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DCPA GI pharm
Pharm GI
| Question | Answer |
|---|---|
| H2 Blockers - uses | GERD/heart burn |
| H2 Blockers - MOA | Inhibits H2 receptors (reduces/neutralizes acid production) |
| H2 Blockers - side effects | headache & diarrhea (transient) |
| H2 Blocker examples | Famotidine (Pepcid), Ranitidine (Zantac), Cimetidine (Tagamet), Nizatidine (Axid) |
| H2 blockers - calcium complications | Calcium reduces the absorption of other medications such as tetracyclin |
| H2 blockers-administration | 30-60 minutes prior to a meal |
| Famotidine | Pepcid |
| Famotidine (Pepcid)- Drug interactions | Decrease effect of ketoconazole & itraconazole |
| Ranitidine | Zantac |
| Ranitidine (Zantac)- Drug interactions | Variable effects on Warfarin & Increases blood levels of glyburide, glipizide, metoprolol & phenytoin |
| Cimetidine | Tagamet |
| Cimetidine (Tagamet)- interactions | Drugs metabolized by P450 system, many cardiovascular drugs, & warfarin |
| Nizatidine | Axid |
| Nizatidine (Axid) | Decrease effects of ketoconazole, itraconazole & iron supplements |
| Proton Pump Inhibitors-MOA | Inhibit proton pump (decreases acid production) |
| Proton Pump Inhibitors- Use | Heart burn |
| Proton Pump Inhibitors - administration | 30 minutes prior to a meal (usually AM) |
| Proton Pump Inhibitors - side effects | Headache, diarrhea, abdominal discomfort, flatulence (transient) |
| Proton Pump Inhibitors - examples | Omeprazole (prilosec), esomeprazole (Nexium), Lansoprazole (Prevacid), Rebeprazole (Aciphex), Pantoprazole (Protonix) |
| Omeprazole | Prilosec |
| Omeprazole (Prilosec)- DI | Diazepam, Ketoconazole & warfarin (increases PT/INR - only one proven too) |
| Esomeprazole | Nexium |
| Esomeprazole (Nexium)- DI | Diazepam, Digoxin, warfarin & ketoconazole |
| Lansoprazole | Prevacid |
| Lansoprazole (Prevacid) - DI | Theophylline, digoxin, ketoconazole & warfarin |
| Lansoprazole (Prevacid) - uses | GERD, PUD, Esophogitis, etc. (More uses than all other PPI) |
| Rebeprazole | Aciphex |
| Rebeprazole (Aciphex)- DI | Warfarin, Digoxin & Ketoconazole |
| Pantoprazole | Protonix |
| Pantoprazole (Protonix)- DI | Warfarin & ketoconazole |
| Pantoprazole (Protonix) - administration | Given at the first bite of food. |
| OTC Antacids | Magnesium Hydroxide (Milk of Magnesia), Aluminum hydroxide(Amphojel), Magnesium/aluminum salts (Maalox), Calcium Carbonate (TUMS), Calcium/magnesium (Rolaids) |
| Magnesium Hydroxide | Milk of Magnesia |
| Magnesium Hydroxide (Milk of Magnesia) - MOA | Saline laxative (osmotic retention of fluid which increases peristalsis) which also neutralizes the stomach |
| Magnesium Hydroxide (Milk of Magnesia)- SE | Diarrhea |
| Magnesium Hydroxide (Milk of Magnesia)- DI | Decreased absorption of Fe & digoxin |
| Magnesium Hydroxide (Milk of Magnesia)- Contraindications | Renal impairment (accumulation of magnesium) |
| Aluminum Hydroxide | Amphojel |
| Magnesium/aluminum salts | Maalox |
| Aluminum Hydroxide (Amphojel) & Magnesium/aluminum salts (Maalox) - MOA | Neutralizes Acid |
| Aluminum Hydroxide (Amphojel) & Magnesium/aluminum salts (Maalox)- Contraindications | Renal impairment (aluminum toxicity) |
| Aluminum Hydroxide (Amphojel) & Magnesium/aluminum salts (Maalox)- SE | Constipation, stomach cramps, impaction, hypophosphatemia (low K+ & high aluminum - with prolonged use) |
| Aluminum Hydroxide (Amphojel) & Magnesium/aluminum salts (Maalox)- DI | Decrease the effect of digoxin, iron, allopurinol (gout med.) |
| Calcium Carbonate | TUMS |
| Calcium/Magnesium | Rolaids |
| Calcium Carbonate (TUMS)& Calcium/Magnesium (Rolaids) - SE | Hypercalcemia (prlong use - not for calcium supplement), constipation |
| Calcium Carbonate (TUMS)& Calcium/Magnesium (Rolaids) - Form | Chewable |
| Sucralfate | Carafate |
| Sucralfate (Carafate)- MOA | Bings to proteins in exudate of ulcers forming a paste-like coating ("band-aid") |
| Sucralfate (Carafate)- SE | Constipation |
| Sucralfate (Carafate)- DI | Decreases effectivness of multiple drugs therefore, seperate other drugs by 2 hours |
| Misoprostal | Cytotec |
| Misoprostal (Cytotec)- Use | Prevent NSAID induced stomach ulcers |
| Sucralfate (Carafate)- Use | Protectant to heal gastric or duodenal ulcers (Best for people who need constant NSAID relief - ie. RA & OA) |
| Misoprostal (Cytotec)- MOA | Synthetic Prostoglandin |
| Misoprostal (Cytotec)- SE | Diarrhea, abdominal pain, headache & flatulence |
| Misoprostal (Cytotec)- Contraindications | Pregnancy (prostoglandins = uterine contractions) |
| Cisapride | Propulsid |
| Cisapride (Propulsid)- MOA | Increased GI motility, LES pressure & peristalsis |
| Cisapride (Propulsid)- SE | Prolonged QT interval & lead to abnormal heart rhythms (Pulled off the market) |
| Metoclopramide | Reglan |
| Metoclopramide (Reglan) - Contraindication | Hx of bowel obstruction, perforation or hemorrhage |
| Metoclopramide (Reglan) - SE | Drowsiness, restlessness, dizziness & GI upset (diarrhea) |
| Metoclopramide (Reglan) - DI | Decreased gastric absorption (decreases digoxin)& increased intestinal absorption (increases cyclosporin) |
| IBS | More than three months of symptoms (continuous or intermittent) - Dx of exclusion |
| IBS - Lifestyle changes | Decrease Fat, Increase fiber (slowly), limit caffeine & milk, increase water & exercise |
| Tegaserod | Zelnorm |
| Tegaserod (Zelnorm)- Use | Constipation |
| Tegaserod (Zelnorm)- Contraindication | Renal or liver impairment, gall bladder disease or bowel obstruction |
| Tegaserod (Zelnorm)- SE | Diarrhea, headache, nausea, flatulence (transient) |
| Lubiprostone | Amitiza |
| Lubiprostone (Amitiza)- Use/MOA | Constipation - GI motility enhancer |
| Lubiprostone (Amitiza)- Contraindications | Hx of Bowel obstruction |
| Lubiprostone (Amitiza)- SE | Diarrhea, abdominal pain/distention |
| Types of laxatives | Stimulant, saline, bulk, glycerine, stool softeners, hyperosmotic, PEG solutions, regular |
| Stimulant laxative - examples | Bisacodyl (Dulcolax), Senna (Senekot, Ex-lax) |
| Stimulant laxative - SE | Cramping & dependency (chronic use) |
| Stimulant laxative - MOA | Activate smooth muscle of bowel to increase peristalsis |
| Stimulant laxative - Contraindications | Bowel Obstruction |
| Saline laxative - examples | Milk of magnesia, fleet phosphosoda, magensium citrate |
| Bisacodyl | Dulcolax |
| Senna | Sennekot, Ex-lax |
| Saline laxative - MOA | Draw fluid into intestine by way of osmosis which stimulates peristalsis |
| Saline laxative - SE | Mild cramping & flatulence |
| Bulk laxative - examples | Metumucil, Citrucel, Fibercon |
| Bulk laxative - MOA | Contains psysllium (absorbs water in intestine = increase in peristalsis & decrease transit time) |
| Bulk laxative - Contraindications | Fecal Impaction |
| Bulk laxative - Use | Safe in children |
| Glycerine laxative - administration | Fleet depositories - must be ratained in rectum for 5-15 minutes |
| Glycerine laxative - MOA | Local colon irritant which causes instant fecal lubrication & stimulates local peristalsis to evacuate lower colon |
| Glycerine laxative - Use | Safe for children & gives that "extra" push (Do NOT use routinely - dependence) |
| Stool softeners (Laxative) - Example | Docusate (Colace) |
| Docusate | Colace |
| Stool softeners (Laxative) - MOA | Surfactant which increases amount of water & fat incorporated into stool |
| Stool softeners (Laxative) - Use | People who need to avaoid straining (post-surgical, etc.) - Do NOT use for prolonged time = dependence |
| Hyperosmotic Laxative - example | Lactulose syrup |
| Hyperosmotic Laxative - MOA | Degreaded to NH4+ in the gut which draws water into distended colon = increase in peristalsis |
| Hyperosmotic Laxative - Contraindications | CAUTION with DM (galactose) |
| PEG Solutions (Laxative) - Examples | Nulytely, Miralax, Colyte |
| PEG Solutions (Laxative) - MOA | Evacuates bowel with strong electrolytes & osmotic effects (Used before GI exam - colonoscopy) |
| PEG Solutions (Laxative) - SE | Cramping, bloating & nausea |
| Regular laxative - examples | Mylicon drops (babies with colic), Gas X |
| Regular laxatives - Use | Decrease pain & bloating associated with intestinal gas (decreased distention = increase in bowel movement) |
| Antidiarrheal - Examples | Loperamide (Immodium), Diphenoxylate/atropine (Lomotil), Bismuth (Pepto-Bismol) |
| Loperamide | Immodium |
| Loperamide (Immodium)- MOA | Acts directly on intestinal muscles to decrease peristalsis which prolongs transit time & increases fluid absorption |
| Loperamide (Immodium)- DI | May increase absorption of CNS depressants & TCAs |
| Loperamide (Immodium)- SE | Drowsiness & constipation |
| Diphenoxylate/atropine | Lomotil |
| Diphenoxylate/atropine (Lomotil) - MOA | Inhibits GI motility & propulsion |
| Diphenoxylate/atropine (Lomotil) - DI | MAO Inhibitors & CNS depressant |
| Diphenoxylate/atropine (Lomotil) - SE | Drowsiness & urinary retention |
| Diphenoxylate/atropine (Lomotil) - Containdication | CAUTION - hepatic dysfunction (P450 system) |
| Bismuth subsalicylate | Pepto-Bismol |
| Bismuth subsalicylate (Pepto-Bismol) - MOA | Bismuth: Antibacterial & antiviral properties for the GI tract, Salicylate: antisecratory |
| Bismuth subsalicylate (Pepto-Bismol) - SE | Darkening of the tongue & black stools |
| Antiemetics - Use | Decrease vomitting (pre/post-op, chemo, morning sickness, etc.) |
| Antiemetics - Examples | Promethazine (Phenergan), Obdansetron (Zofran), Metoclopramide (Reglan) |
| Promethazine | Phenergan |
| Promethazine (Phenergan) - Administration | Injectable, syrup, tablet, suppository |
| Promethazine (Phenergan) - MOA | Reduces stimuli to the brainstem reticular system |
| Promethazine (Phenergan) - DI | Additive effects with any CNS depressant & inhibits levodopa (Parkinsons) |
| Promethazine (Phenergan) - SE | Extreme drowsiness |
| Obdansetron | Zofran |
| Obdanserton (Zofran) - Administration | Injection, tablet, solution, dissolving tablet |
| Obdanserton (Zofran) - MOA | Selective 5HT3-receptor antagonist |
| Obdanserton (Zofran) - SE | HA, Fever, Constipation, or Diarrhea |
| Metoclopramide (Reglan) - uses | Antiemetics & Prokinetic agent |
| Metoclopramide (Reglan) - MOA | blocks dopamine receptors in the trigger zone of CNS, increase ACH in upper GI causing enhanced motility & accelerated gastric emptying w/o stimulating digestive secreations |
| Antispasmotics - Examples | Hyoscyamine (Levsin, Levsin SL, Levbid), Dicyclomine (Bentyl) |
| Hyoscyamine | Levsin, Levsin SL, Levbid |
| Hyoscyamine (Levsin, Levsin SL, Levbid) - MOA | Blocks action of ACH at parasympathetic sites in smooth muscle, secretory glands & CNS |
| Hyoscyamine (Levsin, Levsin SL, Levbid) - SE | Constipation, dry nose/throat & skin |
| Dicyclomine | Bentyl |
| Dicyclomine (Bentyl) - MOA | Blocks action of ACH at parasympathetic sites in smooth muscle, secretory glands & CNS & effective for smooth muscles of the bladder (urinary incontinence) |
| Dicyclomine (Bentyl) - DI | Increased toxicity with TCA, narcotic anagelsics & antihistamines |
| Dicyclomine (Bentyl) - SE | Drowsiness, HA, constipation |
| Dicyclomine (Bentyl) - Use | Main use = urinary incontinence & antispasmodics |
| Hemorrhoid treatment goals: | Shrink distended vessel & ease symptoms (pain, burning, itching) |
| Hemrrhoid treatment - examples | Anusol HC cream/suppositories, Proctocort, Proctofoam |
| Anusol HC Cream | Used externally or just inside the rectum (topical) - Shrinks hemorrhoids |
| Proctocort | Contains an administration tip which delivers medication about an inch inside the rectum - shrinks hemorrhoids |
| Anusol HC suppositories | Inserted inside rectum for as long as possible in order to dissolve and coat the area |
| Proctofoam | Foam is sprayed into the rectum and expands to reach higher up than other creams/foams and coats more effectively |
| IBD Treatment - Examples | Mesalamine (5-aminosalicyclic acid), Sulfasalazine (Azulfidine) |
| Mesalamine | 5-aminosalicyclic acid |
| Sulfasalazine | Azulfidine |
| Mesalamine (5-aminosalicyclic acid) & Salfasalazine (Azulfidine) - MOA | Converted in the colon to salicyclic acid, decreases leukotrienes = decrease in inflammation (ONLY RELIEVES INFLAMMATION) |
| Mesalamine (5-aminosalicyclic acid) & Salfasalazine (Azulfidine) - SE | HA, abdominal pain & flatulence |
| Mesalamine (5-aminosalicyclic acid) & Salfasalazine (Azulfidine) - administration | Tablets, enemas & suppositories |
| Clostridium Difficile Toxin | Uncommon complication of AB therapy, NMF & community aquired (rare) |
| Clostridium Difficile Toxin Treatment | Avoid anti-diarrheals & anti-motility drugs. Give Metronidiazole. Alternative is Vancomycin. Resistant = Metronidiazole & rifampin |
| Metronidiazole - SE | Disulfuric Reaction |
| Helicobacter Pylori - Causes | PUD |
| Helicobacter Pylori - Dx | Breath test, blood test or biopsy (endoscopy), stool antigen test (most specific test) |
| Helicobacter Pylori - Tx | Prevpak or Helidac (Penicillan allergy) |
| Prevpak | Lansoprazole, amoxicillian & clarithromycin |
| Helidac | Bismuth, Metronidazole, tetracyclin & omeprazole |
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