GI drugs II

Question 1

patho of GERD

Answer 1

inappropriate relaxation, low resting tone, anatomical alteration of the lower esophageal sphincter. acid hypersecretion especially after meals.

Question 2

how to treat GERD simple lifestyle

Answer 2

elevation of head at bed time, avoidance of liquids or foods 2-3hrs before bed, avoid fatty or spicy food, no cigs or ETOH, weight loss, liquid antacids, pregnancy.

Question 3

how to treat GERD with persistent symptoms W/O esophagitis

Answer 3

alginic antacids, promobility drugs, H2-blockers.

Question 4

what promobility drugs treat GERD

Answer 4

cisapride, metaclopramide

Question 5

what H2 blockers treat GERd

Answer 5

cimetidine, ranitidine, famotidine, nizatidine

Question 6

how to treat GERD with persistent symptoms with esophagitis

Answer 6

H2 blockers double dose, H2 blockers and promobility agent. PPI. antireflux surgery

Question 7

what PPI for GERD with esophagitis

Answer 7

omeprazole, lansoprazole, rabeprazole, esomeprazole, pantoprazole, dexlansoprazole.

Question 8

metaclopramide

Answer 8

peripheral dopamine antagonist

Question 9

adverse effects of metaclopramide

Answer 9

tremor.

Question 10

what mediates vomiting

Answer 10

chemo-receptor trigger zone in the medulla vomiting center.

Question 11

what stimulates vomiting

Answer 11

alcohol, ipecac, infection, inflammation, mass effects, vestibular irritation, headaches, apomorphine, chemotherapy.

Question 12

how do antiemetics work

Answer 12

on the chemoreceptor trigger zone

Question 13

what are the phenothiazines and agents

Answer 13

neuroleptic class of antiemetics -perchlorperazine, promethazine

Question 14

mechanism of perchlorperazine

Answer 14

CNS interaction with the dopamine receptor -antagonistic. adverse affects are largely extrapyramidal

Question 15

mechanism of promethzine

Answer 15

antihistaminic and anticholinergic.

Question 16

what are the adverse affects of promethazine

Answer 16

somnolence

Question 17

what are the benzamide derivatives

Answer 17

unknown effect. trimethobenzamide and metaclopramide

SE not as severe as the phenothiazines

Question 18

mechanism of metoclopramide

Answer 18

CNS and peripheral dopamine receptor antagonism

Question 19

tetrahydrocannabinol

Answer 19

probable anticholinergic mechanism

Question 20

what are the serotonin antagonists

Answer 20

ondansetron, granesitron, dolasetron,

Question 21

what are the SE of the serotonin antagonists

Answer 21

HA, dizziness, somnolence

Question 22

what is the treatment for gastroparesis

Answer 22

promotility drugs.

Question 23

what is gastroparesis

Answer 23

obstruction or loss of gastric tone.

Question 24

what are the promobility drugs

Answer 24

metaclopramide, cisapride, domperidone

Question 25

what is secretory diarrhea

Answer 25

increased secretion or decreased absorption of NaCl

Question 26

what is osmotic diarrhea

Answer 26

nonabsorbable molecules in the gut lumen

Question 27

what is inflammatory absoroptive surface diarrhea

Answer 27

destruction of the mucosa impaired absorption, outpouring of blood/mucous

Question 28

what happens in decreased absorption diarrhea

Answer 28

impaired reabsorption of electrolytes

Question 29

what happens in a motility disorder

Answer 29

increased motility with decreased time for absorption of electrolytes and/or nutrients. decreased motility with bacterial overgrowth.

Question 30

5 causes of acute diarrhea

Answer 30

``` viral/bacterial/parasitic infections food poisoning drugs fecal impaction heavy metal poisoning ```

Question 31

travelers diarrhea

Answer 31

bacterial infections, viral and parasitic infections

Question 32

what are the bacterial causes of travelers diarrhea

Answer 32

mediated by enterotoxins made by e coli. mediated by invasion of the mucosa and inflammation by e coli, shigella, camplobacter. or a combination of both enterotoxins and invasion such as salmonella.

Question 33

causes of chronic/recurrent diarrhea

Answer 33

IBS, inflammatory bowel disease, parasitic infections, malabsorption syndrome, drugs, heavy metals.

Question 34

causes of chronic diarrhea of unknown origin

Answer 34

surreptious laxative abuse, IBS, unrecognized inflammatory, bile acid malabsorption, other

Question 35

causes of incontinence

Answer 35

sphincter malfunction (surgeries, fissures, fistulas, hemorrhoids, episiotomy, anal crohns, diabetic neuropathy, idiopathic)

Question 36

what drug classes treat diarrhea

Answer 36

anticholinergics, opioid agonists, colloids and pectins

Question 37

atropine sulfate

Answer 37

treatment of diarrhea by relaxing the bowel smooth muscle.

Question 38

loperamide

Answer 38

opioid treatment for diarrhea, increases rectal tone and disrupts peristalsis via mu receptor

Question 39

diphenoxylate

Answer 39

opioid treatment for diarrhea, usually combined with atropine, mu receptor, contracts the circular muscle causing segmentation. (codeine sulfate works the same)

Question 40

what causes constipation

Answer 40

drugs, functional, colonic, rectal, neurologic, metabolic

Question 41

hwo do we treat constipation

Answer 41

with laxatives or carthartics

Question 42

antiinflammatories for the treatment of colitis

Answer 42

mesalamine, sulfasalazine, olsalazine. corticosteroids and antibiotics.

Question 43

what are the chronic immunosuppressive agents for inflammatory bowel diseases

Answer 43

azothioprine, corticosteroids, infliximab, cyclosporine

Question 44

what is the mechanism of azothioprine

Answer 44

antimetabolite that interferes with DNA synthesis

Question 45

what is the mechanism for infliximab

Answer 45

monoclonal antibody, binds and neutralizes TNF-a

Question 46

what is the mechanism for cyclosporin

Answer 46

polypeptide that inhibits T cell helpers and lymphocytes

Question 47

classes of drugs used to treat IBS

Answer 47

opioids, bulking agents, antidepressants, anticholinergics, serotonergic agonists and antagonists

Question 48

bulking agents

Answer 48

metamucil and fibercon.

Question 49

opioids for IBS

Answer 49

loperamide

Question 50

anticholinergics for IBS

Answer 50

dicyclomine hydrochloride, hyoscyamine sulfate

Question 51

antidepressants for IBS

Answer 51

SSRIs..

Question 52

serotinergic agonists for IBS

Answer 52

for when diarrhea predominates. alosetron. constipation or ischemic bowel can occur

Question 53

serotonergic antagonists for IBS

Answer 53

constipation predominant tegaserod maleate.