GI Pharm Flashcards by tcarlso 3

What are the acid secreting cells within the stomach?

Parietal cells

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What are the pepsin secreting cells within the stomach?

Chief cells

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What are the two major “aggressive factors” that the stomach secretes?

Pepsinogen

HCl

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What is the major “protective factor” that the stomach secretes?

bicarb

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What are the transporters in parietal cells that secrete H+ ions?

H/K ATPase

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What cells in the stomach secrete intrinsic factor? What is the role of intrinsic factor?

Parietal cells

Vitamin B12 absorption

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What are the cells in the stomach that secrete mucus/bicarb?

Superficial epithelial cells

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What are the cells in the stomach that secrete histamine?

ECL cells

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What are the cells in the stomach that secrete gastrin?

G cells

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What are the cells in the stomach that secrete ACh?

NErve cells

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What is the role that ACh plays in the stomach?

Promotes mucus, bicarb, and HCl secretion

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What are the cells in the stomach that serete somatostatin? What is the role of somatostatin?

D cells

Suppressses HCl secretion

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What is the role of gastrin?

Increases HCl output from parietal cells

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What is the effect of PGE2 in the stomach?

Decreases the output of H/K ATPases

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What is the neuronal input to gatric acid secretion? Does this facilitate or impair secretion?

ACh

Facilitates

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What is the paracrine input to gatric acid secretion? Does this facilitate or impair secretion?

Histamine

Facilitates

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What is the endocrine input to gatric acid secretion? Does this facilitate or impair secretion?

Gastrin

Facilitates

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What is the role of pepsinogen?

Protein digestion

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What do enterochromaffin cells secrete?

Histamine

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Besides their direct effect on parietal cells, how else do ACh and gastrin increase HCl secretion?

Induce histamine release

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What are the two substances that increase protective factor secretion?

ACh

Prostaglandins

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Do prostraglandin exert their effects on gastric cells via that endocrine, or paracrine pathway

Paracrine

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What are the three major effects of prostagladins?

Increase mucus/bicarb
Suppress HCl
Increase gastric blood flow

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What are peptic ulcers?

Break i nthe protective mucosal lining of the lower esophagus, stomach, or duodenum

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What are duodenal ulcers?

Ulcers of the duodenum

Which occur more frequently: peptic, duodenal, or gatric ulcers?

Duodenal

What are gastric ulcers?

Ulcers of the stomach

What is a cushing ulcer?

Stress ulcers associated with head trauma of brain surgery

What are ischemic ulcers?

Ulcers caused by hemorrhage, severe burns

What are the two most common causes of ulcers in the US?

NSAIDs | H. Pylori infx

True or false: rapid gastric empyting may cause ulcers?

True

ASA inhibits what enzyme?

COX1/2

True or false: melena or BRBPR are symptoms of an ulcer

True

The goal of antacids is to raise the pH of the stomach above what level?

What are the two MOA of antacids?

neutralize acid | Stimulate prostaglandin secretion

What is the duration of action for the simple antacids?

1-2 hours

What is the specific, adverse effect of using NaHCO3? (3)

metabolic alkalosis Excessive NaCl absorption Gas/bloating

What is the specific adverse effect of using CaCO3?

acid rebound | gas/bloating

What is the specific, adverse effect of using Mg(OH)2?

Osmotic diarrhea | Hypermagnesemia

What is the specific, adverse effect of using Al(OH)2?

Constipation

What is the major drawback of using simple antacids for treating ulcers?

Have to dose often

What is the acid rebound effect of CaCO3?

Increase the output of acid when neutralized

What disease increases the liklihood of having hypermagnesemia, hypercalcemia etc when taking simple antacids?

Renal insufficiency

True or false: simple antacids are usually used in combination with other therapies

True

True or false: simple antacids are equally efficacious as H2 receptor antagonists

True

What is the GERD heal rate of simple antacids?

50%

What is the peptic ulcer rate heal rate of simple antacids?

80%

Milk of magnesia is what chemcial?

Mg(OH)2

Alka-seltzer is what chemial?

NaHCO3

Histamine receptors use what type of receptor (Na gates or G protein)?

G protein coupled

Histamine inhibition of H2 receptors in competitive, or non-competitive?

Competitive

What don't H2 receptor antagonists decrease acid secretion by 100%?

Only affect the direct pathway; ACh and gastrin can still increase hitsmine secretion

What are the H2 receptor antagonists suffix?

tidine

What type of drug is cimetidine?

H2 receptor antagonist

What type of drug is ranitidine?

H2 receptor antagonist

What type of drug is nizatidine?

H2 receptor antagonist

What type of drug is famotidine?

H2 receptor antagonist

What is the most common effect of H2 receptor antagonists?

Headaches

What are the uncommon, but severe effects that H2 receptor antagonists cause?

CNS effects (hallucination, agitation etc) Endocrine distruption

How long do H2 receptors antagonists last?

10 hours

Which H2 receptor antagonist specifically has higher chances of adverse effects?

Cimetidine (tagemet)

True or false: H2 receptor antagonists work directly in the stomach to antagonize H2 receptors?

False--have to absorb through the GI tract first. Too difficult to act in the stomach w/ mucus and all that

What is the MOA of PPIs?

Inhibition of the K/H ATPase

What activates PPIs?

Low pH

PPIs reversibly, or irreversibly bind the proton pumps?

Irreversibly

What is the suffix that denotes a PPI?

-prazole

What type of drug is omeprazole?

PPI

What type of drug is Lansoprazole?

PPI

What type of drug is Rabeazole?

PPI

What type of drug is Esomeprazole?

PPI

What type of drug is Pantoprazole?

PPI

What is the duration of action for PPIs?

24 hours, but 3-4 days to reach maximum effect

What is the major concern with using PPIs?

B12 deficiency

Why does it take 3-4 days for PPI to take maximal effect?

Vesicular network of stored proton pumps has to be depleted

What is the GERD heal rate, and puptic ulcer heal rate of PPIs?

90%

What is the MOA of sucralfate?

Adheres to ulcer and creates a physical barrier Stimulates mucus secretion

What is the chemical in sucralfate?

sucrose + octasulfate + Al(OH)3

What is the active ingredient in peptobismol?

Bismuth subsalicylate

What is the MOA of bismuth (peptobismol)?

Adheres fo ulcer and creates a physical barrier Stimulates mucus secretion