Test 2

  1. aluminum hydroxide
    • constipation
    • often combined with magnesium hydroxide to counteract diarrhea
    • can bind to certain drugs as well as pepsin (can help heal ulcers)
  2. Magnesium hydroxide
    • diarrhea
    • frequently used as a laxative
    • watch for mag toxicity with renal impairment
  3. calcium carbonate
    • constipation
    • can cause acid rebound or milk alkali syndrome
    • incr CO2 in the stomach and causes belching
    • watch for kidney stones
  4. sodium bicarbonate
    • no effect on bowel function
    • used to treat alkalosis and incr urine pH to hasten drug elimination
  5. H2 blockers

    cimetidine, ranitidine, famotidine
    • block H2 receptors in the stomach and slow down gastric acid
    • *ulcer healing, GERD, aspiration pneumonitis prevention (surgery)
    • **cimetidine has a huge effect on drug metabolism = P450 inhibitor that can lead to toxicity of other medications; can also block androgen receptors
    • watch for GI effects, arrythmias, CNS effects
  6. PPI's

    omeprazole, lansoprazole, esomeprazole, pantoprazole
    • irreversibly block Na/K pump in stomach to block 97% of acid production
    • *GERD, PUD
    • limit length of tx due to concerns for osteoporosis and cancer, B12
    • If taken for H.pylori must be started with abx
  7. Mucosal protectants

    • gel creates protective barrier over ulcer
    • *short term tx of ulcers
    • watch for constipation and nausea
    • Give two hours before or after other meds
  8. bismuth subsalicylate
    • inhibits pepsin, incr mucus production, antimicrobial H. pylori
    • *H.pylori ulcers, diarrhea
    • watch for tinnitus, don't give to kids with chicken pox or flu
  9. misoprostol
    • synthetic prostaglandin
    • *used for prophylaxis of NSAID ulcers, induction of labor and delivery
    • abortifacient if given early in pregnancy
  10. Prokinetics

    metocloperamide, cisapride
    • increase GI motility
    • *GERD, post-op N/V
    • watch for sedation and diarrhea with high doses, tardive diskinesia with long term tx
    • Don't give to pts with obstruction or perfed bowel
    • **cisapride can only be given by special permission
  11. antidiarrheals

    diphenoxylate (lomotil), loperamide (imodium) - opiates
    kaopectate, pepto, attapulgite - adsorbents
    • reduce GI motility, enhance water reabsoprtion
    • *short term tx of diarrhea
    • low abuse potential with opiates but can cause resp depression and sedation
    • dont' use for infectious diarrhea, tx cause
  12. Bulk-forming laxatives

    psyllium, methylcellulose
    • non-absorbable substances that for a gel to soften stools
    • *used for constipation and also sometimes diarrhea
    • take with lots of fluid to prevent obstruction, can help lower choelsterol
  13. sufactant laxatives

    • lower surface tension to help water enter feces and incr intestinal fluid
    • *use prophyllactically after rectal surgery
    • take with lots of water
  14. lubricants

    minteral oil
    • coat fecal mass to help lubricate
    • *to prevent straining
    • can alter fat vitamin absorption, cause lipid pneumonia, dehydration, incontinence
  15. Stimulant laxatives

    bisocodyl, senna, phenophthaline
    • irritate bowel to stimulate peristalsis
    • *widely abused by the public to treat "constipation"
    • senna turns urine colors
    • don't use more than once/wk
  16. Osmotic laxatives

    mag citrate, milk of mag, miralax, golytely
    • draw water into the bowel to soften feces, swelling of stool promotes peristalsis
    • *elimnatino of poisons/parasites, bowel prep for procedures
    • watch for electrolyte imbalance and dehydration
  17. relistor
    prevents opiate induced constipation by blocking mu receptors in GI tract
  18. lubirostone
    • open's Cl channels in teh gut to draw water in
    • *used for IBS-C and chronic idiopathic constipation
  19. dopamine antagonists

    compazine, phenergan
    • inhibit dopamine receptors in the CTZ
    • *N/V, hiccups, psych
    • watch for anticholingergic fx, orthostatic Hypo, parkinsonian movements
  20. serotonin antagonists

    • block serotonin receptors of vagal nerve
    • *chemo and post-op nausea/vomiting
    • better if given prophylactically
  21. obesity drugs

    meridia, orlistat
  22. Antihistamines

    Benadryl, phenergan, vistaril, periactin (1),
    Claritin, Zyrtec, Allegra (2)
    Astalin, Astepro, Patanase (intranasal 2nd)
    • block H1 receptors throughout body, no effect on release of histamine! (also has antimuscarinic properties)
    • *allergic rhinitis, motion sickness, urticaria, insomnia, prevention of allergic reactions
    • overdose causes CNS excitation (resembles atropine poisoning)
    • 2nd generation drugs = less sedation and muscarinic blockade
    • can worsen asthma (1st generation)
  23. Nasal glucocorticoids

    budesonide, fluticasone, monetasone
    • inhibit inflammatory mediators to reduce secretions, inflammation
    • * rhinitis, sinusitis, nasal polyps
    • Can cause drying of mucosa = nose bleeds,
    • sore throat and thrush = limited if administered properly
  24. nasal decongestants

    oxymethazoline, phenylephrine, pseudophedrine
    • stimulate a1 receptors on nasal blood vessels
    • **highly addicting**
    • can lead to rebound congestion, tachy, restlessness, insomnia
    • Withdraw one nare at a time and give nasal steroids until off drug
  25. cromolyn sodium
    • mast cell stabilizer - inhibit histamine and leukotriene release
    • *prophylaxis of allergic rhinitis, asthma control
    • no local or systemic absorption - can be used safely in pregnancy
  26. oral decongestants

    pseudophedrine, phenylephrine, ephedrine, epinephrine
    • a1 agonists - shrink respiratory membranes
    • *systemic relief of sinusitis, colds, flu
    • caution with uncontrolled HTN
    • watch for CNs stim, urinary retention, cardiac rhythms, HTN
    • Don't give with MAOI's, BB, methyldopa, alkalinizing drugs
  27. Antitussives

    benzonatate, dextromethorphan - non-narcotic
    codeine, hydrocodone
    • supress cough reflex in medulla
    • *suppress dry non-productive cough
    • watch for dizziness, N/V, CNS effects
    • opiate ones much more effective but potential for abuse
  28. Expectorants

    guiafenisen, ipecac syrup
    • incr respiratory fluids, reduces viscosity of secretions
    • *persistent cough, mucus plugs, colds
    • watch for GI probs, careful in women due to enhanced preg risk (reduces mucus plug in cervix)
    • Short term use, encourage fluid intake
  29. Mucolytics

    mucomyst (acetylcisteine)
    • reduces thickness of secretions
    • *chronic bronchitis, COPD, CF
    • watch for bronchospasm, severe rhinorrhea
  30. inhaled corticosteroids

    beclamethasone, budesonide, fluticasone
    • decreases inflammatory mediators and cells
    • *used for maintenance therapy of asthma (prevention)
    • watch for throat irritation, thrush, adrenal suppression with long term high doses
    • **use a spacer when possible, rinse mouth after dosing to prevent thrush
  31. oral glucocorticoids

    prednisone, prednisolone
    used in short bursts for exacerbation

    • use for less than 10 days where possible, taper off.
    • Can cause bone loss, hyperglycemia, growth suppression, wt gain when used long term.
  32. IgE antibody

    omalizumab (xolair)
    • suppresses immune repsonse
    • injectable, used only when glucocorticoids fail.
    • VERY expensive
  33. Leukotriene receptor antagonists

    montelukast, zileutron
    • inhibit leukotrienes hence reduced inflammation
    • *prevention and control of asthma
    • watch for GI effects, HA
    • check liver enzymes and watch with other medication (coumadin, theophylline)
  34. B2 Adrenergic agonists (short acting)

    albuterol, levabuterol, pirbuterol, terbutaline
    • stimulate B2 receptors in lung to cause bronchodilation
    • *rescue drugs for asthma (all asthma pts should have one)
    • can cause muscle tremor, hyperactivity, HA
  35. B2 Adrenergic agonists (long acting)

    salmeterol, formoterol, aformoterol (copd)
    Advair/symbicort (combo of glucocort and LABA)
    • block B2 receptors in the lung
    • *oral or inhaled for prophylaxis/control of asthma
    • watch for tremor, cardiac effects with high doses
    • **can be counteracted in pts on BB
  36. muscarinic antagonists (inhaled)

    ipratroprium bromide, tiotropium
    • block Ach in bronchial smooth muscle = bronchodilation
    • *used for bronchospasm of COPD, chronic bronchitis
    • low SE because poorly absorbed
  37. Methylxanthines

    theophylline, caffiene
    • bronchodilator, CNS stimulant
    • *used mostly when other drugs have failed
    • watch for cardiac SE
    • **very narrow therapeutic range and many drug interactions
  38. Sulfonylureas (basal/PP glucose)

    tolbutamide, glyburide, glipiside, glimepiride
    • Increase insulin secretion
    • *1st line oral drug
    • 2nd generation much better SE profile
    • **watch for hypoglycemia, careful with renal impairment
    • bad for prego's
  39. Meglitinides

    repaglinide, nateglinide
    • increase insulin release
    • *used for PP glucose control, take only with meals
    • **watch for hypoglycemia, don't take if you don't eat
    • cause wt gain
  40. Biguanides

    • increase insulin sensitivity
    • *control basal/PP glucose,
    • watch for nausea, diarrhea, lactic acidosis (rare)
    • safe for pregnancy
    • can stimulate wt loss!, lower cholesterol
  41. TZD's/glitazones

    rosiglitazone, pioglitazone (Avandia, Actos)
    • decrease insulin resistance
    • *reduce basal/PP glucose
    • Lots of drug interactions from P450 and protein binding
    • Watch for fluid retention, edema
    • check LFT's periodically, can incr lipid levels
  42. a gluconidase inhibitors

    acarbose, miglitol
    • delay absoprtion of carbs
    • *for PP glucose reduction
    • causes GI distrubances and flatulence
    • **if given with insulin you have must tx hypo with straight glucose
    • avoid with metformin for GI effects, careful giving to pts with GI probs
  43. GLP-1 agnoists

    • mimics incretin hormones = stim release of insulin, supress appetite, slow emptying
    • *for use with metformin or sulfonylurea for PP glucose
    • watch for pancreatitis, don't give with renal disease
    • can promote wt loss
  44. DPP-4 inhibitor (gliptins)

    sitagliptin, saxagliptin
    • prevent the enzyme that breaks down incretins
    • *used to control basal glucose
    • major effects are respiratory, no effect on wt
    • watch for drug interaction with digoxin
    • **saxagliptin has many more SE
  45. amylin agonist

    • delays gastric emptying, suppresses glucagon
    • *used for PP glucose control
    • major risk of hypoglycemia when combined with insulin
    • nausea is a common side effect.
    • Don't give with altered GI motility
Card Set
Test 2
Diabetes, GI, Pain, Respiratory