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73 Cards in this Set
- Front
- Back
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What are the 8 GI disorders?
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1. GERD
2. PUD 3. duodenal ulcer 4. nausea 5. emesis 6. IBS 7. diarrhea 8. constipation |
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Which type of cell is involved in the synthesis and activation of pepsin?
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Chief cells
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What is GERD?
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backflow of stomach acid into the esophagus
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What are the usual symptoms of GERD?
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heartburn and an uncomfortable burning sensation behind the breastbone
more serious symptoms: difficulty swallowing and chest pain |
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What does GERD stand for?
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gastroesophageal reflux disease
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What causes PUD?
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Helicobacter Pylori bacteria and NSAID's - mainly
also... benign pancreatic tumor secretions and unknown causes |
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What is benign PUD?
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normal gastric acid production but the mucosal barrier is weak
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What is malignant PUD?
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excessive secretion of gastric acid that overwhelms the mucosal barrier
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What does PUD stand for?
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Peptic Ulcer Disease
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What is used in the treatment of heartburn, GERD, and PUD?
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- antacids
- H2 receptor blockers - mucosal protective agents - proton pump inhibitors - anti-cholinergics - prostaglandin analogs - anti-microbial agents |
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What are the two types of antacids?
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systemic and nonsystemic
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What is an example of a systemic antacid?
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sodium bicarbonate
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What are two examples of nonsystemic antacids?
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- aluminum hydroxide and magnesium hydroxide combinations
- calcium carbonate |
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What are the H2 receptor blockers?
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- Cimetidine
- Famotidine - Ranitidine - Nizatidine |
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H2 receptor blockers may alter the effects of other drugs through interactions with _____.
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CYP450
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True or false:
H2 receptor blockers have very few side effects. |
true (except for Cimetidine which inhibits the metabolism of estrogen)
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How do H2 receptor blockers work?
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The inhibit secretion of gastric acid through competitive inhibition of Histamine H2 receptors.
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What are the proton pump inhibitors?
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(-prazole's)
- omeprazole - esomeprazole - rebeprazole - lansoprazole - pantoprazole |
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How do proton pump inhibitors work?
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They are strong inhibitors of gastric acid secretion through irreversible inhibition of the proton pump, preventing "pumping" or release of gastric acid
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True or false:
Proton pump releasers provide faster relief and healing then H2 receptor blockers. |
true
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Proton pump inhibitors have a __ to __ week course treatment.
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4 to 8
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What is an example of a prostaglandin treatment?
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Misoprostol
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What is Misoprostol used for?
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treatment of NSAID induced injury
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What are the side effects of misoprostol?
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- diarrhea
- pain - cramps |
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Which drug should not be given to women of childbearing years unless a reliable method of birth control can be DOCUMENTED? Why?
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misoprostol
It can cause birth defects and premature birth. |
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What is an example of an anticholinergic treatment?
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pirenzipine
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What type of antagonist is pirenzipine?
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a muscarinic M1 acetylcholine receptor antagonist
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How does pirenzipine work?
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It blocks gastric acid secretions.
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What are the anticholinergic side effects of pirenzipine?
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- anorexia
- blurry vision - constipation - dry mouth - sedation |
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What are the mucosal protective agents?
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- sucralfate
- chelated bismuth |
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True or false:
Sucralfate requires an acid pH to activate. |
true
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How does sucralfate work?
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It forms a sticky barrier in an acidic environment and adheres to the ulcer site, forming a barrier.
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Which medication can cause black stools?
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chelated bismuth
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What is the triple therapy used in anti-H. pylori therapy?
What is the quadruple therapy? |
1. proton pump inhibitor +
2. amoxicillin/tetracycline + 3. metronidazone/clarithromycin (for quad therapy, add bismuth) |
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What are the two main inflammatory bowel diseases?
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1. ulcerative colitis
2. Crohn's disease |
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What is the purpose of treatment for inflammatory bowel disease?
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to resolve acute episodes and prolong remission
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What are the drugs used in the treatment of inflammatory bowel disease?
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- aminosalicylates
- corticosteroids - thiopurines - methotrexate - cyclosporin - infliximab |
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Which of the inflammatory bowel disease drugs causes significant side effects?
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cyclosporin
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true or false:
Constipation usually is effectively treated with dietary modification and only if this fails should laxatives be used. |
true
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What are the types of therapy for constipation?
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1. bulking agents
2. osmotic laxatives 3. stimulant drugs 4. stool softeners |
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How do bulk laxatives work?
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They cause an increase in bowel content volume which triggers stretch receptors in the intestinal wall. This causes reflex contraction (peristalsis) that propels the bowel content forward.
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What are the bulk laxatives?
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- psyllium
- bran - methylcellulose |
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True or false:
Bulk laxatives must be taken with lots of water or it will make constipation worse. |
true
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How do saline and osmotic laxatives work?
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Fluid is drawn into the bowel by osmotic force, increasing volume and triggering peristalsis.
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What are saline and osmotic laxatives used for?
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to purge the intestine (for surgery and poisoning)
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What are the types of saline and osmotic laxatives?
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- nondigestible sugars and alcohols (lactulose)
- salts - polyethylene glycol |
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What are examples of stool softeners?
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- docusate sodium
- liquid Paraffin - Glycerin suppositories |
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How do the irritant/stimulant laxatives-cathartics work?
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They increase intestinal motility by irritating the gastric mucosa and pulling water into the lumen.
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What are the irritant/stimulant laxatives-cathartics indicated for?
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severe constipation where more rapid effect is required
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What are the irritant/stimulant laxatives-cathartics?
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- castor oil
- senna - bisacodyl - lubiprostone |
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What are the causes of diarrhea?
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- toxins
- microorganisms - antibiotic associated colitis |
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What are the indications for the treatment of diarrhea?
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- >2-3 days
- severe diarrhea in the elderly or small children - chronic inflammatory disease - when the specific cause has been determined |
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How do the anti-diarrheal agents work?
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The are anti-motility agents that reduce peristalsis by stimulating opioid receptors in the bowel which allows for more water to be absorbed by the gut.
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What are the anti-diarrheal agents?
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- morphine
- codeine - diphenoxylate - loperamide |
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Which anti-diarrheal agent is 40-50 x more potent than morphine, and is antisecretory against cholera toxin and some E. coli toxin?
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loperamide
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What are the contraindications for anti-diarrheal agents?
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- toxic materials
- microorganisms - antibiotic associated |
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What is the major cause of diarrhea and colitis in patients exposed to antibiotics?
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C. diff
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What is the treatment for C. diff?
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- discontinue offending antibiotic
- Metronidazole - Vancomycin |
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What is an example of an antiflatulant?
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simethicone
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How do antiflatulants work?
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They alter the elasticity of mucus-coated bubbles, causing them to break. (Large bubbles to smaller bubbles = less pain)
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What is syrup of Ipecac used for?
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It induces emesis.
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What are the classes of antiemetic drugs?
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- Muscarinic M1 receptor antagonists
- Histamine H1/ Dopamine D2 receptor antagonists - Serotonin 5-HT3 receptor antagonists |
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What is the muscarinic M1 receptor antagonist for antiemesis?
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scopolamine
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What are the side effects of Scopolamine?
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- dry mouth
- dizziness - restlessness - dilated pupils - delirium at high doses - allergic reaction |
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What are the histamine H1/ dopamine D2 receptor anagonists?
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phenothiazines like
- promethazine - prochlorperazine |
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What is special about the histamine H1/ dopamine D2 receptor anagonists?
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They are neuroleptics (antipsychotics).
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What are the side effects of histamine H1/ dopamine D2 receptor anagonists?
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- blurred vision
- dry mouth - dizziness - restlessness - seizures - extrapyramidal effects (Tardive dyskinesia) |
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What are the serotonin 5-HT3 receptor antagonists?
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- ondansetron
- granisetron |
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Which of the antiemetic drugs are excellent for chemotherapy induced nausea and vomiting?
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the serotonin 5-HT3 receptor antagonists
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What are the common side effects of the serotonin 5-HT3 receptor antagonists?
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-headache and constipation
(There are very few common side effects - usually well tolerated.) |
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Where is the vomiting center?
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the medulla
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What are the antiemetic therapeutic sites?
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- vestibular apparatus
- CTZ - cerebral cortex - stomach |
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What is the gold standard for antiemetics?
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Serotonin 5-HT3 receptor antagonists
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