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Pharmacology - Winter > 11 - GI Disorders > Flashcards

11 - GI Disorders Flashcards

1
Q

Gastric mucosa is secreted from ______

A

Mucosal epithelial cells

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2
Q

What is the function of the mucous layer in the gut?

A

Protects cells from acid and enzymes

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3
Q

What happens if the mucous layer of the stomach is lost?

A

It will allow acid to reach the cells and cause an ulcer

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4
Q

What is the primary role of stomach acid?

A

Kill bacteria, viruses and other parasites (not for digestion)

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5
Q

What can overproduction of stomach acid cause?

A

Ulcers

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6
Q

How long are antacids recommended to be used for?

A

Very short term (1 day)

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7
Q

What is a systemic antacid that is used?

A

NaHCO3 (sodium bicarbonate)

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8
Q

What is the mechanism of sodium bicarbonate as an antacid?

A
  • Dissociates into Na+ and HCO3-

- Bicarbonate ion absorbed into the blood and slightly increases pH

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9
Q

What are advantages to bicarbonate antacids?

A
  • Quick and easy

- Effective in short term to reduce stomach acid

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10
Q

What are problems w/ bicarbonate antacids?

A
  • Alkalotic urine can increase deposition of calcium and phosphate to form a kidney stone
  • Increases blood sodium, thus exacerbating hypertension
  • Acid rebound due to feedback regulation
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11
Q

What are some non-systemic antacids?

A
  • Calcium carbonate
  • Aluminum hydroxide
  • Magnesium hydroxide
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12
Q

What is important to note about non-systemic antacids?

A
  • Do not effect extracellular or blood pH

- Aluminum and calcium are constipating, so are often combined w/ magnesium

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13
Q

What is the mechanism of anticholinergics for GI ulcers?

A
  • Muscarinic ACh receptors in parietal cells stimulate HCl secretion
  • Inhibition of these receptors reduces acid secretion
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14
Q

What are side effects of anticholinergics?

A
  • Dry mouth
  • Vision problems
  • Sedation
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15
Q

What are cytoprotective drugs? What are the 2 major examples?

A
  • Drugs that protect cells from acidic damage, either directly or through stimulation of mucous
  • Sucralfate and misoprostol
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16
Q

What is the function of sucralfate?

A
  • Binds to H+ ions to form a gooey paste, increasing pH
  • Binds to degenerating cells, forming a protective layer
  • “Artificial” mucous
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17
Q

What is important to note about sucralfate?

A
  • Not absorbed into bloodstream, but can inhibit absorption of other drugs
  • Works for 8-12 hours
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18
Q

What is the action of misoprostol for GI ulcers?

A

Prostaglandin analogue, so stimulates production of mucosal barrier

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19
Q

What is the action of H2 blockers for GI ulcers?

A

Stimulation of H2 receptors in parietal cells increases HCl production

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20
Q

Do H2 blockers cause any adverse effects?

A

No b/c very specific to organ and the receptor type

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21
Q

What are examples of H2 blockers?

A
  • Cimetidine
  • Ranitidine
  • Famotidine
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22
Q

Rank from least to most effective: ranitidine, famotidine, cimetidine

A

Cimetidine < ranitidine < famotidine

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23
Q

What are the ingredients of Pepcid AC?

A
  • Pepcid = famotidine = H2 blocker

- AC = antacid

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24
Q

What are side effects of PPI’s?

A
  • Osteoporosis

- Increased risk of stroke

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25
Q

What are the actions of proton pump inhibitors?

A
  • Inhibit gastric H+/K+ ATPase

- Binds to H+ extrusion sites, and block release of H+ and Cl-

26
Q

What are PPI’s especially good for?

A
  • Rapid reduction of acid

- GERD and other acid-dependent disorders

27
Q

What are the 2 most common PPI’s?

A
  • Omeprazole

- Esomeprazole

28
Q

Are PPI’s given as pro-drugs?

A

Yes, converted to active drug in the secretory canaliculus of the parietal cell

29
Q

What is the mechanism of H. pylori to cause ulcers?

A
  • Burrows in gastric mucosa to escape gastric acid
  • Produces urease (enzyme that converts urea to ammonia and CO2)
  • Urease kills mucosal epithelial cells, leaving the gut unprotected
30
Q

What can be done to test for an H. pylori infection?

A
  • Breath test for urea
  • Serological
  • Culture
  • Histology
31
Q

What is the recommended tx for H. pylori infection?

A
  • Triple therapy = PPI to control acid and 2 effective antibiotics to kill H. pylori
  • Quadruple therapy = add bismuth
32
Q

___ is the most prevalent type of ulceration

A

GERD

33
Q

Which drugs reduce LES pressure?

A
  • Beta blockers
  • Ca channel blockers
  • Nicotine
34
Q

What is the most effective tx for GERD?

A
  • Behaviour change
  • Avoid fat, caffeine, chocolate peppermint, and alcohol
  • Avoid large meals and stop smoking
35
Q

What is ulcerative colitis?

A
  • Inflammation of submucosa

- Ulcerations may cover entire surface of colon

36
Q

What does ulcerative colitis cause?

A
  • Diarrhea
  • Bleeding
  • Severe pain
37
Q

What is Crohn’s disease?

A
  • Inflammatory disease which can cover entire digestive system
  • Tends to be separate, isolated regions
  • Fistulas may form and intestinal wall may be breached
  • May also be associated w/ severe skin inflammation
38
Q

Does IBD have a cure?

A

No, only treatments which are variably effective

39
Q

Which condition will be eliminated w/ surgical removal of the colon?

A

Ulcerative colitis

40
Q

What is the first-line tx for mild to moderate ulcerative colitis?

A

5-amino salicylic acid (mesalamine)

41
Q

What is the MOA of 5-ASA?

A

Unknown

42
Q

What is significant about sulfasalazine?

A

5-ASA linked to sulfapyridine, and the 5-ASA is only released in the large intestine by bacteria

43
Q

What are 3 possible responses px can have to glucocorticoids?

A
  • Steroid responsive = sx improve over 1-2 weeks and disease remains in remission as steroids are tapered off
  • Steroid dependent = px respond to steroids but experience relapse of the disease w/ tapering of the steroids
  • Steroid unresponsive = px do not respond to steroid tx
44
Q

When are glucocorticoids used for ulcerative colitis?

A

Moderate to severe cases

45
Q

What are the side effects of glucocorticoids?

A
  • Weight gain, stress, and emotional responses
  • Steroid-dependent diabetes
  • Increased risk of infection
46
Q

When are immunosuppressants used for UC and Crohn’s?

A

Only used for Crohn’s that are unresponsive to prednisone and TNF alpha inhibitors (if UC is unresponsive to these drugs, recommend colon removal)

47
Q

Which immunosuppressants are thiopurine derivatives?

A
  • Mercaptopurine

- Azothiopurine

48
Q

When are thiopurines used?

A
  • For steroid-resistant or dependent px

- Useful in remission and reduction of relapse of UC and Crohn’s

49
Q

What is a side effect of thiopurines?

A

Small risk of major infection, esp. in co-tx w/ steroids

50
Q

What is methotrexate? When is it used?

A
  • Dihydrofolate reductase inhibitor (blocks DNA synthesis)

- Reserved for steroid resistant or dependent px

51
Q

When is cyclosporine used?

A

Only for severe Crohn’s cases

52
Q

What is cyclosporine?

A

Calcineurin inhibitor

53
Q

When are TNF alpha inhibitors indicated?

A

2nd line when px not responsive to prednisone

54
Q

Which drug is a TNF alpha inhibitor that is effective as a UC tx?

A

Infliximab

55
Q

What is a side effect of TNF alpha inhibitors?

A

Increased chance of serious lung infection

56
Q

What is the difference between prebiotics and probiotics?

A
  • Prebiotics = food that helps good bacteria grow

- Probiotics = drug that actually contains bacteria

57
Q

What is the simple tx for diarrhea?

A
  • Clear liquids

- BRAT diet (banana, rice, apple sauce, tea)

58
Q

What can be used for diarrhea that isn’t caused by an infectious agent?

A

Opiates or opiate-related agents b/c they decrease intestinal motility

59
Q

What are side effects of opiates?

A
  • CNS depression

- Constipation

60
Q

Which opiates are used for diarrhea?

A

Tincture of opium, paregoric, and/or codeine

61
Q

Which opiate-related agents are used for diarrhea?

A
  • Diphenoxylate

- Ioperamide

62
Q

What do adsorbents do? What are examples?

A
  • Coat the wall of the GI tract and adsorb bacteria or toxins causing diarrhea
  • Ex: kaopectate and pepto-bismol

Pharmacology - Winter (18 decks)

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