GI Disorders

Question 1

What are the clinical manifestations of GERD

Answer 1

pyrosis and regurgitation

bloat, belch, nausea

epigastric pain

sore throat /hoarse/chronic cough/ halitosis

Question 2

what is Pyrosis

Answer 2

heartburn

Question 3

What 3 things worsens GERD

Answer 3

meals
trigger foods
lying down

Question 4

What is the stomach content that moves into the esophagus during GERD called

Answer 4

chyme

Question 5

What maintains a pressure barrier between the stomach and the esophagus

Answer 5

lower esophageal sphincter (LES)

Question 6

What supports the LES? (2)

Answer 6

tone of diaphragm
esophageal hiatus

Question 7

Decreased LES tone results in ___________ reflux

Answer 7

increased

Question 8

What are triggers that decrease LES tone
(5 things) (4 meds)

Answer 8

caffeine
onions, garlic
alcohol, tobacco
mint
fatty meats

MEDs: antihistamines, oral contraceptives, CCBs, anticholinergics

Question 9

What are 4 things when indicated that you can do to increase LES tone

Answer 9

avoid trigger foods
consider meds SE
Avoid tight clothes
Weight loss

Question 10

What cell is gastric acid secretion stimulated at in the stomach

Answer 10

parietal cell

Question 11

What 3 factors stimulate the parietal cells in the stomach to increase gastric acid

Answer 11

acetylcholine
histamine
gastrin

Question 12

When the parietal cells in the stomach are stimulated what enzyme is activated to secrete H+ into the lumen of the stomach

Answer 12

H+/K+ ATPase proton pump

Question 13

what are the three drug classes to reduce acid

Answer 13

antacids
histamine-2 receptor blockers
PPIs

Question 14

Prescribing acid reducers is a stepwise approach based on what 4 things

Answer 14

-predictability
- frequency
- severity of symptoms
-degree of esophageal damage

Question 15

what acid reducer class are salts (weak bases) that interact with acids to neutralize them, can increase LES tone
(stops acid not cause of acid)

Answer 15

antacids

Question 16

Antacids have a quick peak and a _________ duration

Answer 16

short

Question 17

for greatest benefit, what should be administered with antacids to delay gastric empyting

Answer 17

food

Question 18

What are four common preparations of antacids

Answer 18

-magnesium hydroxide
-aluminum hydroxide/magnesium hydroxide
- aluminum hydroxide/magnesium carbonate
-calcium carbonate

Question 19

what is an example of magnesium hydroxide

Answer 19

milk of magnesia

Question 20

what is an example of aluminum hydroxide/magnesium hydroxide

Answer 20

maalox/mylanta

Question 21

what is an example of aluminum hydroxide/magnesium carbonate

Answer 21

gaviscon

Question 22

what is an example of calcium carbonate

Answer 22

rolaids
tums

Question 23

Calcium and aluminum can cause what side effect

Answer 23

constipation

Question 24

magnesium can cause what side effect

Answer 24

diarrhea

Question 25

Antacids result is a decreased absorption of what meds (5)

Answer 25

aspirin digoxin isoniazid PCN phenytoin

Question 26

What med is binded by magnesium based antacids that decreased its bioavailability

Answer 26

tetracycline

Question 27

when histamine stimulates the H2 receptor H+ is exchanged for K+ into the lumen of the stomach which causes what to happen

Answer 27

acid secretion

Question 28

Histamine 2 blockers have what kind of effect on the proton pump (like a dimmer)

Answer 28

indirect

Question 29

What is the suffix for H2 blockers

Answer 29

-tidine

Question 30

What are 3 H2 blockers

Answer 30

ranitidine (zantac) famotidine (pepcid) cimetidine (tagamet)

Question 31

PPIs are _____________ agents

Answer 31

anti-secretory

Question 32

PPIs bind _______ to the ATPase to block acid production

Answer 32

directly

Question 33

PPIs can reduce gastric acid by what percent

Answer 33

90%

Question 34

what are 4 therapeutic uses of PPIs

Answer 34

-GERD -Reflex esophagitis/erosive gastritis -peptic ulcer disease -zollinger-ellison syndrome (hypersecretory disorder)

Question 35

How long does it take the cell to resynthesize new proton pumps

Answer 35

18 hrs

Question 36

when are PPIs recommended to be taken

Answer 36

30 minutes before meal (before breaky preffered)

Question 37

What are 4 risks for PPI use

Answer 37

diarrhea fracture risk kidney disease c diff

Question 38

PPIs can interact with what 2 med types that are needed

Answer 38

calcium thyroid meds

Question 39

what is the ending for PPIs

Answer 39

prazole

Question 40

what condition is where the cells of the esophagus become metaplastic

Answer 40

Barrett esophagus

Question 41

Antidiarrheals should be avoided if the sx were associated with these 4 things

Answer 41

abdominal pain, fever, distention, bloody stool

Question 42

What are 2 antimotility agents

Answer 42

loperamide (imodium) diphenoxylate with atropine (lomotil)

Question 43

What antidiarrheal inhibits peristalsis by directly interfering with muscular contraction in the intestinal wall (and increases anal sphincter tone)

Answer 43

loperamide (imodium)

Question 44

loperamide is also a _____ receptor agonist

Answer 44

mu

Question 45

what antidiarrheal is an opioid derivative that drives constipation or slowed GI motility and lacks analgesic properties

Answer 45

diphenoxylate

Question 46

What drug comboed into an antidiarrheal has an anticholinergic effect

Answer 46

atropine

Question 47

what are adverse effects of lomotil

Answer 47

anticholinergic effects

Question 48

what are drug-drug interactions to avoid with lomotil

Answer 48

ones that cause CNS depression (etoh, antihistamines, opioids)

Question 49

the bismuth in peptiobismol has what effect

Answer 49

antimicrobial

Question 50

the salicylate in peptobismol has what effect

Answer 50

antisecretory effect

Question 51

what are adverse effects of peptobismol

Answer 51

black stools/tongue

Question 52

what drug should not interact with peptobismol

Answer 52

aspirin

Question 53

peptobismol should be avoided in patients with what kind of impairment

Answer 53

renal

Question 54

what 4 groups get constipated

Answer 54

elderly children IBS/CIC Pregnancy

Question 55

what non pharm ways to manage constipation

Answer 55

adequate fluid/fiber appropriate activity level behavioral concerns (potty train, poop position)

Question 56

what constipation med has direct action on the intestinal mucosa resulting in increased GI motility

Answer 56

irritants and stimulants

Question 57

what are adverse effects of irritants and stimulants

Answer 57

water and electrolyte loss abdominal cramping

Question 58

what are fiber products that are nonabsorbable and hydrophilic that absorb and retain water and increase rate of transit

Answer 58

bulk laxatives

Question 59

Bulk laxatives have no role in what kind of constipation

Answer 59

acute (work very slow)

Question 60

what are adverse effects of bulk laxs

Answer 60

gas bloating

Question 61

What are 3 examples of bulk laxs

Answer 61

psyllium (metamucil) methylcellulose (citrucel) Wheat dextrin (benefiber)

Question 62

what are nonabsorbable salts that act to draw water into the GI tract

Answer 62

osmotic laxs

Question 63

What are two examples of osmotic laxatives

Answer 63

polyethylene glycol glycerin suppositories

Question 64

Miralax is used as prep for what procedure

Answer 64

colonoscopy

Question 65

what osmotic lax is safe for all ages

Answer 65

glycerin suppositories

Question 66

What constipation med lowers surface tension at the oil water interface allowing water and lipids to enter teh stool

Answer 66

stool softeners

Question 67

T/F stool softeners are safe for pregnancy

Answer 67

T