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Pathophysiology & Pharmacology > Drugs For Treating Gastrointestinal Disorders > Flashcards

Drugs For Treating Gastrointestinal Disorders Flashcards

1
Q

GI Anatomy/Physiology

A

The GI tract is a long tube, which digests and absorbs food, liquids, and chemicals.

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2
Q

GI Anatomy/Physiology: Stomach

A
  • Lined with parietal cells that increase gastric acid formation
  • Lower Esophageal Sphincter (LES)
    ~ Prevents stomach contents from
    entering the esophagus
  • Pyloric Sphincter
    ~ Prevents intestinal enzymes and bile
    from entering stomach.
    ~ Prevents stomach acid from entering
    the small intestine.
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3
Q

Gastric Acid

A
  • Hydrochloric Acid (HCI)
    ~ Gastric acid always produced
    > Activates pepsin for protein
    digestion
    > Kills bacteria
    ~ Rate of production increases:
    > At night due to parasympathetic
    NS stimulation
    > With slight smell of food or food in
    the stomach
  • The stomach is lined with a mucous membrane that helps to protect from acid irritation
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4
Q

Mechanism for Gastric Acid Increase

A
  • Presence of food stimulates release of:
    (see it, smell it, eat it)
    ~ Gastrin
    ~ Acetylcholine
    ~ Histamine
  • Parietal cells have receptors for all three chemicals.
    ~ Binding to receptors activates the
    proton pump within the parietal cells.
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5
Q

Proton Pump

A
  • Actively transports hydrogen atoms into the stomach
    ~ Hydrogen atoms combine with
    chloride ions and from hydrochloric
    acid
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6
Q

Heartburn/Gastroesphegeal Reflux Disease (GERD)

A
  • Gastric acid enters the esophagus causing a burning sensation
    ~ Can break down the esophagus as it
    lacks the protective membrane of the
    stomach
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7
Q

Heartburn/Gastroesphegeal Reflux Disease (GERD): Cause

A
  • LES is relaxed
  • Activity increasing intra-abdominal pressure
    ~ Coughing
    ~ Sneezing
    ~ Laughing
    ~ Lifting/pushing objects
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8
Q

Heartburn/Gastroesphegeal Reflux Disease (GERD): Worsening Factors

A
  • Foods/Drugs that Increase Stomach Acidity
    ~ Chocolate
    ~ Carbonated Beverages
    ~ Orange/Tomato Juice
    ~ Peppermint/Spearmint
    ~ Garlic
    ~ Onions
    ~ Caffeine
    ~ Aspirin (acetylsalicylic acid)
  • Foods/Drugs that Slow Digestion
    ~ Large Meals
    ~ Fatty Meals
    ~ Blood Pressure Medications
    ~ Opioid Agonists
  • Drugs that Decrease LES Function
    ~ Antidepressants
    ~ Anticholinergics
    ~ Beta Agonists
    ~ Sedatives
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9
Q

Peptic Ulcer Disease

A
  • Chronic erosion of the stomach lining and wall
  • Cause
    ~ Gastric acid causes damage after
    protective mechanism in stomach fails
  • Can cause a whole all the way through and cause internal bleeding
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10
Q

Stomach Protection vs. Gastric Acid

A
  • Mucous lining
  • Bicarbonate buffer secretion
  • PGE2 (Fever)
    ~ Inhibits Proton Pump = less acid
  • PGI2 (blood thinner)
    ~ Increases mucous lining production
    ~ Increases bicarbonate buffer secretion
    > Good, but can be the reason why
    taking NSAIDs are bad long term
  • Protective mechanisms compromised by:
    ~ NSAID/Aspirin Use
    > PG Production Inhibited
    • PGE2
    • PGI2
    > Acidic Compounds
    ~ H. pylori Infection
    > H. pylori is a Gram-negative
    bacterium. (treat w/ antibiotics)
    • Contaminated food or water.
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11
Q

Effects of H. pylori in the Stomach

A
  • 30-65% of all people have this bactenum in the stomach, but it does not always result in ulceration.
    ~ Produces enzyme that breaks down
    the mucous lining of the stomach
    ~ Immune response can also damage
    tissues
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12
Q

Proton Pump Inhibitors

A
  • Drug Action
    ~ Inhibits Proton Pump
    > Irreversibly inhibits enzyme that is
    part of the proton pump so that
    acetylcholine, gastrin, and
    histamine binding has less effect
    on stomach acid formation.
    • Good for GERD and peptic ulcer
    • One dose per day is effective.
    > Some inactivated by gastric acid,
    but must pass to the small
    intestine (shouldn’t be chewed or
    crushed because it be broken
    down further)
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13
Q

Proton Pump Inhibitors Adverse Effects

A
  • Headache
  • Dizziness
  • Nausea
  • Constipation
  • Diarrhea
  • Can increase the effects of drugs that are metabolized by the same enzyme
    ~ Warfarin (anticoagulant)
    ~ Phenytoin (anticonvulsant)
    ~ Benzodiazepine (anti anxiety)
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14
Q

H2 Receptor Antagonist

A
  • In the GI tract HT binds to H2 receptors
    ~ Activates the proton pump
  • H2 receptor antagonist block the binding of HT to the H2 receptors inhibiting the proton pump
    ~ Good for GERD and peptic ulcer
  • Not as effective as Proton Pump inhibitors because those target the whole system
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15
Q

H2 Receptor Antagonists Adverse Effects

A
  • Headache
  • Diarrhea
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16
Q

Antacids

A
  • Introduction of a base to neutralize stomach acid
    ~ Much less effective/shorter duration
    than proton pump inhibitors or H2
    antagonists.
    ~ Faster acting than proton pump
    inhibitors or H2 antagonists.
17
Q

Antacids Adverse Effects

A
  • Aluminum Hydroxide
    ~ Decreases smooth muscle motility -
    Constipation
  • Magnesium Hydroxide
    ~ Draw water from small intestine lining
    - Diarrhea
  • Calcium Carbonate/Sodium Bicarbonate
    ~ React with gastric acid and for COz -
    Belching/Abdominal Distention
  • Aluminum, magnesium, and calcium can
    bind to some drugs (tetracycline).
  • Raising pH can decrease absorption of other drugs (NSAIDS)
18
Q

Lower GI Anatomy and Physiology

A
  • Small Intestine:
    Major site of digestion and absorption of carbs, lipid, protein.
  • Large Intestine:
    Absorption of water & elimination of solid waste.
19
Q

Constipation

A
  • Abnormal retention of feces
    ~ Causes
    > Dehydration
    > Decreased Bowel Motility
    > Limited Fiber Intake
    > Medications
    > Disease
20
Q

Laxatives: Bulk Forming

A
  • Composed of plant products with cell wall that cannot be digested.
    ~ Increases bulk
    ~ Absorbs fluid adding more bulk
    ~ Stimulates intestinal afferents
    causing peristalsis and mucus
    production.
  • Ex
    ~ Metamucil
    ~ Citrucel
  • Can bind with some drugs decreasing their absorption
    ~ Tetracycline
    ~ Warfarin (blood thinner)
21
Q

Laxatives: Osmotic

A
  • Ingestion of a salt/sugar/fat solution.
  • Component of solution not well absorbed.
    ~ Modifies osmotic balance causing
    water to move into the intestine to
    stimulate intestinal afferents causing
    peristalsis and mucous production
  • Ex
    ~ Miralax
22
Q

Laxatives: Stimulant

A
  • Stimulate smooth muscle in the intestine to increase motility/contractility
  • Ex
    ~ Ex-Lax
    ~ Dulcolax
    ~ Castor oil
  • These will go into effect immediately so need to be mindful of when taking
23
Q

Stool Softeners

A
  • More preventive for constipation
  • Help fat and water to mix
    ~ Softens stool and facilitates
    movement
  • Ex
    ~ Colace
    ~ Mineral oil
24
Q

Diarrhea

A
  • Frequent and loose bowel movements
  • Causes
    ~ Excessive Excretion - Infectious
    organism produces excess secretion
    of water and electrolytes.
    ~ Inflammation - Infectious organism or
    condition inflames the wall of the
    intestines causing exudate
    production.
    ~ Osmotic Imbalance - Concentrated
    substances can not be absorbed,
    results in flow of fluid into the
    substance and out of tissues.
25
Q

Anti-diarrheals: Opioids

A
  • Bind to opioid receptors
    ~ Inhibit afferents lining the bowel
    > Decreased Motility/Contractility
    > Decreased Intestinal Secretion
  • Opioids used for diarrhea do not penetrate CNS well so abuse potential is small.
  • Ex
    ~ Imodium
    ~ Lomotil
    ~ Motofen
26
Q

Anti-diarrheals: Bismuth Subsalicylate

A
  • Converted to salicylic acid and bismuth oxycholride.
    ~ Salicylic acid (aspirin) decreases
    inflammation
    ~ Bismuth oxychloride has antacid and
    antibacterial effects
  • Same considerations when using aspirin:
    ~ Not for children with viral infection.
    ~ Not for anyone taking blood thinners.
    ~ Not for anyone with aspirin allergy.
  • Ex
    ~ Pepto Bismol
    ~ Kaopectate
27
Q

Irritable Bowel Syndrome

A
  • Bowel symptoms and changes in habits without any identifiable, underlying cause.
    ~ Should not be confused with
    inflammatory bowel disease.
    ~ Appears to be an idiopathic functional
    disorder
28
Q

Irritable Bowel Syndrome S&S

A
  • Pain
  • Bloating
  • Cramping
    ~ Symptoms usually resolve following
    elimination.
  • Abnormal Bowel Habits
    ~ More than 3X per day (diarrhea)
    ~ Less than 3X per week (constipation)
    ~ Incomplete Bowel Movement
  • Abnormally hard or loose stool.
  • Urgency

Pathophysiology & Pharmacology (20 decks)

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