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Therapeutics > GI > Flashcards

GI Flashcards

1
Q

________ stimulate the production of mucus and can be inhibited by NSAIDs

A

Prostaglandins

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2
Q

Side effects of NaHCO3?

A

systemic alkalosis, fluid retention

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3
Q

Which are in Alka-Seltzer?
NaHCO3
CaCO3
Al(OH)3
Mg(OH)2

A

ASA + NAHCO3

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4
Q

What are side effects of CaCO3?

A

hypercalcemia, nephrolithiasis, milk-alkali syndrome

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5
Q

Which medications contain CaCO3?
Rolaids
Tums
Alka-Seltzer
Maalox

A

Rolaids- CaCO3 + Mg(OH)2
Tums- CaCO3

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6
Q

What are side effects of Al(OH)3?

A

constipation, hypophosphatemia

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7
Q

Which medications contain Al(OH)3?
AlternaGel
Rolaids
Tums
Alka-Seltzer
Maalox/Mylanta
Gaviscon

A

AlternaGel- Al(OH)3
Maalox/Mylanta- Al(OH)3 + Mg(OH)2
Gaviscon- Al(OH)3 + Mg(OH)2

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8
Q

What is a side effect of Mg(OH)2?

A

Diarrhea

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9
Q

Which medications contain Mg(OH)2?
AlternaGel
Rolaids
Tums
Alka-Seltzer
Maalox/Mylanta
Gaviscon

A

Rolaids- CaCO3 + Mg(OH)2
Maalox, Mylanta- Al(OH)3 + Mg(OH)2
Gaviscon- Al(OH)3 + Mg(CO)3

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10
Q

Where is histamine secreted in the stomach?

A

Secreted from ECL and attaches to parietal cell

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11
Q

Which are H2RAs?
Diphenhydramine
Benzimidazoles
Cimetidine
Vanoprazan
Famotidine

A

Diphenhydramine (Benadryl)
Cimetidine (Tagamet)
Famotidine (Pepcid)

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12
Q

Which are PPIs?
Diphenhydramine
Benzimidazoles
Cimetidine
Vanoprazan
Famotidine

A

Benzimidazoles- Omeprazole (Prilosec) and Esomeprazole (Nexium)
Vanoprazan

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13
Q

T/F: H2RAs are prodrugs

A

F: PPIs

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14
Q

H2RAs or PPIs?: can result in Vit B12 deficiency

A

PPI

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15
Q

H2RAs or PPIs?: irreversible inhibition

A

PPI

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16
Q

Which are mucosal protectants?
Pepto-Bismol
Sucralfate (Carafate)
Vanoprazan
Misoprostol (Cytotec)
Bisacodyl (Dulcolax)

A

Sucralfate (Carafate)
Misoprostol (Cytotec)

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17
Q

Which is contraindicated when avoiding aluminum?
Sucralfate (Carafate)
Tums
Alka-Seltzer
Maalox

A

Sucralfate and Maalox

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18
Q

What is the first-line treatment method for H. Pylori and Peptic Ulcers?

A

Pepto-Bismol (Bismuth subsalicylate)

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19
Q

Which laxatives are bulk and osmotic?
Castor Oil
MiraLax
Metamucil
Bisacodyl
GloLytely

A

Metamucil, Miralax, golytely

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20
Q

What is the D2 dopamine receptor antagonist that blockades results to increase ACh release and anti-emetic effects?
Tegaserod (Zelnorm)
Linaclotide (Linzess)
Prucalopride (Motegrity)
Metoclopramide (Reglan)

A

Metoclopramide (Reglan)

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21
Q

What is metoclopramide (Reglan)?
PPI
Prokinetic
H2RA
Mucosal Protectant

A

Prokinetic

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22
Q

Which are opioid receptor antagonist used for GI disorders?
Prucalopride (Motegrity)
Lubiprostone (Amatiza)
Tegaserod (Zelnorm)
Metoclopramide (Reglan)
Linaclotide (Linzess)

A

Prucalopride (Motegrity)
Tegaserod (Zelnorm)

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23
Q

Which are chloride channel activators used for GI disorders?
Prucalopride (Motegrity)
Lubiprostone (Amatiza)
Tegaserod (Zelnorm)
Metoclopramide (Reglan)
Linaclotide (Linzess)

A

Lubiprostone (Amatiza)
Linaclotide (Linzess)

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24
Q

Symptoms or complications resulting from refluxed stomach contents into the esophagus or beyond into the oral cavity (including the larynx) or lung

A

GERD

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25
Q

What happens to LES pressure in GERD?

A

Lowers LES pressure

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26
Q

Which foods decrease LES pressure in GERD?

A

Fatty meals, Chocolate, Coffee, Tea, Garlic, Onions, Chili Peppers, Alcohol

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27
Q

What are direct irritants to esophageal mucosa?

A

Spicy foods, orange and tomato juice, coffee, tobacco

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28
Q

What common meds decrease LES pressure?

A

Caffeine, Nicotine, Estrogen, Progesterone

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29
Q

What common meds are a direct irritant to esophageal mucosa?

A

Aspirin (ASA), NSAIDs, Iron

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30
Q

Which diagnostic test is preferred for assessing mucosal injury and complications?
Upper endoscopy
Reflux (pH) test
Manometry
Barium Radiography

A

Upper endoscopy

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31
Q

Which diagnostic test useful for patients not responding to acid suppression after normal endoscopy?
Upper endoscopy
Reflux (pH) test
Manometry
Barium Radiography

A

Reflux (pH) test

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32
Q

Which diagnostic test useful for a patient who failed 2 trials of PPI with normal endoscopy findings?
Upper endoscopy
Reflux (pH) test
Manometry
Barium Radiography

A

Manometry

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33
Q

Which diagnostic test is not useful since it lacks sensitivity and specificity?
Upper endoscopy
Reflux (pH) test
Manometry
Barium Radiography

A

Barium Radiography

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34
Q

How many days of OTC without relief must occur before a PPI can be introduced?

A

14 days

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35
Q

What are the side effects of calcium?

A

Constipation; milk-alkali syndrome

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36
Q

What are the side effects of Aluminum?

A

Constipation; confusion, nephrotoxicity

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37
Q

What are the side effects of magnesium?

A

Diarrhea; Accumulation

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38
Q

When should medications be taken if taking antacids?

A

2 hrs before or 4-6hrs after antacids

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39
Q

What is tums?
Calcium carbonate
Magnesium hydroxide
Al + Mg
Al + Mg + Simethicone
Ca + Mg
Ca + Simethicone

A

calcium carbonate

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40
Q

what is milk of magnesia?
Calcium carbonate
Magnesium hydroxide
Al + Mg
Al + Mg + Simethicone
Ca + Mg
Ca + Simethicone

A

Magnesium hydroxide

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41
Q

What is Maalox/Gaviscon?
Calcium carbonate
Magnesium hydroxide
Al + Mg
Al + Mg + Simethicone
Ca + Mg
Ca + Simethicone

A

Al + Mg

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42
Q

What is Mylanta?
Calcium carbonate
Magnesium hydroxide
Al + Mg
Al + Mg + Simethicone
Ca + Mg
Ca + Simethicone

A

Al + Mg + Simethicone

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43
Q

What is Rolaids?
Calcium carbonate
Magnesium hydroxide
Al + Mg
Al + Mg + Simethicone
Ca + Mg
Ca + Simethicone

A

Ca + Mg

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44
Q

What is Alka-Seltzer?
Calcium carbonate
Magnesium hydroxide
Al + Mg
Al + Mg + Simethicone
Ca + Mg
Ca + Simethicone

A

Ca + Simethicone

45
Q

Which has reversible/irreversible inhibitions?
PPIs vs H2RAs?

A

H2RAs: Reversible
PPIs: Irreversible

46
Q

What is the first, second and third line therapy for a pregnant woman experiencing GERD?

A

1st- Lifestyle Mod
1st (Med)- antacids
2nd- H2RAs
3rd- PPI (EXCEPT Omeprazole)

47
Q

What GI meds should be avoided when lactating?

A

PPIs and H2RAs

48
Q

Where would pain be present in H.Pylori clinical presentation?

A

Duodenum>Stomach

49
Q

Where would pain be present in NSAID clinical presentation?

A

Stomach>Duodenum

50
Q

Where would pain be present in stresses clinical presentation?

A

Stomach>Duodenum

51
Q

______ pain relieves while eating food, while ______ pain worsens while eating food

A

Duodenum pain relieves while eating food, while stomach pain worsens while eating food

52
Q

What are the three main afflicters of peptic ulcer disease (PUD) ?

A

Bugs (H. Pylori), Drugs (NSAIDs), and Stress (Recovery)

53
Q

What is the treatment method for H. Pylori?

A

PPI + 2-3 antibiotics

54
Q

What is in quadruple therapy?

A

PPI BID, Bismuth Subsalicylate, Metronidazole, and Tetracycline

55
Q

What are the two types of convenience packaging for H. Pylori quadruple therapy?

A

Helidac- 14 blister cards
Pylera- 3-in-1 capsule

56
Q

Which treatment option contains triple, sequential and LOAD therapy?
Clarithromycin
Levofloxacin
Rifabutin

A

Levofloxacin

57
Q

Which H. Pylori therapy does not contain amoxicillin?
Triple
Sequential
Quadruple (LOAD)
Hybrid

A

Bismuth Quadruple (LOAD)

58
Q

Which H. Pylori therapy is salvage therapy?
Triple
Sequential
Quadruple (LOAD)
Hybrid

A

Triple in Rifabutin
Quadruple LOAD in Levofloxacin

59
Q

Which regimen is best for macrolide exposure?
Triple
Sequential
Quadruple (LOAD)
Hybrid

A

Levofloxacin Triple or Sequential

60
Q

What is the prophylaxis regimen used for NSAID induced PUD?

A

PPIs, H2RAs, Sucralfate while on NSAIDs

61
Q

What is the treatment regimen for NSAID induced PUD?

A

PPIs, H2RAs, Sucralfate
8 wks if on NSAIDs stopped, 12 wks if continued

62
Q

If NSAID therapy must be continued with potential PUD, which is recommended?

63
Q

What locations are common for contagious diarrhea?

A

Daycares and Long-term care facilites

64
Q

Norovirus causes what symptoms?

A

Diarrhea and vomiting

65
Q

What are the four pathophysiological pathways of diarrhea?

A

Secretory, Osmotic, Exudative and Altered Intestinal transit

66
Q

Which diarrheal pathway is characterized by a change in active ion transport either from a decrease in sodium absorption or increase in chloride secretion into the lumen?
Secretory
Osmotic
Exudative
Altered Intestinal Transit

67
Q

In secretory diarrhea, what ion transport change occurs? Is this altered by fasting?

A

Decrease sodium absorption and increase in chloride secretion into the lumen
Not altered by fasting

68
Q

Which diarrheal pathway is a subset of secretory and is secondary to inflammatory disease of the bowel (IBD)?
Secretory
Osmotic
Exudative
Altered Intestinal Transit

69
Q

Which diarrheal pathway is caused when poorly absorbed substances are retained in intestinal fluids resulting in an influx of water and electrolytes into the lume?
Secretory
Osmotic
Exudative
Altered Intestinal Transit

70
Q

What influx into the lumen in osmotic diarrhea? Is it altered by fasting state?

A

influx of water and electrolytes
Improves with fasting state

71
Q

What questions should be asked is choosing the treatment method for diarrhea?

A

Is the drug
Indicated, Effective, Safe, Adherance/Convenient?

72
Q

What diet is recommended in the treatment of diarrhea?

73
Q

In pharmacological treatment goals of diarrhea, we want to (increase/decrease) fluid accumulation in lumen, (increase/decrease) propulsive contractions, and (increase/decrease) mixing contractions

A

decrease fluid accumulation in lumen, decrease propulsive contractions, and increase mixing contractions

74
Q

What can be taken to prevent travelers diarrhea?
Calcium carbonate
Antibiotics
Bismuth subsalicylate
Loperamide

A

Bismuth subsalicylate

75
Q

What is the mild, moderate, and severe treatment options for travelers diarrhea?

A

Mild: Loperamide or BSS may be considered (antibiotics not recommended)
Mod: Antibiotic may be used, loperamide may be considered as monotherapy or adjunct
Severe: Antibiotics should be used (single dose preferred), Loperamide may be adjunct

76
Q

Which diarrheal drug activates the mu opioid receptors on the smooth muscle of the bowel to reduce peristalsis?

A

antimotility drugs

77
Q

What antimotility agent is used in the treatment of diarrhea that is OTC? Rx?

A

OTC: Loperamide (Imodium)
Rx: Combo Atropine

78
Q

What is a serious risk associated with loperamide?

A

cardiac- QT prolongation

79
Q

Which are absorbents?
Loperamide (Imodium)
Psyllium (Metamucil)
Bismuth subsalicylate (Pepto Bismol)
Polycarbophil (FiberCon)

A

Psyllium (Metamucil)
Polycarbophil (FiberCon)

80
Q

Which are anti-motility?
Loperamide (Imodium)
Psyllium (Metamucil)
Bismuth subsalicylate (Pepto Bismol)
Polycarbophil (FiberCon)

A

Loperamide (Imodium)

81
Q

Which are anti-secretory?
Loperamide (Imodium)
Psyllium (Metamucil)
Bismuth subsalicylate (Pepto Bismol)
Polycarbophil (FiberCon)

A

Bismuth subsalicylate (Pepto Bismol)

82
Q

How often does constipation occur for it to be acute?

A

< 3 bowel movements per week

83
Q

How often does constipation occur for it to be chronic?

A

symptoms lasting over 6 weeks

84
Q

Agents with strong anti_______ properties care a common cause of constipation

A

anticholinergic

85
Q

How should fiber be added to a diet of someone who is constipated?

A

Add high-fiber to diet slowly, increasing fiber over 7-10 days

86
Q

Prunes and kiwifruit is used for (diarrhea/constipation/nausea/vomiting)

A

constipation

87
Q

T/F: Docusate softens stools better than bulk laxatives

A

F: Bulk laxatives soften stools better than docusate

88
Q

What surfactant decreases fecal surface tension (stool softener) to prevent constipation?

A

Docusate (DOSS)

89
Q

What should be avoided in renal patients?
Milk of magnesia
Mineral oil
Docusate (DOSS)
Polyethylene Glycol (Miralax)
Metamucil
Stimulant Lax

A

Milk of magnesia

90
Q

Which is excellent for chronic constipation?
Milk of Magnesia
Mineral Oil
Docusate (DOSS)
Polyethylene Glycol (Miralax)
Metamucil

A

Polyethylene Glycol (Miralax)

91
Q

Which is the DOC for opioid induced constipation?
Milk of magnesia
Mineral oil
Docusate (DOSS)
Polyethylene Glycol (Miralax)
Metamucil
Stimulant Lax

A

Stimulant Lax- Senna and Bisacodyl

92
Q

Which therapeutic option will give relief ASAP-1hr?
Citrate of Magnesia
Bisacodyl
Enema
Senna Tab
Glycerin Suppository
PEG
Milk of Magnesia

A

Enema, Bisacodyl or Glycerin suppository

93
Q

Which therapeutic option will give relief within 3-6hrs?
Citrate of Magnesia
Bisacodyl
Enema
Senna Tab
Glycerin Suppository
PEG
Milk of Magnesia

A

Citrate of Magnesia and larger doses of PEG (Miralax)

94
Q

Which therapeutic option will give relief within 24hrs?
Citrate of Magnesia
Bisacodyl
Enema
Senna Tab
Glycerin Suppository
PEG
Milk of Magnesia

A

Bisacodyl or senna tablets

95
Q

Which therapeutic option will give relief within 48hrs?
Citrate of Magnesia
Biascodyl
Enema
Senna Tab
Glycerin Suppository
PEG
Milk of Magnesia

A

Milk of Magnesia and PEG (Miralax)

96
Q

When should follow-up occur in acute constipation? Chronic?

A

Acute: 1-2 days
Chronic: 1-2 weeks

97
Q

What is the first step (non-pharm) for nausea and vomiting?

A

Put gut to rest: clear liquid diet, IV hydration

98
Q

What are the three important drug therapy options for treating nausea and vomiting?

A

Antihistamines/Anticholinergics
Serotonin Antagonists
Corticosteroids

99
Q

Which is better tolerated in nausea and vomiting?
Antihistamines/Anticholinergics
Serotonin Antagonists
Corticosteroids

A

Corticosteroids

100
Q

What two Antihistamines/Anticholinergics are mainly used in motion sickness?

A

Dimenhydrinate (Dramamine) and Meclizine (Bonine)

101
Q

What medication is used for N/V Secondary to gastroenteritis pain?
Dimenhydrinate (Dramamine)
Ondansetron
Promethazine
Meclizine

A

Ondansetron
Promethazine

102
Q

Which medication is used for post-op NV?
Aprepitant (Emend)
Lorazepam
Olanzapine

103
Q

Why are the serotonin antagonist (-trons) more efficable in nausea and vomiting?

A

They have central and peripheral effects

104
Q

What is the most common diagnoses GI disorder?

105
Q

What diet is best for IBS?

A

Low FODMAP diet

106
Q

What is the non-pharmacologic management recommended with IBS?

A

Physical activity and cognitive behavioral therapy

107
Q

What is the step-wise treatment of IBS-C?

A
  1. Increase fiber and fluid intact (avoiding foods making sympt worse)
  2. Add bulk-forming lax
  3. Consider anti-spasmodic or anticholinergic
  4. Lubiprostone
    … Serotonin (SSRIs)
108
Q

What are non-pharm treatment options for IBS-D?

A

Manage stress and diet (lactose-free and caffeine-free)

109
Q

What is the step-wise process for IBS-D treatment?

A
  1. Dietary mods
  2. Loperamide or anti-spasmodic
  3. Serotonin-3 antagonist (Tricyclic antidepressants)

Therapeutics (16 decks)

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