Farmakoloji

Question 1

Prokinetic agents function

Answer 1

Agents that
• increase lower esophageal sphincter pressures may be useful for GERD
• improve gastric emptying may be helpful for gastroparesis and postsurgical gastric emptying delay.
• stimulate the intestine function may be beneficial for postoperative ileus or chronic intestinal pseudoobstruction.
• enhance colonic transit may be useful in the treatment of constipation.

Question 2

Cholinomimetic agents

Answer 2

Betanecol
Neotigmin

Question 3

• Muscarinic M3 receptor agonist on muscle cells and at myenteric plexus synapses
• Used in treatment of GERD and gastroparesis - seldomly used now

Answer 3

Betanecol

Question 4

– (The acetylcholinesterase inhibitor) • Enhance gastric, small intestine, and colonic emptying
• Used for the treatment of hospitalized patients with acute large bowel distention (known as acute colonic pseudo-obstruction or Ogilvie’s syndrome).
• Adverse cholinergic effects include excessive salivation, nausea, vomiting, diarrhea, and bradycardia.

Answer 4

Neostigmin

Question 5

Metoclopramide
Domperidone

Answer 5

Dopamine D2- Receptor antagonists

Question 6

• Normally activation of dopamine receptors inhibits cholinergic smooth muscle stimulation- blockage of this affect- Potentiate prokinetic effect
• Increase esophageal peristaltic amplitude, increase lower esophageal sphincter pressure, and enhance gastric emptying - no effect on intestine
• Used in therapy of Gastroesophageal reflux disease, impaired gastric emptying due to postsurgical disorders (vagotomy, antrectomy) and diabetic gastroparesis
• Effective in dyspepsia via acceleration of gastric emptying
• Prevention of vomiting
Adverse effect
• neuropsychiatric side effects, restlessness, drowsiness, insomnia, anxiety, and agitation , extrapyramidal disorders (dystonias, akathisia, parkinsonian features), increased prolactin related side effects; galactorrhea, gynecomastia, impotence, and menstrual disorders.

Answer 6

Metoclopramide
Domperidone

Question 7

• Directly stimulate motilin receptors on gastrointestinal smooth muscle. • Motillin increase gastric emptying and gastric motor activity
• Intravenous erythromycin
• used in gastroparesis and
• acute upper gastrointestinal hemorrhage to promote gastric emptying of blood before endoscopy.

Answer 7

Macrolides
Eritromycin etc

Question 8

1-Stimulation of 5-HT receptors on the presynaptic terminal of submucosal intrinsic primary afferent nerves
2- enhances the release of their neurotransmitters, including calcitonin gene-related peptide, Ach
3- stimulates second-order enteric neurons 4- promote the peristaltic reflex

Answer 8

Serotonin 5-HT4- receptor agonists

Question 9

Seratonin agonists

Answer 9

Cisapride
Tegaserod
Prucalopride- Velusetrag

Question 10

DRUGS that are used in intestinal motility dysfunction
Regularly colonic movements are important properly evacuation of bowel . If this movements are slown down, patient can get a constipation, at the opposite condition cause a diarrhea
Laxatives promotes empty the bowel, make defecation easier

Answer 10

Laxatives

Question 11

Laxatives types

Answer 11

1. Bulk- forming laxatives
2. Stool surfactant agents (softener)
3. Osmotic laxatives
4. Magnesium citrate, magnesium hydroxide, sodium phosphate

Question 12

• indigestible, hydrophilic colloids that absorb water, forming a bulky, emollient gel that distends the colon and promotes peristalsis.
• Treatment of constipation
• natural plant products (psyllium, methylcellulose)
• synthetic fibers (polycarbophil)
• Adverse effect: Bloating and flatulence

Answer 12

Bulk formin laxatives

Question 13

• These agents soften stool material, permitting water and lipids to penetrate • Docusate (oral or enema) and glycerin suppository.
• Considered safed in pregnacy after the childbirth and surgery

Answer 13

Stool surfactant agents (softener)

Question 14

• High doses of osmotically active agents produce prompt bowel evacuation within 1–3 hours.
• Used to cleanse the bowel prior to colonoscopy.
• Sodium phosphate –orally, rectally
• Require adequate hydration for effect
• Electrolyteabnormalities-shouldnotbeusedinpatientswhoarefrailorelderly,haverenal insufficiency, have significant cardiac disease

Answer 14

Magnesium citrate
Magnesium hydroxide
Sodium phosphate

Question 15

• Used for complete colonic cleansing before gastrointestinal colonoscopic procedures.
• As a perioperative colon periparation- For optimal bowel cleansing, 4 L of solution should be ingested rapidly (over 2-4 hours) on the evening before the procedure

Answer 15

Lactulose
Balanced polyethylene (PEG) solutions

Question 16

Aloe
Senna
Cascara

Answer 16

Stimulant purgatives (cathartics)

Question 17

• available in tablet and suppository formulations
• used in conjunction with PEG solutions for colonic cleansing prior to colonoscopy. • within 6–10 hours when given orally and 30–60 minutes when taken rectally.
• !!! Concern about long-term use of cathartics could lead to dependence and destruction of the myenteric plexus, resulting in colonic atony and dilation.

Answer 17

Bisacodyl

Question 18

Methylnaltrexone bromide
Alvimopan

Answer 18

Opioid receptor antagonists

Question 19

Methylnaltrexone bromide
Alvimopan
(Opioid receptor antagonists)

Answer 19

Do not readily cross the blood brain barrier

Question 20

prostanoic acid derivative
• act by stimulating the type 2 chloride channel (ClC-2) in the small intestine that increases chloride- rich fluid secretion into the intestine, so stimulates intestinal motility and shortens intestinal transit time.

Answer 20

Lubiprostone

Question 21

• stimulate intestinal chloride secretion by binding to and activating guanylate cyclase-
C on the luminal surface.
• contraindicated in pediatric patients
• used in chronic constipation and irritable bowel syndrome (IBS) with predominant constipation.

Answer 21

Linaclotide
Plecanatide

Question 22

• Increase colonic transit time and fecal water absorption, decrease mass colonic movements and the gastrocolic reflex.
• Reduce peristalsis by activating presynaptic opioid (μ) receptors in GI tract and decreasing acetylcholine release
• The most important point to pay attention during opiod therapy is their inhibiting effect in CNS and addiction potency .Although these factor we hava some safety agent that used as antidiarrheal

Answer 22

Opioid agonists

Question 23

Loperamide
Diphenoxylate
Eluxadoline

Answer 23

Opioid agonists

Question 24

Prophylaxis of traveller’s diarrhea

Answer 24

Bismuth compounds

Question 25

Bile salt-binding resins

Answer 25

(Anti diarrheic)
Cholestryramine
Colestipol
Colesevelam

Question 26

Octreotide

Answer 26

Synthetic octapeptide with actions similar to somatostatin

Question 27

Drugs used in the treatment of irritable bowel syndrome

Answer 27

• Antidiarrheal agents, especially loperamide
• Fiber supplements, osmotic laxatives
• Antispasmodic- anticholinergics- dicyclomine and hyoscyamine
• Trisiclic antidepresan (low doses of amitriptyline or desipramine)
• 5-HT3 antagonist -Alosetron for -severe IBS with diarrhea in women- risk of gastrointestinal toxicity
• Chloride channel actıvators –Lubiprostone, Linaclotide
• Lubiprostone -women with IBS with predominant constipation
• Linaclode- adults with IBS with constipation
• high cost and lack of information about long-term safety and efficacy

Question 28

Midenin kısa süreli mukozal inflamasyonu

Answer 28

Hafif Akut Gastrit/ Gastropati

Question 29

Gisde ne varlığı her zaman patolojik

Answer 29

Nötrofil

Question 30

􏰀 Mide yüzey epiteli büyük alanlarda dökülmüştür 􏰀Genellikle yüzeyel
􏰀 Derin olduğunda ülser

Answer 30

Şiddetli akut eroziv hemorajik gastrit

Question 31

şok, sepsis ve ciddi travma sonucu-splanktik
vazokonstrüksiyon

Answer 31

Stres ülserleri

Question 32

Antiacids

Answer 32

Sodiumbicarbonate
Calcium carbonate
Magnesium hydroxide/ alüminyum hydroxide

Question 33

Misoprostol

Answer 33

Prostaglandin analog