G.I. Midterm Part 2
List some common functions of the digestive system:
- Nervous and Hormonal control
Breaking down into smaller constituents that are able to be absorbed is known as what?
What prevents the stomach acids from going up into the esophagus?
What in the mouth helps with lubrication/mixing (making swallowing easier)?
What in the mouth helps with mixing food?
What in the mouth is responsible for grinding food up?
Which component of the digestive system makes enzymes that help with digesting proteins/fats/carbs?
Which accessory organ to the digestive system makes bile?
Where is bile stored?
Bile helps with the digestion/metabolism of what?
Inflammatory processes in the GI system is mediated by which organ?
The organs that are essentially apart of the digestive system are known as what?
alimentary canal organs
List some accessory organs associated with the digestive system:
- salivary glands
- parotid gland
- sublingual gland
- submandibular gland
Which organ has muscle that mixes/churns food to break it down into smaller pieces?
Which organ undergoes segmentation which is like mixing to help with further breakdown of food?
What helps move things forward in the GI system?
Peristalsis occurs in which organs in the GI system?
- small intestine
What process mainly occurs in the small intestine?
Nutrients are transferred from the small intestine into the circulation via what?
True or False: The large intestine does not have a lot of absorption going on.
True (only water is being absorbed in the large intestine)
The stomach empties its components into which portion of the small intestine?
What is the middle component of the small intestine?
Which portion of the small intestine empties its components into the large intestine?
The ileum meets the beginning of the large intestine via the what?
List the flow of food once it enters the large intestine?
ascending colon --> transverse colon --> descending colon --> sigmoid colon --> rectum --> anus
What is the outermost layer of the intestine?
The serosa helps with what?
Which muscle is located underneath the serosa?
The longitudinal muscle controls what?
length of the tract
What is the layer of nerve located underneath the longitudinal muscle?
myenteric nerve plexus
The myenteric plexus is considered a what inside the GI tract?
The myenteric plexus controls the function of what?
- longitudinal muscle
- circular muscle
The main functions of the circular and longitudinal muscle in the GI tract is what?
contraction/relaxation --> peristalsis
What is the muscle located underneath the myenteric nerve plexus?
What is the function of the circular muscle?
controlling the size of the lumen
What is located underneath the circular muscle in the submucosal gland?
Meissner's (submucosal) nerve plexus
The Meissner's (submucosal) nerve plexus regulates what?
- secretory activity (secretion)
What surrounds/is just outside the lumen?
- epithelial lining
- mucosal muscle
- mucosal gland
Which part of the intestines is the opening that allows for the entry of blood vessels (arteries/veins), lymphatics, nerves?
What is the innermost layer of the epithelial cells in the alimentary canal?
List the functions of the mucosa in the alimentary canal:
- secrete mucus, digestive enzymes and hormones
- absorb digestion products into the blood
- protect against infectious diseases
Which component of the mucosa (alimentary canal) is lined richly with mucus-secreting cells?
Which component of the mucosa (alimentary canal) contains connective tissue and MALT (mucosa-associated lymphoid tissue, contains lymphocytes, plasma cells, and macrophages)?
Which component of the mucosa (alimentary canal) produces local movement?
Which layer of the alimentary canal contains dense connective tissue that contains part of the enteric nerve system; elastic fibers that allow stretching?
Which layer of the alimentary canal is responsible for segmentation and peristalsis, contains part of the enteric nerve system?
Which muscles are found within the muscularis externa?
Which layer of the alimentary canal is the outermost protective layer, visceral peritoneum, consisting of squamous cells?
The oral cavity, pharynx, and rectum have what tissue instead of serosa?
List some tissue types located in the serosa layer of the alimentary canal:
- connective tissue
The local constriction of the small intestine and, to a lesser extent, the large intestine to mix food with digestive juices and increase exposure to the intestinal wall is known as what?
The alternating waves of contraction and relaxation of smooth muscle to propel food through the GI is known as what?
Segmentation and peristalsis are under what control?
What contracts and relaxes to control movement or holding of luminal content?
Sphincters are under what control?
Peristalsis is associated with the contraction of what muscle?
Segmentation is happening mostly because of the action of what muscle?
The peristaltic reflex pushes intestinal contents from the oral to the aboral direction. This is known as the what?
"Law of the Gut"
What are the 3 steps associated with peristalsis?
- Circular muscle contraction must occur right behind food mass
- Longitudinal muscles ahead of food mass contract to propel bolus forward
- Contraction of circular muscle layer forces food mass forward
What are the 3 major types of GI control?
- Neural - enteric nervous system
- Hormonal - peptides produced by enteroendocrine cells
- Local - physical, chemical, pH
Which patients are known to experience severe constipation due to GI tract dysfunction years before the onset of motor movement complications?
Parkinson's Disease (PD)
A restricted part of the peripheral nervous system primarily involved in LOCAL control of the activity of the GI tract is known as the what?
Enteric Nervous System (ETS)
The ETS and its "in-house" nervous system is referred to as a what?
The ETS is organized into two major plexuses. What are they?
- Myenteric plexus (Auerbach's)
- Submucosal plexus (Meissner's)
Which plexus of the ETS is associated mainly with secretory and absorptive functions as well as local blood flow?
Submucosal plexus (Meissner's)
Which ETS plexus plays a major role in contraction and relaxation of GI tract smooth muscle (GI motility)?
Myenteric plexus (Auerbach's)
Which nervous system is associated with long reflexes when controlling digestive functions?
Which nervous system is associated locally and goes to the local brain?
Does EPAN or IPAN use long-reflex signals up to the brain?
Which primary afferent nerves use short-reflexes to signal to the local brain (myenteric nerve plexus/submucosal nerve plexus)?
A bolus in the lumen stimulates the release of what from the enterochromaffin cells (ECs)?
The release of 5-HT from the ECs activates which system?
The activation of the IPAN system leads to changes in the what?
The activation of the IPAN leading to changes in the myenteric plexus leads to muscle contraction where?
behind the bolus (ascending excitatory neurons)
The activation of the IPAN leading to changes in the myenteric plexus leads to muscle relaxation where?
just ahead of the bolus (descending inhibitory neurons)
What is the NET result of the IPAN system activation?
propulsion (pushing the bolus forward)
What is an important transmitter or cotransmitter at excitatory neuron-to-neuron junctions in the ENS?
What is a primary excitatory transmitter to smooth muscle and secretory cells in the ENS. Likely the major neuron-to-neuron transmitter in the ENS?
What is a neuropeptide from the tachykinin family. Serves as a co-transmitter with ACh. Stimulates smooth muscle contraction?
Which almost always inhibits GI activity?
What is a co-transmitter at inhibitory ENS neuromuscular junctions?
Nitric Oxide (NO)
The following bullet relates to what?
- Excitatory secretomotor transmitter (e.g., secretion of water into pancreatic juice and bile, secretion of bicarbonate in the pancreas); relaxation of GI smooth muscle; inhibition of gastric acid secretion; increases motility
Vasoactive intestinal peptide (VIP)
True or False: About 95% of total body serotonin is synthesized by EC cells in the duodenum.
High concentrations of 5-HT in the gut lead to what?
nausea and vomiting
5-HT can act directly on smooth muscle to do what?
- initiate contraction (migration motor complex, MMC)
- release mucosal secretions
All 5-HT receptors are GPCR except which one?
5HT-3 (ligand-gated ion channels)
Which 5-HT receptors are in the GI tract on enterocytes, enteric neurons, GI smooth muscle and immune cells?
5HT 1-4 and 7
Which 5-HT receptor is found on intrinsic primary sensory afferents and can cause depolarization of the afferent nerves when stimulated?
Which 5-HT receptor is located on intrinsic and extrinsic primary sensory afferents and stimulation causes depolarization of these nerves?
Which 5-HT is located presynaptically on post-ganglionic nerves to ENHANCE release of acetylcholine; can cause an increase in GI tract secretions; it is involved in peristaltic reflex?
The overstimulation of which serotonin receptor leads to N&V?
5-HT3 (via long reflex)
The overstimulation of 5-HT3 also sends signals via the short reflex to the local brain. This leads to the release of which nuerotransmitters?
- ACh (leading to muscle contraction/cramping)
- CGRP (leading to pain/inflammation)
Which hormone in the GI system is an endocrine hormone and is in the circulation?
Which hormones in the GI system are paracrine hormones?
Which hormones in the GI system are neurocrine hormones?
Hormones are peptides secreted by what?
Which hormone is associated with gastric acid secretion, pepsinogen secretion, and mucosal growth?
Which hormone is associated with pepsinogen secretion, bicarbonate from pancreas, bile formation and secretion, growth of exocrine pancreas, and inhibits gastric acid secretion by gastrin?
Which hormone is associated with stimulating secretin, pancreatic enzyme secretion, gallbladder contraction, growth of exocrine pancreas, and inhibits gastric emptying and secretions?
Which hormone is associated with insulin release and inhibiting gastric acid secretion?
Gastric inhibitory peptide (GIP)
Which hormone is associated with gastric and intestinal motility?
Which hormone is associated with release of acid?
Which hormone is associated with the contraction of stomach muscle?
Which hormone inhibits gastric and other secretions and inhibits bile release?
Which hormone stimulates buffer secretion, relaxes smooth muscle, and inhibits acid secretion?
Vasoactive intestinal peptide (VIP)
Which GI hormones are produced in the stomach mucosa?
Which GI hormone is produced in the enteric neurons?
Vasoactive intestinal peptide (VIP)
Which GI hormone is produced in both the stomach and duodenal mucosa?
Which GI hormones are produced in the duodenal mucosa?
- cholecystokinin (CCK)
- Gastric inhibitory peptide (GIP)
Which GI hormones inhibit gastric emptying?
Which GI hormone speeds up gastric emptying?
The release of GIP results in the release of what?
The release of CCK results in the release of what?
- bile from gallbladder (fat emulsification)
- digestive enzymes from pancreas
The release of secretin results in the release of what?
bicarbonate from pancreas
The release of secretin results in the formation of what?
bile in the liver
Which neurocrine hormone relaxes sphincters in the GI system?
Which paracrine hormone is associated with the inhibition of endocrine hormone secretion?
Which organ makes bile?
Which organ stores bile?
What transfers bile from the gallbladder to the duodenum?
Once bile enters the duodenum, it is mixed with what?
food (helps with digestion)
True or False: Bile is released in the duodenum to counteract acidic components released from the stomach to prevent damage to the tissue.
Bile salts are associated with the absorption of monoglycerides and what?
Which hormone stimulates bicarbonate secretion (therefore bile) from the liver and bicarbonate secretion from the pancreas?
Which hormone causes contraction of the gallbladder?
True or False: CCK constricts the sphincter of Oddi.
CCK is more involved with the secretion/release of what?
What is a concretion in the gallbladder or bile duct known as?
Gallstones are composed chiefly of a mixture of what?
- calcium bilirubinate
- calcium carbonate
Secretin increases the release of what in the pancreas?
In the liver, secretin increases the secretion of what?
True or False: CCK and Secretin inhibit gastric secretions and motility in the stomach.
Which hormone is associated with the contraction of the gallbladder and ejection of bile?
In the pancreas, CCK increases the synthesis and secretion of what?
pancreatic enzymes (and buffers)
What carries food, liquids, and saliva from the mouth to the stomach?
What prevents the movement of food from the stomach to the esophagus?
True or False: Sphincters are constricted (closed) when not swallowing.
True (they are relaxed when swallowing)
The relaxation of sphincters is mediated by what?
The lower esophageal sphincter is known as what?
cardiac sphincter (due to part of stomach called the cardium)
What kind of muscle contracts and relaxes to close and open the lumen of the esophagus?
What occurs when stomach acid, and sometimes bile, backs up (refluxes) into the esophagus?
Over time, esophageal exposure to the acid associated with GERD can produce irritation known as what?
List the symptoms associated with GERD:
- CHEST PAIN
True or False: Hoarseness, dry cough, and bad breath can also be symptoms of GERD.
What is a disorder in which the lining of the esophagus is damaged by stomach acid and changed to a lining similar to that of the stomach?
List some functions of the stomach:
- Temporary storage of ingested food (receptive relaxation allows for gastric accommodation via VIP, NO, CCK) – minimal increase in intragastric pressure
- Mechanical breakdown and disruption of chemical bonds of proteins by HCl and pepsin
- Mixing to form semifluid mixture called chyme Retropulsion; Hunger pangs
- Propulsion towards intestines - Slow Gastric Emptying
- Production of intrinsic factor
True or False: There is very little absorption occurring in the stomach.
Give an example of some things that have a little absorption in the stomach:
Most absorption occurs where in the GI system?
Bile and pancreatic juices contain a lot of what to offset the acidity associated with components in the stomach?
The acidic components of the stomach and the basic components from the pancreas and gallbladder (bile) meet where?
duodenum of SI
What is the proximal portion of the stomach?
The upper arch of the stomach is known as the what?
The wrinkles/ridges in the lumen of the stomach allow the stomach to expand for food. What are the wrinkles/ridges known as?
Which muscular layer of the stomach is responsible for churning (vigorous mixing)?
Which muscular layer of the stomach is the outer layer?
Which muscular layer of the stomach is the middle layer?
Which muscular layer of the stomach is the inner layer?
The surface epithelium of the stomach secretes what?
mucus (from mucous cells)
Mucus has what in it to neutralize the acid in the stomach?
Mucous neck cells of the stomach give what kind of secretions?
Which cells in the stomach give gastric acid?
Chief cells in the stomach make what?
Chief cells in the stomach produce pepsinogen which is activated into pepsin from the HCl of the stomach. Pepsin helps with the digestion of what?
Which enteroendocrine cells secrete 5-HT?
EC-like cells are enteroendocrine cells that secrete what?
What is the major cell type responsible for the secretion of gastric acid?
List some reasons why we need high levels of acid in the stomach:
- Kills microorganisms
- Denatures proteins and inactivates other enzymes in foods
- Breaks down plant cells walls (not cellulose!) and connective tissue in meat
- Activates pepsinogen released by chief cells
What prevents acids to come in and destroying underlying cells in the stomach?
Gastric Diffusion Barrier (GDB)/ Mucous gel
Which cells secrete mucin into the GDB?
True or False: The GDB has bicarbonate rich fluid secreted by the mucous cells to create a diffusion barrier.
What induces the secretion of mucus and bicarbonate into the GDB?
What are the 3 secretagogues responsible for gastric acid secretion?
Histamine, ACh, and Gastrin all have receptors on which cells?
parietal cells (parietal cells are the cells that make acid)
ALL 3 secretagogues (Histamine, ACh, and Gastrin) are related by which common mechanism?
proton pump (H+/K+-ATPase pump)
True or False: Chronic GERD can be associated with PUD.
Gastric ulcers arise due to what?
loss of protection
List the major causes of peptic ulcers:
- Infection with the bacteria Helicobacter pylori (H. pylori)
- Use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, naproxen, and others.
- Excess acid production from gastrinomas, tumors of the acid producing cells of the stomach that increases acid output (seen in Zollinger-Ellison syndrome, elevated gastrin levels).
- Steroids, Cigarettes, Alcohol, Stress
When H. Pylori gets to epithelial cells it secretes which enzyme?
Urease makes what from urea?
ammonia (neutralizes gastric acid due to being basic)
H. Pylori releasing urease gives the bacteria a what?
After the protective bubble is formed around H. Pylori, what occurs?
H. Pylori multiplies
Once H. Pylori multiplies it feasts on the underlying cells causing damage and inflammation. This allows acid to come through and can lead to what?
ulcers or even cancers
What is the brand name of dexlansoprazole?
What is the brand name of esomeprazole?
What is the brand name of lansoprazole?
What is the brand name of omeprazole?
What is the brand name of pantoprazole?
What is the brand name of rabeprazole?
What is the brand name of cimetidine?
What is the brand name of famotidine?
What is the brand name of nizatidine?
What is the brand name of ranitidine?
What is the brand name of misoprostol?
What is the brand name of sucralfate?
Histamine is responsible for the basal secretion of gastric acid meaning what?
the production of acid when not eating
True or False: H2 antagonists are more effective for treating PUD and GERD compared to antacids.
The effects of H2 antagonists are reduced by what?
True or False: H2 antagonists have a quick onset of action, but a short duration.
Tolerance of H2 antagonists can develop within how long of starting treatment and may be resistant to increased doses of medication?
How does the body compensate to decreased acid secretion induced by H2 antagonists?
- up-regulates CCKB (gastrin) receptor
- up-regulation of histamine receptor (H2R)
Increased expression of the gastric receptor (CCKB) is known as what?
Tolerance to H2 receptor antagonists leads to the increase in which cells?
True or False: H2 receptor antagonists are effective for long-term use.
False; not effective
After stopping H2 antagonists, acid levels increase. This is known as what?
The presence of gastrinomas in the pancreas or duodenum that secrete large amounts of gastrin causing a gastrin hypersecretory state is known as what?
True or False: Zollinger-Ellison Syndrome is treated with very high doses of H2RAs.
Which drug is a combination of a PPI and antacid (omeprazole and sodium bicarbonate)?
True or False: Esomeprazole is a pure S-isomer of omeprazole and is less active at the proton pump.
False; more active
Prevpac can be used in the treatment of what?
What are the drugs that make up the Prevpac?
- Prevacid (lansoprazole) 30-mg Capsules
- Clarithromycin 500-mg Tablets
- Amoxicillin 500-mg Capsules
True or False: The binding of PPIs to the proton pumps is irreversible.
PPIs are prodrugs and only bind to the proton pump when?
the proton pump is active (PPIs are highly selective)
Is the half-life of the parent compound of PPIs long or short?
Is the half-life of the activated drug/metabolite of PPIs long or short?
True or False: PPIs are superior compared to H2 blockers.
Which drug's job is to build back the protective barrier that NSAIDs damage?
Cytotec (methyl ester derivative of PgE1)
What is a unique SE associated with misoprostol (Cytotec)?
uterine contractions (can induce labor, cause abortions, premature births or birth defects)
Which drug forms a protective layer/barrier over the erosion/ulcerations (not involved with acid secretion or neutralization)?
List some common antidiarrheals:
What is the brand name of diphenoxylate?
What is the brand name of loperamide?
What are some anti-secretory agents used for diarrhea?
- bismuth subsalicylate
What is the brand name of bismuth subsalicylate?
What is the brand name of octreotide?
List some adsorbents used in the treatment of diarrhea:
- kaolin pectin
What is the brand name of polycarbophil?
What is the brand name of attapulgite?
List some common probiotics used in the treatment of diarrhea:
List some common antibiotics used in the treatment of diarrhea:
What is the brand name of rifaximin?
What is the brand name of ciprofloxacin?
List some common bulk-forming laxatives used in the treatment of constipation:
- calcium polycarbophil
- psyllium hydrophilic mucilloid
What are some brand names of calcium polycarbophil?
What is the brand name of psyllium hydrophilic mucilloid?
What are some brand names of methylcellulose?
List some emollients used in the treatment of constipation:
- docusate calcium
- docusate sodium
What is the brand name of docusate calcium?
Surfak Stool Softener
What are some common brand names of docusate sodium?
- Fleet Sof-Lax
- Phillips Stool Softener
List some common hyperosmotic laxatives used for the treatment of constipation:
- polyethylene glycol
List some common brand names of polyethylene glycol:
List some common saline cathartics used in the treatment of constipation:
- sodium phosphate
- magnesium hydroxide
- magnesium sulfate
What is the brand name of sodium phosphate?
What is the brand name of magnesium hydroxide?
Phillips Milk of Magnesia
What is the brand name of magnesium sulfate?
Which drug used to treat constipation is a selective C-2 chloride channel activator?
What is the brand name of lubiprostone?
Which drugs used to treat constipation are peripheral-acting opioid antagonists?
What is the brand name of methylnaltrexone?
What is the brand name of naloxegol?
The passage of abnormally liquid or unformed stools at an increased frequency is known as what?
The persistent, difficult, infrequent, or seemingly incomplete defecation is known as what?
Opioid receptors are found where in motor neurons?
Which drug's MOA is being described by the bullets below?
- Stimulates absorption of fluid and electrolytes across the intestinal wall (antisecretory action)
- Inhibits prostaglandin (inflammation and hypermotility) when hydrolyzed to salicylic acid
- Binds toxins produced by Escherichia coli. The parent compound and its metabolites are believed to have bactericidal action
The following bullets relate to which drug's MOA?
- Inhibits the secretion of many hormones such as insulin, glucagon, GI hormones (gastrin, CCK, secretin, motilin, 5-HT, VIP, etc.)
- Decreases activity of pancreas, gallbladder and GI tract
- Treatment for watery diarrhea due to VIP-secreting tumors
What is the brand name of ocreotide?
Ocreotide (Sandostatin) may be used in what?
IBS with diarrhea (IBS-D)
True or False: Ocreotide (Sandostatin) reduces perception of rectal distention and visceral pain.
List some common AE associated with ocreotide (Sandostatin):
Which drug class MOA is being described below?
- soluble fiber absorbs water and other material making a softer, bulkier stool that is easier to pass
Bulk-Forming Laxatives can cause what?
True or False: Fiber and bran are included among Bulk-Forming Laxatives.
The following bullets relate to which drug class MOA?
- anionic surfactants that lower the surface tension of stool and allowing mixing of aqueous and fatty substances
- stimulate intestinal fluid and electrolyte secretion (possibly by increasing mucosal cAMP) and alter intestinal mucosal permeability
Emollients (docusate salts)
Which drugs increase osmotic activity in the lumen, which draws fluid into the colon to produce soft, formed stools?
Which drug class MOA is being described below?
- Osmotically-mediated water retention
- Increased pressure in the intestine causes peristalsis
- Stimulation of CCK release (magnesium-containing saline laxatives)
Which drug MOA is being described below?
- Irritates the intestinal lining and increases peristalsis via the myenteric and submucosal plexuses
- Also decreases aquaporin expression in intestinal epithelial cells
Stimulant laxatives (Bisacodyl)
Which drug activates Cl C-2 channels?
What is the most common AE associated with lubiprostone?
List some other AE associated with lubiprostone:
- abdominal pain
- no serious problems with diarrhea or electrolyte imbalance
Drugs that enhance gastrointestinal motility by increasing the frequency of contractions in the small intestine or making them stronger are known as what?
Prokinetic agents (Promotility agents)
Which macrolide antibiotic is a motilin agonist (prokinetic agent)?
True or False: Erythromycin works by stimulating interdigestive waves of gastrointestinal motility (migrating motor complexes).
List some common SE associated with erythromycin:
- Abdominal or stomach cramping and discomfort
- Nausea or vomiting
A long-term or recurrent disorder of gastrointestinal functioning characterized by disturbances in the large and small intestines including motility, sensation and secretion is known as what?
Irritable Bowel Syndrome (IBS)
True or False: IBS is associated with serious damage to the GI tract.
False; no damage to the GI tract
List some common anticholinergic/antispasmodic agents used to control diarrhea:
What is the brand name of dicyclomine?
What is the brand name of chlordiazepoxide/clidinium?
What are some brand names of hyoscyamine?
Anticholinergic/antispasmodic agents control diarrhea by blocking which receptors?
What is the chlordiazepoxide useful for in Librax?
What is the clidinum useful for in Librax?
muscular receptor blocker
Which component of Lomotil is an opioid mu receptor agonist (reduces the release of ACh)?
The atropine portion of Lomotil reduces motility/secretion by blocking what?
Which drug is a 5-HT3 antagonist used to treat IBS with severe diarrhea?
What is the brand name of alosetron?
Which drug is a 5-HT4 agonist used to treat IBS with constipation?
What is the brand name of tegaserod?
Alosteron (Lotronex) is only indicated in which patients?
Women (IBS with severe diarrhea)
Tegaserod (Zelnorm) was originally recalled due to an increased risk of what?
heart attack and stroke
There are how many microorganisms in the gut?
1014 (100 trillion)
True or False: In IBS, there is a disruption of harmony in the gut (related to microflora).
Which drugs enhance the epithelial barrier by helping prevent the colonization of pathogenic organisms?
True or False: Probiotics help the immune system.
Which drug is a semi-synthetic antibiotic that inhibits bacterial DNA-dependent RNA polymerase, poorly absorbed?
Rifaximin (Xifaxan) is indicated for the treatment of which diarrhea?
Rifaximin (Xifaxan) is also indicated for the risk reduction for what?
A course of Rifaximin (Xifaxan) for how long can help relieve symptoms of IBS-D (bloating and diarrhea) and even abdominal pain lasting up to 10 weeks after stopping treatment?
Which drug used for IBS-C activates GC-C receptors?
What is the brand name of linaclotide?
Which drugs are most important in treating N/V?
5-HT3 receptor antagonists
Protective reflexes or biological defense mechanisms that remove toxic or harmful substances from the body after ingestion refers to what?
Which nerve has a strong influence on the vomiting center and can therefore be referred to as the "nausea nerve"?
What creates the neural connection between vomiting center and CTZ?
Which histamine antagonists are used in the treatment of nausea and vomiting?
H1 receptor antagonists
What is a 1st generation H1 receptor antagonist used for N/V?
What are some 2nd generation H1 antagonists used in the treatment of N/V?
What is a 3rd generation H1 antagonist used in the treatment of N/V?
H1 antagonists acting on endothelial cells leads to the release of what?
NO --> causing vasodilation
Which generation of H1 antagonists are non-selective and bind to multiple receptors therefore increasing the risk of AE?
1st generation H1 antagonists do NOT act on which receptors?
- does not help with the reduction of acid secretion
Motion sickness mediated N/V primarily is associated with which receptors?
Which drug is also known as "truth serum" if injected?
List some common phenothiazines used in treating N/V:
Which phenothiazine is a H1 receptor antagonist with some M antagonist activity, weak D2 antagonist?
What is the brand name of promethazine?
Which phenothaizines used to treat N/V are D2 antagonists?
What is the brand name of chlorpromazine?
What is the brand name of prochlorperazine?
H1 receptor antagonists block N&V through the what?
NTS (and possibly CTZ)
D2 receptor antagonists block N&V through the what?
Which drug blocks D2 receptors in the CTZ and is considered an anti-emetic?
What is the brand name of Metoclopramide?
List some indications for metoclopramide:
- Diabetic gastroparesis
List the 3 ways 5HT3 antagonists work to treat N/V:
- Blocking 5-HT3 in stomach/SI --> inhibits the vagal and sympathetic afferents from sending their signals to the NTS
- Blocking 5HT3 in the CTZ --> inhibits the CTZ from sending signals to the NTS
- Blocking 5HT3 in the NTS --> inhibits the NTS from signaling the vomiting (emetic) center
What is the brand name of ondansetron?
What is the brand name of granisetron?
What is the brand name of palonosetron?
What is the brand name of dolasetron?
True or False: 5-HT3 antagonists are safe, well-tolerated, and have few AE.
NK1 receptor antagonists are particularly used to treat which N/V?
Chemotherapy-Induced N&V (CINV)
NK1 receptors are associated with which neurocrine hormone?
List some common NK1 receptor antagonists used to treat N/V:
What is the brand name of aprepitant?
Which NK1 receptor antagonist comes in an injection formulation?
List some common AE associated with NK1 receptor antagonists:
What is a common corticosteroid that may be used to treat N/V?
True or False: The MOA of corticosteroids having an anti-emetic effect is unknown.
What is used prophylactically for CINV when other agents not effective?
Which drug is synthetic THC?
What is the brand name of dronabinol?
Which drug is similar in structure to dronabinol, but is more potent?
What is the brand name of nabilone?
Both dronabinol and nabilone affect which receptors in the brain and GI system?
True or False: CB1 receptors are one of the most common Gi coupled receptors in the brain.
The CB2 receptor is mostly important in what system?
Cannabis/Synthetic Cannabinoids reduce the ability of which neurotransmitters to induce N/V?
List some SE associated with cannabis/synthetic cannabinoids:
- Complex effects on CNS
- a central sympathomimetic effect (tachycardia)
- mood changes
- paranoid reactions
- withdrawal reaction following abrupt D/C
CB1 receptors are located in which centers associated with N/V?
- Vomiting center
In the ENS, CB1 inhibits the release of what?
ACh (therefore inhibiting movement)
CB1 is believed to effect the release of what from EC cells?
True or False: Overall, the anti-emetic effect related to cannabis and synthetic cannabinoids is likely to be CNS related.
Which drug is a non-selective D2 receptor antagonist used off-label for CINV and PONV?
Olanzapine (non-selective --> blocks many different receptors)
What is the brand name of olanzapine?
Olanzapine (Zyprexa) is an antipsychotic used in the treatment of which disorders?
- bipolar disorder