Pharmacology Review – GI, GU, Endocrine, CNS & Related Agents

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Vocabulary flashcards summarizing key pharmacological terms, drug classes, mechanisms, uses, and cautions from the lecture notes.

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68 Terms

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Antacids

Basic compounds (aluminum, magnesium, calcium, sodium salts) that neutralize gastric acid; relieve heartburn, PUD; may cause constipation (Al/Ca) or diarrhea (Mg).

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Simethicone

Antiflatulent often combined with antacids to reduce gas and bloating.

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Rebound Hyperacidity

Return of stomach acid secretion above baseline after discontinuing calcium-containing antacids.

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H2 Receptor Antagonists (H2RAs)

Cimetidine, famotidine, nizatidine; block histamine-2 receptors on parietal cells, ↓ acid up to 90%.

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Cimetidine

First H2RA; inhibits CYP-450, ↑ drug interactions; higher risk of adverse effects in elderly.

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Proton Pump Inhibitors (PPIs)

Omeprazole, pantoprazole, etc.; irreversibly inhibit gastric H⁺/K⁺-ATPase, block all acid secretion.

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Clostridium difficile Risk

Long-term, high-dose PPI use linked to C. difficile infection, fractures, hypomagnesemia.

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Sucralfate

Cytoprotective agent that binds ulcer base, forms barrier against acid and pepsin.

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Misoprostol

Prostaglandin analog that prevents NSAID-induced ulcers by inhibiting gastric acid secretion.

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Adsorbents (Antidiarrheals)

Agents like bismuth subsalicylate; coat GI tract and bind toxins; may cause black tongue/stools.

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Opiate Antidiarrheals

Loperamide, diphenoxylate; decrease bowel motility and relieve rectal spasms.

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Probiotics

Live Lactobacillus cultures that restore normal intestinal flora and suppress pathogens.

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Bulk-Forming Laxatives

Psyllium, methylcellulose; absorb water to form viscous gel, promoting peristalsis—safest long-term.

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Emollient Laxatives

Stool softeners (docusate) and lubricants (mineral oil) that ease fecal passage by adding water/fat.

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Hyperosmotic Laxatives

Lactulose, polyethylene glycol; draw water into colon, causing distention and evacuation.

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Saline Laxatives

Magnesium citrate, milk of magnesia; osmotic action draws water into bowel, rapid watery stool.

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Stimulant Laxatives

Senna, bisacodyl; stimulate enteric nerves to increase peristalsis; may cause cramping.

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Irritable Bowel Syndrome (IBS)

Chronic abdominal pain with diarrhea (IBS-D) or constipation (IBS-C); treated with targeted drugs such as alosetron, rifaximin, lubiprostone.

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Alosetron

5-HT₃ antagonist for severe IBS-D in women; carries ischemic colitis black-box warning.

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Ondansetron

Serotonin (5-HT₃) antagonist used to prevent chemotherapy-induced nausea/vomiting.

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Metoclopramide

Prokinetic dopamine antagonist; ↑ GI motility, antiemetic; risk of tardive dyskinesia with long use.

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Scopolamine

Anticholinergic patch preventing motion sickness; contraindicated in narrow-angle glaucoma.

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Loop Diuretics

Furosemide, bumetanide; inhibit Na⁺/Cl⁻ resorption in loop of Henle; potent diuresis; risk hypokalemia, ototoxicity.

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Thiazide Diuretics

Hydrochlorothiazide; inhibit Na⁺/Cl⁻ resorption in distal tubule; first-line for hypertension.

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Potassium-Sparing Diuretics

Spironolactone, amiloride; antagonize aldosterone in distal nephron, retain K⁺, risk hyperkalemia.

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Mannitol

Osmotic diuretic; reduces intracranial pressure, prevents renal failure; may cause pulmonary edema.

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Crystalloids

IV solutions (NS, LR) containing water and electrolytes, no proteins; quickly distribute into tissues.

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Colloids

Protein-containing IV fluids (albumin, dextran) that expand plasma volume by raising oncotic pressure.

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Hyperkalemia

Serum K⁺ > 5.5 mEq/L; causes muscle weakness, arrhythmias; treated with patiromer, insulin + glucose, etc.

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Hyponatremia

Serum Na⁺ < 135 mEq/L; symptoms include lethargy, seizures; vaptans (conivaptan, tolvaptan) used in euvolemic cases.

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Digoxin

Cardiac glycoside; positive inotrope for HF and AF; narrow therapeutic index, toxicity with hypokalemia.

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ACE Inhibitors

Lisinopril, enalapril; block conversion of Ang I to Ang II; beneficial in HF, hypertension; dry cough common.

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Angiotensin II Receptor Blockers (ARBs)

Losartan, valsartan; block Ang II receptors; used when ACEI not tolerated (no cough).

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Beta Blockers in HF

Carvedilol, metoprolol; block sympathetic stimulation, reduce mortality in heart failure.

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Phosphodiesterase Inhibitor (Milrinone)

Inodilator increasing cAMP; short-term IV therapy for acute decompensated HF; risk dysrhythmias.

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Amiodarone

Class III antidysrhythmic; prolongs repolarization; black-box for pulmonary/hepatic toxicity.

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Warfarin Interaction

Many antidysrhythmics (e.g., amiodarone) potentiate warfarin, requiring INR monitoring.

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Alpha-1 Blockers (Doxazosin)

Peripheral vasodilators for hypertension; first-dose syncope due to orthostatic hypotension.

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Clonidine

Central alpha-2 agonist antihypertensive; abrupt withdrawal causes rebound hypertension.

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Nitrates

Nitroglycerin, isosorbide dinitrate; release NO causing venous > arterial dilation; treat angina; risk tolerance.

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Calcium Channel Blockers

Amlodipine, diltiazem; inhibit Ca²⁺ entry in vascular smooth muscle; treat HTN, angina, dysrhythmias.

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Statins (HMG-CoA Reductase Inhibitors)

Atorvastatin, simvastatin; ↓ LDL synthesis; myopathy/rhabdomyolysis rare but serious adverse effect.

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PCSK-9 Inhibitors

Alirocumab, evolocumab; monoclonal antibodies that dramatically lower LDL-C when added to statins.

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Niacin

Vitamin B₃; lowers triglycerides, raises HDL; causes flushing mitigated by aspirin pre-dose.

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Sulfonylureas

Glipizide, glyburide; stimulate pancreatic insulin release; risk hypoglycemia, weight gain.

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Biguanide (Metformin)

↓ hepatic gluconeogenesis, ↑ insulin sensitivity; first-line T2DM; contraindicated if eGFR < 30 mL/min.

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DPP-4 Inhibitors

Sitagliptin et al.; prevent incretin breakdown, ↑ insulin, ↓ glucagon; risk pancreatitis.

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GLP-1 Agonists

Exenatide, liraglutide; injectable incretin mimetics slowing gastric emptying, promoting weight loss.

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SGLT2 Inhibitors

Canagliflozin, empagliflozin; block renal glucose reabsorption; benefits CV, but risk ketoacidosis, genital infections.

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Rapid-Acting Insulin

Lispro, aspart; onset ~15 min; give within 15 min of meal to avoid hypoglycemia.

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Basal-Bolus Regimen

Long-acting insulin (glargine) for baseline + rapid-acting for meals/corrections—preferred inpatient control.

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Phenytoin

Hydantoin antiepileptic; stabilizes neuronal membranes; narrow therapeutic range; causes gingival hyperplasia.

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Valproic Acid

Broad-spectrum antiepileptic; hepatotoxicity and pancreatitis black-box warnings.

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Levodopa/Carbidopa

Dopamine precursor + dopa-decarboxylase inhibitor to cross BBB and treat Parkinson’s; long-term dyskinesias.

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COMT Inhibitors

Entacapone, tolcapone; block levodopa breakdown; tolcapone hepatotoxic (black-box).

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Benzodiazepines

Diazepam, lorazepam; enhance GABA; anxiolytic, sedative; risk dependence, CNS depression—avoid with alcohol.

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Zolpidem

Non-benzodiazepine hypnotic for insomnia; less REM suppression; risk sleep-walking behaviors.

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Amphetamines

CNS stimulants (Adderall) for ADHD/narcolepsy; increase NE/DA release; Schedule II; insomnia, weight loss.

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Methylphenidate

Ritalin/Concerta; mild CNS stimulant structurally like amphetamine used in ADHD.

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Triptons

Sumatriptan et al.; 5-HT₁B/1D agonists abort migraine via cranial vasoconstriction; contraindicated in CAD.

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Alendronate

Oral bisphosphonate; inhibits osteoclasts; sit upright 30 min post-dose to prevent esophagitis.

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Raloxifene

SERM acting as estrogen agonist in bone, antagonist in breast/uterus; prevents osteoporosis; risk DVT.

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Finasteride

5-Alpha reductase inhibitor for BPH and male baldness; teratogenic—pregnant women avoid handling tablets.

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Sildenafil

PDE-5 inhibitor for erectile dysfunction; contraindicated with nitrates due to severe hypotension.

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Oxytocin

Posterior pituitary hormone; induces/enhances labor, controls postpartum hemorrhage.

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Terbutaline

Beta-agonist tocolytic (rare use) delaying preterm labor; maternal tachycardia limits use.

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Clomiphene

Selective estrogen receptor modulator that induces ovulation by ↑ FSH/LH secretion.

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Bisacodyl

Stimulant laxative; enteric-coated—must not be taken with milk/antacids which dissolve coating.