GI deck 3

Question 1

Stimulants examples

Answer 1

cascara, senna, bisacodyl, and castor oil

Question 2

stimulants action

Answer 2

Direct action on intestinal mucosa by stimulating the myenteric plexus

Question 3

Osmotics example

Answer 3

magnesium hydroxide, magnesium citrate, sodium phosphate, polyethylene glycol electrolyte solution, and polyethylene glycol (PEG) 3350

Question 4

Osmotic action

Answer 4

draw water into the intestinal lumen

Question 5

bulk producing laxative example

Answer 5

psyllium, methylcellulose, and polycarbophil

Question 6

bulk producing laxative action

Answer 6

Natural and semi-synthetic polysaccharides and cellulose that mix with water in the intestine

Question 7

lubrcant example

Answer 7

mineral oil

Question 8

lubricant action

Answer 8

Soften stool and lubricates intestine

Question 9

surfactants example

Answer 9

docusate sodium, docusate calcium, and docusate potassium

Question 10

surfactants action

Answer 10

Reduce the surface tension of the oil–water interface on the stool and facilitate admixture of fat and water into the stool

Question 11

Hyperosmlar laxitive example

Answer 11

glycerine, lactulose

Question 12

hyperosmolar laxitive action

Answer 12

Draws water into the intestine

Question 13

Chloride channel activator example

Answer 13

lubiprostone

Question 14

chloride channel activator action

Answer 14

activate CIC-2 chloride channels in the GI tract to produce chloride-rich secretions that soften the stool

Question 15

Opioid-receptor antagonist example

Answer 15

methylnatrexone

Question 16

opioid receptor antagonist action

Answer 16

Mu receptor antagonist

Question 17

laxative contraindicated in

Answer 17

presence of nausea, vomiting, undiagnosed abdominal pain, or if bowel obstruction is suspected or diagnosed

Question 18

Magnesium hydroxide CI in

Answer 18

renal dysfunction

Question 19

Methylnaltrexone may

Answer 19

opioid withdrawal

Question 20

ADR - Laxative

Answer 20

excessive bowel activity, cramping, faltulece and bloating

Question 21

laxative Raid response and short-term use

Answer 21

Stimulants are the drugs of choice.
Osmotic laxatives also work well (magnesium hydroxide, PEG 3350).
Surfactants: docusate

Question 22

Laxative slower response and long-term use

Answer 22

bulk forming are safest

Question 23

Rapid-acting laxatives are best taken in the

Answer 23

am, lower-acting ones are best taken at bedtime!

Question 24

laxatives patient edcution

Answer 24

– prevention is key as laxatives are a temporary fixes. FIBER!

Question 25

pregnancy laxatives

Answer 25

Bulk-forming laxatives are safest | PEG (Miralax) or docusate may be used.

Question 26

GERD a common problem

Answer 26

in primary care

Question 27

GERD patho

Answer 27

Lower esophageal sphincter tone Gastric content regurgitation into the esophagus Complaints of burning substernal pain that radiates upward Persistent acid reflux that occurs more than twice a week considered GERD

Question 28

Goals of GERD tretment

Answer 28

reduce or eliminate symptoms, heal esophageal lesions, manage or prevent complications, prevent relapse

Question 29

Best treatment combo for GERD

Answer 29

lifestyle modification and drug therapy

Question 30

Drugs used for GERD

Answer 30

``` Histamine2 (H2) receptor antagonists Proton pump inhibitors (PPIs) Antacids Prokinetics Cytoprotective agents ```

Question 31

Mild GERD

Answer 31

OTC antacid or H2RA

Question 32

Moderate to severe GERD

Answer 32

Lifestyle and PPI for 8 weeks

Question 33

no response to PPI

Answer 33

refer out

Question 34

Pediatric GERD is

Answer 34

Very common in infants | Almost 100% in 3-month-old, 4% of 6-month-old, 20% of 12-month-old infants

Question 35

Ped GERD most outgrow by

Answer 35

12 to 18 mo

Question 36

Medical management reserved in those pediatrics who are experiencing

Answer 36

Poor weight gain Feeding difficulties Persistent irritability and pain, apnea, and cyanosis

Question 37

Peptic Ulcer disease incidence

Answer 37

12% in men and 10% in women

Question 38

Peptic ulcer disease patho

Answer 38

Increased acid and pepsin secretion Impaired mucosal cytoprotection Use of nonsteroidal anti-inflammatory drugs (NSAIDs), Helicobacter pylori Gastric: antral stomach region erosion, raised gastrin Duodenal: H. pylori releases toxins, phospholipase enzymes promoting inflammation and erosion

Question 39

Peptic ulcer disease can be caused by

Answer 39

NSAID and H. Pylori

Question 40

Peptic ulcer disase usualy presents as

Answer 40

chronic, upper abdominal pain – often related to eating a meal

Question 41

Peptic ulcer disase Physical exam may show

Answer 41

epigastric tenderness or not, often exams show no other signs

Question 42

Peptic ulcer diases in the absence of

Answer 42

red flag symptoms” testing for and treating H Pylori and/or empiric acid inhibition therapy is appropriate

Question 43

Red flag symptoms for peptic ulcer diseases

Answer 43

Red flag symptoms are: weight loss, bleeding, anemia, vomiting, early satiety, dysphagia

Question 44

All regimens for peptic ulcer disease include a PPI plus

Answer 44

antibiotics to treat H. pylori

Question 45

Triple therapy - PPI plus (peptic Ulcer)

Answer 45

Clarithromycin: 500 mg twice daily, or Metronidazole: 500 mg twice daily Amoxicillin: 1 gm twice daily Treatment for 10 to 14 days

Question 46

Quadruple therapy – PPI plus

Answer 46

Metronidazole: 250 mg four times/day Tetracycline: 500 mg four times/day Bismuth subsalicylate: 525 mg four times/day Treatment for 14 days Usually used as second-line therapy in patients who fail first-line therapy

Question 47

Levofloxacin-based trip therapy

Answer 47

``` PPI: twice daily Levofloxacin: 250 to 500 mg twice daily Amoxicillin: 1 g twice daily Treatment for 10 to 14 days Second-line or rescue therapy ```

Question 48

Peptic ulcer uncomplicated

Answer 48

treatment with h. pylori with PPI

Question 49

PPI is used for

Answer 49

8 to 12 weeks

Question 50

Complicated peptic ulcer what would you do

Answer 50

refer for gastroenterologist for edocopy and treatment for H. pylori

Question 51

When do you consider chronic supressive therapy with PPI or H2Ra

Answer 51

smokers >60, COPD, CAD, hx of bleeding or perforated ulcer, patients on NSAID