GI Flashcards

1
Q
  • Lower the dose of _____, _____, _____ or _____ as H2 blockers may decrease their metabolism and enhance duration of action (slower recovery)
  • _____ is a weak anti-androgenic: may produce _____ and _____ in males
  • Contraindicated in _____ and _____
A
Diazepam
Midazolam
Lidocaine
TCAs
Cimetidine
impotence
gynecomastia
pregnancy
lactation
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2
Q

NSAIDs

  • NSAIDs are the most common cause of _____ in patients without _____ infection
  • topical effects of NDAIDs cause submucosal _____. in addition, by inhibiting _____, NSAIDs inhibit the formation of _____ (PGE2) and their protective _____-2-mediated effects (i.e., enhancing gastric mucosal protection by stimulating _____ and _____ secretion and _____ proliferation and increasing mucosal _____)
  • coexisting _____ infection increases the likelihood and intensity of NSAID- induced damage
  • NSAID use is responsible for approximately one half of _____, which occur most commonly in older patients who are taking _____ or other _____ for _____ or _____
A
PUD
H. Pylori
submucosal erosions
cyclooxygenase
prostaglandins
cyclooxygenase
mucus
bicarbonate
epithelial cell
blood flow
H. Pylori
perforated ulcers
aspirin
NSAIDs
cardiovascular disease
arthropathy
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3
Q

STEROID SPARING: Decrease the long-term need for steroids for recurring flares

  • takes _____ months (slow onset of action) for improvement in symptoms, steroids are started at the same time to produce a faster response and are withdrawn rapidly
  • oral: _____ (Azasan, Imuran )and _____ (Purinethol)
  • used to maintain _____
  • Other examples : _____ (weekly injections), _____ and _____ (Topical- for Pyoderma Gangrenosum)
A
3-6
Azathioprine
6-Mercaptopurine
remission
Methotrexate
Cyclosporine A
Tacrolimus
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4
Q

ERADICATION OF H.PYLORI-DRUG COMBINATION THERAPY
-OAC – _____, _____, and _____ for _____ days;
BMT – _____, _____, and _____ for _____ days;
LAC – _____, _____, and _____ (LAC), for either _____ days or _____ days;

A
Omeprazole
Amoxicillin
Clarithromycin
10
Bismuth subsalicylate
Metronidazole
Tetracycline
14
lansoprazole
Amoxicillin
Clarithromycin
10
14
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5
Q

SE of PPI

  • Increased risk of _____ and _____
  • A risk factor for _____ infection via alteration of the colonic flora
  • Combination therapy: _____ + _____ + _____
  • PPIs may reduce absorption of some _____ and _____ (require _____ environment for absorption)
  • Decrease efficacy of _____ (PPIs inhibit CYP2C19 enzyme, thus interfering with the conversion of Clopidogrel into its active metabolite)
A
pneumonia
bone fracture
C. difficile
Antacids
H2 blockers
PPIs
antibiotics
antifungals
acidic
Clopidogrel
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6
Q

bulk forming

  • _____
  • _____

stimulants

  • _____
  • _____

osmotic

  • _____
  • _____
  • _____ (_____)
  • _____

wetting agents

  • _____
  • _____
A

Psyllium, Methylcellulose

Bisacodyl Senna, Castor oil

Mag hydroxide Lactulose, Glycerin Polyethylene glycol (PEG)
Milk of Magnesia

Docusate
Mineral oil

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7
Q

CELIAC DISEASE (GLUTEN SENSITIVE ENTEROPATHY)

  • Autoimmune disorder of _____ intestine in genetically predisposed (HLA DQ2, DQ8, or both)
  • An inflammatory reaction to dietary gluten resulting in production of _____ that may produce _____ of the _____ (villous atrophy)
  • Intestinal manifestations- _____, flatulance and weight loss.
  • _____- iron deficiency anemia(palor), decreased bone mineral density, dermatitis herpetiformis, neuropathy and muscle wasting
  • Left untreated- low _____ (vitamin D def) and risk for _____
  • Women- risk of _____, spontaneous abortions, preterm deliveries, and LBW
A
small
autoantibodies
shortening
villi
diarrhea
Extraintestinal
BMD
fractures
infertility
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8
Q

2: 5HT3 RECEPTOR ANTAGONISTS FOR IBS-D
- _____ (Zofran) – has excellent safety record
- _____ is present in the entero-chromaffin cells (EC cells)
- These patients have higher mucosal _____ concentrations in the colon
- Improve QOL by slowing transit, reducing bowel frequency, normalizing _____, and reducing _____
- Blocks _____ signals that transmit _____ information (painful and non painful) from the gut to the brain and helps to reduce _____ and abdominal pain.
- SE: _____ (25%) and _____

A
Ondansetron
Serotonin
5-HT
stool consistency
urgency
serotonin
sensory
diarrhea
Constipation
Ischemic colitis
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9
Q

antacids: _____ + _____ = _____ + _____

  • act as buffers to neutralize _____ (act within _____)
  • therapeutic effect is by _____ or _____ properties
  • salts of _____, _____, or _____
  • available as chewable/dissolving tablets, liquid and gums
  • examples: _____, _____, _____
  • inhibit _____ activity by raising pH to _____
  • side effects- _____ (_____ salts) and _____ (_____ salts)
  • mixture of these two can preserve normal _____ function
  • antacids impair the absorption of _____, oral _____, _____, _____, _____, _____ and _____
A
acid
alkali
salt
water
H+ ions
mins
physical
chemical
aluminum
magnesium
calcium
alka-seltzer
gelusil
tums
peptic
5
diarrhea
Mg
constipation
Al
bowel
tetracycline
iron
fluoride
ciprofloxacin
erythromycin
metronidazole
thyroxine
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10
Q

H2 blockers- inhibit _____ and _____ stimulated _____ secretion

  • ________ ________ inhibitors of _____ at all H2- receptors
  • highly selective for _____
  • inhibit _____, _____, and _____ stimulated _____ secretion
  • _____ secretion also falls with reduction in acid volume
  • available both by OTC and prescription:
  • _____ (Tazac, Axid)
  • _____ (Pepcid)
  • _____ (Zantac)
  • _____ (Tagamet)
  • _____ are likely to follow when treatment is stopped
  • all agents are rapidly absorbed from _____
A
basal
food
gastric acid
reversible competitive 
histamine
H2 receptors
histamine
gastrin
Ach
acid
pepsin
Nizatidine
Famotidine
Ranitidine
Cimetidine
relapses
intestine
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11
Q

H. Pylori

  • Gram _____, spiral bact, in _____ and _____
  • Infection occurs by _____ route
  • _____ cavity may be the permanent reservoir (found in dental plaque and saliva) and a _____ route is the most probable mode of transmission
  • Several virulence factors are produced:
  • _____
  • this converts urea into _____ which buffers _____ and creates an _____ (allows to survive for years)
  • Results in
  • High levels of _____ and _____ and reduced levels of _____
  • Impaired _____ secretion
A
–ve
gastric antrum
pyloric sphincter
oral
person-to-person
Urease
ammonia
H+ ions
ALKALINE CLOUD
gastrin
pepsinogen
somatostatin
duodenal bicarbonate
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12
Q

treatment

  • _____-free diet (Dietary education should focus on identifying hidden sources of gluten, planning balanced meals, reading labels, food shopping, dining out, and dining during travel)
  • 5% of patients are refractory to a gluten-free diet
  • Refractory patients –
  • -_____
  • -_____
  • -Remission may be induced by the _____ and maintained with _____ and _____.
  • Dermatitis herpetiformis – _____ skin ointment, _____ or potent topical Steroids (_____ or _____) or very potent (_____)
A
Gluten
Corticosteroids
Immuno-modulators
anti-TNF alpha antibody Infliximab
Prednisolone
Azathioprine
Dapsone
Salfasalazine
Betamethasone valerate
dipropionate
Clobetasol propionate
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13
Q

GERD: a digestive disorder of the _____ (_____)

  • symptoms: chronic _____, _____, _____, _____ pain and early _____
  • Reflux – Excess _____ production, weakness of _____ at LES or _____
  • > 9 million primary care visits annually in US
  • Most common cause of _____
  • If left untreated, esophagitis can cause _____, _____, and chronic _____
  • Scarring narrows the esophagus and interferes with _____
  • Long standing GERD symptoms may cause _____ (10-15%) increasing the likelihood of _____
A
lower esophageal sphincter (LES)
heartburn
dyspepsia
regurgitation
epigastric
satiety
acid
muscular ring
hiatal hernia
esophagitis
bleeding
ulcers
scarring
swallowing
Barrett's esophagus
cancer
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14
Q

STEP III-IMMUNOMODULATORS (Steroid-Sparing drugs)

  • MOA: inhibit _____ mediated and _____ mediated immune reactions- _____
  • inhibit _____, _____ and _____ of cells
  • used if:
  • -No-response or intolerance to _____, _____ or _____
  • -_____ disease or frequent need for steroids
  • -Perianal disease that does not respond to _____
  • -_____
  • -To bolster the effect of a _____ drug and prevent the development of resistance to biologic drugs
  • -Prevent recurrence after surgery
A
cell
antibody
immunosuppressants
production
differentiation
proliferation
Amino-salicylates
antibiotics
corticosteroids
Steroid-dependent
Antibiotics
fistulas
biologic
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15
Q

CD- oral manifestations

  • Seen on _____, _____ mucosa and _____
  • _____ ulcerations
  • Angular _____
  • _____ with or without edema of lips
  • Mucosal _____ in the gingiva
  • Buccal mucosa _____
A
lips
buccal
gingiva
Aphthous
cheilitis
Cobblestoning
tags
abscesses
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16
Q
CLINICIAN’S CONCERNS
drug induced:
-\_\_\_\_\_
-\_\_\_\_\_ disturbance
-\_\_\_\_\_

-may decrease _____ effect of the anticoagulants like _____ and _____

A
agranulocytosis
taste
parotitis
anticoagulant
heparin
warfarin
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17
Q

OPIOID RECEPTOR ANTAGONISTS – µ (peripheral)

  • _____
  • Used in short term tt of opioid _______ without affecting analgesia and withdrawals
A

Methynaltrexone

induced constipation

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18
Q

antiemetics
-_____ – Benzodiazepines like lorazepam
-_____ – Antipsychotics like _____, Prochlorperazine
-D2 antagonists in CTZ and peripheral pro-kinetic action – _____ and _____
-_____ – Ondansetron, Granisetron
_____ is highly selective, high-affinity, non cardiotoxic and safe in children
-_____ – Meclizine, Cinnarizine, Cyclizine, Dimenhydrinate, Promethazine and Diphenhydramine
-Muscarinic antagonists– _____( Scopolamine as a transdermal patch)
-Corticosteroid combination and neurokinin 1 (NK1) receptor antagonist – Aprepitant
-Partial CB1 agonist – _____ and _____

A
GABA agonist
DA antagonists
Promethazine
Metoclopramide
Domperidone
5HT3 antagonist
Granisetron
H1 antagonists
Hyoscine
nabilone, dronabinol
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19
Q

ALARM FEATURES” that warrant prompt gastroenterology referral

  • _____
  • _____
  • early _____
  • unexplained _____
  • progressive _____ or _____
  • recurrent vomiting and family history of _____

-patients with perforated PUD usually present with a sudden onset of severe, sharp _____ pain: _____!

A
bleeding
anemia
satiety
weight loss
dysphagia
odynophagia
GI cancer
abdominal
medical emergency
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20
Q

ANALGESIC OF CHOICE IN PUD AND IBD PATIENTS

  • Avoid prescribing _____ and _____
  • Use _____ or _____ (selective COX-2inhibitor) in combination with _____ or _____
  • IBD pt – avoid long term use of _____, especially in elderly and debilitated to minimize risk of _____
  • Monitor for signs and symptoms of _____
  • Selection of antibiotics for oral infections may be influenced by recent use of antibiotics for _____
A
Aspirin
NSAIDs
Acetaminophen
Celecoxib
PPI
Misoprostal
antibiotics
pseudomembranous colitis
diarrhea
PUD
21
Q

MANAGEMENT1: OPIOIDS FOR IBS-D

  • _____ (Imodium) - binds to the _____ receptor in the gut wallConsequently, inhibiting the release of _____ and _____, thereby reducing _____, and increasing intestinal transit time.
  • Improves QOL as it allows planning of trips and socializing- anxious IBS-D patients
  • Maximum daily dose is 8mg for adults as OTC use and 16mg as prescription use.
  • Much higher doses can cause _____ and even death.
A
Loperamide
opiate
Ach
PGs
peristalsis
cardiotoxicity
22
Q

COLLOIDAL BISMUTH COMPOUNDS-Indirectly inhibit acid secretion

  • Suppress _____ infection and reduce the hypersecretion of _____
  • Form an _____ over the ulcer base preventing further damage by acid and pepsin- _____ drug mechanism
  • Adverse effects: _____ of the _____ and darkening of the _____
  • No significant drug interactions
  • Available as _____, _____
A
H. pylori
acid
insoluble protective layer
Physical
blackening
stool
tongue
Pepto-Bismol
Kaopectate
23
Q

GASTRITIS: inflammation, irritation or erosion of _____

  • acute/chronic
  • causes:
  • -excessive _____ use
  • -chronic _____
  • -_____
  • -medications such as _____, other _____ and _____
  • ______
  • _____ reflux
  • infections caused by _____ and _____
  • if left untreated- severe loss of _____ and increased risk of developing _____
A
stomach lining
alcohol
vomiting
stress
aspirin
NSAIDs
bisphosphonates
H. pylori
bile
bacteria
viruses
blood
stomach cancer
24
Q

3: SECRETAGOGUES FOR IBS-C
-Guanylate cyclase-C receptor agonist: Stimulates _____ secretion by activation of type 2 _____ via _____ (an intracellular second messenger) which in turn promotes _____
–_____ (Amitiza)- does not alter pain thresholds during rectal distension, acts on ____ receptors stimulating chloride receptors, _____ take care of pain
–_____ (Linzess) - improves pain as well by blocking pain signals, works on _____ channels, stimulating chloride receptors, takes care of pain
SE: _____

A
chloride
Cl- ion channels
cGMP
peristalsis
Lubiprostone
GCC
does not
Linaclotide
chloride 2
Diarrhea
25
COMMON SIDE EFFECTS WITH IMMUNOSUPPRESSANT DRUGS - _____ and _____: Canker sores, bone marrow suppression (increase the risk of infection or serious ______) and increased risk of ____________ - _____ and _____: increased risk of infections, high blood pressure, swollen _____, tingling of the fingers and feet, increased _____ - _____: Severe mouth sores and low ___ count. Addition of ______ may reduce some side effects.
``` Azathioprine 6MP bleeding non-hodgkins lymphoma Cyclosporine tacrolimus gums facial hair Methotrexate WBC folic acid ```
26
SUCRALFATE - A salt of sucrose complexed to sulfated _______ - MOA: Similar to ______ compounds - SE: _____ - Contraindicated in _____ because of the risk of _____ absorption and toxicity - Drug interactions: Can reduce the absorption of drugs such as _____ and _____ - Available as _____
``` Aluminum hydroxide bismuth Constipation chronic renal failure Aluminum Phenytoin Tetracycline Carafate ```
27
laxative abuse - Eating disorders – _____ (binge eating followed by purging) - Quick weight control – _____ (boxing, wrestling) - _____ – something is wrong if they don't move their bowels every day
Bulimia Combat sports Older adults
28
STEP IV: BIOLOGIC THERAPY WITH MONOCLONAL ANTIBODIES - _____: If not responded or intolerant to Corticosteroid and/or an Immunosuppressant - -_____ (IV) – Remicade - -_____ (SC) – Humira - -_____ – Cimzia - TNF is a _____ agent in the body's immune response and is _____ in IBD - Watch-out for reactivation of latent _____ and other opportunistic infections, _____ - Cautious use in pts with _____
``` Tumor necrosis factor (TNF) inhibitors Infliximab Adalimumab Certolizumab pegol cytokine upregulated TB Hepatitis B heart failure ```
29
treatment of oral lesions - Local _____ injections to the lesion - _____ 2% in severe cases - Topical _____ at low concentrations of 0.5 mg/kg - 1% _____ ointment three times daily - Steroid _____ (Dexamethasone elixir) - Topical _____ ointment for refractory aphthous ulcers
``` Corticosteroid Lidocaine Tacrolimus Hydrocortisone mouthwashes Dexamethasone ```
30
MISOPROSTOL – A synthetic PGE1 analog - Has _____ inhibitory and _____ protective properties - Simulates _____ and _____ secretion and enhance mucosal blood flow - Binds to a _____ receptor on parietal cells, reducing _____ mediated ____production - Is an _____ drug (stimulates uterine contraction), so not to be used during pregnancy - No significant drug interactions are reported - Available as _____, _____
``` acid inhibitory mucosal mucus bicarbonate prostaglandin histamine, c-AMP abortifacient Cytotec Misodel ```
31
management - Bulk forming – Absorb _____ and _____ to increase _____ pressure (increase in peristalsis) - Stimulants – Stimulate _____ in intestinal smooth muscle, increase mucosal permeability (moves fluids into lumen) - Osmotics – Increase _____ (stimulate peristalsis by increasing intraluminal pressure) - Wetting agents – _____ to ease passage (act like detergents and soften stools by reducing _____, thus allowing intestinal fluids, fatty substances to penetrate fecal mass)
``` water expand intraluminal enteric nerves fluid volume Moisten surface tension ```
32
STEP II- CORTICOSTEROIDS(ANTI-INFLAMMATORY) - For _____ disease flares only - Decrease inflammation by reversing increased capillary _____ and suppressing _____ activity - Not effective in preventing complications or progression of disease - ___-term use is discouraged due to side effects - _____ and _____ Prep (Suppositories, enemas and rectal foams) - -_____ (O) - -_____ (O, Top) - -_____ (O, Inj) - -_____ (O, Top) an enteric-coated controlled-release capsule delivers active _____ to the distal _____ and _____
``` acute increased capillary permeability PMN Oral rectal Prednisone hydrocortisone methylprednisone budesonide glucocorticoid distal small intestine colon ```
33
constipation - 74% nursing home residents - _____, lack of _____, or use of certain medications (_____, _____, _____, _____, _____ and Supplements like _____/_____) - Underlying ds- Stroke, Parkinson's disease, Diabetes, Spinal cord injury, Multiple sclerosis, Hypothyroidism etc - Most pts use OTC remedies and don't report - Discomfort, bloating, hemorrhoids or fecal impaction - Mistaken belief: everyone should move their bowels each day, can lead to dangerous _____ overuse - Bowel movements _____/wk may be normal and healthy for some
``` Diet physical activity Opioids CCBs diuretics antidepressants antacids iron/calcium laxative 3 ```
34
PUD: peptic ulcer disease (gastric/duodenal) | -_____ that develops on the _____ lining of the stomach and or the _____ portion of _____ (extends through _____ mucosa)
``` open sore inside upper SI muscularis ```
35
- _____: inflammation of superficial gastric mucosa - _____: destruction of multiple small zones of superficial mucosa - _____: destruction of full thickness of mucosa
superficial gastritis erosive gastritis gastric ulceration
36
TRAVELLER’S DIARRHEA - Acute diarrhea in those who travel to developing countries and have adventuresome _____ behavior - Main source of infection: Food and water contaminated with _____ matter - Bacteria: _____, Campylobacter, _____, and Shigella - Luxury resorts & cruise ships (_____ virus) - Seafood ingestion syndromes : _____ numbness and reversal of _____ sensation - More susceptible: Immunocompromised or lowered _____ (e.g., on _____ or _____)
``` eating fecal E coli Salmonella Noro Perioral temperature gastric acidity H2blockers PPIs ```
37
MANAGEMENT- Stepwise approach (step-up) - Step I – 5-ASA (_____) _____ daily basis (life long maintenance) - -_____-Pentasa, Rowasa, Asacol - -_____ – Azulfidine - -_____ – Giazo - MOA: exert topical _____ effect by reduction in synthesis of inflammatory _____ (inhibition of _____ production, blocking of _____) - Side effects: _____, Vomiting and GI upset (poor compliance), _____ discoloration of secretions, decrease in _____ absorption (supplements, megaloblastic anemia) - Used during flares and for maintaining _____ - Overall: safe, well-tolerated but drug _____ is very imp - Caution: Patients prescribed anti-inflammatory drugs may have an _____ effect
``` Aminosalicylic acid twice Mesalazine Sulphasalazine Balsalaside anti-inflammatory inflammatory cytokines arachidonic acid metabolite PG synthesis Nausea yellow-orange folate remission compliance additive ```
38
inflammatory bowel disease (IBD) - idiopathic disease - dysfunction of the _____ and _____ immune system - two major types: - -ulcerative colitis (US): limited to the _____ mucosa - -crohns disease (CD): affects any segment of GIT from _____ to _____, involves _____ lesions and is _____ -there is a genetic predisposition for IBD, and patients are more prone to development of _____
``` innate adaptive colonic mouth anus skip transmural malignancy ```
39
h2 blockers pharmacokinetics - undergo _____ metabolism resulting in bioavailability of _____ (except _____) - action starts within an _____ and DOA is _____ hours based on the dose administered - ADRs: _____, _____, _____, _____, _____ and _____ - these drugs are cleared by combination of _____ metabolism, _____ filtration, and _____ secretion - dose reduction is required in patients with moderate to severe _____ and _____ insufficiency - in the elderly, a decrease in _____ and _____ decline in drug clearance occurs
``` first pass hepatic 50% Nizatidine hour 8-12 xerostomia diarrhea myalgia headache constipation fatigue hepatic glomerular renal tubular renal hepatic volume of distribution 50% ```
40
PUD treatment - Address the underlying cause - Lifestyle changes: - Reduction in _____ and _____ foods - _____ loss - Head of bed _____ & avoidance of meals _____ before _____ - Eradication of _____ infection - Withdraw _____ - Anti-secretory therapy 1: _____ 2: _____ blockers 3: _____ inhibitors (PPIs)
``` fatty spicy weight elevation 2-3 hours bedtime H pylori NSAIDs Antacids H2 proton pump ```
41
symptoms of IBD - Abdominal cramping and pain- Commonly in _____ in CD and in _____ or _____ in UC - Irregular bowel habits, passage of _____ with/without blood or pus, _____ - Weight loss, _____ (during flare-up) - _____, _____, _____ - _____ (50%) - Perianal disease (_____, _____): 50% patients with CD - _____ and delayed or failed _____ maturation in children - Malabsorption of _____, _____ and other nutrients leading to _____ and _____ lesions
``` RLQ periumbilical LLQ mucus tenesmus Fever Malaise Arthralgia Uveitis Pyoderma gangrenosum fistulas abscesses Growth retardation sexual iron B12 anemia oral ```
42
proton pump inhibitors- most potent -Given orally: _____ (Prilosec), _____ (Prevacid), _____ (Protonix) -Are _____ that require gastric acid secretion to be converted to the active _____ or _____. -_____ bioavailability is high (77% to 90%) and show equivalent efficacy -Bind to the _____ irreversibly -Half-life is about _____ hour (9 hours for Tenatoprazole, but the duration of acid inhibition is _____ hours (pumps take around 50 hours to resynthesize) -Most PPIs are metabolized by CYP2C19 and CYP3A4. __________ and ______ reduce clearance of the PPIs, as do mutations in CYP2C19.
``` Omeprazole Lansoprazole Pantoprazole prodrugs Sulfenamide Sulfenic acid Oral H,K-ATPase 1 48 hepatic impairment, old age ```
43
irritable bowel syndrome - abdominal pain or discomfort accompanied by a change in _____ habit and an abnormal _____ frequency: - -_____ is a>3 bowel movement/day - -_____ is <3 movements/week - prevalence is 10-15% - more common in _____ 2:1 - often coexists with other GI disorders, both functional (_____, chronic _____) and organic (_____ disease, _____, _____)
``` bowel stool diarrhea constipation women dyspepsia constipation celiac GERD IBD ```
44
STEP 1A- ANTIBIOTICS - Used more often for _____ disease, _____, _____ masses in CD - Most commonly used antibiotics are : - -_____ - -_____
``` perianal fistulas intra-abdominal inflammatory Ciprofloxacin Metronidazole ```
45
GERD and extra-esophageal symptoms - Refluxed gastric contents can go into the throat, airways and lungs causing irritation or damage: - -Chronic _____ - -Chronic _____ - -_____ - -_____ - Progressive breathing problems - Pulmonary diseases (adult-onset _____ or pulmonary _____) -Distinguish _____ from _____ chest pain before diagnosing GERD
``` cough laryngitis aspiration pneumonia asthma fibrosis cardiac non-cardiac ```
46
h2 blockers clinical relevance - use of H2 blockers before treatment ( _____ premedication/surgeries) is beneficial in _____ patients - _____ and _____ may occasionally cause thrombocytopenia - GI pH is _____, concurrent use causes marked reduction in absorption of _____. advise patients to take at a different time. - _____ alters the blood flow to the liver and is an enzyme inhibitor: can enhance DOA of other medications, especially _____ - cimetidine inhibits the metabolism of _____ and _____
``` anesthetic GERD cimetidine ranitidine increased antifungals cimetidine analgesics phenytoin warfarin ```
47
symptoms of PUD - _____ stomach pain - feeling of _____ - _____ or _____ - _____ food intolerance - _____ - _____ - gastric ulcer- pain is _____ after _____ - duodenal ulcer- _____ after meals - etiology is similar to _____ - _____ alone do not increase the risk for PUD, can potentiate _____ risk in patients who use _____ concurrently
``` burning fullness bloating belching fatty heartburn nausea shortly meals 2-3 hours meals gastritis corticosteroids ulcer NSAIDs ```
48
traveller's diarrhea - DD: _____ (e.g., Staphylococcus aureus, Bacillus cereus) - _____ prohylaxis : Not recommended - Avoid high-risk _____ (street vendors) and eating behaviors (cold sauces, salsas) - Empiric treatment: - -_____ solutions (sometimes change in H20 and electrolyte imbalance is the cause of diarrhea) - -_____ agonists – Increase colonic transit time (anti-_____) and Increase fecal water absorption (anti-______) - _____ (does not cross BBB so no addiction potential), has _____ effects - _____ + _____ (Lomotil), CNS effects at higher doses - _____ - Rifaximin (Salix), also used in IBS as has anti-inflammatory and antibacterial properties
``` Gastroenteritis Antibiotic foods Oral rehydration solutions Opioid agonists motility, secratory Loperamide anticholinergic Diphenoxylate atropine Antibiotics ```
49
GI diseases Esophagus –_____ (_____) Stomach – _____, _____ (PUD) Intestines – -Acute: _____ (Bacteria, Viruses and Protozoa) / Traveler’s _____ Chronic: _____ (duodenum), _____ diseases (IBD- UC/Crohn’s), _____ (_____), and _____ disease -_____ Rectum and Anus – Anal fissures, _____
``` Gastroesophageal reflux disease (GERD) gastritis peptic ulcer disease Gasteroenteritis diarrhea Peptic ulcer disease Inflammatory bowel Irritable bowel syndrome (IBS) Coeliac constipation Hemorrhoids ```