Pharmacology Chapter 16 Flashcards
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Questions and Answers

What acts by partially neutralizing gastric hydrochloric acid and are widely available in many over-the-counter (OTC) preparations for the relief of indigestion, heartburn, and sour stomach?

Antacids

What are 6 side effects of antacids?

  1. Constipation (with aluminum or calcium carbonate antacids) 2. Diarrhea (with magnesium antacids) 3. Electrolyte imbalance 4. Urinary calculi (stone formation) and renal complications 5. Osteoporosis (with aluminum antacids) 6. Belching and flatulence (with calcium carbonate and sodium bicarbonate)

What are 4 precautions/contraindications of antacids?

  1. Heart failure 2. Chronic kidney disease or history of renal calculi 3. Cirrhosis of the liver or edema 4. Dehydration or electrolyte imbalance

What are 4 drugs that antacids should be taken within 2 hours of?

<ol> <li>Anti-infectives, especially tetracyclines, quinolones, and isoniazid 2. Digoxin, indomethacin, and iron 3. Salicylates and thyroid hormones 4. Bisphosphonates (i.e., Actonel, Fosamax)</li> </ol> Signup and view all the answers

What are 3 types of drugs that when combined with antacids may increase action and precipitate side effects?

<ol> <li>Diazepam, which increases sedation 2. Amphetamines and quinidine, which increase cardiac irregularities 3. Enteric-coated drugs may be released prematurely in the stomach</li> </ol> Signup and view all the answers

How do histamine 2 blockers (H2-blockers) work to relieve acid indigestion and heartburn?

<p>H2-receptor antagonists reduce gastric acid secretions</p> Signup and view all the answers

What are 3 side effects of histamine 2 blockers (H2-blockers)?

<ol> <li>Diarrhea, dizziness, rash, and headache 2. Mild gynecomastia with cimetidine occurs infrequently and is reversible 3. Mental confusion (especially in older or debilitated adults; less with Pepcid)</li> </ol> Signup and view all the answers

What are 3 precautions/contraindications for histamine 2 blockers (H2-blockers)?

<ol> <li>Renal disease (may need to reduce dose and/or frequency) 2. Pregnancy 3. Lactation</li> </ol> Signup and view all the answers

What are 8 drugs that might cause an interaction when combined with histamine 2 blockers (H2-blockers)?

<ol> <li>Warfarin (Coumadin) 2. Phenytoin 3. Beta-blockers 4. Benzodiazepines 5. Lidocaine 6. Theophylline (also with high doses of Zantac) 7. Tricyclic antidepressants 8. Proton pump inhibitors may interfere with the effectiveness of H2-blockers; when given together the H2-blocker is usually given at bedtime</li> </ol> Signup and view all the answers

What are 5 examples of proton pump inhibitors?

<ol> <li>Omeprazole (Prilosec) 2. Soprazole (Prevacid) 3. Rabeprazole (Aciphex) 4. Pantoprazole (Protinix) 5. Esomeprazole (Nexium)</li> </ol> Signup and view all the answers

What are 2 side effects of proton pump inhibitors?

<ol> <li>Diarrhea, constipation, nausea, vomiting, and abdominal pain 2. Increased risk for pneumonia or intestinal (Clostridium difficile) infection</li> </ol> Signup and view all the answers

What are 5 drugs that might cause an interaction when combined with proton pump inhibitors?

<ol> <li>Clopidogrel (Plavix) 2. H2-blockers (decrease PPI effectiveness) 3. Sucralfate (delays absorption of most PPIs) 4. Benzodiazepines, phenytoin, and warfarin (increased serum levels) 5. Ampicillin, ketoconazole, iron salts, vitamin B12, bisphosphonates (results in poor bioavailability)</li> </ol> Signup and view all the answers

Which gastric mucosal agent is a synthetic form of prostaglandin E1?

<p>Misoprostol (Cytotec)</p> Signup and view all the answers

What are 3 side effects of gastric mucosal agents?

<ol> <li>Diarrhea, nausea, and abdominal pain 2. Menstrual irregularities 3. Spontaneous abortion, possibly incomplete, with potentially dangerous uterine bleeding or maternal or fetal death</li> </ol> Signup and view all the answers

What are 3 precautions/contraindications for gastric mucosal agents?

<ol> <li>Women of childbearing age 2. Pregnant women 3. Children under age 12</li> </ol> Signup and view all the answers

What is administered on an empty stomach and then reacts with hydrochloric acid in the stomach?

<p>Sucralfate (Carafate)</p> Signup and view all the answers

Which bacterial plays a major role in the development of gastritis, gastric and duodenal ulceration, and gastric cancer?

<p>Helicobacter pylori</p> Signup and view all the answers

What is an example of an anticholinergic and antimuscarinic agent used for the treatment of irritable bowel syndrome?

<p>Dicyclomine (Bentyl)</p> Signup and view all the answers

What are 5 side effects of Dicyclomine (Bentyl)?

<ol> <li>Dry mouth and constipation 2. Blurred vision, dizziness, and drowsiness 3. Urinary retention 4. Tachycardia, palpitations 5. Confusion (especially in older adults)</li> </ol> Signup and view all the answers

What are 6 precautions/contraindications for Dicyclomine (Bentyl)?

<ol> <li>Glaucoma (narrow angle) 2. Unstable cardiac disease 3. Obstructive GI disease and ulcerative colitis 4. Obstructive uropathy (BPH and bladder obstruction) 5. Myasthenia gravis 6. Lactation</li> </ol> Signup and view all the answers

What are 3 drugs that might cause an interaction when combined with Dicyclomine (Bentyl)?

<ol> <li>Phenothiazines 2. Tricyclic antidepressants 3. Opiate agonists</li> </ol> Signup and view all the answers

What are 2 drugs that have chemical structures similar to those of aspirin and exhibit anti-inflammatory activity in the GI tract?

<ol> <li>Mesalamine (Asacol, Rowasa) 2. Prodrug sulfasalazine (Azulfidine)</li> </ol> Signup and view all the answers

What are 4 side effects of salicylates?

<ol> <li>Anorexia, nausea, vomiting, diarrhea, and dyspepsia 2. Abdominal pain, cramps, and bloating 3. Headache, weakness, dizziness, and rash 4. Intolerance to sulfasalazine can be minimized by taking the enteric-coated product.</li> </ol> Signup and view all the answers

What are 5 precautions/contraindications of salicylates?

<ol> <li>Allergy to salicylates 2. Allergy to sulfonamides with sulfasalazine 3. Allergy to sulfites (Rowasa enema) 4. Renal impairment 5. Hepatic impairment (with sulfasalazine)</li> </ol> Signup and view all the answers

What are 5 drugs that might cause an interaction when combined with salicylates?

<ol> <li>Warfarin (increased risk of hemorrhage) 2. Methotrexate (increased bone marrow suppression) 3. Cyclosporine (decreased efficacy) 4. Oral diabetic agents (hypoglycemia) 5. Folic acid (absorption is inhibited)</li> </ol> Signup and view all the answers

What antidiarrheal drug has anti-infective and antisecretory properties?

<p>Bismuth Subsalicylate</p> Signup and view all the answers

What are 3 side effects of Bismuth Subsalicylate?

<ol> <li>Transient, occasional constipation 2. Discoloration of tongue and stool (black color) 3. Ringing in ears</li> </ol> Signup and view all the answers

What are 3 drugs that might cause an interaction when combined with Bismuth Subsalicylate?

<ol> <li>Warfarin (increases bleeding) 2. Aspirin and methotrexate (increases toxicity) 3. Quinolones and tetracyclines (decreased bioavailability)</li> </ol> Signup and view all the answers

What are 4 precautions/contraindications for Bismuth Subsalicylate?

<ol> <li>Salicylate hypersensitivity 2. Children recovering from chickenpox or influenza 3. Coagulation abnormalities and ulcers 4. Pregnancy and lactation</li> </ol> Signup and view all the answers

What works by slowing intestinal motility, thus allowing for more reabsorption of fluid?

<p>Opiate agonists</p> Signup and view all the answers

What are 2 side effects of Opiate agonists?

<ol> <li>Anticholinergic effects (e.g., drying of secretions, blurred vision) 2. Abdominal distention, nausea, or vomiting</li> </ol> Signup and view all the answers

What are 6 precautions/contraindications for Opiate agonists?

<ol> <li>Diarrhea caused by infection or poisoning 2. Fever over 101°F 3. Young children (under 3 years of age) 4. Pregnancy 5. Clostridium difficile colitis associated with antibiotics 6. Obstructive jaundice</li> </ol> Signup and view all the answers

What are living microorganisms that can alter a patient's intestinal flora?

<p>Probiotics</p> Signup and view all the answers

What is an acid-producing probiotic bacterium, available in several forms OTC?

<p>Lactobacillus acidophilus</p> Signup and view all the answers

What are 4 precautions/contraindications for probiotics?

<ol> <li>Anyone with a high fever; weakened immune system 2. Those sensitive to milk products 3. Long-term use, unless directed by the physician 4. Patients with prosthetic heart valves</li> </ol> Signup and view all the answers

What is caused primarily by the eradication of the native intestinal flora with broad-spectrum antimicrobials?

<p>Clostridium difficile diarrhea (C. diff)</p> Signup and view all the answers

What are used in the symptomatic treatment of gastric bloating and postoperative gas pains?

<p>Antiflatulents</p> Signup and view all the answers

What promote evacuation of the intestine and are used to treat constipation?

<p>Laxatives</p> Signup and view all the answers

What are the 7 types of laxatives?

<ol> <li>Bulk-forming laxatives 2. Stool softeners 3. Emollients 4. Saline laxatives 5. Stimulant laxatives 6. Osmotic laxatives 7. Chloride channel activators</li> </ol> Signup and view all the answers

Which type of laxative softens the stool by absorbing water?

<p>Bulk-forming laxatives</p> Signup and view all the answers

What type of laxative promotes stool movement through the intestines?

<p>Emollients</p> Signup and view all the answers

What type of laxative promotes secretion of water into the intestinal lumen?

<p>Saline laxatives</p> Signup and view all the answers

What are 4 side effects of saline laxatives?

<ol> <li>Electrolyte imbalance 2. CNS symptoms, including weakness 3. Edema 4. Cardiac, renal, and hepatic complications</li> </ol> Signup and view all the answers

What are 6 precautions/contraindications of saline laxatives?

<ol> <li>Long-term use 2. Heart failure or other cardiac disease 3. Edema 4. Diuretics 5. Acute abdominal pain 6. Colostomy</li> </ol> Signup and view all the answers

What type of laxative are cathartic in action?

<p>Stimulant laxatives</p> Signup and view all the answers

What are 5 side effects of stimulant laxatives?

<ol> <li>Abdominal cramps 2. Rectal and/or colonic irritation 3. Loss of normal bowel function 4. Electrolyte disturbances 5. Discoloration of urine with senna</li> </ol> Signup and view all the answers

What are 4 precautions/contraindications of stimulant laxatives?

<ol> <li>Acute abdominal pain 2. Ulcerative colitis 3. Children and pregnant/lactating women 4. Long-term use</li> </ol> Signup and view all the answers

What type of laxative draws water from the tissues into the feces?

<p>Osmotic laxative</p> Signup and view all the answers

What type of laxative works by increasing intestinal fluid secretion?

<p>Chloride channel activators</p> Signup and view all the answers

What are 3 side effects of Chloride channel activators?

<ol> <li>Nausea and diarrhea 2. Headache 3. Abdominal bloating or pain and flatulence</li> </ol> Signup and view all the answers

What are 3 precautions/contraindications for Chloride channel activators?

<ol> <li>Severe diarrhea or bowel obstruction 2. Renal or hepatic impairment 3. Pregnancy and breast-feeding</li> </ol> Signup and view all the answers

What are used in the prevention or treatment of nausea, vomiting, vertigo, or motion sickness?

<p>Antimetics</p> Signup and view all the answers

Study Notes

Antacids

  • Antacids partially neutralize gastric hydrochloric acid, providing relief for indigestion, heartburn, and sour stomach.
  • Common side effects include constipation (aluminum/calcium), diarrhea (magnesium), electrolyte imbalance, urinary calculi, osteoporosis (aluminum), and belching/flatulence (calcium/sodium bicarbonate).
  • Precautions include heart failure, chronic kidney disease, cirrhosis, and dehydration.
  • Antacids can interact if taken within 2 hours of anti-infectives, digoxin, salicylates, and bisphosphonates.

H2-Blockers

  • Histamine 2 blockers reduce gastric acid secretions to relieve acid indigestion and heartburn.
  • Side effects may include diarrhea, dizziness, rash, headache, mild gynecomastia (cimetidine), and mental confusion (especially in older adults).
  • Renal disease, pregnancy, and lactation are precautions for use.
  • Potential interactions include warfarin, phenytoin, beta-blockers, benzodiazepines, lidocaine, and proton pump inhibitors.

Proton Pump Inhibitors (PPIs)

  • Common PPIs include omeprazole, lansoprazole, rabeprazole, pantoprazole, and esomeprazole.
  • Used for short-term relief of GERD and ulcers, with potential long-term use for severe cases.
  • Side effects consist of diarrhea, constipation, nausea, vomiting, and heightened risk of pneumonia or C. difficile infection.
  • Interactions with clopidogrel, H2-blockers, sucralfate, and some anticoagulants may occur.

Gastric Mucosal Agents

  • Misoprostol inhibits gastric acid secretion and protects the mucosa, especially important for patients on NSAIDs.
  • Side effects include diarrhea, nausea, menstrual irregularities, and risks of spontaneous abortion.
  • Precautions include women of childbearing age, pregnant women, and children under 12.

Sucralfate

  • Sucralfate adheres to mucosa in the stomach, protecting ulcers from irritation when administered on an empty stomach.

Helicobacter pylori

  • This bacterium contributes significantly to gastritis, ulceration, and gastric cancer.

Anticholinergics for GI Motility

  • Dicyclomine is an anticholinergic agent that decreases gastrointestinal motility.
  • Side effects include dry mouth, constipation, blurred vision, dizziness, urinary retention, and confusion.
  • Contraindications involve glaucoma, unstable cardiac disease, and obstructive GI conditions.

Salicylates

  • Mesalamine and sulfasalazine are used to treat Crohn's disease and ulcerative colitis, promoting targeted release in the intestinal tract.
  • Side effects can include anorexia, nausea, vomiting, headache, and abdominal cramps.
  • Allergies to salicylates/sulfonamides, renal/hepatic impairment are contraindications.

Bismuth Subsalicylate

  • Functions as an antidiarrheal with antisecretory properties.
  • Possible side effects include constipation, tongue/stool discoloration, and ringing in the ears.
  • Interactions with warfarin and antibiotics may diminish effectiveness.

Opiate Agonists

  • Work by slowing intestinal motility to aid in fluid reabsorption, utilized as an antidiarrheal.
  • Side effects involve anticholinergic effects and abdominal distention, as well as nausea or vomiting.
  • Contraindications include diarrhea due to infections, fever, young children, and obstructive jaundice.

Probiotics

  • Living microorganisms that can positively influence intestinal flora, effective in managing various GI diseases.
  • Lactobacillus acidophilus is an example of an acid-producing probiotic available OTC.
  • Precautions include weakened immune systems, sensitivity to milk, and potential bacteremia risks in vulnerable populations.

Clostridium difficile Diarrhea

  • Mainly occurs due to disruption of native intestinal flora from broad-spectrum antimicrobials and PPI/H2-blocker overuse.

Antiflatulents

  • Used to relieve gastric bloating and gas pains by dispersing gas bubbles in the GI tract.

Laxatives

  • Classification includes bulk-forming, stool softeners, emollients, saline, stimulant, osmotic, and chloride channel activators.
  • Bulk-forming laxatives increase fecal mass to ease defecation, while emollients coat and soften stool.
  • Stimulant laxatives produce strong peristaltic activity and are habit-forming; their use should be limited.

Chloride Channel Activators

  • Increase intestinal fluid secretion through specific chloride channel activation, with side effects including nausea, diarrhea, and headache.

Antiemetics

  • Utilized for treating nausea, vomiting, vertigo, or motion sickness.

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Description

Test your knowledge on gastrointestinal drugs, particularly focusing on antacids and their effects. This quiz covers key concepts like the mechanism of action of antacids and their side effects. Perfect for students looking to solidify their understanding of pharmacology.

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