test 3 Flashcards
1
Q
Celio/ and lapar/o
A
Related to the abdomen
2
Q
Cholecyst/o
A
Related to the gall bladder
3
Q
Choledoch/o
A
Related to the bile duct
4
Q
Enter/o
A
Related to the intestines
5
Q
Gastr/o
A
Related to the stomach
6
Q
Hepat/o
A
Related to the liver
7
Q
Peritone/o
A
Related to the peritoneal cavity
8
Q
-emesis
A
Related to vomiting
9
Q
-lith
A
Referring to a stone
10
Q
-pepsia
A
Referring to digestion
11
Q
-phagia
A
Related to eating/swallowing
12
Q
-rrhage
A
Related to bleeding
13
Q
-stenosis
A
A narrowing or stricture
14
Q
Anorexia
A
Lack of appetite
15
Q
Ascites
A
Collection of fluid in the peritoneal cavity
16
Q
Deglutition
A
Swallowing
17
Q
Dysphagia
A
Difficulty swallowing
18
Q
Hematochezia
A
Presence of bright red blood in the stool
19
Q
Melena
A
Black, tarry stools containing digested blood
20
Q
Steatorrhea
A
Presence of fat in the stool
21
Q
Fistula
A
Abnormal tubular conection between organs, vessels,
intestines, etc
22
Q
Cirrhosis
A
Liver disease characterized by the replacement of
normal parenchyma with connective tissue
23
Q
ALT
A
Alanine transaminase/aminotransferase
24
Q
AST
A
Aspartate transaminase/aminotransferase
25
BM
Bowel movement
26
GERD
Gastroesophageal reflux disease
27
GIT
Gastrointestinal tract
28
IBD
Inflammatory bowel disease
29
IBS
Irritable bowel syndrome
30
LFTs
Liver function tests
31
PUD
Peptic ulcer disease
32
Gastrointestinal diseases
```
Gastroesophageal Reflux Disease (GERD)
Peptic ulcer disease (PUD)
• Gastric Ulcer
• Duodenal Ulcer
Liver disease
• Portal hypertension
• Cirrhosis
• Drug-Induced diseases
• Viral hepatitis
Pancreatitis
Inflammatory Bowel Disease (IBD)
• Ulcerative Colitis
• Crohn’s Disease
Irritable Bowel Syndrome (IBS)
Symptomatic problems
Diarrhea
Constipation
```
33
Gastroesophageal Reflux DZ Pathophysiology
Abnormal reflux of gastric contents from the
stomach to the esophagus
Mucosal irritation, pain, bleeding, perforation,
strictures and hyperplasia can result
34
Proton Pump Inhibitors
Drugs of choice for treatment of GERD
MOA
• Inhibits H+/K+ ATPase pump on parietal cells
responsible for secretion of HCl into stomach
• Causes potent reduction of acid secretion
35
```
Omeprazole
• Esomeprazole
• Lansoprazole
• Rabeprazole
• Pantoprozole
```
Proton Pump Inhibitors
36
Proton Pump Inhibitors Dosage forms
Oral
Parenteral (esomeprazole, lansoprazole, pantoprazole)
Omeprazole suspension (Zegerid®)
37
Proton Pump Inhibitors Important points to consider
Oral products should not be crushed or chewed
| Generally given prior to meals
38
Cimetidine
• Ranitidine
• Nizatidine
• Famotidine
H2 receptor antagonists
39
H2 receptor antagonists MOA
Binds to histamine-2 receptors on parietal cells to
| reduce acid secretaion in the stomach
40
H2 receptor antagonists dosage forms
Oral
| • Parenteral (cimetidine, ranitidine, famotidine)
41
H2 receptor antagonists Important points
Cimetidine has been associated with a number of
significant drug interactions (inhibits microsomal
enzyme systems)
42
TNTC
Antacids
43
Antacids MOA
Basic compounds that directly neutralize stomach acid
| to form inert salts
44
Antacids dosage forms
Oral
45
Antacids Important points
Provides symptomatic relief from pain
| • May have to be dosed frequently
46
Antacids Common adverse reactions
Can cause electrolyte disturbances
• May induce diarrhea (magnesium containing antacids)
or constipation (aluminum containing antacids)
47
Metoclopramide (Reglan®)
• Cisapride (Propulsid®) – removed from U.S. market in
2000, still available under compassionate use protocols
Promotility agents
48
Promotility agents MOA
Increases gastrointestinal motility, accelerates gastric
| emptying
49
Promotility agents Important points
Metoclopramide can be used to treat a variety of
disorders (nausea/vomiting, gastroparesis
• Cisapride is associated with serious ventricular
arrhythmias and was withdrawn from the market
(although still available via compassionate use because
of its significant prokinetic activity)
50
Promotility agents Common adverse reactions
CNS stimulation
• Diarrhea
• Extrapyramidal reactions (dyskinesias)
51
Peptic ulcer disease (PUD) Pathophysiology
Gastric ulcer – exact mechanism unknown but is
related to decreased mucosal resistance, use of
NSAIDs and presence of H. pylori bacteria
Duodenal ulcer – exact mechanism unknown but
is related to increased acidity, decreased mucosal
protection and presence of H. pylori bacteria
52
PUD Antibiotics MOA
Inhibit protein translation for susceptible bacteria
53
PUD Antibiotics Important points
Antibiotics are typically given for several weeks, and
patients should be educated on the importance of
compliance
54
PUD Antibiotics Common adverse reactions
GI complaints
• Allergic reactions
• Tetracycline has photosensitivity reaction and can stain
teeth/bones
• Metronidazole can cause disulfiram-like reaction if
ingested with EtOH
55
Inflammatory Bowel Disease (IBD) Pathophysiology
```
Etiology remains unknown
Related to the following risk factors:
• Infectious pathogens
• Genetics
• Immunologic changes
• Environmental factors (food, drugs, smoking)
2 main categories of IBD:
• Ulcerative colitis
• Crohn’s Disease
```
56
Sulfasalazine
• Mesalamine
• Olsalazine
• Basalazide
Drug Therapy for IBD
| 5-aminosalicylic acid derivatives
57
5-aminosalicylic acid derivatives MOA
Local anti-inflammatory actions in the intestinal tract
| drugs typically given PO or PR
58
5-aminosalicylic acid derivatives Important points
Oral dosage forms should not be crushed or chewed
59
5-aminosalicylic acid derivatives Common adverse reactions
Sensitivity reactions
| • GI complaints
60
Prednisone or prednisolone
• Dexamethasone
• Methylprednisolone
• Budesonide
Drug Therapy for IBD
| Corticosteroids
61
Corticosteroids important points
If used for prolonged periods, dose must be tapered
| slowly if discontinued to avoid adrenal insufficiency
62
Corticosteroids Common adverse reactions
```
A significant number of systemic effects can occur
(partial list)
– Adrenal insufficiency
– Water/electrolyte disturbances
– Musculoskeletal effects
– Unusual fat deposition
– Increased risk of infection
```
63
Irritable Bowel Syndrome (IBS) pathophysiology
```
Exact mechanism unknown but probably related
to:
• Altered somatovisceral / motor dysfunction in the gut
• Visceral hypersensitivity
Resulting problems are
• Diarrhea OR
• Constipation
• Intestinal pain
```
64
Antidiarrheal agents MOA
Typically involves one of the following:
– Antimotility - Reduction in GI motility allowing for
greater water reabsorption in colon
– Adsorbents - Adsorption of toxins or digestive
fluids to the adsorbent agent
– Antisecretory – Reduce gastrointestinal secretions
65
```
Antimotility drugs
– Diphenoxylate / atropine (Lomotil®)
– Loperamide (Imodium®)
• Adsorbents
– Attapulgite
– Polycarbophil
• Antisecretory
– Bismuth subsalicylate (Pepto-Bismol®, Kaopectate®)
```
Antidiarrheals
66
Antidiarrheals Important points
Should not be used for prolonged periods of time
67
```
Bulk forming agents
– Methylcellulose
– Polycarbophil
• Stool softeners
– Docusate sodium / calcium
• Stimulants
– Bisacodyl or senna
• Hyperosmotic agents
– Magnesium citrate / hydroxide/ sulfate
– PEG
```
Anti-constipation agents
68
Alosetron (Lotronex®)
| • Tegaserod (Zelnorm®)
Serotonergic agents
69
Serotonergic agents MOA
```
Alosetron = 5-HT3 antagonist
– Modulates enteric nervous system, regulating pain
receptors and GI secretions
– For diarrhea predominant IBS
• Tegaserod = 5-HT4 agonist
– Modulates enteric nervous system,
regulatingvisceral pain receptors and affects GI
secretions
– Used for constipation-predominant IBS
```
70
Important points related to alosetron
Alosetron was withdrawn from market because of
potential for ischemic colitis and serious constipation
and may cause hospitalization or death.
• It is available under restricted guidelines now, and only
prescribers enrolled in the Lotronex® program may
prescribe the drug
• Alosetron is indicated only for women with severe
diarrhea-predominant IBS who have not responded to
conventional therapy
• Alosetron should be immediately discontinued if
constipation or symptoms of ischemic colitis develop
71
Important points related to tegaserod
potential for inducing cardiac ischemia resulting in MI
or stroke
• The FDA has made tegaserod available to physicians
via a restricted distribution program for emergency
situations that are life-threatening or require
hospitalization
72
Nausea
imminent need to vomit
73
Retching
Labored movement of abdominal and
| thoracic muscles prior to vomiting
74
Vomiting
Forceful expulsion of gastric contents
75
Nausea & vomiting are not diseases but are
symptoms of other problems
76
Nausea & Vomiting Etiology
```
GI diseases
Cardiovascular disease
Neurologic processes
Metabolic / endocrine disorders
Psychogenic causes
Drugs
Gastric outlet obstruction
Motility disorders
Infections
Labyrinthine diseases
```
77
Antiemetic agents moa
```
Typically involves neurotransmitter modulation of the
following receptors:
– Histamine
– Acetylcholine
– Dopamine
– Serotonin
– Muscarine
– Cannabinoids
```
78
```
5-HT3 antagonists
– Ondansetron (Zofran®)
– Granisetron (Kytril®)
– Dolasetron (Anzemet®)
– Palonosetron (Aloxi®)
• Dopamine receptor antagonists
– Phenothiazine class
Prochlorperazine (Compazine®)
Chlorpromazine (Thorazine®)
– Metoclopramide
H1 receptor antagonists
– Cyclizine (Marezine®)
– Meclizine (Antivert®)
– Hydroxyzine (Vistaril®)
– Dimenhydrinate (Dramamine®)
– Diphenhydramine (Benadryl®)
• Muscarinic receptor antagonists
– Scopolamine (Transderm Scop®)
Cannabinoid receptor antagonists
– Dronabinol (Marinol®)
– Marijuana
• Corticosteroids
– Prednisone
– Dexamethasone
```
Antiemetic agents
79
Antiemetic drugs are typically effective only for
| certain types of nausea/vomiting
```
Motion sickness
– Antihistamines
– Anticholinergics
• Gastroparesis
– Metoclopramide
• Surgery
– Trimethobenzamide
– Phenothiazines
– 5HT-3 Antagonists
Stimulation of the CTZ (drugs)
– 5HT3 antagonists
– Phenothiazines
– Butyrophenones
– Metoclopramide
– Corticosteroids
– Cannabinoids
```
80
Antiemetic agents Important points
The etiology of the nausea/vomiting is important to
| consider when selecting an antiemetic
