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Gastrointestinal Disorders and Drugs
Exam #2
72
Pharmacology
Graduate
03/16/2010

Additional Pharmacology Flashcards

 


 

Cards

Term
Drugs and the GI system
Definition
  • Peptic ulcer durgs (Most common)
  • Adsorbent (only goes into 1st few layers of the GI lining)
  • Antiflatulent
  • Digestive Drugs
  • Antidiarrheal and laxative durgs
  • Antiemetic and emetic drugs
Term
Projectile vomiting
Definition
Usually due to increased intracranial pressure
Term
Dyspepsia
Definition
  • Pain or disxomport in upper abdomen
  • common causes include:
    • non-ulcer dyspepsia
    • Gastroesophageal reflux disease
    • Duodenal ulcer
    • Gastric ulcer
Term
Duodenal ulcer
Definition
Caue pain hours after eating (ie in middle of night)
Term
Gastric Ulcer
Definition
Cause pain imediately after a meal
Term
Peptic ulcer disease (PUD)
Definition
  • Duodenal + Gastric Ulcers
  • a chronic disease
  • Group of ulcerative disorders of the GI tract that require acid and pepsin for their formation:
    • Helicobacter pylori-associated ulcers
    • NSAID-induced ulcers (PG inhibition)
    • Stress related mucosal damage (stress ulcers, ie pregnancy)
Term
Alarm symptoms of serious GI pathology
Definition
  • Dysphagia
  • Weight loss > 3 Kg over 6 months
  • persistent vomitting
  • Bleeding, Hematemesis, Melena
  • anemia
  • Fever, Chills
Term
Hematemesis
Definition

Vomitting blood

  • Once ulcer has eaten through blood vessel.
  • Now only a very small layer preventing a perferation of the mucosa
  • Medical emergency
Term
Melena
Definition
black tary stool, due to digested blood
Term
Gastroprotective prostaglandins
Definition
  • PGE, PGI
  • inhibited by NSAIDs, therefore their use can lead to ulcers
Term
Non-phamracological Treatment of PUD
Definition
  • Bland diets no longer prescribed
  • Moderation if a food/bev makes dyspepsia worse
  • Common offenders: coffee, alcohol, orange juice, spicy foods, fatty foods, large meals or eating on the run
  • Smoking
Term
Stimulants of HCl acid secretion
Definition

Histamine

gastrin

ACh

 

Act at the proton pump

Term
Peptic ulcer durgs
Definition
  • Either eradicate H. pylori or restore balance between acid and pepsin secretions
  • Systemic antibiotics
  • antacids
  • Histamine-2(H2) receptor antagonists
  • proton pump inhibitors
  • peptic durgs (ie Misoprostol, Sucralfate)
Term
Systemic antibiotics for peptic ulcer treatment
Definition
  • used for ulcers caused by H. pylori
  • Use at least 2 antibicrobial durgs and an antacid for 2 weeks
  • Antibiotics used include:

metronidazole

tetracycline

clarithromycin

amoxicillin

  • combined with an H2 receptor antagonist or proton pump inhibitor to ↓ stomach acid and promote healing

 

Term
Antacids
Definition

Over the counter medications

Include:

  • Magnesium hydroxide and alluminum hydroxide (end result = H2O)
  • Calcium Carbonate (end result = ↑ CO2)
Term
Antacid pharmacokinetics
Definition
  • work locally in stomach by neutralizing gastric acid
  • distributed throughout the GI tract
  • Eliminated 1° in feces

 

Term
antacid pharmacodynamics
Definition
reduce the total amount of acid in the GI tract
Term
Antacid pharmacothreapeutics
Definition
  • Prescribed to relieve pain and promote healing in PUD
  • also used to relieve sympotms of acid indigestion, heart-burn, dyspepsia or GERD
  • also used to prevent stress ulcers, GI bleeding, and hyperphosphatemia in kidney failure
Term
antacid drug interactions
Definition
  • antacids can interfere with the absorption of oral durgs given at the same time
  • Thyroxin: antacid prevents absorption, can lead to hypothyroidism again
  • Ciprofloxacin: antacid bonds with it and prevents it from working, infection will progress
Term
Examples of Histamine 2 receptor antagonists
Definition
  • commonly prescribed anti-ulcer drugs, including:
  • Cimetidine (Tagament)
  • Nizatidine (Axid)
  • Ranitidine (Zantac)
  • Famotidine (Pepcid)
Term
-tidine
Definition
histamine 2 receptor antagonists
Term
H2 receptor antagonists
Definition
  • Block histamine from stimulating the acid-secreting parietal cells of the stomach
  • Chemical structure similar to histamine
  • compete with histamine for binding in H2 receptors on gastric parietal cells
  • Inhibit both meal-stimulated secretion and basal secretion of gastric acid
  • promote healing of duodenal and gastric ulcers
  • reduce gastric acid production and provent stress ulcers

 

Term
H2 receptors
Definition
Primarily concerened with gastric acid secretion
Term
How H2 receptor antagonists prevent stress ulcers
Definition
  • interfere with binding thus block acid secretion (reversible competitive inhibitors)

 

  • 90% reductionin basal and food stimulating secretion of gastric acid after a single dose
Term
Clinical uses of Histamine H2 Antagonists
Definition
  1. GERD
  2. Duodenal ulcers
  3. Gastric ulcers

2+3 = Peptic ulcers

Term
Cimetidine
Definition

Used in treatment of Zollinger-Ellison Syndrome

  • require high doses for long periods of time
  • Caues impotence and Gynecomastia, due to    anti-antiadronergic effects
  • Therefore not used, especially in men, fo treatment of ulcers or GERD
Term
Indication for Proton Pump inhibitors
Definition
  • Treatment of Gastric ulcers
  • Active duodenal ulcers and peptic ulcers (H. Pylori)
  • Erosive Esophagitis
  • GERD
Term
Proton Pump inhibitor pharmacokinetics
Definition

Given orally in Interic-coated form to bypass the stomach and are dissolved and absorbed in the small intestine

  • DO NOT CRUSH
  • Given Once a day
Term
Proton pump pharmacodynamics
Definition
  • Block the last step in secretionof gastric acid by combining with hydorgen, potassium, and ATP in the parietal cells
  • Irreversibly inhibit the proton pump (H+K+ATPase) located in the luminal membrane of the gastric parietal cells  

 

Term
Proton pump inhibitor drugs
Definition

Rapeprazole (Pariet)

Pantoprazole (Rantoloc)

Omeprazole (losec)

 Lansoprazole (Prevacid)

Term
Prostaglandin analogs (Gastroprotective)
Definition

Misoprostol (analog of PGE1)

  • stimulates mucous flow and bicarbonate secretion in the stomach
  • binds the prostaglandin receptor onthe parietal cell and inhibits HCl secretion
  • Very effectiv in NSAID induced ulcers
  • (Good for arthritis and POTS disease)

 

 

Term
Misoprostol (Cytotec)
Definition

analog of the  gastroprotective prostaglandin PGE1

 

Protects against NASID induced ulcers, by boosting productionof gastric mucus

 

DO NOT USE during Pregnancy (prostoglandins important for uterine development, can lead to early uterine ripening) 

 

Term
Cox inhibitors
Definition

There are 3 different COX molecules Cox 1, 2, and 3

  • NSAIDs inhibit all of them and therefore all prostaglandins (PGA, PGB, PGG, PGE and PGI)
  • PGE and PGI are gastro protective
  • Therefore inhibition of these PG may effect GI

Celebrix only inhibits Cox 2, which only inhibits PGA, B and G, therefore does not effect GI and cause ulcers

Term
Sucraflate (Carafate)
Definition

Peptic ulcer durg

  • works locally in stomach by rapidly reacting with HCl to form a thick, paste-like substance that adheres to the gastric mucose.
  • "Liquid band-aid"

 

Term
Octreotide
Definition
  • synthetic polypeptide, which resembles Somatostatin
  • Longer half life than somatostatin
Term
Somatostatin
Definition
  • a peptide released into the GIT by Paracrine cells and D cells
  • reduces intestinal fluid secretion
  • slows gastrointestinal motility
  • inhibits secretion of hormones such as GH, insulin, and Gastrin
  • Half life = 3 minutes
  • DO NOT give to diabetics, children... anyone b/c of effects on GH & insulin
Term
Digestive durgs
Definition
  • aid digestion in pts who are missing enzymes or other substances needed to digest food
  • NOT Absorbed, act locally in GIT, excreted in feces
  • action resembles the action of the substances they replace

 

Term
Examples of digestive drugs
Definition
  • Dehydrocholic acid - replaces bile
  • Pancreatin and Pancrealipase - replace pancreatic enzymes
Term
Pancrealipase contents
Definition
  • Trypsin to digest proteins
  • Amylase to digest carbohydrates
  • Lipase to digest fats

 

Pancreatic enzymes given to patientw with pancreatitis and cystic fibrosis

Term
Chronic pancreatitis
Definition
  • usually due to alcholism, may also be virally induced
  • symptoms: radiating pain in lower right abdomen that moves to back

 

Term
antidiarrheal drugs
Definition

Include: 

Opioid-related drugs

Kaolin

Pectin

Term
Laxative drugs
Definition

Include:

Hyperosmolar drugs

dietary fiber & related bulk-forming substances

emollients

stimulants

lubricants

Term
Opioid related durgs
Definition

Antidiarrheal effect

↓ peristalsis in the intestines 

 

Include:

Diphenoxylate (Lomotil)

Loperamide (Imodium)

Term
Pharmacokinetics of opioid related durgs
Definition

Loperamide:

Not well absorbed

distributed in serum

metabolized in liver

excreted in feces

Term
Pharmacodynamics of opioid related durgs
Definition
Slow GI motility by depressing the circular and longitudinal muscle action in the small and large intestines
Term
Pharmacotherapeutics of Opioid related drugs
Definition

 

  • Used to treat acute, nonspecific diarrhea
  • Loperamide also used to treat chronic diarrhea

 

 

Term
Kaolin and Pectin
Definition

 

  • Locally acting OTC antidiarrheals 
  • work by adsorbing irritants and soothing intestinal mucosa (irritant is maintained on surface until it's denatured and eliminated)

 

Term
Kaolin and Pectin pharmacokinetics
Definition

Not absorbed or distributed

excreted in feces

Term
Kaolin and pectin pharmacodynamics
Definition

 

  • Blind with bacteria, toxins, and other irritants of intestinal mucosa
  • Pectin ↓ pH in intestinal lumen; provides a soothing effect on irritated mucosa
  • Used to relieve milt to moderate diarrhea

 

Term
Hyperosmolar laxatives
Definition

 

  • work by drawing water into intestine promoting bowel distention and peristalsis (BM promoted by drawing H2O into intestine)

 

Include:

Glycerin

Lactulose

Milk of magnesia

 

Term
Glycerin
Definition
Hyperosmolar laxative used in bowel training
Term
Lactulose
Definition

Hyperosmolar laxative used to treat:

  • constipation 
  • decrease ammonia production and absorption form the intestines in liver disease (due to improper protein metabolism, can lead to hepatic encephally

Term
Dietary fiber and related bulk-forming laxatives
Definition

 

  • high fiber diet = most natural way to prevent or treat constipation
  • caused distention of GIT
  • not absorbed systemically
  • polysaccharides of these drugs are converted into osmotically active metabolites that draw water into colon
  • excreted in feces
  • increase stool mass and water content promoting peristalsis

 

Term
Examples of dietary fiber and related bulk forming laxatives
Definition

Methylcellulose (Citrucel)

Polycarbophil (Fiberall)

Psyllium hydrophilic mucilloid (Metamucil)

Term
Drug interactions of dietary fiber & related bulk forming laxatives
Definition

Decrease absorption of Digoxin, warfin, and salicylates if given within 2 hrs of these laxatives

 

(give active drug 1st, then wait 2 hrs)

 

Term
Emmolient laxative
Definition

 

  • also called stool softeners
  • Include: Calcium, Potassium, sodium salts of Docusate
  • Soften stool and make bm easier by allowing water and fats to penetrate the stool

 

Term
Stimulant laxatives
Definition

  • also known as irritant cathartics

Include:

Bisacodly (Dulcolax)

Cascara sarada

caster oil

phenolphthalein (ex-lax)

senna (senokot)

Term
pharmacokinetics of stimulant laxatives
Definition

 

  • Minimally absorbed
  • metabolized in liver
  • excreted in urine and feces

 

Term
Pharmacodynamics of stimulant laxatives
Definition

  • Stimulate peristalsis and produce a bm by irritating the intestinal mucosa or stimulating nerve endings of the intestinal smooth muscle

Term
Antiemetic drugs
Definition

  • prevent vomiting (Emesis)

Types: 

antihistamines

phenothiazines

serotonin receptor antagonists

 

Term
Antihistamine antiemetic drugs
Definition

  • Prevent or treat notion sickness and narcotic induced nausea
  • Dimenhydrinate (Gravol), 
  • meclizine hydrochloride (antivert)

Term
Phenothiazine antiemetic drugs
Definition

 

  • control severe nausea and vomiting post surgery, viral related, during chemotherapy and radiation treatment
  • Block vomiting center in the brain
  • Prochlorperazine (Stemetil)
  • Promethazine hydrochloride (Phenergan)

 

 

Term
Serotonin receptor antagonists 
Definition

  • control severe nausea and vomiting post surgery, viral related, during chemotherapy and radiation treatment
  • Ondansetron (Zofran)
  • Expensive drug
  • Used in chemotherapy
  • block serotonin stimulation centrally in the chemoreceptor trigger zone (CTZ) and peripherally in the Vagal nerve terminals, both of which stimulate vomiting

Term
Weight loss drugs
Definition

Phenteramine (Ionamin)

Sibutramine (Meridia)

Orlistat (Xenical)

Term
Phenteramine (Ionamin)
Definition

  • Adrenergic appetite suppressant
  • can raise bp
  • use for 3-6 months only. 2-5 Kg weight loss

Term
Sibutamine (Meridia)
Definition

  • Blocks serotonin and NE reuptake in the brain
  • can raise bp
  • use for 3-6 months only. 2-5 Kg weight loss

Term
Orlistat (Xenical)
Definition
blocks fat absorption in the gut by blocking lipases
Term
Vitamins
Definition

  • essential nutrients needed for normal functioning, growth, and maintenance of body tissues
  • DO NOT provide calories (energy)
  • needed in very small amounts

 

Term
Functions of vitamin A
Definition

  • cell synthesis
  • especially epithelial tissues
  • deficiency leads to keratinization, skin breakdown
  • production immune cells (B cells, T cells, etc)
  • Vision/xerophthalmia (dry eyes)
  • bone growth

Term
Vitamin D deficiency
Definition

  • adults: Osteomalacia
  • arab women who cover skin
  • soft bones
  • Children: Rickets
  • little sunlight exposure
  • bowed legs
  • beaded ribs

Term
Thiamine (vit B) and folic acid 
Definition

  • Hospitalized alcoholics are routinely given Thiamine on admission for Encephalopathy
  • folic acid 1-5 mg daily should always be taken when pregnant to prevent neural tube defects
  • Spina bifida

Term
Vitamin K
Definition

  • newborns given dose of vit. K until vit. K producing bacteria establish themselves in their intestinal tract

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