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3b_Boards - SketchyPharm > (5) GI & Endo: GI (1.1-1.3) > Flashcards

(5) GI & Endo: GI (1.1-1.3) Flashcards

1
Q

What is the neuroanatomical name for the vomiting center?

A

nucleus tractus solitarius

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2
Q

Which cranial nerves signal to the nucleus tractus solitarius?

A

(1) CN X
(2) CN VIII

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3
Q

which serotonin receptor mediates the vagal afferents from the GI tract?

A

5-HT3

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4
Q

what is the neuroanatomical name for the chemoreceptor trigger zone?

A

Area postrema

(Located in the fourth ventricle, but outside the BBB)

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5
Q

MOA: Ondansetron

A

5-HT3 receptor antagonist

(“On -DANCE-atron”)

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6
Q

Adverse Effects (4) : Ondansetron

A

(1) Constipation
(2) Headache/Dizziness
(3) Torsades
(4) Serotonin syndrome

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7
Q

what type of nausea can first-generation antihistamines (H1 receptor blockers) treat?

A

vestibular

(motion sickness)

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8
Q

name 2 receptors found in high concentration throughout the vestibular system

A

(1) H1
(2) M1

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9
Q

name 2 receptors found in high concentration in the area postrema

A

(1) D2
(2) NK1
* (NK1 = neurokinin 1 receptors, which are activated by substance P)*

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10
Q

MOA: Metoclopramide

A

D2 receptor antagonist

(In area postrema ∴ Good at treating drug-induced nausea)

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11
Q

what drug can be used to treat delayed gastric emptying (unrelated to cholinergics)?

A

Metoclopramide

(Notice completely different MOA but many similarities to Bethanochol)

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12
Q

Contraindication: Metoclopramide

A

Bowel obstruction

(Parkinson’s)

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13
Q

Adverse Effects (7): Metoclopramide

A

(1) Diarrhea
(2) Drowsiness
(3) Depression
(4) Extrapyramidal effects
(5) Neuroleptic malignant syndrome
(6) Elevated prolactin
(7) Torsades de Pointes

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14
Q

what adverse effect is associated with chronic Metoclopramide use?

A

Tardive dyskinesia

  • (causes repetitive, involuntary movements, such as grimacing and eye blinking;*
  • due to long-term use of neuroleptic drugs used to treat psychiatric conditions)*
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15
Q

what is the endogenous ligand for the NK1 receptor?

A

Substance P

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16
Q

MOA: Aprepitant

A

NK1 receptor antagonist

(Often preferred over other anti-emetics ∵ it doesn’t affect dopamine or 5-HT ∴ fewer side effects)

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17
Q

what neurotransmitter is released at the mucosa in response to GI irritation?

A

5-HT

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18
Q

Which gastric cell secretes HCl?

A

Parietal cell

(Remember it also secretes intrinsic factor for Vit. B12 absorption)

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19
Q

What transporter pumps H+ into the lumen of the stomach?

A

H+/K+ ATPase

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20
Q

What directly stimulates parietal cells to secrete HCl?

A

(1) Histamine
(2) Gastrin
(3) Acetylcholine

21
Q

Which histamine receptor is responsible for increasing HCl secretion?

A

H2

22
Q

What paracrine-acting molecule stimulates HCl secretion from parietal cells?

A

Histamine

(Contrast with gastrin)

23
Q

What stimulates the release of histamine from ECL cells?

A

Gastrin

(Endocrine molecule, contrast with histamine)

24
Q

What secretes GRP?

A

Vagus n.

(Thus indirectly stimulating HCl release via GRP and directly stimulating HCl via ACh)

25
Q

Suffix: H2 receptor antagonist

A

“-tidine”

26
Q

Indications (2) : PPIs/H2 receptor antagonists

A

(1) GERD
(2) GI Ulcers
* (PPIs are first line)*

27
Q

Adverse Effects (4) : Cimetidine

A

(1) Inhibits CYP450
(2) Gynecomastia
(3) Impotence
(4) Elevated prolactin

28
Q

MOA: PPIs

A

Irreversibly inhibit H+/K+ ATPase

29
Q

Suffix: PPI

A

“-prazole”

30
Q

What is the preferred pharmacologic treatment for Zollinger-Ellison syndrome?

A

PPI

(Otherwise, octreotide can be used)

31
Q

Adverse Effects (5) : PPIs

A

(1) C. difficile infection
(2) Respiratory infections
(3) ↓ Absorption of divalent cations
(4) ⇒ ↑ Risk of osteoporosis
(5) ⇒ Hypomagnesemia

32
Q

How does somatostatin reduced acid production?

A

By inhibiting the release of:

(1) Histamine from ECL cells
(2) Gastrin by G cells

33
Q

What type of gastrinomas can be treated with somatostatin?

A

SST receptor (+)

(… obviously need the receptor to mediate the ligand’s effect)

34
Q

Which gastric cell secretes histamine?

A

ECL cells

35
Q

Name 3 osmotic laxatives

A

(1) Magnesium salts
(2) Polyethylene glycol
(3) Lactulose
* (Magnesium salt = Milk of Magnesia)*

36
Q

MOA: Senna

A

Stimulant laxative

37
Q

What is the etiology of melanosis coli?

A

Chronic senna use

38
Q

Describe how lactulose helps with hepatic encephalopathy

A

Metabolism of lactulose by GI bacteria ⇒ ↓ pH ⇒ NH3 → NH4<strong>+</strong> ⇒ Prevents absorption of intestinal ammonia

39
Q

How does liver cirrhosis lead to encephalopathy?

A

⇒ ↑ NH4+

40
Q

Describe why Rifaximin is useful in the treatment of hepatic encephalopathy

A

Kills ammonia producing bacteria

(Poorly absorbed lumenal antibiotic, similar to Neomycin)

41
Q

MOA: Psyllium

A

Indigestible material ⇒ Distention ⇒ Promotes peristalsis

42
Q

MOA: Docusate

A

Stool surfactant agent

(Facilitates penetration of stool by water and lipid ⇒ Softer)

43
Q

Which opioid receptor is found in high density in the GI tract?

A

μ

(mu)

44
Q

Which μ-opioid agonist does not cross the BBB?

A

Loperamide

45
Q

How do μ-opioid agonist reduce GI motility?

A

Increase colonic phasic segmenting activity

(↑ Activity of GI circular smooth muscle while ↓ activity of GI longitudinal smooth muscle)

46
Q

Which antidiarrheal agent is combined with atropine to prevent abuse?

A

Diphenoxylate

47
Q

Name a contraindication to antidiarrheals

A

Bloody diarrhea / Fever

48
Q

Name 2 tumors which can cause secretory diarrhea

A

(1) VIPoma
(2) Carcinoid tumor

49
Q
A

3b_Boards - SketchyPharm (32 decks)

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