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Digestive System > Drug-induced Gastrointestinal Diseases > Flashcards

Drug-induced Gastrointestinal Diseases Flashcards

1
Q

Drug-induced Gastrointestinal Diseases

Clinical manifestations include

A

ulceration, diarrhea, constipation, hepatic and cholestatic diseases, pancreatitis, nausea, vomiting and anorexia

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2
Q

Tablets and capsules can get lodged within the esophagus, causing direct mucosal damage. An important warning sign

A

is a dull, aching pain in the chest or shoulder after taking the drug

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3
Q

esophageal injury is often characterized by

A

odynophagia (painful swallowing) or dysphagia (difficulty swallowing).

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4
Q

If potentially toxic substance stays in contact with the esophageal mucosa for a sufficiently long period of time, it can cause

A

“pill esophagitis”

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5
Q

order of Distribution of medications associated with drug-induced esophageal injury

A

NSAIDs
tetracyclines
potassium chloride
….

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6
Q

Pill esophagitis occurs most commonly in patients who take their medications with insufficient quantities of ___ or while lying down.

A

water

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7
Q

antiretroviral drug, HIV-1 protease inhibitor

A

Nelfinavir (Viracept)

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8
Q

Gl side effects of

A

Nelfinavir (Viracept)

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9
Q

when a drug gets lodged in your esophagus and its removed via endoscopy, you may still develop at the site where the drug had been lodge obstructing the esophagus.
This could be traversed only after dilation with a pediatric scope.

A

stricture (narrowing)

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10
Q

the drugs most commonly associated with drug-induced GI injury.

A

NSAIDs

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11
Q

The anti-inflammatory effects of NSAIDs are largely attributable to inhibition of ___, and their upper GI side-effects to inhibition of prostaglandin synthesis in the gastric mucosa, mediated via ___.

A

COX-2

COX-1

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12
Q

The antiplatelet effects of NSAIDs, valuable in cardioprotection, also result from inhibition of ___, with aspirin having the most pronounced antithrombotic effect of

A

COX-1

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13
Q

The mechanisms through which NSAIDs produce damage in the GI tract can be subdivided into __ (topical) actions and __ actions

A

local

systemic

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14
Q

Dual injury hypothesis

A

direct toxic effect on GI mucosa

and indirect systemic effects through active hepatic metabolites and decrease in mucosal prostaglandins

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15
Q

Systemic effects on the synthesis of mucosal prostaglandins have predominant :

different routs of administration and enteric-coated aspirin in order to prevent topical mucosal injury have failed to prevent the development of _____.

A

ulcers

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16
Q

direct effects of NSAIDs

A

hyperemia
erosions
sub-epithelial hemorrhage

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17
Q

systemic effects of NSAIDs lead to inhibition of

A

prostaglandins
bicarbonate
mucus production

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18
Q

characteristics of COX -___:
impairs platelet aggregation
reduces mucus and bicarb secretion
reduce mucosal blood flow

A

1

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19
Q

characteristics of COX -___:
reduces angiogenesis
increased leukocyte adherence

A

2

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20
Q

3 main types of GI lesions

A

-Superficial damage
-Endoscopically documented
non-symptomatic (silent)
-Symptomatic ulcers causing complications (GI hemorrhage)

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21
Q

Even a __ dose of aspirin is associated with a markedly increased risk for developing bleeding ulcers

A

low

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22
Q

__ increase the risk of upper GI bleeding possibly by decreasing platelet serotonin and interfering with platelet aggregation

A

SSRIs

23
Q

this Protective Strategies in Preventing NSAIDs-induced Ulcers utilizes the lowest dose possible

In addition, concomitant use of other agents known to increase the risk of upper GI ulceration (low dose aspirin, anticoagulants, corticosteroids, SSRIs) should be avoided.

A

Low-risk

24
Q

this Protective Strategies in Preventing NSAIDs-induced Ulcers suggests:
concomitant acid suppression therapy should be considered: proton pump inhibitors (PPI), misoprostol (synthetic prostaglandin E1 (PGE1) analogue)

A

moderate to high risk

25
Q

To prevent NSAID-mediated adverse effects on the GI tract, the use of a selective ____ inhibitor (celecoxib), may be considered in some patients

A

COX-2

26
Q

is the only COX-2 inhibitor licensed for use in the US

A

Celecoxib

27
Q

COX-2 is also found in the __ endothelium, where it generates prostacyclin, which inhibits platelet aggregation and has vasodilator properties

A

vascular

28
Q

stops the COX-2-mediated production of prostacyclin, which can result in increased platelet aggregation

A

COX-2 inhibitor

29
Q

___ accounts for 7% of all adverse drug effects

over 700 drugs have been implicated in causing this

A

diarrhea

diarrhea

30
Q

excessive amounts of solutes present in the intestinal lumen, which interfere with absorption of water

A

Osmotic diarrhea

31
Q

-excessive endogenous fluid secretion by enterocytes and colonocytes

A

Secretory diarrhea

32
Q

may cause diarrhea due to transit times that are too brief to complete fluid and electrolyte absorption

A

Rapid intestinal motility

33
Q

mechanism of erythromycin, cisapride

A

motility diarrhea - short transit time

34
Q

mechanism of antimicrobials AAD

A

pseudomembranous colitis - bacterial proliferation

35
Q

mechanism of anti-neoplastics CTID

A

exudative diarrhea - protein losing enteropathy

36
Q

Occurs in ~ 5-25% of the patients receiving antibiotics.

resolves after discontinuation of the antibiotic

A

Antibiotic associated diarrhea (AAD)

37
Q

Gram-positive spore-former, survives under harsh conditions and during antibiotic therapy

A

C. difficile CDAD

38
Q

Clinically significant strains of C. difficile produce __ exotoxins, which have been shown to disturb the function of the intestinal epithelium

A

2

39
Q

antibiotics associated with C. difficile CDAD

A

Clindamycin, ampicillin, amoxicillin, quinolones and the cephalosporins

40
Q

C. difficile CDAD ranges from a few days of intestinal fluid loss to life-threatening ____________

A

pseudomembranous colitis (PMC)

41
Q

is associated with intense inflammation and dilated and damaged crypts covered by exudates of neutrophils, mucus and fibrin, which form the yellow membrane

A

pseudomembranous colitis (PMC)

42
Q

Treatment of C. difficile CDAD

A

discontinuation of the offending antibiotic if possible, fluid and electrolyte replacement

43
Q

antimicrobial therapy is indicated for patients with moderate to severe disease or with significant coexisting conditions. some examples are : (3)

A

vancomycin, metronidazole, or bacitracin

44
Q

Many __ agents and supplements are known to induce diarrhea:

A

herbal

45
Q

__ is the most common digestive symptom in the US

3 times more common in women than in men

A

Constipation

46
Q

Drugs that result in the following:

Prolongation of intestinal transient time (reduced peristalsis)
Increased anal sphincter tone
Increased electrolyte and water reabsorption
Impaired defecation response

A

Opioids and related compounds

47
Q

these drugs have Parasympatholytic actions affecting innervation of many regions of the gastrointestinal tract

A

Drugs with anticholinergic properties (antihistamines, antidepressants, antiparkinsonian agents, antispasmodics, and antipsychotics)

48
Q

inhibit the activity of parasympathetic nervous system, mainly through preventing ACh from binding to the M2 receptors in the gut

A

Anticholinergics

49
Q

Many patients with ____ disease are prone to constipation and this is often exacerbated by their medications.

A

Parkinson Disease (PD)

50
Q

__ ____ receptors in the brain mainly modulate pain perception, while those in the GI tract have been shown to interfere with bowel motility.

A

Mu opioid

51
Q

the following occurs upon activation of which receptor:
reduced activity of the myenteric plexus =>
decreased tone of the longitudinal smooth muscles, but increased tone of circular smooth muscles => substances stay in the intestine for longer time =>
more water is absorbed

A

Activation of peripheral m receptors

52
Q

indicated for the treatment of opioid-induced constipation in patients with advanced illness (e.g., cancer, AIDS)

A

Methylnaltrexone

53
Q

has been approved to accelerate recovery from postoperative gastrointestinal dysfunction following partial large or small bowel resection

A

Alvimopan

Digestive System (8 decks)

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