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GI Flashcards

1
Q

Drugs categories that affect gastric secretion?

A

Antacids
H2RAs
PPIs
Protectants

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2
Q

When are drugs affecting gastric treatment used?

A 
Dyspepsia (indigestion)
Gastric/duodenal ulcers
GERD
Barrett's Esophagus
Hypersecretory states (Zollinger-Ellison)
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3
Q

What are the steps that lead to gastric acid release?

A

Dietary peptides in lumen bind to G cells
G cells produce gastrin
Gastrin stimulates ECL cells to make histamine
Histamine binds to parietal cells
Parietal cells produce H+ ions that go into the stomach

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4
Q

What inhibits gastric acid production? (molecule and cell that makes it)

A

Somatastatin released by D cells in response to stomach acid

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5
Q

Ulcers: A failure of _____ _____

A

mucosal protection

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6
Q

_____ maintains the mucosal layer

A

prostaglandins

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7
Q

Parietal cells have what pump for acid production?

A

H/K/ATPase (proton pump)

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8
Q

What do NSAIDs inhibit?

A

PGE production –> decreased mucous production

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9
Q

What controls histamine release by ECL cells (besides gastrin)

A

ENS - by releasing acetylcholine

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10
Q

Does chloride move out of parietal cells with or against its gradient?

A

Against

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11
Q

How do antacids work?

A

They neutralize acids

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12
Q

What are the antacids?

A

Sodium bicarb
Calcium bicarb
Aluminum hydroxide
Magnesium hydroxide

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13
Q

Side effects: Sodium bicarb

A

systemic alkalosis, fluid retention

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14
Q

Side effects: calcium bicarb

A

hypercalcemia, nephrolithiasis, milk-alkali syndrome

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15
Q

Side effects: aluminum hydroxide

A

Constipation, hypophosphatemia

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16
Q

Side effects: Magnesium hydroxide

A

Diarrhea, hypermagnesemia

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17
Q

AlternaGEL

A

Aluminum hydroxide

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18
Q

Tums

A

Calcium carbonate

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19
Q

Maalox/Mylanta

A

Aluminum hydroxide & mag hydroxide

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20
Q

Rolaids

A

Calcium bicarb & mag hydroxide

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21
Q

Alka-Seltzer

A

ASA & NaHCO3 (for hangovers)

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22
Q

Gaviscon

A

Sodium alginate + antacids (weak base)

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23
Q

What does Gaviscon do?

A

Prevent reflux and effective in GERD

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24
Q

What are the dosage forms of commercial antacids?

A

chewable tablets

Liquid suspension

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25
What's the first-gen H2RA?
Cimetidine
26
H2RAs reduce gastric acid secretion in response to what?
Histamine, gastrin, acetylcholine (things upstream of histamine)
27
Cons of cimetidine?
DRUG INTERACTIONS CNS effects (esp elderly) Antiandrogen Thrombocytopenia
28
What's the benefit of cimetidine?
Clears up warts
29
What CYPs does cimetidine inhibit?
2C6 and 2D9
30
2nd gen H2RAs?
Ranitidine Nizatidine Famotidine
31
2nd gen h2RAs have longer or shorter half-life?
Loner --> daily dosing
32
2nd gen H2RA more or less potent?
More
33
Where do PPIs work?
Directly on proton pump in parietal cell
34
What's vanoprazan?
Potassium-competitive acid blocker (NOT PPI - acts on transmembrane region)
35
What are the PPIs?
``` -Oprazole's Esomeprazole Omeprazole Lansoprazole Pantoprazole Rabeprazole ```
36
T/F: PPIs are prodrugs
True - activated by acid in parietal cells
37
PPIs should be taken when?
In the morning
38
PPIs are reversible/irreversible?
Irreversible
39
PPIs have a short/long half life?
Short - but long effect b/c they irreversibly inhibit PPIs until protein is turned over
40
Side effect of PPIs?
Hypergastrinemia --> hypsecretion upon drug withdrawal
41
Why does hypergastrinemia occur?
B/c PPIs are inhibiting negative feedback of acid onto G cells, which causes lots of gastrin to be produced
42
How do PPIs react w/ PP?
Disulfide bond - via sulfur
43
How long do PPIs take for full effect?
1-4 days
44
ADEs of PPIs?
``` Nausea CYP2C19 interactions (w/ omeprazole) Increased infection Vit B12 deficiency Decreased Ca absorption/increased bone fractures ```
45
Do PPIs decrease acid more or less than H2RAs?
More
46
Do H2RAs or PPIs work faster?
H2RAs
47
What is acid rebound?
Gastric acid secretion increased upon wtihdrawal of meds
48
PPI --> decreased Ca absorption --> what?
Increased parathyroid hormone Increased bone resorption decrease bone strength Fractures
49
Do PPIs cause dementia?
No - just correlation
50
PPI recommendations: which patients?
GERD | Barret esophagus
51
Should patients on PPIS for GERD stay on PPIs forever?
No try to stop/reduce if uncomplicated GERD
52
What should NOT be taken with PPIs?
Probiotics!
53
T/F: Take Ca, Vit B12, mag with PPI
No - don't raise intake above daily recommended allowance
54
What are mucosal protectants?
Sucralfate Misoprostol Bismuth subsalicylate
55
Sucralfate is a ____ complex of ___
Aluminum hydroxide complex of sucrose
56
Sucralfate works how?
Polymerizes at ulcer site to prevent protective barrier
57
Sucralfate activated by __ pH
Acidic
58
Misoprostol MOA?
PGE1 derivative --> enhanced mucus and bicarb secretion
59
ADEs of misoprostol?
Diarrhea, abortifacient
60
What causes peptic ulcers?
H Pylori
61
How does H Pylori cause peptic ulcers?
Reduces D-cell production of somatastatin | Increase gastrin secretion
62
Therapy to eradicate H Pylori?
Bismuth salt (PeptoBismol) Antibiotic H2 blocker/PPI Ranitidine bismuth citrate (Tritec)
63
What antibiotics for H Pylori?
Metronidazole Tetracycline Amoxicillin Clarithromycin
64
Use of peptobismol?
Mild diarrhea | H Pylori eradication
65
What is bismuth subsalicyate converted to in GI
bismuth salt and salicylic acid
66
What controls GI motility?
ENS innervation (enteric nervous system)
67
Myenteric plexus receives input and signals what?
Parasympathetic and sympathetic response
68
Submocal plexus signas what?
Parasympathetic only
69
Threet ypes of laxatives?
Bulk/saline Stool softeners Secretory/stimulant
70
How do bulk/saline laxatives work?
Non-absorbale, hydrophilic mass in the presence of water - draws water into the intestines, which leads to distention/stretch response
71
What are bulk/saline laxatives?
Psyllium, methylcellulose, bran, milk of mag, non absorbable sugars (also PEG is similar)
72
How do stool softeners work?
Surfactant/lubricant to increase H20 absorption and pass stool more easily
73
What are stool softener examples?
Docusate, mineral oil, glycerin
74
Stool softeners can decrease absorption of ___
fat solubler vitamins
75
Secretory/stimulant laxative examples
``` Castor oil Dephenylmethane derivatives (Bisacodyl) Anthraquinones (Cascara, senna, aloes) ```
76
How do secretory/stimulant work?
Irritate mucous, affects fluid balance and induces peristalsis
77
What is gastroparesis?
Neuropathy that slows GI - usually from diabetes or PD
78
What is ileus?
Small bowel doesn't recover after surgery
79
What receptors affect the cholinergic motor neuron that stimulates smooth muscle?
5-HT4 Motilin D2 M3 on smooth muscle cells
80
Metoclopramide mechanism?
D2 receptor antagonist --> increased Ach release
81
What are metocolopramide side effects?
Sedation, PD, hyperprolactinemia
82
Metoclopramide uses?
Gastric emptying, gastroparesis, GERD
83
What's erythromycin?
Motillin agonist - rapid tolerance
84
What's neostigmine?
Ach esterase inhibitor (Toxicity)
85
What's bethanechol
Agonist of muscarinic acid receptors (toxicity)
86
Prucalopride?
5HT4 agonist (not approved yet)
87
What drugs activate GCC to activate the chloride channel?
Plecanatide | Linaclotide
88
What drug directly activates chloride channel?
Lubiprostone
89
What are chloride channel activators used in?
IBS + Constipation
90
What do Cl channel activators do?
Increase Cl-fluid secretion into intestine
91
What opioid pathway causes constipation?
B-arrestin
92
Opioid receptors ___ smooth muscle contraction
Decrease
93
What strategy to overcome opioid constipation?
Drug that only works on G protein pathway, not Beta arrestin (Oliceridine)
94
WHat are centrally acting opioid antagonist?
Naloxone Naltrexone Nalmefene
95
What are peripherally acting opioid antagonists?
Naloxegol Alvimopan Naldemedine
96
Where do anti-diarrhealas work?
On smooth muscle innervation to slow process - allows increased water absorption
97
Opiate anti-diarrheals?
Loperamide and diphenoxylate (w/atropine) - have poor CNS penetration
98
What are anti-diarrheal options?
Bismuth | Cholestyramine/colestipol/colesevam
99
What do bile-salt binding resins do for diarrhea?
Ion exchange resins - correct osmotic imbalance
100
ADE of bile-salt binding resins?
Decrease abs or drugs and fat-soluble vitamins
101
IBS?
Abdominal pain + distension + diarrhea/constipation
102
What is alosetron?
5HT3 antagonist for women w/IBS + diarrhea
103
What are the drugs to inhibit GI motility?
Anti-diarrheals opiates ANticholinergics
104
What are anticholinergic drugs for GI?
Dicyclomine | Hysoscyamine
105
Side effect of 5HT3 receptor antagonists?
Constipation!
106
What's the effect of serotonin in the GI?
Stimulates peristalsis and signals to CNS emetic centers
107
What's Akynzeo?
Combo of neutpitant and palonosetron
108
When are 5ht3 antogonists used?
For chemo-induced NV
109
Cannabinoid use?
N/V with chemo - refractory
110
Cannabinoid drugs?
Dranobinol | Nabilone
111
Motion sickness anti-emetics?
Antihistamines/anticholinergics Diphenhydramine Meclizine Scopolamine
112
Does scopolamine or meclizine have more anticholinergic effects?
scopolamine
113
Dopamine antagonists?
``` Prochlorperazine Promethazine Thiethylperazine Droperidol Metocolopramide Trimethobenzamine ```

Pharmacotherapy IV (5 decks)

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