GI & GU Flashcards
What is nausea?
Nausea is a non-specific symptom that can occur due to multiple causes, including neurological factors, gastroenteritis, motion sickness, low blood sugar, and cardiac symptoms in females.
What is the relationship between nausea and vomiting?
Nausea and vomiting (N/V) can occur together or separately, with nausea often preceding vomiting.
What can induce nausea?
GERD (Gastroesophageal Reflux Disease) may also induce nausea.
What is Gravol (Dimenhydrinate) used for?
Gravol is used for motion sickness, radiation therapy-induced nausea, and Ménière’s disease and vertigo.
How does Gravol work?
Gravol affects the vomiting center in the brain (vagal pathways) and the inner ear.
What is Zofran (Ondansetron) used for?
Zofran is used for chemotherapy-induced nausea and vomiting (CINV) and post-operative N/V prevention.
How does Zofran work?
Zofran blocks serotonin (5-HT3 receptors), which is a neurotransmitter that triggers vomiting.
What neurotransmitters do antiemetics target?
Antiemetics target serotonin, dopamine, and histamine.
What is GERD?
GERD occurs when stomach acid frequently flows back into the esophagus, causing irritation.
What are common symptoms of GERD?
Common symptoms include heartburn, regurgitation, trouble swallowing, and pain when lying down.
What is the mechanism of antacids?
Antacids neutralize stomach acid.
What are examples of antacids?
Examples include aluminum hydroxide gel, calcium carbonate, magnesium hydroxide, and combination antacids like Gaviscon and Pepto-Bismol.
What do H2 blockers do?
H2 blockers block histamine receptors in the stomach lining, reducing acid production.
What are examples of H2 blockers?
Examples include famotidine, cimetidine, and ranitidine.
What do PPIs do?
PPIs block proton pumps in the stomach lining, reducing acid production at the source.
What are examples of PPIs?
Examples include omeprazole, esomeprazole, lansoprazole, and pantoprazole.
What are bladder control medications used for?
Bladder control medications treat overactive bladder and urge incontinence.
How do bladder control medications work?
They use anticholinergics to block acetylcholine, reducing involuntary bladder contractions.
What are examples of bladder control medications?
Examples include oxybutynin, tolterodine, darifenacin, solifenacin, trospium, and fesoterodine.
What are common side effects of bladder control medications?
Common side effects include dry mouth, constipation, blurry vision, rapid heartbeat, and cognitive side effects.
What is the mechanism of loperamide (Imodium)?
Loperamide slows down intestinal motility, allowing more fluid to be absorbed.
What are potential risks of loperamide overdose?
Overdose can cause CNS depression, respiratory depression, and cardiac toxicity.
What are uterotonics used for?
Uterotonics are used to induce uterine contractions.
What is oxytocin?
Oxytocin is produced by the hypothalamus and initiates uterine contractions by binding to oxytocin receptors.
What are prostaglandins used for?
Prostaglandins stimulate uterine contractions and are used for gastric ulcer prevention and labor induction.
What are tocolytics used for?
Tocolytics are used to prevent or delay labor.
What is the mechanism of NSAIDs as tocolytics?
NSAIDs block prostaglandin synthesis to inhibit contractions.
What is the mechanism of magnesium sulfate?
Magnesium sulfate is used to prevent contractions with better tolerance than terbutaline.
What is the cause of erectile dysfunction (ED)?
ED is caused by inadequate blood flow to the penis.
What are the muscles involved in an erection?
The corpus cavernosum and corpus spongiosum are involved in an erection.
What are common oral ED medications?
Common oral ED medications include sildenafil, vardenafil, tadalafil, and avanafil.
What is the mechanism of action for ED medications?
ED medications enhance the effects of nitric oxide (NO), increase cGMP, and prevent cGMP breakdown.
What are common side effects of ED medications?
Common side effects include flushing, headache, indigestion, and nasal congestion.
What are serious adverse effects of ED medications?
Serious adverse effects include priapism, sudden vision loss, and sudden hearing loss.
What is the cGMP pathway?
The cGMP pathway maintains erection by relaxing smooth muscle.
What do PDE5 inhibitors do?
PDE5 inhibitors prevent the breakdown of cGMP, ensuring prolonged vasodilation and blood flow.
What is the generic name of Gravol?
Dimenhydrinate
What is Gravol (Dimenhydrinate) primarily used for?
Preventing motion sickness, treating vertigo, and managing radiation-induced nausea.
What is the mechanism of action for Dimenhydrinate?
It affects the vomiting center in the brain and the inner ear by blocking histamine (H1) receptors.
What is the primary use of Ondansetron (Zofran)?
Preventing and treating nausea and vomiting caused by chemotherapy, radiation, and surgery.
How does Ondansetron (Zofran) work?
It blocks serotonin (5-HT3) receptors in the brain, preventing vomiting signals.
What are common side effects of Zofran?
Headache, constipation, QT prolongation.
Name three classes of medications used to treat GERD.
Antacids, H2 Blockers, Proton Pump Inhibitors (PPIs)
What is the mechanism of action of antacids?
They neutralize stomach acid, providing rapid relief of heartburn and indigestion.
Give two examples of antacids.
Tums (Calcium Carbonate) and Mylanta.
What is the mechanism of H2 blockers?
They block histamine receptors (H2) on gastric parietal cells, reducing acid production.
Name two common H2 blockers.
Famotidine (Pepcid) and Ranitidine (Zantac).
How do Proton Pump Inhibitors (PPIs) work?
They inhibit the H+/K+ ATPase enzyme, blocking gastric acid secretion.
List two examples of PPIs.
Omeprazole (Prilosec) and Pantoprazole (Protonix).
What class of drugs is used to treat overactive bladder?
Anticholinergic medications.
How do anticholinergics treat overactive bladder?
They block acetylcholine, reducing bladder contractions.
Name two medications for overactive bladder.
Oxybutynin (Ditropan) and Solifenacin (Vesicare).
What is a common side effect of anticholinergic bladder medications?
Dry mouth, constipation, and blurry vision.
What is the primary mechanism of Loperamide (Imodium)?
It slows intestinal motility, allowing more fluid absorption and reducing diarrhea.
What are the risks of Loperamide overdose?
Cardiac arrhythmias (QT prolongation), CNS depression, and respiratory depression.
What is the primary use of Oxytocin (Pitocin)?
Inducing labor and managing postpartum hemorrhage.
How does Oxytocin induce labor?
It binds to oxytocin receptors on uterine smooth muscle, causing contractions.
Name a medication used to prevent preterm labor.
Magnesium sulfate.
What is the mechanism of action of magnesium sulfate as a tocolytic?
It inhibits calcium channels, relaxing uterine smooth muscle.
What medication can be used to treat postpartum hemorrhage if oxytocin is ineffective?
Misoprostol (a prostaglandin analog).
What class of medications is used to treat erectile dysfunction?
PDE5 inhibitors.
How do PDE5 inhibitors work?
They enhance nitric oxide (NO) effects, increase cGMP, and improve blood flow to the penis.
Name three common PDE5 inhibitors.
Sildenafil (Viagra), Tadalafil (Cialis), and Vardenafil (Levitra).
What is a serious adverse effect of PDE5 inhibitors?
Priapism (prolonged erection lasting >4 hours).
Why should nitrates not be taken with PDE5 inhibitors?
The combination can cause severe hypotension and cardiovascular collapse.
A 55-year-old male with GERD has persistent symptoms despite antacids. What is the next step?
Start a PPI (e.g., omeprazole).
A patient receiving chemotherapy complains of nausea and vomiting. What medication is most effective?
Ondansetron (Zofran).
A pregnant woman presents with preterm labor at 32 weeks. What is the first-line medication to delay labor?
Magnesium sulfate.
An elderly woman reports frequent urges to urinate and occasional leakage. What medication should be considered?
Oxybutynin (Ditropan) or Solifenacin (Vesicare).
A patient reports severe diarrhea after starting antibiotics. What is the recommended anti-diarrheal?
Loperamide (Imodium), but only if no infection is suspected.
A 65-year-old man with a history of hypertension presents with erectile dysfunction. What medication is appropriate?
Sildenafil (Viagra), with caution for blood pressure.
A 40-year-old woman is experiencing excessive bleeding after delivery. What is the first-line treatment?
Oxytocin (Pitocin).
A 32-week pregnant patient receiving magnesium sulfate develops respiratory depression. What should be done?
Discontinue magnesium sulfate and administer calcium gluconate as an antidote.
A patient develops sudden vision loss after taking sildenafil. What should you do?
Discontinue the medication and refer for urgent ophthalmology evaluation.
A patient presents with prolonged QT on ECG after taking high doses of loperamide. What is the cause?
Cardiac toxicity due to loperamide overdose.
A young female reports severe heartburn during pregnancy. What is the safest medication?
Antacids like Tums (Calcium Carbonate).
A 30-week pregnant woman needs a tocolytic but is allergic to magnesium. What is an alternative?
Nifedipine or Terbutaline.
A patient with GERD and peptic ulcer disease requires long-term acid suppression. What is the best option?
Proton Pump Inhibitors (PPIs).
A 24-year-old female undergoing chemotherapy develops severe nausea and vomiting despite initial antiemetic treatment. What medication can be added to improve symptom control?
Add a corticosteroid (e.g., dexamethasone) or a dopamine antagonist (e.g., metoclopramide).
A patient with a history of motion sickness reports nausea before a long car ride. Which medication should they take beforehand?
Dimenhydrinate (Gravol) – best for motion sickness prevention.
A 40-year-old patient with vertigo reports persistent nausea. What is the most appropriate antiemetic?
Dimenhydrinate (Gravol), as it helps treat vertigo-related nausea.
A postoperative patient develops nausea despite receiving ondansetron. What is an alternative medication?
Metoclopramide or promethazine as an adjunct antiemetic.
A patient receiving radiation therapy for head and neck cancer reports significant nausea. What is the best prophylactic medication?
Ondansetron (Zofran) – for radiation-induced nausea.
A pregnant woman in her first trimester presents with hyperemesis gravidarum. What is the safest antiemetic option?
Vitamin B6 (pyridoxine) and doxylamine; ondansetron can be considered if severe.
A 50-year-old male reports chronic heartburn despite taking antacids for months. What is the next step in treatment?
Start a proton pump inhibitor (PPI) such as omeprazole.
A patient with a history of peptic ulcer disease develops worsening GERD symptoms. Which medication class provides the most effective long-term relief?
Proton pump inhibitors (PPIs).
A 60-year-old male with GERD develops worsening symptoms despite PPI use. What should be the next step?
Consider adding an H2 blocker at bedtime or evaluate for H. pylori infection.
A patient with GERD and osteoporosis presents for follow-up. What concern should you have regarding long-term PPI use?
Risk of osteoporosis and fractures – consider calcium and vitamin D supplementation.
A patient with GERD who is taking both PPIs and NSAIDs develops epigastric pain. What is the best course of action?
Consider switching to COX-2 selective NSAIDs and continue PPI for protection.
A patient with Barrett’s esophagus is on long-term PPI therapy. What is the goal of this therapy?
Prevent progression to esophageal adenocarcinoma by reducing acid exposure.
A 70-year-old woman reports frequent urination and urgency but denies incontinence. What is the most appropriate initial medication?
Oxybutynin (Ditropan) or Tolterodine (Detrol).
A patient with overactive bladder complains of dry mouth and constipation after starting oxybutynin. What is an alternative medication?
Consider switching to solifenacin (Vesicare) or darifenacin with fewer anticholinergic side effects.
A 45-year-old male develops severe diarrhea after taking antibiotics for pneumonia. What should be the next step?
Evaluate for C. difficile infection before administering anti-diarrheal medications.
A patient with irritable bowel syndrome (IBS) complains of frequent diarrhea. What medication can be used for symptomatic relief?
Loperamide (Imodium), if no evidence of infection.
A patient with opioid-induced constipation takes loperamide for diarrhea. What is the potential risk?
Prolonged use can cause toxic megacolon or severe constipation.
A 60-year-old patient with chronic diarrhea develops QT prolongation on ECG. Which medication is the likely cause?
Loperamide overdose – can cause cardiac arrhythmias.
A 38-week pregnant woman presents with postpartum hemorrhage. What is the first-line medication?
Oxytocin (Pitocin) – induces uterine contractions to control bleeding.
A patient undergoing labor induction receives oxytocin. What is a potential complication?
Uterine hyperstimulation, which may lead to fetal distress.
A 32-week pregnant woman presents with preterm labor. What is the first-line tocolytic to delay labor?
Magnesium sulfate.
A patient in preterm labor develops respiratory depression after receiving magnesium sulfate. What should be administered?
Calcium gluconate – antidote for magnesium toxicity.
A patient with a history of NSAID use presents with postpartum hemorrhage. What medication can be given to induce contractions?
Misoprostol (prostaglandin analog).
A woman at 34 weeks gestation presents with preterm contractions. She is allergic to magnesium sulfate. What alternative can be used?
Nifedipine (calcium channel blocker) or Terbutaline.
A 55-year-old male with a history of hypertension presents with erectile dysfunction. What is the best initial treatment?
PDE5 inhibitors, such as Sildenafil (Viagra) or Tadalafil (Cialis).
A patient taking nitrates for angina presents with ED. What medication should be avoided?
PDE5 inhibitors – contraindicated due to risk of severe hypotension.
A patient reports prolonged erection lasting more than 4 hours after taking sildenafil. What is the condition, and what is the next step?
Priapism – requires immediate intervention with aspiration or phenylephrine injection.
A diabetic patient with erectile dysfunction has poor response to PDE5 inhibitors. What is the next option?
Consider intracavernosal injections or vacuum devices.
A 62-year-old male with a history of BPH and ED prefers a medication with a longer duration. What is the best option?
Tadalafil (Cialis) – longer half-life and effective for BPH.
A 68-year-old male with chronic GERD and peptic ulcer disease presents with black tarry stools. What should be done?
Assess for GI bleed, discontinue NSAIDs, and initiate high-dose PPI therapy.
A patient with severe diarrhea after travel to a developing country presents with dehydration. What is the initial treatment?
Oral rehydration therapy and loperamide if no evidence of infection.
A 32-year-old pregnant woman with preterm labor is started on magnesium sulfate. What should be monitored closely?
Respiratory rate, deep tendon reflexes, and urine output to assess for magnesium toxicity.
A patient with recurrent UTIs is placed on oxybutynin for overactive bladder. What potential side effect should be monitored?
Dry mouth, constipation, and cognitive impairment (especially in elderly patients).
A 50-year-old male with GERD has been taking PPIs for over 2 years. What complication should be monitored?
Osteoporosis and hypomagnesemia.
A patient taking tadalafil for ED reports back pain and muscle aches. What is the most likely cause?
A common side effect of tadalafil due to PDE11 inhibition.
A patient with Barrett’s esophagus continues to experience reflux symptoms despite PPI therapy. What is the next step?
Consider endoscopic evaluation or referral for anti-reflux surgery.
A 30-year-old female presents with heavy menstrual bleeding. Which uterotonic can be used for management?
Misoprostol or Oxytocin depending on the clinical situation.
A 45-year-old male with severe GERD reports worsening symptoms after starting ibuprofen for back pain. What is the next step?
Stop NSAIDs and continue PPIs or consider a COX-2 inhibitor.
A 65-year-old male develops new-onset dyspepsia and unintentional weight loss. What should be the next step?
Endoscopy to rule out malignancy or other serious conditions.
