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Pharmacology > GI Disorders (Chapter 11) > Flashcards

GI Disorders (Chapter 11) Flashcards

1
Q

What is the pylorus ?

A

Separates the stomach from duodenum (small intestine)

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2
Q

how long is the small intestine?

A

7-9 m

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3
Q

what is the lower esophageal sphincter for ?

A

relaxes for food to get into stomach

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4
Q

what are the 5 components of the stomach?

A 
esophagus
lower esophageal sphincter
stomach
pylorus
duodenum
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5
Q

what keeps stomach acid in its proper place ?

A

the lower esophageal sphincter and the pylorus

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6
Q

what keeps bile from getting into the stomach?

A

pylorus

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7
Q

is the esophagus protected from acidity?

A

no

which is why the sphincter separates it

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8
Q

what is the pH of stomach acid? from what ?

A

pH 1-5 from hydrochloric acid (HCl)

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9
Q

what is the pathway food goes through ?

A

from esophagus and then through pylori into duodenum, where it is absorbed and processed by healthy bacteria into vitamins and nutrients.
Then through peristalsis digested food moves through intestine.

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10
Q

how are the intestines protected from acidity?

A

with mucus

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11
Q

why is it important that the duodenum be protected from acidity?

A

if it’s not, tissue can be damaged, leading helpful bacteria to die and bad ones to take over

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12
Q

explain the nervous control of peristalsis

A

PNS promotes peristalsis, allowing bowel movements

SNS oppose this process

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13
Q

what is peristalsis ?

A

the rhythmic movement of intestine, which moves the bowel movement along

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14
Q

how does diarrhea happen?

A

if bowel movement is too fast, water is not absorbed efficiently, and stool is watery

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15
Q

how does constipation happen?

A

if bowel movement too slow, water is absorbed too much and the stool is too hard, and promotes constipation

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16
Q

what are 3 non-drug causes of constipation ?

A

changes to bacterial flora
presence of poorly absorbed substances (magnesium)
inflammation of intestine

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17
Q

what influences the rate of secretion of HCl?

A

the smell or eating of food

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18
Q

what is the cell that senses release of gastrin, ach, and histamine ?

A

parietal cell

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19
Q

what are the three substances that are released when you smell or eat food ?

A

gastrin
acetylcholine
histamine

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20
Q

what are the three receptors that receive gastrin, ach, histamine?

A

gastrin receptor
ach receptor
H2 receptor

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21
Q

what is the course of action to produce stomach acid ?

A 
senses food
release of gastrin, ach, histamine
sensed by parietal cell 
bind to gastrin, ach, H2 receptors
activates a proton pump called the H+ K+ -ATPase , which pumps protons into stomach
H+ combines with Cl- to produce HCl
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22
Q

does more protons make a solution more or less acid?

A

more

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23
Q

how does stomach acid digest proteins ?

A

when acid rises, activates pepsin from pepsinogen. pepsin digests the proteins.

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24
Q

what inhibits stomach acid production ?

A

endogenous chemical messengers from prostaglandin family
PGE2 inhibits acid secretion from parietal cells
PGI2 increases production of protective mucus and bicarbonate buffer.

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25
Q

what are the 4 classes of drugs to treat GI disorders?

A

proton pump inhibitors (PPI)
H2 receptor antagonists
PGE2 receptor agonists
antacids

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26
Q

why is it bad for the stomach to take too many NSAIDs?

A

they inhibit protective effects of PGE2, creates increased stomach acid

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27
Q

what are the causes of heartburn?

A

spicy/fast food

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28
Q

what is heartburn?

A

acid indigestion

due to contact of gastric acid with the esophageal mucosa

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29
Q

what does heartburn feel like ?

A

burning chest pain primarily behind sternum but can move up towards neck.

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30
Q

what can reflux of acid in heartburn cause ?

A

spontaneous regurgitation of gastric contents to throat, which can initiate bronchoconstriction in asthmatics

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31
Q

what is the frequency of people who experience heartburn once a month

A

1/3

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32
Q

what does it mean if heartburn happens more than 2x a week?

A

it is then called gastro-esophageal reflux disease

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33
Q

what can be 4 complications of gastroesophageal reflux disease ?

A

damage to esophagus, inflammation, erosion of esophagus

Barrett’s esophagus

esophageal cancer

ulcer

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34
Q

when are the symptoms of GERD felt the most ?

A

when lying down

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35
Q

what is the cause of GERD?

A

lower esophageal apogeal sphincter doesn’t function well, allowing acid and pepsin into the esophagus

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36
Q

what movements are contributing factors to GERD?

A

straining, bending over

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37
Q

what drugs can be contributing factors to GERD?

A

NSAIDs

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38
Q

what food and beverage can be contributing factors to GERD because of their direct irritant effect? (4)

A

spicy food
coffee/caffeine
citrus
tomato juice

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39
Q

what phase of life can be a contributing factor to GERD?

A

pregnancy

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40
Q

at what age does GERD become more common? why

A

after 65, because the protective mucosa diminishes

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41
Q

what is peptic ulcer disease? (PUD)

A

erosion of mucosa of stomach (gastric ulcer) or small intestine (duodenal ulcer)

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42
Q

what is the most common symptom of PUD?

A

abdominal pain, burning, cramping

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43
Q

what is the pain caused by PUD alleviated by?

A

antacids

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44
Q

how does pain from PUD vary with food intake ?

A

begins 1-3 hrs after eating

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45
Q

what are the two main causes of PUD?

A

NSAIDs and H. Pylori infection

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46
Q

what is a contributing factor to PUD ?

A

cigarettes

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47
Q

what is H. Pylori? how is it transmitted ?

A

a gram negative bacteria that can live between the mucus layer and the epithelial stomach lining. it’s transmitted through fecal- oral route (contaminated food)

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48
Q

what is the most common cause of gastric and duodenal ulcers ?

A

gastric & duodenal ulcers= PUD

H.Pylori

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49
Q

what antibiotics could H.Pylori be treated with?

A

it is a gram-negative bacteria
Aminoglycosides
Carbapenems

broad spectrum:
Cephalosporins
Tetracyclines
Fluoroquinolones

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50
Q

what is the most common cause of PUD in people without H.Pylori?

A

NSAID abuse

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51
Q

what is considered constipation ?

A

less than three bowel movements per week, stool hard and dry, straining necessary

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52
Q

is constipation a disease ?

A

no

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53
Q

what diseases is constipation associated with ?

A

endocrine diseases like diabetes and hypothyroidism

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54
Q

what drugs is constipation associated with?

A

drugs with anticholinergic effects

  • opioids
  • MAOI
  • antidepressants
  • antihistamines

antacids

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55
Q

how can lifestyle bring on constipation ?

A

“inconvenient timing”: too busy to poop

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56
Q

what is diarrhea characterized by ?

A

increased frequency of bowel movements, or decreased consistency of stool. (doesnt have to have nasty consistency to be diarrhea)

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57
Q

why can diarrhea be fatal?

A

dehydration

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58
Q

after how much time with diarrhea should one seek medical attention?

A

a few weeks

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59
Q

what diseases cause diarrhea ?

A

AIDS, IBD, IBS

infection is a major cause (bacteria, virus, flu, protozoa)

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60
Q

what medications cause diarrhea ?

A

tetracyclines: disruption of bacterial flora

cholinergic agonists

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61
Q

what food causes diarrhea ?

A

fatty foods, roughage (fiber)

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62
Q

what is irritable bowel syndrome? (IBS)

A

common disorder where colon is very sensitive

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63
Q

what are two other names for IBS?

A

spastic colon

colitis

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64
Q

what is the main cause of IBS?

A

stress

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65
Q

how can chewing gum exacerbate IBS?

A

introduces air, gassiness magnifies

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66
Q

what are the 4 main symptoms of IBS?

A

gassiness, bloating, diarrhea, constipation

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67
Q

what is inflammatory bowel disease (IBD)

A

refers to Crohn’s disease and ulcerative colitis

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68
Q

what is Crohn’s disease ?

A

IBD
autoimmune, lining of intestine attacked by immune system but can affect any part of digestive tract.
fistulas form, causing intestine disturbance

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69
Q

what is the main telling symptom of IBD ?

A

FEVER

systemic inflammation consistent with autoimmune disease

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70
Q

what is ulcerative colitis ?

A

inflammation of colon and rectum

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71
Q

what GI disease has to be supervised by a physician

A

IBD

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72
Q

what GI disease can be treated with surgery

A

IBD

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73
Q

what is another word for hemorrhoids

A

piles

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74
Q

what are hemorrhoids

A

painful swelling of anus of the haemorrhoidal blood vessels

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75
Q

what movements may cause hemorrhoids ?

A

straining, lifting, sitting, standing

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76
Q

can hemorrhoids be hereditary ?

A

yes

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77
Q

can IBD be hereditary?

A

yes

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78
Q

what can cause hemorroids- constipation or diarrhea ?

A

both

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79
Q

what are symptoms of mild hemorrhoids (4)

A

bleeding, itching, burning, inflammation

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80
Q

what are symptoms of sever hemorrhoids (5)

A 
increased bleeding typically after defecation
anal pain
protrusion outside anal canal 
seepage
blood clots
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81
Q

what vessels are involved in hemorrhoids ?

A

venous or arterial, internal or external

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82
Q

what life stage can be associated with hemorrhoids

A

pregnancy

83
Q

why is accurate diagnosis of hemorrhoids important ?

A

because similar symptoms found in other anorectal diseases (polyps and cancer)

84
Q

what OTC can minimize IBD ?

A

none

85
Q

how to deal with hemorrhoids ?

A

OTC

surgical removal for big ones

86
Q

what food and beverage can be contributing factors to GERD because of their effect of decreasing lower esophageal sphincter function? (5)

A 
fatty foods
alcohol
chocolate
peppermint
spearmint
87
Q

what are the three ways carbonated beverages exacerbate GERD?

A

contribute to acidity
increase stomach pressure
contribute to reflex through belching

88
Q

elevating the head of the bed can help with which disease ?

A

GERD

89
Q

what eating recommendations would you give someone who has GERD ?

A

avoid certain foods
avoid large meals 2-3 hours before lying down, sleeping because eating increases stomach acidity, and stomach acid increases at night

90
Q

what medications should one avoid if they have GERD ?

A

antihistamines (anticholinergic), tricyclic antidepressants, opioids

91
Q

what recommendation would you give someone who has GERD and wants to take NSAIDs?

A

drink lots of water

92
Q

how would you minimize abdominal pressure if someone has GERD?

A

less tight fitting clothes

less obesity

93
Q

what food should one avoid if they have PUD? (4)

A

alcohol, caffeine, spicy food

94
Q

what directives would you give someone that has PUD symptoms ?

A

must see a doctor and get tested for H. Pylori

95
Q

what NSAID recommendation would you give someone with PUD?

A

minimize NSAID. if no NSAID, then eradicate with prescription drug

96
Q

what is the best non drug intervention for IBS?

A

managing diet and stress
keeping a food diary
eliminate carbonated beverage/gum

97
Q

what is PUD?

A

peptic ulcer disease

98
Q

what is GERD?

A

gastro esophageal reflux disease

99
Q

what are the 4 goals of drug treatments for PUD and GERD?

A

neutralize acidity
inhibit acid production
block effect of acid on tissue
increase effects of mucus

100
Q

what are two ways to increase pH? why?

A

neutralize acidity
inhibit acid production

this inhibits the pepsinogen to pepsin conversion

101
Q

if someone has PUD/ GERD with diarrhea/constipation, what is the best way to treat these symptoms ?

A

treat the underlying disease

102
Q

what are the pharmacokinetics of PUD/GERD drugs

A

not absorbed well in blood, so local effect on GI with little systemic effect/adverse reaction

103
Q

what are the pharmacodynamics of PUD/GERD drugs ?

A

drugs block proton pumps, preventing protons into stomach, often irreversibly for longer duration of action

104
Q

what is a marked property of PUD/GERD drugs? what are the implications of this

A

pills are covered in protective coating, should not be crushed or chewed. the protective coating is what makes it work- pill has to survive stomach acid to then get into small intestine to get absorbed

105
Q

what is PPI?

A

proton pump inhibitor

106
Q

what is the most and least effective medication to treat GERD? order them

A

PPI more effective
then H2
antacids least effective

107
Q

what drugs inhibit H+ K+ -ATPase pump?

A

PPI

108
Q

what makes PPI have a long duration of action?

A

the fact that they are irreversible

109
Q

what are the two diseases that PPI treat

A

GERD and PUD

110
Q

why is it important to time intake of PPI drug ?

A

PPI only inhibit actively secreting proton pumps, therefore, it is better to dose 15-60 min before a meal

111
Q

how long is the half life and duration of action of PPI? how many times a day should one take it ?

A

half life of 1-2 hours

effect much longer due to irreversible effect

112
Q

why do PPI have the potential to decrease the metabolism rate (increase the effect) of other drugs ?

A

because PPI are metabolized by cytochrome 450 enzymes

113
Q

are PPI OTC?

A

only one

114
Q

what can H2 receptor antagonists be used with?

A

alone or combined with antacids

115
Q

what are H2 receptor antagonists effective for ?

A

heartburn, GERD, PUD

116
Q

what type of acid secretion are H2RA best for inhibiting ?

A

basal and nocturnal as opposed to secretion stimulated by food

117
Q

how is H2RA drug action terminated ?

A

in liver (metabolized) but mostly in kidney (excreted)

118
Q

are H2RA OTC?

A

most are

119
Q

what are the advantages of antacids ?

A

they work faster (onset of action after 5-15 min), even though they are less effective

120
Q

are antacids drugs ?

A

nope

121
Q

what are the four salts that antacids may contain ?

A

aluminum, magnesium, calcium, sodium

122
Q

what mixture would cause a lot of belching and burping ?

A

Na+, Ca2+

123
Q

what is the purpose of antacids ?

A

increase gastric pH

124
Q

what does the short duration of antacids entail?

A

frequent dosing

125
Q

what are the capacity, duration, and side effects of aluminum salt antacids ?

A

lowest acid neutralizing capacity
longest duration
decrease smooth muscle motility, resulting in constipation

126
Q

what antacid can be used to treat diarrhea ? why?

A

aluminum

decrease smooth muscle motility, resulting in constipation

127
Q

if you want to mix aluminum and magnesium salts to regulate acid, will it give a normal state, diarrhea, or constipation?

A

diarrhea

128
Q

what antacid can be used to treat constipation?

A

magnesium salts

129
Q

what is the mechanism of action of magnesium salts ?

A

facilitate water absorption, causing diarrhea

130
Q

which antacids are more likely to cause gassiness?

A

calcium and sodium salts

131
Q

what antacid should be avoided and why ?

A

sodium bicarbonate

may cause metabolic alkalosis

132
Q

how do antacids interact with other drugs ?

A

directly or by reducing bioavailability

133
Q

what are intake recommendations for antacids ?

A

use them 2 hours apart from oral administration of other drugs

134
Q

what is the main function of sucralfate ?

A

physical barrier

135
Q

what is sucralfate mostly used to treat ?

A

PUD

136
Q

how does a physical barrier like sucralfate work ?

A

forms mucus - like substance on the stomach lining, protecting the stomach. also inhibits pepsin, binds bile acids, and stimulates prostaglandins

137
Q

what are intake precautions for sucralfate ?

A

take well before a meal because it affects bioavailability of other drugs (2+ hrs)

138
Q

what is alginic acid’s function?

A

physical barrier

139
Q

what are two physical barriers ?

A

sucralfate and alginic acid

140
Q

what is alginic acid usually taken with?

A

antacids

141
Q

how should alginic acid be taken in order to be effective ?

A

with a full glass of water, forming a viscous foam that floats and provides a protective barrier

142
Q

the alginic acid mechanism only works if the patient does this:

A

is in upright position

143
Q

what is another name for misoprostol

A

cytotec

144
Q

what is misoprostol’s function

A

synthetic version of PGE1 which protects stomach

145
Q

what are 3 main adverse effects of misoprostol

A

diarrhea, nausea, abdominal cramps

146
Q

what medication is severely contraindicated during pregnancy for GI problems ?

A

misoprostol because it induces labor

147
Q

what is misoprostol used for, and how ?

A

in conjunction with NSAID to reduce the incidence of NSAID- induced ulcers

148
Q

what are three ways to administer laxatives?

A

orally
rectally as enema (syringe)
rectally as suppository

149
Q

what are 4 functions of different laxatives ?

A

bulk forming
stool softener
osmotic
stimulant of PNS

150
Q

what are the advantages of rectal laxatives ?

A

laxative reaches colon immediately, onset of action is shorter

151
Q

which type of laxative is recommended for long term medication and requires a physician recommendation ?

A

bulk forming

152
Q

which laxative is better for short term results ?

A

osmotic

153
Q

which laxative is better as a preventative measure ?

A

stool softener

154
Q

which laxative promotes peristalsis ?

A

stimulant

155
Q

what is an osmotic lax ?

A

stool easier to pass

156
Q

what class of drugs are usually used as anti-diarrheal?

A

opioids

157
Q

how are opioids anti diarrheal?

A

they act through mu-receptor to decrease smooth muscle contractibility

158
Q

what is the only OTC opioid for anti-diarrhea ?

A

loperamide bc lower abuse potential

159
Q

what are the 3 main anti-diarrhea opioids ?

A

loperamide (imodium)
diphenoxylate (lomotil)
difenoxin (motofen)

160
Q

what is bismuth subsalicylate used for ?

A

anti-diarrhea

161
Q

what is pepto bismol also called

A

bismuth subsalicylate

162
Q

what are the two main anti-diarrhea drugs ?

A

bismuth subsalicylate

opioids

163
Q

what medication would be better to treat acute traveler’s diarrhea ?

A

opioids

164
Q

what medication would be better to treat chronic diarrhea?

A

opioids

165
Q

what medication would be better to treat mild traveler’s diarrhea?

A

bismuth subsalicylate (pepto bismol)

166
Q

what are the pharmacokinetics of bismuth subsalicylate ?

A

acidity converts it to salicylic acid and bismuth oxylchloride

167
Q

which drug is used in multi-drug combinations for h.pylori ?

A

bismuth salicylate (pepto bismol)

168
Q

what is bismuth salicylate bad in combination with ?

A

blood thinners, NSAIDs

169
Q

what is the most popular drug used for the diarrhea symptoms in IBS ?

A

loperamide (Imodium)

170
Q

what is the most popular drug used for the constipation symptoms in IBS ?

A

bulk-forming laxatives (psyllium)

171
Q

what is a drug used for IBS that does not act just on the stomach? what is their advantages

A

tricyclic anti-depressants
orally
antidepressant + alleviate pain

172
Q

what are the main 3 kinds of drug categories that treat IBD?

A

anti-inflammatory
immunosuppressant
corticosteroids

173
Q

what do most drug generic names for IBD end with ? (2)

A
  • ine

- mab

174
Q

what is the surgery done in IBD ?

A

fistulas cut out

175
Q

what drugs are not really recommended for IBD although they work

A

immunosuppressive

they are expensive and there are a bunch of side effect and risk of opportunistic infections.

176
Q

which drug cures IBD ?

A

none

177
Q

what are the 8 different kind of drugs against hemorrhoids ?

A
  • corticosteroids
  • local anesthetics
  • astringents
  • vasoconstrictors
  • antiseptics
  • protectants
  • counterirritants
  • keratolytics
178
Q

what is the most commonly used corticosteroid? at what % is it sold ? how? what are its advantages ?

A

hydrocortisone
sold at 0.25% and 1%
only one available OTC
no systemic adverse effects

179
Q

what do corticosteroids relieve in hemorrhoids ? (3)

A

reduce inflammation, itching, swelling

180
Q

what are local anesthetics good for in hemorrhoid treatment (3) ? what are its disadvantages ? what are the recommendations?

A

blocks nerve impulses and provides therefore temporary relief of itching, burning, pain

allergic reactions may occur
discontinue if redness, swelling, pain do not diminish or become worse

181
Q

5 examples of local anesthetics used for hemorrhoids

A 
benzocaine
benzyl alcohol 
dibucaine
pramoxine
tetracaine
182
Q

what is the role of astringents in hemorrhoid treatment ?

A

they repair damaged tissues

183
Q

what are 3 examples of astringents used for hemorrhoids ?

A

calamine
zinc oxide
witch hazel

184
Q

what is Hamamelis water ?

A

witch hazel, an astringent

185
Q

what are two vasoconstrictors used in hemorrhoid treatment

A

pseudoephedrine

phenylephrine

186
Q

explain the vasoconstriction mechanism in hemorrhoid treatment

A

reduce swelling by constricting blood vessels, relieve local itching by slight anesthetic effect. mechanism is alpha-adrenergic effect.

187
Q

what are the adverse effects for vasoconstrictors for the butt ?

A

same as for nasal decongestants

nervousness, tremor, precaution for patients with hypertension

188
Q

if a patient has hypertension or diabetes, which hemorrhoid medication should they avoid ?

A

vasoconstrictors

189
Q

are antiseptics effective as hemorrhoid medication ?

A

not really

no evidence of preventing infection

190
Q

what are protectants ? how do they work for hemorrhoid medication ?

A

form physical barrier on skin

help promote clotting

191
Q

what do aluminum hydroxide gel, lanolin, mineral oil, zinc oxide, cocoa butter, shark liver oil, bismuth salts, petrolatum, glycerin, hard fat have in common ?

A

protectants, treat hemorrhoids

192
Q

what kind of feeling do counterirritants produce to treat hemorrhoids ?

A

cooling, tingling, warmth

193
Q

two examples of counterirritants

A

camphor, menthol

194
Q

what are keratolytics and what do they do

A

increase the rate at which damaged tissue of hemorrhoid excreted

195
Q

two examples of keratolytics

A

alcloxa, resorcinol

196
Q

what is one of the most overused medicines ?

A

GI medicine

197
Q

what GI diseases are popular with athletes

A

marathon runner’s diarrhea, IBS, GERD (exacerbated by exercise)

198
Q

what is marathon runner’s diarrhea ?

A

intestines bounce around, fecal matter destabilizes, gets into microtears, gets into bloodstream

199
Q

a patient has recurring PUD, and keeps taking H2RA. what to do ?

A

get tested for h.pylori

200
Q

what are 4 severe signs of GERD and PUD ?

A

weight loss
bleeding
anemia
difficulty swallowing

201
Q

what is a medical emergency that can be confused with acid reflux (GERD)

A

heart attack: chest pain radiating to jaw and arm

202
Q

what is the AT’ role w/ GI meds ?

A

compliance and can recommend lifestyle changes

203
Q

when is eating more fiber recommended ?

A

constipation

204
Q

What is the best drug therapy for h pylori?

A

PPI and antiobiotics

Pharmacology (15 decks)

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