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Pharmacology Exam 3 > GI > Flashcards

GI Flashcards

1
Q

Why are head trauma and burn trauma patients susceptible to stress ulcers?

A

Hypermetabolic – producing more acid

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2
Q

List three mechanisms by which NSAIDs cause ulcers

A

Decreased gastric mucus production, cause anticoagulation, lower stomach pH

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3
Q

How does H. pylori contribute to ulcer production?

A

Surrounded by shield of bicarb causing chronic low-grade inflammation and irritation in stomach lining

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4
Q

What is Zollinger-Ellison syndrome?

A

And acid producing pancreatic tumor that can contribute to ulcer development

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5
Q

List two mechanisms of ulcer treatment

A

Increased mucus production, decrease acid

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6
Q

List four mechanisms to treat GERD

A

Decrease acid, coat and protect esophagus, improve LES tone, lower abdominal pressure

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7
Q

List two chemicals that stimulate acid production by the parietal cell

A

Acetylcholine and histamine

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8
Q

What chemical stimulates mucus production?

A

Prostaglandins

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9
Q

Which patients typically develop stress ulcers?

A

Critically ill, mechanically ventilated, head trauma and burn trauma

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10
Q

Differentiate the action of histamine at H1 and H2 receptors

A

At H1 receptors, stimulates allergic reactions

At H2 receptors, histamine stimulates gastric acid production

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11
Q

List examples ofhistamine-2 receptor blockers

A

Famotidine, ranitidine (all end in “tidine”)

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12
Q

What drugs commonly interact with H2 receptor blockers?

A

Acid loving drugs like itraconazole, digoxin, iron

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13
Q

List three adverse affects of H2 receptor blockers

A

CNS alterations, confusion, thrombocytopenia

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14
Q

How are H2 receptor blockers eliminated and what determines dose adjustment?

A

Renally illuminated: dose adjustment required when CrCl is less than 50 mL/min

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15
Q

What is bacterial translocation?

A

When normal gut bacteria moves into pulmonary system (causing nosocomial pneumonia) due to increased pH (seen in ICU patients)

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16
Q

What is the most potent form of ulcer treatment?

A

Proton pump inhibitor

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17
Q

How do proton pump inhibitors work?

A

Permanent inhibition of acid secreting ATPase pump in parietal cell (Final common pathway inhibition)

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18
Q

How are PPI’s eliminated?

A

Hepatically – good for patients with renal insufficiency

19
Q

When are prokinetic agents used?

A

Used as anti-emetics, in cases of GERD, and treatment of gastroparesis, and to facilitate feeding tube placement

20
Q

What patients often have gastroparesis?

A

Diabetics with nephropathy

21
Q

Where are NG tubes placed?

A

Post pyloric stomach – to prevent reflux

22
Q

How does metoclopramide work?

A

Enhances upper G.I. response to acetylcholine causing increased G.I. motility and accelerated gastric emptying, also blocks dopamine receptors in chemo trigger zone

23
Q

How does cisapride work?

A

Increases LES tone and G.I. motility and accelerates gastric emptying, enhances G.I. response to Ach at myenteric plexus (effects seen throughout entire G.I. tract)

24
Q

Which prokinetic causes diarrhea especially often?

A

Cisapride

25
Q

What is one potential serious side effect of cisapride (Propulsid)? How is cisapride regulated as a result?

A

QT interval prolongation (torsades)

Propulsid limited access program w/ black box warning

26
Q

What drugs can interact with prokinetic agents like cisapride and metoclopramide?

A

Acetylcholinergics

27
Q

Why is Prilosec often preferred to antacids?

A

Antacids must be taken four times a day, have chalky consistency, only neutralize existing acid

28
Q

What is the effect of aluminum and magnesium respectively?

A

Aluminum – constipation, magnesium – diarrhea

AcMd

29
Q

Which patients must be careful when taking antacids?

A

Patients with hypertension – antacids can contain sodium

30
Q

What is Misoprostol?

A

A prostaglandin analogue that increases mucus in the gut to prevent NSAID induced ulcers

31
Q

List two brand names of Misoprostol

A

Cytotec, Arthrotec (diclofenac and Misoprostol combination)

32
Q

Why does Misoprostol not increase pain if it is a prostaglandin analogue?

A

Affects a different family of prostaglandins

33
Q

List two adverse affects of Misoprostol

A

Diarrhea and uterine contractions (avoid in pregnancy)

34
Q

Which G.I. medication is a category X for pregnancy?

A

Misoprostol -abortifacient

35
Q

What is polyethylene glycol used for?

A

Treatment for constipation (do not confuse with propyleneglycol or ethylene glycol)

36
Q

List whether the following medications are stimulants or lubricants: Docusate sodium, bisacodyl, castor oil, senna

A

Docusate sodium – lubricant bisacodyl – stimulant
Castor Oil – lubricant
Senna- stimulant

37
Q

What is simethicone and how does it work?

A

Surfactant that decreases formation of gas bubbles in G.I. tract to prevent flatulence

38
Q

What is Lomotil?

A

An antimotility agent for treating diarrhea (contains an anti-spasmodic and an anti-cholinergic)

39
Q

How does Loperamide (Imodium) work to treat diarrhea?

A

Decreases gastric motility

40
Q

Which G.I. disturbing bacteria should never be treated with anti-motility agents?

A

C diff – toxin should be flushed out

41
Q

What is first-line defense medication for ulcerative colitis?

A

Sulfasalazine (sulfapyridine and aspirin combination)

42
Q

What treatment for ulcerative colitis has systemic effects?

A

Corticosteroids – should be used as last resort

43
Q

What medication is best for irritable bowel syndrome?

A

Dicyclomine: anti-spasmodic/anti-cholinergic specific to intestinal musculature

44
Q

List eight anti-emetics

A

Antihistamines, phenothiazines, 5-HT3 (serotonin) receptor blockers, prokinetics, BDZs, Canabanoids, corticosteroids, substance P receptor blockers

Pharmacology Exam 3 (8 decks)

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