Gastroenterology & Delzicol Flashcards
(107 cards)
1
Q
The ____ obtains nutrients from foods we eat.
A
GI System
2
Q
The ____ is composed of a long, hollow, muscular tube that begins at the mouth and ends at the anus.
A
Esophagus
3
Q
The central cavity or passage inside the GI tract is called the ___.
A
Lumen
4
Q
List the 7 components of the GI tract in descending order.
A
- Oral Cavity
- Pharynx
- Esophagus
- Stomach
- Small Intestine
- Large Intestine
- Anal Canal
5
Q
List the 3 components of the small intestine.
A
- Duodenum
- Jejunum
- Ileum
6
Q
List the 6 components of the large intestine.
A
- Cecum
- Ascending Colon
- Transverse Colon
- Descending Colon
- Sigmoid Colon
- Rectum
7
Q
____ is a substance that helps digest fats from the liver.
A
Bile
8
Q
The GI tract is lined with specialized cells and underlying tissues called the
A
Mucosa
9
Q
List the 6 functions of the GI tract.
A
MAISED
- Mechanical Processing
- Absorption
- Ingestion
- Secretion
- Excretion
- Digestion
10
Q
___ occurs when food enters the GI tract via the mouth.
A
Ingestion
11
Q
__ is the crushing and shearing of food using the teeth and tongue, swirling and churning motions of the stomach and intestine.
A
Mechanical Processing
12
Q
___ is the chemical breakdown of food into molecules suitable for absorption.
A
Digestion
13
Q
__ is when water, acids, enzymes, and other compounds are secreted into the GI tract to aid in digestion.
A
Secretion
14
Q
__ is the movement of nutrients and water out of the digestive tract and eventually into the bloodstream.
A
Absorption
15
Q
___ is the removal of waste products and indigestible foods, which leaves the body as feces.
A
Excretion
16
Q
List the 5 components of the upper GI tract.
A
- Oral Cavity
- Pharynx
- Esophagus
- Stomach
- Duodenum
17
Q
The ___ propels food from the oral cavity to the stomach.
A
Esophagus
18
Q
The breakdown of food in the stomach primarily occurs in the ___.
A
Pylorus
19
Q
Although the ___ is the first portion of the small intestine, it is classified as part of the upper GI tract.
A
Duodenum
20
Q
The ___ receives acidic stomach contents called ___, as well as digestive secretions from the pancreas and liver.
A
Duodenum
Chyme
21
Q
A major function of the Duodenum is ___?
A
To neutralize stomach acids before the damage the small intestine.
22
Q
The lower GI tract consists of the last two sections of the ___, along with the ___, ___, and ____.
A
Small intestine….
Large intestine, Rectum, and Anal Canal
23
Q
About ___% of digestion and nutrient absorption occurs in the small intestine.
A
90%
24
Q
The small intestine averages about ___ft in length.
A
20ft
25
The small intestine, also called the ___, has 3 major segments. What are they?
small bowel
1. Duodenum
2. Jejunum
3. Ileum
26
___ of the small intestine neutralizes chyme and receives digestive secretions.
Duodenum
27
___ of the small intestine performs most of the digestion and nutrient absorption.
Jejunum
28
___ of the small intestine controls entry into the colon at the ___ valve
Ileum
| Ileum valve
29
The horseshoe shaped large intestine, or large bowel, begins at the end of the __ and extends to the ___.
Duodenum
| Anus
30
The large intestine averages ___ft in length.
5ft
31
3 primary functions of the large intestine.
1. Reabsorbs water while compacting intestinal contents into feces
2. Absorbs vitamins
3. Stores feces until time for defecation
32
__ is the beginning of the large intestine.
Cecum
33
__ of the large intestine is an expanded pouch that receives materials from the ileum.
Cecum
34
4 components of the colon
1. Ascending Colon
2. Transverse Colon
3. Descending Colon
4. Sigmoid Colon
35
Movement of feces from the ___ into the ___ triggers the urge to defecate.
Sigmoid Colon into the Rectum
36
The stomach's average pH is between ____.
(1 - 2.5)
37
Secretions from the ___ raise the pH in the duodenum to near neutral levels
Pancreas
38
3 accessory organs of the digestive tract.
1. Pancreas
2. Liver
3. Gallbladder
39
___ lies behind the stomach and secretes fluid to neutralize the acidity of the stomach acids of chyme entering the duodenum and helps digest food.
Pancreas
40
The ___ lies in the upper right abdomen. It produces bile which helps digest food.
Liver
41
The ___ receives, stores, and concentrates bile from the liver and secretes it into the Duodenum when stimulated by a fatty meal.
Gallbladder
42
Ulcerative Colitis is a GI disorder that primarily involves the __ and ___.
Rectum and Colon
43
In Ulcerative Colitis (UC), ____ occurs in the rectum and may continuously extend upward into the colon.
Mucosal Inflammation
44
The most common procedure used to detect a GI tract disorder is ___.
Endoscopy
45
___ and ___ are the two most common and best understood types of IBD.
Ulcerative Colitis and Crohn's Disease
46
___ are the mainstay of therapy for inducing and maintaining remission in mildly to moderately active UC. ___ are also effective in inducing and UC remission but are not recommended for maintenance therapy.
Aminosalicylates
| Corticosteroids
47
__ is an immune-mediated condition causing chronic intestinal inflammation.
IBD - Inflammatory Bowel Disease
48
Both UC and CD are __ in origin.
Idiopathic
49
In CD, the inflammatory changes may involve any part of the GI tract, however the most common sites of involvement are the __ & __.
Terminal Ileum and Cecum
50
___ is often characterized by discontinuous lesions referred to a skip lesions, with normal mucosa seen between areas of inflammation.
Crohn's Disease
51
The inflammation seen in CD tends to be ___, involving all layers of the bowel wall.
Transmural
52
UC inflammation starts in the __ and extends proximally to any length of the colon in a continuous manner (no skip lesions).
Rectum
53
Unlike CD, the inflammation of UC is limited to the ___, and the ulcerations seen at endoscopy are diffuse and superficial.
Mucosa
54
___ is the study of populations to determine the frequency and distribution of disease.
Epidemiology
55
Gender distribution is equal in UC, however in CD, ___ are slightly more affected.
Females
56
Pea age for onset in CD and UC is ___, with a secondary peak occurring between ___.
15yr-30yr
| 60y-80yr
57
There is a paradoxical environment between ___ and IBD. In CD, it is shown to have increased need for surgery, flare ups, and post-op recurrence rates. Conversely in UC, it can be negatively correlated with disease activity.
Smoking
58
__ is the study of the causes or origin of a disease or disorder.
Etiology
59
UC is a disease that affects the ___ of the colon, but usually not the small intestine.
Mucosa
60
UC is categorized into 4 categories based on severity, what are they?
1. Ulcerative Proctitis
2. Proctosigmoiditis
3. Left-Sided UC
4. Pancolitis
61
____ is the mildest form of UC and affects 15-20cm of the rectum. This accounts for 25%-30% of all UC cases.
Ulcerative Proctitis
62
___ is a form of UC that is limited to the rectum and sigmoid colon. It accounts for 15%-20% of all UC cases.
Proctosigmoiditis
63
__ is a form of UC that extends beyond the sigmoid up to the splenic flexure. It accounts for 30%-40% of all UC cases.
Left-Sided Ulcerative Colitis
64
__ is a form of UC that is inflammation of the whole colon. It accounts for 20% of all UC cases.
Pancolitis
65
3 main symptoms of Ulcerative Colitis.
1. Bloody Diarrhea
2. rectal urgency to defecate
3. tenesmus
also abdominal cramps and rectal bleeding
66
___ is a term for the feeling that one needs to defecate, even though the bowl may be empty.
Tenesmus
67
Patients with UC have variable presentations from mild to most severe. In a small percentage of patients with ___ colitis, the bowel injury can lead to massive dilation of the colon. These patients usually require hospitalization and possible surgery.
Pancolitis
68
Any patient with rectal bleeding or diarrhea should be considered for a diagnosis or ___.
IBD - Inflammatory Bowel Disease
69
In UC patients, recent ___ has been associated with flares or new onset UC.
smoking cessation
70
__ or __ with biopsy is the very best procedures for diagnosing UC.
Colonoscopy or Sigmoidoscopy w/biopsy
71
In patients with suspected UC or disease relapse, the most important laboratory studies are ___.
Stool Studies
72
Treatment for UC has 5 "step-up" approaches depending on severity. List the 5 approaches.
1. Oral or Rectal steroids / 5-ASA
2. Oral Steroids
3. Immunomodulators / Biologics
4. IV Steroids / IV Cyclosporine
5. Surgery
73
Drugs containing ___ (melamine preparations) are the mainstay of therapy for inducing and maintaining remission in mildly to moderate UC.
5-ASA (Aminosalicylates)
74
5-ASA act ____, so the active drug needs to be delivered directly to the site of disease.
Topical
75
Oral 5-ASA formulations are available and grouped into 3 categories based on delivery mechanism. They are?
1. Prodrugs
2. Delayed Release
3. Controlled Release
76
___ is a type of oral 5-ASA that must undergo a chemical conversion before becoming the active pharmacological agent.
Prodrug
77
___ is a type of oral 5-ASA that is covered in a pH dependent coating that dissolves to release 5-ASA in the GI tract.
Delayed Release
78
Asacol (now Delzicol) is a ___ formulation for delivering mesalamine. It is coated in a __ resin that protects the drug from the release in the more acidic small bowel.
Delayed Release
| Eudragit-S
79
The Asacol, ___ coated tablets release 5-ASA at a pH of __ starting in the terminal ileum.
Eudragit-S
| 7
80
Asacol HD is a pH dependent release formulation. It is coated in 2 layers. The outer coating is a combination of ____ and ___ begins to breakdown at a pH of _ to _ midway through the small intestine and the inner coating of ___ begins to break down at a pH of 7 in the terminal ileum.
Eudragit-S and Eudragit-L
5 to 6
Eudragit-S
81
__ is a type of oral 5-ASA that is independent of pH. These delivery systems slowly dissolve throughout the small intestine and colon.
Controlled Release
82
___ are often used as an initial induction agent in moderately to severely active UC.
Corticosteroids
83
___ are drugs that specifically inhibit the body's immune response.
Immunomodulators
84
__ are drugs that are derived from living organisms. They include a range of products such as vaccines, allergenics, gene therapy, tissues, etc.
Biologics
85
Nonpharmacologic treatments for UC include __ and __.
probiotic and nutritional therapy
86
__ are living, nonpathogenic bacteria that when ingested, are thought to alter/improve the bacterial balance in the GI tract.
probiotics
87
__ is the standard procedure for UC. It consists of removing the entire colon and creating an end ileostomy for the ileostomy bag.
Proctocolectomy
88
List the 3 big competitors of Delzicol (Warner Chilcott)
1. Lialda
2. Apriso
3. Pentasa
89
Delzicol is an aminosalicylate indicated for the treatment of __ and for the ___.
Treatment of mild to moderately active UC
| Maintenance of UC in remission
90
Delzicol's recommended dosage for treatment of mild to moderate UC is ___ (equivalent to __ daily) for __ weeks.
800mg (2 400mg pills)
2.4g daily
6 weeks
91
Delizcol's recommended dosage for the maintenance of remission UC is __ daily in divided doses.
1.6g daily
92
Should Delzicol be swallowed whole, without breaking, cutting, or chewing?
Yes
93
Dose of Delzicol should be given how long before and how long after a meal?
1 hour before a meal
| 2 hours after a meal
94
What is the contraindication of Delzicol?
Patients with hypersensitivity to mesalamine, aminosalicylates, or Delzicol's ingredients.
95
The most common adverse reactions (observed in ≥ 5% of patients) were:
Abdominal pain, eructation, pain, headache, back pain, diarrhea, rash, dyspepsia, rhinitis, flu syndrome, asthenia, flatulence, vomiting, fever, arthralgia, constipation, and GI Bleeding
96
Does Delzicol have any drug reactions?
No - No drug reaction studies
97
Use of Delzicol should be cautioned in what 4 types of patients?
1. Geriatric
2. Pediatric
3. Nursing Mothers
4. Renal Impairments
98
In Geriatric patients using Delzicol, ___ should be monitored.
Blood cell counts
99
Delzicol's pregnancy category is __?
B
100
Mesalamine is a ____ agent.
Non-Steroidal Anti-Inflammatory agent
101
The Mechanism of Action of mesalamine is unknown, but appears to be __ rather than __.
Topical rather than systemic
102
Delzicol delayed release capsules are supplied from the pharmacy as ___(color) capsules containing ___mg mesalamine.
Red
| 400mg
103
The concurrent use of mesalamine with known ___ agents may increase the risk of renal reactions.
Nephrotoxic
104
The concurrent use of mesalamine with ___ may increase blood disorders
Azathioprine
105
The Tmax for mesalamine in delayed release formulations is absorbed after oral ingestion usually ranges from __to__hrs.
4 to 16hrs
106
After Intravenous administration of mesalamine, the elimination half-life is approximately __.
40minutes
107
Mesalamine is mainly excreted by the ___.
Kidneys
