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Flashcards in GI drugs II Deck (53):
1

patho of GERD

inappropriate relaxation, low resting tone, anatomical alteration of the lower esophageal sphincter. acid hypersecretion especially after meals.

2

how to treat GERD simple lifestyle

elevation of head at bed time, avoidance of liquids or foods 2-3hrs before bed, avoid fatty or spicy food, no cigs or ETOH, weight loss, liquid antacids, pregnancy.

3

how to treat GERD with persistent symptoms W/O esophagitis

alginic antacids, promobility drugs, H2-blockers.

4

what promobility drugs treat GERD

cisapride, metaclopramide

5

what H2 blockers treat GERd

cimetidine, ranitidine, famotidine, nizatidine

6

how to treat GERD with persistent symptoms with esophagitis

H2 blockers double dose, H2 blockers and promobility agent. PPI. antireflux surgery

7

what PPI for GERD with esophagitis

omeprazole, lansoprazole, rabeprazole, esomeprazole, pantoprazole, dexlansoprazole.

8

metaclopramide

peripheral dopamine antagonist

9

adverse effects of metaclopramide

tremor.

10

what mediates vomiting

chemo-receptor trigger zone in the medulla vomiting center.

11

what stimulates vomiting

alcohol, ipecac, infection, inflammation, mass effects, vestibular irritation, headaches, apomorphine, chemotherapy.

12

how do antiemetics work

on the chemoreceptor trigger zone

13

what are the phenothiazines and agents

neuroleptic class of antiemetics -perchlorperazine, promethazine

14

mechanism of perchlorperazine

CNS interaction with the dopamine receptor -antagonistic. adverse affects are largely extrapyramidal

15

mechanism of promethzine

antihistaminic and anticholinergic.

16

what are the adverse affects of promethazine

somnolence

17

what are the benzamide derivatives

unknown effect. trimethobenzamide and metaclopramide
SE not as severe as the phenothiazines

18

mechanism of metoclopramide

CNS and peripheral dopamine receptor antagonism

19

tetrahydrocannabinol

probable anticholinergic mechanism

20

what are the serotonin antagonists

ondansetron, granesitron, dolasetron,

21

what are the SE of the serotonin antagonists

HA, dizziness, somnolence

22

what is the treatment for gastroparesis

promotility drugs.

23

what is gastroparesis

obstruction or loss of gastric tone.

24

what are the promobility drugs

metaclopramide, cisapride, domperidone

25

what is secretory diarrhea

increased secretion or decreased absorption of NaCl

26

what is osmotic diarrhea

nonabsorbable molecules in the gut lumen

27

what is inflammatory absoroptive surface diarrhea

destruction of the mucosa impaired absorption, outpouring of blood/mucous

28

what happens in decreased absorption diarrhea

impaired reabsorption of electrolytes

29

what happens in a motility disorder

increased motility with decreased time for absorption of electrolytes and/or nutrients. decreased motility with bacterial overgrowth.

30

5 causes of acute diarrhea

viral/bacterial/parasitic infections
food poisoning
drugs
fecal impaction
heavy metal poisoning

31

travelers diarrhea

bacterial infections, viral and parasitic infections

32

what are the bacterial causes of travelers diarrhea

mediated by enterotoxins made by e coli. mediated by invasion of the mucosa and inflammation by e coli, shigella, camplobacter. or a combination of both enterotoxins and invasion such as salmonella.

33

causes of chronic/recurrent diarrhea

IBS, inflammatory bowel disease, parasitic infections, malabsorption syndrome, drugs, heavy metals.

34

causes of chronic diarrhea of unknown origin

surreptious laxative abuse, IBS, unrecognized inflammatory, bile acid malabsorption, other

35

causes of incontinence

sphincter malfunction (surgeries, fissures, fistulas, hemorrhoids, episiotomy, anal crohns, diabetic neuropathy, idiopathic)

36

what drug classes treat diarrhea

anticholinergics, opioid agonists, colloids and pectins

37

atropine sulfate

treatment of diarrhea by relaxing the bowel smooth muscle.

38

loperamide

opioid treatment for diarrhea, increases rectal tone and disrupts peristalsis via mu receptor

39

diphenoxylate

opioid treatment for diarrhea, usually combined with atropine, mu receptor, contracts the circular muscle causing segmentation. (codeine sulfate works the same)

40

what causes constipation

drugs, functional, colonic, rectal, neurologic, metabolic

41

hwo do we treat constipation

with laxatives or carthartics

42

antiinflammatories for the treatment of colitis

mesalamine, sulfasalazine, olsalazine. corticosteroids and antibiotics.

43

what are the chronic immunosuppressive agents for inflammatory bowel diseases

azothioprine, corticosteroids, infliximab, cyclosporine

44

what is the mechanism of azothioprine

antimetabolite that interferes with DNA synthesis

45

what is the mechanism for infliximab

monoclonal antibody, binds and neutralizes TNF-a

46

what is the mechanism for cyclosporin

polypeptide that inhibits T cell helpers and lymphocytes

47

classes of drugs used to treat IBS

opioids, bulking agents, antidepressants, anticholinergics, serotonergic agonists and antagonists

48

bulking agents

metamucil and fibercon.

49

opioids for IBS

loperamide

50

anticholinergics for IBS

dicyclomine hydrochloride, hyoscyamine sulfate

51

antidepressants for IBS

SSRIs..

52

serotinergic agonists for IBS

for when diarrhea predominates. alosetron. constipation or ischemic bowel can occur

53

serotonergic antagonists for IBS

constipation predominant tegaserod maleate.