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SPEARS GI EXAM 1

CLASSDRUGSMOAADRSNOTES
Two major causes of PUD Helicobacter (H.) pylori-induced and NSAID-induced
H2-histamine receptor blockers (PUD/GERD) cimetidine, famotidine, nizaridine, ranitidine Selective, reversible competitive inhibitors at parietal cells, cAMP dependent CNS-hallucinations cimetidine: Endocrine/metabolic: decreases libido, impotence, gynecomastia, galactorrhea, breast soreness ​ decrease basal and meal acid secrection
Proton pump inhibitors (PUD/GERD) Dexlansoprazole (dexilant)​, Esomeprazole (nexium)​, Lansoprazole (prevacid)​, Omeprazole​ (prilosec), Pantoprazole (prontonix), Rabeprazole (aciphex) Block (ATP pump) H/K ATPase at parietal cells generally safe, common harmless ADRs, can cause B12 def, reduced mineral absorption and increased bone fracture risk more effective than histamine blockers, take on empty stomach, irreversibly inactivates pump
Antacids (PUD/GERD) Calcium carbonate (tums), sodium bicarbonate, aluminum, hydrozide Weak bases that neutralize (H), results in higher pH (less acid) endocrine/metabolic, and GI effects (Mg diarrhea),(Al/Ca constipation) low dose antacids - high dose laxative
Potassium-competitive acid blocker (PUD/GERD) Vonoprazan (voquenza) K competitive acid blocker (P-CAB) - reversibly competes with K to bind to H/K ATPase Fracture risk
Coating agents (PUD/GERD) Bismuth subsalicylate (pepto-bismol), bismuth subcitrate potassium inhibits growth of H. pylori AND salts combine with mucus glycoproteins forming a layer that coats erosions/ulcers avoid in renal insufficiency, may cause constipation, salicylate toxicity (Reye's syndrome) with prolonged use/high dose - avoid in pediatric and pregnant patients
Coating agent (PUD/GERD) sucralfate (carafate) sucrose sulfate + Al (OH)3, physical barrier at ulcer/erosion site to restrict damage, binds positively charged proteins of epithelial cells
Prokinetic agents (GERD) Metoclopramide (reglan) Dopamine 2 receptor antagonist, works to reduce reflux of gastirc contents and increase emptying rate Prokinetic action (peripherally acting): increase emptying rate Atcs centrally to prevent nausea at dopamine receptor at high doses BW: tardive dyskinesia (facials ticks) CNS restlessness, drowsiness, insomnia, anxiety, depression, parkinson-like syndromes
Dopamine 2 receptor antagonists Amisulpride Metoclopramide (at higher doses) Antipsychotics (prochlorperazine, droperidol, haloperidol, olanzapine) all work to block D2 receptor in chemoreceptor trigger zone (CTZ) sedations used for chemo induced vomiting and postoperative nausea and vomiting (PONV)
5HT3 receptor antagonists Ondansetron, granisetron, dolasetron, palonosetron Blocks 5HT3 in peripheral system (intestinal nerves) and targets CTZ serotonin syndrome with SS/SNRIS, QT prolongation used for chemo induced vomiting and postoperative nausea and vomiting (PONV)
Neurokinin NK1 receptor antagonists Aprepitant, rolapitant, netupitat and palonosetron cross BBB, block NK1 fatigue, dizziness, diarrhea, combined with steroids or 5HT3's prevent acute and delayed emesis from chemotherapy or surgery
Corticosteroids Dexamethasone, methylprednisone larger dose usually required for antemetic effect, unknown MOA enhances efficacy of 5HT3's PONV/CINV
Antihistamines Cyclizine * Diphenhydramine*​ Dimenhydrinate* Hydroxyzine​ Meclizine* Promethazine*​ Scopolamine (Hyoscine)* Doxylamine competitive, reversible H1 antagonism dizziness, sedation, confusion motion sickness, nausea with pregnancy weak CYP2D6 inhibitor
Cannabinoid receptor agonists Dronabinol (CB1 and Cb2 receptor) Nabilone (synthetic delta 9) (CB1 receptor agonist) Marijuana Agonists at CB1 or CB2, antiemetic effects via 5HT1a mechanism cannabinoid induced hyperemesis syndrome (get nausea when you smoke) for chemo-induced nausea/vomiting, interacts with CNS depressants CB1 receptors are located in the CNS
Created by: beezy41
 

 



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