Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

IPAP 21-2 Soph Semester > GI MEDs > Flashcards

GI MEDs Flashcards

(115 cards)

Start Studying
1
Q

Where is pepsinogen found

A

Pepsinogen: inactive form of pepsin found in the Chief cells of the gastric glands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is pepsin

A

Pepsin: protein splitting enzyme capable of digesting nearly all types of dietary protein and is formed from pepsinogen in the presence of HCl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the role of Intirisic Factor

A

Intrinsic Factor: aids in the absorption of vitamin B12 and is found in the Parietal cells of the gastric glands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What stimulates the production of HCL in the Proptoin Pump

A

Acetylcholine (parasympathetic)
Histamine
Gastrin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the role of prostaglandins in protection of the GI

A

Inhibit basal and stimulated gastric acid secretion

Diminishes proton pump action

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the alarm s/s of GERD

A

Alarm Symptoms: dysphagia, odynophagia, bleeding, weight loss, choking, and epigastric mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the nonpharm approach to GERD

A

DIet modification

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What medications should be avoided in pts w/ GERD

A

Avoid medications that may reduce LES pressure, delay gastric emptying, or cause direct irritation

Alpha antagonist, anticholinergic, benzodiazepines, CCBs, estrogen, nitrates, opiates, TCAs, theophylline, NSAIDs, and aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the pharm approach to moderate GERD

A

Start with H2 inhibitors in addition with antacids for breakthrough GERD symptoms

If symptoms are not controlled after 4 weeks and max dose of H2 inhibitors switch to a Proton Pump Inhibitor (PPI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the pharm approach to frequent GERD

A

Start with PPI

should administer 30-60min prior to meal; may increase to BID dosing if needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the causes of PUD

A

Helicobacter pylori (H.pylori) positive

NSAID induced

Stress Ulcers or Stress-Related Mucosal Damage (SRMD)
SRMD is the preferred term because the mucosal lesions range from superficial gastritis and erosions to deep ulcers

Zollinger-Ellison Syndrome (ZES): gastric acid hypersecretory disease caused by gastrin-secreting tumor and leading to multiple, severe duodenal ulcers

Minor contributor to PUD: inadequate mucosal defense against gastric acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

All pts with PUD should be tested for

A

H. Pylori

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the noninvasive and invasive Tests for H. Pylori

A

Noninvasive:
Fecal antigen assay
Urea-breath testing (UBT)
Serologic testing

Invasive:
Gastric mucosal biopsies by endoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Wha this the Tx for H. Pylori ulcers

A

Anti-secretory agent: Proton Pump Inhibitor (PPI)

Two antibiotics
1st Line: Triple therapy - clarithromycin + amoxicillin (may replace with metronidazole if allergic to PCN)

2nd Line: Quadruple therapy - for patients that cannot take clarithromycin: tetracycline + metronidazole + bismuth subsalicylate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the length of Tx for duodenal ulcers and gastric ulcers

A

If PUD is present, continue PPI for 4-8 weeks for duodenal and 8-12 weeks for gastric ulcers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How are the urea breath test and the stool antigen test performed

A

Urea-breath test (UBT) or stool antigen tests are preferred

Must be off PPI for 1-2 weeks prior to the test

Can wait to confirm until after completion of the PPI course

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is standard triple therapy

A

PPI PO twice daily

Clarithromycin 500 mg PO twice daily
Amoxicillin 1 g orally PO twice daily
(or metronidazole 500 mg PO BID, if PCN allergic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is standard Quad therapy

A

PPI PO twice daily

Bismuth subsalicylate 262mg - two tablets PO four times daily

Tetracycline 500mg PO four times daily

Metronidazole 500mg PO three times daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What does COX-1 do

A

Increase blood flow to gastric mucosa and kidneys

Increase platelet aggregation via thromboxane A2 pathway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What does COX-2 do

A

Increase renal blood flow

Makes PG that activate and sensitize nociceptors (increased pain)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the Tx approach to NSAID induced ulcers

A

DC NSAIDS Or reduce
Switch to Acetominphine or Asprin

Celecoxib (Celebrex):
Should be reserved as last line
Associated with cardiovascular risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the prevention methods for stress ulcers

A

Proton Pump Inhibitors (PPI)

Histamine-2 Receptor Antagonists (H2RA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the 1st line therapy for intermittent S/s of acid

A

Antacids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the MOA of Sodium Bicarb

A

Mechanism of Action:
Reacts with HCL to produce carbon dioxide and sodium chloride.

CO2 results in gastric distention and belching

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is the MOA of calcium carbonate
Calcium Carbonate (Tums, Oscal) Less acid neutralizing capability compared to sodium bicarbonate and other antacids
26
What is the MOA and clin use of Mag Hydroxide
Mechanism of Action: reacts slowly with HCL to form magnesium chloride and water Clinical Use: may be used as antacid or laxative (diarrhea)
27
What is the ADE and caution of Mag Mydroxide
Adverse Effects: osmotic diarrhea caused by unabsorbed magnesium salts Caution: renal insufficient patients should not take magnesium hydroxide long-term
28
What is the MOA of aluminum hydroxide
Mechanism of Action: reacts with HCl to form aluminum chloride and water. Antacid
29
What is the ADE of aluminum hydroxide
Aluminum salts cause constipation Aluminum is also absorbed and excreted in the kidneys (Renal insufficiency: should not take long-term)
30
What is the MOA of H2 antagonists
Mechanism of Action: competitively block the binding of histamine to H2 receptors on the parietal cell, inhibiting gastric acid secretion induced by histamine Suppress basal and meal-stimulated acid secretion Reduces acid secretion stimulated by gastrin and cholinometic agents
31
Which is better in erosive esophagitis, PPI or H2 blocker
PPI
32
What are the ADE of H2 blockers
CNS effects such as headache, dizziness, fatigue, somnolence, and confusion are most common Prolonged cimetidine use is associated with rare development of gynecomastia
33
What is cimetidine
H2 blocker
34
How is cimetidine cleared
Competes with the medications and creatinine for tubular secretion in the kidney
35
What is Ranitidine
H2 blocker Low percentage of side effects and good efficacy
36
What is Famotidine
Pepcid AC
37
What are the most effective agents for the Tx of GERD
PPI ``` Pantoprazole (Protonix) Omeprazole (Prilosec) Omeprazole/Bicarbonate ion (Zegrid) Esomeprazole (Nexium) Rabeprazole (Aciphex) Lansoprazole (Prevacid) Dexlansoprazole (Dexilant) ```
38
What is the MOA of PPI
Administered as a prodrug Irreversibly binds to the H+/K+ ATPase enzyme system (proton pump) of the cells suppressing secretion of hydrogen ions
39
What is the advantage of PPI over H2RAs
Greater degree of acid suppression achieved and typically longer duration of action than H2RAs
40
What are the newly learned ADE of PPI
Increase RSK of FX Hypomagnesemia C. DIff CAP
41
What is the MOA and clin use of Surcralfate
Covers the ulcer site and protects it against acid Stimulates prostaglandin release Not absorbed systemically, adverse effects are uncommon Requires acidic pH for activation Clinical Use: Heals peptic ulcers, but not widely used as much because it is not as effective as H2 blockers and PPIs
42
What is the MOA of misoprostol
Prostaglandin Analog Synthetic, oral prostaglandin E1 analog that has both antisecretory and mucosal protective properties Clinical Use: Approved for the prevention of NSAID-induced ulcers in high-risk patients
43
Can pregnant pts get misoprostol
NO | Miscarriages
44
What is the only combination Rx product that contains metronidazole and tetracycline for the treatment of H. pylori
Bismuth, aka petobismol
45
What is the clin use of Bismuth/ Pepto
Nonspecific treatment of dyspepsia and acute diarrhea Prevention of traveler’s diarrhea Used in quadruple drug regimens for H. pylori eradication
46
What are the ADE of Pepto/ bismuth
Blackening of Stool Darkening Of tongue Renal insufficiency May bind to other drugs
47
What is the MOA and Clin Use of Metoclopramide
Prokinetic Agent Dopamine antagonist; stimulates motility of the upper GI track without effecting secretions Enhances the response to Acetylcholine of tissue in upper GI tract causing enhanced motility and accelerated gastric emptying without stimulating gastric, biliary, or pancreatic secretions Also block serotonin receptors in the chemoreceptor trigger zone, resulting in the anti-emetic action Clinical Use: gastroesophageal reflux, prevention of N/V from chemotherapy, impaired gastric emptying (i.e diabetic gastroparesis)
48
What drug helps N/V in chem pts
Metoclopramide 5HTs Antagonists
49
What are the MOA and Clin use of Ondansetron/ Granisetron/ Dolasetron/ Palonosetron
5hT3 antagonists Mechanism of Action: block presynaptic serotonin receptors on sensory vagal fibers in gut wall as well as central blockade in the vomiting center and CTZ ``` Clinical Use: General medical use Post-operative nausea and vomiting Chemotherapy Induced Nausea and Vomiting (CINV) Radiation-Induced nausea and vomiting ```
50
What is the ADE of Ondansetron and other drugs that end in -setron
Well tolerated; most common is headache, dizziness, and constipation QTc prolongation; small but statistically significant prolongation of QT interval (most pronounced with dolasetron)
51
Which 5HT3 has the most pronounces QT elongation effects
Dolasetron
52
``` What drug class are Meclizine (Antivert,Bonine) Diphenhydramine (Benadryl) Dimenhydrinate (Dramamine) Doxylamine (Unisom) Doxylamine/pyridoxine (Diclegis) ```
Antihistamines
53
What is the MOA of antihistamines
Block histamine H1 at the vestibular apparatus preventing vomiting due to motion sickness All cause some drowsiness and anticholinergic side effects
54
What drug class are prochloperazine and promethazine
Phenothiazines
55
What is the MOA and CLin use of Phenothizies: prochloperazine and promethazine
Mechanism of Action: Block dopamine, muscarinic, and histamine receptors in Chemoreceptor Trigger Zone (CTZ) Sedation is due to their anti-histamine activity Clinical Use: effective oral, injectable, and rectal anti-emetics for inpatient and outpatient use
56
What is promethazine
A 1st gen antihistamine used for the treatment of nausea, vomiting, and motion sickness DO NOT USE SubQ IV formulation should be diluted because of tissue necrosis r
57
What is the MOA and Clin use of scopalamine
Mechanism of Action: cholinergic antagonist with greater central (more lipophilic; blocks muscarinic receptors in the vestibular system) than peripheral effects Clinical Indication: motion sickness; surgical adjunct (blocks short-term memory and decreases saliva)
58
What are the important monitoring and ADE of scopalamine
Monitoring: HR, temperature, Urinary Output (UOP) Adverse Effects: excessive anticholinergic effects (dry mouth: 67%; drowsiness:17%)
59
What is the MOA and Clin use of Droperidol
Mechanism of Action: blocks dopamine receptors in chemoreceptor trigger zone (CTZ) of the CNS Clinical Use: Butyrophenone antipsychotic, no longer used as antipsychotic Indicated for Postoperative Nausea/Vomiting (PONV) Most often used for sedation in endoscopy and surgery, in combination with opioids or benzodiazepines
60
Where is droperidol most often used
Most often used for sedation in endoscopy and surgery, in combination with opioids or benzodiazepines
61
What are the ADE of Droperidol, a drug used in sedation for endoscopy
EPS, Dystonias, Drowsiness, Agitaton, Confusion
62
What is the MOA and clin of metoclopramide
Mechanism of Action: Dopamine antagonist; stimulates motility of the upper GI track without effecting secretions Enhances the response to Acetylcholine of tissue in upper GI tract causing enhanced motility and accelerated gastric emptying without stimulating gastric, biliary, or pancreatic secretions Also block serotonin receptors in the chemoreceptor trigger zone, resulting in the anti-emetic action Dosed several times a day Clinical Use: gastroesophageal reflux, prevention of N/V from chemotherapy, impaired gastric emptying (i.e diabetic gastroparesis)
63
What are the ADE of metroclopramide
EPS
64
What is the MOA and clin use of Trimethobenzamide
Mechanism of Action: Block emetic impulses in the chemoreceptor trigger zone (CTZ) Does not cause extrapyramidal symptoms like metoclopramide Clinical Use: Used for apomorphine pre-treatment in Parkinson’s patients Indicated for post-operative N/V and for nausea associated with gastroenteritis
65
What drug is used in the apomorphine pre-treatment in Parkinson’s patients
Trimethobenzamide
66
Dexamethasone and Methylprenisone are what drug class
Corticosteroids
67
What are the clincal use of corticosteroids
Chemotherapy N/V w. 5HT3 Antagonsits (SRAs)
68
How are BZD used to prevent NV
Clinical Use: used before the initiation of chemotherapy to reduce anticipatory nausea and vomiting caused by anxiety Products: Lorazepam (Ativan) Diazepam (Valium)
69
What kind of drugs are Dronabinol and Nabilone
Cannaboids used to treat NV in chemo pts | And anorexia with AIDS pts
70
What drug is used in conjunction with 5-HT3 antagonist and steroid for both the acute and delayed phases of cisplatin-induced emesis
Aprepitant
71
Drugs that end in --prepitant are used to treat what
Chemo induce NV
72
What is the Tx approach to mild Diarrhea
rehydration fluids + lactose free diet, avoid caffeine
73
What is the Anitbiotic therapy for Travelers Diarrhea
Fluoroquinolones Azithromycin Rifaximin (Xifaxan) only works in the colon Rifamixin treats IBS-diarrhea dominant
74
How do you treat antibiotics C. Diff
Metronidazole or oral vancomycin
75
How do Opiods agonists stop diarrhea
Activates presynaptic opioid receptors (mu receptors) in the enteric nervous system Inhibit presynaptic cholinergic nerves in the submucosal and mesenteric plexuses Lead to increase colonic transit time and fecal water absorption Decreases mass colonic movement and the gastrocolic reflex
76
How is the MOA and clin use of Loperamide
Mechanism of Action: Mu opioid agonist; activates opioid receptors in the enteric system, leading to inhibition of acetylcholine release and decreased peristalsis Does not cross the BBB Meperidine derivative Posses “no” analgesic properties or potential for addiction Clinical Use: Control mild to moderate symptoms of non-invasive diarrhea
77
What is the antidiarheal drug for non invasive diarrhea
Loperamide ( you know this one, its what you always had to have on hand in the field as a medic) ( doc i shit my pants )
78
What are the common causes of constipation
``` Altered motility Neurogenic causes (Parkinson disease) Endocrine/metabolic disorders (e.g. hypothyroidism, diabetes, hypokalemia, hypercalcemia, uremia) Pregnancy Psychogenic causes Structural abnormalities or obstruction Nutritional (e.g, reduced fiber and water intake) Medications ```
79
What is the MOA and clin use of osmotic Laxatives
Mechanism of Action: Rapid movement of water into the distal small bowel and colon, leads to high volume of liquid stool Increase volumes leads to bowel distension and reflex urge to defecate Followed by rapid relief of constipation Clinical Use: Acute or intermittent constipation Preoperative or pre-procedure bowel preparation
80
What type of laxative is magnesium based products
Osmotic
81
What kind of laxative is sodium phosphate
Osmotic
82
What is the caution with mag sulfate as an osmotic laxative
Caution with in patients with renal impairment due to the risk of magnesium intoxication Electrolyte Abnml
83
What is the black box label for sodium phosphate
Nephropathy with oral products
84
What is the MOA and Clin use of lactulose and 70% sorbitol
Mechanism of Action: metabolize by colonic bacteria, producing increased osmotic pressure causing fluid accumulation, severe flatus, cramps, and defecation Clinical Use: Management of acute, intermittent, or chronic constipation Lactulose: Preferred in chronic liver disease in the prevention and treatment of overt hepatic encephalopathy (OHE) episodes and portal systemic encephalopathy (PSE) Reduces ammonia levels
85
What osmotic laxative is preferred in chronic liver disease
Lactulose
86
What kind of laxative is polyethylene solutions
Osmotic Used for preoperative/colon preparation for endoscopic or radiologic procedures
87
How is Polyethylene taken
Isotonic solution contain an inert non-absorbable, osmotically active sugar Induce bowel movement/diarrhea to cleanse the bowel usually within 4 hours Ingest 2-4 Liters over 2-4 hours
88
What is the 2-4 liters a pt should drink for preoperative/colon preparation for endoscopic or radiologic procedures
Polyethylene Gycol
89
What is PEG 3350 power approved for
Approved for irritable bowel syndrome constipation dominant (IBS-C)
90
What are Gylcerin suppository and Mineraol Oil
Lubircating agents
91
What pts should suppository or mineral oil be used on
Management of acute or intermittent constipation | Pediatric patients
92
What are psyllium and wheat dextrin
Fiber used to treat constipation
93
What pts should not receive plant fibers
Celiac pts
94
What synthetic fiber can be used in celiac pts for constipation
Methyl cellulose
95
What kind of laxative is docusate
Stool surfactant/ Stool softener
96
How is ducosate used
Prevention of opioid induced constipation in combination with Senna or prevention of straining (pregnant/post-operative) Preferred for prophylaxis not acute treatment of constipation
97
To prevent straining in pregnancy or op pts what stool softener can be used
Docusate
98
What is the DOC for IBS in women older than 18 yrs old
Lubiprostone
99
What is the DOC in short term emergency Tx of IBS and Chronic Constipation in women older than 55 years old
Tegaserod
100
What is Linaclotide used for
IBS and Chronic constipation
101
What is the DOC for opiod induced constipation
Methyl naltrexone
102
What is the DOC for postoperative ileus
Alivmopan
103
What is the DOC for opiod induced constipation in adult pts with chronic non cancer pain
Naloxegol
104
Define Ulcerative colitis
Superficial, mega colon developing, Risk factor for cancer, that is usually confined to the rectum and terminal colon Has continuous inflammation
105
Define chrons
Cobblestone patchy appearance, that rarely leads to cancer, does not develop mega colon, and can be anywhere from mouth to anus in the GI, and can extend deep to the submucosa
106
What are the 1st line products for IBD
Sulfasalazine and Mesalamine
107
What do Sulfasalazine and mesalamine treat
IBD: chrons and UC
108
What TCAs can be used to treat IBS
Amitriptyline, nortriptyline, and imipramine Can worsen constipation
109
What SSRIs can be used to treat IBS
Fluoxetine, setraline, citalopram, and paroxetine are all viable options
110
What is Rifaximin used for
Treats IBS-D And travelers Diarhhea
111
What is the caution with Rifaxamin
Caution in liver impairment
112
What is eluxadoline used for
IBS-D
113
What pts should eluxamide, a drug for IBS-D be avoided in
should not be used in patients with a history of bile duct obstruction, pancreatitis, severe liver impairment, or severe constipation, and in patients who drink more than three alcoholic beverages per day
114
What is alosetron used for
Women with IBS-D
115
What are the black box warnings of alosetron, A 5hT3 antagonist used to treat IBS-D in women
Ischemic colitis and Constipation

IPAP 21-2 Soph Semester (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions