Pharm7

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Author:
Neda317
ID:
305724
Filename:
Pharm7
Updated:
2015-07-28 21:56:45
Tags:
pharm
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Description:
378-380 GI
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  1. H2 blockers
    Cimetidine , ranitidine , famotidine , nizatidine
  2. H2 blockers
    MOA
    use
    toxicity
    • MECHANISM Reversible block of histamine H2-receptors -> dec H+ secretion by parietal cells.
    • USE: Peptic ulcer, gastritis, mild esophageal reflux.
    • TOXICITY: Cimetidine is a potent inhibitor of cytochrome P-450 (multiple drug interactions); it also has antiandrogenic effects (prolactin release, gynecomastia, impotence, dec libido in males); can cross blood-brain barrier (confusion, dizziness, headaches) and placenta. Both cimetidine and
    • ranitidine dec renal excretion of creatinine. Other H2 blockers are relatively free of these effects.
  3. Proton pump inhibitors
    Omeprazole, lansoprazole, esomeprazole, pantoprazole, dexlansoprazole
  4. Proton pump inhibitors
    MOA
    use
    toxicity
    • MOA: Irreversibly inhibit H+/K+ ATPase in stomach parietal cells.
    • USE: Peptic ulcer, gastritis, esophageal reflux, Zollinger-Ellison syndrome.
    • TOXICITY Increased risk of C. difficile infection, pneumonia. dec serum Mg2+ with long-term use.
  5. Bismuth, sucralfate
    MOA
    Use
    • MOA: Bind to ulcer base, providing physical protection and allowing HCO3
    • – secretion to reestablish pH
    • gradient in the mucous layer.
    • USE: inc ulcer healing, travelers’ diarrhea.
  6. Misoprostol
    MOA
    USE
    toxicity
    • MOA: A PGE1 analog. inc production and secretion of gastric mucous barrier, dec acid production.
    • USE: Prevention of NSAID-induced peptic ulcers (NSAIDs block PGE1 production); maintenance of a PDA. Also used off-label for induction of labor (ripens cervix).
    • TOXICITY: Diarrhea. Contraindicated in women of childbearing potential (abortifacient).
  7. Octreotide
    MOA
    use
    tox
    • MOA: Long-acting somatostatin analog; inhibits actions of many splanchnic vasoconstriction hormones.
    • USE: Acute variceal bleeds, acromegaly, VIPoma, carcinoid tumors.
    • TOXICITY: Nausea, cramps, steatorrhea.
  8. about Antacid use
    • Can affect absorption, bioavailability, or urinary excretion of other drugs by altering gastric and
    • urinary pH or by delaying gastric emptying.
    • All can cause hypokalemia.
  9. antacid drugs name
    • Aluminum hydroxide
    • Calcium carbonate
    • Magnesium hydroxide
  10. Aluminum hydroxide
    overuse
    • Constipation and hypophosphatemia; proximal
    • muscle weakness, osteodystrophy, seizures

    Aluminimum  amount of feces.
  11. Calcium carbonate
    overuse
    Hypercalcemia, rebound acid inc

    •  Can chelate and dec effectiveness of other drugs
    • (e.g., tetracycline).
  12. Magnesium hydroxide 
    overuse
    • Diarrhea, hyporeflexia, hypotension, cardiac
    • arrest
    • Mg = Must go to the bathroom.
  13. Osmotic laxatives
    Magnesium hydroxide, magnesium citrate, polyethylene glycol, lactulose
  14. Osmotic laxatives (Magnesium hydroxide, magnesium citrate, polyethylene glycol, lactulose) 
    MOA
    USE
    tox
    • MOA: Provide osmotic load to draw water into the GI lumen.
    • USE : Constipation.
    • Lactulose also treats hepatic encephalopathy since gut flora degrade it into metabolites (lactic acid and acetic acid) that promote nitrogen excretion as NH4+.

    TOXICITY: Diarrhea, dehydration; may be abused by bulimics
  15. Sulfasalazine
    • MOA: A combination of sulfapyridine (antibacterial) and 5-aminosalicylic acid (anti-inflammatory).
    • Activated by colonic bacteria.
    • USE: Ulcerative colitis, Crohn disease (colitis component).
    • TOXICITY: Malaise, nausea, sulfonamide toxicity, reversible oligospermia.
  16. Ondansetron
    MOA
    USE
    TOX
    • MOA: 5-HT3 antagonist;dec vagal stimulation. Powerful central-acting antiemetic.
    • USE: Control vomiting postoperatively and in patients undergoing cancer chemotherapy.
    • TOXICITY: Headache, constipation, QT interval prolongation.
  17. Metoclopramide
    MOA
    use 
    tox
    • MOA: D2 receptor antagonist. inc resting tone, contractility, LES tone, motility. Does not influence colon transport time.
    • USE: Diabetic and postsurgery gastroparesis, antiemetic.
    • TOXICITY: inc parkinsonian effects, tardive dyskinesia. Restlessness, drowsiness, fatigue, depression, diarrhea.
    • Drug interaction with digoxin and diabetic agents. Contraindicated in patients with small bowel obstruction or Parkinson disease (due to D1-receptor blockade).
  18. Orlistat
    MOA
    USE
    TOX
    • MOA: Inhibits gastric and pancreatic lipase -> dec breakdown and absorption of dietary fats.
    • USE: Weight loss.
    • TOXICITY: Steatorrhea, dec absorption of fat-soluble vitamins.
  19. what are vomiting receptors in body
    • 1-Seratonin R (5HT3)
    • 2-Dopamin R (D2)
    • 3-muscurinic R (M1)
    • 4-Histamin (H1)
    • 5-neurokinin/substance P R (NK1)
  20. tx for hepatic encephalopathy
     lactulose (inc NH4+  generation) and rifaximin.
  21. rifaximin 

    use
    MOA
    • use: hepatic encephalopathy
    • MOA: kills intestinal bacteria who makes NH3+

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