Clinical & Drugs

Question 1

Its with high heart rate:

Answer 1

1) Drug=Propranolol
2) Blocks beta receptor
- decreases heart rate by decreasing cAMP

Question 2

Propranolol

Answer 2

1) Blocks beta receptor

=decreases HR by decreasing cAMP

Question 3

VIPoma

Answer 3

1) Over secretion of VIP
2) Explosive Diarrhea
3) Hypokalemia (Decrease K+)
4) Achlorhydria (Decrease HCl)

Drug: Octreotide=synthetic SST

Question 4

Verner Morrison Syndrome

Answer 4

1) Over secretion of VIP
2) Explosive Diarrhea
3) Hypokalemia (Decrease K+)
4) Achlorhydria (Decrease HCl)

Drug: Octreotide=synthetic SST

Question 5

Pancreatic Cholera

Answer 5

1) Over secretion of VIP
2) Explosive Diarrhea
3) Hypokalemia (Decrease K+)
4) Achlorhydria (Decrease HCl)

Drug: Octreotide=synthetic SST

Question 6

WDHA

Answer 6

1) Over secretion of VIP
2) Explosive Diarrhea
3) Hypokalemia (Decrease K+)
4) Achlorhydria (Decrease HCl)

Drug: Octreotide=synthetic SST

Question 7

GERD

Answer 7

1) Lower esophageal sphincter sucks at job

Question 8

Chronic Gastritis

Answer 8

1) Lower esophageal sphincter sucks at job

Question 9

Gastroparesis

Answer 9

1) Gut Paralysis
2) Drug= Erythromycin
3) Stimulates motion receptors
- side effect=diarrhea

Question 10

NSAIDS

Answer 10

1) Ibuprofen, asprin

2) Blocks the production of prostaglandins

Question 11

NSAID + Misoprostol

Answer 11

1) Prostaglandin E1

2) Tx: Chronic Inflammatory disease where they need NSAID

Question 12

Celebrex

Answer 12

1) NSAID
2) Hits version of enzyme that messes w/prostaglandins
that’s not expressed in stomach

Question 13

Zyrtec/benadryl

Answer 13

1) Antihistamines

2) Block H1 receptors

Question 14

Drugs w/ -tidine

Answer 14

1) Ranitidine, Famotidine, Cimetidine
2) H2 antagonists or H2 blockers
3) Decrease acid production (60-70%)

Question 15

Proton Pump Inhibitors

Answer 15

1) AKA H+/K+ ATPase inhibitors
- prazole (omeprazole)
2) Blocks 95% acid production
3) SUicide inhibitor=irreversible
4) Side effects:
- infection
- pneumonia
- C. Diff diarrhea
5) -prazole

Question 16

Zollinger Ellison Syndrome

Answer 16

1) AKA Gastrinoma
2) Tumor of G cells
3) Over secretion of gastrin= Increase Acid Production
4) Many Tiny Ulcers in stomach, duodenum, pylorus
5) Symptoms:
- pain in gut
- heartburn
6) Tx: High doses PPI

Question 17

Pernicious Anemia

Answer 17

1) Autoimmune disease
- parietal cells are attacked
2) No intrinsic factor produced
- can’t absorb B2, even if you eat
3) Symptoms:
- arise 3-5 years later
- Tingling fingers
- numbness of feet
- GAIT walking
- peripheral neuropathy
- paresthesia
4) Signs:
- Megloblastic anemia (MVC>100fL)
- Elevated methylmalonic acid
- hypersegmented neutrophils

Question 18

Peptic Ulcer Disease (PUD)

Answer 18

1) H. Pyloric colonization due to NSAID use
2) Tx: Triple Therapy (PPI + 2 abx)
Antibiotics: Clarithromycin + Amoxicillin (or metronidazole if allergic to penicillin or pregnant)
3) Reduces stomach acid production
-kills bacteria

Question 19

Achalasia

Answer 19

1) Failure of myenteric plexus to allow relaxation of lower esophageal sphincter
2) Unknown cause
3) Symptoms:
- 4-5 bites and full
4) Symptoms:
- look for birds beak deformity on barium swallow
5) Tx: Nifedipine
- Blocks calcium channel so muscle dilates
* * do not give to hypotension patients

Question 20

Curling (Stress) Ulcer

Answer 20

1) Necrosis of stomach or duodenum
2) due to:
- burns
- massive loss of body fluid/hypotension
3) Blood flow to gut stopped and goes to:
- heart
- kidney
- brain BC MORE IMPORTANT
4) Tx:
- Ranitidine
- Sucralfate
- blocks H2 receptors
- turns into gel=physical barrier

Question 21

Hirschsprungs Disease

Answer 21

1) AKA congenital Aganglionic Megacolon
2) Ganglion cells of myenteric plexus (parasympathetic) don’t develop in segment of colon
- colon is paralyze and feces builds up
3) Tx:
- no drug
- surgical resection
- Bethanicol b4 surgery

Question 22

Motion Sickness vomiting

Answer 22

1) Tx:
- metoclopramide
- proclorperazine
2) Blocks Dopamine

Question 23

Gut Vomitting

Answer 23

1) Tx: Ondansetron

- blocks 5HT

Question 24

Toxin Vomiting

Answer 24

1) Tx: Aprepitant

- blocks substance P (NK1 receptor)

Question 25

Salmonella

Answer 25

1) Chicken, Turkey, eggs, reptiles 2) Gets in macrophage - releases IL-1 - stimulates mast cells to release prostaglandins and histamine 3) result=increased secretions and increased motility 4) DIARRHEA

Question 26

Rotavirus

Answer 26

1) commonly seen in little kids (<2) 2) Causes inflammatory response=Diarrhea 3) Dehdyration quick 4) Most common cause of viral diarrhea in children

Question 27

Diabetic Diarrhea

Answer 27

1) Type 1 or 2 pt w/tingling in hands and feet 2) Poor controlled blood sugar 3) Sympathetic nerves in gut are damaged - NE doesn't get to gut - endless diarrhea 4) Tx: Clonidine - alpha 2 agonist

Question 28

Carcinoid syndrome

Answer 28

1) Tiny tumors in gut -produces to much 5HT 2)Sympotoms: Increased BP -flushing from nipples up -explosive diarhea 3) Tx: Octreotide Cyproheptadine -decreases 5HT release -serotonin antagonist

Question 29

Diarrhea

Answer 29

1) Tx: Opioids | - slows down gut motility

Question 30

Vibrio Cholerae

Answer 30

1) Subunit binds to Gs proteins - ADP ribosylates it - Gs protein is turned on and can't turn off - Increase in cAMP and PKA - CFTR activated 2) Diarrhea=RICE WATER STOOL 3) NO ANTIBIOTICS

Question 31

Heat-Labile Enterotoxin

Answer 31

1) ETEC and B. Cereus 2) Subunit binds to Gs proteins - ADP ribosylates it - Gs protein is turned on and can't turn off - Increase in cAMP and PKA - CFTR activated 3) Diarrhea 4) Tx: Abx not necessary bc toxin is the problem

Question 32

Heat-Stabile Enterotoxin

Answer 32

1) ETEC 2) Toxin binds to guranylin receptor and STa - Increase cGMP and PKG - CFTR actiavted 3) Diarrhea

Question 33

IBS constipation/Idiopathic Constipation

Answer 33

1) Unknown Cause 2) Tx: Linzess (Linaclotide) -binds guanylin receptor -mimics food poisoning=induces DIARRHEA

Question 34

Shiga Toxin

Answer 34

1) Shigella dysentariae and EHEC 2) A-B toxin - cleaves adenine from the 28S rRNA subunit - inhibits protein synthesis (lining of gut dies) 3) Bloody diarrhea 4) May lead to hemolytic uremic syndrome 5) Tx: No abx

Question 35

Salmonella enterica enterica

Answer 35

1) invades mucosa - lives in macrophages - IL-1 production induces COX-2 expression 2) Tx: - Abx not helpful

Question 36

Clostridium Difficile

Answer 36

1) Toxin inhibits GTPases involved in actin polymerization 2) Tight junctions and other features are lost 3) Epithelial cells die 4) Caused by: - broad spectrum antibiotic use - most come=cephalosporins and clindamycin 5) DIARHHEA 6) TX: - metronidazole or oral vancomycin

Question 37

Celiac spruce

Answer 37

1) Amount of folding in duodenum decrease -absorptive surface area=decreased 2) Malabsorption and malnutrition 3) Diarrhea 4) Intruded at 2 y.o not at birth 5) Tx: GLUTEN FREE DIET

Question 38

Cystic Fibrosis

Answer 38

1) Autosomal recessive 2) Mutation of CFTR Chloride channel -delatF508 3) Increased NaCl in seat -Blockage/destruction of pancreas Cirrhosis of liver -chrnoic lung infeciton -infertility in males 4) Tx: Pilocarpine -used for sweat test -Muscarinic receptor agonist