Test #3 Pharmacology of the GI Tract

Question 1

is gastroesophageal reflux disease (GERD) acute or chronic? what about acid reflux?

Answer 1

• GERD is chronic
• acid reflux is acute (isolated incidents)

Question 2

what are GERD/acid reflux episodes referred to as, and what percent of the population do they occur daily in?

Answer 2

• heartburn
• 7%

Question 3

what are aggravating factors of GERD and acid reflux?

Answer 3

• empty stomach
• inclined (?)
• increased age
• obesity
• fatty foods
• caffeine/alcohol/smoking
• large meals
• some drugs

Question 4

how can GERD and acid reflux symptoms be relieved?

Answer 4

• small meals
• reduced fat
• reduced weight
• elevate head of bed
• avoid aspirin/NSAIDs

Question 5

what are some ways that teeth can be protected from gastric acids (GERD and acid reflux)?

Answer 5

• mouth guard
• neutralize acid with basic solution
• don’t brush teeth after gastric juices are in mouth (acidic)

Question 6

what 3 medications are used to treat GERD/acid reflux?

Answer 6

• antacids
• H2 receptor blockers
• proton pump inhibitors (PPIs)

Question 7

what do antacids to do relieve the symptoms of GERD/acid reflux?

Answer 7

neutralize gastric HCl

Question 8

what are the 4 typs of antacids used to relieve the symptoms of GERD and acid reflux?

Answer 8

• magnesium salts
• bicarbonate
• calcium carbonate
• aluminum salts (not very effective)

Question 9

what is the side effect of magnesium salts?

Answer 9

diarrhea

Question 10

what is the side effect of bicarbonate?

Answer 10

causes gas

Question 11

what is the side effect of calcium carbonate?

Answer 11

constipation

Question 12

which GERD/acid reflux medication is chalky?

Answer 12

calcium carbonate

Question 13

are H2 receptor blockers useful for allergies? why or why not?

Answer 13

no, because they are not affective at H1 receptors

Question 14

how do H2 receptor blockers relieve the symptoms of GERD and acid reflux?

Answer 14

they block H2 receptors in the gut, which reduces gastric secretions

Question 15

are H2 receptor blockers typically OTC or Rx?

Answer 15

both

Question 16

what are the 3 types of H2 receptor blockers?

Answer 16

• cimetidine (tagamet)
• ranitidine (zantac)
• famotidine (pepcid)

Question 17

what are the side effects of H2 receptor blockers?

Answer 17

headaches, diarrhea, drowsiness

Question 18

are proton pump inhibitors available OTC or Rx?

Answer 18

both

Question 19

what is the mechanism of PPIs?

Answer 19

disrupts hydrogen exchange for K in gastric parietal cells, which blocks production and release of HCl into the gut

Question 20

what are the side effects of PPIs?

Answer 20

diarrhea, interferes with digestion, increases food allergies, oral sores/ulcers

Question 21

PPIs are often combine with what other medication to relieve symptoms of GERD and acid reflux?

Answer 21

H2 receptor blockers

Question 22

what are 4 types of PPIs?

Answer 22

• omeprazole (prilosec)
• omeprazole + sodium bicarbonate for fast release
• lansoprazole (prevocid)
• esomeprazole (nexium)

Question 23

peptic ulcer disease includes ulcers in what two locations?

Answer 23

gastric (stomach) and duodenum

Question 24

what are the causes of peptic ulcer disease?

Answer 24

inflammation of the epithelium, erosion, infection by H. pylori

Question 25

what percent of peptic ulcer disease is caused by H. pylori infection?

Answer 25

70-80%

Question 26

what are the symptoms of peptic ulcer disease?

Answer 26

epigastric burning, pain, bleeding in stools or vomit (hematemesis)

Question 27

epigastric burning caused by peptic ulcer disease can be alleviated by what?

Answer 27

eating or taking antacids

Question 28

what two things make pain associated with peptic ulcer disease worse?

Answer 28

empty stomach and at night

Question 29

pain associated with peptic ulcer disease is often mistaken for what?

Answer 29

a heart attack (and vice versa - heart attack pain is often mistaken for peptic ulcer disease)

Question 30

what are two general ways peptic ulcer disease is treated?

Answer 30

* suppress acidity to heal sores (this doesn't cure it) * it can be cured with medication if it is H. pylori-related

Question 31

what medications can suppress acidity and heal sores of peptic ulcer disease?

Answer 31

antacids, PPIs, and H2 blockers

Question 32

is H. pylori infection contageous?

Answer 32

yes, especially within family members

Question 33

how is H. pylori-related peptic ulcer disease cured?

Answer 33

* prevpac - combination of lansoprazole (PPI), amoxicillin, and clarithromycin * milk of magnesia (magnesium based) may also help kill bacteria

Question 34

what nutrients are absorbed in the stomach?

Answer 34

water and alcohol

Question 35

what nutrients are absorbed in the duodenum?

Answer 35

Fe, Ca, Mg, Na, fats, water, proteins, vitamins

Question 36

what nutrients are absorbed in the jejunum?

Answer 36

carbohydrates and proteins

Question 37

what nutrients are absorbed in the ileum?

Answer 37

bile salts, vit B12, Cl

Question 38

what nutrients are absorbed in the colon?

Answer 38

water and electrolytes

Question 39

what are 4 types of GI motility disorders?

Answer 39

constipation, diarrhea, irritable bowel syndrome, inflammatory bowel disease

Question 40

what physically causes constipation?

Answer 40

mobility is too slow and too much water is being absorbed

Question 41

what is the pharmacological treatment of constipation?

Answer 41

* laxatives * bisacodyl * docusate

Question 42

describe bisacodyl

Answer 42

* OTC laxative for constipation * stimulant of smooth muscles * fast acting * suppository/oral

Question 43

what are the side effects of bisacodyl?

Answer 43

cramps

Question 44

describe docusate

Answer 44

* aka dulcelax * OTC treatment for constipation * water retention in stools, causing softened stools

Question 45

what is diarrhea?

Answer 45

* loose, watery stools * mobility is too fast, so not enough is absorbed

Question 46

what are the consequences of diarrhea?

Answer 46

dehydration, malnutrition

Question 47

what populations is diarrhea worse in?

Answer 47

young and elderly

Question 48

what are medications used to treat diarrhea?

Answer 48

* loperamine (imodium) * bismuth subsalicylate (pepto-bismol) * anti-cholinergics (atropine)

Question 49

what is loperamine?

Answer 49

* imodium * mild opioid agonist used to treat diarrhea * if diarrhea is severe, you can use strong opioid agonists

Question 50

is there a structural defect associated with irritable bowel syndrome?

Answer 50

no exact cause is unknown

Question 51

what are the symptoms of IBS?

Answer 51

typically episodic pain and bloating

Question 52

IBS could be a ___ disorder

Answer 52

5HT-dependent neuromuscular disorder

Question 53

what percent of the population may suffer from IBS?

Answer 53

20% - it is the most common GI disorder

Question 54

what age population is IBS most common in? what is it associated with?

Answer 54

* young adults and 50 year olds * possible association with stress and poor diet

Question 55

what are the treatment options for IBS?

Answer 55

1. typically symptomatic treatment (ex. treat diarrhea or constipation with diet and anti-stress changes) 2. drugs

Question 56

what are drugs used to treat IBS?

Answer 56

* linaclotide (linzess) * only FDA-approved for IBS with constipation

Question 57

how does linaclotide (linzess) work?

Answer 57

* it is a guanylate cyclase-C agonist * increases bowel movement, fluid secretion, and reduces pain

Question 58

what are the side effects of linaclotide (linzess)?

Answer 58

diarrhea and gas

Question 59

inflammatory bowel disease affects \_\_% of the population

Answer 59

\<1%

Question 60

what two disorders make up inflammatory bowel disease?

Answer 60

crohn's disease and ulcerative colitis

Question 61

what location in the body does crohn's disease affect?

Answer 61

* can affect entire GI, but more intense in ileum and colon and intermittent areas with strictures between * presents as ulcerations, swellings, and scarring

Question 62

crohn's disease is characterized by chronic ___ problems

Answer 62

diarrheal

Question 63

what type of pain is associated with crohn's disease?

Answer 63

hypogastric

Question 64

what is a common location for fissures and fistulas associated with crohn's disease?

Answer 64

perianal area

Question 65

patients with crohn's disease have a higher incidence of ___ and \_\_\_

Answer 65

arthritis and colon cancer

Question 66

what can happen to the liver in patients with crohn's disease?

Answer 66

fatty liver

Question 67

what can cause crohn's disease?

Answer 67

* possible genetic link * perhaps abnormal inflammatory response to normal flora

Question 68

can crohn's disease go into remission?

Answer 68

yes

Question 69

what medications can be used to treat crohn's disease?

Answer 69

* anti-inflammatories * mesalamine (topical) * corticosteroids (systemic) * antibiotics * metronidazole

Question 70

\_\_\_ is similar to crohn's disease but is limited to the colon and is more generalized, without strictures

Answer 70

ulcerative colitis

Question 71

what medications can be used to treat ulcerative colitis?

Answer 71

similar to crohn's disease: * anti-inflammatories * mesalamine (topical) * corticosteroids (systemic) * antibiotics * metronidazole