EXAM 1 (GI MEDS)

Question 1

why use an ssri antagonist

Answer 1

odanestron/zofran emesis control

Block serotonin receptors on vagal afferents and in the chemoreceptor trigger zone (CTZ)

Question 2

What are the 2 glucocorticoids used to treat vomiting

Answer 2

Dexamethasone (MOST COMMON)

Methylprednisolone

Used to suppress chemo-induced vomiting. Can cause hypoglycemia

Question 3

What cannabinoid is used to treat vomiting

Answer 3

Dronabinol (marinol)

Question 3

What dopamine antagonist is used to treat vomiting

Answer 3

Prochlorperazine/promethazine AKA: Compazine/Phenergan

lots of adverse effects so not used as first line. causes severe sedation and can cause extravasation given IV. Also extrapyramidal effects

Question 3

What prokinetic agent is used to treat vomiting

Answer 3

Metoclopramide (reglan) lots of adverse effects so not used as first line.

Block dopamine receptos and makes stomach contents/gastic muscles move contents down so no vomit. Used post-op/caner tx Also extrapyramidal effects

Question 4

What meds can CAUSE constipation

Answer 4

Furosemide

anti-epileptic drugs such as Phenytoin or Dilantin.

antacids and proton pump inhibitors

the biggest medication that contributes to constipation are OPIOD ANALGESICS

Question 5

What are the 2 bulk-forming laxatives used to treat constipation

Answer 5

Methylcellulose and psyllium. Is the preferred method for TEMPORARY use as it acts as natural fiber intake. Makes poops bigger which promotes peristalsis. Forms soft stools w/ in 1-3 days

Question 6

what is the most common STIMULANT laxative

Answer 6

Bisacodyl [Dulcolax]; Senna [Senokot]

Produces semifluid stool in 6 - 12 hours. Should only be taken PRN for short pds. Most widely used/abused

Two effects on bowel:
Stimulate intestinal motility
Increases water and electrolytes in intestinal lumen

Indications
Opioid-induced constipation
Constipation due to slow intestinal transit

Question 7

What osmotic laxative SALT is used for constipation

Answer 7

Milk of magnesia. It increases your Mg in blood so no kidney pts. Draws fluid into stool increasing peristalsis.

Question 8

What osmotic laxative (not salt) is used for constipation

Answer 8

Polyethelene glycol (Miralax)

Can’t be ingested but takes water in to make poo bigger increasing peristalsis

Can be used in small doses for chronic constipateion (17g)

Question 9

What osmotic laxative (not salt) is used for constipation

Answer 9

Lactulose

Can’t be ingested but gut bacteria eat and secrete acids that takes water in to make poo bigger increasing peristalsis

USED FOR LIVER PTS b/c it helps poo out ammonia

Question 10

Whats the risk of using mineral oil for constipation

Answer 10

takes all your vitamins, people use it at home too much as PO or enema

Question 11

hOW DO YOU TREAT Gastroparesis

Answer 11

TREATED W/ METOCLOPRAMIDE [Reglan]
Suppresses emesis (by blocking receptors for dopamine and serotonin in the CTZ)
Increases upper GI motility (by enhancing the actions of acetylcholine)

Question 12

Tx of choice for GERD

Answer 12

PPIs
Omeprazole
Dexlansoprazole
Esomeprazole
Lansoprazole
Pantoprazole
Rabeprazole

Question 13

Pyloric obstruction MANAGEMENT

Answer 13

Nasogastric tube decompression
Proton pump inhibitors or H2-receptor antagonists
Fluid and electrolyte replacement
Parenteral hyperalimentation (intravenous nutrition)
Pyloric stent placement

Question 14

Tx of gastritis

Answer 14

Antibiotics for H. pylori infection
Vitamin B12 is administered to correct pernicious anemia

Question 15

Peptic Ulcer Disease: Treatment

Answer 15

Antibiotics
Antisecretory agents (proton pump inhibitors [PPIs], histamine2 receptor antagonists [H2RAs])
Mucosal protectants
Antisecretory agents that enhance mucosal defenses
Antacids

FIRST
Eradicate H. pylori (antibiotics)

SECOND
Reduce gastric acidity
(antisecretory agents, misoprostol)

LAST
Enhance mucosal defenses
(sucralfate, misoprostol)

Question 16

First-choice drugs for treating gastric and duodenal ulcers

Answer 16

Histamine2-Receptor Antagonists

Cimetidine [Tagamet]
Famotidine [Pepcid]
Nizatidine [Axid]

Question 17

Sucralfate [Carafate] is used to

Answer 17

Creates a protective barrier for up to 6 hours

Question 18

Misoprostol [Cytotec] is used to

Answer 18

prevention of gastric ulcers caused by long-term NSAID therapy

Question 19

T/F: Except for sodium bicarbonate, antacids do not alter systemic pH

Answer 19

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Question 20

4 major groups of antacids

Answer 20

Aluminum compounds
Aluminum hydroxide
constipation

Magnesium compounds
Magnesium hydroxide (milk of magnesia)
Magnesium oxide
diarrhea and magnesium toxicity

Calcium compounds
Calcium carbonate (TUMS)

Sodium compounds
Sodium bicarbonate
Avoid with HTN and HF

Question 21

Drugs for IBD

Answer 21

Not curative; may control disease process
5-Aminosalicylates
Glucocorticoids
Immunosuppressants
Immunomodulators
Antibiotics

Question 22

what is Sulfasalazine [Azulfidine]

Answer 22

5-Aminosalicylates
Approved indications are IBD
Sulfasalazine is metabolized by intestinal bacteria into two compounds
5-aminosalicylic acid (5-ASA) – reduces inflammation
Sulfapyridine – causes adverse effects
anemia, Nausea, fever, rash, and arthralgia are common.

Question 23

long term therapy of ipd

Answer 23

Suppresses immune response

Thiopurines: Azathioprine [Imuran] and Mercaptopurine [Purixan]
To induce and maintain remission
Increased risk of toxicity
Major adverse effects are pancreatitis and neutropenia (secondary to bone marrow suppression)

Cyclosporine [Sandimmune, Neoral, Gengraf]
Stronger and works faster
Cyclosporine is a potentially toxic compound that can cause renal impairment, neurotoxicity, and generalized suppression of the immune system.

Methotrexate
Can promote short-term remission and reduce the need for glucocorticoids

Question 24

Monoclonal antibody products that modulate immune responses
for IBS

Answer 24

TNF-inhibitors
Infliximab [Remicade]
Certolizumab [Cimzia]
Adalimumab [Humira]

Question 25

the Exocrine pancreas does

Answer 25

Produces digestive enzymes
Produces alkaline fluid that neutralizes chyme

Question 26

the Endocrine pancreas does

Answer 26

Secretes insulin, amylin, glucagon, somatostatin, and pancreatic polypeptide

Question 27

T/F: LIVER COVERED BY GLISSON CAPSULE THAT, WHEN DISTENDED, CAUSES PAIN BECAUSE IT IS INNERVATED

Answer 27

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Question 28

tx of portal hypertension

Answer 28

transjugular intrahepatic portosystemic shunts (TIPS) for long term solution

Emergency management of bleeding varices includes drugs that produce vasoconstriction of the splanchnic arterial bed, decrease portal blood flow, and decrease portal hypertension
Somatostatin analog octreotide (Sandostatin) or vasopressin

Nonselective β-blockers given to↓ Portal venous pressure and esophageal variceal bleeding
Nadolol [Inderal]
Propranolol [Corgard]

Question 29

gallstone tx

Answer 29

Once gallstones become symptomatic, a laparoscopic (or open) cholecystectomy (surgical removal of the gallbladder) is usually performed.

Other options
Bile acids (cholesterol solvents), such as ursodiol and chenodiol, are used to dissolve stones. Stones may recur.

ERCP with endoscopic sphincterotomy (papillotomy)

Endoscopic retrograde cholangiopancreatography (ERCP)

Extracorporeal shock-wave lithotripsy (ESWL)

Question 30

Acute cholecystitis tx

Answer 30

Treatment focuses on pain control, control of infection with antibiotics, and maintaining fluid and electrolyte balance

If nausea and vomiting are severe, NG tube insertion and gastric decompression may be used to prevent further gallbladder stimulation.

Opioids are given for pain management.

Anticholinergics (antispasmodics) can decrease GI secretions and counteract smooth muscle spasms.

Question 31

Chronic cholecystitis tx

Answer 31

Fat-soluble vitamin (A, D, E, and K) replacement may be needed

Bile acids, such as ursodiol and chenodiol, can help with digestion and vitamin absorption

Cholestyramine, bile acid sequestrant, may provide relief from itching (excess bile products may accumulate under the skin)