Pharm GI from pharm perspective Flashcards Preview

GI & Liver Fall 2013 CBD > Pharm GI from pharm perspective > Flashcards

Flashcards in Pharm GI from pharm perspective Deck (25):
1

Role of SNS in GI motility and sphincter tone:
Receptors & effects in Walls?
Receptors & effects in Sphincters?
Secretions?
Prevailing control?

Walls: relaxes, alpha1 & 2
Sphincters: contracts, alpha1
Secretions: no
Prevailing control: no

(probably by inhibition of sympathetics)

2

Role of PNS in GI motility and sphincter tone:
Receptors & effects in Walls?
Receptors & effects in Sphincters?
Secretions?
Prevailing control?

Walls: contracts, M3
Sphincters: relaxes, M3
Secretions: increases, M3
Prevailing control: yes

3

effect of ganglionic blocade in PNS (cholinergic)?

reduced tone/motility. Constipation. Decreased secretions.

4

Role of serotonin:
Other name
Excess & insufficiency results?

Other name: 5-HT
Excess: motility up = D-IBS
Insufficiency: motility down = C-IBS

5

Tegaserod

Partial 5HT-4 agonist, selective serotonin agonist

tx of C-IBS

Withdrawn - heart attack, stroke

6

Treatment of IBS - full agonist/antagonist or partial?

partial, to prevent overtreatment to opposite problem.

7

etiology of IBS

breach of wall -> dendritic cell uptake of antigens -> presentation to T cells, alpha4beta7 integrin adhesion of T cells, CNS signaling -> symptoms

noninflammatory, no ulcers or damage!

8

5 classes of drugs for IBS

stool softeners
antidiarrheal agents
antiplasmotics
TCAs
SSRIs

9

Are probiotics useful in IBS?

Yes, but not high success rates

10

Acupuncture in IBS?
Herbal medicines in IBS?
Psychology in IBS?

Acupuncture in IBS? no
Herbal medicines in IBS? unproven, but promising
Psychology in IBS? not in adults, maybe in adolescents.

11

IBD:
2 examples
etiology
pivotal signaling agent

2 examples: chron's and ulcerative colitis
etiology: dysbiosis -> inflammation
pivotal signaling agent: TNFalpha

12

4 TNFalpha inhibitors

infliximab
adalimumab
golimumab
certolizumab pegol

13

Treat IBD with TNFalpha inhibs?

Yes, but not front line. 3rd in line. (glucocorticoids, then immunomodulators, then TNFalpha inhibs)

14

3 opioid receptors and their effects

delta: delayed transit
kappa & mu: delayed transit & visceral antinicociception

15

Opioid effects on:
gallbladder
gastroduodenum
small bowel
colon
anorectum

gallbladder: biliary pain, digestion delay
gastroduodenum: anorexia, nausea, emesis
small bowel: constipation, delayed digestion
colon: constipation, bloating, spasms, pain
anorectum: incomplete evacuation, strain

16

5 types of drug induced diarrhea

osmotic
secretory
disordered (cholinergic tone)
inflammatory (flora disruption)
C difficile (acid/base or epithelial homostasis)
Fatty

17

metformin side effect

steatorrhea

18

octreaotride side effect

paradoxical steatorrhea (treats secretory d)

19

drugs to avoid in pill-induced esophagitis?

anticholinergics

20

role of P-gp/MDR1

dramatically increases drug bioavailability

21

role of cyp3A4 vs P-gp/MDR1?

P-gp/MDR1 may control CYP3A4

22

4 notorious drugs with gastric interactions

antacids, doxycycline, tetracycline, fluoroquinolones

23

cimetidine AE WRT PPIs

inhibits tons of cyps

24

PPIs metabolism

CYP2C19
all but dexlansoprazole inhibit 2C19

25

dexlansoprazole

doesn't inhibit CYP2C19