GI pharmacology Flashcards

1
Q

what is the differential of postpandial epigastric pain

A

pancreatitis
PUD
gallstones
IBS
food intolerance
celiacs
GERD
crohns disease
constipation
Gastroesophageal malignancy
=

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2
Q

what are the key substances involved in gastric acid secretion?

A

Histamine
Gastrin
ACh

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3
Q

what conditions are treated with acid suppression drugs

list 4

A

GERD
PUD
gastritis
zollinger-ellison syndrome

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4
Q

what is zollinger-ellison syndrome

A

rare gastric dx that causes excess gastric acid secretion

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5
Q

what is the most common cause of PUD

A

H. Pylori infection

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6
Q

t/f: excess alochol consuption causes indirect injurty to mucosal cells, impairing mucus secretion

A

False
alcohol causes direct injury to mucosal cells, impairing mucus secretion. Low ethonal content such as beer/wine stimulate production of gastric acid- increasing risk of gastritis

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7
Q

t/f: zollinger-ellison syndrome is a commmon condition caused by gastrin-secreting tumors of the esophagus (Barret esophagus) known as gatrinomas.

A

FAlSE: it is a rare conditiont caused by gastrin secreting tumors of the pancrea of duodenum known as gastrinomas. More than 60% are malignant.

Gastrinomas secrete excessive amounts of gastrin, which bind to parietal cells in the stomach, resulting in hypersecretion of acid

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8
Q

what are the most commonly used acid suppressants

A

PPI, H2 antagonists, antacids

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9
Q
A
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10
Q

what is the mechanism of PPI

A

irreversibly bind and impair the action of H+/K+ATPase in sstomach parietal cells to reduce acid secretion

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11
Q

what is the mechanism of action of H2 blockers?

A

block histamine H2 receptors on parietal cells

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12
Q

T/F: antacids are weak bases that directly neutralize and reduce acid secretion in the stomach

A

TRUE

they don’t reduce acid secretion, just neutralize it

HCL is a strong acid (gets rid of all of its H+)

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13
Q

Gastric ulcers are usually located in the lesser curvature of the stomach. What would make this location a dangerous place for an ulcer?

A

it can lead to bleeding from L gastric artery

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14
Q

DW is a 58 year old woman you are seeing in the oncology outpatient. DW has breast cancer and chronic pain secondary to bony metasases. Her pain is well controlled on non-steroidal anti-inflammatory drugs and low dose opions. “i can deal with the pain, but i dont want anymore meds for that. Im having a hard time moving my bowels. I already tried magnesium citrate, fiber, stool softeners, even nasty castor oil. Nothing worked. Even lactulose didn’t work and that works for almost everyone.”
Is there anything else I can try?”
What is causing the constipation and how can you treat it?

A

Cause: Opiods
Treat: laxatives

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15
Q

what are the classes of laxatives

A

Bulf forming
stool surfactant (softeners)
osmotic
stimulant (cathartics)

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16
Q

what common food ascts as a bulk-forming laxative?

A

Bran
absorbs water int the lumen to distend the intestine and trigger peristalsis

17
Q

what are some of the adverse effects of metoclopramide

A
  • restlessness
  • fatigue
  • sdystonia
  • extrapyramidal symptoms
  • mental depression
  • **tardive dyskinesia **
  • parkinsonian
    *** neuroleptic malignant syndrome **
17
Q

what is neuroleptic malignant syndrome

A
18
Q

Where does area postrema (vomiting center) receive input from

A
  • nucleus tractus solitarius
  • GI tract via vagus nerve
  • Vestibular system
  • CNS
19
Q

Receptors

A

Muscarinic (M1)
Histamine (H1)
Nueokinin (NK-1)
Dopamine (D2)
Seratonin (5-HT)

20
Q

what is a major stimulus of acid secretion

A

histamine

21
Q

PPI’s are first line for

A
  • Gerd
  • PUD
  • Gastritis
  • Zollinger-ellison
22
Q

when are H2 blockers used?

A

in pts with poor response to PPIs

23
Q

What does bismuth and sucralfate do?

A

Physically provide a barrier to ulcerss and promote mucosal secretion

24
Q

common side effects of bismuth and sucralfate

A

black stools (mistaken for melana a lot)

25
Q

what is Misoprostol? what is it used for?

A

PGE1 analog

Use: for prevention of NSAID induced peptic ulcers

26
Q

when should misoprostol never be prescribed

A

as an acid suppressant for women of childbearing age because it is an abortifacient

27
Q

what is the risk of longterm PPI use

A
  • C diff
  • pneumonia
  • fractures
  • osteoporosis
  • hypomagnesemia
28
Q

what h2 blocker is not safe?

A

cimitidine.

29
Q

what is the mc effect of famatodine

A

headache

30
Q

when are laxatives useful

A

acute and chronic constipation, opiate induced constipation and IBS-c

31
Q

when are antiemetics used?

A

acute vomiting, chemotherapy induced vomiting, even vestibular motion sickness

32
Q

Antidiarrheals commonly used for

A

chronic diarrhea, acute bacterial or viral gastroenteritis, IBS_D ileostomy related diarrhea