Lecture 13- Over the counter drugs- Digestive Problems

Question 1

What are some problems that affect the Gastrointestinal tract?

Answer 1

• peptice ulcers
• gastroesophageal reflux disease (heartburn)
• nausea and vomitting
• Motility problems; constipation adn diarrhea

Question 2

Acid-peptic disease is a group of disorder involving either ____ acid secretion or erosion of the ____ ____ of the gastrointestinal tract.

Answer 2

excessive; mucosal lining.

Question 3

Acid-peptice disease includes ____, ____, and ____ ____ ____

Answer 3

heartburn, peptic-ulcers, stress-related gastritis

Question 4

The stomach is divided into 2 sections, what are they and which one is the top layer?

Answer 4

Fundus and the antrum; top layer is fundus

Question 5

Which cells in the fundus are responsible for secretion of acid in the stomach?

Answer 5

parietal cells.

Question 6

Which protom pump moves acid from the parietal cells into the gastric lumen?

Answer 6

H+/K+ ATPase

Question 7

Which cells in the antrum respond to intraluminal dietary peptides to release gastrin which binds to ____ receptors on parietal cells?

Answer 7

G-cells and CCK

Question 8

Gastrin also stimulates ____ cells (H-cells) to release histamine which binds to H ____ receptors on parietal cells.

Answer 8

enterochromaffin; H2

Question 9

Which nerve stimulates postganglionic neurons of the enteric nervous sytem to release ____ which binds to muscarinic receptors (M3) on parietal cells?

Answer 9

vagus nerve; ACh

Question 10

Is the vagus nerve part of the parasympathetic nervous system or the symphathetic nervous system?

Answer 10

parasympathetic

Question 11

An increase in acid secretion causes ____ cells to release ____ and inhibit gastrin release from G-cells (____ feedback loop)

Answer 11

D cells; somatostain; negative

Question 12

Fill in the blanks:
* G cells —> ____ —–> ____
* ____ —-> H cells —-> ____ —> H____ receptors
* ____ —> Acetylcholine —-> M3 receptors
* Increased Acid secretion —-> ____ —-> ____ —-> ____

Answer 12

• G-cells - gastrin - CCK
• Gastrin - H cells - Histamine - H2 receptors
• Vagus Nerve - ACh - M3 receptors
• Increased acid secretion - D cells - somatostain - gastrin inhibition

Question 13

Antacids are ____ bases that neutralize stomach acid by reacting with protons in the lumen of the gut. When used regularly, in the large doses needed to raise stomach pH, antacids reduce the recurrence rate of ____ ____.

Answer 13

weak bases; peptice ulcers

Question 14

The most common antacids include ____ hydroxide and ____ hydroxide.

Answer 14

Magesium (MgOH2) and aluminum (AlOH3)

Question 15

Which antacid has a strong laxative effect and which one has a constipating acting?

Answer 15

Magnesium is a laxative
Aluminum has a constipating action

Question 16

What is an example of a proton pump inhibitor which are lipophilic weak bases that diffuse into the parietal cell and inactivate the ____ ____ transporter?

Answer 16

Omeprazole ; H+/K+ ATPase

Question 17

Prolonged use of omeprazole can lead to ____ because acid secretion inhibits gastrin release that may increase cancer risk.

Answer 17

hypergastrinemia

Question 18

What is hypergastrinemia?

Answer 18

elevated levels of gastrin secreted in the stomach.

Question 19

OTC anti- ____ can help when dealing with nausea and vomitting caused by motion sickness and other conditions.

Answer 19

emetics

Question 20

Proton pump inhibitors will decrease the bioavailability of vitamin ____ and certain drugs that require acidity for their absorption.

Answer 20

B12

Question 21

____ ____, which is an active ingredient in Peptobismol, can be used to treat ulcers.

Answer 21

Bismuth Subsalicylate

Question 22

Bismuth Subsalicylate hydrolyzes in the gut to Bismuth ____ and ____ ____.

Answer 22

Bismuth oxychloride; salicylic acid

Question 23

Salicyclic acid is absorbed in the gut and inhibits ____ synthesis (anti-inflammatory properties)

Answer 23

prostaglandin

Question 24

____ is a theoclate salt, composed of diphenhydramine and 8-chlorotheophylline.

Answer 24

Dimenhydrinate

Question 25

Dimenhydrinate acts as a ____ ____ but is an inverse agonist at the H1 receptor, driven by diphenhydramine.

Answer 25

competitive antagonist

Question 26

Dimenhydrinate blocks ____ activity in the vestibular system, but less sedation than diphenhydramine as it is less potent.

Answer 26

histamine

Question 27

Which one is less potent, dimenhydrinate or diphenhydramine?

Answer 27

dimenhydrinate

Question 28

Gastrointestinal motility is controlled by ____ ____ ____ (enteric nervous system), neurons which are only present in the GIT.

Answer 28

intrinsic neural plexus

Question 29

Removing ____ automatic control results in disorganized gastric activity (nausea or vomitting).

Answer 29

extrinsic

Question 30

What is known as the second brain in our body?

Answer 30

Enteric nervous system

Question 31

____ plexus provides motor innervation to the muscular layer of the gut which mediates peristalsis, outer layer

Answer 31

myenteric

Question 32

____ plexus provides secretomotor (induce a gland to secret a substance) innervation to the mucosa, inner layer.

Answer 32

submucosal

Question 33

Enteric neurons are predominantly ____ but release a lot of other neurotransmitter such as serotonin and dopamine.

Answer 33

cholinergic

Question 34

The autonomic nervous sytem is divded into ____ and ____ system.

Answer 34

parasympathetic; sympathetic

Question 35

All ____ganglionic neurons are cholinergic; they release acetylcholine.

Answer 35

pre

Question 36

Postganglionic parasympathetic neurons are ____, whereas postganglionic sympathetic neurons are ____, they release noradrenaline

Answer 36

cholinergic; adrenergic

Question 37

Acetylcholine binds to ____ receptors (M2) on GI smooth muscle leading to ____ (stimulates motility)

Answer 37

muscarinic; contraction

Question 38

M2 receptors are G____ - coupled receptors

Answer 38

Gi

Question 39

Postganglionic parasympathetic = ____ --> myenteric

Answer 39

cholinergic

Question 40

Postganglionic sympathetic = ____ ---> enteric

Answer 40

adrenergic.

Question 41

____ are substances that loosen stool or stimulate bowel movement.

Answer 41

laxatives

Question 42

What are the 4 types of laxatives?

Answer 42

1. Bulk forming 2. osmotic 3. lubricant 4. stimulant

Question 43

Which laxatives contain naturally occuring plant fiber like psyllium and methyl cellulose that draw water into the stool to make them larger and easier to pass?

Answer 43

Bulk forming laxatives

Question 44

Which laxatives contains ingredients like polyethylene glycol or magnesium that draw fluid into the bowel from nearby tissue?

Answer 44

osmotic laxatives

Question 45

Which kind of laxative has glycerin suppositories that coat the surface of stools or anus to make it easier for stool to pass?

Answer 45

Lubricant laxatives

Question 46

Which kind of laxative contains ingredients like senna and bisacodyl that causes the bowels to squeeze the stools out?

Answer 46

stimulant laxatives

Question 47

What are the 2 types of bulk forming laxatives and what do they do?

Answer 47

Psyllium and methyl cellulose; they draw water into the stoll; they are plant fibers

Question 48

What are the 2 types of osmotic laxatives and what do they do?

Answer 48

Polyethylene glycol and magnesium; they draw water into stoll from nearby tissues.

Question 49

What are the 2 types of stimulant laxatives and what do they do?

Answer 49

Senna and bisacodyl; they stimulate the bowels to squeeze the stool out.

Question 50

____ is a loose, watery stool that occurs when colon is unable to adequately absorb the liquid from the food and fluids you ingest.

Answer 50

Diarrhea

Question 51

What are the 2 most common OTC treatment for diarrhea?

Answer 51

* Loperamide * Bismuth subsalicylate

Question 52

Like codeine, what else is a mu opioid agonist?

Answer 52

loperamide

Question 53

mu opioid receptors are located on the ____ plexus which provides motor innervation of the gut, controls peristalsis

Answer 53

myenteric

Question 54

Loperamide has ____ (strong/weak) analgesic activity but effectively slows gut motility.

Answer 54

weak.

Question 55

How is loperamide different from codeine?

Answer 55

* less analgesic * less respiratory depression * no effect on cough

Question 56

Loperamide is a ____ agonist but has weak analgesic activity.

Answer 56

full

Question 57

Loperamide is a substrate for ____ (aka P-gp). P-gp is located on endothelial cells at the ____ ____ ____ and actively pumps drugs out of the brain.

Answer 57

P-glycoportein; blood brain barrier

Question 58

Loperamide brain levels are kept ____ (high/low) due to active extrusion by P-gp.

Answer 58

low

Question 59

P-gp is inhibited by tricyclic antidepressents such as ____.

Answer 59

amitriptyline.

Question 60

Blocking P-gp will ____ (increase/decrease) brain concentration of loperamide.

Answer 60

increase