Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
GI Review 2 (sb)
| Question | Answer |
|---|---|
| Mesalamines | Sulfasalazine (azulfidine), Asacol (coated), Pentasa (coated), Rowasa (topical) |
| Mesalamines MOA | Inhibits PG synthesis and inflammatory cell migation into the bowel wall (inhibits IL-1 and TNFalpha and NFB and inhibits the LOX pathway) |
| Mesalamines Use | IBD |
| Mesalamines Adverse | 1st gen- N/V/D, HA, rash, fever, decreased folic acid. rarely bone marrow suppression, pancreatitis, hepatitis, anemia |
| Mesalamines Monitoring | 1st gen- renal function |
| Site of action- Pentasa | Jejunum |
| Site of action- Asacol | Ileum |
| Site of action- Sulfasalazine | proximal colon |
| Site of action- rowasa | distal colon |
| Azathioprine Class | Immunosuppressant- Purine analogs |
| Azathioprine MOA | Impairs purine synthesis and inhibits cell proliferation- t cell death |
| Azathioprine Use | IBD, sub for steroid- takes weeks to months to work |
| Azathioprine Adverse | dose related- N/V, bone marrow suppression, pancreatitis, increase LFTs, lymphoma |
| Azathioprine Interactions | TPMT genetic variability- increase toxicity or decrease effectiveness, xanthine oxidase inhibitors |
| Azathioprine monitoring | CBC every 2-4 weeks for 2 months then every 4-8 weeks |
| methotrexate MOA | Inhibition of dihydrofolate reductase- blocks DNA synthesis-cell death, anti-inflammatory, T Lymphocyte death |
| methotrexate Use | IBD (CD>UC) |
| methotrexate Adverse | early- nausea other- bone marrow suppression, fatigue, megaloblastic anemia, alopecia, mucositis |
| methotrexate Conta | PREGOS |
| methotrexate Monitoring | CBC at baseline and then monthly |
| methotrexate Pearls | Weekly IM injections given with folic acid |
| Cyclosporine MOA | Calcineurin inhibitor- inhibits IL-2 inhibits t-cell signal transduction, potent immunomodulator |
| Cyclosporine Use | Severe UC (when everything else has failed) |
| Cyclosporine Adverse | nephrotoxicity, HTN, hirsutism, gingival hyperplasia, muscle tremor, hyperlypoproteinemia, hyperglycemia |
| Cyclosporine Interactions | CYP3A4 |
| Cyclosporine Monitoring | Switch from IV to PO ASAP |
| Budesonide (Entocort EC) class | glucocorticoids |
| Budesonide (Entocort EC) MOA | inhibition of the production of IL-1 and TNFa and IL-8 (reduce inflammatory cell adhesion molecules), inhibit gene transcipriton of nitric oxide synthase and COX2 |
| Budesonide (Entocort EC) Use | Uses: mild to mod crohns. maintenance for 3 months, controlled release in distal ileum and colon |
| Budesonide (Entocort EC) pearls | Taper ASAP |
| infliximab (Remicade) Class | Biologics- anti TNF |
| infliximab (Remicade) MOA | Inactivated TNF-alpha and reduces inflammation, pain and destruction |
| infliximab (Remicade)/ Natalizumab (Tysabri) Use | IBD (CD more severe cases) |
| infliximab (Remicade) Adverse | Infusion reaction, reactivation of TB or worsening HF |
| infliximab (Remicade) Contra | NYHA III/IV |
| infliximab (Remicade) Monitoring | Get TB test before starting |
| Natalizumab (Tysabri) Class | biologics- anti-integrin |
| Natalizumab (Tysabri) MOA | targets integrin, prevents vascular adhesion and migration of inflammatory cells |
| Natalizumab (Tysabri) Adverse | JC virus activation (PML) |
| Natalizumab (Tysabri) Contra | Do not use with any other immunosuppressive agents |
| Natalizumab (Tysabri) Pearls | get JC virus screening before use |
| Ciprofloxacin (Cipro) Class | FQ |
| Ciprofloxacin (Cipro) MOA | inhibits IIA DNA topoisomerase (winding and unwinding DNA) |
| Ciprofloxacin (Cipro) Use | Infectious diarrhea, intra-abdominal infections/ complications |
| Ciprofloxacin (Cipro) Adverse | N/V/D, arthropathy, tendonitis, insomnia, HA, Dizziness, photosensitivity, dysglycemia, QTc interval prolongation |
| Ciprofloxacin (Cipro) Contra | No pregos, kids, or breast feeders |
| Ciprofloxacin (Cipro) Interactions | Decreased with cations and increases warfarin |
| Ciprofloxacin (Cipro) Monitoring | Arrhythmias, tendon rupture (BB) |
| metronidazole (flagyl) Class | Nitroimidazole antibiotic |
| metronidazole (flagyl) MOA | IBS: Flagyl may kill susceptible GI organisms (anaerobes) in the small intestine that have overgrown and contribute to symptoms. HE: Aerobic gut flora endogenously produce ammonia; as you kill the flora, you reduce ammonia. |
| metronidazole (flagyl) Use | HE, IBS when SIBO is suspected |
| metronidazole (flagyl) Adverse | HA, metallic taste in mouth, N/V/D |
| metronidazole (flagyl) Interactions | Alcohol |
| Neomycin sulfate Class | aminoglycoside antibiotic |
| Neomycin sulfate MOA | reduces intestinal ammonia by inhibiting urease producing bacteria |
| Neomycin sulfate Uses | HE |
| Neomycin sulfate Adverse | nephrotoxicity, ototoxicity, neurotoxicity (rare) |
| Neomycin sulfate Monitoring | ammonia levels, hearing, kidney function |
| Neomycin sulfate Pearls | poor absorption so adverse effects are rare but only used as a last resort |
| lactulose (Kristalose) Class | osmotic laxative |
| lactulose (Kristalose) MOA | poorly absorbed molecules attract/retain water in intestine, increase volume, peristalsis |
| lactulose (Kristalose) Uses | Constipation, pre-op for colonoscopy and abd surgery |
| lactulose (Kristalose) Adverse | dehydration, hypernatremia, hypokalemia, abd pain, abd distention, belching, cramping, diarrhea, flatulence, N/V |
| lactulose (Kristalose) Contra | pts requiring a low galactose diet |
| lubiprostone (Amitizia) Class | Chloride channel activator |
| lubiprostone (Amitizia) MOA | stimulates chloride rich fluid secretion in the intestinal lumen= increase motility and decrease intestinal transit time |
| lubiprostone (Amitizia) Use | IBS-C |
| lubiprostone (Amitizia) Adverse | nausea, dyspnea (1st hour or 1st dose but will go away) |
| lubiprostone (Amitizia) Contra | GI obstruction |
| Tegaserod (Zelnorm) Class | 5-HT4 receptor agonist |
| Tegaserod (Zelnorm) MOA | partial agonist of 5-HT4 receptor, stimulating enteric neurons to promote peristaltic reflex |
| Tegaserod (Zelnorm) Uses | IBS-C |
| Tegaserod (Zelnorm) Adverse | CV death |
| Tegaserod (Zelnorm) Pearls | only available in emergency |
| alosetron (Lotronex) Class | 5-HT3 receptor antagonist |
| alosetron (Lotronex) MOA | blocks 5-HT3 receptors- inhibits enteric cholinergic neurons- inhibits colonic motility- increases total colonic transit time |
| alosetron (Lotronex) Use | IBS-D |
| alosetron (Lotronex) Adverse | GI tox, constipation, ischemic colitis |
| rifaximin (xifazan) MOA | non-systemic antibiotic that targets gut organisms |
| rifaximin (xifazan) Use | abd pain and bloating in IBS, TD, HE |
| rifaximin (xifazan) Pearls | 14 week course for 10 weeks of relief |
| Bifidobacterium Class | probiotic |
| Bifidobacterium MOA | alters GI flora |
| Bifidobacterium Use | IBS |
| Disulfiram (antabuse) Class | aldehyde dehydrogenase inhibitor |
| Disulfiram (antabuse) MOA | inhibits acetaldehyde degradation after drinking causing blurred vision, vomiting, chest pain, dizziness, palpitations, nausea, HA, sweating, flushing, and weakness |
| Disulfiram (antabuse) Use | alcohol abstinence |
| Disulfiram (antabuse) Adverse | drowsiness |
| Prednisolone Class | medium potency intermediate acting glucocorticoid |
| Prednisolone MOA | anti-inflammatory, decreases cytokines, acetaldehyde adducts and collagen formation |
| Prednisolone Use | alcoholic liver disease (slows down cirrhosis) |
| Prednisolone Adverse | cushings syndrome |
| Prednisolone Contra | GI bleed, chronic hep B, untreated active infection, renal failure |
| Prednisolone Monitoring | bp, blood sugar, bone density, eyes |
| interferon a 2a (pegasys) and 2b (intronA) Class | Glycoprotein cytokines |
| interferon a 2a (pegasys) and 2b (intronA) MOA | Binds to cell surface receptors dening virus. Increases expression of MHC antigens and enhances phagocytic activity of macrophages. |
| interferon a 2a (pegasys) and 2b (intronA) Use | Hep B and C |
| interferon a 2a (pegasys) and 2b (intronA) Adverse | flu like syndrome, increase LFTs (not bad though), CNS depression and seizures, autoimmune exacerbation, GI upset, cardiac arrhythmias, and changes in BP |
| interferon a 2a (pegasys) and 2b (intronA) Contra | hepatic decompensation, autoimmune disease, cardiac arrhythimias, depression |
| interferon a 2a (pegasys) and 2b (intronA) Monitoring | LFTs |
| ribavirin (copegus) Class | anti-viral, guanasine analog |
| ribavirin (copegus) MOA | Interferes with the synthesis of guanasine triphosphate and inhibit viral replication |
| ribavirin (copegus) Use | Hep C |
| ribavirin (copegus) Adverse | dose dependent- hemolytic anemia, depression, fatigue, irritability, rash, pruritus, cough, insomnia, nausea |
| ribavirin (copegus) Contra | anemia, renal disease, PREGO X |
| ribavirin (copegus) Pearls | take with a fatty meal |
| lamivudine (Epivir-HBV)/ adefovir (Hepsera)/ entecavir (Baraclude) Class | antiretroviral- nucleoside analogs |
| lamivudine (Epivir-HBV)/ adefovir (Hepsera)/ entecavir (Baraclude) MOA | Inhibit the action of viral DNA polymerase by taking the place of nucleotides in the elongating strand of viral DNA leading to early termination of DNA synthesis |
| lamivudine (Epivir-HBV)/ adefovir (Hepsera)/ entecavir (Baraclude) Use | Lami- HBV and HIV Ade & Ente- HBV only |
| lamivudine (Epivir-HBV)/ adefovir (Hepsera)/ entecavir (Baraclude) Adverse | well tolerated but can cause fatigue and elevated CPK adefovir: dose related nephrotoxicity |
| lamivudine (Epivir-HBV)/ adefovir (Hepsera)/ entecavir (Baraclude) Monitoring | Renal function |
| lamivudine (Epivir-HBV)/ adefovir (Hepsera)/ entecavir (Baraclude) Pearls | test for HIV co-infection before starting tx, renally adjust all meds as needed, none of these cure chronic HBV just suppress viral load |
| boceprevir (Victrelis) / tealprevir (incivek) Class | Direct acting antiviral agents |
| boceprevir (Victrelis) / tealprevir (incivek) MOA | Inhibition of the HCV nonstructural protein 3/4A serine proease; HCV genotype 1 |
| boceprevir (Victrelis) / tealprevir (incivek) Use | tx of naive and experienced HCV |
| boceprevir (Victrelis) / tealprevir (incivek) Adverse | anemia B- dysgeusia, T- rash, pruritis, nausea, anorectal discomfort, diarrhea |
| boceprevir (Victrelis) / tealprevir (incivek) contra | Pregos |
| boceprevir (Victrelis) / tealprevir (incivek) interactions | CYP450 drugs |
| boceprevir (Victrelis) / tealprevir (incivek) Pearls | combo with PegIFN and wt based ribavirin |
| spironolactone (Aldactone)/ furosemide (Lasix) Class | Diuretics |
| spironolactone (Aldactone)/ furosemide (Lasix) MOA | (S)- blocks aldosterone receptors which results in increase Na excretion and decrease K excretion (F)- inhibits Na and Cl reabsorption in the thick ascending limb |
| spironolactone (Aldactone)/ furosemide (Lasix) Use | ascites due to cirrhosis, hypertension, edema, hypokalemia |
| spironolactone (Aldactone)/ furosemide (Lasix) Adverse | (S) hyperkalemia, gyncomastia |
| spironolactone (Aldactone)/ furosemide (Lasix) Contra | renal insufficiency, hyperkalemia |
| spironolactone (Aldactone)/ furosemide (Lasix) Monitoring | UA, daily weights |
| Albumin 25% Use | use when removing a large paracentesis to prevent circulatory dysfunction and with SBP when SrCr >1mg/dL and BUN >30 or TBili >4 |
| pancrelipase (pancrease) Class | digestive enzyme replacement (lipase-protease-amylase) |
| pancrelipase (pancrease) MOA | enzymes aiding in hydrolysis |
| pancrelipase (pancrease) Use | pancreatic insufficiency- replacement therapy for malabsorption, pain in chronic pancreatitis |
| pancrelipase (pancrease) Adverse | mouth irritation, hyperuricemia, fibrosing colonopathy |
| pancrelipase (pancrease) Contra | allergy to porcine proteins |
| pancrelipase (pancrease) Interactions | antacids |
| pancrelipase (pancrease) Monitoring | renal function, uric acid, stool patterns, fat absorption |
| Octreotide Class | growth hormone inhibitor |
| Octreotide MOA | supresses secretion of GH, insulin-like growth factors, serotonin and GIP |
| Octreotide Use | Carcinoid tumors, acromegaly, OFF LABEL: esophageal hemorrhage, diarrhea |
| Octreotide Adverse | arrhythmias, glucose changes, constipation, flatulence, nausea |
Created by:
duanea00
Popular Pharmacology sets