Gi: Lower Gi Pharm

Front 1

In which "GI class" of drugs is Cisapride?

Back 1

Prokinetics (> GI motility)

Front 2

In which "GI class" of drugs is Domeperidone?

Back 2

Prokinetics (> GI motility)

Front 3

In which "GI class" of drugs are the macrolide antibiotics (Erthromycin)?

Back 3

Prokinetics (> GI motility)

Front 4

In which "GI class" of drugs is Metoclopramide?

Back 4

Prokinetics (> GI motility)

Front 5

In which "GI class" of drugs is Diphenoxylate?

Back 5

Antidiarrheals (Opiates)

Front 6

In which "GI class" of drugs is Loperamide?

Back 6

Antidiarrheals (Opiates)

Front 7

In which "GI class" of drugs is Cholestyramine?

Back 7

Antidiarrheals (Bile Acid Binding)

Front 8

In which "GI class" of drugs is Colestipol?

Back 8

Antidiarrheal (Bile acid binding resins)

Front 9

In which "GI class" of drugs are Kaolin/Pectin?

Back 9

Antidiarrheal (Absorbants)

Front 10

In which "GI class" of drugs are Bismuth subsalicylate and Octerotide?

Back 10

Antidiarrheal

Front 11

In which "GI class" of drugs is Docusate?

Back 11

Stool Softner

Front 12

In which "GI class" of drugs is Mineral Oil?

Back 12

Stool Softner

Front 13

In which "GI class" of drugs is Psyllium?

Back 13

Bulk Lax

Front 14

In which "GI class" of drugs are Anthraquinone derivatives?

Back 14

Stimulant cathartics

Front 15

In which "GI class" of drugs is Cascara sagrada?

Back 15

Stimulant cathartics

Front 16

In which "GI class" of drugs is Danthron?

Back 16

Stimulant cathartics

Front 17

In which "GI class" of drugs is Senna?

Back 17

Stimulant cathartics

Front 18

In which "GI class" of drugs is Bisacodyl?

Back 18

Stimulant Cathartics

Front 19

In which "GI class" of drugs is castor oil?

Back 19

Stimulant Cathartics

Front 20

In which "GI class" of drugs is Lactulose?

Back 20

Osmotic cathartic

Front 21

In which "GI class" of drugs is Mg Hydroxide?

Back 21

Osmotic cathartic

Front 22

In which "GI class" of drugs is Na Phosphate?

Back 22

Osmotic cathartic

Front 23

In which "GI class" of drugs is Polyetheylene glycol solution?

Back 23

Osmotic cathartics

Front 24

In which "GI class" of drugs is Lubiprostone?

Back 24

Misc Lax & Cathartics

Front 25

In which "GI class" of drugs is Alvimopan?

Back 25

Opiod receptor antagonist: Misc Lax & Cathartics

Front 26

In which "GI class" of drugs is Methylnaltrexone?

Back 26

Opiod receptor antagonist: Misc Lax & Cathartics

Front 27

< motility does what to water absorption?

Back 27

increases water absorption

Front 28

What secretes ACh in regards to the GI system?

Back 28

Interneurons of the submucosal and myenteric plexi as well as pre and post gang of parasympathetics

Front 29

ACh does what in regards to the GI system? (General)

Back 29

> both motility and secretion

Front 30

What does Somatostatin do to intestinal and pancreatic secretions? To intestinal motility?

Back 30

decreases all of them; also inhibits gallbladder contraction

Front 31

The 4 big NTs that regulate motility and water absorption of the lower GI tract

Back 31

ACh, Serotonin (5HT), Dopamine and Enkephalins

Front 32

_____ interneurons in the myenteric plexus help to regulate the peristaltic reflex

Back 32

Cholinergic

Front 33

Class of Atropine

Back 33

ACh antagonist

Front 34

ACh will ____ motility and _____ water excretion

Back 34

Increase motility and Increase water excretion (decreases absorption)

Front 35

5HT1 will _____ water absorption

Back 35

Increase (by increasing NANC-mediated inhibition of water excretion)

Front 36

5HT3 will _____ distal relaxation

Back 36

increase by exciting NANC neurons

Front 37

5HT4 will ____ proximal contraction

Back 37

increase

Front 38

Dopamine (D2) will ____ ACh induced motility

Back 38

Decrease; thus < motility

Front 39

u Enkephalins stimulates what? (in regard to water)

Back 39

Stimulates 5HT1 increase in water absorption

Front 40

k and u Enkephalins ____ ACh induced motility

Back 40

INHIBIT

Front 41

The "SETRONs" are what class of drugs? What effect will do they have on the GI system?

Back 41

5HT3 Antagonistis; inhibit peristalsis, > contraction by decrease motility

Front 42

What class of drugs (agonist/antagonists) are Cisapride and Tegaserod and what effect do they have on the GI system?

Back 42

5HT4 Agonist; will > motility

Front 43

Name 2 D2 antagonists and their effects on the GI system

Back 43

Metoclopramide and Domperidone; will > motility

Front 44

Name 2 u enkephalin agonists and their effects on the GI system

Back 44

Diphenoxylate and Loperamide; < motility and secretion and > water absorption

Front 45

Name 2 k and u antagonists?

Back 45

> motility and > secretion

Front 46

One of the major roles for serotonin in the gut is thought to be regulation of the ________ reflex

Back 46

Peristaltic (consists of both a proximal contraction and distal relaxation)

Front 47

Bottom line: 5HT4 agonists ___ GI motility

Back 47

Increase GI motility (decrease transit time)

Front 48

Bottom line: 5HT3 antagonists ____contractility but _____ coordination

Back 48

Increase contractility but decrease coordination (increase transit time)

Front 49

What differentiates prokinetics from laxatives and cathartics?

Back 49

Lax and cathartics tend to act more indirectly, and to influence only the LI

Front 50

General MOA of Prokinetics

Back 50

> motility throughout entire GI tract; thought to be through actions on the enteric nervous system; > LES pressure

Front 51

Which Choolinomimetic has severe SE?

Back 51

Cisapride may cause fatal arrhythmias

Front 52

MOA of Metoclopramide and Domperidone

Back 52

D2 receptor antagonists; cause inhibition of dopamine inhibition of ACh induced contraction

Front 53

Between Metoclopramide and Domperidone, which has CNS effects?

Back 53

Metoclopramide has CNS effects and can be used as an antiemetic (Domperidone does not cros the BBB)

Front 54

MOA of Cisapride

Back 54

5HT4 agonist; partial 5HT3 antagonist

Front 55

MOA of Macrolide antibiotics (Erythromycin) in regards to GI

Back 55

stimulate motilin receptors -->initiation of migrating motor complex (at subclinical doses for antibiotic actions, still may cause resistance, however!)

Front 56

Therapeutic uses (although controversial) of Marcolides in regards to GI

Back 56

To tx impaired gastric emptying (vagotomy) and diabetic gastroparesis; GERD too although not as much since PPIs are around

Front 57

SE of dystonia, parkinsonism and Tardive dyskinesia if pts are given high doses; increased prolactin release (impotence, galactorrhea, menstrual disorders)

Back 57

Metoclopramide (prokinetic)

Front 58

In what sort of pts should antidiarrheals NOT be used

Back 58

those with bloody diarrhea, high fever or systemic toxicity

Front 59

Most effective agents to tx treatable forms of diarrhea

Back 59

Opiates (Diphenoxylate and Loperamide)

Front 60

How do Diphenoxylate and loperamide increase phasic colonic segmenting activity (motility)?

Back 60

Activating k and u receptors which inhibit cholinergic neurons and serotonergic neurons that regulate propulsion (Increased transit time!)

Front 61

How do Dipehnoxylate and Loperamide inhibit water excretion?

Back 61

Activation of serotinergic neurons (u) which stimulate 5HT1or2 receptors on enteric neurons that inhibit water excretion

Front 62

Between the Opiates Loperamide and Diphenoxylate, which one does NOT cross the BBB?

Back 62

Loperamide does not (available OTC)

Front 63

SE of the Opiates (Diphenoxylate and Loperamide)

Back 63

Toxic megacolon in given to pts with severe ulcerative colitis (at high doses, a physical dependence on Diphenoxylate may occur)

Front 64

MOA of Cholestyramine and Colestipol

Back 64

Bile acid binding resins

Front 65

Drugs used to tx diarrhea associated with malabsorption of bile salts (colonic secretory diarrhea); Crohn's disease or surgical resection

Back 65

Cholestyramine, Colestipol

Front 66

SE of Cholestyramine, Colestipol

Back 66

Bloatal, flatulence, imparied intestinal absorption of concurrently administered drugs and fat-soluble vitamins

Front 67

@ high doses, Somatostatin will ____ motility

Back 67

inhibit

Front 68

Synthetic analogue of Somatostatin

Back 68

Octerotide (inhibits gastric motility)

Front 69

Therapeutic uses of Octerotide

Back 69

Diarrhea due to vagotomy, dumping syndrome, short bowel, AIDS, tx effects of carcinoid tumors and VIPomas

Front 70

Gallstones in 50% of pts, Impaired pancreatic secretion (leading to fat soluble vitamin def and steatorrhea), hyper/hypoglycemia, hypothyroidism, bradycardia

Back 70

Octerotide

Front 71

MOA of Bismuth Subsalicylate in the LI

Back 71

inhibits PG and Cl- secretion in the LI (stimulates PG, mucous and Bicarb secretion in the stomach)

Front 72

Possible tx of Traveller's Diarrhea

Back 72

Opiates (most effective) and Bismuth Subsalicylate

Front 73

SE of Bismuth Subsalicylate

Back 73

Black stool and tongue; possible salicylate tox (tinnitus)

Front 74

MOA pectin

Back 74

indigestible carb (Absorbant)

Front 75

MOA of Kaolin

Back 75

naturally occurring Mg Al silicate (Absorbant)

Front 76

SE of absorbants (Kaolin and Pectin)

Back 76

May bind other medications

Front 77

Which will have a strong effect/short latency: lax or cathartics?

Back 77

Cathartics (Lax will have mild effect but long latency)

Front 78

Slowest of the lax and cathartics

Back 78

Stool softeners and bulk forming lax

Front 79

Acts as a surfactant and softens the stool by allowing mixing of aqueous and fatty substances

Back 79

Docusate

Front 80

Lubricates feces-->decreased water absorption from stool

Back 80

Mineral Oil

Front 81

SE of Mineral Oil

Back 81

Severe lipid pneumonitis is aspirated, < absorption of fat soluble vitamins

Front 82

Name the Bulk Lax

Back 82

Dietary fiber, Methylcellulose, Psyllium

Front 83

MOA of Bulk Lax

Back 83

> mass of stool-->distenstion-->enteric reflexes--> increase GI motility

Front 84

Name the fast acting Contact cathartics

Back 84

Anthraquinone derivatives (Senna, Dantrhon, Cascara sagrada), Bisacodyl and Castor Oil

Front 85

Of the Contact Cathartics, which acts on BOTH the LI and SI

Back 85

Castor Oil (Other just act on LI)

Front 86

Hydrolyzed in the upper SI to form Ricinoleic acid

Back 86

Castor Oil

Front 87

May cause a brown pigmentation of the colonic mucosa (melanosis coli)

Back 87

Anthraquinones (Contact cathartic)

Front 88

May cause dehydration and uterine contractions

Back 88

Castor Oil

Front 89

Reduces plasma ammonia concentrations in the plasma (useful in tx protal-systemic encephalopathy) and also > water and electrolye concentrations in the colon

Back 89

Lactulose

Front 90

Nonabsorbed sugar that is met by olonic bacteria, producing severe flatulence, cramps and ab discomfort

Back 90

Lactulose

Front 91

SE of all osmotic lax (but esp Sodium Phosphate)

Back 91

intravascular volume depletion and electrolyte imbalances (hypokalemia) and should be used with caution in pts with sig cardiac disease!

Front 92

MOA of Lubiprostone

Back 92

activates chloride channel ClC2 to increase liquid secretion

Front 93

Selective u receptor antagonists that do not cross the BBB (Misc cathartics)

Back 93

Alvimopan, Methylnaltrexone

Front 94

Lubiprostone is used to tx what?

Back 94

chronic, idiopathic constipation and constipation-predominant IBS

Front 95

Used in pts receiving palliative care (long term) as a cathartic

Back 95

Methylnatrexone

Front 96

Used to shorten period of postoperative ileus following small or large bowel resection (cathartic)

Back 96

Alvimopan (Short term!)

Front 97

SE of Alvimopan

Back 97

cardiotoxicity (hence only short term use in hospitalized pts!)