Term
| Which drugs are cytoprotective? |
|
Definition
Sucralfate
Misoprostol
Arthrotec |
|
|
Term
|
Definition
a combination of diclofenac (an NSAID) and misoprostol
treats arthritis and prevents possible NSAID assc. ulcers |
|
|
Term
| what do cytoprotective drugs do? |
|
Definition
| they protect the GI mucosa |
|
|
Term
| Sucralfate is a polymer of... |
|
Definition
| sucrose and aluminum hydroxide |
|
|
Term
| how does sucralfate protect the GI mucosa? |
|
Definition
it adheres to the ulcer crater and prevents its contract with gastric acid
it also stimulates PG synthesis which provides protection
all of this allows the ulcer to heal |
|
|
Term
| how often do you take sucralfate? |
|
Definition
|
|
Term
|
Definition
PO (tablet or liquid)
essentially no absorption |
|
|
Term
| what is sucralfate indicated for? |
|
Definition
active PUD
suppress recurrences of ulcers |
|
|
Term
|
Definition
|
|
Term
| How is misoprostol cytoprotective? |
|
Definition
| its a PG analogue that inhibits gastric acid secretion while promoting the secretion of mucous and bicarb |
|
|
Term
|
Definition
diarrhea, and other GI complaints
contraindicated in pregnancy, can stimulate uterine contractions |
|
|
Term
| why would you use misoprostol? |
|
Definition
| to prevent NSAID-induced ulcers only |
|
|
Term
| Is diarrhea is disease or disorder? |
|
Definition
| no, its a sxs of a GI disorder |
|
|
Term
| Most cases of diarrhea only need _____ to treat it. |
|
Definition
|
|
Term
|
Definition
infection
maldigestion
inflammation
functional disorders of the bowel |
|
|
Term
|
Definition
| characterized by stools of excessive volume and fluidity, and by increased frequency of defecation |
|
|
Term
| what are the most serious complications associated with diarrhea? |
|
Definition
dehydration
and
depletion of electrolytes |
|
|
Term
| management of diarrhea is directed at: |
|
Definition
Dx and Txt of underlying d/o
replacement of lose water and salts
relief of cramping
reducing the passage of unformed stools |
|
|
Term
| antidiarrheal drugs fall into which 2 groups? |
|
Definition
1. specific antidiarrheal drugs
2. nonspecific antidiarrheal drugs |
|
|
Term
| what do specific antidiarrheals treat? |
|
Definition
| the underlying causes of diarrhea |
|
|
Term
| what do nonspecific antidiarrheals treat? |
|
Definition
|
|
Term
| Nonspecific antidiarrheal drugs |
|
Definition
opiods (diphenoxylate + aropine, Loperamide, Paregoric)
bulk forming agents (attapulgite, polycarbophil)
Bismuth Subsalicylate
antispasmodics |
|
|
Term
| how do opioids help with diarrhea? |
|
Definition
they stimulate the opioid receptors in the GI tract and suppress peristalsis and thereby facilitate absorption of water and electrolytes
this reduces the fluidity and volume of stools and the frequency of defecation |
|
|
Term
| why is dependence not really an issue when opioids are prescribed for diarrhea? |
|
Definition
|
|
Term
| why is diphenoxylate combined with atropine? |
|
Definition
| it is included to discourage abuse |
|
|
Term
| what is the only indication for diphenoxylate? |
|
Definition
|
|
Term
| loperamide is a structural analog of... |
|
Definition
|
|
Term
| why do you not see opioid like SEs from using loperamide for diarrhea? |
|
Definition
| bc it is poorly absorbed and does not readily cross the BBB |
|
|
Term
| which opioid used for diarrhea is really only prescribed for babies? |
|
Definition
|
|
Term
| how does attapulgite help with diarrhea? |
|
Definition
| it pulls diarrhea-causing substances from the digestive tract, also provides bulk |
|
|
Term
| how does polycarbophil (fibercon) help with diarrhea? |
|
Definition
| it gives the stool a more firm, less watery consistency |
|
|
Term
| how does bismuth subsalicylate help with diarrhea? |
|
Definition
it decs the secretion of fluid into the intestine
|
|
|
Term
| how does bismuth help treat PUD? |
|
Definition
1. forms a protective coating over the ulcer crater
2. promotes secretion of bicarb and PGs
3. suppresses growth of H. pylori |
|
|
Term
| how do antispasmodics help with diarrhea? |
|
Definition
| the can relieve cramping assc with diarrhea but they do not alter fecal consistency or volume |
|
|
Term
| how long should you use antidiarrheals? |
|
Definition
|
|
Term
|
Definition
| they stimulate intestinal peristalsis and inc. movement of contents through the bowel |
|
|
Term
| why would you prescribe/use laxatives? |
|
Definition
- to treat constipation
- to evacuate the bowel prior to surgery or dx procedures
- to purge the system of poisons |
|
|
Term
|
Definition
| refers to the production of a soft, formed stool over a period of one or more days (mild) |
|
|
Term
|
Definition
| when evacuation of bowel is fluid and prompt (intense) |
|
|
Term
| what is the primary cause of constipation? |
|
Definition
| poor diet - a diet deficient in fiber and fluids |
|
|
Term
| what 2 ways does fiber facilitate colonic function? |
|
Definition
1. some types absorb water, thereby softening the feces and increasing the mass
2. other types are digested by colonic bacteria, whose subsequent growth increases fecal bulk |
|
|
Term
| which drugs can be used as an adjunct to antihelmintic therapy? |
|
Definition
|
|
Term
| what are the different types of laxatives? |
|
Definition
bulk forming
surfactants
contact agents
saline laxatives
glycerin
lactulose
mineral oil
polyethylene glycol |
|
|
Term
| what is the MOA of bulk forming agents used as laxatives? |
|
Definition
| absorb water and increase the mass in the GI tract. The mechanical distention stimulates peristalsis |
|
|
Term
| which are the safest of all laxatives? |
|
Definition
bulk forming agents
methylcellulose (citrucel)
Psyllium (metamucil)
bran |
|
|
Term
| what do you need to tell patients to do when they take bulk forming agents? |
|
Definition
| to take with a full glass of water |
|
|
Term
| which drugs are surfactant laxatives? |
|
Definition
docusate sodium
docusate sodium + casanthranol
docusate calcium
docusate calcium + casanthranol |
|
|
Term
| what is the MOA of surfactant laxatives? |
|
Definition
decrease surface tension on stool and allow water to penetrate and soften the contents
(almost like a soap) |
|
|
Term
| MOA of contact agent laxatives |
|
Definition
stimulants irritate the intestinal mucosa and increase intestinal motility
also alter electrolyte and fluid absorption |
|
|
Term
| surfactant laxatives containing sodium should be used in caution in which patients? |
|
Definition
|
|
Term
| which drugs are contact agent laxatives? |
|
Definition
senna - senakot
cascara sagrada
phenolphthalein - exlax
bisocodyl - dulcolax
castor oil |
|
|
Term
| which laxatives are most often abused? |
|
Definition
|
|
Term
|
Definition
| produce an osmotic effect in the intestinal lumen that causes fluid accumulation, intestinal distention and peristalsis |
|
|
Term
|
Definition
Magnesium hydroxide - MOM
magnesium sulfate - epsom salts
magnesium citrate - citrate of Mg
Sodium Phosphate - phospho-soda
sodium biphosphate + sodium phosphate - fleets enema |
|
|
Term
|
Definition
| fluid and electrolyte alterations |
|
|
Term
| how does glycerin help with constipation? |
|
Definition
| it pulls water from the extraluminal spaces into the feces and stimulates reflex evacuation |
|
|
Term
| how is glycerin usually admin'ed? |
|
Definition
|
|
Term
| which laxative is good for infants and children? |
|
Definition
|
|
Term
| What is the major use of Lactulose? |
|
Definition
to reduce ammonia levels in liver dysfunction
(by 25-50%) |
|
|
Term
| As a laxative, Lactulose __________ into the intestinal lumen making the stool softer. |
|
Definition
|
|
Term
| Is lactulose a safe laxative? |
|
Definition
| yes, because its bascially not absorbed |
|
|
Term
| How does mineral oil act as a laxative? |
|
Definition
| it lubricates the feces and the intestinal mucosa preventing water from being resorbed from the feces |
|
|
Term
| Mineral oil is used to treat constipation and maintain soft stools when _____________ is contraindicated. |
|
Definition
|
|
Term
| How can you administer mineral oil? |
|
Definition
|
|
Term
| Mineral oil can impair the absorption of what other medications? And what can you do to prevent this? |
|
Definition
fat soluble vitamins
oral contraceptives
anticoagulants
you can stagger the doses so its not an issue |
|
|
Term
| List the SEs of Mineral Oil. |
|
Definition
N/V/D, abd cramping
Anal irritation, pruritis ani, infection
aspiration pneumonia
may soil underwear :( |
|
|
Term
| When is polyethylene glycol used? |
|
Definition
| for patients who are about to have some procedure, like a colonscopy |
|
|
Term
| If emesis is secondary to motion sickness, what might you prescribe? |
|
Definition
antihistamines (dramamine)
Anticholinergics
benadryl |
|
|
Term
| If emesis is due to a "central cause" you might prescribe... |
|
Definition
Phenothiazine
Cannabinoid
Metoclopramide |
|
|
Term
| How do Phenothiazines help treat emesis due to a "central cause"? |
|
Definition
they inhibit dopaminergic transmission at the CTZ
they also inhibit stimulation of the vagus nn (which innervates the stomach) |
|
|
Term
|
Definition
Promethazine - Compozine
Prochlorperazine - Phenygrin |
|
|
Term
| Metoclopramide inhibits ______________ at the CTZ, and improves gastric ______________ . |
|
Definition
dopaminergic transmission
emptying |
|
|
Term
| Which drugs are good to give a person suffering from emesis due to chemotherapy? |
|
Definition
| Serotonin receptor antagonists |
|
|
Term
| List the serotonin receptor antagonists. |
|
Definition
Ondansetron - Zofran
Granisetron - Kytril
Dolasetron - Anzemet |
|
|
Term
| Serotonin receptor antagonists antagonize the serotonin receptors found on the _________________ and in the ________. |
|
Definition
vagal nerve terminals
CTZ |
|
|
Term
| What are the 3 major causes of PUD? |
|
Definition
1. H. Pylori
2. Increased Acid Secretion
3. Inadequate Mucosal Defense vs. Gastric acid |
|
|
Term
| Based on the 3 major causes for PUD, what needs to happen to each to treat them? |
|
Definition
1. Eradicate H. Pylori
2. Decrease secretion of HCl or neutralize HCl
3. Protect gastric mucosa |
|
|
Term
| Which drugs eradicate H. Pylori? |
|
Definition
Metronidazole (Flagyl)
Amoxicillin
Clarithromycin
Tetracyclin
Bismuth
Use in combinatino for 2 weeks |
|
|
Term
| Treating H. Pylori results in a ______ cure rate with low recurrence rates. |
|
Definition
|
|
Term
| Bismuth Subsalicylate inhibits _________ and increases the secretion of _____________. It has an ________________ effect too. |
|
Definition
pepsin
mucus
antibacterial |
|
|
Term
| What are the receptors types found parietal cells that stimulate acid secretion? |
|
Definition
histamine
Cholinergic
CCK-B receptors for gastrin
PG receptors |
|
|
Term
| Which drug groups inhibit acid secretion? |
|
Definition
Histamine2 Receptor Antagonists
Proton Pump Inhibitors
Muscarinic Receptor Antagonists
|
|
|
Term
| List the Histamine2 Receptor Antagonists. |
|
Definition
Cimetidine - tagamet
Ranitidine - Zantac
Famotidine - Pepcid
Nizatidine - Axid |
|
|
Term
| Histamine2 Receptor Antagonists block these receptors to inhibit ________________. (MOA) |
|
Definition
|
|
Term
Ranitidine and Famotidine decrease the _________, ___________ and _____________ secretion of gastric acid. |
|
Definition
basal
food-stimulated
nocturnal |
|
|
Term
| H2RAs have a minimal effect on gastric acid secretion induced by _______ and _____________. |
|
Definition
PSNS
parasympathomimetics |
|
|
Term
|
Definition
|
|
Term
| With continued use of H2RAs, receptor production is ______________ and patients become tolerant to them. |
|
Definition
|
|
Term
| Why is Cimetidine not recommended? |
|
Definition
| Because it has so many drug interactions |
|
|
Term
| Which H2RA is the most potent? |
|
Definition
|
|
Term
| H2RAs are absorbed well ________. |
|
Definition
|
|
Term
| Which H2RA is the best one, but it has just not caught on? |
|
Definition
|
|
Term
| Which is the only H2RA that does not have metabolites that are excreted renally? |
|
Definition
|
|
Term
|
Definition
Omeprazole - Prilosec
Lansoprazole - Prevacid
Rabeprazole - Aciphex
Pantoprazole - Protonix
Esomeprazole - Nexium |
|
|
Term
| PPIs bind to and irreversibily inhibit the __________ of the parietal cells, resulting in a marked decrease in _______________. |
|
Definition
H/K -ATPase pump
acid secretion |
|
|
Term
| Why is tolerance not a problem with PPIs? |
|
Definition
| since new proton pumps are continuously being synthesized |
|
|
Term
| PPIs produce a dose dependent inhibition of up to ________% of gastric acid secretion. |
|
Definition
|
|
Term
| A single PPI dose can inhibit acid secretion for _________. |
|
Definition
|
|
Term
| PPIs inhibit ________ and _________ gastric acid secretion. |
|
Definition
|
|
Term
| Which drugs would be good to use to treat hypersecretory states like ZE syndrome? |
|
Definition
|
|
Term
| PPIs must be administered as ______________ or _________________ because they are unstable in the presence of acid. |
|
Definition
enteric coated preparations
or
buffered suspensions |
|
|
Term
| What is Prevacid Naprapac? |
|
Definition
a combination of Lansoprazole and naproxen
(Naproxen may not produce ulcers in this combination) |
|
|
Term
| _____________ (a PPI) effects are decreased by cigarette smoking. |
|
Definition
|
|
Term
| Which PPI is extensively metabolized by CYP2C19 and 3A4, but does not have any clinically significant interactions with warfarin, quinidine or phenytoin? |
|
Definition
|
|
Term
| PPIs are indicated for treatment of: |
|
Definition
PUD
GERD/Erosive gastritis
Hypersecretory Syndromes |
|
|
Term
| Muscarinic Receptor Antagonists are mos often prescribed for _____________. |
|
Definition
|
|
Term
| List the muscarinic receptor antagonists |
|
Definition
Dicyclomine
Glycopyrrolate
Phenobarbital + hyocyamine + atropine
(these are antispasmodics) |
|
|
Term
| Muscarinic receptor antagonists are considered _________________. |
|
Definition
|
|
Term
| Which different agents neutralize stomach acid? |
|
Definition
Magnesium Hydroxide - MOM
Aluminum Hydroxide
Calcium Carbonate + Simethicon
Sodium Bicarbonate |
|
|
Term
| Absorption of antacids is neither ___________ nor ____________. |
|
Definition
|
|
Term
| What are the commonly used cations in antacids? |
|
Definition
magnesium
calcium
Aluminum |
|
|
Term
| What is the most common anion used in antacids? |
|
Definition
|
|
Term
| What problems can occur if antacids are absorbed? |
|
Definition
hypermagnesium in pts with renal failure
acid-base abnormalities |
|
|
Term
| Antacids have a _________ onset of action? |
|
Definition
|
|
Term
| Which antacids have the 1st and 2nd fastest onsets of actions? |
|
Definition
1. Sodium Bicarb
2. Mg Hydroxide |
|
|
Term
| Why is Sodium Bicarbonate not used much as an antacid anymore? |
|
Definition
| because of its high sodium content |
|
|
Term
| What is the duration of action of antacids? |
|
Definition
If taken on an empty stomach = 1 hr
If taken after a meal = 3 hr |
|
|
Term
| Why are frequent doses of antacids required? |
|
Definition
| because of their short duration of action |
|
|
Term
| With antacids, anions combine with the ___________________ secreted by the stomach to form ______, thereby increasing the _____ of the stomach contents. (MOA) |
|
Definition
acidic hydrogen cations
water
pH |
|
|
Term
| Antacids only increase stomach pH to _____ but this neutralizes about _____ of the gastric acid. |
|
Definition
|
|
Term
| Antacids are as effective as any other drug therapy for PUD, but what is the catch? |
|
Definition
| pH must be kept at 3.5 to 4.0 throughout each 24 hour period, so you need to take about 200 cc/day. (about 7 times a day) |
|
|
Term
| Antacids are used to treat: |
|
Definition
PUD
GERD
Acid Indigestion
Prevent Stress ulcers |
|
|
Term
| Why would you combine Aluminum hydroxide with Magnesium hydroxide? |
|
Definition
because they offset their SEs
Aluminum Hydroxide - constipation
Mg Hydroxide - diarrhea
Maalox, Mylanta etc. |
|
|
Term
| How do antacids cause drug interactions? |
|
Definition
by interfering with the absorption of other drugs administered at the same time
by binding with them
or by changing their transit time |
|
|
Term
|
Definition
Diarrhea/Constipation
hypermagnesium characterized by hypotension, N, V, EKG changes, mental depression and coma
Calcium - "milk-alkali syndrome" |
|
|
Term
| Which drugs increase GI motility? |
|
Definition
Prokinetic agents
(Metoclopramide) |
|
|
Term
| What might cause decreased motility? |
|
Definition
systemic disease
intrinsic Gi problem
medications |
|
|
Term
| Which GI drug has a new black box warning? |
|
Definition
|
|
Term
| Metoclopramide is usually dosed ___ or ___ for ____________________ |
|
Definition
tid or bid
chronic gastroparesis |
|
|
Term
| List the SEs of Metroclopramide |
|
Definition
Insomnia
Parkinsonian effects/dystonias
galactorrhea and menstral disorders (stimulates prolactin release) |
|
|
