GI Flashcards
- 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 _____
Diazepam Midazolam Lidocaine TCAs Cimetidine impotence gynecomastia pregnancy lactation
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 _____
PUD H. Pylori submucosal erosions cyclooxygenase prostaglandins cyclooxygenase mucus bicarbonate epithelial cell blood flow H. Pylori
perforated ulcers aspirin NSAIDs cardiovascular disease arthropathy
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of action) for improvement in symptoms, steroids are started at the same time to produce a faster response and are withdrawn rapidly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)
3-6 Azathioprine 6-Mercaptopurine remission Methotrexate Cyclosporine A Tacrolimus
ERADICATION OF H.PYLORI-DRUG COMBINATION THERAPY
-OAC – _____, _____, and _____ for _____ days;
BMT – _____, _____, and _____ for _____ days;
LAC – _____, _____, and _____ (LAC), for either _____ days or _____ days;
Omeprazole Amoxicillin Clarithromycin 10 Bismuth subsalicylate Metronidazole Tetracycline 14 lansoprazole Amoxicillin Clarithromycin 10 14
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)
pneumonia bone fracture C. difficile Antacids H2 blockers PPIs antibiotics antifungals acidic Clopidogrel
bulk forming
- _____
- _____
stimulants
- _____
- _____
osmotic
- _____
- _____
- _____ (_____)
- _____
wetting agents
- _____
- _____
Psyllium, Methylcellulose
Bisacodyl Senna, Castor oil
Mag hydroxide Lactulose, Glycerin Polyethylene glycol (PEG)
Milk of Magnesia
Docusate
Mineral oil
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
small autoantibodies shortening villi diarrhea Extraintestinal BMD fractures infertility
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 _____
Ondansetron Serotonin 5-HT stool consistency urgency serotonin sensory diarrhea Constipation Ischemic colitis
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 _____
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
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 _____
basal food gastric acid reversible competitive histamine H2 receptors histamine gastrin Ach acid pepsin Nizatidine Famotidine Ranitidine Cimetidine relapses intestine
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
–ve gastric antrum pyloric sphincter oral person-to-person Urease ammonia H+ ions ALKALINE CLOUD gastrin pepsinogen somatostatin duodenal bicarbonate
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 (_____)
Gluten Corticosteroids Immuno-modulators anti-TNF alpha antibody Infliximab Prednisolone Azathioprine Dapsone Salfasalazine Betamethasone valerate dipropionate Clobetasol propionate
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 _____
lower esophageal sphincter (LES) heartburn dyspepsia regurgitation epigastric satiety acid muscular ring hiatal hernia esophagitis bleeding ulcers scarring swallowing Barrett's esophagus cancer
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
cell antibody immunosuppressants production differentiation proliferation Amino-salicylates antibiotics corticosteroids Steroid-dependent Antibiotics fistulas biologic
CD- oral manifestations
- Seen on _____, _____ mucosa and _____
- _____ ulcerations
- Angular _____
- _____ with or without edema of lips
- Mucosal _____ in the gingiva
- Buccal mucosa _____
lips buccal gingiva Aphthous cheilitis Cobblestoning tags abscesses
CLINICIAN’S CONCERNS drug induced: -\_\_\_\_\_ -\_\_\_\_\_ disturbance -\_\_\_\_\_
-may decrease _____ effect of the anticoagulants like _____ and _____
agranulocytosis taste parotitis anticoagulant heparin warfarin
OPIOID RECEPTOR ANTAGONISTS – µ (peripheral)
- _____
- Used in short term tt of opioid _______ without affecting analgesia and withdrawals
Methynaltrexone
induced constipation
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 _____
GABA agonist DA antagonists Promethazine Metoclopramide Domperidone 5HT3 antagonist Granisetron H1 antagonists Hyoscine nabilone, dronabinol
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: _____!
bleeding anemia satiety weight loss dysphagia odynophagia GI cancer abdominal medical emergency
