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39 Cards in this Set
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Antacids
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Hydroxides of : AL Mg
Sodium Bicarbonate Calcium Carbonate Other carbonates |
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Antacids
Side effects |
Mg: Diarrhea
Al: Constipation High sodium Only a problem if renal function is impaired |
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Antacids
Drug interactions |
1) Decrease Bioavailability of phenytoin, digitalis and propanolol
2) Increase: Absorption of sulfonamides Rate of L-dopa absorption Blood levels of Valproic acid Elimination of salycylates and phenobarbital |
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Antacids
Uses |
Symptomatic relief of heartburn or gastritis
Adjunct to drug therapy in ulcer and GERD |
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H2 Histamine Receptor antagonists
Agents |
First line of treatment for peptic ulcer
Cimetidine (Tagamet) Ranitidine (Zantac) Famotidine (Pepcid) Nizatidine (Axid) |
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H2 Histamine Receptor antagonists
Mechanism |
Inhibit Gastric acid secretion by blocking H2 receptor on Parietal cells
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H2 Histamine Receptor antagonists
Uses |
1) Treatment of duodenal and gastric ulcers, gasroesophageal reflux, and Zollinger-Ellison syndrome
2) Pre operative administration to lessen damage of reflux 3) Prevent stress ulcers |
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H2 Histamine Receptor antagonists
Side effects |
Low incidence, mostly elderly, low renal function
Headache Dizziness Nausea Antiandrogen effect (cimetidine, chronic high dose) |
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H2 Histamine Receptor antagonists
Drug interaction |
Cimetidine inhibits CYP3A
Decreases metabolism of 1) Warfarin, 2) phenytoin, 3) theophyline, 4) phenobarbital, 5) some benzodiasepines, 6) propanolol, 7) nifedipine, 8)digoxin, 9) quinidine, and 10) TCA |
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Proton Pump inhibitors
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Omeprazole (Prilosec)
Esomeprazole (Nexium) Lansoprazole (Prevacid) Rabeprazole (Aciphex) Pantoprazole (Protonix) |
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Proton Pump inhibitors
Mechanism |
1) Irreversibly inhibit H+,K+ ATPase in parietal cells
2) DOC for GERD 3) Administered in inactive form, converted in parietal cells to active form 4) Last for 3 days 5) Take on empty stomach 6) For one to two months |
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Proton Pump inhibitors
Adverse Side effects |
Nausea, diarrhea, and abdominal colic
Decrease absorption of Ca++ Increase Risk of osteoporosis |
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Proton Pump inhibitors
Drug interactions |
1) Omeprazole, esomeprazole, lansoprazole inhibit CYP2C19 and CYP3A4 interact with phenytoin, diazepam, warfarin
2) Rabeprazole and pantoprazole barely effect liver metabolism |
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Proton Pump inhibitors
Uses |
1) Healing of duodenal ulcers in 4 weeks and gastric ulcers in 8 with higher dose
2) Effective in treating ulcers that did not respond to H2 blockers 3) DOC for GERD 4) High dose for Zollinger-Ellison |
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Cytoprotective agents
Sucralfate (carafate) |
Aluminum salt of sulfated sucrose
Polymerizes in stomach acid to form protective barrier SE: Constipation, decreases absorption of digitalis, tetracycline, and phenytoin |
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Cytoprotective agents
Misoprostol (Cytotec) |
1) Prostaglandin E1 analogue
2) Increases mucus secretion, decreases acid production 3) Prevents ulceration by NSAIDS 4) May cause abortion, contraindicated in pregnancy |
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Cytoprotective agents
Colloidal Bismuth Salicylate (Pepto Bismal) |
1) Coats the Stomach
2) antibacterial against H. pylori 3) Contraindicated if allergic to aspirin |
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Antibacterial agents and treatment for Peptic ulcer
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1) Metronidazole, amoxicillin, tetracycline, and clarithromycin
2) Helidac-bismuth subsalicylate, metronidazole, and tetracycline 3) Tritec-ranitidine and bismuth citrate, for use with Clarithromycin |
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Prokinetic agents
Metoclopramide (Reglan) |
1) D2 receptor antagonist
2) Enhances motility and tone of smooth muscle 3) Antiemetic (CTZ in CNS) 4) Use: gastroparesis, Esophageal reflux 5) SE: GI cramping and diarrhea, extrapyramidal symptoms 6) Contraindicated in pregnancy |
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Prokinetic agents
Bethanechol (Urecholine) |
Muscarinic agonist increase tone and motility of GI
Uses: postoperative ileus Increase lower esophageal tone Does not get into CNS Common SE of antimuscarinics: SLUDGE |
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Antispasmodics/Anticholinergics
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1) Glycopyrrolate and Dicyclomine
2) Decrease over activity 3) Reduce cramping and spasms 4) Anticholinergic side effects |
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Anti-emetics and anti-nausea agents
5HT3 receptors antagonists |
1) Ondansetron(Zofran), other Setrons
2) Useful in treatment of vomiting due to vagal stimulation and chemotherapy. 3) Not useful against motion sickness 4) SE: headache, dizziness, constipation |
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Anti-emetics and anti-nausea agents
Phenothiazines and Butyrophenones |
1) Prochlorpermazine and promethazine (phenergan) block Dopamine, muscarinic and histamine receptors
2) Use: postoperative nausea and vomiting as well as other causes 3) Cause sedation 4) Droperidol blocks central DA receptors, can be injected |
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Anti-emetics and anti-nausea agents
Cannabinoids |
Dronabinol (THC)
Nabilone THC analogue 1) Anti-emetic and appetite stimulant 2) Used for Chemo induced N/V 3) Combination with prochlorperazine or promethazine increases effectiveness of both |
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Bulk forming laxatives
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Methylcellulose (Citrucel)
Psyllium (metamucil) Acts like fiber, prevents constipation and diverticulitis SE: Bloating and flatulence, impaction or obstruction if not enough water is consumed |
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Osmotic Laxatives
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1) Poorly absorbed salts and sugars
2) Have intense effects to prepare bowel for surgery or colonoscopy 3) Only lactulose can be used chronically |
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Osmotic Laxatives
Magnesium salts |
Magnesium hydroxide (Milk of Magnesia)
Magnesium sulfate (Epsom salts) Magnesium citrate ( EvacQ Kwick) |
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Osmotic Laxatives
Sodium Salts |
Orally or as enema
Administer with large amounts of water Contra indicated in CHF |
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Osmotic Laxatives
Lactulose |
Disaccharide
Metabolized to Lactic acid by colonic bacteria SE: gas abdominal distention and flatulence Use: reduce hyperammonemia with cirrhosis or other hepatic failure |
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Osmotic Laxatives
Sorbitol or mannitol |
Used as sweetener
Over consumption will cause laxative effect |
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Osmotic Laxatives
Polyethylene glycol (Golytely) |
OTC Miralax for occasional constipation
GoLytely for surgical prep NG tube or orally |
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Agents that affect mucosa
laxatives |
Irritants stimulates peristalsis, enhances secretion, and inhibits water absorption
produces semi formed stool in2-8 hr |
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Mucosa
Bisacodyl (dulcolax) |
inhibit absorption of water
stimulate peristalsis |
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Mucosa
Senna and Cascara Sagrada |
Very mild
effective in 8-10 hr |
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Mucosa
Castor oil |
Requires presence of bile
Not used in pregnancy Cause cramps and pain Dehydration Used for prep for diagnostic procedures |
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Lubricating agents and fecal softners
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Not absorbed
Increase bulk Softening the stool |
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Lubricating and softener
Mineral oil |
Takes 2-3 days
Oil lubricates stool Decreases absorption of lipid soluble vitamins Absorped slightly |
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Lubricating and softener
Ducosate sodium |
Emusifying agent allow water to pentrate colonic contents and soften them.
Increase water absorption (oral) |
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Lubricating and softeners
Glycerin |
Supositories lubricate distal end of bowel.
Stimulate peristalsis Possible osmotic effect |