GI Flashcards
(49 cards)
1
Q
GI diseases
Esophagus –_____ (_____)
Stomach – _____, _____ (PUD)
Intestines –
-Acute: _____ (Bacteria, Viruses and Protozoa) / Traveler’s _____
Chronic: _____ (duodenum), _____ diseases (IBD- UC/Crohn’s), _____ (_____), and _____ disease
-_____
Rectum and Anus – Anal fissures, _____
A
Gastroesophageal reflux disease (GERD) gastritis peptic ulcer disease Gasteroenteritis diarrhea Peptic ulcer disease Inflammatory bowel Irritable bowel syndrome (IBS) Coeliac constipation Hemorrhoids
2
Q
GERD: a digestive disorder of the _____ (_____)
- symptoms: chronic _____, _____, _____, _____ pain and early _____
- Reflux – Excess _____ production, weakness of _____ at LES or _____
- > 9 million primary care visits annually in US
- Most common cause of _____
- If left untreated, esophagitis can cause _____, _____, and chronic _____
- Scarring narrows the esophagus and interferes with _____
- Long standing GERD symptoms may cause _____ (10-15%) increasing the likelihood of_____
A
lower esophageal sphincter (LES) heartburn dyspepsia regurgitation epigastric satiety acid muscular ring hiatal hernia esophagitis bleeding ulcers scarring swallowing Barrett's esophagus cancer
3
Q
GERD and extra-esophageal symptoms
- Refluxed gastric contents can go into the throat, airways and lungs causing irritation or damage:
- -Chronic _____
- -Chronic _____
- -_____
- -_____
- Progressive breathing problems
- Pulmonary diseases (adult-onset _____ or pulmonary _____)
-Distinguish _____ from _____ chest pain before diagnosing GERD
A
cough laryngitis aspiration pneumonia asthma fibrosis cardiac non-cardiac
4
Q
GASTRITIS: inflammation, irritation or erosion of _____
- acute/chronic
- causes:
- -excessive _____ use
- -chronic _____
- -_____
- -medications such as _____, other _____ and _____
- _____ pylori
- _____ reflux
- infections caused by _____ and _____
- if left untreated- severe loss of _____ and increased risk of developing _____
A
stomach lining alcohol vomiting stress aspirin NSAIDs bisphosphonates helicobacter bile bacteria viruses blood stomach cancer
5
Q
- _____: inflammation of superficial gastric mucosa
- _____: destruction of multiple small zones of superficial mucosa
- _____: destruction of full thickness of mucosa
A
superficial gastritis
erosive gastritis
gastric ulceration
6
Q
PUD: peptic ulcer disease (gastric/duodenal)
-_____ that develops on the _____ lining of the stomach and or the _____ portion of _____ (extends through _____ mucosa)
A
open sore inside upper SI muscularis
7
Q
symptoms of PUD
- _____ stomach pain
- feeling of _____
- _____ or _____
- _____ food intolerance
- _____
- _____
- gastric ulcer- pain is _____ after _____
- duodenal ulcer- _____ after meals
- etiology is similar to _____
- _____ alone do not increase the risk for PUD, can potentiate _____ risk in patients who use _____ concurrently
A
burning fullness bloating belching fatty heartburn nausea shortly meals 2-3 hours meals gastritis corticosteroids ulcer NSAIDs
8
Q
H. Pylori
- Gram _____, spiral bact, in _____ and _____
- Infection occurs by _____ route
- Oral cavity may be the permanent reservoir (found in dental plaque and saliva) and a _____ route is the most probable mode of transmission
- Several virulence factors are produced:
- _____- UREASE converts urea into _____ which buffers _____ and creates an _____ (allows to survive for years)
- Results in
- High levels of _____ and _____ and reduced levels of _____
- Impaired _____ secretion
A
–ve gastric antrum pyloric sphincter oral person-to-person Urease ammonia H+ ions ALKALINE CLOUD gastrin pepsinogen somatostatin duodenal bicarbonate
9
Q
“ALARM FEATURES” that warrant prompt gastroenterology referral
- _____
- _____
- early _____
- unexplained _____
- progressive _____ or _____
- recurrent vomiting and family history of _____
-patients with perforated PUD usually present with a sudden onset of severe, sharp _____ pain: _____!
A
bleeding anemia satiety weight loss dysphagia odynophagia GI cancer abdominal medical emergency
10
Q
NSAIDs
- NSAIDs are the most common cause of _____ in patients without _____ infection
- topical effects of NDAIDs cause _____. in addition, by inhibiting _____, NSAIDs inhibit the formation of _____ (PGE2) and their protective _____-2-mediated effects (i.e., enhancing gastric mucosal protection by stimulating _____ and _____ secretion and _____ proliferation and increasing mucosal _____)
- coexisting _____ infection increases the likelihood and intensity of _____- induced damage
- NSAID use is responsible for approximately one half of _____, which occur most commonly in older patients who are taking _____ or other _____ for _____ or _____
A
PUD H. Pylori submucosal erosions cyclooxygenase prostaglandins cyclooxygenase mucus bicarbonate epithelial cell blood flow H. Pylori NSAID perforated ulcers aspirin NSAIDs cardiovascular disease arthropathy
11
Q
PUD treatment
- Address the underlying cause
- Lifestyle changes:
- Reduction in _____ and _____ foods
- _____ loss
- Head of bed _____ & avoidance of meals _____ before _____
- Eradication of_____infection
- Withdraw _____
- Anti-secretory therapy
1: _____
2: _____ blockers
3: _____ inhibitors (PPIs)
A
fatty spicy weight elevation 2-3 hours bedtime H pylori NSAIDs Antacids H2 proton pump
12
Q
antacids: _____ + _____ = _____ + _____
- act as buffers to neutralize _____ (act within _____)
- therapeutic effect is by _____ or _____ properties
- salts of _____, _____, or _____
- available as chewable/dissolving tablets, liquid and gums
- examples: _____, _____, _____
- inhibit _____ activity by raising pH to _____
- side effects- _____ (_____ salts) and _____ (_____ salts)
- mixture of these two can preserve normal _____ function
- antacids impair the absorption of _____, oral _____, _____, _____, _____, _____ and _____
A
acid alkali salt water H+ ions mins physical chemical aluminum magnesium calcium alka-seltzer gelusil tums peptic 5 diarrhea Mg constipation Al bowel tetracycline iron fluoride ciprofloxacin erythromycin metronidazole thyroxine
13
Q
H2 blockers- inhibit _____ and _____ stimulated _____ secretion
- reversible competitive inhibitors of _____ at all H2- receptors
- highly selective for _____
- inhibit _____, _____, and _____ stimulated _____ secretion
- _____ secretion also falls with reduction in acid volume
- available both by OTC and prescription:
- _____ (Tazac, Axid)
- _____ (Pepcid)
- _____ (Zantac)
- _____ (Tagamet)
- _____ are likely to follow when treatment is stopped
- all agents are rapidly absorbed from _____
A
basal food gastric acid histamine H2 receptors histamine gastrin Ach acid pepsin Nizatidine Famotidine Ranitidine Cimetidine relapses intestine
14
Q
pharmacokinetics
- undergo _____ metabolism resulting in bioavailability of _____ (except _____)
- action starts within an _____ and DOA is _____ hours based on the dose administered
- ADRs: _____, _____, _____, _____, _____ and _____
- these drugs are cleared by combination of _____ metabolism, _____ filtration, and _____ secretion
- dose reduction is required in patients with moderate to severe _____ and _____ insufficiency
- in the elderly, a decrease in _____ and _____ decline in drug clearance occurs
A
first pass hepatic 50% Nizatidine hour 8-12 xerostomia diarrhea myalgia headache constipation fatigue hepatic glomerular renal tubular renal hepatic volume of distribution 50%
15
Q
clinical relevance
- use of H2 blockers before treatment ( _____ premedication/ _____) is beneficial in _____ patients
- _____ and _____ may occasionally cause _____
- GI pH is _____, concurrent use causes marked reduction in absorption of _____. advise patients to take at a different time.
- _____ alters the blood flow to the liver and is an enzyme inhibitor: can enhance DOA of other medications, especially _____
- cimetidine inhibits the metabolism of _____ and _____
A
anesthetic surgeries GERD cimetidine ranitidine thrombocytopenia increased antifungals cimetidine analgesics phenytoin warfarin
16
Q
- Lower the dose of _____, _____, _____ or _____ as H2 blockers may decrease their metabolism and enhance duration of action (slower recovery)
- _____ is a weak anti-androgenic: may produce _____ and _____ in males
- Contraindicated in _____ and _____
A
Diazepam Midazolam Lidocaine TCAs Cimetidine impotence gynecomastia pregnancy lactation
17
Q
proton pump inhibitors- most potent
- Given orally: _____ (Prilosec), _____ (Prevacid), _____ (Protonix)
- Are _____ that require gastric acid secretion to be converted to the active _____ or _____.
- _____ bioavailability is high (77% to 90%) and show equivalent efficacy
- Bind to the _____ irreversibly
- Half-life is about _____ hour (9 hours for _____), but the duration of acid inhibition is _____ hours (pumps take around 50 hours to resynthesize)
- Most PPIs are metabolized by _____ and _____. Hepatic impairment and old age reduce clearance of the PPIs, as do mutations in CYP2C19.
A
Omeprazole Lansoprazole Pantoprazole prodrugs Sulfenamide Sulfenic acid Oral H,K-ATPase 1 Tenatoprazole 48 CYP2C19 3A4
18
Q
SE
- Increased risk of _____ and_____
- A risk factor for_____infection via alteration of the colonic flora
- Combination therapy: _____ + _____ + _____
- PPIs may reduce absorption of some _____ and _____ (require _____ environment for absorption)
- Decrease efficacy of _____ (PPIs inhibit _____ enzyme, thus interfering with the conversion ofClopidogrelinto its active metabolite)
A
pneumonia bone fracture C. difficile Antacids H2 blockers PPIs antibiotics antifungals acidic Clopidogrel CYP2C19
19
Q
COLLOIDAL BISMUTH COMPOUNDS-Indirectly inhibit acid secretion
- Suppress _____ infection and reduce the _____ of _____
- Form an _____ over the ulcer base preventing further damage by acid and pepsin- _____ drug mechanism
- Adverse effects: _____ of the _____ and darkening of the _____
- No significant drug interactions
- Available as _____, _____
A
H. pylori hypersecretion acid insoluble protective layer Physical blackening stool tongue Pepto-Bismol Kaopectate
20
Q
SUCRALFATE
- A salt of sucrose complexed to _____.
- MOA: Similar to bismuth compounds
- SE: _____
- Contraindicated in _____ because of the risk of _____ absorption and toxicity
- Drug interactions: Can reduce the absorption of drugs such as _____ and _____
- Available as _____
A
sulfated Aluminum hydroxide Constipation chronic renal failure Aluminum Phenytoin Tetracycline Carafate
21
Q
MISOPROSTOL – A synthetic PGE1 analog
- Has _____ and _____ protective properties
- Simulates _____ and _____ secretion and enhance mucosal blood flow
- Binds to a _____ receptor on _____ cells, reducing _____ production
- Is an _____ drug (stimulates uterine contraction), so not to be used during pregnancy
- No significant drug interactions are reported
- Available as _____, _____
A
acid inhibitory mucosal mucus bicarbonate prostaglandin parietal histamine-mediated c-AMP abortifacient Cytotec Misodel
22
Q
ERADICATION OF H.PYLORI-DRUG COMBINATION THERAPY
-OAC – _____, _____, and _____ for _____ days;
BMT – _____, _____, and _____ for _____ days;
LAC – _____, _____, and _____ (LAC), for either _____ days or _____ days;
A
Omeprazole Amoxicillin Clarithromycin 10 Bismuth subsalicylate Metronidazole Tetracycline 14 lansoprazole Amoxicillin Clarithromycin 10 14
23
Q
inflammatory bowel disease (IBD)
- idiopathic disease
- dysfunction of the _____ and _____ immune system
- two major types:
- -ulcerative colitis (US): limited to the _____ mucosa
- -crohns disease (CD): affects any segment of GIT from _____ to _____, involves _____ lesions and is _____
-there is a genetic predisposition for IBD, and patients are more prone to development of _____
A
innate adaptive colonic mouth anus skip transmural malignancy
24
Q
symptoms
- Abdominal cramping and pain- Commonly in _____ in CD and in _____ or _____ in UC
- Irregular bowel habits, passage of mucus with/without blood or pus, _____
- Weight loss, _____ (during flare-up)
- _____, _____, _____
- _____ (50%)
- Perianal disease (_____, _____): 50% patients with CD
- _____ and delayed or failed _____ maturation in children
- Malabsorption of _____, _____ and other nutrients leading to _____ and _____ lesions
A
RLQ periumbilical LLQ tenesmus Fever Malaise Arthralgia Uveitis Pyoderma gangrenosum fistulas abscesses Growth retardation sexual iron B12 anemia oral
25
CD- oral manifestations
- Seen on _____, _____ mucosa and _____
- _____ ulcerations
- Angular _____
- _____ with or without edema of lips
- Mucosal _____ in the gingiva
- Buccal mucosa _____
```
lips
buccal
gingiva
Aphthous
cheilitis
Cobblestoning
tags
abscesses
```
26
MANAGEMENT- Stepwise approach (step-up)
- Step I – 5-ASA (_____) _____ daily basis (life long maintenance)
- -_____-Pentasa, Rowasa, Asacol
- -_____ – Azulfidine
- -_____ – Giazo
- MOA: exert topical _____ effect by reduction in synthesis of _____ (inhibition of _____ production, blocking of _____)
- Side effects: _____, Vomiting and GI upset (poor compliance), _____ discoloration of secretions, decrease in _____ absorption (supplements, megaloblastic anemia)
- Used during flares and for maintaining _____
- Overall: safe, well-tolerated but drug _____ is very imp
- Caution: Patients prescribed anti-inflammatory drugs may have an _____ effect
```
Aminosalicylic acid
twice
Mesalazine
Sulphasalazine
Balsalaside
anti-inflammatory
inflammatory cytokines
arachidonic acid metabolite
PG synthesis
Nausea
yellow-orange
folate
remission
compliance
additive
```
27
```
CLINICIAN’S CONCERNS
drug induced:
-_____
-_____ disturbance
-_____
```
-may decrease _____ effect of the anticoagulants like _____ and _____
```
agranulocytosis
taste
parotitis
anticoagulant
heparin
warfarin
```
28
STEP 1A- ANTIBIOTICS
- Used more often for _____ disease, _____, _____ masses in CD
- Most commonly used antibiotics are :
- -_____
- -_____
```
perianal
fistulas
intra-abdominal inflammatory
Ciprofloxacin
Metronidazole
```
29
STEP II- CORTICOSTEROIDS(ANTI-INFLAMMATORY)
- For _____ disease flares only
- Decrease inflammation by reversing _____ and suppressing _____ activity
- Not effective in preventing complications or progression of disease
- Long-term use is _____ due to side effects
- _____ and _____ Prep (Suppositories, enemas and rectal foams)
- -_____ (O)
- -_____ (O, Top)
- -_____ (O, Inj)
- -_____ (O, Top) an enteric-coated controlled-release capsule delivers active _____ to the _____ and _____
```
acute
increased capillary permeability
PMN
discouraged
Oral
rectal
Prednisone
hydrocortisone
methylprednisone
budesonide
glucocorticoid
distal small intestine
colon
```
30
STEP III-IMMUNOMODULATORS (Steroid-Sparing drugs)
- MOA: inhibit _____ mediated and _____ mediated immune reactions- _____
- inhibit _____, _____ and _____ of cells
- used if:
- -No-response or intolerance to _____, _____ or _____
- -_____ disease or frequent need for steroids
- -Perianal disease that does not respond to _____
- -_____
- -To bolster the effect of a _____ drug and prevent the development of resistance to biologic drugs
- -Prevent recurrence after surgery
```
cell
antibody
immunosuppressants
production
differentiation
proliferation
Amino-salicylates
antibiotics
corticosteroids
Steroid-dependent
Antibiotics
fistulas
biologic
```
31
STEROID SPARING: Decrease the long-term need for steroids for recurring flares
- takes _____ months (slow onset of action) for improvement in symptoms, steroids are started at the same time to produce a faster response and are withdrawn rapidly
- oral: _____ (Azasan, Imuran )and _____ (Purinethol)
- used to maintain _____
- Other examples : _____ (weekly injections), _____ and _____ (Topical- for Pyoderma Gangrenosum)
```
3-6
Azathioprine
6-Mercaptopurine
remission
Methotrexate
Cyclosporine A
Tacrolimus
```
32
STEP IV: BIOLOGIC THERAPY WITH MONOCLONAL ANTIBODIES
- _____: If not responded or intolerant to Corticosteroid and/or an Immunosuppressant
- -_____ (IV) – Remicade
- -_____ (SC) – Humira
- -_____ – Cimzia
- TNF is a _____ agent in the body's immune response and is _____ in IBD
- Watch-out for reactivation of latent _____ and other opportunistic infections, _____
- Cautious use in pts with _____
```
Tumor necrosis factor (TNF) inhibitors
Infliximab
Adalimumab
Certolizumab pegol
cytokine
upregulated
TB
Hepatitis B
heart failure
```
33
treatment of oral lesions
- Local _____ injections to the lesion
- _____ 2% in severe cases
- Topical _____ at low concentrations of 0.5 mg/kg
- 1% _____ ointment three times daily
- Steroid _____ (Dexamethasone elixir)
- Topical _____ ointment for refractory aphthous ulcers
```
Corticosteroid
Lidocaine
Tacrolimus
Hydrocortisone
mouthwashes
Dexamethasone
```
34
COMMON SIDE EFFECTS WITH IMMUNOSUPPRESSANT DRUGS
- _____ and _____: Canker sores, bone marrow suppression (increase the risk of infection or serious bleeding) and increased risk of non-Hodgkin’s lymphoma
- _____ and _____: increased risk of infections, high blood pressure, swollen gums, tingling of the fingers and feet, increased facial hair
- _____: Severe mouth sores and low WBC count. Addition of folic acid may reduce some side effects.
```
Azathioprine
6MP
Cyclosporine
tacrolimus
Methotrexate
```
35
ANALGESIC OF CHOICE IN PUD AND IBD PATIENTS
- Avoid prescribing _____ and _____
- Use _____ or _____ (selective COX-2inhibitor) in combination with _____ or _____
- IBD pt – avoid long term use of _____, especially in elderly and debilitated to minimize risk of _____
- Monitor for signs and symptoms of _____
- Selection of antibiotics for oral infections may be influenced by recent use of antibiotics for _____
```
Aspirin
NSAIDs
Acetaminophen
Celecoxib
PPI
Misoprostal
antibiotics
pseudomembranous colitis
diarrhea
PUD
```
36
irritable bowel syndrome
- abdominal pain or discomfort accompanied by a change in _____ habit and an abnormal _____ frequency:
- -_____ is a>3 bowel movement/day
- -_____ is <3 movements/week
- prevalence is 10-15%
- more common in _____ 2:1
- often coexists with other GI disorders, both functional (_____, chronic _____) and organic (_____ disease, _____, _____)
```
bowel
stool
diarrhea
constipation
women
dyspepsia
constipation
celiac
GERD
IBD
```
37
MANAGEMENT1: OPIOIDS FOR IBS-D
- _____ (Imodium) - binds to the _____ receptor in the _____. Consequently, inhibiting the release of _____ and _____, thereby reducing _____, and increasing intestinal transit time.
- Improves QOL as it allows planning of trips and socializing- anxious IBS-D patients
- Maximum daily dose is _____ for adults as OTC use and _____ as prescription use.
- Much higher doses can cause _____ and even death.
```
Loperamide
opiate
gut wall
Ach
PGs
peristalsis
8mg
16mg
cardiotoxicity
```
38
2: 5HT3 RECEPTOR ANTAGONISTS FOR IBS-D
- _____ (Zofran) – has excellent safety record
- _____ is present in the entero-chromaffin cells (EC cells)
- These patients have higher mucosal _____ concentrations in the colon
- Improve QOL by slowing transit, reducing bowel frequency, normalizing _____, and reducing _____
- Blocks _____ signals that transmit _____ information (painful and non painful) from the gut to the brain and helps to reduce _____ and abdominal pain.
- SE: _____ (25%) and _____
```
Ondansetron
Serotonin
5-HT
stool consistency
urgency
serotonin
sensory
diarrhea
Constipation
Ischemic colitis
```
39
3: SECRETAGOGUES FOR IBS-C
-Guanylate cyclase-C receptor agonist: Stimulates _____ secretion by activation of type 2 _____ via _____ (an intracellular second messenger) which in turn promotes _____
--_____ (Amitiza)- does not alter pain thresholds during rectal distension
--_____ (Linzess) - improves pain as well by blocking pain signals
SE: _____
```
chloride
Cl- ion channels
cGMP
peristalsis
Lubiprostone
Linaclotide
Diarrhea
```
40
TRAVELLER’S DIARRHEA
- Acute diarrhea in those who travel to developing countries and have adventuresome _____ behavior
- Main source of infection: Food and water contaminated with _____ matter
- Bacteria: _____, Campylobacter, _____, and Shigella
- Luxury resorts & cruise ships (_____ virus)
- Seafood ingestion syndromes : _____ numbness and reversal of temperature sensation
- More susceptible: Immunocompromised or lowered _____ (e.g., on _____ or _____)
```
eating
fecal
E coli
Salmonella
Noro
Perioral
gastric acidity
H2blockers
PPIs
```
41
- DD: _____ (e.g., Staphylococcus aureus, Bacillus cereus)
- _____ : Not recommended
- Avoid high-risk _____ (street vendors) and eating behaviors (cold sauces, salsas)
- Empiric treatment:
- -_____(sometimes change in H20 and electrolyte imbalance is the cause of diarrhea)
- -_____ – Increase colonic transit time (anti-motility) and Increase _____ water absorption (anti-secretory)
- _____ (does not cross BBB so no addiction potential), has _____ effects
- _____ + _____ (Lomotil), CNS effects at higher doses
- _____ - Rifaximin (Salix), also used in IBS as has anti-inflammatory and antibacterial properties
```
Gastroenteritis
Antibiotic prophylaxis
foods
Oral rehydration solutions
Opioid agonists
fecal
Loperamide
anticholinergic
Diphenoxylate
atropine
Antibiotics
```
42
constipation
- 74% nursing home residents
- _____, lack of _____, or use of certain medications (_____, _____, _____, _____, _____ and Supplements like _____/_____)
- Underlying ds- Stroke, Parkinson's disease, Diabetes, Spinal cord injury, Multiple sclerosis, Hypothyroidism etc
- Most pts use OTC remedies and don't report
- Discomfort, bloating, hemorrhoids or fecal impaction
- Mistaken belief: everyone should move their bowels each day, can lead to dangerous _____ overuse
- Bowel movements _____/wk may be normal and healthy for some
```
Diet
physical activity
Opioids
CCBs
diuretics
antidepressants
antacids
iron/calcium
laxative
3
```
43
management
- Bulk forming – Absorb _____ and _____ to increase _____ pressure (increase in peristalsis)
- Stimulants – Stimulate _____ in intestinal smooth muscle, increase mucosal permeability (moves fluids into lumen)
- Osmotics – Increase _____ (stimulate peristalsis by increasing intraluminal pressure)
- Wetting agents – _____ to ease passage (act like detergents and soften stools by reducing _____, thus allowing intestinal fluids, fatty substances to penetrate fecal mass)
```
water
expand
intraluminal
enteric nerves
fluid volume
Moisten
surface tension
```
44
bulk forming
- _____
- _____
stimulants
- _____
- _____
osmotic
- _____
- _____
- _____ (_____)
- _____
wetting agents
- _____
- _____
Psyllium, Methylcellulose
Bisacodyl Senna, Castor oil
Mag hydroxide Lactulose, Glycerin Polyethylene glycol (PEG)
Milk of Magnesia
Docusate
Mineral oil
45
OPIOID RECEPTOR ANTAGONISTS – µ (peripheral)
- _____
- Used in short term tt of opioid induced constipation without affecting _____ or precipitating _____
Methynaltrexone
analgesia
withdrawls
46
laxative abuse
- Eating disorders – _____ (binge eating followed by purging)
- Quick weight control – _____ (boxing, wrestling)
- _____ – something is wrong if they don't move their bowels every day
Bulimia
Combat sports
Older adults
47
antiemetics
-_____ – Benzodiazepines like lorazepam
-_____ – Antipsychotics like _____, Prochlorperazine
-D2 antagonists in CTZ and peripheral pro-kinetic action – _____ and _____
-_____ – Ondansetron, Granisetron
_____ is highly selective, high-affinity, non cardiotoxic and safe in children
-_____ – Meclizine, Cinnarizine, Cyclizine, Dimenhydrinate, Promethazine and Diphenhydramine
-_____ – Hyoscine( Scopolamine as a transdermal patch)
-Corticosteroid combination and neurokinin 1 (NK1) receptor antagonist – Aprepitant
-Partial CB1 agonist – Nabilone and Dronabinol
```
GABA agonist
DA antagonists
Promethazine
Metoclopramide
Domperidone
5HT3 antagonist
Granisetron
H1 antagonists
Muscarinic antagonists
```
48
CELIAC DISEASE (GLUTEN SENSITIVE ENTEROPATHY)
- Autoimmune disorder of _____ intestine in genetically predisposed (HLA DQ2, DQ8, or both)
- An inflammatory reaction to dietary gluten resulting in production of _____ that may produce _____ of the _____ (villous atrophy)
- Intestinal manifestations- _____, flatulance and weight loss.
- _____- iron deficiency anemia(palor), decreased bone mineral density, dermatitis herpetiformis, neuropathy and muscle wasting
- Left untreated- low _____ (vitamin D def) and risk for _____
- Women- risk of _____, spontaneous abortions, preterm deliveries, and LBW
```
small
autoantibodies
shortening
villi
diarrhea
Extraintestinal
BMD
fractures
infertility
```
49
treatment
- _____-free diet (Dietary education should focus on identifying hidden sources of gluten, planning balanced meals, reading labels, food shopping, dining out, and dining during travel)
- 5% of patients are refractory to a gluten-free diet
- Refractory patients –
- -_____
- -_____
- -Remission may be induced by the _____ and maintained with _____ and _____.
- Dermatitis herpetiformis – _____ skin ointment, _____ or potent topical Steroids (_____ or _____) or very potent (_____)
```
Gluten
Corticosteroids
Immuno-modulators
anti-TNF alpha antibody Infliximab
Prednisolone
Azathioprine
Dapsone
Salfasalazine
Betamethasone valerate
dipropionate
Clobetasol propionate
```
