Elimination

Question 1

What is the main function of the small intestines? Large intestine?

Answer 1

SI: Absorption of nutrients
LI: Reabsorption of water

- Vit B + K synthesis

Question 2

Describe the positive feedback of HCl.

Answer 2

Gastrin secreted by G-cells….

> > Production of HCl acid (by parietal cells)&raquo_space; Proton pump releases HCl (mediated by H, K, ATPase)

> > Histamine&raquo_space; binds to H2 receptors (stim. by parietal cells)&raquo_space; Increases HCl production

Question 3

Foveolar or Goblet cells secrete ______.

Answer 3

Mucous, HCO3

Question 4

Anatacid

Answer 4

Neutralizes existing avid by increasing stomach pH without decreasing HCl production.

• Sx relief only
• Unscheduled

**2 hours post/pre other PO meds

Question 5

What 2 drug classes does Magnesium hydroxide (Milk of Magnesia) belong to?

Answer 5

1. Antacid
   S/e: diarrhea
2. Saline/Osmotic laxative
   - Best for pre-procedure
   - 1-3 hours (fast onset)

Question 6

Bismuth Subsalicylate
(Pepto-Bismol)
- 3 drug classes

Answer 6

1. Antacid
2. Anti-infective
3. Anti-diarrheal

Question 7

How do PPIs differ from H2-receptors?

Answer 7

PPI has higher efficacy + longer t1/2.

Question 8

Ranitdine (Zantac)

Answer 8

Selectively inhibits H2-receptor to decrease HCl production (H2-receptor blocker)

*Doesn’t cross BBB = no drowsiness

Question 9

Complications of diarrhea

Answer 9

• Electrolyte imbalance
• Dehydration
• Malabsorption

Question 10

Opioids

• S/e
• Contraindications?

Answer 10

Antidiarrheal

S/e: CNS depression
Contraindication: pregnancy, drug abuse

Question 11

Lomotil (dyphenosylate)

Answer 11

Atropine (Antidiarrheal)

Low dose: OTC
High dose: Rx

Question 12

Imodium (Loperamide HCl)

- Meperidine + atropine

Answer 12

Atropine (Antidiarrheal)

Question 13

Metamucil

Answer 13

Bulk forming laxative

• Must take w/ water
• Onset: 1-2 days

Question 14

Lactulose

Answer 14

Saline + Osmotic laxative

• Best for pre-procedure
• Fast onset: 1-3 hrs
• Contraindication: lactose intolerance

Question 15

GoLytely

Answer 15

Saline + Osmotic laxative

• Best for pre-procedure
• Fast onset: 1-3 hrs

Question 16

Ducolax; Senna; Castor oil

Answer 16

Stimulant laxative
**Not first choice for constipation + pre-surgery

S/e: N+V, cramping

Question 17

Colace (Docusate sodium)

When is it mainly used?

Answer 17

Softener (laxative)

• *Mainly used for post-MI + surgery
• Decreases straining

Question 18

Mineral oil; Glycerine

Answer 18

Laxatives

• Lubrication
• Supplementary tx

Question 19

Cathartics Enema

Answer 19

A pre-procedural bowel preparation that expands the bowel for fast evacuation

• Have pt lie on their LS

Question 20

Gasex

Answer 20

Tx: bloating

Question 21

Gravol (dimenhydrinate + cholortheophyline) 
Ginger gravol (OD s/e??)

Answer 21

H1 antagonist

Ginger gravol OD:

• Bleeding
• CNS depression

Question 22

Tx for motion/morning sickness; Nausea

Answer 22

Reduces vestibular excitation.

1. H1 antagonists
2. Antimuscarinic anticolinergics

Question 23

Tx for drug-induced pain; Chemo/visceral pain

Answer 23

5HT3 (serotonin) antagonists

Question 24

Tx for GI pain

Answer 24

Phenothiazines (D2-receptor antagonism) - stimulates GI motility

Question 25

Tx for Chemo/Chronic disease

Answer 25

Cannabinoids (CB 1, CB 2 agonism) - binds to receptor that stimulates GABA

Question 26

Dramamine (Meclizine)

Answer 26

H1 antagonist

Question 27

Diclectin (doxylamine + pyridoxine hydrochloride)

Answer 27

H1 antagonist

**For pregnant women

Question 28

Scopolamine (Hyoscine)

Answer 28

Antimuscarinic anticholinergic

• Has some affinity to H1-receptors

Question 29

Ondansetron (Zofran)

- What is its drug schedule?

Answer 29

5HT3 antagonism

- Rx only!

Question 30

Metoclopramide
(Maxeran, Reglan)

• s/e?
• Drug schedule?

Answer 30

Phenothiazines (D2-receptor antagonism)

s/e: sedation
- Rx only

Question 31

Prochlorperzine (Stemetil)

• s/e?
• Drug schedule?

Answer 31

Phenothiazines (D2-receptor antagonism)

s/e: sedation
- Rx only

Question 32

Dronabinol (Marinol); Cesamet/Nabilone;

Cannabis

Answer 32

Cannaboids

Question 33

Traveler’s Diarrhea

• Tx and PK?

Answer 33

Diarrheal condition usually caused by bacteria.

Tx: Ciprofloxacin

• 70% bioavailability
• Directly binds to bacteria in GI
• t1/2 = 4 hours

Question 34

C. difficle

• Type of infection?
• Clinical presentations?
• Tx?

Answer 34

Destroys intestinal lining by releasing Toxin A (enterotoxin) and Toxin B (cytotoxin).

• HAI (esp. in elderly)

Presentations:

• *Bloody diarrhea w/ pus
• Fever
• Ab. pain

Tx:
1st line: FLAGYL (Metronidazole)
2nd line: VANCOMYCIN

Question 35

Tenesmus

Answer 35

The feeling of incomplete defecation

Question 36

Dysentery

Answer 36

Bloody diarrhea

Question 37

IBS

• Triggers?

Answer 37

Inflammatory Bowel Syndrome - CNS dysregulation of normal motility

Triggers: stress, menstruation, diet, food intolerances

S+S:
- Ab pain, discomfort, cramping, bloating, diarrhea/constipation

Question 38

Fecal impaction

Answer 38

A procedure that removes a mass of stool.

If not removed , can cause partial/complete bowel obstruction

Question 39

Hirschsprung Disease

Answer 39

Congenital disease that causes issues w/ peristalsis in GI.

• D/t parasympathetic ganglion n. cells (responsible for bowel mvt) in the wall of colon not developing before birth

Question 40

Paralytic ileus

Answer 40

“Pseudo-obstruction” - Impaired bowel motor activity w/o physical obstruction.

• Often d/t surgery

Question 41

What are factors that affect constipation?

Answer 41

1. Diet

2. Perstalsis