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GIT Flashcards

1
Q

Constipation in general?

A

It is defined as infrequent/difficult stool passage, or incomplete defacation, sometimes with feeling of straining

Diagnosis: if there’s no bowel movement for more than one time in 2 to 3 days

Causes: infrequent fluid/fiber intake, inappropriate diet, decreases physical activity, drugs, diseases

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2
Q

Alternating between constipation and diarrhea is a sign of

A

irritable bowel syndrome

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3
Q

2 types of plant-based laxatives and where they work?

A
  1. Bulk forming laxatives (on bowel lumen via PHYSIOCHEMICAL effect
  2. Purgative/stimulating laxatives (directly on the GI mucosa)
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4
Q

Talk about bulk forming laxatives?

A
  • most commonly recommened as initial treatment for constipation
  • contain high percentage of fibers and sometimes polysaccharides (mucilage)
  • they either take 12 hours to act or take as long as 3 days to show effectiveness
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5
Q

What’s the point of polysaccharides/mucilage in bulk forming laxatives?

A

To cause swelling and lubrication in the GIT

Examples: bran, cellulose, agar-agar

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6
Q

How do bulk forming laxatives work?

A
  1. They absorb water from GIT
  2. Then create bulky, viscous stool
  3. The stool distends the colon
  4. Transit time will be decreased, while peristalsis will be increased
  5. Stool passage
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7
Q

Which type of laxatives is always taken with plenty of water?

A

Bulk forming laxatives

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8
Q

What is the side effect of bulk forming laxaives?

A

Increase in gas/flatus. Why?
Because they influence the composition of food material in GI especially through colonic bacteria, in turn influencing the GI flora and metabolism of food in GIT

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9
Q

Safety & contraindications of bulk forming laxatives?

A

They’re not absorbed from the intestines into the body, which makes them generally safe, for elderly and for pregnant women especially.
* Safe for long term use also
Contraindicated in:
1- bedridden patients
2- patients with altered cognition
3- bowel obstruction
4- stenotic lesions in the GIT
5- not to be taken with loperamide or opiates

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10
Q

Plants that are bulk forming?

A
  1. Linseed/flaxseed
  2. Bran
  3. Psyllium
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11
Q

Talk about linum usitatissimum

A
  • we use the ripe seed and ground them so that it can absorb and swell in GI
  • it’s main constituent is mucilage
  • dose: 3 to 6 capsuls 1000mg oil
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12
Q

Herb-drug interaction of linseed?

A

Reduce the absorption of some drugs (antiobiotics)
Why? Because thr muscilage absorbs the drug instead
Solution? Take them after 0.5-1 hour before the drugs

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13
Q

Talk about triticum aestivum

A
  • bran
  • it is insoluble fiber
  • contains 46% non starch polysaccharides
  • SHOULD NOT be used in patients with gluen induced enteropathies
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14
Q

Talk about psyllium?

A
  • high in fiber, more than polysaccharides
  • contains 10% -30% polysaccharides (mucilage content)
  • more effective than lactulose & other lax
  • causes more frequent & bulkier stool movements
  • lower incidence of s/e
  • GEL FORMING FIBER
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15
Q

Gel forming lax?

A

Psyllium

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16
Q

How do stimulant laxatives work? (On intestinal mucosa)

A

By increasing MOTOR activity of the bowels —> by directly stimulating the nerve plexus in intestinal wall causing:
1. Increased movement
2. Stimulation of the local reflexes (chloride channels)

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17
Q

When should you use stimulant laxatives?

A
  1. In preparation for rectal/bowel examination
  2. When osmotic (bulk forming) laxatives have been ineffective
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18
Q

MOA of stimulant laxatives?

A
  1. Direct action on intestinal mucosa/GI nerve plexus
  2. Increases the fluid & electrolysis in the lumen, reducing the re-absorption
  3. Water incorporates with stool to soften it
  4. Increases peristalsis & evacuation
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19
Q

What’s the main chemical constituent in stimulating laxatives and how long does it take for it to work

A

Anthraquinons and others that are similar to it
Takes 6-10 hours

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20
Q

Chemical constituent in senna?

A

Dinathrone glycosides
(Particularly sennoside A B C D)

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21
Q

Side/adverse effects of senna? مهمهمهمهمهم

A
  1. Abdominal pain
  2. Flatulence
  3. Nausea
  4. Bloating
  5. Changes in heart rhythm
  6. Electrolyte disturbances (hypokalemia)
  7. Abnormal coloration of urine —> yellowish brown turns red due to increase in pH
  8. Over-emptying
  9. Reduction of spontaneous bowel function —> which develops lax habit
  10. Rebound constipation
  11. Enlarged fingers, curved fingertips
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22
Q

Senna could be carcinogenic. How?

A

Through evidence that showed that several anthraquinones are MUTAGENIC in the Ames test.
Some have been found to induce GENOTOXIC effects in cultured mammalian cells
So they could possibly behave as TUMOR PROMOTER

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23
Q

Melanosis coli?

A

It is a side effect of senna because it could give pigment to the colonic mucosa (melantoic Pigmentation)
This is reversible

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24
Q

Drug-herb interactions of senna

A
  1. Interaction with Digoxin because it may potentiate it due to loss of potassium (hypokalemia)
  2. Further loss of potassium if used with thiazide diuretics & licrorice root (it causes hypokalemia)
  3. It decreases the transit time so it increases the absorption of oral drugs
25
Contraindications of senna?
1. Intestinal obstruction (because it could lead to rupture) 2. Stomach inflammation 3. Instestinal inflammatory diseases (IB, ulcerative colitis, Crohn's) 4. Children under 10-12 why? Due to water & electrolysis loss مهمة 5. Pregnancy and breastfeeding
26
Talk about diarrhea
- it's an increased frequency of stool/3 times per day - it's a decreased consistency of fecal discharge - increased fluidity & volume (of stool) - usually self limiting after 48 hours
27
First line treatment of diarrhea?
Oral rehydration therapy using sugar-salt solution often with starch Homemade salt and 6 levels of sugar with water
28
What does rice have to do with diarhea?
Starch may be derived from rice because it has polysaccharides Which is hydrolyzed in the GIT, and this hydrolysis results in sugar The sugar is absorbed Rice suspensions thus actively shift the balance of Na towards the mucosal side, enhance the absorption of water and provide the body with energy, and the efficacy of rice starch has been demonstrated in several clinical studies
29
In diarrhea, stool has too much water to reabsorb
True
30
Tannins for diarrhea?
- they're astringent & polymeric polyphenols - they work by binding to surface proteins of inflammed membranes, tighten them and contract them - they inhibit the absorption of toxic viral/bacterial products - results in fluid retention (restricted secretion of water into GI lumen) which can reduce diarrhea & bleeding
31
Tannins for diarrhea?
- they're astringent & polymeric polyphenols - they work by binding to surface proteins of inflammed membranes, tighten them and contract them - they inhibit the absorption of toxic viral/bacterial products - results in fluid retention (restricted secretion of water into GI lumen) which can reduce diarrhea & bleeding
32
Do tannins give a protective film? What does it do?
Yes, they give a protective film that would hinder the absorption of toxins & blunt the actions of local irritants & normalize hyperperistalisis
33
Tannins cause proteins to be deposited on the epithelial surface, forming a stable, coherent membrane.
True
34
Tannins cause proteins to be deposited on the epithelial surface, forming a stable, coherent membrane.
True
35
Talk about camelia plant (tea)
1. Its active constitiuents are catchines, flavonols, and xanthine alkaloids (caffeine) 2. Its drug-herb interaction is reduced absorption of iron & rosuvastatin & warfarin effect It also increases simvastatin & sildenafil 3. S/e of tea: nervous system stimulation which could lead to anxiety and others 4. Contraindications: must be avoided in kidney disorder (due to diuretic effect) & heart disorders (increase HR) & sleep disorders especially in infants 5. Safe in pregnancy & lactation as long as it's below 200-300 mg of caffeine 6. It's a tannin so it's used in diarrhea
36
Talk about nausea & vomiting
- common symptoms could be caused by pregnancy, motion sickness, fume, smoke, anesthesia, posioning, others - the stimuli that could cause them originates from the visceral/vestibular/chemoreceptor trigger zone CTZ mediated by serotonin, dopamine, ACH, histamine
37
Current medical therapy of N/V falls into two categories
1. Anti-emetic agents: directly supress nausea & prevent vomiting (centrally acting) 2. Prokinetic agents: they modulate the gastrointestinal motility
38
Sources of n/v in neurons?
1. GIT: vagus afferntis (visceral/somatic organ) - obstruction/gastroparesis 2. Motion sickness: vestibular apparatus 3. By sight, smell, or emotion: cerebral cortex 4. By drug metabolites or toxins: CTZ
39
Active constitiuents of ginger?
1. Phenols (gingerol & shogaol) 2. Sesquiterpene oil (zingiberene)
40
Ginger mechanism of action for emesis?
It decreases emesis through 5-HT3 antagonism, and it acts on gastrointestinal level not central level
41
Uses of ginger?
1. Effective & safe for n/v in pregnancy 2. Could be used as adjuvent treatment in chemotherapy induced n/v 3. An alternative to alleviate post-op n/v 4. Motion sickness
42
S/e, interactions, & contraindications of ginger?
Adverse effects: heartburn, diarrhea, nausea, especially after heavy menstrual bleeding & elective cesarean secrion Interactions: 1. Warfain/heparin/antiplatelets it could increase risk of bleeding. 2. PPIs & H2RA it could promote flow of gastric acid Contraindications: patients with GALLSTONES due to ginger's cholagoge effect
43
Treatment of dyspepsia
1. Cholagogues: agents that stimulate the flow of bile into duodenum, they promote emptying of gallbladder and bile ducts 2. Choloretic: an agent that stimulates the production of bile by liver **both of them should not be jsed in cases of bile duct obstruction or jaundice 3. Bitter stimulants: directly on mucosa of upper GIT & bitter receptors of tongue. Stimulate secretion of saliva & gastric juice & gastrin secretion
44
Bitter stimulants actions
When taken, the vagal nerve is stimulated & rest & digest is activated
45
What nerves are stimulated by bitter stimulants?
1. Cephalic vagal reflex: it stimulates oropharyngal bitter receptors to increase more saliva & vagal stimulation to digestive organs 2. Local reflex: stimulation of both, oropharyngal & GI bitter receptos which act LOCALLY to increase digestive secretions 3. Hyperaemia: it is the MAJOR influence of bitters on digestion. Improving blood circulation to abdominal organs (increases absorption)
46
Talk about dandelion/taraxum
We use the root to increase bile production (it has cholerectic effect) It contains: 1. Sesquiterene lactones (bitter stimulants) 2. Triterpene (taraxsterol)
47
Talk about mentha piperita/peppermint oil
-It's composed of: menthol, menthyl acetate, and menthone -It has carminative action to reduce the tonus of esophageal sphincter (bloating reduction) -It acts as a smooth muscle relaxant (through calcium oum antagonistic effects) (antisapsmodic)
48
Interactions and warnings of peppermint oil
1. It increases bv of felodipine 2. Avoid if you have heartburn/GERD because it might be increased
49
Talk about gastrtits
- inflammation of the lining of the stomach - may be short episode or long term - may be asymptomatic - symptoms include upper abdominal pain, bloating, loss of appetite, heartburn - common cause: H.pylori, use of NSAIDS, alcohol, smoking, crohns disease
50
Treatment of gastritis
Symptomatic relief: chamomile & liqorice root Pharmaceuticals for mild inflammation: 1. Emollient (like alginate) to line and soothe the mucosa 2. Antacids 3. Carimnative (anise oil & peppermint oil)
51
Talk about alginates/alginic acid
- anionic polysaccharides - it binds to water to form viscous gum - acts as a protective coating
52
Talk about chamomile
Composition: 1. Sesquiterpene (bisabolol) 2. Flavonoid (apigenin) 3. Terpenoid (matricin) 4. Chamazulene
53
How much does pharmaceutical chamomile contain?
Not less than 0.4% of volatile oil No less than 0.3% of apigenin
54
Chamomile mechanism of action as an anti inflammatory?
- The apigenin might be the anti inflammatory component, which inhibits phospholipase A & cyclo oxygenase & lipo oxygenase - As for volatile oils, chamzulene & a-bisabolol, they interfere with 5-lipo oxygenase & lipo oxygenase production
55
Talk about liqorice root
-Contains: glycyrrhizin/ flavonoids (liquitrin & isoliquitrin) -It has anti ulcer effect -dose should not exceed 200-600mg for a duration of 4-6weeks
56
Mechanism of action of liqorice root?
- inhibition of 15-hydroxy prostaglandin dehydrogenade (dehydrogenase reductase SDR) - increasing prostaglandin E to heal the ulcer - promoting MUCIN PRODUCTION - decreasing ACID PRODUCTION - potent inhibition of h.pylori growth
57
Side effects of liqorice?
1. Increasing hydrocortisone levels at Mineralcorticoids receptor 2. Results in sodium Na retention & potassium K excretion & hypertension 3. Headache 4. Lethargy 5. Retention 6. Heart failure & cardiac arrest eventually
58
Contraindications & herb drug interaction of liqorice
Contraindications: hypertension, hypokalemia, renal failure, pregnancy Intercations: diuretcis, cardiac glycosides, may reduce effects of antihypertensive

Phytotherapy Mid Material (3 decks)

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