PharmGIAaron2.txt

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PharmGIAaron2.txt
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  1. Cimetidine
    H2 agonist on parietal cells (tagamet)

    renal impair equals low dose

    Most side effects of any H2

    anti androgenic
  2. Famotidine
    H2 antagonist on parietal cell (pepcid)

    renal impair equals low dose
  3. Magnesium compounds
    Longer action than NaHCO3

    up Mg in blood

    Cathartics and up intestinal motility
  4. Nizatidine
    H2 antagonist on parietal cell

    Renal impair= now dose
  5. Ranitidine
    H2 antagonis on parietal cells

    Inhibits acid by gastrin, muscarinic agonists and basal and meal induced

    • down volume of juice
    • down pepsin, down IF

    Renal impair equals low dose
  6. Sodium Bicarb
    Baking soda

    short acting

    transient metabolic alkalosis

    Na+ load= fluid retention

    exacerbated GERD, belching

    Not for: GERD, peptic ulcers, HTN
  7. Sucralfate
    Complex Al-sucrose sulfate

    Coats ulcer

    Acid/pepsin barrier

    No-antacid effect

    Stimulates prostaglandin E

    activated by acid environmenbt

    lower availability of tetracycline, phenytoin, digoxin, cimetidine
  8. rabeprazole
    least metabolized CYP2D1A

    rapid onsed

    PPI

    before meal
  9. omeprazole
    PPI

    OTC

    before meal
  10. Pantoprazole
    PPI

    before meal
  11. Dexlansoprazole
    PPI

    before meal
  12. Esomeprazole
    PPI

    before meal
  13. Lansoprazole
    PPI

    before meal
  14. Anthraquinones
    Stimulant/irritant laxative

    aloe, senna, cascara
  15. Alosetron
    5HT3 antagonist

    severe IBS

    Nausea, bloating, pain

    Bad: constipating
  16. Bismuth subsalicylate
    pepto bismol

    may prevent colonization w/ e. coli

    prostaglandin= diarrhea

    inhibit cox=antimotility

    bad: tinnitus, constipate
  17. difenoxin
    active compound of opiate diphenoxylate
  18. Diphenoxylate
    and atropine= lomotil

    opiate for diarrhea

    inhibits pre-synaptic cholinergic neurons in submucosal and myenteric plex.

    Few systemic side efx
  19. Dicyclomine
    Anticholinergic for IBS muscarinic

    Anti-spasmodic
  20. Hyoscyamine
    Anti-cholinergic for IBS

    anti-spasmodic for pain and discomfort

    inhibit muscarinic receptors nin myenteric plexus and smooth muscle
  21. Loperamide
    opioid (imodium)

    doesn't cross BBB

    inhibit pre-synaptic cholinergic neurons in submucosal and myenteric plexus

    for diarrhea
  22. Agar
    Hydrophilic colloid

    Chronic constipation
  23. Lactulose
    Osmotic agent

    Flatulence
  24. Docusate
    Stool softener

    Allow H2) and lipids to penetrate
  25. Bran
    hydrophilic colloid

    chronic constipate
  26. Mag sulfate
    osmotic agents

    CHF=change in intravasc. volume
  27. Sorbitol
    Osmotic agent

    Flatulence
  28. Psyllium
    Hydrophilic colloids

    Chronic constip
  29. polyethylene glycol
    Colonic cleansing before endoscopy

    balanced= no electrolyte shifts
  30. methylnaltrexone
    opiate antagonist for opiate constipation

    does not cross BBB
  31. Methylcellulose
    hydrophilic colloids

    1st line chronic constipation
  32. Lubiprostone
    Chloride channel activator

    For: chronic constipation

    Up liquid into lumen, shortens transit
  33. Metoclopramide
    D2 receptor antagonist

    Inhibie smooth muscle stim

    Up peristaltic amplitude

    Up lower esophageal sphincter pressure

    enhance gastric empty

    low transit tiimes

    For: anti emetic
  34. Tegasrod
    5-HT4 agonist

    Stimulates 2nd order neurons of myenteric plexus=peristalsis
  35. Lorazepam
    Benzo

    Before chemo for anxiety and anticipaqtory vomit
  36. Diazepam
    Benzo

    Prior to chemo for anticipatory vomit

    Reduce vomit from anxiety
  37. Aprepitant
    Neurokinin antagonist

    NK1 antaqgonist= first ever cancer chemo and PONV

    Used w/ serotonin agents

    blocks action of substance P
  38. Dronabinol
    Cannabinoid antiemetic

    1st pass hepatic meetab

    appetite stim

    For: chemo w/ others

    Bad: euphoria, dysphoria, sedate, hallucinate, potentiates psychoactive
  39. Scopolamine
    Anti-muscarinic anti emetic

    1st line for motion sickness

    transdermal patch
  40. Meclizine
    antihistamine anti emetic

    Bad: sedation, drowsy, dry mouth, urine reatin, cycloplegia
  41. Promethazine
    Antimistamine anti emetic

    sedation, dry mouth, confuse, urine retain, cycloplegia
  42. Droperidol
    D2 antagonist

    antipsychotic and sedative

    antiemetic via central domamine

    Bad: proarrythmic, extrapyramidal, hypotension
  43. Metoclopramide
    D2 receptor antagonist

    Central dopamine block

    Bad: Extrapyramidal, restless, dystonia
  44. Prochlorperazine
    inhibits dopaminergic, muscarinic, and histaminergic

    Anti emetic via central dopamine blockade

    Bad: Sedative=histamine
  45. Dolasetron
    5HT3 antagonist

    vagal stim emesis

    Acute chemo, surg, rads
  46. Granisetron
    5HT3 antagonist

    vagal stim emesis

    acute surg, rads, chemo
  47. Ondansetron
    5ht3

    Intestin vagal afferents, and central receptors in vomit center and CTZ

    Only emesis from vagal stim.

    Acute chemo, rads, surgery

    Bad: HA, dizzy, constipate
  48. Thiabendazole
    • For cutaneous larva migrans
    • S. stercoralis

    Also nematode trichinosis, T. spiralis (does not destroy larva in muscle)

    Inhibits glucos uptake, acute reductase

    adults, eggs, larva

    Bad Olfactory, disturb, crystalluria, leukopenia, hallucinate, Stevens-Johnson, hepatic
  49. Pyrantel Pamoate
    For: nematodes

    depolarizes myoneural junct. Spastic paralysis

    Worms alone whjen passed

    poorly absorbed= less toxic

    Bad: no preggo, less y/o, or w/ piperazine
  50. Praziquantel
    For: all cestode and trematode

    Up permeability to Ca2+

    Impairs attachment

    40mg/kg initially, lethal only for adults

    Treat whole house

    Bad: fever sedation, HA, abd. discomfort
  51. Oxaminaquine
    Alt. drug for trematode S. mansoni

    Converted to unstable ester yielding reactive electrophiles
  52. Niclosamide
    For: cestodes- tapeworms

    Inhibits glucose uptake

    Causes detachment and pooping out

    oral but not absorbed so up conc in intestines
  53. Metrifonate
    Alt for treamatode S. haemotobium

    Organophosphate inhibitor of cholinesterase

    Insecticide

    Treat urinary schistosomas in africe

    Inhibits plasma cholinesterase or host

    Bad: vertigo, lassitude, nausea, colic
  54. Mebendazole
    For: most GI nematodes- pinworms

    given to all household members

    Inhibits glucose uptake adult t regg inhibits microtubule poly by B-tubulin

    Oral but poor absorbed

    Abd. discomfort and diarrhea

    Not: preggo
  55. Ivermectin
    For: nematodes, O. volvulus, and S. stercoralis

    Tonic paralysis of peripheral musculature

    Potentiates GABA

    Not in meningitis

    Bad: itching, swollen glands, postural hypo, CNS
  56. Diethylcarbamezapine
    For: microfilaria, W. bancrofti, B. malavi, L. Loa in blood

    Alt for nematod, O. volvulus

    No effect for adult worm or microfilaria in lymph node

    Hyper polarizes helm. muscle

    Alters surface membanes

    May cause system rxn from massive kill, start with small dose.

    Encephalopathy w/ L. Loa
  57. Bithionol
    For CDC only

    For: trematode F. hepatica

    Also- chinese liver flukes

    oral

    Bad: vomit, diarrhea, uticaria, photosensitivity
  58. Albendazole
    New, broad spectrum anti helinthic.

    Aot for hookworkm pinworm, porkworms, and threadworms

    Drug of choice: hydatid dz, cysticercosis

    Inhibits glucose uptake in helm. kills adults and eggs

    Take- empty stom- for intraluminal w/ fatty- tissue

    Not: preggo
  59. Terbinafine
    Synthetic allylamine

    Inhibits fungal squalene eposidase.

    Accumulates squalene epoxide (toxic)

    Bad: GI upset and headache

    daily for 12 wks= 90% rare

    on chymycosis

    better than griseo
  60. Griseofulvin
    Inhibits fungal mitosis by producing multinucleated cells.

    Interacts w/ polyenergized microtubules

    Bad: now w/ prophyria, induces liver enzymes, anti-inflammation

    Teratogen and carcinogen

    For: skin infections, microsporum, trichophyton, epidermophyton
  61. Caspofungin
    Echinocandin

    Disrupts fungal cell wall synthby inhibiting B-(1,3)-D- glucan synth .

    very expensive

    Refractory invasive aspergillosis
  62. Clotrimazole
    Toxic and old

    Ulsed topically

    0.5%- skin

    3-10%- vaginal
  63. Posaconazole
    Newest and very expensive

    Broad spectrum

    For: aspergillosis

    Available as oral suspension
  64. Itraconazole
    Newer than kero

    less toxic and broader spectrum
  65. Fluconazole
    triazole

    Inhibits sterol 14-alpha-dmethylase

    Greater GI absorb, cross BBB

    Bad: no endocrine effects, N/V, renal, hepatic

    Relapse cryptomening..

    Prophylax in AIDS for candidiasis
  66. Ketaconazole
    imidazole

    inhibits sterol 14 alpha demethylase

    • absorbed well from GI
    • H2 blockers down absorption

    Bad: N/V, menstrual irreg, gynecomastia renal insuf. and heptotox

    For: non-meningeal syst. blusto, histo, cocciolis
  67. Flucytosine
    inside fungal cell deaminated to 5FU anoalog of deoxyuridylic acid

    5FU blocks thymidylate synthase

    well abosrbed GI and corss BBB

    Bad: bone marrow suppress, up LFT
  68. Nystatin
    Polyene

    Same as Amp B.

    K+/mg++ pore

    only topical

    For: candidiasis
  69. Amphotericin B
    Polyene

    forms ion channel K+ Mg++

    Binds ergosterol

    No GI abosrption

    Monitor renal-creatinine

    Bad: neurotox, hypersiensitivity

    For: life threatining mycotics
  70. Artesunate
    Water soluble arteminins

    • P. falciparum
    • iron from heme reduces peroxide bond
  71. Artemether
    Lipid soluble artemisinis

    WHO drug

    Worldwide for P. falciparum

    iron form heme reduces peroxide bondin artemisinis

    = high valent iron-oxo spears
  72. Chloroquine
    Aralen phosphate

    Suppressive trends and acute uncomplicated malaria

    effective against erythrocytic forms so ameliorates symptoms.

    Fast acting- afebrile ulcer 1-2d

    Blocks synth DNA and RNA

    Oral/IV Protoporphyrin IX

    Slowing divided doses

    MDR durg resist

    Not in: Psoriasis and porphyria
  73. Quinine
    Cinchona alkaloid

    Clinical cure against severe chloroquine resistant P. falciparum

    Best for cerebral malaria

    Not by itself

    Weak base- accumulates in food vacuoles

    Bad: HTN, cinchonium - sweat, tinnitus, blurred vis, blood dyscrasias, hypoglycermia

    Not: myasthenia gravis, tinnitus and optic something.
  74. Metronidazole
    Geniutal trichomoniasis

    Intes6tinal and hepat6ic amoebiasis

    Asymptomatic amebiasis

    Drug of choice - giardiasis

    + electron sink in protozoa, nitro group reduced

    Oral, IV = Up levels CSF

    Bad: metallic taste, neurotoxin, red brown urine, urethral burning, phlebitis

    Not: preggo, alcohol, CNS dz, dyscrasias, preggo
  75. Dehydroemetine
    Alt. drug for amebic hepatitis and amebic abscess

    Followed by chloroquine and iodoquinol

    Cardiovascular effect, UI tox, weakness, neuropathy

    Not: w. preexisting cardio, muscular, neuro
  76. Quinacrine
    Used for: giardiasis 90% cure rate

    Binds DNA through an intercalation. prevents synth of nucleic acid blocking DNAand RNA poly

    Oral

    Bad: yellow stain of skin and sclera. blue and black pigment in nail beds.
  77. Mefloquine
    Mulitdrug resistant P. flaciparum, as suppressive and clinical.

    affects membranes

    only give for short time to avoid reistance

    Bad: 50%= dizzy, ataxia, and HA Neuropsych
  78. Atovaquone and Proquanil
    For: uncomplicated cases of multiresistant as a suppressive and clinical agent

    Interferes w/ 2 diff path in pyrimidine biosynth

    Inhibits mitochondrial, ETC, and dihydrofolate reductase

    Take w/ food or milk- not with tetracycline
  79. Quinidine
    Antiarrythmic drug

    Dextrostereoisomer of quinine

    Anti-malarial
  80. Diloxanide furoate
    Drug of choice for asymptomatic amebiasis - only from CDC.

    Well tolerated, some GI, pruritis
  81. Sodium Stibogluconate
    Pentavalent antimonial

    Drug of choice for all 3 forms leishmaniasis

    inhibits phosphofructokinase IV, IM, oral infiltrate

    Bad: myalgia, ECG, pruritus, rash, myocardial damage
  82. Pyrimethamine
    Chloroquine-resistant infections

    Not in acute setting by itself

    Inhibits dihydrofolate reductase blocks purine and pyrimidines.

    Synergistic w/ sulfonamides

    Bad: flase acid problems, S/S if given w/ sulfaloxine
  83. Doxycycline
    a tetracycline for suppressive therapy against multi drug reistant

    P. falciparum

    Pts nable to take mefloquine

    acute malaria w/ quinine

    Active against blood stages but not liver stages
  84. Emetine
    Alt. drug amebic hepatitis and abscess.

    Then use chloroquine and iodoquinol

    Severe amebic dysentery-cannot cure

    Replaced METRANIDOZOLE

    Inhibits proetin synth by blocking chain elongation- prevents translocation

    SQ or IM

    Bad: CV effects- arrhythmias, EKG changes, GI tox, muscle weak, peripheral neuropath
  85. Nifurtimox
    Acute and chronic CHAGAS dz

    Superoxide radical

    oral

    Adverse w/ EtOH

    Bad: HA, insomnia, convulsions, myalgia

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