Lec 2 - GI Drugs

Question 1

Gastrin is released from ____ cells into the ____.

Answer 1

G, bloodstream

Question 2

gastrin:
binds ___ cells via the ____ receptor, causing a release of histamine;
binds ____ cells, causing a release of acid;

which is the more important effect?

Answer 2

ECL, CCKb (more important);

parietal

Question 3

Gastrin is release in response to _____ and _____

Answer 3

peptides, vagal stimulation

Question 4

vagal effects:
ACH binds ____ receptors on ____ cells, causing an increase in acid release;
_____ binds G cells, causing gastrin release

Answer 4

M3, parietal;

GRP

Question 5

Histamine is released from ____ cells. it binds ____ receptors, which are G __ coupled on parietal cells

Answer 5

ECL;

H2, s

Question 6

what 2 endogenous molecules inhibit release of acid from parietal cells?

Answer 6

prostaglandins, somatostatins

Gi associated

Question 7

what kind of pump releases acid? where are parietal cells located?

Answer 7

H+/K+ ATPase;

fundus and body of stomach

Question 8

what kind of cell is somatostatin released from?

Answer 8

D cells

Question 9

histamine activates a ___ dependent pathway. Ach and gastrin activate a ____ dependent pathway

Answer 9

cAMP, IP3/Ca2+

Question 10

Antacids:

____ has a high neutralizing capacity; adverse effects include alkalosis and fluid retention

Answer 10

NaHCO3

Question 11

MgOH2 has a ____ neutralizing capacity. the main side effect is ____

Answer 11

high, diarrhea

Question 12

CaCO3 has a ____ neutralizing capacity. the main side effect is _____ syndrome, hypercalcemia, and nephrolithiasis

Answer 12

moderate, milk-alkali

Question 13

AlOH3 has a high neutralizing capacity. adverse effects include ____ and hypo______

Answer 13

constipation, phosphatemia

Question 14

simethicone (mylicon, phazyme) is a mild ____ that enhances release of ____.

Answer 14

surfactant; gas

Question 15

H2 receptor antagonists end in “___”;

Answer 15

dine;

cimeti, raniti, famoti, nizatidine

Question 16

H2 blockers are _____ antagonists. They reduce acid secretion in response to histamine, _____, and _____.

Answer 16

competitive, gastrin, Ach

Question 17

which of the H2 blockers inhibits CYP enzymes and can cause thrombocytopenia? ( ie warfarin, phenytoin, sulfonylureas interaction)

Answer 17

cimetidine

Question 18

cimetidine also has anti ___ effects. name 3 symptoms

Answer 18

androgenic;

gynecomastia, impotence, galactorrhea (due to prolactin)

Question 19

proton pump inhibitors (PPIs) all end in “____”

Answer 19

prazole

ie omeprazole, lanso, esome, panto, dexlanso

Question 20

PPIs are ____ that are activated by ___ pH; they are (irreversible or reversible) inhibitors

Answer 20

prodrugs, acidic;

irreversible

Question 21

PPIs cause an increase in ____, which can result in ____ hypersecretion of gastric acids

Answer 21

gastrin; rebound

Question 22

PPIs:
____ is a CYP2C19 inhibitor (warfarin, phenytoin, clopidrogel)

all cause a decrease in absorption of ___ and ____ due to increased gastric pH

Answer 22

omeprazole;

digoxin, ketoconazole

Question 23

PPIs cause an increase risk of _____ infection and ____. they can cause _____

Answer 23

C diff, pneumonia;

osteoporosis

Question 24

“Acid rebound” is more common with what type of drugs

Answer 24

H2 antagonists

Question 25

____ polymerizes and forms a protective barrier at ulcer sites. it requires a _____ pH

Answer 25

sucralfate, acidic can decrease abs of tetracycline, digoxin, phenytoin

Question 26

_____ is a synthetic prostaglandin _ derivative. it causes decreased ____ secretion and increased _____ and ___ secretion

Answer 26

misoprostol, E1; | acid; bicarb, mucus

Question 27

H. pylori causes a reduction in ____ cell production of ____ and an increase in secretion of ____

Answer 27

D, somatostatin; | gastrin

Question 28

triple therapy typically used for H pylori:

Answer 28

amoxicillin (or metronidazole) + clarithromycin + PPI (or H2 blocker) also bismuth salt

Question 29

_____ is used in treatment of mild diarrhea and eradication of H pylori

Answer 29

bismuth subsalicylate`

Question 30

____ is a D2 receptor antagonist

Answer 30

metroclopramide

Question 31

blockade of D2 receptors in the myenteric plexus leads to increased _____ release. also has anti ___ effects

Answer 31

Ach; | emetic

Question 32

metroclopramide: | used for post-surgery and _____ gastroparesis, ____, and anti-emesis

Answer 32

diabetic, GERD

Question 33

side effects of metroclopramide: | ____ effects, CNS ____, hyper_____

Answer 33

parkinsonian, sedation, prolactinemia (ie gynecomastia, galactorrhea)

Question 34

what macrolide is prokinetic? it is a ____ agonist

Answer 34

eryrthromycin, motilin

Question 35

cisapride, tegaserod, and prucalopride are all withdrawn from the market. they are ____ agonists

Answer 35

5-HT4

Question 36

linaclotide is an activator of _____. it used used for ____, such as in IBS

Answer 36

guanylate cyclase 2, constipation

Question 37

linaclotide: | increased intracellular ____ causes increased secretions and decreased ____

Answer 37

cGMP; | pain

Question 38

sennam biscaodyl, cascara, and castor oil all stimulate ____. they open ___ channels in the intestinal mucosa to facilitate movement of ions and water into the intestinal lumen

Answer 38

peristalsis, Cl-

Question 39

lubiprostone is a specific ___ activator. it is used for chronic ____, such as in IBS

Answer 39

Cl C2; | constipation

Question 40

name 2 bulk laxatives, besides bran and milk of magnesia

Answer 40

psyllium, methycellulose

Question 41

bulk laxatives are ____ fibers that draw water into the gut lumen, leading to ____ and ____

Answer 41

soluble; | distention, peristalsis

Question 42

lactulose is a ____ laxative that is used to treat what disease?

Answer 42

osmotic, hepatic encephalopathy

Question 43

MgOH, magnesium citrate, and polyethylene glycol are ____ laxatives

Answer 43

osmotic

Question 44

____ is a stool surfactant that lubricates the lower bowell

Answer 44

docusate

Question 45

dicyclomine is a _____. it treats diarrhea

Answer 45

anti-cholinergic

Question 46

2 opiates typically used in diarrhea. which is given with atropine to prevent addiction?

Answer 46

diphenoxylate and loperamide; | diphenoxylate

Question 47

anti-diarrheals are contraindicated in what 2 conditions?

Answer 47

``` inflammatory disease (ie ulcerative collitis); bacteria induced diarrhea ```

Question 48

kaolin and pectin absorb potential intestinal ____ and water

Answer 48

toxins (ie anti-diarrheal)

Question 49

_____ is indicated for patients with HIV/AIDS on retroviral therapy. it blocks ____ and Ca activated Cl channels

Answer 49

cofrelemer; | CFTR

Question 50

aloesetron is a ____ receptor antagonist. it used used for women with chronic ___, such as in IBS

Answer 50

5HT3; | diarrhea

Question 51

alosetron blocks visceral afferent ___ ____ and _____ colon motility

Answer 51

pain sensation, decreases

Question 52

aloestron can cause fatal _____

Answer 52

ischemic colitis

Question 53

3 systems that feed into the vomiting center. what is the vomiting center?

Answer 53

vestibular, area postrema, gastric receptors; Nucleus tractus solitarius

Question 54

in addition to metroclopramide, name 2 other D2 antagonists

Answer 54

promethazine, prochlorperazine

Question 55

meclizine and _____ are anti-emetic via anti Ach effects

Answer 55

scopalamine

Question 56

ondansetron (or granisetron) is a ____ receptor antagonist. they decrease ____ stimulation

Answer 56

5HT3, vagal

Question 57

ondansetron is used to treat nausea and vomiting associated with ____. it is combined with ____, which is a NK1 antagonist

Answer 57

chemo; | aprepitant

Question 58

dronabinol and nabilone are ______ aka synthetic _____

Answer 58

cannabinoids, THC