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Pharm > GI Pharm > Flashcards

GI Pharm Flashcards

1
Q

What cell is pepsinogen released from?

A

chief cell

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2
Q

What cell is histamine released from?

A

ECL

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3
Q

What cell is gastrin released from?

A

G-cells

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4
Q

What cell is somatostatin released from?

A

C-cells

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5
Q

What two mechanisms does gastrin activate acid secretion?

A

activates ECL cells

directly activates parietal cells

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6
Q

How does PGE2 inhibit gastric acid formation?

A

couples to Gi

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7
Q

What two stomach cells can acetylcholine activate leading to acid secretion?

A

parietal

ECL

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8
Q

What three mechanisms does somatostatin employ to limit gastric acid secretions?

A

inhibit gastrin release

inhibit ECL cells

inhibit parietal cells

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9
Q

What is the fastest antacid drug to work?

A

sodium bicarb

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10
Q

What antacid drug works at moderate speed?

A

calcium bicarb

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11
Q

What two antacids work at slow speed?

A

aluminum hydroxide

magnesium hydroxide

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12
Q

Metabolic alkalosis can be caused by what antacid?

A

sodium bicarb

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13
Q

What antacid can cause acid rebound?

A

calcium bicarb

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14
Q

What two antacids can cause bloating?

A

sodium bicarb

calcium bicarb

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15
Q

What antacid can cause osmotic diarrhea?

A

magnesium hydroxide

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16
Q

What antacid can cause constipation?

A

aluminum hydroxide

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17
Q

What disease can cause the antacids to produce complications?

A

renal insufficiency

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18
Q

Antacids are as efficacious as what family of GI drug?

A

H2 antagonist

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19
Q

H2R antagonists block which two hormones that usually trigger acid secretion?

A

gastrin

acetylcholine

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20
Q

Are H2R lipophilic or hydrophilic?

A

lipophilic

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21
Q

What are the four H2R?

A

Cimetidine

Rinatidine

Nizatidine

Famotidine

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22
Q

What is the most common effect of H2R antagonists?

A

headache

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23
Q

What are the three endocrine side-effects of H2R antagonists?

A

antagonize androgen receptors

inhibit estradiol synthesis

increase prolactin levels

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24
Q

H2R antagonists inhibit what enzyme?

A

hepatic CYP

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25
Q

What is required for PPI activation?

A

low pH

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26
Q

Where are PPI’s absorbed?

A

small intestine

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27
Q

How many days after initial administration are the PPI’s producing their intended effects?

A

3-4 days

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28
Q

What are the five PPI’s?

A 
Omeprazole
Lansoprazole
Rabeprazole
Esomeprazole
Pantoprazole
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29
Q

How long do the PPIs work for?

A

24 hours

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30
Q

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?

A

B12

calcium, iron and zinc

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31
Q

What two drugs form a protective coating over the stomach? What two agents do these two drugs prevent from exacerbating a peptic ulcer?

A

Sucralfate and bismuth subsalicyclate

H+ and pepsin

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32
Q

What PDE Inhibitor can promote bicarb secretion?

A

Misoprostol

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33
Q

What mucosal protective agent can cause cramping and diarrhea?

A

Misoprostol

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34
Q

What mucosal protective agent can cause blackening of the tongue and stool?

A

bismuth subsalicyclate

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35
Q

What mucosal protective agent can cause diarrhea?

A

Sucralfate

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36
Q

What mucosal protective agent can cause impaired drug absorption?

A

Sucralfate

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37
Q

What two cancers has H. pylori infection been linked to?

A

Lymphoma and adenocarcinoma

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38
Q

What is the transmission route for H. pylori?

A

fecal-oral

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39
Q

The treatment of H. pylori ulcers is done by what drug combination?

A

PPI

clathiromycin

amoxicillin or metronidazole

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40
Q

What does serotonin do in the gut? By what mechanism?

A

promote motility

induces the release of Ach onto M3 receptors or GI smoove muscle

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41
Q

What serotonin receptor promotes gastric motility?

A

5-HT4

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42
Q

What does dopamine do to gastric motility? By what mechanism?

A

decreases

D2 receptors

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43
Q

What hormone promotes gastric motility?

A

motilin

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44
Q

What D2 antagonist can target GI smooth muscle? What is the effect of this?

A

Metoclopramide

Promote motility

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45
Q

What would bethanechol do to gastric motility? Via what mechanism?

A

promote motility

activating of M3 receptor on GI smooth muscle

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46
Q

What would neostigmine do to gastric motility? Via what mechanism? What two conditions can neostigmine be used to treat?

A

increase motility

AchE Inhibitor

ileus and urinary retention (non-obstructive)

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47
Q

What does erythromycin do to gastric motility? Via what mechanism?

A

increases motility

activates motilin receptor

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48
Q

What is the bulk forming laxative? What is the MOA of this drug?

A

Methylcellulose

retains water and adds bulk

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49
Q

What is the surfactant laxative?

A

glycerin

50
Q

What is the osmotic laxative?

A

Lactulose

51
Q

What is the ENS stimulant laxative?

A

Senna

52
Q

What laxative is the serotonin receptor laxative? What specific serotonnin receptor isotype?

A

Tegaserod

5-HT4

53
Q

What laxative is the chloride channel activator? What molecule is this drug a derivative of?

A

Lubiprostone

prostaglandin

54
Q

What two laxatives are the µ-opioid receptor antagonist?

A

Methylnaltrexone

Alvimopan

55
Q

What does distension in the GI tract do?

A

promote peristalsis

56
Q

What are the two opioid receptors agonists used to treat diarrhea?

A

Loperamide

Diphenoxylate

57
Q

What does bismuth subsalicyclate inhibit the synthesis of? Where in the GI tract does this occur?

A

prostaglandin

intestines

58
Q

What bile acid resin is used to treat diarrhea? What other one? Where in the GI tract do these two drugs function?

A

Cholestyramine

Colestipol

ileum

59
Q

What somatostatin receptor agonist is used to treat diarrhea?

A

Octreotide

60
Q

Where in the brain is the emetic center located?

A

medulla

61
Q

What is the isoform of the serotonin receptor found in the GI tract responsible for emesis?

A

5-HT3

62
Q

What receptors are found in the vestibular system regarding emesis?

A

H1 and M1

63
Q

What is another name for the chemoreceptor trigger zone? What three emetic receptors are found here?

A

area postrema

NK1, D2, 5HT3

64
Q

What is another name for the vomiting receptor? What four emetic receptors are found here?

A

nucleus of the tractus solitarius

M1, H1, NK1, 5HT3

65
Q

What four receptors can contribute to emesis but are not found in the emetic center of the brain?

A

GABA

cannabinoid

glucocorticoid

opioid

66
Q

What is the MOA of Ondansetron?

A

5-HT3 Antagonist

67
Q

What is the MOA of scoppolamine?

A

M1 antagonist

68
Q

What is the MOA of metoclopramide?

A

D2 antagonist

69
Q

What is the MOA of dimenhydrinate?

A

H1 antagonist

70
Q

What is the MOA of aprepitant?

A

NK1 antagonist

71
Q

What three receptors can Prochlorperazine inhibit?

A

M1, H1 and D2

72
Q

What is the MOA of lorazepam?

A

GABA agonist

73
Q

What is the MOA of nabilone?

A

cannabinoid agonist

74
Q

What is the MOA of dexamethasone? What other family of drugs can dexamethasone be useful in the treatment of?

A

GR agonist

5-HT3 antagonists

75
Q

What two tricyclic antidepressants can be used to treat IBS?

A

Desipraminine

amitriptyline

76
Q

What two anti-muscarinics can be used to treat IBS pain?

A

Dicyclomine

Hyoscyamine

77
Q

What is the MOA of how tricyclics can treat IBS?

A

downregulates serotonin receptors responsible for GI pain response

78
Q

Which serotonin receptor isotype can relay GI pain?

A

5-HT3

79
Q

Which 5HT3 receptor antagonist is used to treat IBS in women? What is the most important side effect of alosetron?

A

Alosetron

ischemic colitis

80
Q

What two diseases fall under the umbrella of IBS?

A

Ulcerative Colitis

Crohn’s

81
Q

Though Crohn’s disease can effect any part of the GI tract, what is the most often affected region?

A

ileum

82
Q

What layer of the GI tract is the initial site of origin for Crohn’s disease? What two layers does it spread to?

A

Submucosa

mucosa and serosa

83
Q

What specific structure does Ulcerative colitis arise from?

A

Crypts of Lieberkuhn

84
Q

What is the rationale to treat IBD with aminosalicyclates?

A

decrease COX production of prostaglandins

85
Q

What two pro-inflammatory cytokines can aminosalicylates suppress the formation of?

A

IL1

TNF-alpha

86
Q

Why are antimetabolites used during the treatment of IBS?

A

suppress immune cell proliferation

87
Q

What proinflammatory cytokine can aminosalicyclates interfere with?

A

txn of NF-KB

88
Q

What are the two most commonly used orally active aminosalicyclates?

A

Sulfasalazine

Mesalamine

89
Q

What are the three types of patients that receive glucocorticoids for their IBD?

A

respond

respond but flare during tapering

no response

90
Q

What are the four steroids used to treat IBD?

A

Presnisone
Prednisolone
Hydrocortisone
Budesonide

91
Q

What chemokine can glucocorticoids suppress the formation of?

A

IL-8

92
Q

What are the three antimetabolites used to treat IBD?

A

6-mercaptopurine

azathioprine

Methotrexate

93
Q

What is the anti-TNF antibody?

A

Inflixamib

94
Q

What three antibiotics have been shown to be effective in the Tx of IBD?

A

Cipro, Metronidazole and Clathiromycin

95
Q

What do prostaglandins do to GI blood flow?

A

increase

96
Q

Where does bismuth subsalicyclate promote PG synthesis? Inhibit?

A

promote = stomach

inhibit = intestine

97
Q

What metal is contained in sucralfate? What can this metal cause?

A

aluminum

constipation

98
Q

What does aluminum do to smooth muscle contraction?

A

promotes

99
Q

What do prostaglandins do to smooth muscle?

A

promote contraction

100
Q

Which GI drug can produce Parkinsonian life symptoms

A

Metaclopramide

101
Q

Which mu-opioid antagonist, methylnaltrexone or alvimopan, carries a risk for MI after prolonged use?

A

alvimopan

102
Q

How do glucocorticoids prevent emesis?

A

potentiate anti-emetic effects of 5HT3 antagonists

103
Q

Do the aminosalicyclates need to be absorbed to function or can they function at the luminal surface?

A

topically

104
Q

When are antimetobolites used to treat IBD?

A

when pt’s do not respond to steroids

105
Q

What two aminosalicyclates are used to treat IBD?

A

Sulfasalazine

Mesalazine

106
Q

When are low-dose anti-metabolites used to treat IBD?

A

maintenance of therapy

107
Q

Which anti-diarheal drug can produce atropine effects?

A

Diphenoxylate

108
Q

What causes a Cushing Ulcer?

A

head trauma

109
Q

How does castor oil work as a laxative?

A

stimulates GI smooth muscle contraction

110
Q

Aprepitant can cause inhibition of what specif CYP enzyme?

A

CYP3A4

111
Q

What is the Rx name for Loperamide?

A

Imodium

112
Q

Other than motility, activation of 5HT4 receptors in the gut can do what?

A

decrease firing of sensory neurons

113
Q

What causes a Curling ulcer? Where in the GI tract does this manifest?

A

hemorrhage

duodenum

114
Q

Why is Tegaserod no longer on the market?

A

cardiovascular complications

115
Q

Aminosalicyclates inhibit the txn of what molecule?

A

NF-KB

116
Q

What type of drug is used for active IBS?

A

steroids

117
Q

What type of drug is used for remission of IBS?

A

antimetabolites

118
Q

Which anti-ametic can inhibit the CYP enzymes?

A

Aprepitant

119
Q

Which anti-emetic can prolong the QT interval?

A

zofran

120
Q

Why was tegaserod pulled from the market?

A

CV complications

Pharm (12 decks)

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