GI Pharm Flashcards
1
Q
What cell is pepsinogen released from?
A
chief cell
2
Q
What cell is histamine released from?
A
ECL
3
Q
What cell is gastrin released from?
A
G-cells
4
Q
What cell is somatostatin released from?
A
C-cells
5
Q
What two mechanisms does gastrin activate acid secretion?
A
activates ECL cells
directly activates parietal cells
6
Q
How does PGE2 inhibit gastric acid formation?
A
couples to Gi
7
Q
What two stomach cells can acetylcholine activate leading to acid secretion?
A
parietal
ECL
8
Q
What three mechanisms does somatostatin employ to limit gastric acid secretions?
A
inhibit gastrin release
inhibit ECL cells
inhibit parietal cells
9
Q
What is the fastest antacid drug to work?
A
sodium bicarb
10
Q
What antacid drug works at moderate speed?
A
calcium bicarb
11
Q
What two antacids work at slow speed?
A
aluminum hydroxide
magnesium hydroxide
12
Q
Metabolic alkalosis can be caused by what antacid?
A
sodium bicarb
13
Q
What antacid can cause acid rebound?
A
calcium bicarb
14
Q
What two antacids can cause bloating?
A
sodium bicarb
calcium bicarb
15
Q
What antacid can cause osmotic diarrhea?
A
magnesium hydroxide
16
Q
What antacid can cause constipation?
A
aluminum hydroxide
17
Q
What disease can cause the antacids to produce complications?
A
renal insufficiency
18
Q
Antacids are as efficacious as what family of GI drug?
A
H2 antagonist
19
Q
H2R antagonists block which two hormones that usually trigger acid secretion?
A
gastrin
acetylcholine
20
Q
Are H2R lipophilic or hydrophilic?
A
lipophilic
21
Q
What are the four H2R?
A
Cimetidine
Rinatidine
Nizatidine
Famotidine
22
Q
What is the most common effect of H2R antagonists?
A
headache
23
Q
What are the three endocrine side-effects of H2R antagonists?
A
antagonize androgen receptors
inhibit estradiol synthesis
increase prolactin levels
24
Q
H2R antagonists inhibit what enzyme?
A
hepatic CYP
25
What is required for PPI activation?
low pH
26
Where are PPI's absorbed?
small intestine
27
How many days after initial administration are the PPI's producing their intended effects?
3-4 days
28
What are the five PPI's?
```
Omeprazole
Lansoprazole
Rabeprazole
Esomeprazole
Pantoprazole
```
29
How long do the PPIs work for?
24 hours
30
What nutrient can a patient be deficient after long-term PPI use? What three metals can a patient become deficient in after long-term PPI use?
B12
calcium, iron and zinc
31
What two drugs form a protective coating over the stomach? What two agents do these two drugs prevent from exacerbating a peptic ulcer?
Sucralfate and bismuth subsalicyclate
H+ and pepsin
32
What PDE Inhibitor can promote bicarb secretion?
Misoprostol
33
What mucosal protective agent can cause cramping and diarrhea?
Misoprostol
34
What mucosal protective agent can cause blackening of the tongue and stool?
bismuth subsalicyclate
35
What mucosal protective agent can cause diarrhea?
Sucralfate
36
What mucosal protective agent can cause impaired drug absorption?
Sucralfate
37
What two cancers has H. pylori infection been linked to?
Lymphoma and adenocarcinoma
38
What is the transmission route for H. pylori?
fecal-oral
39
The treatment of H. pylori ulcers is done by what drug combination?
PPI
clathiromycin
amoxicillin or metronidazole
40
What does serotonin do in the gut? By what mechanism?
promote motility
induces the release of Ach onto M3 receptors or GI smoove muscle
41
What serotonin receptor promotes gastric motility?
5-HT4
42
What does dopamine do to gastric motility? By what mechanism?
decreases
D2 receptors
43
What hormone promotes gastric motility?
motilin
44
What D2 antagonist can target GI smooth muscle? What is the effect of this?
Metoclopramide
Promote motility
45
What would bethanechol do to gastric motility? Via what mechanism?
promote motility
activating of M3 receptor on GI smooth muscle
46
What would neostigmine do to gastric motility? Via what mechanism? What two conditions can neostigmine be used to treat?
increase motility
AchE Inhibitor
ileus and urinary retention (non-obstructive)
47
What does erythromycin do to gastric motility? Via what mechanism?
increases motility
activates motilin receptor
48
What is the bulk forming laxative? What is the MOA of this drug?
Methylcellulose
retains water and adds bulk
49
What is the surfactant laxative?
glycerin
50
What is the osmotic laxative?
Lactulose
51
What is the ENS stimulant laxative?
Senna
52
What laxative is the serotonin receptor laxative? What specific serotonnin receptor isotype?
Tegaserod
5-HT4
53
What laxative is the chloride channel activator? What molecule is this drug a derivative of?
Lubiprostone
prostaglandin
54
What two laxatives are the µ-opioid receptor antagonist?
Methylnaltrexone
Alvimopan
55
What does distension in the GI tract do?
promote peristalsis
56
What are the two opioid receptors agonists used to treat diarrhea?
Loperamide
Diphenoxylate
57
What does bismuth subsalicyclate inhibit the synthesis of? Where in the GI tract does this occur?
prostaglandin
intestines
58
What bile acid resin is used to treat diarrhea? What other one? Where in the GI tract do these two drugs function?
Cholestyramine
Colestipol
ileum
59
What somatostatin receptor agonist is used to treat diarrhea?
Octreotide
60
Where in the brain is the emetic center located?
medulla
61
What is the isoform of the serotonin receptor found in the GI tract responsible for emesis?
5-HT3
62
What receptors are found in the vestibular system regarding emesis?
H1 and M1
63
What is another name for the chemoreceptor trigger zone? What three emetic receptors are found here?
area postrema
NK1, D2, 5HT3
64
What is another name for the vomiting receptor? What four emetic receptors are found here?
nucleus of the tractus solitarius
M1, H1, NK1, 5HT3
65
What four receptors can contribute to emesis but are not found in the emetic center of the brain?
GABA
cannabinoid
glucocorticoid
opioid
66
What is the MOA of Ondansetron?
5-HT3 Antagonist
67
What is the MOA of scoppolamine?
M1 antagonist
68
What is the MOA of metoclopramide?
D2 antagonist
69
What is the MOA of dimenhydrinate?
H1 antagonist
70
What is the MOA of aprepitant?
NK1 antagonist
71
What three receptors can Prochlorperazine inhibit?
M1, H1 and D2
72
What is the MOA of lorazepam?
GABA agonist
73
What is the MOA of nabilone?
cannabinoid agonist
74
What is the MOA of dexamethasone? What other family of drugs can dexamethasone be useful in the treatment of?
GR agonist
5-HT3 antagonists
75
What two tricyclic antidepressants can be used to treat IBS?
Desipraminine
amitriptyline
76
What two anti-muscarinics can be used to treat IBS pain?
Dicyclomine
Hyoscyamine
77
What is the MOA of how tricyclics can treat IBS?
downregulates serotonin receptors responsible for GI pain response
78
Which serotonin receptor isotype can relay GI pain?
5-HT3
79
Which 5HT3 receptor antagonist is used to treat IBS in women? What is the most important side effect of alosetron?
Alosetron
ischemic colitis
80
What two diseases fall under the umbrella of IBS?
Ulcerative Colitis
Crohn's
81
Though Crohn's disease can effect any part of the GI tract, what is the most often affected region?
ileum
82
What layer of the GI tract is the initial site of origin for Crohn's disease? What two layers does it spread to?
Submucosa
mucosa and serosa
83
What specific structure does Ulcerative colitis arise from?
Crypts of Lieberkuhn
84
What is the rationale to treat IBD with aminosalicyclates?
decrease COX production of prostaglandins
85
What two pro-inflammatory cytokines can aminosalicylates suppress the formation of?
IL1
TNF-alpha
86
Why are antimetabolites used during the treatment of IBS?
suppress immune cell proliferation
87
What proinflammatory cytokine can aminosalicyclates interfere with?
txn of NF-KB
88
What are the two most commonly used orally active aminosalicyclates?
Sulfasalazine
Mesalamine
89
What are the three types of patients that receive glucocorticoids for their IBD?
respond
respond but flare during tapering
no response
90
What are the four steroids used to treat IBD?
Presnisone
Prednisolone
Hydrocortisone
Budesonide
91
What chemokine can glucocorticoids suppress the formation of?
IL-8
92
What are the three antimetabolites used to treat IBD?
6-mercaptopurine
azathioprine
Methotrexate
93
What is the anti-TNF antibody?
Inflixamib
94
What three antibiotics have been shown to be effective in the Tx of IBD?
Cipro, Metronidazole and Clathiromycin
95
What do prostaglandins do to GI blood flow?
increase
96
Where does bismuth subsalicyclate promote PG synthesis? Inhibit?
promote = stomach
inhibit = intestine
97
What metal is contained in sucralfate? What can this metal cause?
aluminum
constipation
98
What does aluminum do to smooth muscle contraction?
promotes
99
What do prostaglandins do to smooth muscle?
promote contraction
100
Which GI drug can produce Parkinsonian life symptoms
Metaclopramide
101
Which mu-opioid antagonist, methylnaltrexone or alvimopan, carries a risk for MI after prolonged use?
alvimopan
102
How do glucocorticoids prevent emesis?
potentiate anti-emetic effects of 5HT3 antagonists
103
Do the aminosalicyclates need to be absorbed to function or can they function at the luminal surface?
topically
104
When are antimetobolites used to treat IBD?
when pt's do not respond to steroids
105
What two aminosalicyclates are used to treat IBD?
Sulfasalazine
Mesalazine
106
When are low-dose anti-metabolites used to treat IBD?
maintenance of therapy
107
Which anti-diarheal drug can produce atropine effects?
Diphenoxylate
108
What causes a Cushing Ulcer?
head trauma
109
How does castor oil work as a laxative?
stimulates GI smooth muscle contraction
110
Aprepitant can cause inhibition of what specif CYP enzyme?
CYP3A4
111
What is the Rx name for Loperamide?
Imodium
112
Other than motility, activation of 5HT4 receptors in the gut can do what?
decrease firing of sensory neurons
113
What causes a Curling ulcer? Where in the GI tract does this manifest?
hemorrhage
duodenum
114
Why is Tegaserod no longer on the market?
cardiovascular complications
115
Aminosalicyclates inhibit the txn of what molecule?
NF-KB
116
What type of drug is used for active IBS?
steroids
117
What type of drug is used for remission of IBS?
antimetabolites
118
Which anti-ametic can inhibit the CYP enzymes?
Aprepitant
119
Which anti-emetic can prolong the QT interval?
zofran
120
Why was tegaserod pulled from the market?
CV complications
