copmlex N/V | Phenothiazines, Serotonin antagonists, Prokinetic agents, Cannabinoids, Glucocorticoids, Benzodiazepines, Butyrophenones, Neurokinin-1 antagonists |
| Magnesium is associated with | osmotic diarrhea |
| Antacid examples | maalox, mylanta, tums |
| ____ are best for motion sickness or emotional N/V | Antihistamines/Anticholinergics. Benadryl, Transderm Scop, Dramamine, Bonine |
| Flat soda antiemetic | Phosphorated Carbohydrate Solution. Can just have caffeine free coke (but not sugar free) |
| Associated with extrapyramidal reactions (including parkinsons!) | Phenothiazines and Reglan (Prokinetic) |
| Compazine and Phenergan are | Phenothiazines |
| Best for Post-Operative and Chemo-induced N/V | Serotonin Antagonists. Super expensive!! ($50/pill). Not effective for motion sickness. |
| Which antiemetic can cause QT prolongation? | Serotonin antagonists |
| Zofran and Kytril are | Serotonin Antagonists |
| Reglan is a | Prokinetic agent |
| Haldol | Butyrophenone. Usually not used b/c it is an antipsychotic with AEs |
| Neurokinin-1 antagonists are FDA approved for | highly emetogenic chemotherapy (cisplatin-based chemo). Expensive |
| Types of diarrhea | Secretory, osmotic, exudative, altered intestinal transit |
| Acute diarrhea is caused by | viral, bacterial and protozoal infections |
| Frequent BM, never bloody | Acute Diarrhea |
| Drinks to avoid in Diarrhea | hypertonic fruit juices, carbonated beverages, and caffeinated beverages. (high sugar so will act like sorbitol and cause a secondary diarrhea) |
| Tx options for Diarrhea | Antimotility agents, adsorbents, antisecretory agents |
| AE's of Antimotility agents | Dizziness and constipation |
| Contraindication to antimotility agents | Acute bacterial diarrhea. At least in the hospital, don't use an antimotility until you get your C. diff back. Also contraindicated in colitis and in children<2 years old |
| Most potent Antimotility agent that is also OTC | Loperamide. Great for nonspecific diarrhea and traveler's diarrhea |
| AE of Lomotil | Abuse. If you are going to give it, give it with atropine to discourage abuse |
| ____ is an antimotility agent that is a tincture of opium and has abuse potential | Paragoric |
| Adsorbent Agents | Kaopectate (activated attapulgite) and FiberCon (calciumpolycarbophil) |
| What are the AE's and CIs of Bismuth Subsalicylate | AE's - dark tongue and black stool; CI's: children/teen with viral illness due to risk of Reye's Syndrome |
| Sx treatment of carcinoid tumors and VIPomas | Octreotide (sandostatin) |
| Prophylactic Abx in traveler's Diarrhea | NOT RECOMMENDED. |
| DOC for tx of Traveler's Diarrhea in children and women | azithromycin |
| Bulk-forming laxatives are best for | prevention of constipation |
| ___ laxatives are best for acute evacuation of the bowel | Saline Laxatives (magnesium citrate, MOM). Onset 5-30 min(pr) or 3-6 hours (po) |
| Golytely | Polyethylene glycol (used in bowel prep). .5-1hour bowel cleansing |
| Facilitate mixing of aqueous and fatty materials within intestinal tract; water and electrolyte secretion in large and small bowel | Emollient Laxatives (docusate - Colace) |
| How to take emollient laxatives | must take with greater than or equal to 8oz of water. loses effectiveness in 30 days |
| Lubricants (mineral oil) dosing | NOT recommended for routine use, in the elderly, or children <6 years old. Take on empty stomach, NOT before bed or in the recumbent position due to risk of aspiration |
| Red discoloration of the Urine can be seen in | Anthraquinones, particularly Sennosides (Senakot) |
| ____ is a stimulant that can be used in constipation that may induce premature labor in pregnant patients | Castor Oil |
Created by:
ltm12