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GERR > Pharmacology - Pharmacology of the upper and lower GI tract drug treatment > Flashcards

Pharmacology - Pharmacology of the upper and lower GI tract drug treatment Flashcards

1
Q

which cells found in the gastric mucosa are the targets of GI drugs

a.mucous neck cells
b.parietal cells
c.enterochromaffin like cells
d.chief cells
e.d cells

A

b.parietal cells

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2
Q

which of these substances acting on the gastric parietal cell causes decreased action of the membranous H+/K+ ATPase pump

a.Ach
b.Prostaglandin E2
c.histamines
d.gastrin

A

b.Prostaglandin E2

all others cause increased action of pump

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3
Q

a defect in the gastric/ duodenal mucosa is known as a peptic ulcer . This is caused by an imbalance between gastroduodenal mucosal defence and what ?

a.peptic acid production
b.peptic acid secretion
c. somatastain secretion
d.gastrin production

A

b.peptic acid secretion

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4
Q

principles of peptic ulcer disease therapy

A

relief of pain
ulcer healing
prevention of relapse and complications

MUST INVESTIGATE ANYONE AT INCREASED RISK OF GASTRIC CARCINOMA AS TREATMENT MAY MASK SYMPTOMS

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5
Q

Why is it imperative that anyone at increased risk of gastric carcinoma should be investigated when undergoing PUD therapy

a.PUD therapy can increase risk of gastric carcinoma

b. PUD can increase speed of development of gastric carcinoma

c. PUD therapy can mask early symptoms

A

c. PUD therapy can mask early symptoms

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6
Q

peptic ulcer treatments

A

removal of irritants (NSAIDS/H pylori)
antacids
PPIs
H2 histamine receptor antagonists
antibiotics

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7
Q

NSAIDS exacerbate the peptic ulcer disease. NSAIDS block the cox 1 receptor this stops the action of which substance which would normally reduce gastric parietal cell H+ (acid) secretion

a. Ach
b.Prostaglandins E2
c.Histamines
d.gastrin

A

b.Prostaglandins E2

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8
Q

infection with which bacteria exacerbates PUD

a.neisseria meningitis
b.strep
c. staph aureus
d. h pylori
e.e coli

A

d. h pylori

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9
Q

what effects do antacids have in order to provide symptomatic relief in peptic ulcer disease

a.increase gastric pH
b.decrease gastric pH
c.decrease amouhnt of gastric acid
d.increase amount of gastric acid

A

a.increase gastric pH

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10
Q

most antacids are salts made up of

a.iron and magnesium
b.calcium and magnesium
c.aluminium and magnesium
d.iron and sodium

A

c.aluminium and magnesium

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11
Q

which of these antacids can cause metabolic alkalosis, sodium and water retention and rnal stone formation

a.sodium bicarbonate
b. calcium bicarbonate
c.magnesium bicarbonate

A

a.sodium bicarbonate

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12
Q

extended use of antacids can lead to…

a.ongoing acid under production
b.ongoing acid over production

A

b.ongoing acid over production

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13
Q

-prazole

A

protein pump inhibitors

eg omeprazole
lansoprazole
pantoprazole
esomeprazole

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14
Q

which part of the gastric cell does omeprazole inhibit

a.Ach receptor
b.Prostaglandin receptor
c.histamine receptor
d.gastrin receptor
e.H+/K+ ATPase pump

A

e.H+/K+ ATPase pump

-prazole = proton pump inhibitor

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15
Q

omepraole acts …………. on the proton pump of gastric parietal cells

a.reversibly
b.irreversibly

A

b.irreversibly

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16
Q

uses of omeprazole

A

dyspepsia
PUD
reflux oesophagitis

very effective and relatively well tolerated

CARE AS MASKS GASTRIC CANCER SYMPTOMS

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17
Q

Omepraxole has many side effects such as hypomagnesaemia, interstitial nephritis, increased risk of pneumonia and CKD and increased infection by which bacteria?

a.h pylori
c.e coli
d.c diff
e. staph aureus

A

d.c diff

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18
Q

which of these drugs does NOT interact with omeprazole (PPI)

a.warfarin
b. clopidogrel
c. verapamil

A

c. verapamil

omeprazole is a weak cyp450 (produces thromboxan a2) inhibitor so can increase anticoagulant effect of warfarin

omeprazole is a weak cyp450 inhibitor so reduces antiplatelet effect of clopidogrel

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19
Q

-tidine

A

H2 (hist) receptor anatgonists

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20
Q

which part of the gastric parietal cell is targeted by cimetidine

a. ach receptor
b.pprostaglandin E2 receptor
c.histamine receptor
d.gastrin receptor
e.proton pump

A

c.histamine receptor
-tidine = H2 receptor antagonist

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21
Q

H2 receptor antagonists are……….. antagonists

a.competitive
b.non competitive

A

a.competitive

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22
Q

which of these drugs is second line for PUD and reflux oesophagitis

a. omeprazole
b.cimetidine

A

b.cimetidine

H2 receptor NTAGONISTS ARE 2nd line

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23
Q

which of these drugs is known to cause gynecomastia as a side effect?

a.omeprazole
b.cimetidine
c.ranitidine
d.docusate

A

b.cimetidine

H2 receptor antagonist

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24
Q

what does cimetidine interact with

A

potent inhibitor of cytochrome p450 dependent metabolism

25
Q

what type of bacteria is helicobacter pylori

a. gram negative
b.gram positive cocci
c.gram positive rods

A

a. gram negative bacillus

26
Q

if peptic ulcer disease is not caused by NSAIDS what is the next most likely cause

a.alcohol
b.caffeine
c.aspirin
d.h pylori infetion

A

d.h pylori infetion

27
Q

which enzyme found in h pylori bacteria is responsible for conversion of urea to ammonia and co2- which then damages the mucosal protection system

a. carbonic anhydrase
b.glucose phosphatase
c.glycogen synthase
d.urease

A

d.urease

28
Q

how is h pylori tested for \

a.serology
b. carbon 13 urea breath test
c. urine test
d. blood tests

A

b. carbon 13 urea breath test

give c13 urea drink
if urease present in h pylori c13 converted to c13 co2 and breathed out

29
Q

how is h pylori tretated in most cases

a. double therapy of antibitoic and PPI
b.double therapy of antibiotic and H2 receptor antagonist
c.triple therapy of PPI and 2 antibiotics
d.triple therapy of PPI, H2 receptor antagonist and an antibiotic

A

c.triple therapy of PPI and 2 antibiotics

30
Q

Triple therapy required for H pylori infection induced PUD, which of these drugs most suitable

a,omeprazole , clarithromycin and amoxicillin

b.cimetidine, clarithromycin and amoxicillin

c. ranitidine , omeprazole and amoxicillin

d.omeprazole, clarithromycin and metronidazole

A

a,omeprazole , clarithromycin and amoxicillin

d.omeprazole, clarithromycin and metronidazole USED IN PENICILLIN ALLERGY

31
Q

Triple therapy required for H pylori infection induced PUD in patient with a penicillin allergy , which of these drugs most suitable

a,omeprazole , clarithromycin and amoxicillin

b.cimetidine, clarithromycin and amoxicillin

c. ranitidine , omeprazole and amoxicillin

d.omeprazole, clarithromycin and metronidazole

A

d.omeprazole, clarithromycin and metronidazole

32
Q

how long is triple therapy undertaken for in cases of h pylori infection in PUD

a.3 days
b. 5 days
c. 7 days
d. 9 days

A

c. 7 days

33
Q

large ulcer complicated by haemorrhage , with h pylori present following triple therapy for 7 days what should be given

a. second round of antibiotivcs for one more week

b.PPI for one more week

c.PPI for 3 more weeks

d.repeat triple therapy for one more week

A

c.PPI for 3 more weeks

use different antibiotic for second treatment course eg tetracycline/ levofloxacin

34
Q

if peptic ulcer occurs in patient on NSAIDS what is the first course of action

a.prescribe H2 receptor antagonist
b. prescribe PPI

A

b. prescribe PPI

35
Q

if bleeding of peptic ulcer occurs in patient on NSAIDS what is the first course of action

a.prescribe H2 receptor antagonist
b. prescribe PPI
c.withdraw NSAID

A

c.withdraw NSAID

then prescribe PPI

36
Q

H pylori positive patients about to start an NSAID what should be done

a.do not start on NSAID give alternative treatment

b.eradication therapy of h pylori

c. give PPI

A

b.eradication therapy of h pylori

37
Q

in cases of acute bleeding, chronic bleeding, weight loss , dysphagia ,persistent vomiting and those with unezplained persistent dyspepsia what should be done

a.upper GI endoscopy
b.urgent triple therapy
c. PPI given
d. urgent upper GI endoscopy

A

d. urgent upper GI endoscopy

38
Q

patient over 55 years with unexplained persistent dyspepsia what should be done

a.c13 breath test
b.urgent upper gi endoscopy
c. investigation of gastric carcinoma

A

b.urgent upper gi endoscopy

39
Q

what is the main tretament of constipation

a.pharmacological
b.non pharmacological

A

b.non pharmacological

increase fluid intake
increase mobility
increased fibre intake
stop constipating drugs
excluding underlying pathology

40
Q

which of these drugs is a common cause of constipation

a.opiods
b.ppi
c.h2 receptor antagonist
d. antibiotics

A

a.opiods

41
Q

what effect do opiods, antacids containing ca and al, anti muscarinics and antihistamines have on digestion

a.diarrhoea
b.constipation

A

b.constipation

42
Q

causes of constipation

A

local pain
drugs
benign colorectal disease
endocrine cause
malignancy

43
Q

macrogols eg movicol are an example of which type of constipation treatment

a. osmotic laxative
b.faecal softener
c.bulk laxative
d. stimulant laxative

A

a. osmotic laxative

causes more H2o to enter the colon

44
Q

docusate is an example of which type of constipation treatment

a. osmotic laxative
b.faecal softener
c.bulk laxative
d. stimulant laxative

A

b.faecal softener

increase intestinal fluid secretion

45
Q

fybrogel is an example of which type of constipation treatment

a. osmotic laxative
b.faecal softener
c.bulk laxative
d. stimulant laxative

A

c.bulk laxative

swells and distends the colon

46
Q

bisacodyl and senna are examples of which type of constipation treatment

a. osmotic laxative
b.faecal softener
c.bulk laxative
d. stimulant laxative

A

d. stimulant laxative

stimulate the enteric nervous system

47
Q

which of these drugs is a stimulant laxative (works by stimulating the enteric ns)

a.movacol
b.docusate
c.fybrogel
d.bisacodyl

A

d.bisacodyl

48
Q

which of these drugs is a faecal softener

a.movacol
b.docusate
c.fybrogel
d.bisacodyl

A

b.docusate

49
Q

which of these drugs is a bulk laxative (swells and distends colon)

a.movacol
b.docusate
c.fybrogel
d.bisacodyl

A

c.fybrogel

50
Q

which of these drugs is a stimulant laxative

a.movacol
b.docusate
c.fybrogel
d.bisacodyl

A

d.bisacodyl

51
Q

everyone on ……….. should be put on laxatives in order to prevent constipation

a.ppi
b.h2 receptor antagonists
c.opiods

A

c.opiods

52
Q

management of constipation

A

treat reversible causes eg diet, fluid intake, analgesia if pain on defecation
adjust constipating med if possible

53
Q

what is the first line of action for uncomplicated constipation

a.dietary changes
b. bulk forming laxatives
c.osmotic laxatives
d.stimulant laxatives

A

a.dietary changes

54
Q

following unsuccessful dietary changes what is the first line drug for constipation

a.dietary changes
b. bulk forming laxatives
c.osmotic laxatives
d.stimulant laxatives

A

b. bulk forming laxatives (fybrogel)

55
Q

what laxative should be given in constipation with hard stools

a.dietary changes
b. fybrogel
c.movicol
d.bisacodyl
e.docusate

A

c.movicol

osmotic laxative

56
Q

what laxative should be given in constipation with soft stools but still hard to pass

a.dietary changes
b. fybrogel
c.movicol
d.bisacodyl
e.docusate

A

d.bisacodyl /senna

stimulant laxative

57
Q

what laxative should be given in opiod induced constipation

a.dietary changes
b. fybrogel
c.movicol
d.bisacodyl
e.docusate

A

c.movicol
d.bisacodyl

use an osmotic and a stimulant

AVOID bulk forming

58
Q

when should laxatives be stopped

a.after full course
b. after 1 month
c.when stools return to normal

A

c.when stools return to normal

GERR (53 decks)

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