Term
| Where are the gastrin containing cells? |
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Definition
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Term
| Where are enterochromaffin-like cells? |
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Definition
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Term
| What is the secreted by ECL cells? |
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Definition
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Term
| What stimulates histamine release in ECL cells? |
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Definition
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Term
| What is released by parietal cells? |
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Definition
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Term
| What inhibits histamine release at ECL? |
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Definition
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Term
| What stimulates the release of HCl at parietal? |
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Definition
| ACh/M3, histamine/H2, gastrin/CCK-B |
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Term
| Risk factors of peptic ulcer disease (9) |
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Definition
| coffee, alcohol, tobacco, salicylates, NSAIDs, heredity, age, H. pylori, stress |
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Term
| Heartburn and GERD risk factors (3) |
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Definition
| hiatal hernia, weakened esophageal sphincter pressure, overweight |
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Term
| Rx of peptic acid disease (4) |
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Definition
| reduce gastric acid secretion, enhance mucosal defense, neutralize gastric acid, eradicate H. pylori |
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Term
| Sites of action for treatment of peptic acid dx |
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Definition
| H2 receptor, proton pump, lumen, mucosa |
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Term
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Definition
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Term
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Definition
| Directly block histamine-stimulated gastric acid secretion – antagonists at histamine H2 receptors, Blunt parietal cell responses to ACh and gastrin |
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Term
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Definition
| Very low toxicity – but reduce dose in renal dysfunction |
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Term
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Definition
| Up to 90% inhibition of nocturnal gastric acid secretion, gastric and duodenal ulcers, GERD |
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Term
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Definition
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Term
| H2 antagonist adverse effects |
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Definition
| Cimetidine only: antiandrogenic properties and binding to microsomal P450 |
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Term
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Definition
| famotidine with long-term NSAID therapy reduces the number of ulcers |
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Term
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Definition
| famotidine with long-term NSAID therapy reduces the number of ulcers, prophylaxis after acute event to prevent recurrence |
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Term
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Definition
| Proton Pump inhibitor, Irreversible inhibition of parietal cell proton pump (H+/K+-ATPase) results in prolonged 90-98% inhibition of gastric acid secretion |
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Term
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Definition
| weak base accumulates in acidic parietal cells then protonated form of drug binds covalently to enzyme – are acid labile so need enteric coating to get past stomach |
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Term
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Definition
| combines omeprazole with bicarb to allow for more rapid absorption |
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Term
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Definition
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Term
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Definition
| well-tolerated, but nausea, diarrhea, and dizziness can occur |
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Term
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Definition
| better during the day, but does have nocturnal application |
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Term
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Definition
| ulcers and GERD, first choice in Zollinger-Ellison Syndrome |
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Term
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Definition
| OTC, except for zegredid poor choice for occasional heartburn |
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Term
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Definition
| no indication of gastric carcinoid tumors, 50% increase in pneumonia in one study – possibly to more bacterial aspiration from less acidic stomach, nor increased risk of heart attack or other heart complications |
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Term
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Definition
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Term
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Definition
| poor, stay in GI and directly neutralize acid |
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Term
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Definition
| Mg-diarrhea, Al and Ca-constipation |
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Term
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Definition
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Term
| Antacid drug interactions |
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Definition
| can increase or decrease the absorption of many classes of drugs, changes dissolution rate of gastric emptying |
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Term
| Al or Ca drug interaction |
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Definition
| decreased absorption of TCN, isoniazid, ketoconazole |
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Term
|
Definition
| increase in urinary pH alters elimination or acidic (salicylates) and basic (quinidine) drugs |
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Term
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Definition
| a PPI plus clarithromycin with metronidazole or amoxicillin, sometimes also use bismuth-containing compounds |
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Term
| Sucralfate, bismuth subsalicylate muchanism |
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Definition
| forms paste-like gel at low pH that adheres to positively charge proteins of epithelial cells as ulcer craters, coating actions protects cells against acid and pepsin attack |
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Term
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Definition
| can adsorb other drugs, e.g. TCN, phentoin, digoxin, so what 2 hrs before admin; do not co-admin with antacids |
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Term
| What type of drug is metoclopramide? |
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Definition
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Term
| Metoclopramide mechanism (4) |
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Definition
| enhances release of ACh in myenteric plexus, improves intestinal smooth muscle response to ACh, increases esophageal clearance and improved tone in esophageal sphincter, increased intestinal motility |
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Term
| Metoclopramide adverse effects |
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Definition
| has DA D2 receptor antagonist activity that can cause extrpyramidal (Parkinson-like) symptoms and tardive dyskinesia |
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Term
|
Definition
| antiemetic for cancer patients |
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Term
| What can cause constipation? |
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Definition
| can be the result of reduced colonic motility and/or increased hardness of intestinal contents |
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Term
| Constipation and dietary rx |
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Definition
| add fiber and plenty of water to improve bulk and consistency of feces |
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Term
| What is the laxative effect? |
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Definition
| Results in excretion of soft stool |
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Term
| What is laxative cathartic effect? |
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Definition
| More intense effect with greatly increased intestinal activity and watery stool – e.g. for a colonoscopy |
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Term
| Laxative contraindications |
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Definition
| Cramps, colic, nausea, vomiting, other symptoms of appendicitis, undiagnosed abdominal pain |
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Term
| What type of drug is lubiprostone? |
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Definition
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Term
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Definition
| idiopathic chronic constipation: abdominal pain, bloating, straining, hard stools with no known cause; more common in elderly females |
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Term
|
Definition
| increases intestinal fluid secretion>>increased number of bowel movements |
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Term
| lubiprostone adverse effects |
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Definition
| diarrhea, abdominal pain, distention |
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Term
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Definition
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Term
| Mg(OH)2 laxative mechanism |
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Definition
| admin as a hypertonic solution which increases osmotic pressure within lumen>>stimulation of peristalsis |
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Term
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Definition
| evacuation in less than 3 hours |
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Term
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Definition
| antidiarrheal agent, opioids with low abuse potential because they are very poorly absorbed |
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Term
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Definition
| slows intestinal transit time due to stimulation of mu opioid receptors in intestinal smooth muscle, muscarinic antagonist |
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Term
| Loperamide adverse effects |
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Definition
| constipation, toxic megacolon, can cross BBB and cause CNS toxicity |
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Term
| Loperamide counter-indication |
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Definition
| patients with UC or acute bacillary/amoebic dysentary |
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Term
| Physiology of nausea and vomiting |
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Definition
| In the CNS, both the vomiting center in the brainstem and the Chemoreceptor Trigger Zone (CTZ) which sits just outside the blood brain barrier have high concentrations of 5-HT3 receptors. These areas also receive input from the vagal system. Activation of these centers, as occurs in cancer chemotherapy or after general anesthesia, results invomiting and nausea. |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
| IV or orally, little effect on muscarinic or dopaminergic receptors |
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Term
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Definition
| addition of dexmethasone (corticosteroid) or aprepitan (neurokinin 1 receptor) |
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Term
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Definition
| Rx for IBS-C or chronic idiopathic constipation (CIC) |
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Term
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Definition
| 5-HT4 receptor agonist stimulates submucosal and myenteric plexi to release ACh and other transmitters, resulting in more rapid transit through stomach and intestines. |
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Term
| tegaserod adverse effects |
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Definition
| diarrhea, but generally resolves after several days of treatment; heart attack, stroke and unstable angina |
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Term
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Definition
| taken off general market by FDA, if physician decides drug is necessary for IBS-C or CIC (chronic idiopathic constipation) then can prescribe for these conditions only in women younger than 55 who have no known heart disease |
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Term
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Definition
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Term
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Definition
| 5-HT3 receptor antagonist alosetron, which is FDA approved only for women with diarrhea-predominant IBS; decresed colonic motility via enteric and CNS blockade of 5-HT3 receptors |
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Term
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Definition
| constipation, serious but rare (0.3%) is ischemic colitis which can be fatal |
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Term
|
Definition
| UC and Chrohn’s, 5-aminosalicylic acid (5-ASA) |
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Term
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Definition
| interferes with intermediates in inflammatory pathways, topical 5-ASA is effective |
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Term
| sulfasalazine adverse effects |
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Definition
| up to 40% of patients cannot tolerate: nausea, HA, HS, bone marrow suppression |
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Term
|
Definition
| enemas and suppositories used for lesions near anus in Chrohn’s, different formulations based on location of lesions |
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Term
|
Definition
| IBD, immunosuppression, purine anti-metabolite |
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Term
| Azathoiprine adverse effects |
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Definition
| bone marrow suppression, rashes, fever, nausea |
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