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OP: PASS PCOL!!! > GI Motility And Water Reflux, Emesis, And Biliary And Pancreatic Disease > Flashcards

GI Motility And Water Reflux, Emesis, And Biliary And Pancreatic Disease Flashcards

1
Q

Most important regulator of physiological gut function

A

Enteric Nervous System

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2
Q

ENS is an extensive collection of nerves that constitute the _ of the ANS

A

Third Division

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3
Q

ENS lies within the wall of the ___

A

GI tract

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4
Q

Nerve fiber found between the circular and longitudinal muscle layers

A

Myenteric/Auerbach’ Plexus

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5
Q

Nerve fiber located within the submucosa

A

Submucosal/Meissner’s

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6
Q

What is the primary neurotransmitter of the excitatory motor neuron?

A

Acetylcholine (Ach)

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7
Q

Principal neurotransmitter in the inhibitory motor neurons

A

Nitric Oxide (NO)

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8
Q

Cells scattered throughout the epithelium of the intestine

A

Enterochromaffin Cells

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9
Q

Enterochromaffin cells secrete ______

A

Serotonin (5-HT)

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10
Q

Impaired relaxation of the lower oesophagal sphincter associated with defective oesophagal peristalsis that results in dysphagia and regurgitation

A

Achalasia of the esophagus

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11
Q

Delayed gastric emptying

A

Gastroparesis

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12
Q

Presentin in the GI tract and has several inhibitory effects involving motility, reduce lower esophageal sphincter and intragastric pressure

A

Dopamine

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13
Q

ACh is released from ___

A

Myenteric Motor Neurons

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14
Q

Half life of metoclopramide domperidone

A

4-6 hours

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15
Q

Metoclopramide undergoes___ and ____

A

Sulfation and Glucoronide Conjugation

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16
Q

Used as an adjunctive measure in medical or diagnostic procedures

A

Metoclopramide injection

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17
Q

Used for the treatment of persistent hiccups

A

Metoclopramide

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18
Q

When is metoclopramide administered?

A

30 mins. before meal and at bedtime

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19
Q

Metoclopramide onset of action after an ORAL dose

A

30-60 minutes

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20
Q

Metoclopramide onset of action if given INTRAMUSCULARLY

A

10-15 mins

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21
Q

Metoclopramide onset of action after given INTRAVENOUSLY

A

1-3 minutes

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22
Q

It predominantly antagonizes the D2 receptors without the major involvement of other receptors

A

Domperidone

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23
Q

Dosage of Domperidone

A

10-20 mg 3x a day

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24
Q

T or F. Domperidone does not readily cross the blood-brain barrier

A

True

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25
Q

It plays an important role in the
normal motor and secretory
function of the gut.

A

5-HT / Serotonin

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26
Q

How many percent of total 5-HT in the body exists in the GI tract

A

> 90%

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27
Q

What specialized cell produces 5-HT?

A

Enterochromaffin Cells

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28
Q

5-HT triggers peristaltic reflex by stimulating intrinsic sensory neurons in the myenteric plexus via which receptors?

A

5-HT1p and 5-HT4 receptors

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29
Q

5-HT triggers peristaltic reflex by stimulating extrinsic vagal and spinal sensory neurons via which receptor?

A

5-HT3 receptors

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30
Q

It is a benzofuran derivative and a specific 5-HT4-receptor agonist that facilitates cholinergic neurotransmission

A

Prucalopride

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31
Q

Prucalopride acts throughout the length of the ____ increasing _____ and _____ without affecting gastric emptying in healthy volunteers

A

intestine; oral-cecal transit; colonic transit

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32
Q

It is a potent contractile agent of the upper GI tract

A

Motilin

33
Q

Motilin is a ____ peptide hormone found in the GI ___ and in some _______ of the ______

A

22-amino acid; M cells; enterochromffin cells; upper small bowel

34
Q

Motilin levels ___ in association wiih the migrating motor complex

A

Fluctuates

35
Q

Motilin appears to be responsible for the amplification, if not the actual induction of ______

A

Phase 3 activity

36
Q

Motilin receptors are found on _____ and ____

A

Smooth muscle cells and Enteric neurons

37
Q

It mimics the effects of motilin

A

Erythromycin

38
Q

Motilin-like effects are most pronounced at higher doses of ___

A

250-500 mg

39
Q

The best established use of erythromycin as a prokinetic agent is in patients with _____, where it can improve _____ in short term

A

Diabetic gastroparesis; gastric emptying

40
Q

Erythromycin induces ____ migrating motor complex in dogs and increases ______

A

phase 3; smooth muscle contractility

41
Q

Multiple effects if erythromycin on upper GI motility (Enumerate the 2)

A
  1. Increasing lower esophageal pressure
  2. Stimulating gastric and small-bowel contractility
42
Q

Erythromycin has little or no effect on __

A

Colonic motility

43
Q

Intravenous standard dose of erythromycin for gastric stimulation

A

3 mg/kg

44
Q

Standard dose for gastric stimulation of erythromycin for ORAL administration

A

200-250 mg every 8 hours

45
Q

A macrolide nonantibiotic that shows promise for the treatment of gastroparesis

A

Mitemcinal (GM-611)

46
Q

Decreased stool frequency

A

Constipation

47
Q

Useful for the treatment of chronic constipation

A

Prucalopride

48
Q

Synthetic prostaglandin analog primarily used for protection against gastric ulcers resulting from the use of NSAIDs

A

Misoprostol

49
Q

Microtubule formation inhibitor used for gout

A

Colchicine

50
Q

Prostanoid activator of Cl channels

A

Lubiprostone (Amitiza)

51
Q

14-amino acid peptide agonist of granulated cyclase C that stimulates secretion and motility

A

Linaclotide

52
Q

This compound shows promise in the treatment of IBS-C and chronic constipation

A

Linaclotide

53
Q

Its promising strategy is the prevention of opioid-induced constipation with peripherally acting MOR antagonist

A

Lubiprostone

54
Q

It was the approved treatment of opioid induced in 2008

A

Methylnaltrexone

55
Q

Approved treatment of opioid-induced constipation in adult patients with chronic noncancer pain

A

Naldemedine

56
Q

Oral Dosage of Naldemedine

A

0.2 mg/day

57
Q

Approved treatment for opioid-induced constipation in adults

A

Naloxegol

58
Q

Dosage of Naloxegol for ORAL admnistration

A

1.25 or 25 mg once per day

59
Q

Drug given for post operative ileus

A

Alvimopan

60
Q

Alvimpoan is given ___ prior to surgery and then twice daily for up to maximum of ___ days or until discharge, not exceeding __ doses

A

30 mins. to 5 h; 7 days; 15

61
Q

Excessive fluid weight, with 200 g per day

A

Diarrhea

62
Q

Stool weight is determined by ___

A

Stool water

63
Q

Most cases of diarrhea result from disorders of ____ and ____

A

Intestinal water; electrolyte transport

64
Q

These drugs absorb water and increase stool bulk. They are used for constipation but are sometimes useful in acute episodic diarrhea and in mild chronic diarrhea in patients suffering with IBS

A

Carboxymethyl Cellulose and Calcium Polycarbophil

65
Q

These drugs bind water avidly and also may bind enterotoxins

A

Clays (Kaolin) and Silicates (Attapulgite)

66
Q

This drug absorbs 8x its weight in water

A

Attapulgite

67
Q

These agents are best avoided within 2-3 hours of taking other medications

A

Clays and other Silicates

68
Q

Bile acid sequestration (Name 3)

A
  1. Cholestyramine
  2. Cholestipol
  3. Colesevalam
69
Q

It is useful in the treatment of bile salt-induced diarrhea, as in patients with resection of the distal ileum

A

Cholestyramine

70
Q

It is helpful for the relief of pruritus associated with partial biliary obstruction and in conditions such as primary biliary cirrhosis

A

Cholestyramine

71
Q

These drugs are widely used in the treatment of diarrhea

A

Opioids

72
Q

Mechanisms of Opoids include effects on intestinal motility ____, intestinal secretion ___ or absorption _____

A

µ receptors; δ receptors; µ and δ receptors

73
Q

It is a piperidine bhtyramide derivative with µ receptor activity, and is an orally active anti-diarrheal agent

A

Loperamide

74
Q

Loperamide is a______ derivative

A

Piperidine butyramide derivative

75
Q

Loperamide is ____ times more potent than morphine as an anti-diarrheal agent and penetrate the CNS __

A

40-50x; poorly

76
Q

These are piperidine derivatives that are related structurally to meperidine

A

Diphenoxylate and Difenoxin

77
Q

An octapeptide analog of somatostatin (SST) that is effective in inhibiting the severe secretory diarrhea brought about by hormone secreting tumors of the pancreas and the GI tract

A

Octreotide and Somatostatin

78
Q

The mechanism of action of Octreotide and Somatostatin appears to involve inhibition of hormone secretion, including ____ and other various ____

A

5-HT; GI peptides

OP: PASS PCOL!!! (2 decks)

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