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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
Q

The upper esophageal sphincter (UES/pharyngoesophargeal)

A

Prevents air entry into esophagus & reflux into pharynx

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26
Q

The lower esophageal sphincter (LES/gastroesophagus)

A

Prevents acidic gastric content entry into esophagus

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27
Q

The intraluminal pressure of esophagogastric junction is

A

the measure of strength of gastric barrier

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28
Q

What is the LES pressure intrinsic component

A

Neurohormonal control (excitatory cholinergic will stimulate contraction)

Myogenic control (spontaneous action potential will cause tonic contraction)

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29
Q

What is LES pressure extrinsic component

A

Crurak diaphragm & ligaments can increase pressure outside of LES

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30
Q

What is gastric barrier pressure?

A

LES pressure mini intragasttric pressure

Major mechanism in preventing reflux of gastric contents

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31
Q

Transient LES relaxation will cause

A

Decrease in pressure

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32
Q

What is the primary mechanism of GERD?

A

Transient LES relaxation

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33
Q

Swallowing & pharyngeal stimulation will promote

A

Antegrade flow of food

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34
Q

Gastric distension & high fat meals will allow

A

Retrograde flow

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35
Q

What decreases LES Pressure?

A

Cricoid Pressure & GA (by 7-14mmHg depending on skeletal muscle relaxation

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36
Q

Parietal cells…

A

Secrete hydrochloric acid & intrinsic factor

Are stimulated by histamine, ACh & gastrin

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37
Q

Gastric mucosa

A

stores, processes food for digestion & secretes H+

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38
Q

Chief cells

A

Secrete pepsinogen involved in PRO digestion

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39
Q

G cells

A

secrete gastrin, which influenced parietal cell activity & increases LES tone

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40
Q

Gastric pH is

A

3.5

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41
Q

What determines the rate of gastric emptying?

A

Volume; Composition of fluid
(hypertonic, highly acidic, high in fat/PRO slows emptying

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42
Q

The small intestine receives _____ but only sends _______of chyme to colon

A

9L/day of fluid

1-2L

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43
Q

Where is the primary site oof digestion & absorption?

A

Small initestine

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44
Q

Mucosal epithelial cells contain

A

digestive enzyme

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45
Q

Mucous glans secrete ____to protect duodenal barrier from ___________, which is inhibited by_______

A

Mucus; Acidic gastric fluid; SNS

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46
Q

Where is water & electrolytes absorbed?

A

From colon (from chyme)

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47
Q

____stimulates colonic contraction

A

PSNS

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48
Q

______cells secrete protective mucus

A

Epithelial cells

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49
Q

What causes delayed emptying?

A

Diabetic gastroparesis

Hypergylcemia

Impaired neural control

Inflammatory processes

GERD

Acute viral gastroenteritis

Drug induced (opioids, beta agonists, tricyclic antidepressants, & high concentrations of alcohol)

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50
Q

Mechanism of GERD

A

Transient relaxation of LES

Weak LES, weak crural diaphragm, or both

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51
Q

GERD will cause symptoms of

A

Heartburn & tissue damage, which increases the risk of Barrett Esophagus

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52
Q

GERD treatment

A

Medical or surgical

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53
Q

What is Hiatal hernia

A

Portion of stomach herniates into chest cavity

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54
Q

What promoted GERD

A

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

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55
Q

GERD can

A

Increase risk of PONV & pulmonary aspiration of gastric contents

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56
Q

What can cause active reflux?

A

Activity vs rest

Sitting vs supine

Triggers

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57
Q

Clears are good until

Light meal & milk okay for

A

2 hrs before

3-4 hours

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58
Q

What can help with GERD while providing anesthesia?

A

RSI

Trendelenburg for induction

Ultrasound

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59
Q

What are the main factors associated with pulmonary aspiration

A

Fluid volume & acidity of contents

Presents of particulate matter

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60
Q

Pulmonary morbidity includes

A

Hypoxia

Pneumonitis

PNA & bacterial infection

Respiratory failure, ARDS & cardiopulmonary collapse

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61
Q

What are the goals of Antacids & GI motility drugs

A

Decrease volume of gastric contents

Increase pH of gastric contents

62
Q

What are examples of oral antacids

A

Aluminum, Ca+ & Mg+ salts

63
Q

MOA of oral antacids

A

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
Q

MOA of Sodium Citrate (Bicitra)

A

Increases gastric fluid pH

65
Q

When is Sodium Citrate (Bicitra) administered?

A

Pre-op to pregnant & non-pregnant at high risk of aspiration

66
Q

Sodium Citrate (Bicitra) is less likely to

A

Cause foreign body reaction if aspirated

67
Q

Dosing of Sodium Citrate (Bicitra)

A

15-30mL PO

15-30min before induction

68
Q

Adverse effects of oral antacids

A

High Na+ content (caution ini HTN & CHF)

Hypermagnesemia

Hypercalcemia

Metabolic alkalosis

Alkalinization increases infection risks

N/V & stomach pain

69
Q

Function of histamine

A

Gastric acid secretion

Inflammation

Neuronal transmission

Bronchoconstriction

70
Q

What are histamine receptors

A

H1 & H2-target of anesthesia practice

H3 & H4- involved in CNS & immunomodulation

71
Q

H-receptor antagonists are

A

Competitive & have reversible inhibition

72
Q

1st generation H-1 receptor antagonists

A

Activate muscarinic, cholinergic, serotonin & alpha-adrenergic receptors

73
Q

1st generation H-1 receptor antagonists can cause

A

Sedation

74
Q

1st generation H-1 receptor antagonists meds include

A

Diphenhydramine, promethazine, chlorpheniramine & hydroxyzine

75
Q

2nd generation H-1 receptor antagonists

A

Have little effect on other receptor types

Less CNS toxicity

Mostly non-sedating

76
Q

2nd generation H-1 receptor antagonists med examples

A

Loratadine, fexofenadone, acrivastine & azelastine

77
Q

Uses for H-1 receptor antagonists

A

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
Q

Diphenhydramine (Benadryl) is a

A

H-1 antagonist in the respiratory tract, vasculature & GI smooth muscle

79
Q

Pre-op uses for Diphenhydramine (Benadryl) include

A

Sedation, antiemetic, opioid sparing effects w/morphine in PCA, & had LA properties

80
Q

Dose of Diphenhydramine (Benadryl)

A

12.5-50 mg IV

81
Q

Diphenhydramine (Benadryl) is incompatible with

A

Dexamethasonoe

82
Q

Infuse Diphenhydramine (Benadryl) over

A

1-2 min

83
Q

Side effects of H-1 receptor antagonist: 1st generation

A

Somnolence

Impaired congnitive function

Dry mouth

Blurred vision

Urinary retention

Tachycardia, prolonged QTc & heart block

Antihistamine intoxication includes seizures & conduction abnormalities

84
Q

H-2 receptor antagonists meds include

A

Famotidine (most potent), ranitidine, nizatidine, & cimetidine (least potent)

85
Q

MOA of H-2 receptor antagonists

A

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
Q

Uses for H-2 receptor antagonists

A

Duodenal ulcer disease

Inhibition of gastric secretions

GERD & heartburn

87
Q

Famotidine (Pepcid) blocks

A

H2 receptor in gastric parietal cells

88
Q

Perioperative uses of Famotidine (Pepcid)

A

Antiemetic, full stomach 7 aspiration risk

89
Q

Dose of Famotidine (Pepcid)

A

20mg IV with an onset of <30min

Decrease dose in renal dysfunction

Administer night before or morning of surgery

90
Q

Side effects of H2 receptor antagonists

A

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
Q

Examples of proton pump inhibitors

A

Omeprazole, esomeprazole, pantoprazole, lansoprazole

92
Q

MOA of proton pump inhibitors

A

Direct inhibition of H+/K+ pump (proton pump)

Decreases secretion of HCL by gastric parietal cells

93
Q

Proton pump inhibitors are most effective with

A

GERD, heartburn & esophagitis (prevents relapse)

94
Q

Perioperative use of Omeprazole

A

Increases gastric pH & decreases fluid volume

Administer 3+ hours before induction

95
Q

Omeprazole dose & duration

A

20mg PO

24hour duration

96
Q

Omeprazole, a prodrug metabolized to become_____, causes prolonged inhibition of ____________

A

PPI

Gastric acide secretion

97
Q

PPI side effects

A

Crosses the BBB, which can cause a headache, agitation, & confusion

GI upset such as ABD pain, N/V, & GIT bacterial growth

98
Q

Dopamine Antagonist includes

A

Metoclopramide & domperidone

99
Q

MOA of dopamine antagonist

A

Increases LES tone & peristaltic contractions

Accelerated the rate of gastric emptying (decrease transit time)

Causes pylorus & duodenal relaxation

100
Q

Uses of dopamine antagonists

A

GERD, diabetic gastroparesis, full stomach, aspiration risk & antiemetic

101
Q

Metoclopramide (reglan) MOA)

A

Selective cholinergic stimulation of GIT

Sensitizes GI smooth muscle to effects of ACh

Causes release of ACH from cholinergic nerves

102
Q

Perioperative uses & doses for Metoclopramide (raglan)

A

Trauma, full stomach, obese, autonomic dysfunction, & pregnancy patients

10-20mg IV o er 3-5min

Give 15-30min before induction

103
Q

Dopamine Antagonist Side effects

A

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
Q

CNS coordination of vomiting

A

Efferent signals via vagus & phrenic nerve & abd musculature receives input

105
Q

When vomiting, the _____will close & _____is elevated to close off posterior nares

A

Glottis; Soft palate

106
Q

Triggers of N/V

A

NT- dopamine (D2), Acetylcholin (M), Serotonin (5HT3), Histamine (H1) & Sub P (NK1)

Motion

Anticipation

Drugs

107
Q

When does PONV happen

A

Within 24048 hours of anesthesia

108
Q

Risk for PONV

A

Aspiration, wound complications & esophageal rupture

109
Q

Patient risk factors of PONV

A

Women (progesterone & estrogen affect CRTZ

Non-smoker

Motion sickness

Hx PONV

Younger adult & older children

110
Q

What anesthesia risk factors increase risk of PONV

A

Volatile Anesthetics

Nitrous oxide

Opioids (decrease peristalsis, delay gastric emptying, distend abd

Duration of exposure

Neostigmine

111
Q

Surgical risk factors of PONV

A

Surgical duration

Laparoscopic & Laparotomies

Gynecologic

ENT

Breast & Plastics

Herniorrhhaphy, tonsillectomy & adenoidectomy (strabismus)

Orthopedics

Surgery on male gentials

112
Q

5-HT3 Receptor Antagonists example medication

A

Ondansetron, granisetron, dolasetrono & tropisetron

113
Q

MOA of 5-HT3 Receptor Antagonists

A

Antagonism of excitatory serotonin(5-HT3 ligand-gated ion channel (highly selective for 5-HT3

114
Q

GIT cells release______via ______ _______to vomiting centers

A

Serotonin; Vagal Afferents

115
Q

Ondansetron (Zofran) is structurally related to ________, which has no effect on __, ___, ___, or ____-receptors

A

Serotonin

D2, H1, M, or adrenergic

116
Q

Perioperative use of Ondansetron

A

PONV prophylaxis & treatment

Highly effective 2-5 min before induction of GA

4-8 mg IV

Plasma peak within 30min

117
Q

Side effects of Ondansetron

A

HA, Diarrhea & transient increase in plasma concentration of liver enzymes

Cardiac arrhythmias & induction disturbances (AV block) & QTc prolongation

118
Q

Anticholinergics include

A

Scopolamine & atropine

119
Q

MOA of Anticholinergics

A

Antagonism of muscarinic acetylcholine (M1) receptors

Vestibular system inputs & activation of CRTZ

120
Q

Transdermal Scopolamine blocks

A

Impulses from inner ear to medulla

121
Q

Perioperative uses of Scopolaamine

A

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
Q

Anticholinergic side effetcs

A

Dry mouth

Blurred Vision

Tachy

Dry skin & rash

Hyperthermia

Central anticholinergic syndrome (restlessness, somnolence, hallucinations, seizures, coma & respiratory failurer

123
Q

What drug can be given to treat central anticholinergic syndrome?

A

Physostigmine

124
Q

Whist medication is a corticosteroid

A

Dexamethasone

125
Q

Perioperative use of corticosteroid

A

PONV

Give upon induction (immediately after)

Hyperglycemia risk

Similar efficacy to ondansetron & droperidol

126
Q

Dopamine receptor Antagonists medications include

A

Benzamides, butyrophenones & phenothiazine

127
Q

MOA of Dopamine receptor Antagonists

A

Antagonize dopamine activation of D2 receptor in CRTZ

128
Q

Benzamides (Metoclopramide) causes

A

GIT stimulation via cholinergic mechanism

129
Q

Butyrophenones cause

A

Anti- adrenergic/cholinergic & histamine effects

130
Q

Phenothiazine can cause

A

Anti-adreneergic & histaminergic effects

131
Q

Droperidol & haloperidol are

A

1st generation antipsychotics

132
Q

Droperidol black box warning

A

Can prolong QT in high doses

133
Q

Droperidol is effective against _____ & rescue

A

PONV

134
Q

When to administer Droperidol & at what dose

A

Administer at end of surgery

Dose 0.625-1.25mg IV

135
Q

Haloperidol is an _____at low doses

Dose is_____

A

Antiemetic

0.5-2mg IV

136
Q

Phenothiazine include

A

Perphenazinie, promethazine & prochlorperazine

137
Q

Phenothiazine are

A

Typical antipsychotics

138
Q

Promethazine can cause

Dose

A

Sedation

25mg IV

139
Q

Perphenazine dose

A

5mg IV

140
Q

Side effects of Dopamine Receptor Antagonists

A

Anticholinergic effects-dry mouth & sedation

Anti-dopaminergic effects- GI symptoms

QTc prolongation

Ortho HOTN

Agranulocytosis

141
Q

Neurokinin-1 receptor Antagonists include

A

Aprepitant, fosprepitant, casopitant, & rolapitant

142
Q

Neurokinin-1 receptor Antagonists bocks

A

Substance P activation of NK-1 receptors from vagal afferents to vomiting center neurons

143
Q

Neurokinin-1 receptor Antagonists are highly effective for

A

Chemotherapy-induced N/V (CINV)

Very $$$

144
Q

Aprepitant (Emend) perioperative use

A

Recommendation ti reserve for high risk PONV

Administer prophylactically within 3 hours of induction

PO or IV (30min infusion)

145
Q

Side effects of Aprepitant (Emend)

A

HA, fatigue, constipation, inflammation, neutropenia & fever

146
Q

Other Antiemetics include

A

Propofol

Midazolam

Mirtazapine

Gabapentin (with dexamethasone)

147
Q

Midazolam may _____dopamine activity in CRTZ at a dose of _____ before end of surgery

A

Decrease. 2mg IV 30 min before end of surgery

148
Q

Mirtazapine is an ______that may decrease risk if given with________

A

Antidepressant

Dexamethasone

149
Q

______can help with nausea at a dose of 0.5 mg/kg IM at end of surgery

A

Ephedrine

150
Q

PC^ stimulation…

A

Significantly reduces N/V and decreases need for rescue antiemetics

151
Q

Relation between IVF & preventing vomiting

A

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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