Pharmacology - Drugs Acting on GI Tract (Exam 4)

Question 1

Functions of GI tract

Answer 1

Digest/absorb ingested nutrients
Excrete waste products of digestion

Question 2

GI diseases often present with _______ ___________

Answer 2

oral manifestations

Question 3

GI related drug for treating Xerostomia

Answer 3

Sialagogues (cholinergic agonists)

Question 4

GI related drug for short term control of salivary flow in dental procedures

Answer 4

Antisialoagogues (anticholinergics)

Question 5

GI related drug for treating nausea and vomiting

Answer 5

Antiemetics

(antihistamines, D2 antagonists, cannabinoids)

Question 6

Name 2 causes of nausea and vomiting in dentistry

Answer 6

1. Swallowing blood after oral surgery
2. Opioid analgesics during and post surgery

Question 7

Acid peptic diseases are caused by damage in GI mucosa from ____________ and ___________ (ON EXAM)

Answer 7

gastric acid and pepsin

Question 8

2 most common acid peptic diseases

Answer 8

1. GERD (gastroesophageal reflux disease)
2. PUD (peptic ulcer disease)

Question 9

What is the major component of digestive fluid produced in the stomach?

Answer 9

Hydrochloric acid (HCl)

Question 10

pH of stomach acid

Answer 10

1-2

Question 11

Hydrochloric acid is secreted through the? (ON EXAM)

Answer 11

Proton pump (H+/K+ ATPase)

Question 12

Which cells is the proton pump (H+/K+ ATPase) found in?

Answer 12

Parietal cells

Question 13

Which cells produce hydrochloric acid?

Answer 13

Parietal cells

(H+/K+ ATPase proton pump is in parietal cells!)

Question 14

Name 3 local and systemic endocrine effects that control and stimulate the proton pump (ON EXAM)

Answer 14

1. Gastrin
2. Histamine
3. ACh

Question 15

Most common symptom of GERD

Answer 15

Heartburn

Question 16

What is GERD caused by?

Answer 16

Abnormal reflux of gastric contents retrograde through cardiac sphincter into esophagus

Question 17

What is peptic ulcer disease caused by? (ON EXAM)

Answer 17

Helicobacter pylori infection (main cause)

Extended use of NSAIDS (less common)

Question 18

Primary complication of peptic ulcer disease

Answer 18

Hemorrhage

Question 19

T/F: antacids are weak acids

Answer 19

False! They’re weak bases

Question 20

What happens if you take too many antacids?

Answer 20

Affects absorption of other medications by directly binding to the drug or altering the drug’s solubility

Question 21

What drugs can antacids affect?

Answer 21

Antifungals (ketoconazole, itraconazole)
Antibiotics (tetracycline, fluoroquinolone)

Question 22

H2 receptor antagonists can inhibit up to _____ of total 24-hr acid secretion

Answer 22

70%

Question 23

Example of mucosal protective agents

Answer 23

Pepto bismol (bismuth subsalicylate)
Sucralfate

Question 24

What does pepto bismol protect against?

Answer 24

Ulcers and erosions

Question 25

What does pepto bismol treat?

Answer 25

Acute nonspecific diarrhea

Question 26

What does pepto bismol reduce in acute diarrhea?

Answer 26

Stool frequency Liquidity

Question 27

What does pepto bismol bind to?

Answer 27

Enterotoxins

Question 28

T/F pepto bismol has some antimicrobial effects

Answer 28

True

Question 29

What is sucralfate a complex of?

Answer 29

Aluminum hydroxide + sulfated sucrose

Question 30

T/F sucralfate provides a mechanical barrier over the surface of a gastric ulcer

Answer 30

FALSE, it provides a physical barrier over the surface of a gastric ulcer

Question 31

Drug class of choice for peptic ulcer disease and GERD

Answer 31

Proton pump inhibitors

Question 32

PPIs are __________ (longer/shorter) lasting and ________ (more/less) potent than H2 blockers

Answer 32

longer; more

Question 33

Proton pump inhibitor suffix

Answer 33

"-prazole"

Question 34

H2 receptor antagonist suffix

Answer 34

"-tidine"

Question 35

Main difference between PPIs and H2 antagonists

Answer 35

PPIs: IRREVERSIBLY inhibit proton pump H2 antagonists: REVERSIBLY inhibit H2 receptor

Question 36

Which drug slows the metabolism of lidocaine and benzodiazepines, and is a potent inhibitor of cytochrome P450 enzymes?

Answer 36

Cimetidine

Question 37

3 adverse effects with long term PPI use

Answer 37

1. Alters normal gastric pH 2. Alters medication absorption 3. Impacts metabolism of medications by CYP450

Question 38

What is the mechanism of prostaglandins?

Answer 38

Bind to parietal cell receptor to decrease acid secretion Stimulate mucus and bicarbonate secretion to inhibit acid secretion

Question 39

Contraindications of prostaglandins

Answer 39

Pregnancy

Question 40

How do we treat an H. pylori infection?

Answer 40

Triple regimen of a PPI with two antibiotics (clarithromycin + amoxicillin/metronidazole)

Question 41

What is the effectiveness of the triple regimen being influenced by?

Answer 41

Growing incidence of bacterial resistance to clarithromycin

Question 42

What treatment is recommended in areas of high resistance and in cases where clarithromycin-based therapy has failed in treating H. pylori infections?

Answer 42

Quadruple therapy (PPI/H2 blocker + pepto bismol + metronidazole + tetracycline)

Question 43

These drugs should be avoided in patients with an ulcer

Answer 43

Corticosteroids

Question 44

What should NOT be used for pain management of pts with PUD? Why?

Answer 44

Aspirin and Ibuprofen They're NSAIDS

Question 45

What drugs are used for chronic idiopathic constipation?

Answer 45

Linaclotide and Plecanatide Lubiprostone Prucalopride Lactitol

Question 46

What drugs are used for chronic idiopathic constipation and IBS-C?

Answer 46

Linaclotide and Plecanatide Lubiprostone

Question 47

What kind of drugs are Linaclotide and Plecanatide, and what do they do?

Answer 47

Guanylate cyclase-C agonists Increase fluid secretion and muscle movement

Question 48

What kind of drug is Lubiprostone, and what does it do?

Answer 48

Cl- channel activator Increases fluid secretion

Question 49

What kind of drug is Prucalopride, and what does it do?

Answer 49

Serotonin receptor agonist Has prokinetic activity and increases peristalsis

Question 50

What kind of drug is Lactitol, and what does it do?

Answer 50

Non-absorbable disaccharide Sweetener in food, laxative, and increases peristalsis

Question 51

Gastroparesis is most common in pts with?

Answer 51

Diabetes mellitus

Question 52

Name 2 GI stimulants that can treat gastroparesis

Answer 52

Metoclopramide (antiemetic activity) Erythromycin

Question 53

Difference between IBS and IBD

Answer 53

IBS: intestinal disorder where we do NOT know the cause IBD: intestinal disorders with severe inflammation and bleeding and damage to GI tract

Question 54

What do medications for IBS-C do?

Answer 54

Increase fluid secretion in intestine

Question 55

What are 2 types of IBD?

Answer 55

Crohn's disease Ulcerative colitis

Question 56

Pts with IBD are at increased risk of developing caries and oral infections. Why?

Answer 56

IBD treatment involves suppressing the immune response which leads to more infections and caries

Question 57

Avoid prescribing _________ for IBD pts because they may trigger a flare-up

Answer 57

NSAIDS

Question 58

What does sucralfate reduce the absorption of?

Answer 58

Tetracycline

Question 59

What drugs are opioid derivatives?

Answer 59

Diphenoxylate Loperamide

Question 60

What is the mechanism of Diphenoxylate and Loperamide?

Answer 60

Mu-opioid receptor agonists Decrease motility

Question 61

What do Diphenoxylate and Loperamide treat?

Answer 61

Acute nonspecific diarrhea

Question 62

Which opioid derivative is available OTC since it does not cross BBB or cause addiction?

Answer 62

Loperamide

Question 63

Which drugs antagonize Metoclopramide's prokinetic activity in the GI tract?

Answer 63

Opioids Anticholinergics