GI pharm

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thedewhub
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300781
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GI pharm
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2015-04-14 15:55:16
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GI pharm
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GI pharm
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GI pharm
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  1. Gi antimicrobial agent therapy in PUD GERD
    • triple therapy- metronidazole, amoxicillin, PPI
    • quad therapy- bismuth subsalicylate, metronidazole, tetracycline, PPI
  2. dicyclomine-
    blocks cholinergic recetpr
  3. cimetidine
    blocks h2 histamine receptors, histamine has pos effect on adenylcyclase
  4. misoprostol
    stimulates prostaglandin receptor, has neg effect of adenyl cyclase
  5. omeprazole
    • blocks proton pump
    • inhibits h-K ATPase
    • decreases ulcer bleeding
    • superior to h2B in GERD
    • should be administered >3hrs befor anesthesia
    • zollinger ellison syndrome
    • affect drug absorption and Tums
  6. gastrin
    ca effect on proton mump
  7. Histamine blockers, MOA,
    • competitive antagonists of histamine which markedly reduces acid levels to promote healing
    • cimetidine, ranitidine, famotidine, nizatidine
  8. Histamine blockers SE
    • cimetidine infereres with cytochrome p450
    • dizziness, diarrha, constip, ha, impotence
  9. PPI general and SE
    • good for short term use
    • does not inhibit gastric motility
    • mucousal hyperplasia
  10. prostaglandins, MOA, Agents, SE
    • inhibit cAMP production to turn off prton pump
    • misoprostol
    • Diarrhea nausea, contra in pregnancy
  11. antimuscarinics MOA, agents, SE
    • inhibit acetycholine from binding to parietal cells, decreases intracell Ca and histamine release
    • pirenzipine- npt as effective as H2B-used refract
    • dry mouth, tachy
  12. Antacids
    • mostly for transient acid burn relief
    • act quickly
    • may get alkalinization- increases gastric motility, decrease esophogeal spinhcter tone, decrease esophogeal clearance
    • alter drug absorption
  13. NaH(CO3)
    • proimpt and rapid antacid action
    • brief systemic alkalosis
    • seful in alkalinize urine
    • increase Na load- not tolerated in HTN and HD
  14. Ma(OH)2
    • prompt neutralizatio
    • no acid rebound
    • laxative effect
    • neurologic, neuromuscular, and CV impairment in pts with renal dysfn
  15. CaCO3
    • neutralizes
    • chronic use get metabolic alkalosis
    • hypercalcemia may occur with renal dz
    • acid rebound
    • gas
  16. Aluminum hydroxide
    • slowing of gastric emptying and marked constipation
    • unpleasant taste
    • hypophosphatemia
  17. which antacid is not associated with acid rebound?
    Mg(OH)2
  18. General antacids complications
    • chronic alkalinization- may get C-Diff
    • acid rebound- Ca containing antacids
    • milk alkali syndrome
    • phosphorus depletion
  19. most common se in acid neutralizing drugs
    c diff
  20. antacid associated with hypophosphatemia?
    Al(OH)3
  21. antacid drug interactions
    • hasten delivery of drug into SI
    • decrease bioavailabiloity of orally administered cimetidine
    • pH increase- increases absorption of NSAIDS
  22. Mucousal protective agents- indications,
    duodenal and gastric ulcers
  23. Mucousal protective agents-MOA
    Sucralfate- form protective layer protein complex, decrease back diffusion of H, requires pH for activation
  24. Mucousal protective agents SE
    minimal, Aluminum intox may occur- do not use in combo with H2 blocker or antacids
  25. gastrointenstinal prokinetics- general
    accelerates the rate of gastric emptying
  26. Reglan
    • dopamine antagonist- lacks local anesthetic activity
    • increases lowere esophogeal sphinter tone
    • stim motility of the upper GI in normal persons
    • net effect- accelerated gastric clearance
  27. Reglan MOA
    • increase SM tension in lowe eso spincter and gastric fundus
    • increase gastric and SI motility
    • pylorus and duodenum relaxation during stomach contraction
  28. reglan pharmacokinetics
    • rapid PO absorb
    • 2-4hr elimination kidney metab
    • 85% or oral dose in urine
    • renal fn impairment prolongs the half time
  29. reglan indications
    • preoperative gastric fluid volume
    • antiemitiec effect
    • iv admin before anesthesia
    • reverses opiate gastric stasis
  30. reglan se
    • ab cramp
    • dysarrthymia
    • sedation, dysphoria, agistation dry mouth
    • Breast ca history should not have chronic use
  31. compazine and SE
    • antiemitic- block dopaine receptors
    • sedation, extrapyridamal symptoms
  32. ondansetron MOA SE
    • antiemitic- serotonin receptor antagonist-
    • se- ha, diarrhea
  33. droperidol MOA and SE
    • antiemitic, refract use, inhibits dopamine recept in medulla trigger zone
    • CV effects, CNS
  34. dexamethasone
    antiemitic use sometimes, block prostaglandins, can cause hyperglycemia in DM
  35. cannabinoids MOA, SE
    • antiemitic sometimes
    • dysphoria, hallucinations, sedation, vertigo, disoritentation
  36. Substance P/ Neurokinin 1receptor blockers
    • antiemitic, coadmin with dexamethasone
    • induces p45o metab
    • Se constipation and fatigue
  37. castor oil
    laxative, hydrolyzed in upper SI, increase intestincal motility
  38. cascar, senokot, aloes-
    laxative, emodin alkaloids
  39. bulking laxatives
    • hdrophilic colloids
    • agar, psyllium seed, bran, saline cathartics, lactulose, sorbitol
  40. stool softeners
    mineral oil, glycerin suppos, detergents
  41. antidiarrheal drugs general
    • inhibition of ACh rleease through presynatpric opioid receptos in the enteric NS
    • Lomotil
    • loperamide
  42. loperamide
    antidiarrheal, opiate- does not cross BBB, little sedation, IBS indicatef
  43. gallstone dissolution
    • oral therpay- effecive in small stone
    • chenodiol
    • ursodiol
    • methy tert-butyl- ether
  44. 5-ASA ZINE- sulfasalaszine
    • IBD treatment
    • - inhibit proinflam cytokines
  45. glucoCC -budesonide
    • IBD treatment
    • - inhibit inflam cytokines
  46. purine analogs, azathioprine, 6-mercaptopurine. and SE
    • IBD treatment
    • immunosuppresive propeties
    • induction and maintance of remission
    • SE- NV, bone marrow depression, hepatic toxicity
  47. methotrexate
    • IBD treatment
    • inhibition of dihydrofolate reductase
    • induce and maintain remission of crohns
  48. TNF alpha AB. MOA SE
    • IBD treatment
    • bind to soluble and membrane bound TNFalpha
    • used for acute and chronic trmt of crohns
    • SE- infections
  49. reglan contra-
    cisplatin use

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