#5 Gi Pharmacology 10/06/06

Front 1

main causes of peptic ulcer disease?

Back 1

1) increase in attack factors = H. pylori, acid, pepsin
2) decrease in defense factors = < mucous barrier

Front 2

two besic approaches to therapy?

Back 2

1) to decrease the acidity and/or peptic activity
2) to enhance the resistance of the mucosa or to protect the base of the ulcer

Front 3

how to decrease the acidity and/or peptic activity?

Back 3

1) by blocking secretion of acid and/or pepsin
2) neutralization of HCL or inactivation of pepsin
3) eradicating H.pylori

Front 4

drugs to decrease attack

Back 4

1) proton pump inhibitors
2) H2-antihistamines
3) antacids
4) antimuscarinics
5) prostaglandins
6) antibiotics
7) antidepressants

Front 5

proton pump inhibitors (PPI)

Back 5

1) Omeprazole (Prilosec) = prototype
2) Lansoprazole (Prevacid)
3) Rabeprazole (Aciphex)
4) Esomeprazole (Nexium)
5) Pantoprazole (Protonix)

Front 6

2) H2-antihistamines

Back 6

1) Cimetidine (Tagamet)
2) Ranitidine (Zantac)
3) Famotidine (Pepcid)
4) Nizatidine (Axid)

Front 7

3) antacids

Back 7

1) Mg (OH)2
2) Al (OH)3
3) CaCO3
4) NaHCO3

Front 8

4) antimuscarinics

Back 8

1) Glycopyrrolate (RObinul)
2) Dicyclomine (Bentyl)
3) Methscopolamine (Pamine)
4) Propantheline (Pro-Banthine)

Front 9

5) Prostaglandin

Back 9

1) Misoprostol (Cytotec)

Front 10

6) Antibiotics

Back 10

1) Metronidazole (Flagyl)
2) Tetracycline
3) Clarithromycin (Biaxin)
4) Amoxicillin (Amoxil)

Front 11

7) antidepressant

Back 11

1) Tricyclics

Front 12

proton pump involves?

Back 12

H/K-ATPase

Front 13

ATPase appears to be?

Back 13

unique, and is not known to be in other cells = devoid of SE

Front 14

Omeprazole (Prilosec)

Back 14

1) prototype inhibitor
2) irreversibly inhibits the ATPase

Front 15

irreversible inhibition of ATPase cause?

Back 15

1) profound inhibition of gastric acid secretion (95-100%) for several days
2) GI bacterial overgrowth
3) diarrhea
4) subsequent colonization of the resp. tract

Front 16

reversible inhibitor of the pump?

Back 16

Lansoprazole (Prevacid) = gastric acid suppression is not prolonged

Front 17

drugs which will be decreased in their absorption?

Back 17

1) ketoconazole
2) ampicillin
3) digoxin
4) iron salts

Front 18

PPI inhibit metabolism of these drugs

Back 18

1) phenytoin
2) warfarin
3) diazepam

Front 19

SE of PPI

Back 19

1) headache
2) diarrhea
3) abd. pain
well tolerated

Front 20

a major fraction of gastric acid is secreted in response to the activation of?

Back 20

1) H2-histamine receptors on parietal cell memb. and
2) the subsequent activation of adenylate cyclase

Front 21

H2-antihistamines have pronounced effects on both?

Back 21

acid and pepsin secretion

Front 22

acid and pepsin secretion is elecited by?

Back 22

1) histamine
2) gastrin
3) caffeine
4) food
5) insulin
6) vagus stimulation

Front 23

H2-antihistamines do not directly affect?

Back 23

1) gastrin secretion
2) GI motility
3) LES pressure

Front 24

H2-antihistamines are most effective when taken at?

Back 24

bedtime

Front 25

H2-antihistamine OTC for?

Back 25

1) acid indigestion
2) sour stomach
3) heartburn

Front 26

drugs to increase defense

Back 26

1) ulcer coating
2) steroid congeners
3) prostaglandins
4) antacids

Front 27

1) ulcer coating

Back 27

1) Sucralfate (Carafate)
2) Bismuth compounds (Pepto-Bismol)
3) Graviscon

Front 28

2) steroid congeners

Back 28

1) Carbenoxolone

Front 29

3) Prostaglandins

Back 29

1) Misoprostol (Cytotec)

Front 30

4) Antacids

Back 30

1) Al(OH)3

Front 31

Sucralfate (Carafate)

Back 31

1) a complex of sulfated sucrose and aluminum hydroxide
2) for duodenal ulcers
3) bind to free protein in the base of ulcer craters
4) forms a complex which protects from acid, pepsin, and bile salts
5) stimulate local production of PG-E

Front 32

SE of Sucralfate

Back 32

1) metalic taste
2) mausea
3) constipation
4) < absorption of some drugs

Front 33

Bismuth subsalicylate (Pepto-Bismol)

Back 33

1) selectively bind to ulcers
2) providing a coating and protection from acid and pepsin
3) stimu. mucus production
4) increase PG synthesis
5) to eradicate H.pylori

Front 34

tripotassium dicitrato-bismuthate

Back 34

1) available in Europe
2) a stable colloidal complex

Front 35

SE of bismuth compounds

Back 35

1) black stools
2) black tongue
3) OD of salicylates

Front 36

Gaviscon

Back 36

1) antacid
2) contains alginate
3) protects the mucosa and impaired gastric reflux
4) for GERD

Front 37

Carbenoxolone

Back 37

1) synth. derevative of glycyrrhizic acid
2) > production , secretion, and viscosity of mucus
3) widely used in Europe
4) for gastric and duodenal ulcers

Front 38

SE of Carbenoxolone

Back 38

1) mineralocorticoid activity
2) Na and water retention
3) HTN
4) hypokalemia

Front 39

Misoprostol (Cytotec)

Back 39

1) PG-E1 analog
2) > mucus and HCO3 production
3) < acid production
4) only for ulcer pt who cannot discontinue NSAID use

Front 40

antacids

Back 40

1) neutralize H ion
2) mucosal protection
3) bind injurious substances
4) weak bases, form salt and water
5) > pH to 3.5-4.5
6) consists of metal salts

Front 41

acid neutralizing capacity (ANC)

Back 41

the # of mEq of HCL that can be brought to pH 3.5 in 15 min

Front 42

antacids are used for?

Back 42

1) dyspepsia
2) adjuncts to other tx for PUD

Front 43

magnesium hydroxide

Back 43

1) high neutralizing capacity
2) SE = diarrhea and hyperMg

Front 44

Aluminum hydroxide

Back 44

1) high neut. capacity
2) SE = constipation and hypoPhos
3) SE = decrease bone mass

Front 45

Calcium carbonate

Back 45

1) moderate neut. capacity
2) liberation of CO2 = abd. distention, nausea, flatulence, belching

Front 46

large doses of Ca carbonate cause?

Back 46

1) transient hyperCa
2) rebound acid secretion
3) milk-alkali syndrome
4) nephrolithiasis

Front 47

sodium bicarbonate

Back 47

1) high neut.capacity
2) SE = syst. alkalosis, fluid retention, acid rebound, CO2 liberation
3) not for chronic use

Front 48

Simethicone

Back 48

added to some antacids, help to relieve gas

Front 49

for eradication of H. pylori

Back 49

1) ranitidine bismuth citrate (tritec) + clarithromycin (Biaxin)

Front 50

HELIDAC pack

Back 50

tetracycline or amoxicillin + metronidazole + pepto-bismol

Front 51

eradication of H.pylori

Back 51

omeprazole + clarithromycin

Front 52

GERDs

Back 52

1) a functional decrease in the tome of LES
2) HCL and bile acids into the esophagus = ulcer, erosive esophagitis
3) heartburn = regurge and dyspepsia

Front 53

anticholinergics

Back 53

1) decrease LES tone
2) never be used for reflux esophagitis

Front 54

medications that decrease LES tone?

Back 54

1) theophylline
2) progesterone
3) nitrates
4) Ca channel blocker

Front 55

prokinetic agents

Back 55

1) favor motion and can improve GI proplusion
2) increase gastric emptying

Front 56

neural regulation of gastric motility

Back 56

1) acetylcholine
2) dopamine
3) serotonin

Front 57

gastric motility can be stimulated by?

Back 57

1) D2 antagonists
2) 5-HT3 antagonists
3) 5-HT4 agonists

Front 58

motilin receptors

Back 58

1) in small intestine
2) potential target for prolinetic agents
3) erythromycin also stimulate motilin receptors

Front 59

Metoclopramide (Reglan)

Back 59

1) prokinetic
2) 5-HT3 antagonists
3) may act as a D2 antagonists
4) cholinomimetic effect
5) crosses the BBB

Front 60

SE of reglan

Back 60

1) extrapyramidal symptoms
2) depression
3) hyperprolactemia
4) hervousness
5) dystonia
6) abd. cramping
7) anticholinergic SE

Front 61

Domperidone (Motilium)

Back 61

1) non-US
2) prokinetic
3) D2 antagonist
4) Tx for gastric hypomotility in diabetics

Front 62

benefit of Domperidone?

Back 62

does not cross BBB (no extrapyramidal SE) and is not anticholinergic, and better tolerated

Front 63

anti-emetics

Back 63

antagonists of
1) serotonin
2) dopamine
3) acetylcholine
4) histamine

Front 64

5-HT3 antagonists

Back 64

1) receptor in GI tract

Front 65

N/V believed to be triggered by release of serotonin from ?

Back 65

the enterochromaffin cells of the small intestine which then activates 5-HT3 receptors on vagal afferents, triggering the vomiting reflex

Front 66

Ondansetron (Zofran)SE

Back 66

1) well tolerated
2) HA
3) constipation
4) dizziness

Front 67

benefit of ondansetron

Back 67

not an antagonist of dopamine receptors = no extrapyramidal SE

Front 68

Granisetron HCL (Kytril)

Back 68

1) for chemo-induced emesis
2) 5-HT3 antagonist

Front 69

which medication is given with Granisetron HCl to improve acute antiemetic effecacy?

Back 69

Dexamethasone

Front 70

Alosetron (Lotronex)

Back 70

1) 5-HT3 antagonist
2) severe potential GI SE

Front 71

Alosetron is only approved for last chance in women with?

Back 71

irritable bowel syndrome

Front 72

other 5-HT3 antagonists

Back 72

1) Dolasetron (Anzemet)
2) Palonosetron (Aloxi)

Front 73

D2 antagonists

Back 73

1) Benzamides
2) Metoclopromide (Reglan)
3) Trimethobenzamide (Tigan)
4) Domperidone
5) Phenothiazine
6) Butyrophenones
7) Chlorpromazine (Thorazine)
8) Prochlorperazine (Compazine)

Front 74

SE of phenothiazine

Back 74

1) hypotension
2) sedation
3) extrapyramidal movement disorders

Front 75

Prochlorperazine (Compazine) IM cause

Back 75

dystonias

Front 76

Butyrophenones

Back 76

1) D2 antagonists
2) Haloperidol (Haldol)
3) Droperidol (Inapsine)
4) for CA chemo.
5) less sedation and hypotension

Front 77

Corticosteroids

Back 77

1) antiemetic
2) Dexamethasone and other glucocorticoids
3) for moderately emetogenic chemo.
4) reduce SE, diarrhea

Front 78

Cannabinoids

Back 78

1) anti-emetic
2) Delta-9-tetrahydrocannabinol
3) for chemo.

Front 79

SE of cannabinoids

Back 79

1) hallucinations
2) disorientation
3) vertigo

Front 80

tx of motion sickness

Back 80

histamine H1-receptor antagonists with anticholinergic + antimuscarinic

Front 81

Benzodiazepines

Back 81

1) antiemetic
2) Lorazepam (Ativan)
3) Alprazolam (Xanax)