Step 1: Gi Viii Drugs

Front 1

How do H2 blockers work? Nomenclature?
- clinical uses?

Back 1

block Histamine 2 receptor on parietal cells, which decreases intracellular cAMP --> \\H+ production.
- "-dine" Cimetidine, ranitidine, famotidine, nizatidine
- PUD, gastritis, mild esophageal reflux.

Front 2

Which H2 blocker is a potent P450 inhibitor?
- other effects?
- can it cross BBB?
- placenta?

Back 2

Cimetidine
- decreases hormone synth (gynecomastia, etc.)
- yes --> dizziness, confusion, HA

Front 3

Which H2 blockers decrease renal clearance of creatinine?

Back 3

Cimetidine and ranitidine

Front 4

What are the proton pump inhibitors?
- mech?
- uses?

Back 4

omeprazole, lansoprazole
- inhibit K/H ATPase.
- PUD, chronic gastritis, esophageal reflux, ZE syndrome.

Front 5

What is the triple tx of H. pylori?

Back 5

metronidazole, bismulth/sucralfate, Amoxicillin (or Tetracycline).

Front 6

Mechanism of Bismuth, sucralfate?
- uses?

Back 6

b/ulcer base, providing physical protection. Allows HCO3 secretion to reestablish pH gradient in the mucous layer.

increases ulcer healing, and tx's traveler's diarrhea.

Front 7

What is the mechanism of misoprostol?
- clinical use?
- toxicities?

Back 7

PGE1 analog --> ^^production and secretion of gastric mucous barrier & \\acid production.
- prevention of NSAID induced peptic ulcers; maintenance of a patent ductus arteriosus.
- diarrhea. contraindicated in women of childbearing potential (abortifacient).

Front 8

What drug that is used to prevent NSAID ulcers is also used to maintain a PDA and INDUCE labor?

Back 8

misoprostol, a PGE1 analog.

Front 9

Pirenzepine and propantheline are what?
- used often?
- toxicities?

Back 9

muscarinic antagonists:
block M1 on ECL
M3 directly on parietal.
- rarely used for PUD.
- antimuscarinic toxicities: dry mouth, tachycardia, difficulty focusing eyes.

Front 10

All of the antacid drugs can cause which electrolyte disturbances?
- what does aluminium hydroxide overuse in particular cause?
- magnesium hydroxide
- calcium carbonate

Back 10

HYPOkalemia.
- constipation. proximal muscle weakness, osteodystrophy, seizures. [aluMinimun amount of feces]
- diarrhea, hyporeflexia, hypotension, cardiac arrest [Mg = must go to bathroom]
- hypercalcemia, rebound acid increase.

Front 11

Which antacid can chelate and \\effectiveness of other drugs (e.g. tetra/doxycycline)?

Back 11

calcium carbonate = an antacid.

Front 12

What is a monoclonal Ab to TNF-a?
- clinical uses?
- tox?

Back 12

Infliximab.
- Crohn's and RA
- respiratory infection (including reactivation of latent TB), fever, hypotension.

Front 13

Sulfasalazine
- what is it?
- clinical uses?
- toxicities?

Back 13

combination of sulfapyridine (antibacterial) and 5-aminosalicyclic acid (anti-inflammatory). Activated by colonic bacteria.
- UC and Crohns
- malaise, nausea, sulfonamide toxicity, reversible oligospermia.

Front 14

Which GI drug can knock down the sperm count in semen?

Which could do this, plus lower libido, and cause gynecomastia?

Back 14

Sulfasalazine

H2 blockers (-tidine)

Front 15

What is ondansetron?
- use?
- tox?

Back 15

5HT3 central acting antiemetic
- controls vomiting posoperatively and in patients undergoing cancer chemo
- HA, constipation

Front 16

What is a GI drug used to tx diabetic and post-surgery gastroparesis?
- major side effect?
- other side effects?
- mechanism of drug?

Back 16

Metoclopramide
- Parkinsonian effects.
- DEPRESSION, nausea, vomiting, diarrhea, restlessness, drowiness, fatigue.
- D2 receptor antagonist. increases resting tone, contractility, LES tone, motility.

Front 17

Does metoclopramide speed up colon transit time?

Back 17

No! Just increases resing tone, contractility, LES tone, and motility.

D2 receptor ANTAGONIST.

Front 18

What is ursodiol?
- may be combined with what to dissolve gallstone fragments?

Back 18

ursodeoxycholic acid
- primary bile acid that reduces cholesterol secretion into bile and is effective in dissolving cholesterol glalstones in some pts.
- sonic lithotripsy.

Front 19

What drug that is also used tx diarreha in a variety of endocrine dz such as carcinoid, gastrinoma, and gulcagonoma is used to tx VARICEAL BLEEDING and acromegaly?

Back 19

Octreotide.

Front 20

After exposure to which inhaled anesthetic agent, pts, may experience hepatitis with focal to massive heaptic necrosis?

Back 20

Halothane.

Front 21

What is Docusate / dorcusate sodium?

Back 21

Stool softener: acts as a detergent to allow water and fatty substances to mix, thus increasing luminal mass. Particularly useful to prevent constipation.

Front 22

What type of painkillers are used as antidiarrheals too?

Back 22

opioid receptor agonists, such as loperamide and diphenoxylate.

Front 23

When you block the ACh receptor on the parietal cell, the abilities of which of the following to induce acid secretion are decrease:
- gastrin?
- Ach?
- Histamine?

Back 23

Only directly works on ACh, but ALL three see a decrease because the gastric acid secretagogues are synergistic.

Front 24

63 yo man is receiving 5-FU for colon cancer. Because of his profound nausea, he is prescribed aprepitant. What is the mechanism of this agent?

Back 24

NK1 receptor antagonist. NK1 receptors are present in the brain-stem centers that control the emetic reflex.

Front 25

Mechanism and use of Dronabinol (Marinol)?

Back 25

orally active cannabinoid used for chemotx induced N&V.

Front 26

What is Prochlorperazine, and what is it used to tx re: GI sx?

Back 26

Dopamine antagonist, used to tx N&V.

Front 27

What is Scopolamine? What is it used to tx?

Back 27

muscarinic antagonist used to tx motion sickness and preoperative nausea. NOT used to tx N&V from chemo.

Front 28

Can dexamethasone and methylprednisolone be used to tx nausea?
- if so, nausea caused by what? if not, why not?

Back 28

yes.
- nausea from chemotherapy.

Front 29

High pitched "tinking" bowel sounds + abdominal distention = ?

What types of agents are DEFINITELY contraindicated here?

Back 29

bowel obstruction.

ones that stimulate motillity (like metoclopramide) --> they can cause a perforation.

Wouldn't use sucralfate or Aluminium or Ca antacids here either, b/c they can cause constipation. Mg antacids would be fine (they can cause diarrhea).

Front 30

Granisetron is what?

Back 30

Like ondansetron: 5HT3 receptor antagonist used to tx nausea (like that caused by chemo).

Front 31

What drug is a phenothiazine that blocks DA receptors in the chemoreceptor trigger zone?
- where is this trigger zone?

Back 31

prochlorperazine
- floor of the 4th ventricle i/medulla.

Front 32

What things increase nausea in the CTZ? Decrease? Implications for drug tx?

What does substance P act on in the spinal cord in order to send signals to the vomiting center?

What receptors does the vomiting center have?

Back 32

D2 and 5HT3 increase nausea, and CB1 decreases it. Thus, ANTAGONISTS of D2 and 5HT3 are used to treat nausea, and AGONISTS of CB1 can be used for the same purpose. These would tone down the CTZ, and stop it from stimulating the vomiting center's M1 receptors.

NK-1

M3.

Front 33

What does Megestrol do? Mech?

Orlistat?

Phentermine?

Back 33

progesterone derivative that increases appetite.

inactivates enzymes that fx to digest fats --> ^^WL.

Amphetamine derivative that is anorexigenic (\\appetite)

Front 34

5-HIAA in urine, + flushing, diarrhea, abdominal pain =?
- tx?

Back 34

sounds like carcinoid syndrome.
- octreotide.

Front 35

What is the preferred pain drug for use in Cholescystic pain? why?

Back 35

Meperidine, b/c it's least likely to cause spasm of the sphincter of Oddi, probably b/c of it's antimuscarinic properties.

Front 36

How does Sibutramine work?

Back 36

blocks 5HT and NE reuptake in order to stimulate appetite, and may also increase energy expenditure (tox ~ tachycardia and HTN).