Term
| Number 1. Helicobacter pylorus // NSAIDS reducing synthesis of protective prostaglandins (PGE2 and PGI2)// stress raising glucocorticoids or prescribed antiinflammatory steroids reducing synthesis of PGE2 and PGI2)// overproduction of gastrin by Zollinger Ellison syndrome (tumor producing this GI hormone)// drugs elevating acetylcholine levels like the Achase inhibitors used for Alzheimer's disease (e.g. donepezil, rivastigmine)// excessive histamine release by stimuli inflaming the stomac |
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Definition
| Correct Answer: Stomach ulcers can be caused by |
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Term
| Number 2. 1) kill Helicobacter pylorus bacteria with antibiotics 2) inhibit proton pumps (PPs) on parietal cells with proton pump inhibitors (PPIs) 3) antagonize H2 histamine receptor to reduce their stimulation of PPs 4) antagonize acetylcholine stimulation of muscarinic receptors to reduce PPs 5) inhibit gastrin release with GHIH analog (octreotide) to block drive of PPs 6) increase mucus production to protect the stomach lining and decrease acid secretion with PGE2 receptor agonist 7) buffer stomach acid with antacids 8) coat the ulcerated pits with negatively charged marcomolecules (sucralfate & bismuth) to reduce protease digestion of pits |
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Definition
| Correct Answer: 8 strategies to reduce stomach ulceration are: |
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Term
| Number 3. (blank), (blank), (blank), (blank), (blank) are antibacterial agents that are used to cure H. Pylori infections that cause ulcers in the stomach. (blank)is both antibacterial for H. pylorus and a coating agent. |
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Definition
Correct Answer: bismuth, tetracycline, metronidazole, clarithromycin, amoxicillin
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Term
| Number 4. proton pump inhibitors // inhibit the proton pumps in parietal cells that secrete stomach acid // used with antibiotics to treat H. pylorus // used to treat or prevent NSAIDs induced ulcers // glucocorticoid induced ulcers // Zollinger Ellison syndrome (excess gastrin) // also for GERD |
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Definition
| Correct Answer: omeprazole, lansoprazole, esomeprazole, pantoprazole, rabeprazole |
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Term
Number 5. H2 histamine blockers //inhibits histamine receptors on parietal stomach cells that stimulate acid secretion
used to prevent and treat stomach ulcers caused by inability to eat during surgical/medical procedures // stress //H. pylorus with antibiotics //NSAIDs
glucocorticoids //Zollinger Ellison syndrome (excess gastrin) but PPIs are better for this severe ulcerating condition |
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Definition
Correct Answer: cimetidine, ranitidine, famotidine, nizatidine
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Term
| Number 6. Gastro-esophageal reflux disease is caused by abdominal pressure pushes stomach up into thorax and the negative pressures used for breathing allow reflux of stomach acid into the esophagus. Abdominal pressure increases in obesity, pregnancy and overeating. Erosion of the esophageal sphincter by ulcers also allows reflux into the esophagus. Vasodilation of esophageal blood vessels by vasodilator drugs or alcohol can make GERD cause a life threatening esophageal hemorrhage. GERD is treated by PPIs or H2 blockers to reduce stomach acid to promote healing |
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Definition
| Correct Answer: What is GERD, what causes it and how is it treated ? |
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Term
Number 7. Antimuscarinic agents used to decrease stomach acid secretion and gastric motility to decrease the pain of ulcers.
These are also used to treat diarrhea to decrease motility and slow the transit through the GI tract to permit more absorption of nutrients and water. |
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Definition
| Correct Answer: propantheline, mepenzolate, hyoscyamine |
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Term
| Number 8. prostaglandin PGE2 analog // inhibits stomach parietal cell acid secretion and stimulates mucus production to protect the stomach lining. It also activates uterine contractions. //treats NSAID and glucocorticoid induced stomach ulcers. This drug can induce abortion in a pregnant women because it causes strong uterine contractions. It also causes diarrhea because prostaglandin E2 stimulating fluid movements into the colon. Misoprostol is also used with mifoprestone (progesterone inhibitor) to induce a therapeutic abortion. |
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Definition
| Correct Answer: misoprostol |
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Term
| Number 9. drug name for GHIH analog = Growth Hormone inhibitory hormone (somatostatin) analog. (blank) inhibits growth hormone release and other hormones stimulating growth like the digestive hormone gastrin which causes stomach acid secretion. Patients with Zollinger Ellison syndrom have severe ulcers due to overproduction of gastrin. (blank) also inhibits insulin release (treats insulinomas) and inhibits VIP = vasoactive intestinal peptide which increases blood flow to the intestine and causes diarrhea for those with carcinoid tumors secreting excess VIP. (blank) also treats acromegaly because it decreases Growth Hormone rele |
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Definition
| Correct Answer: octreotide |
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Term
| Number 10. muscarinic, H1 histamine, D2 dopamine, 5HT3 serotonin, substance P, CB1 = cannabinoid. Steroids have antiinflammatory actions that are useful. Benzodiazepines reduce anxiety/anticipation of nausea. |
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Definition
| Correct Answer: What receptors activities can control nausea? |
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Term
| Number 11. (blank) antimuscarinic often used now as a transdermal patch to decrease nausea for motion sickness behind the ear or for surgery to decrease salivation and reduce nausea. |
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Definition
| Correct Answer: scopolamine |
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Term
| Number 12. antihistamines (1st generation that cross the blood brain barrier) that decrease nausea for motion sickness or morning sickness. They are move useful if given before nausea begins. Drowsiness is advantageous to sleep through the nauseating situaion. |
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Definition
| Correct Answer: diphenhydramine, dramamine, meclizine |
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Term
Number 13. dopamine antagonists , some have antiM and antiH activity to give them 3 receptor activities reducing nausea.
inhibit dopamine receptors in the chemoreceptor trigger zone in the brain.
used for extreme nausea during cancer chemotherapy or migraine or post surgery |
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Definition
| Correct Answer: chlorpromazine, promethazine, metoclopramide, droperidol |
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Term
Number 14. cannabinoid receptor agonists.
inhibit the emetic center at its center most effect sites.
used for extreme nausea in some states (Schedule II) that use if for medical purposes for severe nausea but marijuana like agents are still Schedule I in some states and according to the federal government. |
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Definition
| Correct Answer: dronabinol, nabilone |
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Number 15. 5HT3 receptor antagonists
inhibit nausea at 5HT3 receptors located at 3 sites in the chemoreceptor trigger zone and nausea centers . These serotonin receptors are also located in the GI tract. These drugs are sed for extreme nausea secondary to cancer chemotherapy. like cisplatin. These are very expensive - each pill can be $120. They are maximally effective when given in combination with dexamethasone to decrease the inflammation and nausea caused by dying cells due to cytotoxic cancer agents. |
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Definition
| Correct Answer: ondansetron, granisetron, dolasetron |
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Term
Number 16. benzodiazepines . antianxiety agents
used for anticipatory nausea before a second or third round of chemotherapy when the patients dread of the nausea caused by chemotherapy makes them vomit at just the thought of it. |
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Definition
| Correct Answer: alprazolam, lorazepam |
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Term
Number 17. glucocorticoids
changes gene expression of neurotransmitters to have antiinflammatory and metabolic effects. They prevent nausea and cachexia(wasting) in cancer patients when combined with 5HT3 antagonists like ondansetron. |
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Definition
| Correct Answer: dexamethasone, methylprednisolone |
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Term
| Number 18. (blank) is a substance P antagonist - a very effective antinauseant since substance P stimulates nausea at several sites in the chemoreceptor trigger zone and in the intestine can cause vomiting and hyperactivity of the intestines. The antagonist aprepitant is an expensive new drug reserved for extreme nausea as in cancer chemotherapy |
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Definition
| Correct Answer: aprepitant |
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Term
| Number 19. (blank),(blank),(blank), (blank) are antacids (H+ plus OH- = H2O water). They buffer stomach acid for rapid but temporary relief from occasionaly heart burn and mild stomach ulcer pain. These drugs precipitate tetracycline so it can not kill H. Pylorus. Ulcer patients must be counselled not to take antacids with this antibiotic to successful ulcers caused by H. pylorus. Mg(OH)2 = milk of magnesia is an antacid at low concentrations and a laxative at high concentrations. Mg deficiency causes smooth muscle contractions so Mg can also be a bronchodilator and a uterine and intestinal relaxant and it can also reduce cardiac arrhythmias too. Ca in any form including Tums can be useful for osteoporosis. Al+3 serves no useful function |
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Definition
aluminum hydroxide, calcium hydroxide, magnesium hydroxide, sodium bicarbonate
Correct Answer: Al(OH)3, Mg(OH)2, Ca(OH)2 and sodium bicarbonate
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Term
| Number 20. (blank), (blank)mucosal protective agents that coat ulcerated pits. Negatively charged coaters stick to + charges of the proteins at pH2 stomach environment and prevent peptidases from digesting the ulcerated pit deeper. (blank) is also thought to inhibit the growth of H. Pylori bacteria that cause stomach ulcers. |
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Definition
| Correct Answer: bismuth, sucralfate |
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Term
| Number 21. weak opioid agonists uses as antidiarrheals. They act as antimotility agents. Opioids presynaptically inhibit release of acetylcholine to decrease intestinal motility to reduce diarrhea. Loperamide is Imodium AD available OTC. |
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Definition
| Correct Answer: loperamide, diphenoxylate |
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Term
Number 22. Antimuscarinic agents used to decrease stomach acid secretion and gastric motility to decrease the pain of ulcers.
These are also used to treat diarrhea to decrease motility and slow the transit through the GI tract to permit more absorption of nutrients and water. |
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Definition
| Correct Answer: propantheline, mepenzolate, hysoscamine |
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Term
Number 23. adsorbents
bind bacterial toxins and hold them in the gut to prevent diarrhea and vomiting.
used to treat diarrhea |
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Definition
| Correct Answer: kaolin, pectin, methylcellulose, attipulgite, magnesium aluminum silicate |
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Term
| Number 24. NSAID = nonsteroidal antiinflammatory agent used to decrease prostaglandin production by inhibiting cyclooxygenase. Prostaglandins causes fluid movements in the intestine and these are dried up when PGE2 is low which reduces diarrhea. |
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Definition
| Correct Answer: subsalicylate (aspirin-like) |
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Term
| Number 25. normal flora bacteria provided in capsules (10 - 20 bacteria) or as yogurt (lactobacillus) or activia (3 beneficial bacteria) or kefir (10 GI normal flora bacteria). These prevent diarrhea by crowding out pathogens while also providing many nutrients we can not make for ourselves (e.g. folate, Vit K). Some boost the immune system and prevent constipation too. Probiotcis should be used to restore normal flora when antibiotics are used for infections. |
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Definition
| Correct Answer: probiotics |
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Term
| Number 26. irritants (contain ricinoloeic or emodin), that stimulate motility and fluid movement into the GI tract // used to treat constipation. |
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Definition
| Correct Answer: castor oil, cascara, senna, aloe |
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Term
Number 27. (blank) are bulk forming laxatives. The draw and gel fluid in the colon to increase bulk of chyme and loosen stools to move more easily.
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Definition
| Correct Answer: phenophthalein, bran, psyllium, Mg, prunes |
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Term
| Number 28. stool softeners // emulsify the stool to soften bowel movements // for post surgery patients (reverse constipation of narcotic pain relievers and reduce straining when there are abdominal sutures or bowel surgery // postpartum or for patients with aneurysms or hypertension to prevent straining which raises blood pressure sharply and could cause rupture and major internal bleeding. Glycerin suppositories or mineral oils are used in babies or in quadraplegics without bowel muscle strength to evacuate the rectum. |
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Definition
| Correct Answer: docusate, mineral oil, glycerin suppositories, lactulose |
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Term
| Number 29. (blank) is a stool softener that is also used to detoxify ammonium when produced in excess in the body (secondary to bladder infection etc). Lactulose acidifies feces and traps NH3 as NH4+ in the feces to be evacuated with the bowel movement. This prevents brain damage by preventing NH3 accumulation in the blood and entry into the brain cerebrospinal fluid. |
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Definition
| Correct Answer: lactulose |
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