study guide for exam 1

druhg

what do we want to increase in the elderly

few

insoluble fiber

benofiber

metamucil

some soluble, has clumping which can lead to impaction. by irritating colon you increase secretions into lumen

crohns

autoimmune, inflammation thru wall of GI tract

dangers of crohns

can form fistulas and perforations

u.c.

aautoimmune, only an ulcer and only in colon

treatment for crohns

rest, diet, sulfasalazine

how does sulfasalazine work

breaks down to 5 asa, decreases inflammatory response, decreases NF kappa B complex mechanism which also decreases inflammation

how does azothiaprine work

breaks down to 6mp, decreases cell division = decreased immune cells = decreased inflammation

how does methotrexate work

it is a folic acid derivative, it inhibits DNA synthesis which leads to decreased cell division. at doses in IBD, it decreases IL1B binding to its receptor so it decreases inflammation

wat is methotrexate also used for

rheumatoid arthritis and cancer

how does cyclosporin work

inhibits calcineurin, decreases IL2 levels= decreased t cell proliferation = decreased inflammation

what is a potential risk of prednisone

it can mask a perforation

ADME

absorption, distribution metabolism, excretion

how does a drug get in? figure 14.4

o

barriers to absorption

plasma membrane, solubility of drug, type of transport needed

how do we get into cells?

FAD, facilitated diffusion, active transport, diffusion

problems with getting in

in diffusion the membrane is not permeable to ions

whats a pro drug

a drug that must be metabolized to become active

drug formulation route

pill slower than liquid,

IV faster than pill,

higher dose=faster therapeutic action,

size of drug molecule=large is slower,

surface area= bigger area is faster,

digestive motility= higher motility means decreased absorption

faster blood flow=higher absorption

what is first pass metabolism

gI system-absorbed into blood- goes to portal vein-goes to live-in metabolized (can be more or less active) -goes into circulation

how long do PPIs take to be effective

24-48 hours

can you take half of a ppi?

no, it will not work

\#1 type of drug for diarrhea?

mu opiod receptor agonists

what can PPI’s cause?

cancerous growths in colon

Gerd stage I

lifestyle changes, use famotidine as needed

stage II

unrelenting

stage III gerd

PPI everyday

H pylori causes ___% of ulcers

80%

H pylori 3 part treatment

CLARITHROMYCIN + your choice of tetracycline, metroindazone, or amoxicillin + FAMOTIDINE (or Ppi)

quadruple therapy H pylori

add pepto

how long is H pylori treatment?

14 days

what does the sympathetic nervous system do?

decrease motility

parasympathetic system

inc. motility, rest and digest

what does 5HT4 receptor do

control parasympathetic activity, increase gastric emptying with stimulation

vasointestinal peptide

decreases muscle activity and increases relaxation of muscle tone

opiods lead to

constipation

steps to emesis

“GOATED GP, DUJT, SARDINE PC, CCD ME”


1. decreased gastric tone by D2 stim
2. decreased gastric peristalisis
3. duodenum and upper jejunum tone increases
4. upper portion of stomach relaxes, D2 stimulation
5. pyloris constricts
6. coordinated contraction of diapragm and abdominal muscles


1. explusion of contents

\

only drug for emesis approved for use in preg women?

metacloperamide

what does atropine do

increase anal spincter tone, prevent risk of mu opiod abuse

what is diarrhea

imbalance of salt and water aborption

types of diarrhea

HOI - hormonal, osmotic, infection

what is hormonal diarrhea

from a tumor

what is osmotic diarrhea

lactose intolerance

how are potassium and magnesium used before a colonoscopy?

they cause diarrhea

what is infectious diarrhea

e coli, bad water

drug for ameaboic dysentery

metroindazole

what causes constipation

imbalance btwn H2O and Na+ absorption

complications of IBD

toxic megacolon (tachycaerdic, fever, increased colon diameter), 4-5% mortality, w/ perforation = 40% mortality

what drugs should be used for flares?

predisone, azothiaprine+infixomab

drug protein complexes

albumin binds and transports drugs in plasma

affinity

depends on how a drug comes off a protein (high affinity=low capacity)

additives

stack on each other, lower doses = lower off target effects and increased compliance

synergistic

combined effect

antagonistsic

block a different drug

displacement

1 drug binds to x better, displaces other drug

barriers

blood brain barrier, testis barrier, placental barrier

women dont have testis barrier

born w amount of eggs theyre gonna have, as age increases, risk of damage to eggs (causing birth defects) increases as well

metabolism

biotransformation of a molecule to make it water soluble

p450 system

diagram

extretion

elimination of drug, happens thru bile or urine

kidney

main source of excretion

3 steps to urine formation

“gf ts tr” “girlfriend toaster'“ 1) glomerular secretion 2) tubular secretion 3) tubular reabsorption

acidic wants

basic environment

liver

excreted in bile

bile is

recirculated back to liver, some exrected some reuptake and secretion

figure 4.4

0

loading dose

huge amt of drug starting

ED 50

50% of patients have efficacy here

therapeutic index

LD50/ED50

we want therapeutic index to be

HIGH

potency vs efficacy

more potent = need less of drug to get same effect

how is a drug active?2 ways

external and internal receptors

external receptors

resides in plasma

receptors have

2nd messenger systems

partial antagonist

partially blocks

partial agonist

partially stimulates

pharmacotherapy factors

CAPHLESS G - culture, age, personal habits, lifestyle, environemnt, sex, support network, gender

\#1 obstacle for recovery

state of mind

lonliness or despair

can impact compliance

literacy

go thru pamphelt and see if they can follow along

table 9.1

9

ace inhibitors

do not work as well in the black population

cimetidine

decreases ethanol metabolism (mostly in women), decreases estradiol metabolism in men (can lead to gynacomastia)

alzheimers

1\.5-3x more prevalent in females

women more likely to go to a doctor for all issues except______

heart issues

what can impact metabolism of drugs

muscle to fat ratio

benzodiapezenes

decreased metabolism in females

cultural differencs

DAB diet, alternative therapies (medicine man), beliefs about disease (“gods will”

barriers to healthcare

RINA rural, insurance, “not that bad”, age

inhibiting D2 can cause

symptoms of parkinsons

preg D

use as a last resort

kidneys want

to CHARGE molecules

stomach wants

to NEUTRALIe molecules

schedule I

no clinical use (marijuana) heroin, LSD

schedule II

opiods, hydrocodone, oxycodone

schedule III

benzos, low hydrocodone (>15mg), codeine, anabolic steroids

schedule IV

codeine (decreased concentrations),

dopamine inhibits

milk production. inhibiting dopamine can cause Male + female lactation

are there H2 redceptors in the brain?

NO