Pharmacology - Pharmacology of the upper and lower GI tract drug treatment Flashcards
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
b.parietal cells
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
b.Prostaglandin E2
all others cause increased action of pump
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
b.peptic acid secretion
principles of peptic ulcer disease therapy
relief of pain
ulcer healing
prevention of relapse and complications
MUST INVESTIGATE ANYONE AT INCREASED RISK OF GASTRIC CARCINOMA AS TREATMENT MAY MASK SYMPTOMS
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
c. PUD therapy can mask early symptoms
peptic ulcer treatments
removal of irritants (NSAIDS/H pylori)
antacids
PPIs
H2 histamine receptor antagonists
antibiotics
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
b.Prostaglandins E2
infection with which bacteria exacerbates PUD
a.neisseria meningitis
b.strep
c. staph aureus
d. h pylori
e.e coli
d. h pylori
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.increase gastric pH
most antacids are salts made up of
a.iron and magnesium
b.calcium and magnesium
c.aluminium and magnesium
d.iron and sodium
c.aluminium and magnesium
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.sodium bicarbonate
extended use of antacids can lead to…
a.ongoing acid under production
b.ongoing acid over production
b.ongoing acid over production
-prazole
protein pump inhibitors
eg omeprazole
lansoprazole
pantoprazole
esomeprazole
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
e.H+/K+ ATPase pump
-prazole = proton pump inhibitor
omepraole acts …………. on the proton pump of gastric parietal cells
a.reversibly
b.irreversibly
b.irreversibly
uses of omeprazole
dyspepsia
PUD
reflux oesophagitis
very effective and relatively well tolerated
CARE AS MASKS GASTRIC CANCER SYMPTOMS
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
d.c diff
which of these drugs does NOT interact with omeprazole (PPI)
a.warfarin
b. clopidogrel
c. verapamil
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
-tidine
H2 (hist) receptor anatgonists
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
c.histamine receptor
-tidine = H2 receptor antagonist
H2 receptor antagonists are……….. antagonists
a.competitive
b.non competitive
a.competitive
which of these drugs is second line for PUD and reflux oesophagitis
a. omeprazole
b.cimetidine
b.cimetidine
H2 receptor NTAGONISTS ARE 2nd line
which of these drugs is known to cause gynecomastia as a side effect?
a.omeprazole
b.cimetidine
c.ranitidine
d.docusate
b.cimetidine
H2 receptor antagonist
what does cimetidine interact with
potent inhibitor of cytochrome p450 dependent metabolism
what type of bacteria is helicobacter pylori
a. gram negative
b.gram positive cocci
c.gram positive rods
a. gram negative bacillus
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
d.h pylori infetion
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
d.urease
how is h pylori tested for \
a.serology
b. carbon 13 urea breath test
c. urine test
d. blood tests
b. carbon 13 urea breath test
give c13 urea drink
if urease present in h pylori c13 converted to c13 co2 and breathed out
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
c.triple therapy of PPI and 2 antibiotics
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,omeprazole , clarithromycin and amoxicillin
d.omeprazole, clarithromycin and metronidazole USED IN PENICILLIN ALLERGY
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
d.omeprazole, clarithromycin and metronidazole
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
c. 7 days
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
c.PPI for 3 more weeks
use different antibiotic for second treatment course eg tetracycline/ levofloxacin
if peptic ulcer occurs in patient on NSAIDS what is the first course of action
a.prescribe H2 receptor antagonist
b. prescribe PPI
b. prescribe PPI
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
c.withdraw NSAID
then prescribe PPI
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
b.eradication therapy of h pylori
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
d. urgent upper GI endoscopy
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
b.urgent upper gi endoscopy
what is the main tretament of constipation
a.pharmacological
b.non pharmacological
b.non pharmacological
increase fluid intake
increase mobility
increased fibre intake
stop constipating drugs
excluding underlying pathology
which of these drugs is a common cause of constipation
a.opiods
b.ppi
c.h2 receptor antagonist
d. antibiotics
a.opiods
what effect do opiods, antacids containing ca and al, anti muscarinics and antihistamines have on digestion
a.diarrhoea
b.constipation
b.constipation
causes of constipation
local pain
drugs
benign colorectal disease
endocrine cause
malignancy
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. osmotic laxative
causes more H2o to enter the colon
docusate is an example of which type of constipation treatment
a. osmotic laxative
b.faecal softener
c.bulk laxative
d. stimulant laxative
b.faecal softener
increase intestinal fluid secretion
fybrogel is an example of which type of constipation treatment
a. osmotic laxative
b.faecal softener
c.bulk laxative
d. stimulant laxative
c.bulk laxative
swells and distends the colon
bisacodyl and senna are examples of which type of constipation treatment
a. osmotic laxative
b.faecal softener
c.bulk laxative
d. stimulant laxative
d. stimulant laxative
stimulate the enteric nervous system
which of these drugs is a stimulant laxative (works by stimulating the enteric ns)
a.movacol
b.docusate
c.fybrogel
d.bisacodyl
d.bisacodyl
which of these drugs is a faecal softener
a.movacol
b.docusate
c.fybrogel
d.bisacodyl
b.docusate
which of these drugs is a bulk laxative (swells and distends colon)
a.movacol
b.docusate
c.fybrogel
d.bisacodyl
c.fybrogel
which of these drugs is a stimulant laxative
a.movacol
b.docusate
c.fybrogel
d.bisacodyl
d.bisacodyl
everyone on ……….. should be put on laxatives in order to prevent constipation
a.ppi
b.h2 receptor antagonists
c.opiods
c.opiods
management of constipation
treat reversible causes eg diet, fluid intake, analgesia if pain on defecation
adjust constipating med if possible
what is the first line of action for uncomplicated constipation
a.dietary changes
b. bulk forming laxatives
c.osmotic laxatives
d.stimulant laxatives
a.dietary changes
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
b. bulk forming laxatives (fybrogel)
what laxative should be given in constipation with hard stools
a.dietary changes
b. fybrogel
c.movicol
d.bisacodyl
e.docusate
c.movicol
osmotic laxative
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
d.bisacodyl /senna
stimulant laxative
what laxative should be given in opiod induced constipation
a.dietary changes
b. fybrogel
c.movicol
d.bisacodyl
e.docusate
c.movicol
d.bisacodyl
use an osmotic and a stimulant
AVOID bulk forming
when should laxatives be stopped
a.after full course
b. after 1 month
c.when stools return to normal
c.when stools return to normal
