GI 375 - 380

Question 1

name of the drug that blocks gastric/pancreatic lipase

Answer 1

orlistat

Question 2

what is the clinical app of orlistat?

Answer 2

weight loss (dec breakdown and absorption of dietary fats)

Question 3

side effects of orlistat?

Answer 3

steatorrhea, dec absorption of fat-soluble vitamins

Question 4

side effects of ondansetron?

Answer 4

QT polongation, headache, constipation

Question 5

what type of antibiotic also causes QT prolongation?

Answer 5

macrolides

Question 6

what is the target of ondansetron?

Answer 6

5HT3

Question 7

2 functions of ondansetron?

Answer 7

1. dec vagal stimulation

2. powerful central acting antiemetic

Question 8

what is metoclopramide?

Answer 8

D2 receptor antagonist

Question 9

what is the clinical app for metoclopramide?

Answer 9

diabetic and postsurgery gastroparesis, antiemetic

Question 10

2 conditions that are contraindicated to metoclopramide?

Answer 10

small bowel obstruction, parkinson dz

Question 11

metoclopramide can interact with what kinds of drugs?

Answer 11

digoxin, diabetic agents

Question 12

side effects of metoclopramide?

Answer 12

inc parkinsonian effects, tardive dyskinesia, restlessness, drowsiness, diarrhea

Question 13

does metoclopramide affect the colon transportation time?

Answer 13

no

Question 14

name 4 H2 blockers

Answer 14

cimetidine, ranitidine, famotidine, nizatidine

Question 15

what is the mech of H2 blockers?

Answer 15

reversible block of histamine H2 receptors –> dec proton secretion by parietal cells

Question 16

among H2 blockers, what is unique about cimetidine?

Answer 16

inhibitor of P450 and also has antiandrogenic effects (prolactin release, gynecomastia, impotence, dec libido in males)

Question 17

what 2 H2 blockers dec renal excretion of creatinine?

Answer 17

cimetidine, ranitidine

Question 18

4 clinical applications for octreotide

Answer 18

1. variceal bleeds
2. acromegaly
3. VIPoma
4. carcinoid tumors

Question 19

what is the common side effect of all antacid?

Answer 19

hypokalemia

Question 20

name 4 osmotic laxatives

Answer 20

1. magnesium hydroxide
2. magnesium citrate
3. polyethylene glycol (prep for colonoscopy)
4. lactulose

Question 21

the mech of osmotic laxatives?

Answer 21

provide osmotic load to draw water into the GI lumen

Question 22

what is sulfasalazine?

Answer 22

combination of sulfapyridine (antibacterial) and 5-aminosalicylic acid (anti-inflammatory)

Question 23

sulfasalazine need to be activated by

Answer 23

colonic bacteria

Question 24

3 clinical usage for sulfasalazine?

Answer 24

1. UC
2. Crohn (colitis component)
3. rheumatoid arthritis

Question 25

name 3 antacids

Answer 25

1. aluminum hydroxide 2. calcium carbonate 3. magnesium hydroxide

Question 26

which antacid can chelate and dec the effectiveness of drugs such as tetracycline, fluoroquinolones

Answer 26

calcium carbonate

Question 27

what is the drug that ripens cervix?

Answer 27

misoprostol (PGE1 analog)

Question 28

name two H2 blockers that reduce renal excretion of creatinine?

Answer 28

cimetidine, ranitidine

Question 29

mech of proton pump inhibitor?

Answer 29

irreversible inhibition of Na+/K+ ATPase

Question 30

3 side effects of PPI?

Answer 30

1. inc risk of C. difficle infection 2. pneumonia 3. dec serum Mg2+ with long term use

Question 31

does PPI inhibit or induce P450?

Answer 31

inhibit

Question 32

mech of bismuth, sucralfate?

Answer 32

bind to ulcer base providing physical protection and allowing HCO3- secretion to reestablish pH gradient in the mucous layer

Question 33

which drug is a prodrug that requires acid to be activated?

Answer 33

sucralfate

Question 34

bismuth is also used is what other path?

Answer 34

H. pylori (Quadruple tx: PPI, bismuth, metronidazole, tetracycline)

Question 35

4 clinical applications for octreotide?

Answer 35

1. variceal bleeds 2. acromegaly 3. VIPoma 4. carcinoid tumors

Question 36

what path is associated with "disorganized glandular structure with cellular infiltration?"

Answer 36

pancreatic adenocarcinoma

Question 37

where does pancreatic adenocarcinoma usually arise from?

Answer 37

pancreatic duct

Question 38

what is the most common location of pancreatic adenocarcinoma?

Answer 38

pancreatic head

Question 39

what are the clinical symptoms from obstructive jaundice due to pancreatic adenocarcinoma?

Answer 39

1. painless jaundice 2. puritis 3. dark urine 4. pale stool

Question 40

what are the 2 tumor markers for pancreatic adenocarcinoma?

Answer 40

CA 19-9, CEA

Question 41

name 5 risk factors for pancreatic adenocarcinoma

Answer 41

1. tobacco use 2. chronic pancreatitis 3. diabetes 4. age > 50 yrs 5. Jewish and African American males

Question 42

name 4 unique presentations of pancreatic adenocarcinoma

Answer 42

1. abdominal pain radiating to back 2. weight loss (due to malabsorption and anorexia) 3. migratory thrombophlebitis 4. obstructive jaundice with palpable nontender gallbladder

Question 43

explain the pathophysio of the migratory thrombophlebitis?

Answer 43

precoabulant effect of the circulating "mucin" released by tumor cells --> inc coagulation factors

Question 44

what is another name for migratory thrombophlebitis?

Answer 44

Trousseau syndrome

Question 45

what is Courvoisier sign?

Answer 45

obstructive jaundice with palpable nontender gallbladder

Question 46

what path is associated with inc risk of gallbladder carcinoma?

Answer 46

porcelain gallbladder

Question 47

what infectious agent is associated with cholangiocarcinoma?

Answer 47

clonorchis sinensis (Chinese liver fluke)

Question 48

what is the treatment for porcelain gallbladder?

Answer 48

prophylactic cholecystectomy due to high rates of gallblader carcinoma

Question 49

define porcelain gallbladder

Answer 49

calcified gallbladder due to chronic cholecystitis

Question 50

what is the complication of acute pancreatitis?

Answer 50

pancreatic pseudocyst (lined by granulation tissue, not epithelium can rupture and hemorrhage)

Question 51

3 clinical presentations for acute pancreatitis?

Answer 51

1. epigastric abdominal pain radiating to back 2. anorexia 3. nausea

Question 52

what are the consequences of acute pancreatitis other than pseudocysts?

Answer 52

1. DIC 2. ARDS 3. diffuse fat necrosis 4. hypocalcemia (Ca2+ collects in pancreatic Ca2+ soap deposits) 5. infection 6. multiorgan failure

Question 53

is amylase and lipase a good marker for confirming chronic pancreatitis?

Answer 53

no (amylase and lipase may or my not be elevated in chronic pancreatitis)

Question 54

is amylase/lipase good makers for acute pancreatitis?

Answer 54

yes (amylase and lipase always elevate in acute pancreatitis)