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Pharmacology Finals > Gastrointestinal Diseases > Flashcards

Gastrointestinal Diseases Flashcards

1
Q

Drugs used in Acid-Peptic Diseases

Anti secretory agents

A

Histamine 2 receptor antagonists
Proton pump inhibitors
Anti muscarinic

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2
Q

Drugs used in Acid-Peptic Diseases

Mucosal protective agents

A

Sucralfate
Prostaglandin analogs
Colloidal bismuth compounds
Carbenoxolone

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3
Q

Drugs used in Acid-Peptic Diseases
Antacids

A measure for the overall buffering capacity against acidification for a solution.

A

Acid-Neutralization Capacity (ANC)

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4
Q

Drugs used in Acid-Peptic Diseases
Antacids

ANC defined as the difference between what?

A

Cation of strong bases and

Anions of strong acids

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5
Q

Drugs used in Acid-Peptic Diseases
Antacids

ANC, the amount of acid needed to change the pH value from the sample’s value to a chosen different value. Depends on?

A

Rate of dissolution
Water solubility
Rate of reaction with acid
Rate of gastric emptying

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6
Q

Drugs used in Acid-Peptic Diseases
Antacids

Weak bases + gastric acid =

A

Salt and water

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7
Q

Drugs used in Acid-Peptic Diseases
Antacids

MOA

A

Reduction of intra gastric acidity
Stimulate mucosal PG production
Promote mucosal defense mechanism

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8
Q

Drugs used in Acid-Peptic Diseases
Antacids

Dosage

A

156 mEq given 1 hour after meal

Neutralize up to 2 hours

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9
Q

Drugs used in Acid-Peptic Diseases
Antacids

Particulate antacids (non systemic)

A

Magnesium OH

Aluminum OH

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10
Q

Drugs used in Acid-Peptic Diseases
Antacids

No particulate antacids (systemic)

A 
Sodium bicarbonate (baking soda, alka seltzer)
Calcium carbonate (Tums, Os-Cal)
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11
Q

Drugs used in Acid-Peptic Diseases
Antacids

Non particulate antacids

A 
Reacts rapidly with HCL
Metabolic acidosis
Gastric distention and belching
Exacerbate fluid retention
HTN
Renal insufficiency
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12
Q

Drugs used in Acid-Peptic Diseases
Antacids

Less soluble

A

Calcium carbonate

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13
Q

Drugs used in Acid-Peptic Diseases
Antacids

Non particulate

Adverse effects

A

Hypercalcemia
Renal insufficiency
Metabolic alkalosis
Milk alkali syndrome

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14
Q

Drugs used in Acid-Peptic Diseases
Antacids

Particulate antacids (non systemic)

A

Reacts slowly with HCL

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15
Q

Drugs used in Acid-Peptic Diseases
Antacids
Particulate

Reacts slowly with HCL

A

MgCl or AlCl and water

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16
Q

Drugs used in Acid-Peptic Diseases
Antacids
Particulate

Unabsorbed magnesium lead to

A

Osmotic diarrhea

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17
Q

Drugs used in Acid-Peptic Diseases
Antacids
Particulate

Unabsorbed aluminum

A

Constipation

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18
Q

Drugs used in Acid-Peptic Diseases
Antacids
Particulate

Combined to minimize effects

A

Gelusil
Maalox
Mylanta

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19
Q

Drugs used in Acid-Peptic Diseases
Antacids
Particulate

Minimally absorbed

A

Excreted by kidneys

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20
Q

Drug interactions of all antacids

A

Tetracyclines
Fluoroquinolones
Itraconazole
Iron

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21
Q

Drugs used in Acid-Peptic Diseases
Antacids

Reduce absorption by?

A

Antacid binding with the drugs

Increase intra gastric pH

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22
Q

Drugs used in Acid-Peptic Diseases
Anti secretory: H2 - receptor antagonists

MOA

A

Competitive inhibition at parietal cell H2 receptors
Suppress basal and meal-stimulated acid secretion
Reduce gastric secretion
Reduce concentration of pepsin

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23
Q

Drugs used in Acid-Peptic Diseases
Anti secretory: H2 - receptor antagonists

Drugs

A

Cimetidine
Ranitidine
Famotidine
Nizatidine

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24
Q

Drugs used in Acid-Peptic Diseases
Anti secretory: H2 - receptor antagonists

Drugs that has a first pass hepatic metabolism and bioavailability of 50%

A

Cimetidine
Ranitidine
Famotidine

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25
Q

Drugs used in Acid-Peptic Diseases
Anti secretory: H2 - receptor antagonists

Drug that has little first pass and almost 100% bioavailability

A

Nizatidine

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26
Q

Drugs used in Acid-Peptic Diseases
Anti secretory: H2 - receptor antagonists

2 mechanisms in reduction of acid secretion stimulated by

A

Histamine
Gastrin
Cholinomimetic agents

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27
Q

Drugs used in Acid-Peptic Diseases
Anti secretory: H2 - receptor antagonists

Memorize the table

A

Stop answering then memorize the table

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28
Q

Drugs used in Acid-Peptic Diseases
Anti secretory: H2 - receptor antagonists

Clinical uses

A

GERD
PUD
Non ulcer Dyspepsia
Prevention of bleeding from stress-related gastritis

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29
Q

Drugs used in Acid-Peptic Diseases
Anti secretory: H2 - receptor antagonists

GERD

A

6-10 hours duration

BID before meals

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30
Q

Drugs used in Acid-Peptic Diseases
Anti secretory: H2 - receptor antagonists

PUD

A

OD at HS
Prevent occurence- half
NSAID associated - rapid healing if NSAID is DC

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31
Q

Drugs used in Acid-Peptic Diseases
Anti secretory: H2 - receptor antagonists

Adverse effects

A 
Diarrhea
Headache
Fatigue
Myalgia
Constipation
Pregnant and nursing
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32
Q

Drugs used in Acid-Peptic Diseases
Anti secretory: H2 - receptor antagonists

Adverse effects in CNS

A

Mental status changes

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33
Q

Drugs used in Acid-Peptic Diseases
Anti secretory: H2 - receptor antagonists

Adverse effects in elderly

A

Renal or hepatic dysfunction

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34
Q

Drugs used in Acid-Peptic Diseases
Anti secretory: H2 - receptor antagonists

Adverse effects, endocrine effects:cimetidine

A

Gynecomastia
Impotence
Inhibit metabolism of estradiol
Galactorrhea

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35
Q

Drugs used in Acid-Peptic Diseases
Anti secretory: H2 - receptor antagonists

Rare adverse effects

A

Blood dyscrasias

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36
Q

Drugs used in Acid-Peptic Diseases
Anti secretory: H2 - receptor antagonists

Interferes with hepatic cytochrome P450 drug metabolism pathways
Prolonged half lives

A

Cimetidine

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37
Q

Drugs used in Acid-Peptic Diseases
Anti secretory: H2 - receptor antagonists

Binds 4-10 times less

A

Ranitidine

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38
Q

Drugs used in Acid-Peptic Diseases
Anti secretory: H2 - receptor antagonists

Drug interactions

Compete with creatine and certain drugs like

A

Procainamide

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39
Q

Drugs used in Acid-Peptic Diseases
Anti secretory: H2 - receptor antagonists
Drug interactions

Inhibit first pass metabolism of ethanol except

A

Famotidine

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40
Q

Anti secretory proton pump inhibitors

Drugs

A 
Omeprazole (losec)
Lansoprazole (Prevacid)
Rebeprazole (pariet)
Dexlanzoprazole (dexilant)
Pantoprazole (pantoloc)
Esomeprazole (nexium)
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41
Q

Anti secretory proton pump inhibitors

Pro drugs

A

Lipophylic weak bases

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42
Q

Anti secretory proton pump inhibitors

Bioavailability

A

Decreased 50% by food

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43
Q

Anti secretory proton pump inhibitors

Given when

A

1 hour before meal

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44
Q

Anti secretory proton pump inhibitors

Short serum plasma half life

A

1.5 hours

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45
Q

Anti secretory proton pump inhibitors

Long duration of acid inhibition

A

Up to 24 hours

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46
Q

Anti secretory proton pump inhibitors

Required to reach full acid inhibiting potential

A

3-4 days daily medication

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47
Q

Anti secretory proton pump inhibitors

How many hours are required for synthesis of new ATPase pump

A

18 hours

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48
Q

Anti secretory proton pump inhibitors
Clinical uses
GERD
Most effective treatment for

Long term maintenance

A

Erosive reflux disease

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49
Q

Anti secretory proton pump inhibitors
Clinical uses
GERD
Most effective treatment for

Intermittent courses

A

Non erosive reflux disease

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50
Q

Anti secretory proton pump inhibitors
Clinical uses
GERD
Most effective treatment for esophageal complications of reflux disease

A

Peptic stricture

Barrett’s esophagitis

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51
Q

Anti secretory proton pump inhibitors
Clinical uses
GERD
Most effective treatment for

Extra esophageal manifestations of reflux disease

A

Asthma
Chronic cough
Laryngitis
Non cardiac chest pain

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52
Q

Anti secretory proton pump inhibitors
Clinical uses
GERD

Once daily

A

85-90% symptom relief and tissue healing

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53
Q

Anti secretory proton pump inhibitors
Clinical uses
GERD
Most effective treatment for

BID

A

Required in 15% of patients

54
Q

Anti secretory proton pump inhibitors
Clinical uses
GERD
Most effective treatment for

If discontinue

A

Symptoms recur within 6 months

55
Q

Anti secretory proton pump inhibitors
Clinical uses
PUD

Duodenal ulcer

A

90% within 4weeks

56
Q

Anti secretory proton pump inhibitors
Clinical uses
PUD

Gastric ulcer

A

90% within 6-8 weeks

57
Q

Anti secretory proton pump inhibitors
Clinical uses
PUD
Associated with H pylori

2 therapeutic goals

A

Heal the ulcer

Eradication of H. Pylori

58
Q

Anti secretory proton pump inhibitors
Clinical uses
PUD
Associated with H pylori

Most effective regimen

A

2 antibiotics and PPI

59
Q

Anti secretory proton pump inhibitors
Clinical uses
PUD
Associated with H pylori

10-14 day “triple therapy”

A

PPI bid
Clarithromycin 500mg bid
Amoxicillin 1g bid (metronidazole 500 mg bid)

60
Q

Anti secretory proton pump inhibitors
Clinical uses
PUD
Associated with H pylori

Mechanism

A

Direct antimicrobial property

Raising intragastric pH

61
Q

Anti secretory proton pump inhibitors
Clinical uses
PUD
Associated with NSAID ulcers

A

Once daily promote healing despite continued NSAID therapy

Prevent complications from NSAID

62
Q 
Anti secretory proton pump inhibitors
Clinical uses
PUD
Prevention of rebleeding from PU
Administer
A

3-5 days as high dose oral therapy or IV

63
Q 
Anti secretory proton pump inhibitors
Clinical uses
PUD
Prevention of rebleeding from PU
Recommended
A

Initial bolus followed by continuous infusion

64
Q

Anti secretory proton pump inhibitors
Clinical uses

Most efficacy

A

Non ulcer dyspepsia

65
Q

Anti secretory proton pump inhibitors
Clinical uses
Prevention of stress related mucosal bleeding with NGT

A

Omeprazole BID on first day then OD

66
Q

Anti secretory proton pump inhibitors
Clinical uses
Prevention of stress related mucosal bleeding

Without NGT or with significant ileus

A

IV H2 antagonist

67
Q

Anti secretory proton pump inhibitors
Clinical uses
Gastrinoma and other hypersecretory conditions

A

Omeprazole 60-120 mg/d

68
Q

Anti secretory proton pump inhibitors

Adverse effects

A

Diarrhea
Headache
Abdominal pain

69
Q

Anti secretory proton pump inhibitors
Adverse effects

Nutrition

Reduction in oral

A

B12 absorption

70
Q

Anti secretory proton pump inhibitors
Adverse effects

Nutrition

Required to promote absorption of

A

Iron
Calcium
Zinc

71
Q

Anti secretory proton pump inhibitors
Adverse effects
Respiratory and enteric infections

Increased risk of

A

Nosocomial pneumonia

Community acquired respiratory inf

72
Q

Anti secretory proton pump inhibitors
Adverse effects
Respiratory and enteric infections

Enteric infections in

A

Travelers

73
Q

Anti secretory proton pump inhibitors
Adverse effects
Respiratory and enteric infections

Hospitalized patients increased risk of

A

C. Difficile infection

74
Q

Anti secretory proton pump inhibitors
Adverse effects
Potential problems due to increased serum gastrin

Alters normal feedback inhibition

A

Increase median gastrin levels

75
Q

Anti secretory proton pump inhibitors
Adverse effects
Potential problems due to increased serum gastrin

Gastrin levels normalize within

A

4weeks of DC PPI

76
Q

Anti secretory proton pump inhibitors
Adverse effects
Potential problems due to increased serum gastrin

Tumors in rats

A

ECL hyperplasia stimulated by gastrin

77
Q

Anti secretory proton pump inhibitors
Adverse effects
Potential problems due to increased serum gastrin

Promote carcinogenesis

A

Hypergastrenemia

78
Q

Anti secretory proton pump inhibitors
Adverse effects
Potential problems due to decreased gastric acidity

A

Gastric adenocarcinoma

Small benign gastric fundic gland polyps

79
Q

Anti secretory proton pump inhibitors
Drugs interactions

Alter absorption of ketoconazole and digoxin

A

Decreased gastric acidity

80
Q

Anti secretory proton pump inhibitors
Drugs interactions

Inhibit metabolism of Coumadin, diazepam and phenytoin

A

Omeprazole

81
Q

Anti secretory proton pump inhibitors
Drugs interactions

Decrease metabolism of diazepam

A

Esomeprazole

82
Q

Anti secretory proton pump inhibitors
Drugs interactions

Enhance clearance of theophylline

A

Lansoprazole

83
Q

Anti secretory proton pump inhibitors
Drugs interactions

No significant D/I

A

Rebeprazole and pantoprazole

84
Q

Ant i secretory anti muscarinic

Drugs

A

Pirenzipine

Telenzipine

85
Q

Ant i secretory anti muscarinic

Adverse effects

A

Dry mouth and skin
Blurred vision
Constipation

86
Q

Ant i secretory anti muscarinic

A

Inhibit secretion of gastrin , mucus andHCO3

87
Q

Mucosal protective agents
Sucralfate

MOA

A

Negatively charged sucrose sulfate binds to positively charged proteins at ulcer base and erosions

88
Q

Mucosal protective agents
Sucralfate

Stimulate

A

Mucosal prostaglandin and bicarbonate secretion

89
Q

Mucosal protective agents
Sucralfate

Clinical uses

A

Reduce UGIB in ICU

Prevention of stress-related bleeding

90
Q

Mucosal protective agents
Sucralfate

Adverse effects

A

Constipation

91
Q

Mucosal protective agents
Sucralfate

Drug interactions

A

May bind to other medications impairing absorption

92
Q

Mucosal protective agents
Prostaglandin analogs

Primary GI prostaglandins

A

PGE and PGF

93
Q

Mucosal protective agents
Prostaglandin analogs

Acid inhibitory and mucosal protective properties

A

Misoprostol

94
Q

Mucosal protective agents
Prostaglandin analogs

MOA

A

Stimulate mucus and HCO3

Acid inhibition

95
Q

Mucosal protective agents
Prostaglandin analogs
Other actions

A

Stimulate electrolyte and fluid secretion
Intestinal motility
Uterine contractions

96
Q

Mucosal protective agents
Prostaglandin analogs

Clinical use

A

Prevention of NSAID induced ulcers in high risk patients

97
Q

Mucosal protective agents
Prostaglandin analogs

Adverse effects

A

Diarrhea
Cramping abdominal pain
Uterine contractions

98
Q

Mucosal protective agents
Colloidal Bismuth compounds

Drugs

A

Bismuth subsalicylate
Bismuth subcitrate
Bismuth dinitrate

99
Q

Mucosal protective agents
Colloidal Bismuth compounds

Coats ulcer and erosions

A

Protective layer against acid and pepsin

100
Q

Mucosal protective agents
Colloidal Bismuth compounds

Stimulate

A

PG
Mucus
HCO3

101
Q

Mucosal protective agents
Colloidal Bismuth compounds

Direct antimicrobial effects and binds entertoxins

A

Prevent and treat travelers diarrhea

102
Q

Mucosal protective agents
Colloidal Bismuth compounds

Direct antimicrobial activity

A

H. Pylori

103
Q

Mucosal protective agents
Colloidal Bismuth compounds

Clinical use

A

Dyspepsia
Acute diarrhea
Travelers diarrhea

104
Q

Mucosal protective agents
Colloidal Bismuth compounds

Adverse effects

A

Blackening of stool

Darkening of tongue

105
Q

Mucosal protective agents
Carbenoxolone

Alter the composition and quantity of mucus

A

Enhance mucosal barrier

106
Q

Mucosal protective agents
Carbenoxolone

MOA

A

Binds to membrane
Inhibits pepsin activity
Stimulate gastric glycoprotein synthesis

107
Q

Mucosal protective agents
Carbenoxolone

Clinical uses

A

PUD

GERD

108
Q

Mucosal protective agents
Carbenoxolone

Adverse effects

A

Sodium and fluid retention
Hypertension
Hypokalemia
Impaired glucose intolerance

109
Q

Mucosal protective agents
Carbenoxolone

Drug interaction

A

Spirinolocatone alters its therapeutic effects

110
Q

Drugs stimulating gastrointestinal motility

Selectively stimulate gut motor function

A

Pro kinetic agents

111
Q

Drugs stimulating gastrointestinal motility

GERD AD

A

Agents that increase LES pressures

112
Q

Drugs stimulating gastrointestinal motility

Gastro paresis, post surgical gastric emptying delay

A

Agents that improve gastric emptying

113
Q

Drugs stimulating gastrointestinal motility

Agents that enhance colonic transit in the treatment of constipation

A

Laxatives

114
Q

Drugs stimulating gastrointestinal motility
Prokinetic agents

Cholinomimetic agents

A

Betanechol

Neostigmine

115
Q

Drugs stimulating gastrointestinal motility
Prokinetic agents
Cholinomimetics agents

Stimulate muscarinic M3 receptors
GERD and gastro paresis

A

Betanechol

116
Q

Drugs stimulating gastrointestinal motility
Prokinetic agents
Cholinomimetics agents

Acethylcholinesterase inhibitor
Enhance gastricm SI and colonic emptying
Ogilivie’s syndrome

A

Neostigmine

117
Q

Drugs stimulating gastrointestinal motility
Prokinetic agents
Cholinomimetics agents

Adverse effects

A 
Excessive salivation
Nausea
Vomiting
Diarrhea
Bradycardia
118
Q

Drugs stimulating gastrointestinal motility
Prokinetic agents
Dopamine D2 receptor antagonist

Drugs

A

Metoclopramide

Domperidone

119
Q

Drugs stimulating gastrointestinal motility
Prokinetic agents
Dopamine D2 receptor antagonist

MOA

A

Blocks dopamine receptor inhibition of smooth muscle stimulation

120
Q

Drugs stimulating gastrointestinal motility
Prokinetic agents
Dopamine D2 receptor antagonist

MOA

A 
Increase esophageal peristaltic amplitude
Increase LES pressure
Enhance gastric emptying
Anti nausea
Anti emetic
121
Q

Drugs stimulating gastrointestinal motility
Prokinetic agents
Dopamine D2 receptor antagonist
clinical uses

A 
GERD 
Impaired gastric emptying
Vagotomy
Diabetic gastro paresis
Non ulcer dyspepsia 
Post partum lactation stimulation - domperidone
122
Q

Drugs stimulating gastrointestinal motility
Prokinetic agents
Dopamine D2 receptor antagonist

Adverse effects of metoclopramide

A

CNS
EPS
Tar dive dyskinesia

123
Q

Drugs stimulating gastrointestinal motility
Prokinetic agents
Dopamine D2 receptor antagonist

Adverse effects of meto and dom

A 
Elevated prolactin levels
Galactorrhea
Gynecomastia
Impotence
Menstrual disorders
124
Q

Drugs stimulating gastrointestinal motility
Prokinetic agents
Macrolides

Drugs

A

Erythromycin

125
Q

Drugs stimulating gastrointestinal motility
Prokinetic agents
Macrolides

Clinical use

A

Gastro paresis

Acute UGIB to promote gastric emptying prior to endoscopy

126
Q

Drugs stimulating gastrointestinal motility
Prokinetic agents
Macrolides
Erythromycin directly stimulate

A

Motilin receptors on GI smooth muscle

127
Q

Drugs stimulating gastrointestinal motility
Prokinetic agents
Chloride channel activator

Drug

A

Lubiprostone

128
Q

Drugs stimulating gastrointestinal motility
Prokinetic agents
Chloride channel activator

MOA

A

Stimulate chloride channel opening increase liquid secretion and shorten intestinal transit time.

129
Q

Drugs stimulating gastrointestinal motility
Prokinetic agents

Prostanoic acid derivative
For chronic constipation

A

Lubiprostone

130
Q

Drugs used in Acid-Peptic Diseases

Agents that reduce intra gastric acidity

A

Antacids

Anti secretory agents

Pharmacology Finals (1 decks)

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