Carlos Shared "20 Gastrointestinal Pharm" - 14 Picmonics

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20 Gastrointestinal Pharm

Acid suppression therapy
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H2 Receptor Blocker
"-tidine" Suffix
Indications
Gastroesophageal Reflux Disease (GERD)
Peptic Ulcer
Mechanism
Block Histamine H2 Receptors
Parietal Cells
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51 secs
Proton Pump Inhibitors (PPIs)
"-prazole" Suffix
Indications
Zollinger-Ellison Syndrome
Gastritis
Peptic Ulcer
Gastroesophageal Reflux Disease (GERD)
Mechanism
Inhibit H+/K+/ATPase
Side Effects
Hip fracture
Pneumonia
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2 mins
Antacids
All
Can affect absorption, bioavailability, or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying
All can cause hypokalemia
Aluminum hydroxide
SE: Constipation and hypophosphatemia; proximal muscle weakness, osteodystrophy, seizures
Calcium carbonate
SE: Hypercalcemia (milk-alkali syndrome), rebound acid increase
Can chelate drugs and decreases effectiveness (eg tetracycline)
Magnesium hydroxide
SE: Diarrhea, hyporeflexia, hypotension, cardiac arrest
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Sucralfate (Carafate)
Mechanism
Creates Protective Barrier
Indications
GI Ulcers
Side Effects
Constipation
Considerations
Require Acidic Environment
Give on Empty Stomach
Oral Suspension Available
May Decrease Absorption of Other Meds
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2 mins
Dinoprostone and Misoprostol
Mechanism
Prostaglandins
Indications
Promote Cervical Ripening
Prevent GI Ulcers
Medical Abortion
Side Effects
Fetal Distress
Hyperstimulation of Uterus
Considerations
Vaginal Insertion
Give Before Induction of Labor
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2 mins
Octreotide
Indications
Acute Variceal Bleeds
Pituitary Tumors
GH Secreting Tumors
Carcinoid Tumors
VIPoma
Mechanism
Somatostatin Analog
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2 mins
Sulfasalazine
MECHANISM
A combination of sulfapyridine (antibacterial) and 5-aminosalicylic acid (anti-inflammatory).
Activated by colonic bacteria.
CLINICAL USE
Ulcerative colitis, Crohn disease (colitis component).
Rheumatoid arthritis
ADVERSE EFFECTS
Malaise, nausea, sulfonamide toxicity, reversible oligospermia.
Also DRESS syndrome and pancreatitis
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Loperamide
MECHANISM: Agonist at μ-opioid receptors; slows gut motility. Poor CNS penetration (low addictive potential).
CLINICAL: USE Diarrhea.
ADVERSE EFFECTS: Constipation, nausea.
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Ondansetron
Indications
Postoperative Vomiting
Chemotherapy-induced Nausea and Vomiting
Mechanism
5-HT3 Serotonergic Antagonist
Centrally-acting Antiemetic
Side Effects
Headache
Constipation
QT Prolongation
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1 min
Metoclopramide
Indications
Antiemetic
Promotility Agent
Mechanism
Increased Resting Tone
Antagonist at D2 Receptor
Side Effects
Parkinsonian Symptoms
Galactorrhea
Contraindication
Small Bowel Obstruction
Parkinson's Disease
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2 mins
Orlistat
MECHANISM: Inhibits gastric and pancreatic lipase leads to decreased breakdown and absorption of dietary fats.
CLINICAL USE: Weight loss
ADVERSE EFFECTS: Steatorrhea, decreased absorption of fat-soluble vitamins.
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Laxatives
Indicated for constipation or patients on opiates requiring a bowel regimen
Bulk-forming laxatives
NAMES: Psyllium, methylcellulose
MECHANISM: Soluble fibers; draw water into gut lumen, forming a viscous liquid that promotes peristalsis
ADVERSE EFFECTS: Bloating
Osmotic laxatives
NAMES: Magnesium hydroxide, magnesium citrate, polyethylene glycol, lactulose
MECHANISM: Provide osmotic load to draw water into GI lumen. Lactulose also treats hepatic encephalopathy because gut flora degrade it into metabolites (lactic acid, acetic acid) that promote nitrogen excretion as NH4 +
ADVERSE EFFECTS: Diarrhea, dehydration; may be abused by bulimics
Stimulants
NAME: Senna
MECHANISM: Enteric nerve stimulation leads to colonic contraction
ADVERSE EFFECTS: Diarrhea, melanosis coli
Emollients
NAME: Docusate
MECHANISM: Osmotic draw into lumen causes increased water absorption by stool
ADVERSE EFFECTS: Diarrhea
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Aprepitant
MECHANISM: Substance P antagonist. Blocks NK1 receptors in brain.
CLINICAL USE: Antiemetic for chemotherapy-induced nausea and vomiting.
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