Pharm

Question 1

stimulation acid secretion

Answer 1

Ach, histamine, gastrin to parietal cells

Question 2

Ach indirect

Answer 2

release of histamine from ECL in fundus and gastrin from G cells

Question 3

Gastrin indirect

Answer 3

release of histamine from ECL

Question 4

signaling Ach and gastrin

Answer 4

Gq

Question 5

signaling histamine

Answer 5

Gs

Question 6

antacids for GERD

Answer 6

weak bases that react with gastric acid

basic group neutralizes acid to form water, CO2 and chloride salts

Question 7

systemic antacids

Answer 7

NaHCO3

Question 8

non-systemic antacids

Answer 8

CaCO3, AlOH, MgOH

Question 9

role of simethicone

Answer 9

surfactant that decreases foaming and esophageal reflux

Question 10

adverse effects antacids

Answer 10

metabolic alkalosis
Na alterations in CHF
Ca-rebound acid secretion

Question 11

Al causes

Answer 11

constipation

Question 12

Mg

Answer 12

diarrhea

Question 13

hypophosphatemia

Answer 13

from Al and Mg

Question 14

renal function decrease and antacids

Answer 14

systemic toxicity from Al and Mg

Question 15

drug interactions antacids

Answer 15

change in pH

decrease by iron, theophylline, quinolone, isoniazid, tetracycline, ketoconazole

Question 16

MOA histamine H2 antagonists

Answer 16

competitive antagonists
decrease volume and H content of gastric juice
decrease pepsin secretion

Question 17

H2 metabolism in liver

Answer 17

cimetidine, ranitidine, famotidine

Question 18

H2 metabolism in kidney

Answer 18

nizatidine

Question 19

inhibition of acid by H2

Answer 19

mostly nocturnal

Question 20

uses H2 antagonist

Answer 20

gastric and duodenal ulcers
GERD
zollinger-ellison
acute stress ulcers

Question 21

drug interactions H2

Answer 21

cimetidine CYP450 inhibitor

may increase toxicity of secodn drug dose

Question 22

MOA PPI

Answer 22

irreversibly inhibit H/K ATPase to decrease basal and stimulated gastric acid

Question 23

activation of PPI

Answer 23

requires acidic environment

Question 24

uses PPI

Answer 24

peptic ulcers (faster healing than H2RA)
GERD
Zollinger-Ellison

Question 25

PPI with continued NSAID use

Answer 25

lansoprazole

Question 26

prolonged PPI adverse

Answer 26

CKD and ESRD

Question 27

drug interactions PPI

Answer 27

omeprazole and esomeprazole-inhibits 2c19 (can increase level of valium, can inhibit conversion of clopidogrel to active form)

Question 28

MOA misoprostol

Answer 28

analog of PGE1 | decrease acid and increase mucous and HCO3

Question 29

adverse misoprostol

Answer 29

GI exacerbation IBD uterine contractions-contraindicated pregnancy

Question 30

MOA sucralfate

Answer 30

ph<4 sticky gel that adheres to GI epithelial cells and ulcer craters protective barrier and stimulates PGE2 production

Question 31

adverse sucralfate

Answer 31

Al causing constipation | antagonized by increased gastric pH

Question 32

MOA bismuth

Answer 32

coats ulcers, increases mucus and HCO3

Question 33

adverse bismuth

Answer 33

darken oral cavity and stool from reaction with bacterial H2S

Question 34

MOA metoclopramide

Answer 34

cholinergic agonist and dopamine antagonist | increases esophageal clearance, increase LES pressure and gastric emptying

Question 35

uses metoclopramide

Answer 35

GERD | diabetic gastroparesis

Question 36

adverse metoclopramide

Answer 36

hyperprolactinemia CNS tardive dyskinesia

Question 37

triple therapy for h pylori

Answer 37

ppi claritho and metro/amox

Question 38

quadruple therapy for h pylori

Answer 38

ppi metro bismut and tetra or H2RA and bismuth metro and tetra use in areas of high resistance to clarithro and metro

Question 39

luminally active agents

Answer 39

enhance retention of intraluminal fluid by hydrophilic or osmotic mechanisms

Question 40

nonspecific stimulants or irritants

Answer 40

decrease net absorption of fluid

Question 41

prokinetic agents

Answer 41

act on motility

Question 42

bulk forming laxatives

Answer 42

bran, whole grains, psyllium, methylcellulose, Ca polycarbophil absorb water to soften stool

Question 43

osmotic laxatives

Answer 43

soluble but non-absorbable | saline (magnesium salts and phosphate salts), lactulose and mannitol

Question 44

saline laxatives

Answer 44

act via osmotic pressure to retain water in colon

Question 45

lactulose and mannitol

Answer 45

hydrolyzed to short chain FA | osmotic effects retain water and promote colonic propulsive motility

Question 46

stimulant laxatives

Answer 46

bisacodyl stimulates mucosal water and electrolyte secretion

Question 47

surfactant laxatives

Answer 47

docusates and castor oil | lower surface tension to allow mixing of aqueous and fatty substances

Question 48

metabolism castor oil

Answer 48

to ricinoleic acid in SI-anionic surfactant

Question 49

mineral oil

Answer 49

aliphatic hydrocarbon from petroleum | can depress absorption of fat-soluble vitamins

Question 50

aspiration mineral oil

Answer 50

lipid pneumonitis

Question 51

lubiprostone

Answer 51

metabolite PGE1 | opens chloride channels to accelerate stool transit time

Question 52

linaclotide

Answer 52

guanylate cyclase C agonist increasses intraluminal fluid and accelerates intestinal transit

Question 53

adverse linaclotide

Answer 53

diarrhea, abdominal pain, flatulence | cannot be used in patients <18

Question 54

naloxegol

Answer 54

pegylated derivative naloxone | reduced ability to cross BBB

Question 55

adverse naloxegol

Answer 55

abdominal pain, diarrhea, nausea, flatulence, vomiting

Question 56

contraindications laxatives

Answer 56

cramps, colic, nausea, vomiting, undiagnosed pain, appendicitis

Question 57

opioids

Answer 57

diphenoxylate and atropine diphenoxin and atropine loperamide

Question 58

somatostatin

Answer 58

made in D cells | inhibits gastric acid

Question 59

octratide

Answer 59

analog of somatostatin | treat secretory diarrhea from hormone secreting tumors of pancreas and GI tract

Question 60

treatment IBD

Answer 60

as more severe more immunosuppression | IV corticosteroids, anti-TNF and surgery in most severe