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ges > pharmacology Acid suppression therapy H2 blockers Proton pump inhibitors Bismuth, sucralfate Misoprostol Octreotide Antacid use Osmotic laxatives Sulfasalazine Ondansetron Metoclopramide Orlistat > Flashcards

pharmacology Acid suppression therapy H2 blockers Proton pump inhibitors Bismuth, sucralfate Misoprostol Octreotide Antacid use Osmotic laxatives Sulfasalazine Ondansetron Metoclopramide Orlistat Flashcards

1
Q

Proton pump inhibitors work on pumps that exchange which two ions?

A

Hydrogen and potassium

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2
Q

H2 blockers work on which stomach cell type?

A

Parietal cells

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3
Q

Muscarinic antagonists work on which two cell types in the stomach?

A

Enterochromaffin-like cells (with M1 receptors) and parietal cells (with M3 receptors)

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4
Q

Why are misoprostol, sucralfate, and bismuth useful in treating gastric ulcers?

A

These drugs have a protective effect on the mucosa underlying the ulcers

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5
Q

Where does somatostatin act?

A

Somatostatin acts on enterochromaffin-like cells via ST2 receptors

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6
Q

A surgeon damages the vagus nerve while operating. What type of GI therapy would be directly impacted?

A

Muscarinic antagonists, because the vagus nerve stimulates the M1 and M3 receptors

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7
Q

A man has been taking an antacid for GERD pain. What is the mechanism for this drug and where does it target?

A

Antacids work in the stomach lumen and block the secretion of acid, or H+

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8
Q

What type of cell in the antrum is stimulated by food? What hormone is stimulated by food to promote gastric acid secretion?

A

G cell; gastrin

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9
Q

If a patient is deficient in gastrin, which cells and receptors will be understimulated in the fundus?

A

Parietal cells and ECLs (both have G [CCK-B] receptors that are stimulated by gastrin)

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10
Q

A patient has a gastric ulcer causing severe pain. Name at least two medications can be given to help with ulcer healing?

A

Misoprostol, sucralfate, bismuth

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11
Q

You study stomach gastrin activity. You administer food to rats and take several biopsies. Which stomach area will show the most activity?

A

The antrum

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12
Q

Most gastric acid secretion (and the actions of medications that inhibit it) can be found in which area of the stomach?

A

The fundus

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13
Q

Give at least two examples of H2 blockers.

A

Cimetidine, ranitidine, famotidine, nizatidine (take H2 blockers before you dine, & table for 2 to remember H2)

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14
Q

What substance is the endogenous agonist of the H2 receptor?

A

Histamine

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15
Q

What is the effect of H2 blockers on parietal cells?

A

Reversible decrease of hydrogen ion secretion

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16
Q

Name at least two clinical uses of H2 blockers.

A

Peptic ulcers, gastritis, mild esophageal reflux

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17
Q

A patient takes over 10 medications for various reasons. You are worried about drug interactions. Which H2 blocker should you avoid?

A

Cimetidine, as it causes inhibition of cytochrome P-450 and may alter the metabolism of other drugs

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18
Q

Which two H2 blockers can decrease the renal excretion of creatinine?

A

Ranitidine and cimetidine

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19
Q

A 50-y/o man starts a gastritis medication that inhibits cytochrome P-450. What adverse effects for this drug are seen specifically in men?

A

Prolactin release, gynecomastia, impotence, decreased libido (cimetidine is a P-450 inhibitor and has antiandrogenic effects)

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20
Q

A 47-year-old woman has developed confusion, dizziness, and headaches since starting an H2 blocker. What is happening?

A

Cimetidine (able to cross the blood-brain barrier, unlike other H2 blockers) can cause confusion, dizziness, and headaches

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21
Q

A woman on a specific H2 blocker tells her doctor that she wants to get pregnant. The doctor says she needs to stop the H2 blocker. Why?

A

Cimetidine, the H2 blocker she is likely taking, is dangerous to the fetus, because it can cross the placenta

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22
Q

A woman has unexpected galactorrhea. Her medications include sertraline, pantoprazole, cimetidine, aspirin, simvastatin. Is a drug to blame?

A

Yes, as cimetidine can increase prolactin levels, which may cause galactorrhea

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23
Q

A 34-y/o woman has continued GERD pain despite ranitidine & is negative for Helicobacter pylori antigens. Specific drugs to try next?

A

Omeprazole, esomeprazole, pantoprazole, lansoprazole, dexlansoprazole (proton pump inhibitors)

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24
Q

Proton pump inhibitors work by irreversibly inhibiting this protein in stomach parietal cells.

A

H+/K+ ATPase

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25
Q

Name at least two conditions that are treated with proton pump inhibitors.

A

Peptic ulcers, gastritis, esophageal reflux, Zollinger-Ellison syndrome

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26
Q

A patient has been using proton pump inhibitors for a long time. His level of which divalent electrolyte is likely decreased?

A

Magnesium

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27
Q

Before starting a man on an H+/K+ ATPase inhibitor, you explain to him that there are some associated risks. What are some of these?

A

C. difficile infection, pneumonia, hip fractures, hypomagnesemia (with long-term use) (these are proton pump inhibitor side effects)

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28
Q

A man presents with traveler’s diarrhea. What two drugs might you choose to help reestablish the pH gradient in the mucous layer?

A

Bismuth and sucralfate

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29
Q

Misoprostol is a ____ analog.

A

Prostaglandin E1

30
Q

Misoprostol increases the production and secretion of the ____ barrier and decreases the production of ____.

A

Gastric mucous; acid

31
Q

A patient with rheumatoid arthritis starts misoprostol after being intolerant to her prior treatment. What was the complication?

A

Peptic ulcers induced by NSAIDs (misoprostol increases gastric mucous production and decreases acid production)

32
Q

A neonate is noted to be cyanotic on the third day of life. What medication should be ordered immediately?

A

Misoprostol, which maintains a patent ductus arteriosus, allowing pulmonary and systemic circulations to mix in cases of heart disease

33
Q

A woman is given misoprostol at 42 weeks’ gestation. Why?

A

To induce labor

34
Q

Within what population is misoprostol contraindicated?

A

Women of childbearing potential (it is an abortifacient)

35
Q

A 22-year-old woman requests a chemical abortion of her pregnancy. She receives a PGE1 analog. What side effect should she expect?

A

Diarrhea (she has likely been given misoprostol for her chemical abortion)

36
Q

A patient presents with bleeding esophageal varices. What is the mechanism of action of a drug that can acutely help abort the bleeding?

A

Octreotide is a long-acting somatostatin analog that inhibits actions of many splanchnic vasodilatory hormones

37
Q

A patient on pharmacologic treatment for a VIPoma experiences nausea, cramps, and steatorrhea. What medication is she likely taking?

A

Octreotide

38
Q

• A man with recent onset of excessive growth hormone secretion and a woman with a carcinoid tumor both could both benefit from what drug

A

Octreotide

39
Q

A 54-y/o woman being managed for CHF and hypothyroidism has started taking daily antacids. How might this affect her other medications?

A

Interference with absorption, bioavailability, and urinary excretion by altering gastric and urinary pH and delaying gastric emptying

40
Q

Name at least two compounds commonly used as antacids.

A

Aluminum hydroxide, calcium carbonate, magnesium hydroxide

41
Q

Diarrhea, hyporeflexia, hypotension, cardiac arrest, and hypokalemia are side effects of which antacid?

A

Magnesium hydroxide (Mg = must go to the bathroom)

42
Q

A young patient is overusing antacid calcium carbonate. What toxicities does this cause?

A

Hypercalcemia, rebound acid increase

43
Q

All antacids cause what electrolyte abnormality if overused?

A

Hypokalemia

44
Q

A patient who heavily self-medicates her GERD complains of dizziness and diarrhea. Which antacid is she likely overusing?

A

Magnesium hydroxide (can cause diarrhea and hypotension)

45
Q

A patient has hypophosphatemia and osteodystrophy. What medication is he likely chronically overusing to treat his GERD?

A

Aluminum hydroxide

46
Q

A patient with GERD needs to start tetracycline for an infection. Why is it important for you to check the medication list before starting?

A

Calcium carbonate antacids can chelate and reduce the effectiveness of certain other oral medications, such as tetracycline

47
Q

A patient suffering from both constipation and hepatic encephalopathy should be given which medication?

A

Lactulose, since this addresses both problems

48
Q

A patient with a history of bulimia is found to be dehydrated. Abuse of what GI medication could contribute to this finding?

A

Osmotic laxatives

49
Q

How does lactulose treat hepatic encephalopathy?

A

The gut flora degrades lactulose into lactic and acetic acid, promoting nitrogen excretion as NH4+ and reducing NH3 levels

50
Q

For a 24-year-old man with ulcerative colitis, you prescribe a medication that is a combination of two drugs. What are these?

A

Sulfapyridine and 5-aminosalicylic acid (the medicine is sulfasalazine)

51
Q

What is the function of sulfapyridine?

A

It is an antibiotic

52
Q

What activates sulfasalazine in the gut? Be specific

A

Colonic bacteria activate sulfasalazine

53
Q

A patient is on sulfasalazine. What two diseases is the drug typically used to treat?

A

Crohn disease (for the colitis component) and ulcerative colitis

54
Q

A 30-year-old man starts on a drug composed of sulfapyridine and 5-aminosalicylic acid for Crohn disease. Side effects to be monitored for?

A

Reversible oligospermia, malaise, nausea, sulfonamide toxicity (this is sulfasalazine)

55
Q

A patient is found to have Crohn ileitis and asks if he can be started on sulfasalazine. What is the appropriate response?

A

Sulfasalazine would be ineffective, because it is activated by colonic bacteria and thus has no effect proximal to the colon

56
Q

What component of the sulfasalazine is known to be anti-inflammatory?

A

5-aminosalicylic acid

57
Q

Ondansetron is an antagonist of what receptor type?

A

5-hydroxytryptamine3

58
Q

Ondansetron is used to control vomiting primarily in which two settings?

A

After surgery and in conjunction with cancer chemotherapy (if you are feeling queasy at a party, keep on dancing with ondansetron)

59
Q

You give a 47-year-old woman a 5-HT3 antagonist for her nausea while she gets chemotherapy. What two main toxicities should you look for?

A

Headache and constipation (this is ondansetron)

60
Q

What is the mechanism of action for ondansetron?

A

It binds 5-HT3 receptors and antagonizes them, decreasing vagal stimulation

61
Q

What is the mechanism of action of metoclopramide?

A

It is a dopamine receptor antagonist (specifically the D2 receptor)

62
Q

A man with HF and diabetes is receiving a D2 receptor antagonist for gastroparesis. What two types of drugs may cause interactions?

A

Digoxin and diabetic agents (this is metoclopramide)

63
Q

Metoclopramide is contraindicated in patients with what serious gastrointestinal disorder?

A

Small bowel obstruction; it is prokinetic and thus will worsen the discomfort of these patients

64
Q

On what parts of the gastrointestinal tract does metoclopramide act?

A

Lower esophageal sphincter (increases tone and contractility), stomach, small bowel (increases motility) (no effect on colon)

65
Q

Give at least two clinical uses of metoclopramide.

A

Diabetic gastroparesis, postsurgical gastroparesis, antiemesis

66
Q

A Parkinson disease patient with profuse vomiting asks for metoclopramide. Why does the doctor disagree with this choice?

A

Metoclopramide, a D2 receptor antagonist, can cross-react with and block D1 receptors, exacerbating parkinsonian symptoms

67
Q

A diabetic man is given a drug that causes restlessness, drowsiness, and nausea. Does this drug impact colon transit time?

A

No, as this is metoclopramide

68
Q

A 74-y/o woman has hypovolemia due to gastroenteritis. As the resident, would you start with ondansetron or metoclopramide for her nausea?

A

Ondansetron (metoclopramide is useful in GI-based nausea but has a greater risk of adverse effects in the elderly)

69
Q

A man wants a refill of a drug medication a previous doctor prescribed for weight loss. He says it gives him greasy stools. What drug is it?

A

Orlistat (inhibits gastric and pancreatic lipase)

70
Q

A patient asks about a weight loss drug she saw on TV, with greasy stools and vitamin deficiencies as side effects. How does the drug work?

A

It inhibits gastric and pancreatic lipase (this is orlistat)

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