Tp-1 Final N/v & Gerd

Front 1

define nausea

Back 1

inclination to vomit

Front 2

define retching

Back 2

rhythmic contractions

Front 3

T or False

Regurgitation does not equal vomiting

Back 3

True

Front 4

Esophagus is what kind of tissue

Back 4

stratified squamous

Front 5

what is critical for development of esophageal mucosal injury?

Back 5

gastric juices

Front 6

GERD causes....

Back 6

Erosion, ulceration, bad taste, pneumonitis

**Barretts esophagitis
**Adenocarcinoma

Front 7

describe H. pylori

Back 7

causes chronic gastritis

Gram neg rod, motile
produces Urease-protects bug from acid
Does not invade-it superfical colonizes by adhesion

Front 8

define ulcer

Back 8

break in mucosa(anywhere)

extends thru muscularis mucosa into submucosa or DEEPER

Front 9

put in order from inner to outer

submucosa
muscularis mucosa
mucosa

Back 9

mucosa

Muscularis mucosa

submucosa(where blood vessels are)

Front 10

what is the most important factor in Peptic Ulcer Disease

Back 10

H. Pylori

Front 11

how does H. pylori cause damage?

Back 11

produces proteases and phospholipases-break down epithelial cells-->ulcer

Front 12

what are main characteristics of Peptic Ulcers?

Back 12

Duodenum
lesser curvature
body/antrum

Front 13

main characteristics of Duodenal ulcers?

Back 13

acid hyposecretion
rapid gastric emptying

Front 14

what are the complications seen in peptic/duodenal ulcerS?

Back 14

obstruction(most common)
malignant change
hemorrhage
perforation

Front 15

malignant change mostly seen in which type of ulcer?

Back 15

rare in DU
mainly GU

Front 16

what are the symptoms of chronic dyspepsia

Back 16

epigastric pain
N/V

Front 17

2 common causes of PUD

Back 17

H. pylori
NSAIDS

Front 18

H. pylori is listed as a?

Back 18

carcinogen

Front 19

H. pylori secretes catalase, which does what

Back 19

inactivates our neutrophils

Front 20

H. pylor vs NSAID
ulcer depth

Back 20

HP-superfical
NSAID-DEEP

Front 21

HP vs NSAID
-histology
-pain

Back 21

HP-chronic inflam.
NSAID-no inflam

HP-pain
NSAID-pain, but can be asymptomatic

Front 22

GI bleeding is more severe in which cause of ulcer ?

Back 22

NSAID induced-life threatening

Front 23

what are the alarm symptoms for PUD

Back 23

Weight LOSS
bleeding
dysphagia
chest pain

Front 24

Endoscopy does what?

Back 24

visualizes ulcer and can biopsy to detect for HPI

Front 25

fecal antigen test

Back 25

noninvasive
tests for HP antibodies
used for verification of eradication of HP

Front 26

Urea Breath Test

Back 26

noninvasive
HP secretes urease which hydrolyzes a labeled C->>pt exhales the labeled CO2
-if labeled co2 is exhaled-HP is present

Front 27

CLO test

Back 27

detects HP-urease causes medium to turn red

Front 28

campylobacter means?

Back 28

curved bacteria

Front 29

helicobacter means?

Back 29

spiral or helical bacteria

Front 30

first line Tx of HPI eradication

Back 30

PPI + clarithromycin +amoxil/metro/tetra for 2 weeks

Front 31

which PPI is not approved for HP tx

Back 31

pantoprazole or desomeprazole

Front 32

why are antibiotics comboed with PPIs for HP eradication?

Back 32

PPI dec. gastric acid volume, which increased antibiotic

Front 33

which antibiotic should be used once in HP eradication>?

Back 33

clarithromycin-bugs become resistant to drug quickly

Front 34

Drug resist. is rare in which antibtiotics for HP tx?

Back 34

amoxicillin
tetracycline

(metro needs to be increased if used more than once)

Front 35

Risk factors for NSAID-ulcers

Back 35

prior ulcer
age >65
high NSAID use (duh)
ASA at same time-doesnt matter form
SSRI, bisphosphates, plavix

Front 36

1-2 RF for NSAIDs whats tx?
Moderate GI
low cardiac

Back 36

NSAID + PPI or misoprostil

Front 37

>3RF for NSAID whats tx?
high GI
low cardiac

Back 37

tramadol, opoids
celebrex +PPI/misoprostil

Front 38

moderate GI, high CV risk tx?

Back 38

Naproxen +PPI/ misoprostil

Front 39

NSAID ulcer tx for
High GI/High CV risk

Back 39

avoid NSAIDS
Need PPI

Front 40

which drug is safest for cardio problems in ulcers

Back 40

Naproxen

Front 41

whats in vimovo

Back 41

naproxen and esomeprazole

Front 42

tx for NSAID ulcer
DU vs GU

Back 42

DU-4 weeks of PPI
GU-8weeks of PPI

Front 43

which drug keeps the pH higher longer?

Back 43

PPI>H2

Front 44

PPI facts

Back 44

inhibits H+/K+ atpase
-NO dosage adj. for renal

Preg Cat. B except Omeprazole

Front 45

omeprazole is what category

Back 45

C-so use with caution during lactation

Front 46

all PPI's provide same...

Back 46

healing rates
maintenance of healing
relief of symptoms

Front 47

PPIs do what to clarithromycin

Back 47

reduces the degradation of the acid-liable drug

-keeps drug around longer

Front 48

NSAID ulcers
if pt is bleeding on aspirin what should be given?

Back 48

use aspirin + PPI

DO NOT switch to plavix

Front 49

S.E. of PPIs

Back 49

infectious diarrhea ->C. diff ->if so, stop use and give antibiotic

Hip fractures
H.A.

Front 50

H2 antag facts

Back 50

inhibit acid secretion by histamine

ALL req. dose adjus. for renal imp.

Preg. B-watch in lactation

Front 51

what is H2 antag. not used for

Back 51

not used for preventing a GU due to NSAIDS

Front 52

H2 antag use

Back 52

DU-standard dose
GU-double dose needed
relieves dyspepsia

Front 53

Misoprostil
MOA
Cautions

Back 53

moa-prostaglandin analog
-protects mucosa

Cautions-Preg Cat. X

Front 54

Misoprostil efficacy?

Back 54

reduces riask of increasing complications + ulcers

causes diarrhea(start low then incr.)

Front 55

sucralfate
better for?
when to use?

Back 55

best for DU
lastline

Front 56

define GERD

Back 56

reflux of stomach contents back into esophagus

-pt does NOT make extra acid

Front 57

defineNERD

Back 57

Neg. Endo. reflux disease
-usually dont respond to PPIs

Front 58

define EE

Back 58

erosive esophagitis
inflam. with visable damage on endoscopy

Front 59

pathophysio in GERD

Back 59

decrease in LESP allows contents to move up

pressure ABOVE les usually higher then stomach to prevent upflow

Front 60

what can weaken the LES?

Back 60

estrogens, CCB + BB, and fatties/pregnant women increase pressure behind the stomach

Front 61

clinical presentation of GERD

Back 61

heartburn
regurg.
N/v
belching/hiccups

Front 62

lifestyle mods for GERD

Back 62

3 small meals
eat slow
lots of water
dont lay down after meals
DON'T USE PILLOWS(just elevate head 6 inches)

Front 63

Tx:
if GERD symptoms <2days/week
ig >2 days/week

Back 63

<2days/week- OTC antacids, H2B, Prilosec

>2days- Rx dose of H2B,OTC prilosec
-LIFESTYLE MOD. ALWAYS

Front 64

severe GERD sympt. Tx with?

Back 64

PPI
LIFESTYLE MOD. ALWAYS

Front 65

Antacid disadv.

Back 65

no esophageal healing
doesnt neutralize at night

Front 66

alginic acid

Back 66

helps with nighttime heartburn
causes refluxing of viscous sodium alginate

Front 67

H2Bs
adv.
disadv.

Back 67

adv-last for 6-10hours

dis-no increase in LES tone or decrease in freq. of GERD
develop tol. in 5 days

Front 68

indication for PPI tx

Back 68

heartburn >2 days/week
use for 8-16 weeks(usually lifelong)

try for 6 months before considered failure

Front 69

metoclopramide adv

Back 69

prokinetic agent

increases LES pressur
increases esophageal peristalsis

Front 70

metoclopramide disadv.

Back 70

minimal healing
altered mental status(CNS changes)

Front 71

what is the DOC for pt with GERD and healed esophagitis

Back 71

PPI

Front 72

CTZ senses?
responds via?

Back 72

senses toxins

reports via 5-ht3, D, Neurokinin-1

Front 73

enterocromaffin cells sense?
responds via?

Back 73

sesnse damage

respond directly->serotonin
indirectly-> vagal afferent stim

Front 74

vestib. system sesnse?
responds?

Back 74

senses balance and propioception

responds by Ach and histam.

Front 75

simple vs complex vomiting

Back 75

simple-symptomatic Tx only
-Labs:none

complex-fluid/elect. imbalance
-psychogenic causes

Front 76

Know the Path slide in N/V**

Back 76

**

Front 77

Antacids use?
ADE?

Back 77

simple NV-from heartburn, overeating Q2-4 hours

ADE-diarrhea(Mg) or constip.

Front 78

H2 Antag.

Back 78

BID
simple N/V from heartburn/GERD

Front 79

causes for motion sicknes?

Back 79

infection, injury, malignancy

Front 80

scopolamine is ______ antihistamines

Back 80

> or =

Front 81

S.E. for Scopolamine

Back 81

dry mouth, drowsiness, blurred vision

Front 82

what are medications used for motion sickness?

Back 82

anticholinergics and antihistamines
Phenothiazines

Front 83

why arn't claritin or zyrtec used in motion sickness?

Back 83

no drowsiness activity

Front 84

Phenothiazines
actions?
used for?
ADE?

Back 84

actions-D2 antag., anticholinergic

used for breakthrough

ADE-more risk than other therapies-excessive sedation

Front 85

PONV RIsk factors?

Back 85

**NONsmoking**
Female
history of motion sickness/PONV
anesthetics-opoids/N02
long surgery (>60mins)

Front 86

how many drugs per risk factors

Back 86

0-1; no meds
2+; prophylaxis 1-2 meds
(4-5)high risk pts will recieve 3 drugs

Front 87

when should 5-HT3s be given?

Back 87

at END of surgery

Front 88

5HT3 -which is longest acting?
ADE?

Back 88

palonisteron

H.A., constip.->no bad CNS ones

Front 89

Droperidol
actions?
ADE.?

Back 89

blocks dopiminergic CTZ stim.

QT prolongation and torsades de pointes

Front 90

Corticosteroids for N/V
which drugs?
when to give?
mech?

Back 90

dexamethasone, methypred.

**give at anesthetic introduction**

unkown mech

Front 91

aprepitant
when to give?
how does it work?
interactions?

Back 91

3 hours before induction
NK1 antag, inhib GI + CTZ mess.

3A4 inhibitor 2CP inducer

Front 92

what should be done to dexamethasone if takenwith aprepitant?

Back 92

decrease dexam. dose by half if co-admin.

Front 93

Metoclopramide
actions?
ADE?

Back 93

anti-D2 in CTZ
prokinetic agent: inc. motility

ADE-acute dystonic reactions(25%), tardive dyskinesia, psuedoparkinsonism

Front 94

when should dose be adjusted with metoclopramide

Back 94

when pt has kidney problems
-renal adjustment needed**

Front 95

when does acute N/V take place in CINV pts?

delayed?

Back 95

acute-within 24 hours

delayed-onset after 24 hours
peaks in 2-3days

Front 96

breakthrough meds?
what if they didnt work for prophylaxis?

Back 96

metoclopramide, phenothiazines, FHT3

use meds with diff MOA

Front 97

CINV drugs rated by?
pts recived what regimen?

Back 97

rated by emetogenic risk

get prophylaxis + breakthrough

Front 98

RINV risk varies by?

Back 98

area of radiation

Front 99

high risk of 90%
radiation area?
recc?

Back 99

total body

prophylaxis with 5-HT3A + dexamethasone

Front 100

low risk of <30%
radiation area?
recc?

Back 100

head, neck, breast

5HT3 antag

Front 101

what is hyperemesis gravidarum?

Back 101

hyper emesis while pregnant.

Front 102

guidelines for emesis in pregnancy from?

Back 102

ACOG-college of obstericians + gynecologists

Front 103

N/V in preg.
start with?
1st line?
2nd?
3rd?

Back 103

take multivitamin
1st-Vit B6 pyridoxine +/- doxylamine

2nd-diphenhydramine
3rd-phenothiazines, metoclopramide

Front 104

severe N/V in preg tx?

Back 104

hyperemesis gravidarium
tx-IV hydration
corticosteroids for REFRACTORY only

supp nutrition-enteral

Front 105

what factors cause nausea in stomach/small intestine area?

Back 105

chemo
surgery
radiation

Front 106

what factors cause nausea in the CTZ?

Back 106

chemo
anesthetics
opoids

Front 107

what factor causes nausea in the labrynth

Back 107

surgery

Front 108

what could be used for stomach/small intestine nausea?

Back 108

5-HT3 antag

(thru CTZ)
anti-dopinaminergic
anti-muscarinic
anti-histaminic

Front 109

what drugs can be used for the CTZ nausea

Back 109

anti-dopinaminergic
anti-muscarinic
anti-histaminic
cannabinoids

Front 110

what drugs can be used labyrinths nausea?

Back 110

anti-muscarinic
anti-histaminic

Front 111

biggest S.E. of phenothiazines

Back 111

dyskinesias