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DU PA GI Pharm
Duke PA GI Pharmacology
| Question | Answer |
|---|---|
| peptic ulcer disease is a group of ulcerative disorders of the upper GI tract that require __ for their formation | acid and pepsin |
| stimulants of acid secretion | acetylcholine, histamine, gastrin |
| pretective forces in GI | mucus secretion, bicarbonate secretion, mucosal blood flow, cell restitution, prostaglandin |
| Helicobacter pylori produces __ which forms an acid-neutralizing cloud that protects H. pylori but damages tissue | urease |
| more than 95% of patients with DU and 80% with GU are infected with __ | H. pylori |
| NSAID mechanism of injury to stomach | direct action on the mucosa, inhibition of prostaglandins |
| clinical presentation of GU | food worsens pain |
| clinical presentation of DU | pain relieved by food/antacids |
| the more common ulcer | DU |
| most __ are biopsied to r/o cancer | GU |
| by neutralizing acid __ is inhibitied | pepsinogen to pepsin |
| when used at proper doses, they are equally efficacious as histamine2 antagonists | antacids |
| onset of antacids is usually __ after administration | 5-15 min |
| duration of antacids is usually __ | 1-2 hours |
| non-systemic antacids | aluminum hydroxide, magnesium hydroxide, calcium carbonate |
| systemic antacids | sodium bicarbonate (Alka-seltzer) |
| major side effect of Aluminum hydroxide (amphojel) | constipation |
| major side effect of Magnesium Hydroxide (milk of magnesia) | diarrhea |
| most common side effect of calcium carbonate | constipation |
| can deliver large amounts of sodium to systemic circulation, can alter systemic pH, use only for short term | Sodium Bicarbonate (Alka-Seltzer) |
| H2 Receptor Antagonists competitively bind to H2 receptors on the __ and decrease histamine stimulation of gastric acid | parietal cells |
| properly taken H2A will heal __% of DU at 8 weeks and __% of GU at 12 weeks | 90, 80 |
| __ can cause alcohol to remain in your system for longer | Zantac |
| block gastric acid secretion by inhibiting gastric H/K ATPase in gastric parietal cells | PPI |
| produces profound, long lasting anti secretory effects | PPI |
| indicated for treatment and maintenance of DU only. Many drug-drug interactions. Do not use for GU. Forms cytoprotective complex that covers ulcer site. No systemic absorption. Is a huge pill. Is used in the ICU for ventilated patients. | Sucralfate (carafate) |
| a synthetic prostaglandin that increases mucus production and mucosal bicarb. Indicated for NSAID induced gastric ulcers. | Misoprostol (cytotec) |
| AE's of misoprostol (Cytotec) | Diarrhea, ab pain, flatulence, abortifacient |
| retrograde movement of gastric contents from the stomach into the esophagus | GERD |
| drugs that decrease gastric acid | antacids, H2A, PPI |
| drugs that increase LES pressure | bethanechol, metoclopramide, cisapride |
| drugs that increase gastric emptying | metoclopramid, cisapride |
| drugs that increase esophageal clearance | cisapride, bethanechol |
| __ in GERD is less efficacious than in PUD | H2A |
| esophagela healing __ for PPI as compared with H2A | double |
| 3 main causes of N/V | visceral stimuli, chemoreceptor trigger zone, vestibular inpu |
| drug induced N/V | chemotherapy (cisplatin), opiates, antibiotics, cardiac glycosides, SSRI's |
| best used for indegestion instead of N/V | H2A, antacids |
| most practical for long-term treatment for N/V | phenothiazines |
| serotonin antagonists are best for | PONV and CINV |
| serotonin antagonists are not effective for __ | motion sickness |
| examples of serotonin antagonists | Zofran, Kytril |
| very expensive antiemetic | serotonin antagonists |
| prokinetic agents are best used for | gastric stasis or CINV |
| example of a prokinetic agent | reglan |
| cannabinoids are best used for | CINV |
| CINV | chemo induced nausea and vomiting |
| PONV | post-operative nausea and vomiting |
| glucocorticoids are best used for | CINV and PONV |
| examples of glucocorticoids used for N/V | decadron, prednisone |
| benzodiazepines are best used for | anticipatory N/V |
| examples of bezno's used for N/V | valium and ativan |
| butyrophenones are best used for | PONV and CINV |
| example of butyrophenone used for N/V | haldol |
| FDA approved for use in combination with conventional agents for highly emetogenic chemotherapy (cisplatin-based chemo) | Neurokinin-1 antagonists |
| drugs that induce diarrhea | antacids containing magnesium, antibiotics, antineoplastics, colchicine, laxatives, metoclopramide, prostaglandins |
| dietary management for adults | withhold feeding (not for children) |
| pharmacologic treatment options for diarrhea | antimotility agents, adsorbents, antisecretory agents, miscellaneous |
| bacterial diarrhea (C. dif), Colitis, children <2, are contraindications for use of __ | antimotility agents |
| do not use antimotility agents more than __ in acute diarrhea | 48 hours |
| more potent at slowing GI motility than other antimotility agents, newly a generic | loperamide |
| used for symptomatic relief, not very effective for sever acute diarrhea, not systemically absorbed (Kaopectate, FiberCon) | adsorbent agents |
| examples of antisecretory agent | Bismuth subsalicylate, octreotide |
| common pathogens for traveler's diarrhea | E. coli, shigella, Campylobacter, Salmonella, viruses |
| __ is not recommended for prevention of traveler's diarrhea | prphylactic antibiotics |
| nonpharmacological management of constipation | encourage 10g crude fiber in daily diet, 1 month trial |
| pharmacologic treatment options for constipation | bulk forming laxatives, saline/hyperosmotic laxatives, emollient laxatives, lubricants, stimulants |
| bulk forming laxatives (metamucil) are best used for | prevention of constipation |
| best used for acute evacuation of the bowel, pulls water into small and large intestines | saline laxatives (Magnesium Citrate, (MOM) |
| facilitate mixing of aqueous and fatty materials within intestinal tract, best for patients who must avoid straining or to prevent constipation | emollient laxatives (docusate(Colace)) |
| not recommended for routine use, in the elderly, or children <6 years old. Coats stool for easier passage, inhibits colonic absorption of water, increase stool weight and decrease stool transit time. Take on empty stomach, not before bed | lubricants (mineral oil) |
| not recommended for daily use or in the elderly for constipation | stimulants |
| anthraquinone stimulants | cascara sagrada, sennosides (Senakot), casanthrol (Peri-Colace) |
| diphenylemethane stimulants | bisacodyl (dulcolax), phenolphthalein (removed from the marked due to carcinogenic capabilities) |
Created by:
bwyche
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