GI

Question 1

What are the 4 substances that stimulate acid production in the stomach?

Answer 1

Gastrin–from antrum
Ach–vagal inputs, CNS
Histamine–stimulated by Ach and gastrin
Parietal Cell H+/K+ ATPase–final common pathway of other 3

Question 2

What is the mechanism of action of Histamine for acid production?

Answer 2

Increases intracellular adenyl cyclase and cyclic AMP–activate or increase the amount of K/H ATPase

Question 3

What is the mechanism of action of Gastrin for acid production?

Answer 3

Causes influx of Ca++ which in turn activates the K/H ATPase

Question 4

What pharmacologic intervention neutralizes acid?

Answer 4

Antacids

Question 5

What pharmacologic intervention decreases acid production?

Answer 5

Anticholinergics–antimuscarinic
Antihistamines
Proton Pump inhibitors

Question 6

What pharmacologic intervention increases mucosal resistance?

Answer 6

Prostaglandins
Sucralfate
Bismuth

Question 7

Reacts slowly with HCl to form calcium chloride and carbonic acid?

Answer 7

Calcium carbonate

Question 8

What is the disadvantage of using calcium carbonate for ulcer tx and gerd and how is this fixed?

Answer 8

Constipating–use in combination with magnesium compounds which are laxatives

Question 9

What are the side effects of Calcium carbonate?

Answer 9

Milk-alkali syndrome
Nephrocalcinosis
Rebound acidity
Digitalis antagonism

Question 10

What is sodium bicarbonate rarely used for Ulcer tx and GERD?

Answer 10

Induces systemic alkalosis

Question 11

What drug has enhanced affects of amphetamine, quinidine, and cinchophen?

Answer 11

Sodium bicarbonate

Question 12

What are the side effects of magnesium hydroxide and magnesium carbonate used for Ulcer Tx and GERD?

Answer 12

Diarrhea
Hypokalemia
Hypermagnesemia
Complexing of enteric iron
Iron deficiency

May cause magnesium toxicity in the presence of renal disease

Question 13

Combines with HCl to form aluminum chloride and water?

Answer 13

Aluminum hydroxide

Question 14

What antacid is used in renal failure pts?

Answer 14

Aluminum hydroxide

Question 15

What are the major side effects of aluminum hydroxide?

Answer 15

Phosphate depletion and sequelae–weakness, anemia, tetany, apnea

Constipation

Question 16

What do anticholinergic agents do to help with the treatment of Ulcers?

Answer 16

Vagotomy type effect–reduction of HCl secretion: Spasmolytic effect

Question 17

What are the side effects of the anticholinergic agents used for ulcer tx?

Answer 17

Dryness of the mouth
Blurred vision
Atony of bladder
Constipation
Drowsiness
Mental confusion

Question 18

Anticholinergic agents are contraindicated in pts with…

Answer 18

Known pyloric obstruction

Pts with hiatus hernia and peptic esophagitis

Question 19

Name the anticholinergic agents used for ulcer tx…

Answer 19

Atropine sulfate
Propantheline
Methantheline bromide

Question 20

When should anticholinergic agents be administered?

Answer 20

30 min before a meal and at bedtime–attempt to reduce nocturnal secretion by vagal block

Question 21

What are Histamine (H2) receptor blockers used for?

Answer 21

Ulcer tx
Prophylactically for stress ulcers
GERD

Question 22

Name the Histamine (H2) receptor blockers?

Answer 22

Cimetidine
Ranitidine
Famotidine
Nizatidine

Competitive inhibition of the receptor

Question 23

What is the major side effect of the H2 receptor blockers?

Answer 23

Rebound acidity if stopped suddenly

Question 24

What are the uncommon side effects of the H2 receptor blockers?

Answer 24

Headache
Lethargy
Confusion
Depression
Hallucination

Question 25

What 2 H2 receptor blockers bind to cytochrome P450 and interferer with the metabolism of drugs such as theophylline, warfarin, dilatin, lidocaine?

Answer 25

Cimetidine | Ranitidine

Question 26

Name the H/K ATPase inhibitors

Answer 26

``` Omeprazole Lansoprazole Rabeprazole Esomeprazole Pantoprazole Dexlansoprazole--Essentially lansoprazole with a rapid release and extended release component ``` Noncompetitive inhibitors

Question 27

What is required in order for the proton pump inhibitors to work?

Answer 27

Requires acid env. to activate --Dont take with antacids

Question 28

What are the side effect of the proton pump inhibitors?

Answer 28

Headache Gynecomastia Gastric hyperplasia and carcinoid tumors in rats lon term

Question 29

What are the 2 proton pump inhibitors that are used for H. pylori tx?

Answer 29

Omeprazole and Lansoprazole

Question 30

Omeprazole and Lansoprazole are used in combination with what to tx H. pylori?

Answer 30

Tetracycline Metronidazole Clarithromycin

Question 31

Which proton pump inhibitor has the most P450 inhibition?

Answer 31

Omeprazole

Question 32

What are factors that lead to impaired mucosal defense?

Answer 32

NSAIDs H. pylori Zollinger-Ellison syndrome--gastrinoma Smoking Genetics Stress

Question 33

What are the 2 drugs that coat ulcer crater and increase mucosal resistance?

Answer 33

Bismuth salts | Sucralfate

Question 34

What is the mechanism of action of Bismuth salts?

Answer 34

In acid environment it forms crystals that precipitate on the ulcer crater

Question 35

What is the mechanism of action of Sucralfate?

Answer 35

An aluminum hydroxide complex of sucrose, binds to ulcerated tissue, activated in acid env.

Question 36

What are the side effects of Bismuth salts and sucralfate?

Answer 36

Aluminum toxicity possible in renal failure Bismuth salts--turn BM black

Question 37

What are Sucralfate and Bismuth salts used for?

Answer 37

Ulcer tx Tx of H. pylori--combination with tetracycline, metronidazole, and clerithromycin

Question 38

What drug is used with pt who are using a lot of NSAIDs, such as RA pts?

Answer 38

Misoprostol--Prostaglandin E analog

Question 39

What are the 3 things that misoprostol does?

Answer 39

Decrease acid production Increase mucous secretion Increase HCO3 secretion

Question 40

Why isn't Misoprostol very effective

Answer 40

Because endogenous prostaglandin levels are already high in duodenal ulcer pts

Question 41

What are the preferred therapies for H. pylori infection?

Answer 41

A PPI or Ranitidine Bismuth citrate BID + 2 of: Amoxicillin, Clarithromycin, metronidazole

Question 42

Name the promotility agents used for GERD and gastroparesis?

Answer 42

Metochlorpramide--also used as anti-emetic Cisapride Domperidone--only used for Gastroparesis

Question 43

Increase motor tone in lower esophageal sphincter and stomach and also a peripheral and CNS dopamine antagonist?

Answer 43

Metochlorpramide

Question 44

What is the major side effect of metochlorpramide?

Answer 44

Hand tremor and extrapyramidal symptoms

Question 45

Increase motor tone in lower esophageal sphincter and stomach and can cause sudden cardiac death?

Answer 45

Cisapride

Question 46

Promotility agent that improves gastric tone and is used for gastroparesis?

Answer 46

Domperidone

Question 47

Has probable CNS interaction with dopaminergic receptor-antagonist--> leading to reduction of stimulation in the CRTZ in the medulla----used as anti-emetic?

Answer 47

Prochlorperazine

Question 48

What are the side effects of prochlorperazine?

Answer 48

Extra-pyramidal--torticollis

Question 49

Antihistaminic (H1 receptor), anticholinergic used as anti-emetic?

Answer 49

Promethazine

Question 50

What is the major side effect of promethazine?

Answer 50

Somnolence--especially in elderly

Question 51

Benzamide derivative used as anti-emetic?

Answer 51

Trimethobenzamide

Question 52

Suppresses CRTZ by anticholinergic mechanism and is used as anti-emetic and causes the munchies?

Answer 52

Tetrahydrocannabinol

Question 53

Name the 3 drugs used as anti-emetics that block serotonin at 5HT3 receptor in central CRTZ?

Answer 53

Odansetron Granesitron Dolasetron

Question 54

What are the side effects of the 5HT3 receptor antagonists used as anti-emetics?

Answer 54

Headache Dizziness Somnolence

Question 55

What anti-cholinergic is used for the tx of diarrhea by relaxing all bowel smooth muscle?

Answer 55

Atropine sulfate

Question 56

These drugs have less penetration to CNS, stimulates mu receptors in GI tract--increasing rectal tone--disrupting peristalsis--increased absorption time--used for tx of diarrhea (IBS)?

Answer 56

Loperamide --opioid agonist Dipheoxylate--opioid agonist Codeine sulfate--opioid agonist

Question 57

What two anti-diarrheal meds are contraindicated in chowder--because narcotic will cause respiratory suppression?

Answer 57

Dipheoxylate and codeine sulfate

Question 58

What is Lomotil?

Answer 58

Diphenoxylate + atropine

Question 59

What drugs absorb water, but don't precent potential dehydration and are used for the tx of diarrhea?

Answer 59

Metamucil--colloid | Bismuth subsalicylate--pectin

Question 60

Name the irritates of the lumen of the colon that causes peristaltic contractions and are used for constipation...

Answer 60

``` Castor oil Cascara sagrada Senna extract Bisacodyl Phenolphthalein ```

Question 61

Name the osmotic cathartics that draw water into the colon and are used for constipation and to clean the bowel prior to colonoscopy...

Answer 61

``` Magnesium citrate Magnesium sulfate Sodium sulfate Milk of magnesia Sodium phosphate Lactulose ```

Question 62

Bulk forming hydrophilic colloid used for the tx of constipation...

Answer 62

Psyllium seed Methylcellulose Sodium carboxymethylcellulose

Question 63

Lubricant and fecal softeners used for the tx of constipation?

Answer 63

Mineral oil Dioctyl sodium sulfo-succinate Poloxalkol

Question 64

Name the 3 anti-inflammatory agents that work from the lumen to reduce inflammation in pts with acute IBD (UC)...

Answer 64

Sulfasalazine Olsalazine Mesalamine

Question 65

Which of the 3 anti0inflammatory agents can cause toxicity coming from systemic absorption of sulfapyridine--is used for acute IBD (UC)?

Answer 65

Sulfasalazine

Question 66

Which anti-inflammatory used for acute IBD (UC) has a delayed release 5-ASA in order to tx terminal ileum and colon?

Answer 66

Mesalamine

Question 67

Purine antimetabolite that interferes with DNA synthesis and is used for the tx of chronic IBD?

Answer 67

Azathioprine

Question 68

Drug that suppresses T helper and T suppressor lymphocytes and is used for the tx of chronic IBD?

Answer 68

Cyclosporine

Question 69

Monoclonal Ab that binds and neutralizes TNFa and is used for the tx of chronic IBD?

Answer 69

Infliximab

Question 70

Anticholingeric agents that block cholinergic action and are used to reduce spasm in IBS?

Answer 70

Dicyclomine HCl | Hyoscyamine sulfate

Question 71

Used for the tx of diarrhea seen in irritable bowel syndrome by blocking 5HT3?

Answer 71

Alosetron

Question 72

What are the side effects of Alosetron?

Answer 72

Ischemic bowel | Constipation

Question 73

Used for the tx of constipation in irritable bowel syndrome by stimulating 5HT4 receptor?

Answer 73

Tegaserod maleate