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BMS II > Koh GI > Flashcards

Koh GI Flashcards

1
Q

GERD

A

Heartburn, food/acid in esophagus

From faulty sphincter, hiatal hernia, obesity, preg

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2
Q

Gastric Ulcer

A

Lesser curvature of stomach
Pain after eating
some N+V
Older people-10%

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3
Q

Duodenal Ulcer

A

Upper duodenum
pain 2-4 hrs after eating (food helps)
Rarely N/V
Younger pop-90%

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4
Q

Stress Ulcers

A

More acid, less mucus and blood Q
mucosal injury in stomach
very ill pts, but heals fast
EtOH or steroid induced

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5
Q

Defensive factors

A

Mucus
Bicarb
Blood Flow- maintains mucosal integrity
Prostaglandins (PGE1+2) inhibit acid

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6
Q

Aggressive Factors

A 
Gastric and Bile Acids
Pepsin
H. pylori (75% of cases)
NSAIDS
Smoking
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7
Q

Cells of Acid Secretion

A

Parietal- gastrin, H2, M3
Enterochromaffin like- gastrin + M3
->cause histamine relase

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8
Q

Antacid “interactions”

A

Increases gastric emptying
Binds with Fe and tetracyclines
Urinary alkalization
Caution in renal failure

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9
Q

Sodium Bicarbonate

A

Systemic, rapid, short DOA
Best agent, but in combos
Caution in Na restricted pts

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10
Q

Calcium Carbonate

A

Partially systemic, rapid, longer DOA

still subject to rebound, CO2, and Milk-Alkali

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11
Q

Magnesium Products

A

Non-Systemic, fairly rapid
Mg not absorbed but caution in renal failure
Diarrhea main SE

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12
Q

Aluminum salts (Rolaids)

A

Non-Systemic, not absorbed
Slow acting, sustained
binds phosphate
Constipation main SE

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13
Q

Simethicone (Mylanta)

A

Defoaming agent that increases surface tension of gas bubble to speed passage in gut

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14
Q

H2 blockers (general)

A

decreases both basal and stimulated acid
»decreases pepsin levels
no effect on GI emptying or tone
Safe, minor SE, DrOCh for IV

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15
Q

PPIs

A 
most prescribed class
irreversible antagonist of H/K
>>covalent bond
short half life, no dose reduction
DOC for GERD and PUD
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16
Q

Ulcer healing time

A 
gastric = 6-8wks
duodenal = 4wks
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17
Q

“Triple Therapy”

A

PPI (antimicrobial) + 2 antibiotics x2wks

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18
Q

Sucralfate

A

sulfated sucrose, forms paste barrier
no effect on pH
decrease absorption of some drugs

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19
Q

misoprostol (Cytotec)

A

mimics PGE1
inhibits acid, increases bicarb and mucus
TID-QID, CI in preggers
FDA approved for ulcers

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20
Q

Pepto Bismol

A

bismuth not absorbed, salicylate is
antimicrobial, coats ulcers, reduces poop freq
never give if under 12

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21
Q

Bulk-forming laxatives

A 
Absorb water to increase bulk
results in 1-3 days
methylcellulose 
polycarbophil
psyllium
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22
Q

Emollients (stool softeners)

A

allow lipids and water to penetrate stool
1-3 d PO, 6-12hrs rectally
docusate products

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23
Q

Lubricants

A

coats stool»stops H2O reabsorption
results in 8hrs
mineral oil and glycerine supp.
take 2hr before or after food

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24
Q

Osmotics (saline) properties

A

draws fluid into stool
for pre-op
can lead to dehydration
poop in 1-3hrs w high dose, 2-8 low dose

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25
Q

Osmotics products

A

Sugars/Salts: MgOH, sorbitol, lactulose, Mg citrate or phosphate, Na phosphate.
Polyethylene Glycol: large volumes given, “inert”

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26
Q

Stimulant Products (irritants, carthartics)

A

anthraquinone (senna, cascara) 2hr rect
diphenylmethane (bisacodyl) 30min rect, used w PEG
castor oil

27
Q

Chloride Channel Activator

A

lubiprostone (Amitiza)
PG derivative
For IBS-C in women

28
Q

Opioid Antagonists

A

methylnaltrexone (Relistor)

alvimopan (Entereg) CV toxicity!!

29
Q

5-HT4 Agonists

A

tegaserod (Zelnorm) for IBS-C
cisapride (Propulsid)
CV SE!!

30
Q

Acute Diarrhea Tx

A 
4-6H, no food
6-12H, liquids
12H, simple foods
Avoid dairy
drug treatment
31
Q

diphenoxylate (+atropine=Lomotil)

A

congener of meperidine
high doses»morphine like
atropine discourages abuse

32
Q

loperamide

A

no abuse potential
doesn’t cross BBB
longer DOA than diphenoxylate

33
Q

Acute Watery T. Diarrhea

A

E. coli, shigella, salmonella
bind to mucosa, produce cAMP/GMP
»water and elec. in stool
Pepto+doxycyline

34
Q

Dysentery T. Diarrhea

A

shigella, entamoeba
blood and/or mucus in poop
fecal-to-oral
treat w antibiotics

35
Q

Giardiasis T. Diarrhea

A

giardia lamblia
gastric pH promotes cyst survival
2-6wks, metronidazole as tx

36
Q

Vomiting receptors

A

M3, H1, NK1, 5-HT3

37
Q

Chemoreceptor trigger zone (CTZ)

A

aka “area postrema”

D2 dopamine and opioid receptors

38
Q

Vestibular System

A

motion sickness

M1 and H1

39
Q

Vagal and spinal nerves

A

GI mucosal cells release serotonin,

5-HT3 receptors, prov-vomiting signals

40
Q

5-HT3 antagonists

features

A

DOC for prevention during chemo or postoperative emesis

CYP metab and renal excretion

41
Q

Neurokinin receptor antagonists

A

aprepitant (capsule)
fosaprepitant (inj)
combo with 5HT3 blockers and corticosteroids
CYP3A4»interactions (chemo+warfarin)

42
Q

Phenothiazines

A

anti-psychotics
prochlorperazine (Compazine)
promethazine

43
Q

Butyrophenones

A

anti-psychotics
droperidol
AE: prolongation of QT interval

44
Q

Benzamides

And MOA

A

metaclopramide and trimethobenzamide (Tigan)

block DA receptors

45
Q

Cannabinoids

A

MOA unknown for anti-emetic
dronabinol, nabilone
pt supervision recommended

46
Q

Morning Sickness

A

unknown cause
conservative treatment!
antihistamines or metaclopramide if severe

47
Q

Hyperemesis gravidarum

A

2-5% of pregnancies
uncontrolled vomiting
antihistamines then phenothiazines

48
Q

Irritable Bowel Syndrome

A

idiopathic, relapsing,
pain, bloating, cramps, dia&const
discomfort 3x/month x3months
treat pain w low dose TCAs

49
Q

dicyclomine (Bentyl)

A 
For IBS (antispasmodic)
muscarinic antagonists
SE: const.
50
Q

hyoscyamine (Levsin)

A 
For IBS (antispasmodic)
muscarinic antagonist
SE: const.
51
Q

alosetron (Lotronex)

A

5HT3 antagonist
decrease discomfort, increase stool firmness, decrease fecal urgency
approved for IBS-D in WOMEN

52
Q

lubiprostone (Amitiza)

A

Chloride channel activator
prostaglandin analog as laxative
for IBS-C in WOMEN
Preg category C

53
Q

tegaserod (Zelnorm)

A

5HT4 Agonist
promotility
for IBS-C in women
use only in emergency w healthy CV

54
Q

Ulcerative Colitits

A

inflamm of sub/mucosa of colon and rectum
immune cells respond
possible rectal bleeding

55
Q

Crohn’s Disease

A

inflamm of any layers in any GI section
commonly in terminal ileum
surgery often results

56
Q

Hepatic Lobule

A

From portal vein and hepatic artery to the central vein

57
Q

Portal Lobule

A

Drains bile from central vein (hepatocyte) to bile duct in portal triad

58
Q

Acinus

A

Zone I: mitochondria rich, have portal vein and hepatic artery
Zone III: Many CYPs, central vein

59
Q

Bile componenets

A 
Glutathione
Phospholipids
Cholesterol
Bilirubin
Bile salts
60
Q

Canalicular Choestasis

A

decrease in V of bile or component of it
leads to high serum levels of bile salts/bilirubin
caused by metals, hormones, drugs
inhibit active transport

61
Q

Sinusoidal Damage

A

by Dilation: efflux impeded
Blockade: RBCs caught in fenestrae
Destruction of ECs
Toxins: Anabolic steroids, cyclophosphamide

62
Q

Metoclopramide

A

Reglan
Dopamine D2 antagonist
Increase Ach, prokinetic
No effect on SI or colon

63
Q

IBS drugs for women only

A

Tegaserod, IBS-C
Lubiprostone, IBS-C
Alosetron, IBS-D

BMS II (4 decks)

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