Week 8 GI track Flashcards

1
Q

What is ulcer?

A

Ulcers formed in the muscular mucosa in the wall of the GI tract
Ulcers occur when stomach acid damages the lining of the digestive tract.

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2
Q

2 type of ulcer

A

duodenum
stomach(gastric ulcer)

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3
Q

Ulcer
What are 3 main causes?

A

Helicobacter pylori infection
Used NSAIDS
Stress related mucosal damage

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4
Q

What are mucosa protection? 4

A

Mucosa secretion(physical barrier)
Bicarbonate(chemical barrier)
Microcirculation(protection method)
Prostaglandin

Maintain basic environment
Our body have too little these protection stuff

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5
Q

H. pylori
How to transmit?
Most affected populations?

A

Fecal-oral and oral-oral
Kids
Nurses

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6
Q

Ulcer caused by H. pylori
Medication

A

Helidac
Prevpac
Pylera

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7
Q

Which medication H. pylori starting resistance?

A

Prevpac

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8
Q

What NSAIDS dose to our body?

A

Dec production of prostaglandins
(ibuprofen etc)

Prostaglandins support our body’s protective factor(mucus, bicarbonate, microcirculation)

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9
Q

Ulcer caused by NSAIDs
Medication

A

Misoprostil
(Cytotec)

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10
Q

Misoprostil primary used these day is?

A

Promote abortion

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11
Q

Misoprostil
a) action
b) ADRs

A

a) Synthetic prostaglandin E1 analog
Inc mucosal protection
dec gastric acid secretion

b) Diarrhea moderate to severer
Contraindication pregnancy

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12
Q

Helidac®
contain?

A

Bismuth subsalicylate
Metronidazole
Tetracycline
H2RA

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13
Q

Prevpac®
contain?

A

Clarithromycin
Amoxicillin
Lansoprazole

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14
Q

Pylera®
contain?

A

Bismuth subcitrate
Metronidazole
Tetracycline
Omeprazole

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15
Q

What is the GERD?
Gastroesophageal Reflux Disease

A

Most common GI disorder
Tissue damage due to reflux of gastric contents into the esophagus

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16
Q

What is the condition of the GERD?

A

Chronic, relapsing condition related abnormal anatomy and motor function

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17
Q

GERD
Typical symptoms 6

A

Heartburn
Acid regurgitation
Belching (burping)
Abdominal bloating
Early satiety(unable to eat a full meal)
Nausea

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18
Q

GERD
Lifestyle modifications 7

A

Lose weight #1 cause
Smaller meals and low-fat foods
Avoid acid food
-citrus juice, tomato products, caffeine
Avoid lying down for 2-3 hr after meal
Avoid smoking!!
Elevate HOB
Avoid tight clothing

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19
Q

Antacids

A

Neutralize gastric acid
Rapid onset
Short duration of action
(take 7-10 times per day)
Mostly local acting

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20
Q

Aluminum hydroxide
Product name

A

Neutralize gastric acid
Alternagel
Amphojel

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21
Q

Aluminum hydroxide
ADRs

A

Aluminum= Constipation!!
Osteoporosis
Phosphate depletion

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22
Q

Magnesium
Product name

A

Neutralize gastric acid

Milk of Magnesia
Mag-OX

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23
Q

Magnesium
ADRs

A

Diarrhea
Hypokalemia
Hypermagnesemia (renal insufficiency)

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24
Q

Calcium Carbonate
Product name

A

Neutralize gastric acid
Tums
Chooz

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25
Q

Calcium Carbonate
ADRs

A

Calcium stone formation
Acid rebound
(Calcium itself cause make more acid)
Milk-alkali syndrome

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26
Q

Sodium Bicarbonate
Product name

A

Neutralize gastric acid

Alka-Seltzer
Baking soda

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27
Q

Sodium Bicarbonate
ADRs

A

Systemic alkalosis
Sodium overload

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28
Q

Rolaids
Product

A

Calcium carbonate
Magnesium hydroxide
Don’t work well as Mylanta

-Synthetic pharmacodynamic drug drug interaction

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29
Q

Mylanta
Maalox
What contain?

A

Magnesium hydroxide
Aluminum hydroxide
Works better

diarrhea(Mg)+constipation(Al) cancel out
-Pharmacodynamic antagonistic therapeutic drug drug

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30
Q

Antacids
Drug interaction

A

Tetracycline (Antibiotics)
-direct complex
Bisphosphonates
-reduce absorption
Ketoconazole
-Inc gastric pH to alkaline, dec absorption

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31
Q

Antacid + alginic acid=??

A

Gaviscon
Aluminum and magnesium antacids

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32
Q

Gaviscon
action

A

Forms a foam on the liquid present in the stomach
Work only while is int he upright position

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33
Q

What medication decrease acid production?

A

H2RA
Proton Pump Inhibitor (PPI)
Misoprostil

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34
Q

H2RA
Product name

A

Cimetidine
Famotidine
Nizatidine

tidine

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35
Q

H2RA
Action
ADRs

A

Dec histamine-mediated release of acid

Hormonal ADRs with cimetidine

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36
Q

Proton Pump Inhibiter
Product name

A

Omeprazole
Lansoprazole
Dexlansoprazole
Esomeprazole

-prazole

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37
Q

PPI
action
ADRS

A

dec long lasting acid through inhibition of the enzyme responsible for secret gastric acid
95%!!

Dizziness, drowsiness and constipation

38
Q

PPI
Risk

A

risk associated with long term use
Pneumonia with COPD pt
(almost none acid cannot kill bacteria)
Osteoporosis
Inc risk of fracture

39
Q

PPI
how to take?

A

Take 20-30 min BEFORE first major meal of the day

Suppress food activated acid release

40
Q

Simethicone

Product name

A

Mylicon
Gas-X
Mylanta Gas

41
Q

Simethicone
action

A

relive intestinal gas
Prevent form of large gas bubbles

Safe for kids and baby

42
Q

What nausea?
What vomiting?

A

Inclination to vomit
- I’m going to vomit

Ejection of stomach contents

43
Q

Major concern N/V? 4

A

Dehydration
Metabolic alkalosis
(because all acid throwing up)
Loss of electrolytes
Esophageal damage

44
Q

Anticholinergics
Product name?

A

scopolamine
meclizine
dimenhydrinate

45
Q

Anticholinergics
used for?
ADRs?

A

simple nausea
Motion sickness
-doesn’t help pt who already vomiting

Drowsiness
Dry mouth
Dry everything
Constipation

46
Q

Serotonin Receptor Antagonists
Product name

A

dolasetron
granisetron
ondansetron
palonosetron

SETRON!!!

47
Q

Serotonin Receptor Antagonists

used for?
ADRs?

A

Acute N/V
Chemotherapy-including N/V
-if pt not vomit, inc cancer curing raters
headache
Constipation or diarrhea

48
Q

Dopamine Antagonists
Product name

A

promethazine
metoclopramide

49
Q

Dopamine Antagonists
used for?
ADRs?

A

Acute N/V

ADRs
this drug not so common d/t a lot of side effects
-dimness
-confusion
-abnormal involuntary movement

50
Q

Cannabinoids
products name

A

dronabinol
nabilone

Marijuana drug

51
Q

Cannabinoids
used for?
ADRs?

A

Mild moderate nausea
(not for vomiting)
Less effective than others

Sedation
dizziness
ataxia

52
Q

Corticosteroids
Product name

A

dexamethasone
methylprednisolone

53
Q

Corticosteroids
used for?
ADRs?

A

Post-surgical N/V
Only for SHORTERM used*

Short term used for avoid ADRs

54
Q

Neurokinin Antagonist
Product name
Used for?
ADRs?

A

aprepitant
chemotherapy N/V
Post-surgical N/V
** Very expensive, only hospitalization

Well tolerated

55
Q

Hemorrhoid?
heh·mr·oyd

A

56
Q

Constipation
Background

A

Very common (20% of population)
Range vary based on pt so be sure to assess baseline

57
Q

Constipation
Causes

A

Diet (lack of fluid and fiber)
Lifestyle
GI disease
Metabolic disorder
Pregnancy
Drugs (aluminum)

58
Q

Constipation
symptoms-major 5

A

Dec frequency
Hard/dry stool
Painful defecation
Abdominal distention
Palpable mass

59
Q

Constipation
symptoms-minor Kids 4

A

Rectal pressure
Headache
Dec appetite
Abdominal pain

60
Q

Constipation
symptoms RED FLAG 5

A

Blood in stools
(hemorrhoid? GI cancer?)
Weight loss
Fever
Anorexia
Nausea and vomiting

61
Q

Constipation
Complications

A

Anal fissure
Hemorrhoids
Rectal prolapse

Fecal impaction

62
Q

Bulk forming Laxatives
Product name

A

Psyllium
Methylcellulose
Calcium polycarbophil
Wheat dextrin

63
Q

Bulk forming Laxatives
a) action
b) onset

A

Absorbs water to inc fecal mass
Distending bowel to initiate reflex activity 膨らむ

12-72hr

64
Q

Bulk forming Laxatives
a) ADRs
b) Comments

A

Flatulence(accumulation of gas)
Abdominal cramping/blotting

Must drink sufficient water
Avoid in dehydrated patients

65
Q

Stool softeners
a) Product name
-calcium
-sodium
b) onset

A

Docusate surfak
Docusate colace

1 to 2days

66
Q

Stool softeners
action

A

Soften stool mass (keep water in stool)

67
Q

Stool softeners
a) ADRs
b) Comments

A

Diarrhea

Works best for prevention
Prevents straining(pulled muscle)

68
Q

Stimulants
action

A

Inc peristalsis by irritating nerves in colon

69
Q

Constipation
Stimulants
a) products name
b) onset

A

a) Senna, Biscodyl, Castor oil

b) 6-12 hr (PO)
15-30min (suppository/into bottom)

70
Q

Constipation
Stimulants
a) ADRs
b) Comments

A

a) Abdominal cramps (sever)
diarrhea
b) Laxative dependency if use too much

71
Q

Osmotic laxatives
a) Products
b) onset

A

Hypertonic electrolytes,
Magnesium citrate
Magnesium hydroxide (MOM)
Sodium phosphate,
Golytely

Dose dependent
(1-8 hr oral, minutes rectally)

72
Q

Osmotic laxatives
action

A

Inc water content in bowel stimulates peristalsis
Hold water in bowel through osmotic pressure

73
Q

Osmotic laxatives
a) ADRs
b) Comments

A

a) Diarrhea/cramping
Dehydration
Electrolyte imbalance

Caution in renal failure (hypertonic electrolytes)

74
Q

Lubricants
a) Product name
b) onset
c) action

A

a) Mineral oil (not orally)
b) 24-48hr
c) Coats feces easing passage of stool
Maintains water in stool

75
Q

Lubricants
a) ADRs
b) Comments

A

a) Can ne absorbed, causes an inflammatory reaction
Lipid pneumonia
b) Absorb fat soluble vitamins
tends to leak from rectum
Best used a component of an enema

76
Q

Diarrhea
background

A

Not a disease, it a symptom of disease
Marked by inc stoll frequency
(lack of control)
abdominal cramps
Rectal urgency
Loose, watery formed stools

Usually self-limiting
3-4 days

77
Q

Diarrhea
causes

A

Infection(viral and bacteria)
Drugs
(antibiotics, laxatives, orlistat)
Food
Malabsorption

78
Q

Adsorbents
product name
Onset

A

Attapulgite
12hr to 2days

79
Q

Adsorbents
action

A

Absorbs excess fluid in the intestine, stabilizes stool mass

80
Q

Adsorbents
a) ADRs
b) Comments

A

Constipation
Not absorbed (No systemic ADRs)
Drug interactions due to complexation

81
Q

Anti-peristaltic
Product name
Onset

A

Loperamide(Imodium)
45-60 mins

82
Q

Anti-peristaltic
action

A

Prolong intestinal transit time by stimulating GI opioid receptors

Allow for longer water reabsorption

83
Q

Anti-peristaltic
a) ADRs
b) Comments

A

Constipation
abdominal pain

4mg followed by 2mg after each loose stool(Max 16mg/day) for up to 48hr

Contraindication in patients<2 years old

84
Q

Which diarrhea medication has black box waring?

A

Anti-peristaltic/Loperamide(Imodium)
Black box warning!!!

Cardia arrhythmias when used in higher than recommended doses

85
Q

Antisecretory
Product name
onset

A

Bismuth subsalicylate
4-24hr

86
Q

Antisecretory
action

A

Prevent secretions into the bowel, antibiotic

87
Q

Antisecretory
a) ADRs
b) Comments

A

Temporary darkening of tongue
Salicylate allergy

88
Q

What is the Salicylate allergy?

A

Salicylates are a type of drug found in many over-the-counter and prescription medicines.
Aspirin is the most common type of salicylate.
Asthma-like symptoms, such as wheezing and trouble breathing

89
Q

What medication can cause an electrolyte imbalance and should therefore be used with caution in renal patients?

A

Polyethylene glycol (MiraLAX)
Constipation med

90
Q

The drug that treats diarrhea the fastest is?

A

Loperamide 45-60mins