FINAL 02 - Gastrointestinal Drugs Flashcards
(193 cards)
1
Q
Peptic ulcer disease (PUD), gastroesophageal reflux disease (GERD), and stress-related mucosal injury are examples of ___________
A
Acid peptic diseases
2
Q
Group of ulcerative disorders of the upper GIT; caused by H. pylori and nonselective NSAIDs (Acid peptic diseases)
A
Peptic ulcer disease (PUD)
3
Q
Drugs that reduce intragastric acidity and drugs that promote mucosal defense are drugs used for ___________
A
Peptic ulcer disease (PUD)
4
Q
Antacids, H2 receptor antagonists, and proton pump inhibitors are drugs that reduce ___________ (Drugs for PUD)
A
Intragastric acidity
5
Q
Prostaglandin analogs, sucralfate, and bismuth compounds are drugs that promote _____________ (Drugs for PUD)
A
Mucosal defense
6
Q
Abnormal reflux of gastric contents from the stomach into the esophagus (Acid peptic diseases)
A
Gastroesophageal reflux disease (GERD)
7
Q
A substernal sensation of warmth or burning rising up from the abdomen that may radiate to the neck (Symptoms of GERD)
A
Heartburn
8
Q
Drugs that reduce acidity of refluxate, drugs that promote mucosal defense, drugs that promote motility, and alginate are drugs used for ___________
A
GERD
9
Q
Antacids, H2 receptor antagonists, and proton pump inhibitors are drugs that reduce ___________ (Drugs for GERD)
A
Intragastric acidity/Acidity of refluxate
10
Q
Sucralfate is a drug that promotes ___________ (Drugs for GERD)
A
Mucosal defense
11
Q
Dopamine receptor antagonists and serotonin receptor agonists are drugs that promote ____________ (Drugs for GERD)
A
Motility
12
Q
Source cell is ENS (Secretion)
A
ACh
13
Q
Source cell is G cells (Secretion)
A
Gastrin
14
Q
Source cell is ECL cells (Secretion)
A
Histamine
15
Q
Source cell is parietal/oxyntic cells via the proton pump (Secretion)
A
HCl
16
Q
Works by reduction of intragastric acidity and pepsin activity (Drugs that reduce intragastric acidity)
A
Antacids
17
Q
A measure for the overall buffering capacity against acidification for a solution
A
Acid-neutralizing capacity (ANC)
18
Q
Sodium bicarbonate reacts rapidly with HCl to produce ___________, ___________, and ____________ (SCW)
A
Sodium chloride (NaCl), Carbon dioxide (CO2), Water (H2O)
19
Q
Includes baking soda and alka seltzer; causes gastric distention, belching, and metabolic alkalosis (Drugs that reduce intragastric acidity)
A
Sodium bicarbonate
20
Q
Sodium bicarbonate can cause gastric distention and belching due to ____________
A
Carbon dioxide (CO2)
21
Q
Sodium bicarbonate can cause ____________ in high doses or in renal insufficiency due to systemic absorption
A
Metabolic alkalosis
22
Q
Includes Tums and Os-Cal; causes milk-alkali syndrome (Drugs that reduce intragastric acidity)
A
Calcium carbonate
23
Q
Calcium carbonate is less soluble and reacts more slowly than sodium bicarbonate with HCl to form __________, __________, and ___________ (SCW)
A
Sodium chloride (NaCl), Carbon dioxide (CO2), Water (H2O)
24
Q
A triad of hypercalcemia, metabolic alkalosis, and AKI; A/E of calcium carbonate
A
Milk-alkali syndrome
25
___________ and ____________ is used in combination; examples include Gelusil, Maalox, Mylanda, and Kremil-S (MA)
Magnesium hydroxide, Aluminum hydroxide
26
___________ causes osmotic diarrhea
Mg2+
27
___________ causes constipation
Al3+
28
Magnesium hydroxide and aluminum hydroxide react slowly with HCl to form ____________, ___________, and ___________ (AMW)
Aluminum chloride, Magnesium chloride, Water
29
Magnesium hydroxide and aluminum hydroxide do not cause belching because it does not form ___________
Carbon dioxide (CO2)
30
H2 receptor antagonist that has little first-pass effect
Nizatidine
31
Works by competitive inhibition of the parietal cell H2 receptor (Drugs that reduce intragastric acidity)
H2 receptor antagonists
32
Is especially effective against nocturnal acid secretion (Drugs that reduce intragastric acidity)
H2 receptor antagonists
33
Is moderately effective against meal-stimulated acid secretion (Drugs that reduce intragastric acidity)
H2 receptor antagonists
34
Least potent H2 receptor antagonist
Cimetidine
35
Most potent H2 receptor antagonist
Famotidine
36
___________ causes mental status changes (Examples of H2 receptor antagonists)
Cimetidine
37
____________ inhibits CYP1A2, CYP2C0, CYP2D6, and CYP3A4 (Examples of H2 receptor antagonists)
Cimetidine
38
Are substituted benzimidazoles that resemble H2 antagonists (Drugs that reduce intragastric acidity)
Proton pump inhibitors (PPI)
39
Omeprazole and lansoprazole are ____________ (Proton pump inhibitors)
Racemic mixtures
40
S-isomer of omeprazole
Esomeprazole
41
R-isomer of lansoprazole
Dexlansoprazole
42
Proton pump inhibits should be taken ___________ hour before meal
1
43
Reactive thiophilic sulfenamide cation forms a covalent disulfide bond w/ and irreversibly inactivates H+/K+-ATPase, the final common pathway of acid secretion (Drugs that reduce intragastric acidity)
Proton pump inhibitors (PPI)
44
Inhibits both fasting and meal-stimulated gastric acid secretion (Drugs that reduce intragastric acidity)
Proton pump inhibitors (PPI)
45
DOC for Zollinger-Ellison syndrome (Drugs that reduce intragastric acidity)
Proton pump inhibitors (PPI)
46
PPI + clarithromycin + amoxicillin/metronidazole (Therapy for H. pylori-associated ulcers)
Triple therapy (14 days)
47
PPI + amoxicillin + clarithromycin + metronidazole (Therapy for H. pylori-associated ulcers)
Quadruple therapy (14 days)
48
PPI + bismuth subsalicylate + metronidazole + tetracycline (Therapy for H. pylori-associated ulcers)
Quadruple therapy in clarithromycin resistance (14 days)
49
PPIs are continued once a day for ___________ to ____________ weeks after triple/quadruple therapy
4-6
50
Causes minor reduction in cyanocobalamin absorption (Drugs that reduce intragastric acidity)
Proton pump inhibitors (PPI)
51
May reduce insoluble Ca2+ salt absorption (Drugs that reduce intragastric acidity)
Proton pump inhibitors (PPI)
52
Increases risk of CAP and HAP (Drugs that reduce intragastric acidity)
Proton pump inhibitors (PPI)
53
Causes transient increase in serum gastrin (Drugs that reduce intragastric acidity)
Proton pump inhibitors (PPI)
54
Increases chronic inflammation in H. pylori infection (Drugs that reduce intragastric acidity)
Proton pump inhibitors (PPI)
55
Has limited clinical uses; used for prevention of stress-related bleeding (Drugs that promote mucosal defense)
Sucralfate
56
Methyl analog of PGE1; used for NSAID-induced ulcers; used as an abortifacient (Drugs that promote mucosal defense)
Misoprostol (Cytotec)
57
A nonprescription formulation containing bismuth and salicylate (Drugs that promote mucosal defense)
Bismuth subsalicylate
58
Available as a combination prescription w/ metronidazole and tetracycline for H. pylori (Drugs that promote mucosal defense)
Bismuth subcitrate potassium
59
Widely used for nonspecific treatment of dyspepsia and acute diarrhea (Drugs that promote mucosal defense)
Nonprescription bismuth compounds (Examples: Pepto-Bismol, Kaopectate)
60
Prevention of traveler's diarrhea (Drugs that promote mucosal defense)
Bismuth subsalicylate
61
Stimulates M3 receptors; used in the past for GERD and gastroparesis (Drugs that promote motility)
Bethanecol (Cholinomimetic)
62
Blocks D2 receptors; blocks inhibition of cholinergic transmission (Drugs that promote motility)
D2 antagonists
63
Metoclopramide and domperidone are examples of ___________ (Drugs that promote motility)
D2 antagonists
64
Has extrapyramidal effects (Examples of D2 antagonists)
Metoclopramide
65
Does not cross the BBB (Drugs that promote motility)
Domperidone
66
5-HT4 agonist; an investigational, limited-access program for patients with GERD and gastroparesis; prolongs QT interval (Drugs that promote motility)
Cisapride
67
Directly stimulate motilin receptors on GI smooth muscle; used in erythromycin IV (Drugs that promote motility)
Macrolides
68
A polysaccharide extracted from brown algae; usually given in combination with an antacid (Drugs for GERD)
Alginate
69
Decreased frequency, difficulty in initiation or passage of firm or small-volume feces or a feeling of incomplete evacuation
Constipation
70
Laxatives, secretory agents, opioid antagonists, and prokinetics are drugs for ___________
Constipation
71
The evacuation of formed fecal material from the rectum
Laxation
72
The evacuation of unformed, usually watery, fecal material from the entire colon
Catharsis
73
Stimulant laxatives, bulk-forming laxatives, osmotic laxatives, and emollient laxatives are examples of ___________
Laxatives
74
Also known as irritant laxatives and cathartics; administered at the lowest effective dosage and for the shortest period of time (Types of laxatives)
Stimulant laxatives
75
Bisacodyl and sodium picosulfate are examples of __________ (Stimulant laxatives)
Diphenylmethane
76
Senna, aloe, and cascara sagrada are examples of __________ (Stimulant laxatives)
Anthraquinone
77
Comes in enteric-coated tablets and suppositories; its A/E is atonic nonfunctioning colon (Stimulant laxatives - diphenylmethane)
Bisacodyl (Dulcolax)
78
Hydrolyzed by colonic bacteria to active form; used for bowel cleansing before colonoscopy (Stimulant laxatives - diphenylmethane)
Sodium picosulfate
79
Obtained from the dried leaves of Cassia acutifolia; contains the rhein dianthrone glycosides sennoside A and B (Stimulant laxatives - anthraquinones)
Senna
80
Obtained from the bark of buckthorn tree, Frangula purshiana; contains the glycosides barbaloin and chrysaloin (Stimulant laxatives - anthraquinones)
Cascara sagrada
81
Obtained from the bean of the castor plan, Ricinus communis; hydrolyzed into the active form, ricinoleic acid (Stimulant laxatives)
Castor oil
82
Indigestible, hydrophilic colloids that absorb water, forming a bulky, emollient gel that distends the colon and promotes peristalsis (Types of laxatives)
Bulk-forming laxatives
83
Psyllium and methylcellulose are examples of __________ (Bulk forming laxatives)
Natural plant products
84
Polycarbophil is an example of __________ (Bulk forming laxatives)
Synthetic fibers
85
Soluble but nonabsorbable compounds; distends the bowel (Types of laxatives)
Osmotic laxatives
86
Magnesium salts and phosphate salts are ___________ (Osmotic laxatives)
Saline laxatives
87
Lactulose, mannitol, and sorbitol are __________ (Osmotic laxatives)
Nondigestible sugars or alcohols
88
Use for colonic cleansing prior to radiological, surgical, and endoscopic procedures (Osmotic laxatives)
Polyethylene glycol electrolyte solution
89
Stimulate the release of CCK; includes magnesium sulfate, magnesium hydroxide, and magnesium citrate (Osmotic laxatives - saline laxatives)
Magnesium salts
90
Absorbed and requires higher doses than Mg2+ salts; its A/E is acute phosphate nephropathy (Osmotic laxatives - saline laxatives)
Sodium phosphate
91
A synthetic disaccharide of galactose and fructose; used for prevention or treatment of chronic constipation (Nondigestible sugars or alcohols)
Lactulose
92
Draws water via osmosis; used for prevention or treatment of chronic constipation (Nondigestible sugars or alcohols) (SM)
Sorbitol, Mannitol
93
Also known as stool softeners and surfactant laxatives; are surface active agents that become emulsified with the stool (Types of laxatives)
Emollient laxatives
94
Docusate, glycerin suppository, and mineral oil are examples of __________ (Types of laxatives)
Emollient laxatives
95
Includes docusate sodium and docusate calcium; commonly prescribed in hospitals to prevent constipation and minimize straining (Emollient laxatives)
Docusate salts
96
Mixture of aliphatic hydrocarbons obtained from petrolatum; used for prevention and treatment of fecal impaction in young children and debilitated adults (Emollient laxatives)
Mineral oil
97
Lubiprostone, linaclotide, plecanatide, and tenapanor are examples of __________ (Drugs for constipation)
Secretory agents
98
Activator of Cl- channels by binding to a PGE2 receptor; used for IBS with predominant constipation (Secretory agents)
Lubiprostone
99
Short peptides that stimulate CFTR Cl- channels; used as treatment of chronic constipation (Secretory agents) (LP)
Linaclotide, Plecanatide
100
Works by inhibition of isoform 3 of NHE; used for IBS-C (Secretory agents)
Tenapanor
101
Methylnatrexone bromide and alvimopan are examples of __________ (Drugs for constipation)
Opioid antagonists
102
Works by inhibition of peripheral μ-receptor; does not cross the BBB (Drugs for constipation)
Opioid antagonists
103
Used for opioid-induced constipation (Opioid antagonists)
Methylnatrexone
104
Used short-term to shorten the period of postoperative ileus (Opioid antagonists)
Alvimopan
105
Are serotonin 5-HT4 agonists (Drugs for constipation)
Prokinetics
106
A partial agonist of 5-HT4 receptor; was used for chronic constipation and IBS-C (Prokinetics)
Tegaserod
107
Agonist of 5-HT4 receptor; used for chronic constipation in women (Prokinetics)
Prucolapride
108
Refers to the passage of three or more loose/liquid stools or >200 g per day
Diarrhea
109
Cornerstone treatment of diarrhea
Oral rehydration salts (ORS)
110
For suspected __________ infection, discontinue offending antibiotic (Empiric antibiotic therapy)
Clostridium difficile
111
For suspected or proven enterohemorrhagic __________, avoid antibiotics to prevent hemolytic uremic syndrome (Empiric antibiotic therapy)
Escherichia coli
112
First-line drug for acute/traveler's diarrhea
Fluoroquinolones
113
Refers to preparations containing a variety of bacterial strains (ex. Lactobacillus GG and Saccharomyces boulardii)
Probiotics
114
Opioid agonists, bismuth subsalicylate, octerotide, bile acid sequestrants, zinc, and probiotics are examples of drugs for __________
Diarrhea
115
Agonists of peripheral μ-receptors and δ-receptors on enteric nerves (Drugs for diarrhea)
Opioid agonists
116
Diphenoxylate and loperamide are examples of __________ (Drugs for diarrhea)
Opioid agonists
117
A prescription drug metabolized to active form, difenoxin (diphenoxylic acid) (Opioid agonists)
Diphenoxylate
118
Diphenoxylate is co-formulated with __________ (Lomotil) to prevent abuse
Atropine
119
A nonprescription drug; does not cross the BBB; more effective than diphenoxylate (Opioid agonists)
Loperamide
120
A popular OTC preparation; trivalent bismuth and salicylate; prevention and treatment of traveler's diarrhea (Drugs for diarrhea)
Bismuth subsalicylate
121
Has antisecretory, anti-inflammatory, and antimicrobial effects; relieves nausea and cramps
Bismuth
122
Reduces stool frequency and liquidity in acute infectious diarrhea due to inhibition of intestinal prostaglandin and Cl- secretion
Salicylate
123
An octapeptide analog of somatostatin; used for diarrhea due to endocrine tumors (Drugs for diarrhea)
Octreotide
124
A 14-amino acid peptide released in the GIT and pancreas paracrine cells, D cells, and enteric nerves, and hypothalamus
Somatostatin
125
May decrease diarrhea caused by unabsorbed bile acids; includes cholestyramine, colestipol, and colesevelam (Drugs for diarrhea)
Bile acid sequestrants
126
Promotes ion absorption; used as treatment and prevention of acute and chronic diarrhea, especially in developing countries (Drugs for diarrhea)
Zinc
127
Has some degree of benefit in acute diarrheal conditions, antibiotic-associated diarrhea, and infectious diarrhea (Drugs for diarrhea)
Probiotics
128
Effective in antibiotic-associated and in C. difficile diarrhea; might prevent diarrhea in daycare centers (Probiotics)
Saccharomyces boulardii
129
Has variable efficacy; reduction of severity more evident in cases of childhood rotavirus diarrhea (Probiotics)
Lactobacillus rhamnosus GG
130
Are non-digestible compounds in our food that feed the healthy gut bacteria (Prebiotic or probiotic)
Prebiotics
131
Oats, mushrooms, chicory, asparagus, garlic, leeks, onions, Jerusalem artichokes (Prebiotic or probiotic)
Prebiotics
132
Living microbes that when consumed may benefit our health (Prebiotics vs probiotics)
Probiotics
133
Yogurt, kefit, sauerkraut, kimbi, kombucha, miso, tempeh, pickled vegetables (Prebiotics vs probiotics)
Probiotics
134
The "vomiting center"; located in the medulla and coordinates the act of vomiting through interactions with CN VIII and X
Brainstem
135
Chemoreceptor trigger zone, vestibular system via CN VIII, vagal and spinal afferent nerves from GIT, and CNS are the 4 important afferent inputs to the __________
Vomiting center
136
Works by peripheral 5-HT3 receptor blockade (Antiemetics)
5-HT3 antagonists
137
Most effective and primary agents for acute chemotherapy-induced N/V, postoperative N/V (PONV), and N/V secondary to upper abdominal irradiation (Antiemetics)
5-HT3 antagonists
138
Use for IBS-D in women (5-HT3 antagonists)
Alosetron
139
Adjuncts to 5-HT3 antagonists for acute and delayed chemotherapy-induced N//V; includes dexamethasone and methylprednisolone (Antiemetics)
Glucocorticoids
140
Occupy postrema NK1 receptors; used for delayed chemotherapy-induced N/V; includes aprepitant, netupitant, rolapitant, and fosaprepitant (Antiemetics)
NK1 antagonists
141
Acts on vestibular afferents and within the brainstem; used for motion sickness, vertigo, and PONV (Antiemetics)
H1 antagonists
142
Includes diphenhydramine, dimenhydrinate, meclizine, and cyclizine (Antiemetics)
H1 antagonists
143
One of the best agents for motion sickness (Antiemetics - muscarinic antagonists)
Hyoscine (Scopolamine)
144
The major psychoactive chemical extracted from the marijuana plant, Cannabis sativa (Antiemetics - cannabinoid receptor agonists)
Dronabinol (THC)
145
THC analog (Antiemetics - cannabinoid receptor agonists)
Nabilone
146
Used for chemotherapy-induced N/V and appetite stimulation in anorexia (Antiemetics)
Cannabinoid receptor agonists
147
Works by D2 receptor antagonism at the CTZ, reducing excitatory neurotransmitter release (Antiemetics)
D2 antagonists
148
Phenothiazines, butyrophenones, thienbenzodiazepines, and benzamides are examples of __________ (Antiemetics)
D2 antagonists
149
Inhibition of dopamine, muscarinic, and histamine receptors; "general-purpose" antinauseant (Antiemetics - D2 antagonists)
Phenothiazines
150
Prochlorperazine, promethazine, and thiethylperazine are examples of __________ (Antiemetics - D2 antagonists)
Phenothiazines
151
Previously used for PONV; used in conjunction with opiates and benzodiazepines for sedation for surgical and endoscopic procedures (Antiemetics - D2 antagonists)
Droperidol (Butyrophenone)
152
2nd generation antipsychotic; prevention of chemotherapy-induced delayed N/V (Antiemetics - D2 antagonists)
Olanzapine (Thienobenzodiazepine)
153
Moderately useful antiemetics; examples include metoclopramide, trimethobenzamide, and amisulpride (Antiemetics - D2 antagonists)
Benzamides
154
For delayed emesis (Benzamides)
Metoclopramide
155
For prevention of PONV (Benzamides)
Amisulpride
156
Used before the initiation of chemotherapy to reduce anticipatory vomiting or vomiting caused by anxiety; examples include lorazepam and diazepam (Antiemetics - D2 antagonists)
Benzodiazepines
157
Inflammatory disorder involving irritation and ulceration
Inflammatory bowel disease (IBD)
158
Affects colon and rectum (Types of IBD)
Ulcerative colitis
159
Affects colon and proximal parts (Types of IBD)
Crohn's disease
160
Coated to deliver to different segments of the small or large bowel (Drugs for IBD - Aminosalicylates)
Mesalamine/5-ASA
161
5-ASA bound by azo to sulfapyridine (Drugs for IBD - Aminosalicylates)
Azo compounds (Balsalazide, olsalazine, sulfasalazine)
162
First-line for mild to moderate active ulcerative colitis (Drugs for IBD)
Aminosalicylates
163
Most commonly used oral glucocorticoids (Drugs for IBD - glucocorticoids) (PP)
Prednisone, Prednisolone
164
Enemas, foams, suppositories (Drugs for IBD - glucocorticoids)
Hydrocortisone
165
Potent synthetic analog of prednisolone; as DR oral formulations (Drugs for IBD - glucocorticoids)
Budesonide
166
Used for treatment of moderate to severe active IBD (Drugs for IBD)
Glucocorticoids
167
Induction and maintenance of remission of ulcerative colitis and Crohn's disease (Drugs for IBD - immunosuppressive metabolites)
Purine analogs (Azathioprine, 6-mercaptopurine)
168
Induction and maintenance of remission of Crohn's disease (Drugs for IBD - immunosuppressive metabolites)
Methotrexate
169
Infliximab, adalimumab, golimumab, and certolizumab are examples of __________ (Drugs for IBD)
Anti-tumor necrosis factor (TNF) drugs
170
Infliximab, adalimumab, and certolizumbab are used for acute and chronic treatment of moderate to severe __________ (Anti-TNF drugs)
Crohn's disease
171
Infliximab, adalimumab, and golimumab are used for acute and chronic treatment of moderate to severe __________ (Anti-TNF drugs)
Ulcerative colitis
172
Includes vedolizumab and natalizumab (Drugs for IBD)
Anti-integrin
173
2nd-line treatment for IBD unresponsive to anti-TNF (Drugs for IBD - anti-integrin)
Vedolizumab
174
Used for severe refractory Crohn's disease (Drugs for IBD - anti-integrin)
Natalizumab
175
Can cause progressive multifocal leukoencephalopathy (PML) (Drugs for IBD - anti-integrin)
Natalizumab
176
Disease of unknown origin characterized by episodes of abdominal discomfort and abnormal bowel function (diarrhea, constipation, or both)
Irritable bowel syndrome (IBS)
177
Used relieve abdominal pain (Antispasmodics) (Drugs for IBS)
Anticholinergics (Dicyclomine, Hyoscyamine)
178
Prescription MOR against IBS-diarrhea (IBS-D) (Drugs for IBS)
Eluxadoline
179
For IBS-diarrhea (IBS-D) (Drugs for IBS)
Alosetron
180
For IBS-constipation (IBS-C) (Drugs for IBS) (LL)
Lubiprostone, Linaclotide
181
Bile acid agents are drugs for __________
Gallstones
182
Ursodeoxycolic acid (Ursodiol), obeticholic acid, and other agents are examples of ___________ (Drugs for gallstones)
Bile acid agents
183
A naturally occurring bile acid; ↓ biliary lipid secretion and ↓ lithogenicity (Drugs for gallstones - bile acid agents)
Ursodeoxycholic acid (Ursodiol)
184
Traditional therapy for gallstones involving oral litholysis (Drugs for gallstones - bile acid agents)
Ursodeoxycholic acid (Ursodiol)
185
Treatment of small cholesterol gallstones (Drugs for gallstones - bile acid agents)
Ursodeoxycholic acid (Ursodiol)
186
Used for prevention of gallstones in obese patients (Drugs for gallstones - bile acid agents)
Ursodeoxycholic acid (Ursodiol)
187
1st line agent used for early primary biliary cirrhosis (PBC) (Drugs for gallstones - bile acid agents)
Ursodeoxycholic acid (Ursodiol)
188
Ligand for nuclear farnesoid X receptor (Drugs for gallstones - bile acid agents)
Obeticholic acid
189
Used for treatment of PBC in combination w/ ursodiol (Drugs for gallstones - bile acid agents)
Obeticholic acid
190
Inhibits cholesterol synthesis (Drugs for gallstones - other bile acid agents)
Statins
191
Inhibits cholesterol absorption (Drugs for gallstones - other bile acid agents)
Ezetimide
192
Promising therapy for early-stage PBC (Drugs for gallstones - other bile acid agents) (UB)
Ursodeoxycholic acid (Ursodiol) + Budesonide
193
Used for dissolution of gallstones; reserved for patients who are at increased surgical risk (Drugs for gallstones - other bile acid agents)
Chenodiol
