Pharm GI Exam

Gastric or duodenal ulcers that involve digestion of the GI mucosa by the enzyme pepsin

peptic ulcer disease

What is treated with 10- to 14-day course of a proton pump inhibitor (PPI) and the antibiotics clarithromycin and either amoxicillin or metronidazole or a combination of a PPI, bismuth subsalicylate, and the antibiotics tetracycline and metronidazole?

PUD

Acid controlling MOA:

* neutralize stomach acid and promote gastric mucosal defense mechanisms


* Stimulate secretion of mucus, bicarbonate, and prostaglandins

antacids

Precautions of antacids:

calcium salts lead to kidney stones, magnesium salts avoided in renal failure

Contraindications of antacids:

* Severe _________ failure or _________ disturbances-potential toxic accumulation of electrolytes in the antacids themselves


* GI _________: antacids may stimulate GI _________ when they are undesirable because of the presence of an obstructive process requiring _________ intervention

renal, electrolyte, obstruction, motility, surgical

Interactions of Antacids:

* Antacids _________ the ability of other drugs to be absorbed into the body
* Increase __________ pH
* increased absorption of ______ drugs
* decreased absorption of ______ drugs
* Increase __________ pH
* Increased excretion of _______ drugs
* Decreased excretion of _______ drugs

reduce, stomach, basic, acidic, urinary, acidic, basic

Antacid AE:

* overuse:

metabolic acidosis

Antacid AE:

* aluminum and calcium

constipation

Antacid AE:

* magensium

diarrhea

Antacid AE:

* calcium

kidney stones and hyperacidity

Antacid AE:

* calcium carbonate

gas, belching

Aluminum is often combined with magnesium to help with the ________ effects

constipating

Aluminum is _________ for patients with renal diseases

safe

Aluminum Salts:

* Basaljel
* AlternaGEL
* (aluminum and magnesium): Gaviscon, Maalox, Mylanta, Di-Gel

aluminum carbonate, hydroxide salt, combo products

Magnesium should _______ be used in renal patients

never

Magnesium Salts:

* (milk of magnesia)
* Gaviscon (combination product)
* Maalox or Mylanta

magnesium hydroxide, carbonate salt, combo products

Calcium salts:

* May cause constipation or kidney stones
* Not recommended for renal patients
* Long duration of acid action may cause increased gastric secretions
* Often used as an extra source of dietary calcium

An example would be Tums or ________

calcium carbonate

Sodium Bicarbonate

* Highly soluble
* Buffers the acidic properties of HCl
* May cause metabolic alkalosis
* _______ content may cause problems in patients with heart failure, hypertension, or renal insufficiency

An example would be ________

sodium, Alka-Seltzer

Indications for ____ Antagonists include:

* *________*
* peptic ______ disease
* Erosive esophagitis
* Adjunct therapy to control upper GI bleeding
* Zollinger-Ellison syndrome

H2, GERD, ulcer

MOA of H2 Antagonists:

* ________ acid secretion/suppresses acid secretion in the stomach


* **Competitively block the _____ receptor of acid-producing parietal cells**
* **Reduced hydrogen ion secretion from the parietal cells**
* **_________ in the pH of the stomach** 
* **Relief of many of the symptoms associated with hyperacidity-related conditions**

reduce, H2, increase

Definition

* decrease of drug absorption due to chemical binding of another med

chelation

H2 Antagonists:

cimetidine, nizatidine, famotidine, ranitidine

Interactions of H2 Antagonists:

* All H2 antagonists may _______ the absorption of drugs that require an acidic GI environment for absorption
* Smoking ________ effectiveness
* Take 1 to 2 hourse _______ antacids for best results

inhibit, decreases, before

AE of H2 Antagonists:

Cimetidine and Nizatidine can cause _______ and ________ in elderly patients

* Adverse CNS effects

Cimetidine may effect _________ levels

* It can cause impotence and gynecomastia

Thrombocytopenia (platelets less than 150) has been reported with __________

confusion, disorientation, hormone, famotidine

MOA of PPI

inhibits release of positive hydrogen ions during HCl production which stops HCl production

**Indications:________**

* **GERD**
* **Erosive esophagitis**
* **Zollinger-Ellison syndrome**
* **NSAID induced ulcers**
* **Stress Ulcers**
* **H. pylori ulcers**

PPIs

PPIs should be taken _________ before meals

30-60 min

Interactions of PPIs

* Increase _________ levels of diazepam and phenytoin
* ________: increased chance of bleeding
* Absorption of ketoconazole, ampicillin, iron salts, and digoxin
* Clopidogrel


* Sucralfate: may ______ the absorption of PPIs
* Food may _______ absorption of the PPIs.

serum, warfarin, delay, decrease

AE of PPIs:

* PPIs are generally well tolerated.
* Possible predisposition to GI tract ________: Clostridium difficile 
* ____________ and risk of wrist, hip, and spine fractures in long-term users
* Pneumonia
* Depletion of ________
* Link between PPIs and ______ as well as the development of systemic ______ erythematous

PPIs: infections(c. diff), osteoporosis, magnesium, dementia, lupus

Examples of PPIs:

* Protonix
* Nexium
* Prilosec

pantoprazole, esomeprazole

omeprazole

________ are used to relieve the painful symptoms associated with gas

antiflatulents

Example of antiflatulent

simethicone

Misc acid-controlling medication: _______

* Promotes _____/protects mucosa
* used for stress ________ or PUD
* Attracts and binds to the ulcer-affected area and forms a protective ________ from pepsin
* Can give ____ hour before meals and at bedtime
* May ________ other drug absorption, so give other at least 2 hours before

Sucralfate, healing, ulcers, barrier, 1, impair

Misc acid controlling drugs used in ulcers caused by NSAIDs and is dangerous for pregnancy?

misoprostol

Condition caused by:

* Bacteria
* Viruses
* Drug induced
* Nutritional factors
* Protozoa

acute diarrhea

Condition caused by:

* Tumors
* Diabetes mellitus
* Addison’s disease
* Hyperthyroidism
* Irritable bowel syndrome
* AIDS

chronic diarrhea

Diarrhea:

* Sudden onset in a previously healthy person
* Lasts from 3 days to 2 weeks
* Self-limiting
* Resolves without sequelae

acute

Diarrhea:

* Lasts for more than 3 to 4 weeks
* Associated with recurring passage of diarrheal stools, fever, loss of appetite, nausea, vomiting, weight loss, and chronic weakness

chronic

* Abnormally infrequent and difficult passage of feces through the lower GI tract
* Symptom, not a disease
* Disorder of movement through the colon or rectum

Can be caused by a variety of diseases or drugs

constipation

Goals of what kind of med?

* Stop the stool frequency
* Alleviate cramps
* Replenish fluids/electrolytes
* Prevent weight loss

antidiarrheals

What antidiarrheal would be used for a mild case?

adsorbent

MOA of adsorbent antidiarrheal

bind to causative bacteria which is then eliminated through the stool

Interactions of adsorbent antidiarrheals:

* Adsorbents ________ the absorption of many drugs, including _________, quinidine, and hypoglycemic drugs.
* Adsorbents cause increased bleeding time and bruising when given with anticoagulants (_______).
* Toxic effects of ___________ are more likely when given with adsorbents.

decrease, digoxin, warfarin, methotrexate

AE of adsorbent antidiarrheals:

* Increased _______ time
* Constipation, _____ stools
* Confusion
* Tinnitus
* Metallic taste
* _____ tongue

bleeding, dark, blue

Examples of adsorbent antidiarrheals:

bismuth subsalicylate, activated charcoal, antilipemic colestipol and cholestyramine

Unless marked for children, Bismuth subsalicylate (Pepto Bismol) should not be given to children because it increases risk of __________

Reye’s Syndrome

What kind of antidiarrheal would be used in a more severe case?

antimotility

What are the two kinds of antimotility antidiarrheals?

anticholinergic and opiates

MOA of anticholinergic antidiarrheals:

decrease gastric secretions and slow peristalsis

AE of anticholinergic antidiarrheals:

* urinary ________ and impotence
* Headache, dizziness, confusion, anxiety, drowsiness, confusion


* Dry skin, _______
* _______ vision
* _____tension

retention, flushing, blurred, hypo

Examples of anticholinergic (antimotility) antidiarrheals?

belladonna alkaloids, atropine, hyoscyamine

MOA of opiate antimotility antidiarrheals:

decrease bowel motility by reducing pain by relief of rectal spasms

Examples of Opiate antimotility antidiarrheals:

* Imodium
* Lomotil

loperamide, diphenoxylate

Diphenoxylate (Lomotil) is often combined with ____ because of high instances of ____ _____. This medication causes undesirable _____ AE such as the dry mouth and tachycardia

atropine, substance abuse, drying

antibiotic-induced diarrhea (intestinal flora modifiers) type antidiarrheals

probiotics

Adverse Effects of Probiotic Antidiarrheals:

* Drowsiness, dizziness, _________
* Nausea, vomiting, ___________
* Respiratory __________
* Hypotension
* Urinary ________
* Flushing

lethargy, constipation, depression, retention

Examples of probiotics (Bacid)

Lactobacillus acidophilus

Types of laxatives:

bulk forming, emollient, hyperosmotic, saline, stimulant,

What kind of laxative?

* High fiber
* Absorb water to increase bulk
* Distend bowel to initiate reflex bowel activity

bulk forming

AE of ____ forming laxatives:

* Impaction
* ______ disturbances
* __________ imbalances
* Esophageal _______

bulk, fluid, electrolyte, blockage

What are the indications of bulk forming laxatives?

acute and chronic constipation, IBS, diverticulosis

Examples of bulk forming laxatives

psyllium, methylcellulose

What kind of laxative?

* Stool softeners and lubricants


* Promote more water and fat in the stools
* Lubricate the fecal material and intestinal walls

emollient

Indications for emollient laxatives

fecal impaction, acute and chronic constipation

AE of emollient laxatives (____ ______):

* _____ rashes
* Decreased absorption of _______
* Electrolyte imbalances
* ______ pneumonia

stool softener, skin, vitamins, lipid

Examples of emollient laxatives

* Colace, Surfak
* Lubricants

docusate salts, mineral oil

What kind of laxative?

* Increase fecal water content
* Results in bowel distention, increased peristalsis, and evacuation

hyperosmostic

Indications for hyperosmotic laxative

chronic constipation, diagnostic and surgical preps

AE of hyperosmotic laxatives (_____):

* Abdominal _______
* Electrolyte imbalances
* Rectal ________

prep, bloating, irritation

Examples of hyperosmotic laxatives:

* PEG

polyethylene glycol, sorbitol, lactitol, glycerin, lactulose

What kind of laxative?

* Increase osmotic pressure within the intestinal tract, causing more water to enter the intestines
* Results in bowel distention, increased peristalsis, and evacuation

saline

Indications for saline laxative

constipation, diagnostic and surgical preps

AE for saline laxatives:

* ________ toxicity (with renal insufficiency)
* ________
* Electrolyte imbalances
* Diarrhea
* Increased ______

Magnesium, diarrhea, thirst

Examples of saline laxatives

magnesium hydroxide, magnesium citrate

What kind of laxative?

* Increases peristalsis via intestinal nerve stimulation

stimulant

Indications for stimulant laxative

acute constipation, diagnostic and surgical preps

AE of stimulant laxatives:

* _______ malabsorption
* _____ rashes
* Gastric ______
* Electrolyte imbalances
* Discolored ______
* ______ irritation

nutrient, skin, irritation, urine, rectal

Examples of stimulant laxatives:

senna, bisacodyl

How much water to give with laxatives?

6 to 8 oz

Unpleasant feeling that often precedes vomiting

nausea

Forcible emptying of gastric and, occasionally, intestinal contents

emesis

Antiemetic drugs are:

used to relieve nausea and vomiting

MOA of anticholinergic antiemetic/antinausea drugs:

* Bind to and block ACh receptors in the ___ __ _____
* Block transmission of nauseating stimuli to _____ 
* Also block transmission of nauseating stimuli from the ________ formation to the VC

Ach, inner ear labyrinth, CTZ, reticular

Examples of anticholinergic antiemetic/antinausea drugs:

scopolamine 72 hour transdermal patch

Examples of antihistamines antiemetic/antinausea:

dimenhydrinate, diphenhydramine, meclizine, hydroxyzine

MOA/Indications of antidopaminergic antiemetic/antinausea drugs:

* Block dopamine receptors in the ____
* Also used for _______ disorders, intractable________

CTZ, psychotic, hiccups

Examples of antidopaminergic antiem/antinaus:

prochlorperazine, promethazine, amisulpride, droperidol

Antidopaminergic AE:

Phenergan: never administer via ________

Droperidol: controversial because of _______ dysrhythmias

intraarterial, cardiac

What kind of antiem/antinas med:

* Inhibit substance P/neurokinin 1 receptors in the brainstem


* Used in conjunction with serotonin blockers and glucocorticoids
* Use augments the serotonin blockers and glucocorticoids to inhibit acute and delayed phases of chemotherapy-induced emesis.

neurokinin antagonists

Examples of neurokinin antagonists antiem/antinas:

aprepitant, fosaprepitant, rolapitant

Prokinetic drugs

* MOA/Indications:
* Block _______ receptors in the CTZ
* Cause CTZ to be desensitized to impulses it receives from the gastrointestinal (GI) tract
* Also stimulate peristalsis in GI tract, enhancing emptying of stomach contents
* Also used for _______, ________ gastric emptying

dopamine, GERD, delayed

Example of prokinetic antiem/antinaus:

metoclopramide

Serotonin blockers

* MOA/Indications:
* Block _________ receptors in the GI tract, CTZ, and VC
* Used for nausea and vomiting in patients receiving _________ and for postoperative nausea and vomiting

serotonin, chemotherapy

Examples of serotonin blockers:

dolasetron, granisetron, ondansetron, palonosetran

Tetrahydrocannabinoids (antiem/antinaus)

* MOA/Indications:
* Major _______ substance in marijuana
* Inhibitory effects on reticular formation, thalamus, cerebral cortex
* Alter ______ and body’s perception of its surroundings, which may help relieve nausea and vomiting

psychoactive, mood

Examples of Tetrahydro cannabinoids (antiem/antinaus)

dronabinol

Drobinol (THC antiemetic) uses

n/v associated with chemotherapy, anorexia, and weight loss in AIDS patients

Misc. Antiemetic/Antinausea:

* Mint-flavored oral solution
* Used off label for treatment of morning sickness

phosphorated carbohydrate solution

Herbal Product:

* Used for nausea and vomiting, including that caused by chemotherapy, morning sickness, and motion sickness
* Adverse effects
* Anorexia, nausea and vomiting, skin reactions
* Drug interactions
* May increase absorption of oral medications
* Increase bleeding risk with anticoagulants

ginger

Implications for antiemetics/antinausea:

* Many of these drugs cause severe drowsiness; warn patients about __________ or performing any hazardous tasks.
* Taking antiemetics with _________ may cause severe central nervous system _________.
* Teach patients to change positions slowly to avoid _________ effects.
* For chemotherapy, antiemetics are often given __________ minutes before chemotherapy begins.
* Monitor for therapeutic effects.

driving, alcohol, depression, hypotension, 30 to 60