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Pharmacology II-Exam 2 > GIT > Flashcards

GIT Flashcards

1
Q

What is the largest internal organ

A

Liver

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2
Q

Hepatocytes perform

A

Production of bile, plasma, proteins, & amino acids

Metabolism of fat, carbs & protein

Storage of glucose, vitamins & iron

Breakdown of metabolic waste, drugs & toxins

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3
Q

What absorbs nutrients from portal vein, stoage & release, detoxification, modification, bilirubin uptake & conjugation

A

Hepatocytes

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4
Q

Hepatic extracellular vesicles…

A

Communicate cell-to cell

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5
Q

Kupffer Cells are

A

Macrophages maintain hepatic homeostasis

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6
Q

Sinusoidal endothelial cells are

A

Blood borne waste scavengers

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7
Q

Cholangiocyts are

A

Bile duct endothelial cells that secrete bile

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8
Q

HBF receives what % of cardiac output

A

30-40%

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9
Q

Hepatic artery receives ____% of HBF, that’s oxygen rich from the aorta

A

20%

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10
Q

Portal Veiin received ____% of HBF, that is rich in _____ & is partially deoxygenated from organs & comes from intestines, stomach, spleen, & pancreas

A

80%

Nutrients

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11
Q

Blood flow from liver

A

Leaves liver through hepatic vein & into inferior vena cava

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12
Q

Hepatic artery highly dependent on ____&_____

A

Cardiac output

ANS

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13
Q

Portal vein highly dependent on ______&_______

A

Splanchnic vessel tone

Portal venous resistance

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14
Q

What increases the resistance in portal vein

A

Fibrosis & cirrhosis

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15
Q

Iso, Des & Sevo will____ as well as surgical stimulation

A

Decrease HBF

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16
Q

Halothane _____to a______but preserved autoregulation of HBF

A

Decreases HBF to a greater

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17
Q

Role of the sphincter of oddi

A

Located between common bile duct & duodenum

Constricts & will divert bile flow into gallbladder

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18
Q

The gallbladder ____bile in response to _____in duodenum & cholecystokinin release

A

Empties

Fat

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19
Q

This gland is stimulated by an increase in PSNS activity, washes away pathogenic bacteria & has high bicarbonate ion concentration

A

Salivary glands

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20
Q

This organ is responsible for erythrocyte removal, blood storage & release, & immunologic functions

A

Spleen

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21
Q

GI smooth muscle cell ______at pylorus, ileocecal valve, & sphincter influences ________

A

Contracts

Rate of Flow

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22
Q

Peristalsis is

A

Propulsive movements stimulated by distention

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23
Q

What is dynamic paralytic ileus?

A

Paralysis of peristalsis related to trauma or irritation of peritoneum

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24
Q

What are the swallowing centers in the CNS

A

Medulla & lower pons

Stop breathing

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25
The upper esophageal sphincter (UES/pharyngoesophargeal)
Prevents air entry into esophagus & reflux into pharynx
26
The lower esophageal sphincter (LES/gastroesophagus)
Prevents acidic gastric content entry into esophagus
27
The intraluminal pressure of esophagogastric junction is
the measure of strength of gastric barrier
28
What is the LES pressure intrinsic component
Neurohormonal control (excitatory cholinergic will stimulate contraction) Myogenic control (spontaneous action potential will cause tonic contraction)
29
What is LES pressure extrinsic component
Crurak diaphragm & ligaments can increase pressure outside of LES
30
What is gastric barrier pressure?
LES pressure mini intragasttric pressure Major mechanism in preventing reflux of gastric contents
31
Transient LES relaxation will cause
Decrease in pressure
32
What is the primary mechanism of GERD?
Transient LES relaxation
33
Swallowing & pharyngeal stimulation will promote
Antegrade flow of food
34
Gastric distension & high fat meals will allow
Retrograde flow
35
What decreases LES Pressure?
Cricoid Pressure & GA (by 7-14mmHg depending on skeletal muscle relaxation
36
Parietal cells...
Secrete hydrochloric acid & intrinsic factor Are stimulated by histamine, ACh & gastrin
37
Gastric mucosa
stores, processes food for digestion & secretes H+
38
Chief cells
Secrete pepsinogen involved in PRO digestion
39
G cells
secrete gastrin, which influenced parietal cell activity & increases LES tone
40
Gastric pH is
3.5
41
What determines the rate of gastric emptying?
Volume; Composition of fluid (hypertonic, highly acidic, high in fat/PRO slows emptying
42
The small intestine receives _____ but only sends _______of chyme to colon
9L/day of fluid 1-2L
43
Where is the primary site oof digestion & absorption?
Small initestine
44
Mucosal epithelial cells contain
digestive enzyme
45
Mucous glans secrete ____to protect duodenal barrier from ___________, which is inhibited by_______
Mucus; Acidic gastric fluid; SNS
46
Where is water & electrolytes absorbed?
From colon (from chyme)
47
____stimulates colonic contraction
PSNS
48
______cells secrete protective mucus
Epithelial cells
49
What causes delayed emptying?
Diabetic gastroparesis Hypergylcemia Impaired neural control Inflammatory processes GERD Acute viral gastroenteritis Drug induced (opioids, beta agonists, tricyclic antidepressants, & high concentrations of alcohol)
50
Mechanism of GERD
Transient relaxation of LES Weak LES, weak crural diaphragm, or both
51
GERD will cause symptoms of
Heartburn & tissue damage, which increases the risk of Barrett Esophagus
52
GERD treatment
Medical or surgical
53
What is Hiatal hernia
Portion of stomach herniates into chest cavity
54
What promoted GERD
Hiatal hernia Gastric acid is trapped in the hernia sac, which risks the backward flow with LES relaxation during swallowing Problem during contraction of crural diaphragm during inspiration & movement Esophagitis decreases LES pressure
55
GERD can
Increase risk of PONV & pulmonary aspiration of gastric contents
56
What can cause active reflux?
Activity vs rest Sitting vs supine Triggers
57
Clears are good until Light meal & milk okay for
2 hrs before 3-4 hours
58
What can help with GERD while providing anesthesia?
RSI Trendelenburg for induction Ultrasound
59
What are the main factors associated with pulmonary aspiration
Fluid volume & acidity of contents Presents of particulate matter
60
Pulmonary morbidity includes
Hypoxia Pneumonitis PNA & bacterial infection Respiratory failure, ARDS & cardiopulmonary collapse
61
What are the goals of Antacids & GI motility drugs
Decrease volume of gastric contents Increase pH of gastric contents
62
What are examples of oral antacids
Aluminum, Ca+ & Mg+ salts
63
MOA of oral antacids
Increases gastric fluid pH by removing hydrogen ions (reaction w/base to form stable compound) Decreases hydrogen chloride secretion May inhibit digestion, increase gastric motility (gastrin) & may increase LES tone
64
MOA of Sodium Citrate (Bicitra)
Increases gastric fluid pH
65
When is Sodium Citrate (Bicitra) administered?
Pre-op to pregnant & non-pregnant at high risk of aspiration
66
Sodium Citrate (Bicitra) is less likely to
Cause foreign body reaction if aspirated
67
Dosing of Sodium Citrate (Bicitra)
15-30mL PO 15-30min before induction
68
Adverse effects of oral antacids
High Na+ content (caution ini HTN & CHF) Hypermagnesemia Hypercalcemia Metabolic alkalosis Alkalinization increases infection risks N/V & stomach pain
69
Function of histamine
Gastric acid secretion Inflammation Neuronal transmission Bronchoconstriction
70
What are histamine receptors
H1 & H2-target of anesthesia practice H3 & H4- involved in CNS & immunomodulation
71
H-receptor antagonists are
Competitive & have reversible inhibition
72
1st generation H-1 receptor antagonists
Activate muscarinic, cholinergic, serotonin & alpha-adrenergic receptors
73
1st generation H-1 receptor antagonists can cause
Sedation
74
1st generation H-1 receptor antagonists meds include
Diphenhydramine, promethazine, chlorpheniramine & hydroxyzine
75
2nd generation H-1 receptor antagonists
Have little effect on other receptor types Less CNS toxicity Mostly non-sedating
76
2nd generation H-1 receptor antagonists med examples
Loratadine, fexofenadone, acrivastine & azelastine
77
Uses for H-1 receptor antagonists
Environmental allergies Bronchospams Sedation Motion Sickness & antiemetics Allergic reaction & anaphylaxis (considered 2nd line therapy, effective for cutaneous & upper respiratory symptoms & may be given prophylactically before radio contrast dye
78
Diphenhydramine (Benadryl) is a
H-1 antagonist in the respiratory tract, vasculature & GI smooth muscle
79
Pre-op uses for Diphenhydramine (Benadryl) include
Sedation, antiemetic, opioid sparing effects w/morphine in PCA, & had LA properties
80
Dose of Diphenhydramine (Benadryl)
12.5-50 mg IV
81
Diphenhydramine (Benadryl) is incompatible with
Dexamethasonoe
82
Infuse Diphenhydramine (Benadryl) over
1-2 min
83
Side effects of H-1 receptor antagonist: 1st generation
Somnolence Impaired congnitive function Dry mouth Blurred vision Urinary retention Tachycardia, prolonged QTc & heart block Antihistamine intoxication includes seizures & conduction abnormalities
84
H-2 receptor antagonists meds include
Famotidine (most potent), ranitidine, nizatidine, & cimetidine (least potent)
85
MOA of H-2 receptor antagonists
They are selective & reversible inhibition of H-2 receptor in gastric parietal cells by blocking increases in cAMP & blocks activation of histamine on parietal cells in stomach
86
Uses for H-2 receptor antagonists
Duodenal ulcer disease Inhibition of gastric secretions GERD & heartburn
87
Famotidine (Pepcid) blocks
H2 receptor in gastric parietal cells
88
Perioperative uses of Famotidine (Pepcid)
Antiemetic, full stomach 7 aspiration risk
89
Dose of Famotidine (Pepcid)
20mg IV with an onset of <30min Decrease dose in renal dysfunction Administer night before or morning of surgery
90
Side effects of H2 receptor antagonists
Cerebral-HA, somnolence & confusion Cardiac-bradycardia, HOTN & heart block Acute pancreatitis Increased hepatic transaminase levels Thromobocytopenia Agranulocytosis Cimetidine can interfere w/CP450 drug metabolism
91
Examples of proton pump inhibitors
Omeprazole, esomeprazole, pantoprazole, lansoprazole
92
MOA of proton pump inhibitors
Direct inhibition of H+/K+ pump (proton pump) Decreases secretion of HCL by gastric parietal cells
93
Proton pump inhibitors are most effective with
GERD, heartburn & esophagitis (prevents relapse)
94
Perioperative use of Omeprazole
Increases gastric pH & decreases fluid volume Administer 3+ hours before induction
95
Omeprazole dose & duration
20mg PO 24hour duration
96
Omeprazole, a prodrug metabolized to become_____, causes prolonged inhibition of ____________
PPI Gastric acide secretion
97
PPI side effects
Crosses the BBB, which can cause a headache, agitation, & confusion GI upset such as ABD pain, N/V, & GIT bacterial growth
98
Dopamine Antagonist includes
Metoclopramide & domperidone
99
MOA of dopamine antagonist
Increases LES tone & peristaltic contractions Accelerated the rate of gastric emptying (decrease transit time) Causes pylorus & duodenal relaxation
100
Uses of dopamine antagonists
GERD, diabetic gastroparesis, full stomach, aspiration risk & antiemetic
101
Metoclopramide (reglan) MOA)
Selective cholinergic stimulation of GIT Sensitizes GI smooth muscle to effects of ACh Causes release of ACH from cholinergic nerves
102
Perioperative uses & doses for Metoclopramide (raglan)
Trauma, full stomach, obese, autonomic dysfunction, & pregnancy patients 10-20mg IV o er 3-5min Give 15-30min before induction
103
Dopamine Antagonist Side effects
CNS- extrapyramidal reactions (truisms, dystonia & restlessness, neurologic dysfunction, sedation, agitation & dysphoria (single dose) Cardiac- HOTN,tachy, Brady & arrhythmia Inhibition of plasma cholinesterase activity, dry mouth, rash & hives
104
CNS coordination of vomiting
Efferent signals via vagus & phrenic nerve & abd musculature receives input
105
When vomiting, the _____will close & _____is elevated to close off posterior nares
Glottis; Soft palate
106
Triggers of N/V
NT- dopamine (D2), Acetylcholin (M), Serotonin (5HT3), Histamine (H1) & Sub P (NK1) Motion Anticipation Drugs
107
When does PONV happen
Within 24048 hours of anesthesia
108
Risk for PONV
Aspiration, wound complications & esophageal rupture
109
Patient risk factors of PONV
Women (progesterone & estrogen affect CRTZ Non-smoker Motion sickness Hx PONV Younger adult & older children
110
What anesthesia risk factors increase risk of PONV
Volatile Anesthetics Nitrous oxide Opioids (decrease peristalsis, delay gastric emptying, distend abd Duration of exposure Neostigmine
111
Surgical risk factors of PONV
Surgical duration Laparoscopic & Laparotomies Gynecologic ENT Breast & Plastics Herniorrhhaphy, tonsillectomy & adenoidectomy (strabismus) Orthopedics Surgery on male gentials
112
5-HT3 Receptor Antagonists example medication
Ondansetron, granisetron, dolasetrono & tropisetron
113
MOA of 5-HT3 Receptor Antagonists
Antagonism of excitatory serotonin(5-HT3 ligand-gated ion channel (highly selective for 5-HT3
114
GIT cells release______via ______ _______to vomiting centers
Serotonin; Vagal Afferents
115
Ondansetron (Zofran) is structurally related to ________, which has no effect on __, ___, ___, or ____-receptors
Serotonin D2, H1, M, or adrenergic
116
Perioperative use of Ondansetron
PONV prophylaxis & treatment Highly effective 2-5 min before induction of GA 4-8 mg IV Plasma peak within 30min
117
Side effects of Ondansetron
HA, Diarrhea & transient increase in plasma concentration of liver enzymes Cardiac arrhythmias & induction disturbances (AV block) & QTc prolongation
118
Anticholinergics include
Scopolamine & atropine
119
MOA of Anticholinergics
Antagonism of muscarinic acetylcholine (M1) receptors Vestibular system inputs & activation of CRTZ
120
Transdermal Scopolamine blocks
Impulses from inner ear to medulla
121
Perioperative uses of Scopolaamine
Duration 72 hours TD patch 5mcg/hr Best if applied 2-4hours pre-stimulus Most effective for motion sickness Also for PCA & epidural-related N/V Can be given PO & IV
122
Anticholinergic side effetcs
Dry mouth Blurred Vision Tachy Dry skin & rash Hyperthermia Central anticholinergic syndrome (restlessness, somnolence, hallucinations, seizures, coma & respiratory failurer
123
What drug can be given to treat central anticholinergic syndrome?
Physostigmine
124
Whist medication is a corticosteroid
Dexamethasone
125
Perioperative use of corticosteroid
PONV Give upon induction (immediately after) Hyperglycemia risk Similar efficacy to ondansetron & droperidol
126
Dopamine receptor Antagonists medications include
Benzamides, butyrophenones & phenothiazine
127
MOA of Dopamine receptor Antagonists
Antagonize dopamine activation of D2 receptor in CRTZ
128
Benzamides (Metoclopramide) causes
GIT stimulation via cholinergic mechanism
129
Butyrophenones cause
Anti- adrenergic/cholinergic & histamine effects
130
Phenothiazine can cause
Anti-adreneergic & histaminergic effects
131
Droperidol & haloperidol are
1st generation antipsychotics
132
Droperidol black box warning
Can prolong QT in high doses
133
Droperidol is effective against _____ & rescue
PONV
134
When to administer Droperidol & at what dose
Administer at end of surgery Dose 0.625-1.25mg IV
135
Haloperidol is an _____at low doses Dose is_____
Antiemetic 0.5-2mg IV
136
Phenothiazine include
Perphenazinie, promethazine & prochlorperazine
137
Phenothiazine are
Typical antipsychotics
138
Promethazine can cause Dose
Sedation 25mg IV
139
Perphenazine dose
5mg IV
140
Side effects of Dopamine Receptor Antagonists
Anticholinergic effects-dry mouth & sedation Anti-dopaminergic effects- GI symptoms QTc prolongation Ortho HOTN Agranulocytosis
141
Neurokinin-1 receptor Antagonists include
Aprepitant, fosprepitant, casopitant, & rolapitant
142
Neurokinin-1 receptor Antagonists bocks
Substance P activation of NK-1 receptors from vagal afferents to vomiting center neurons
143
Neurokinin-1 receptor Antagonists are highly effective for
Chemotherapy-induced N/V (CINV) Very $$$
144
Aprepitant (Emend) perioperative use
Recommendation ti reserve for high risk PONV Administer prophylactically within 3 hours of induction PO or IV (30min infusion)
145
Side effects of Aprepitant (Emend)
HA, fatigue, constipation, inflammation, neutropenia & fever
146
Other Antiemetics include
Propofol Midazolam Mirtazapine Gabapentin (with dexamethasone)
147
Midazolam may _____dopamine activity in CRTZ at a dose of _____ before end of surgery
Decrease. 2mg IV 30 min before end of surgery
148
Mirtazapine is an ______that may decrease risk if given with________
Antidepressant Dexamethasone
149
______can help with nausea at a dose of 0.5 mg/kg IM at end of surgery
Ephedrine
150
PC^ stimulation...
Significantly reduces N/V and decreases need for rescue antiemetics
151
Relation between IVF & preventing vomiting
Adequate hydration, minimize fasting time & maintain euvolemia 10-30ml/kg reduces PONV & need for rescue

Pharmacology II-Exam 2 (5 decks)

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