Agents Used in Biliary and Pancreatic Disease

Question 1

secretion of bile

The secretion of bile:

Answer 1

Hepatocytes secrete bile into canaliculi

flows into bile ducts.

modification by addition of a watery, bicarbonate-rich secretion from ductalepithelial cells

stores at gall bladder

Question 2

bile acids types

Answer 2

R-3, 7, 12, 24 (glycin or taurine or oh - salts)
cholic (oh oh oh )
chendeoxycholic (oh oh h)
deoxycholic (oh h oh)
lithocholic (so2/oh h h)
ursodeoxycholic (oh oh h)
(acids)

Question 3

ursodeoxycholic acid

Answer 3

hydrophilic
->->->
deminishes cholesterol sythesis and secretion from liver
deminishes cholesterol reuptake from intestine
->->->
gradual solubilization of cholesterol from gallstones, resulting in their eventual dissolution

p/o (with food) and blood concetrations in direct corelation

Question 4

ursodiol side effects

Answer 4

Soft stool and\or diarrhea

very rare:
Severe pain in the URQ,
worsening of cirrhosis
Gallstones calcification

Question 5

resins examples

Answer 5

Colestipol
Cholestyramine
Colesevelam

Question 6

resins mechanism of action

Answer 6

Large, highly positive molecules
Not absorbed
Bind bile acids and prevent recycling to the liver
bile pool Depletion

Question 7

resins side effects

Answer 7

minimal systemic side effects (not abbsorbed)
Mostly GIT: constipation, bloating, nausea
Interfere absorption of many drugs
->->->
drugs should be taken at least 1-2 hours before, 4-6 hours after

Question 8

treatment of Chronic Pancreatitis and Steatorrhea

Answer 8

Pancreatic enzyme supplements
Amylase
Lipase
Proteases

Question 9

Pharmacological therapeutic targets of Chronic Pancreatitis and Steatorrhea

Answer 9

Prevention of malabsorption

Palliation of pain

Question 10

Pancreatic enzyme supplements types of preparations

Answer 10

Pancreatin
Alcohol-derived extract of hog pancreas
low concentrations of lipase and proteolytic enzymes

Pancrelipase
12 times the lipolyticactivity
> 4 times the proteolyticactivity

Question 11

solution for Formulas made of ezymes

Answer 11

PPI or H2antagonist addition

Enteric-coated formulations

Question 12

Pancreatic enzyme supplements Adverse effects

Answer 12

The capsules should be swallowed, not chewed
→ pancreatic enzymes may cause oropharyngealmucositis (or disphagia of any kind)

Excessive doses may cause diarrhea and abdominal pain