GI 375 - 380 Flashcards
name of the drug that blocks gastric/pancreatic lipase
orlistat
what is the clinical app of orlistat?
weight loss (dec breakdown and absorption of dietary fats)
side effects of orlistat?
steatorrhea, dec absorption of fat-soluble vitamins
side effects of ondansetron?
QT polongation, headache, constipation
what type of antibiotic also causes QT prolongation?
macrolides
what is the target of ondansetron?
5HT3
2 functions of ondansetron?
- dec vagal stimulation
2. powerful central acting antiemetic
what is metoclopramide?
D2 receptor antagonist
what is the clinical app for metoclopramide?
diabetic and postsurgery gastroparesis, antiemetic
2 conditions that are contraindicated to metoclopramide?
small bowel obstruction, parkinson dz
metoclopramide can interact with what kinds of drugs?
digoxin, diabetic agents
side effects of metoclopramide?
inc parkinsonian effects, tardive dyskinesia, restlessness, drowsiness, diarrhea
does metoclopramide affect the colon transportation time?
no
name 4 H2 blockers
cimetidine, ranitidine, famotidine, nizatidine
what is the mech of H2 blockers?
reversible block of histamine H2 receptors –> dec proton secretion by parietal cells
among H2 blockers, what is unique about cimetidine?
inhibitor of P450 and also has antiandrogenic effects (prolactin release, gynecomastia, impotence, dec libido in males)
what 2 H2 blockers dec renal excretion of creatinine?
cimetidine, ranitidine
4 clinical applications for octreotide
- variceal bleeds
- acromegaly
- VIPoma
- carcinoid tumors
what is the common side effect of all antacid?
hypokalemia
name 4 osmotic laxatives
- magnesium hydroxide
- magnesium citrate
- polyethylene glycol (prep for colonoscopy)
- lactulose
the mech of osmotic laxatives?
provide osmotic load to draw water into the GI lumen
what is sulfasalazine?
combination of sulfapyridine (antibacterial) and 5-aminosalicylic acid (anti-inflammatory)
sulfasalazine need to be activated by
colonic bacteria
3 clinical usage for sulfasalazine?
- UC
- Crohn (colitis component)
- rheumatoid arthritis
name 3 antacids
- aluminum hydroxide
- calcium carbonate
- magnesium hydroxide
which antacid can chelate and dec the effectiveness of drugs such as tetracycline, fluoroquinolones
calcium carbonate
what is the drug that ripens cervix?
misoprostol (PGE1 analog)
name two H2 blockers that reduce renal excretion of creatinine?
cimetidine, ranitidine
mech of proton pump inhibitor?
irreversible inhibition of Na+/K+ ATPase
3 side effects of PPI?
- inc risk of C. difficle infection
- pneumonia
- dec serum Mg2+ with long term use
does PPI inhibit or induce P450?
inhibit
mech of bismuth, sucralfate?
bind to ulcer base providing physical protection and allowing HCO3- secretion to reestablish pH gradient in the mucous layer
which drug is a prodrug that requires acid to be activated?
sucralfate
bismuth is also used is what other path?
H. pylori (Quadruple tx: PPI, bismuth, metronidazole, tetracycline)
4 clinical applications for octreotide?
- variceal bleeds
- acromegaly
- VIPoma
- carcinoid tumors
what path is associated with “disorganized glandular structure with cellular infiltration?”
pancreatic adenocarcinoma
where does pancreatic adenocarcinoma usually arise from?
pancreatic duct
what is the most common location of pancreatic adenocarcinoma?
pancreatic head
what are the clinical symptoms from obstructive jaundice due to pancreatic adenocarcinoma?
- painless jaundice
- puritis
- dark urine
- pale stool
what are the 2 tumor markers for pancreatic adenocarcinoma?
CA 19-9, CEA
name 5 risk factors for pancreatic adenocarcinoma
- tobacco use
- chronic pancreatitis
- diabetes
- age > 50 yrs
- Jewish and African American males
name 4 unique presentations of pancreatic adenocarcinoma
- abdominal pain radiating to back
- weight loss (due to malabsorption and anorexia)
- migratory thrombophlebitis
- obstructive jaundice with palpable nontender gallbladder
explain the pathophysio of the migratory thrombophlebitis?
precoabulant effect of the circulating “mucin” released by tumor cells –> inc coagulation factors
what is another name for migratory thrombophlebitis?
Trousseau syndrome
what is Courvoisier sign?
obstructive jaundice with palpable nontender gallbladder
what path is associated with inc risk of gallbladder carcinoma?
porcelain gallbladder
what infectious agent is associated with cholangiocarcinoma?
clonorchis sinensis (Chinese liver fluke)
what is the treatment for porcelain gallbladder?
prophylactic cholecystectomy due to high rates of gallblader carcinoma
define porcelain gallbladder
calcified gallbladder due to chronic cholecystitis
what is the complication of acute pancreatitis?
pancreatic pseudocyst (lined by granulation tissue, not epithelium can rupture and hemorrhage)
3 clinical presentations for acute pancreatitis?
- epigastric abdominal pain radiating to back
- anorexia
- nausea
what are the consequences of acute pancreatitis other than pseudocysts?
- DIC
- ARDS
- diffuse fat necrosis
- hypocalcemia (Ca2+ collects in pancreatic Ca2+ soap deposits)
- infection
- multiorgan failure
is amylase and lipase a good marker for confirming chronic pancreatitis?
no (amylase and lipase may or my not be elevated in chronic pancreatitis)
is amylase/lipase good makers for acute pancreatitis?
yes (amylase and lipase always elevate in acute pancreatitis)
