Flashcards in GI drugs II Deck (53):
patho of GERD
inappropriate relaxation, low resting tone, anatomical alteration of the lower esophageal sphincter. acid hypersecretion especially after meals.
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.
how to treat GERD with persistent symptoms W/O esophagitis
alginic antacids, promobility drugs, H2-blockers.
what promobility drugs treat GERD
what H2 blockers treat GERd
cimetidine, ranitidine, famotidine, nizatidine
how to treat GERD with persistent symptoms with esophagitis
H2 blockers double dose, H2 blockers and promobility agent. PPI. antireflux surgery
what PPI for GERD with esophagitis
omeprazole, lansoprazole, rabeprazole, esomeprazole, pantoprazole, dexlansoprazole.
peripheral dopamine antagonist
adverse effects of metaclopramide
what mediates vomiting
chemo-receptor trigger zone in the medulla vomiting center.
what stimulates vomiting
alcohol, ipecac, infection, inflammation, mass effects, vestibular irritation, headaches, apomorphine, chemotherapy.
how do antiemetics work
on the chemoreceptor trigger zone
what are the phenothiazines and agents
neuroleptic class of antiemetics -perchlorperazine, promethazine
mechanism of perchlorperazine
CNS interaction with the dopamine receptor -antagonistic. adverse affects are largely extrapyramidal
mechanism of promethzine
antihistaminic and anticholinergic.
what are the adverse affects of promethazine
what are the benzamide derivatives
unknown effect. trimethobenzamide and metaclopramide
SE not as severe as the phenothiazines
mechanism of metoclopramide
CNS and peripheral dopamine receptor antagonism
probable anticholinergic mechanism
what are the serotonin antagonists
ondansetron, granesitron, dolasetron,
what are the SE of the serotonin antagonists
HA, dizziness, somnolence
what is the treatment for gastroparesis
what is gastroparesis
obstruction or loss of gastric tone.
what are the promobility drugs
metaclopramide, cisapride, domperidone
what is secretory diarrhea
increased secretion or decreased absorption of NaCl
what is osmotic diarrhea
nonabsorbable molecules in the gut lumen
what is inflammatory absoroptive surface diarrhea
destruction of the mucosa impaired absorption, outpouring of blood/mucous
what happens in decreased absorption diarrhea
impaired reabsorption of electrolytes
what happens in a motility disorder
increased motility with decreased time for absorption of electrolytes and/or nutrients. decreased motility with bacterial overgrowth.
5 causes of acute diarrhea
heavy metal poisoning
bacterial infections, viral and parasitic infections
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.
causes of chronic/recurrent diarrhea
IBS, inflammatory bowel disease, parasitic infections, malabsorption syndrome, drugs, heavy metals.
causes of chronic diarrhea of unknown origin
surreptious laxative abuse, IBS, unrecognized inflammatory, bile acid malabsorption, other
causes of incontinence
sphincter malfunction (surgeries, fissures, fistulas, hemorrhoids, episiotomy, anal crohns, diabetic neuropathy, idiopathic)
what drug classes treat diarrhea
anticholinergics, opioid agonists, colloids and pectins
treatment of diarrhea by relaxing the bowel smooth muscle.
opioid treatment for diarrhea, increases rectal tone and disrupts peristalsis via mu receptor
opioid treatment for diarrhea, usually combined with atropine, mu receptor, contracts the circular muscle causing segmentation. (codeine sulfate works the same)
what causes constipation
drugs, functional, colonic, rectal, neurologic, metabolic
hwo do we treat constipation
with laxatives or carthartics
antiinflammatories for the treatment of colitis
mesalamine, sulfasalazine, olsalazine. corticosteroids and antibiotics.
what are the chronic immunosuppressive agents for inflammatory bowel diseases
azothioprine, corticosteroids, infliximab, cyclosporine
what is the mechanism of azothioprine
antimetabolite that interferes with DNA synthesis
what is the mechanism for infliximab
monoclonal antibody, binds and neutralizes TNF-a
what is the mechanism for cyclosporin
polypeptide that inhibits T cell helpers and lymphocytes
classes of drugs used to treat IBS
opioids, bulking agents, antidepressants, anticholinergics, serotonergic agonists and antagonists
metamucil and fibercon.
opioids for IBS
anticholinergics for IBS
dicyclomine hydrochloride, hyoscyamine sulfate
antidepressants for IBS
serotinergic agonists for IBS
for when diarrhea predominates. alosetron. constipation or ischemic bowel can occur