G.I. Midterm Part 2

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1

List some common functions of the digestive system:

  • Movement
  • Secretion
  • Digestion
  • Absorption
  • Circulation
  • Nervous and Hormonal control
2

Breaking down into smaller constituents that are able to be absorbed is known as what?

Digestion

3

What prevents the stomach acids from going up into the esophagus?

Esophageal sphincter

4

What in the mouth helps with lubrication/mixing (making swallowing easier)?

Salivary glands

5

What in the mouth helps with mixing food?

tongue

6

What in the mouth is responsible for grinding food up?

teeth

7

Which component of the digestive system makes enzymes that help with digesting proteins/fats/carbs?

Pancreas

8

Which accessory organ to the digestive system makes bile?

Liver

9

Where is bile stored?

gallbladder

10

Bile helps with the digestion/metabolism of what?

fat

11

Inflammatory processes in the GI system is mediated by which organ?

spleen

12

The organs that are essentially apart of the digestive system are known as what?

alimentary canal organs

13

List some accessory organs associated with the digestive system:

  • tongue
  • salivary glands
    • parotid gland
    • sublingual gland
    • submandibular gland
  • liver
  • gallbladder
  • pancreas
14

Which organ has muscle that mixes/churns food to break it down into smaller pieces?

stomach

15

Which organ undergoes segmentation which is like mixing to help with further breakdown of food?

small intestine

16

What helps move things forward in the GI system?

peristalsis

17

Peristalsis occurs in which organs in the GI system?

  • esophagus
  • stomach
  • small intestine
18

What process mainly occurs in the small intestine?

absorption

19

Nutrients are transferred from the small intestine into the circulation via what?

blood vessels

20

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)

21

The stomach empties its components into which portion of the small intestine?

duodenum

22

What is the middle component of the small intestine?

jejunum

23

Which portion of the small intestine empties its components into the large intestine?

ileum

24

The ileum meets the beginning of the large intestine via the what?

cecum

25

List the flow of food once it enters the large intestine?

ascending colon --> transverse colon --> descending colon --> sigmoid colon --> rectum --> anus

26

What is the outermost layer of the intestine?

serosa

27

The serosa helps with what?

structure/protection

28

Which muscle is located underneath the serosa?

longitudinal

29

The longitudinal muscle controls what?

length of the tract

30

What is the layer of nerve located underneath the longitudinal muscle?

myenteric nerve plexus

31

The myenteric plexus is considered a what inside the GI tract?

little brain

32

The myenteric plexus controls the function of what?

  • longitudinal muscle
  • circular muscle
33

The main functions of the circular and longitudinal muscle in the GI tract is what?

contraction/relaxation --> peristalsis

34

What is the muscle located underneath the myenteric nerve plexus?

circular muscle

35

What is the function of the circular muscle?

controlling the size of the lumen

36

What is located underneath the circular muscle in the submucosal gland?

Meissner's (submucosal) nerve plexus

37

The Meissner's (submucosal) nerve plexus regulates what?

  • secretory activity (secretion)
  • absorption
38

What surrounds/is just outside the lumen?

  • mucosa
  • epithelial lining
  • mucosal muscle
  • mucosal gland
39

Which part of the intestines is the opening that allows for the entry of blood vessels (arteries/veins), lymphatics, nerves?

Mesentery

40

What is the innermost layer of the epithelial cells in the alimentary canal?

Mucosa

41

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
42

Which component of the mucosa (alimentary canal) is lined richly with mucus-secreting cells?

Epithelium

43

Which component of the mucosa (alimentary canal) contains connective tissue and MALT (mucosa-associated lymphoid tissue, contains lymphocytes, plasma cells, and macrophages)?

Lamina propia

44

Which component of the mucosa (alimentary canal) produces local movement?

muscularis mucosae

45

Which layer of the alimentary canal contains dense connective tissue that contains part of the enteric nerve system; elastic fibers that allow stretching?

Submucosa

46

Which layer of the alimentary canal is responsible for segmentation and peristalsis, contains part of the enteric nerve system?

muscularis externa

47

Which muscles are found within the muscularis externa?

  • longitudinal
  • circular
48

Which layer of the alimentary canal is the outermost protective layer, visceral peritoneum, consisting of squamous cells?

serosa

49

The oral cavity, pharynx, and rectum have what tissue instead of serosa?

adventitia

50

List some tissue types located in the serosa layer of the alimentary canal:

  • epithelium
  • connective tissue
51

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?

segmentation

52

The alternating waves of contraction and relaxation of smooth muscle to propel food through the GI is known as what?

peristalsis

53

Segmentation and peristalsis are under what control?

Phasic control

54

What contracts and relaxes to control movement or holding of luminal content?

Sphincters

55

Sphincters are under what control?

Tonic

56

Peristalsis is associated with the contraction of what muscle?

  • longitudinal
  • circular
57

Segmentation is happening mostly because of the action of what muscle?

circular

58

The peristaltic reflex pushes intestinal contents from the oral to the aboral direction. This is known as the what?

"Law of the Gut"

59

What are the 3 steps associated with peristalsis?

  1. Circular muscle contraction must occur right behind food mass
  2. Longitudinal muscles ahead of food mass contract to propel bolus forward
  3. Contraction of circular muscle layer forces food mass forward
60

What are the 3 major types of GI control?

  • Neural - enteric nervous system
  • Hormonal - peptides produced by enteroendocrine cells
  • Local - physical, chemical, pH
61

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)

62

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)

63

The ETS and its "in-house" nervous system is referred to as a what?

mini-brain

64

The ETS is organized into two major plexuses. What are they?

  • Myenteric plexus (Auerbach's)
  • Submucosal plexus (Meissner's)
65

Which plexus of the ETS is associated mainly with secretory and absorptive functions as well as local blood flow?

Submucosal plexus (Meissner's)

66

Which ETS plexus plays a major role in contraction and relaxation of GI tract smooth muscle (GI motility)?

Myenteric plexus (Auerbach's)

67

Which nervous system is associated with long reflexes when controlling digestive functions?

Extrinsic

68

Which nervous system is associated locally and goes to the local brain?

Intrinsic (enteric)

69

Does EPAN or IPAN use long-reflex signals up to the brain?

EPAN

70

Which primary afferent nerves use short-reflexes to signal to the local brain (myenteric nerve plexus/submucosal nerve plexus)?

IPAN

71

A bolus in the lumen stimulates the release of what from the enterochromaffin cells (ECs)?

5-HT

72

The release of 5-HT from the ECs activates which system?

IPAN

73

The activation of the IPAN system leads to changes in the what?

myenteric plexus

74

The activation of the IPAN leading to changes in the myenteric plexus leads to muscle contraction where?

behind the bolus (ascending excitatory neurons)

75

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)

76

What is the NET result of the IPAN system activation?

propulsion (pushing the bolus forward)

77

What is an important transmitter or cotransmitter at excitatory neuron-to-neuron junctions in the ENS?

5-HT

78

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?

Acetylcholine (ACh)

79

What is a neuropeptide from the tachykinin family. Serves as a co-transmitter with ACh. Stimulates smooth muscle contraction?

Substance P

80

Which almost always inhibits GI activity?

Norepinephrine (NE)

81

What is a co-transmitter at inhibitory ENS neuromuscular junctions?

Nitric Oxide (NO)

82

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)

83

True or False: About 95% of total body serotonin is synthesized by EC cells in the duodenum.

True

84

High concentrations of 5-HT in the gut lead to what?

nausea and vomiting

85

5-HT can act directly on smooth muscle to do what?

  • initiate contraction (migration motor complex, MMC)
  • release mucosal secretions
86

All 5-HT receptors are GPCR except which one?

5HT-3 (ligand-gated ion channels)

87

Which 5-HT receptors are in the GI tract on enterocytes, enteric neurons, GI smooth muscle and immune cells?

5HT 1-4 and 7

88

Which 5-HT receptor is found on intrinsic primary sensory afferents and can cause depolarization of the afferent nerves when stimulated?

5HT1P

89

Which 5-HT receptor is located on intrinsic and extrinsic primary sensory afferents and stimulation causes depolarization of these nerves?

5HT3

90

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?

5HT4

91

The overstimulation of which serotonin receptor leads to N&V?

5-HT3 (via long reflex)

92

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)
93

Which hormone in the GI system is an endocrine hormone and is in the circulation?

gastrin

94

Which hormones in the GI system are paracrine hormones?

  • serotonin
  • histamine
95

Which hormones in the GI system are neurocrine hormones?

  • NE
  • ACh
96

Hormones are peptides secreted by what?

enteroendocrine cells

97

Which hormone is associated with gastric acid secretion, pepsinogen secretion, and mucosal growth?

Gastrin

98

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?

Secretin

99

Which hormone is associated with stimulating secretin, pancreatic enzyme secretion, gallbladder contraction, growth of exocrine pancreas, and inhibits gastric emptying and secretions?

Cholecystokinin (CCK)

100

Which hormone is associated with insulin release and inhibiting gastric acid secretion?

Gastric inhibitory peptide (GIP)

101

Which hormone is associated with gastric and intestinal motility?

Motilin

102

Which hormone is associated with release of acid?

Histamine

103

Which hormone is associated with the contraction of stomach muscle?

Serotonin

104

Which hormone inhibits gastric and other secretions and inhibits bile release?

somatostatin

105

Which hormone stimulates buffer secretion, relaxes smooth muscle, and inhibits acid secretion?

Vasoactive intestinal peptide (VIP)

106

Which GI hormones are produced in the stomach mucosa?

  • gastrin
  • serotonin
  • histamine
107

Which GI hormone is produced in the enteric neurons?

Vasoactive intestinal peptide (VIP)

108

Which GI hormone is produced in both the stomach and duodenal mucosa?

Somatostatin

109

Which GI hormones are produced in the duodenal mucosa?

  • secretin
  • cholecystokinin (CCK)
  • Gastric inhibitory peptide (GIP)
  • Motilin
110

Which GI hormones inhibit gastric emptying?

  • gastrin
  • secretin
  • CCK
111

Which GI hormone speeds up gastric emptying?

motilin

112

The release of GIP results in the release of what?

insulin

113

The release of CCK results in the release of what?

  • bile from gallbladder (fat emulsification)
  • digestive enzymes from pancreas
114

The release of secretin results in the release of what?

bicarbonate from pancreas

115

The release of secretin results in the formation of what?

bile in the liver

116

Which neurocrine hormone relaxes sphincters in the GI system?

VIP

117

Which paracrine hormone is associated with the inhibition of endocrine hormone secretion?

somatostatin

118

Which organ makes bile?

liver

119

Which organ stores bile?

gallbladder

120

What transfers bile from the gallbladder to the duodenum?

Bile duct

121

Once bile enters the duodenum, it is mixed with what?

food (helps with digestion)

122

True or False: Bile is released in the duodenum to counteract acidic components released from the stomach to prevent damage to the tissue.

True

123

Bile salts are associated with the absorption of monoglycerides and what?

fatty acids

124

Which hormone stimulates bicarbonate secretion (therefore bile) from the liver and bicarbonate secretion from the pancreas?

Secretin

125

Which hormone causes contraction of the gallbladder?

CCK

126

True or False: CCK constricts the sphincter of Oddi.

False; relaxes

127

CCK is more involved with the secretion/release of what?

bile

128

What is a concretion in the gallbladder or bile duct known as?

Gallstone

129

Gallstones are composed chiefly of a mixture of what?

  • cholesterol
  • calcium bilirubinate
  • calcium carbonate
130

Secretin increases the release of what in the pancreas?

buffers

131

In the liver, secretin increases the secretion of what?

  • buffers
  • bile
132

True or False: CCK and Secretin inhibit gastric secretions and motility in the stomach.

True

133

Which hormone is associated with the contraction of the gallbladder and ejection of bile?

CCK

134

In the pancreas, CCK increases the synthesis and secretion of what?

pancreatic enzymes (and buffers)

135

What carries food, liquids, and saliva from the mouth to the stomach?

Esophagus

136

What prevents the movement of food from the stomach to the esophagus?

sphincters

137

True or False: Sphincters are constricted (closed) when not swallowing.

True (they are relaxed when swallowing)

138

The relaxation of sphincters is mediated by what?

  • NO
  • VIP
139

The lower esophageal sphincter is known as what?

cardiac sphincter (due to part of stomach called the cardium)

140

What kind of muscle contracts and relaxes to close and open the lumen of the esophagus?

circular muscle

141

What occurs when stomach acid, and sometimes bile, backs up (refluxes) into the esophagus?

GERD

142

Over time, esophageal exposure to the acid associated with GERD can produce irritation known as what?

esophagitis

143

List the symptoms associated with GERD:

  • heartburn
  • regurgitation
  • nausea
  • CHEST PAIN
144

True or False: Hoarseness, dry cough, and bad breath can also be symptoms of GERD.

True

145

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?

Barrett's esophagus

146

List some functions of the stomach:

  1. Temporary storage of ingested food (receptive relaxation allows for gastric accommodation via VIP, NO, CCK) – minimal increase in intragastric pressure
  2. Mechanical breakdown and disruption of chemical bonds of proteins by HCl and pepsin
  3. Mixing to form semifluid mixture called chyme Retropulsion; Hunger pangs
  4. Propulsion towards intestines - Slow Gastric Emptying
  5. Production of intrinsic factor
147

True or False: There is very little absorption occurring in the stomach.

True

148

Give an example of some things that have a little absorption in the stomach:

  • ASA
  • alcohol
149

Most absorption occurs where in the GI system?

Small intestine

150

Bile and pancreatic juices contain a lot of what to offset the acidity associated with components in the stomach?

bicarbonate

151

The acidic components of the stomach and the basic components from the pancreas and gallbladder (bile) meet where?

duodenum of SI

152

What is the proximal portion of the stomach?

cardia

153

The upper arch of the stomach is known as the what?

fundus

154

The wrinkles/ridges in the lumen of the stomach allow the stomach to expand for food. What are the wrinkles/ridges known as?

rugae

155

Which muscular layer of the stomach is responsible for churning (vigorous mixing)?

Oblique

156

Which muscular layer of the stomach is the outer layer?

longitudinal

157

Which muscular layer of the stomach is the middle layer?

circular

158

Which muscular layer of the stomach is the inner layer?

oblique

159

The surface epithelium of the stomach secretes what?

mucus (from mucous cells)

160

Mucus has what in it to neutralize the acid in the stomach?

bicarbonate

161

Mucous neck cells of the stomach give what kind of secretions?

acidic secretions

162

Which cells in the stomach give gastric acid?

parietal cells

163

Chief cells in the stomach make what?

  • lipase
  • pepsinogen
164

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?

proteins

165

Which enteroendocrine cells secrete 5-HT?

EC cells

166

EC-like cells are enteroendocrine cells that secrete what?

histamine

167

What is the major cell type responsible for the secretion of gastric acid?

parietal cells

168

List some reasons why we need high levels of acid in the stomach:

  1. Kills microorganisms
  2. Denatures proteins and inactivates other enzymes in foods
  3. Breaks down plant cells walls (not cellulose!) and connective tissue in meat
  4. Activates pepsinogen released by chief cells
169

What prevents acids to come in and destroying underlying cells in the stomach?

Gastric Diffusion Barrier (GDB)/ Mucous gel

170

Which cells secrete mucin into the GDB?

Goblet cells

171

True or False: The GDB has bicarbonate rich fluid secreted by the mucous cells to create a diffusion barrier.

True

172

What induces the secretion of mucus and bicarbonate into the GDB?

  • ACh
  • PGEs
173

What are the 3 secretagogues responsible for gastric acid secretion?

  • ACh
  • Gastrin
  • Histamine
174

Histamine, ACh, and Gastrin all have receptors on which cells?

parietal cells (parietal cells are the cells that make acid)

175

ALL 3 secretagogues (Histamine, ACh, and Gastrin) are related by which common mechanism?

proton pump (H+/K+-ATPase pump)

176

True or False: Chronic GERD can be associated with PUD.

True

177

Gastric ulcers arise due to what?

loss of protection

178

List the major causes of peptic ulcers:

  1. Infection with the bacteria Helicobacter pylori (H. pylori)
  2. Use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, naproxen, and others.
  3. 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).
  4. Others
    • Steroids, Cigarettes, Alcohol, Stress
179

When H. Pylori gets to epithelial cells it secretes which enzyme?

urease

180

Urease makes what from urea?

ammonia (neutralizes gastric acid due to being basic)

181

H. Pylori releasing urease gives the bacteria a what?

protective bubble

182

After the protective bubble is formed around H. Pylori, what occurs?

H. Pylori multiplies

183

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

184

What is the brand name of dexlansoprazole?

Dexilant

185

What is the brand name of esomeprazole?

Nexium

186

What is the brand name of lansoprazole?

Prevacid

187

What is the brand name of omeprazole?

Prilosec

188

What is the brand name of pantoprazole?

Protonix

189

What is the brand name of rabeprazole?

Aciphex

190

What is the brand name of cimetidine?

Tagamet

191

What is the brand name of famotidine?

Pepcid

192

What is the brand name of nizatidine?

Axid

193

What is the brand name of ranitidine?

Zantac

194

What is the brand name of misoprostol?

Cytotec

195

What is the brand name of sucralfate?

Carafate

196

Histamine is responsible for the basal secretion of gastric acid meaning what?

the production of acid when not eating

197

True or False: H2 antagonists are more effective for treating PUD and GERD compared to antacids.

True

198

The effects of H2 antagonists are reduced by what?

food

199

True or False: H2 antagonists have a quick onset of action, but a short duration.

True

200

Tolerance of H2 antagonists can develop within how long of starting treatment and may be resistant to increased doses of medication?

3 days

201

How does the body compensate to decreased acid secretion induced by H2 antagonists?

  • up-regulates CCKB (gastrin) receptor
  • up-regulation of histamine receptor (H2R)
202

Increased expression of the gastric receptor (CCKB) is known as what?

hypergastrinemia

203

Tolerance to H2 receptor antagonists leads to the increase in which cells?

  • parietal
  • ECL
204

True or False: H2 receptor antagonists are effective for long-term use.

False; not effective

205

After stopping H2 antagonists, acid levels increase. This is known as what?

Acid rebound

206

The presence of gastrinomas in the pancreas or duodenum that secrete large amounts of gastrin causing a gastrin hypersecretory state is known as what?

Zollinger-Ellison Syndrome

207

True or False: Zollinger-Ellison Syndrome is treated with very high doses of H2RAs.

True

208

Which drug is a combination of a PPI and antacid (omeprazole and sodium bicarbonate)?

Zegerid

209

True or False: Esomeprazole is a pure S-isomer of omeprazole and is less active at the proton pump.

False; more active

210

Prevpac can be used in the treatment of what?

H. Pylori

211

What are the drugs that make up the Prevpac?

  • Prevacid (lansoprazole) 30-mg Capsules
  • Clarithromycin 500-mg Tablets
  • Amoxicillin 500-mg Capsules
212

True or False: The binding of PPIs to the proton pumps is irreversible.

True

213

PPIs are prodrugs and only bind to the proton pump when?

the proton pump is active (PPIs are highly selective)

214

Is the half-life of the parent compound of PPIs long or short?

short

215

Is the half-life of the activated drug/metabolite of PPIs long or short?

longer

216

True or False: PPIs are superior compared to H2 blockers.

True

217

Which drug's job is to build back the protective barrier that NSAIDs damage?

Cytotec (methyl ester derivative of PgE1)

218

What is a unique SE associated with misoprostol (Cytotec)?

uterine contractions (can induce labor, cause abortions, premature births or birth defects)

219

Which drug forms a protective layer/barrier over the erosion/ulcerations (not involved with acid secretion or neutralization)?

Carafate (sucralfate)

220

List some common antidiarrheals:

  • diphenoxylate
  • loperamide
221

What is the brand name of diphenoxylate?

Lomotil

222

What is the brand name of loperamide?

Immodium

223

What are some anti-secretory agents used for diarrhea?

  • bismuth subsalicylate
  • octreotide
224

What is the brand name of bismuth subsalicylate?

Pepto Bismol

225

What is the brand name of octreotide?

Sandostatin

226

List some adsorbents used in the treatment of diarrhea:

  • kaolin pectin
  • polycarbophil
  • attapulgite
227

What is the brand name of polycarbophil?

Fibercon

228

What is the brand name of attapulgite?

Diasorb

229

List some common probiotics used in the treatment of diarrhea:

  • lactobacilli
  • bifidobacteria
230

List some common antibiotics used in the treatment of diarrhea:

  • rifaximin
  • ciprofloxacin
231

What is the brand name of rifaximin?

Xifaxan

232

What is the brand name of ciprofloxacin?

Cipro

233

List some common bulk-forming laxatives used in the treatment of constipation:

  • calcium polycarbophil
  • psyllium hydrophilic mucilloid
  • methylcellulose
234

What are some brand names of calcium polycarbophil?

  • Fibercon
  • Equalactin
235

What is the brand name of psyllium hydrophilic mucilloid?

Metamucil

236

What are some brand names of methylcellulose?

  • Citrucel
  • Celevac
237

List some emollients used in the treatment of constipation:

  • docusate calcium
  • docusate sodium
238

What is the brand name of docusate calcium?

Surfak Stool Softener

239

What are some common brand names of docusate sodium?

  • Colace
  • Fleet Sof-Lax
  • Phillips Stool Softener
240

List some common hyperosmotic laxatives used for the treatment of constipation:

  • sorbitol
  • lactulose
  • polyethylene glycol
241

List some common brand names of polyethylene glycol:

  • Colyte
  • Miralax
242

List some common saline cathartics used in the treatment of constipation:

  • sodium phosphate
  • magnesium hydroxide
  • magnesium sulfate
243

What is the brand name of sodium phosphate?

Fleet Enema

244

What is the brand name of magnesium hydroxide?

Phillips Milk of Magnesia

245

What is the brand name of magnesium sulfate?

Epsom salt

246

Which drug used to treat constipation is a selective C-2 chloride channel activator?

lubiprostone

247

What is the brand name of lubiprostone?

Amitiza

248

Which drugs used to treat constipation are peripheral-acting opioid antagonists?

  • methylnaltrexone
  • naloxegol
249

What is the brand name of methylnaltrexone?

Relistor

250

What is the brand name of naloxegol?

Movantik

251

The passage of abnormally liquid or unformed stools at an increased frequency is known as what?

Diarrhea

252

The persistent, difficult, infrequent, or seemingly incomplete defecation is known as what?

Constipation

253

Opioid receptors are found where in motor neurons?

myenteric plexus

254

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

Bismuth subsalicylate

255

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

Ocreotide

256

What is the brand name of ocreotide?

Sandostatin

257

Ocreotide (Sandostatin) may be used in what?

IBS with diarrhea (IBS-D)

258

True or False: Ocreotide (Sandostatin) reduces perception of rectal distention and visceral pain.

True

259

List some common AE associated with ocreotide (Sandostatin):

  • gallstones
  • abdominal
  • distention
  • constipation
  • flatulence
  • hyperglycemia
260

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

261

Bulk-Forming Laxatives can cause what?

  • gas
  • bloating
262

True or False: Fiber and bran are included among Bulk-Forming Laxatives.

True

263

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)

264

Which drugs increase osmotic activity in the lumen, which draws fluid into the colon to produce soft, formed stools?

Hyperosmotic laxatives

265

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)

Saline Cathartics

266

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)

267

Which drug activates Cl C-2 channels?

lubiprostone (Amitiza)

268

What is the most common AE associated with lubiprostone?

nausea

269

List some other AE associated with lubiprostone:

  • abdominal pain
  • no serious problems with diarrhea or electrolyte imbalance
270

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)

271

Which macrolide antibiotic is a motilin agonist (prokinetic agent)?

Erythromycin

272

True or False: Erythromycin works by stimulating interdigestive waves of gastrointestinal motility (migrating motor complexes).

True

273

List some common SE associated with erythromycin:

  • Abdominal or stomach cramping and discomfort
  • Diarrhea
  • Nausea or vomiting
274

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)

275

True or False: IBS is associated with serious damage to the GI tract.

False; no damage to the GI tract

276

List some common anticholinergic/antispasmodic agents used to control diarrhea:

  • dicyclomine
  • chlordiazepoxide/clidinium
  • hyoscyamine
277

What is the brand name of dicyclomine?

Bentyl

278

What is the brand name of chlordiazepoxide/clidinium?

Librax

279

What are some brand names of hyoscyamine?

  • Levbid
  • Levsin
  • NuLev
280

Anticholinergic/antispasmodic agents control diarrhea by blocking which receptors?

M3

281

What is the chlordiazepoxide useful for in Librax?

BZD (anxiolytic)

282

What is the clidinum useful for in Librax?

muscular receptor blocker

283

Which component of Lomotil is an opioid mu receptor agonist (reduces the release of ACh)?

Diphenoxylate

284

The atropine portion of Lomotil reduces motility/secretion by blocking what?

M3 receptors

285

Which drug is a 5-HT3 antagonist used to treat IBS with severe diarrhea?

Alosetron

286

What is the brand name of alosetron?

Lotronex

287

Which drug is a 5-HT4 agonist used to treat IBS with constipation?

Tegaserod

288

What is the brand name of tegaserod?

Zelnorm

289

Alosteron (Lotronex) is only indicated in which patients?

Women (IBS with severe diarrhea)

290

Tegaserod (Zelnorm) was originally recalled due to an increased risk of what?

heart attack and stroke

291

There are how many microorganisms in the gut?

1014 (100 trillion)

292

True or False: In IBS, there is a disruption of harmony in the gut (related to microflora).

True

293

Which drugs enhance the epithelial barrier by helping prevent the colonization of pathogenic organisms?

Probiotics

294

True or False: Probiotics help the immune system.

True

295

Which drug is a semi-synthetic antibiotic that inhibits bacterial DNA-dependent RNA polymerase, poorly absorbed?

Rifaximin (Xifaxan)

296

Rifaximin (Xifaxan) is indicated for the treatment of which diarrhea?

Traveler's diarrhea

297

Rifaximin (Xifaxan) is also indicated for the risk reduction for what?

hepatic encephalopathy

298

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?

2 weeks

299

Which drug used for IBS-C activates GC-C receptors?

linaclotide

300

What is the brand name of linaclotide?

Linzess

301

Which drugs are most important in treating N/V?

5-HT3 receptor antagonists

302

Protective reflexes or biological defense mechanisms that remove toxic or harmful substances from the body after ingestion refers to what?

Vomiting (emesis)

303

Which nerve has a strong influence on the vomiting center and can therefore be referred to as the "nausea nerve"?

Vagus nerve

304

What creates the neural connection between vomiting center and CTZ?

NTS

305

Which histamine antagonists are used in the treatment of nausea and vomiting?

H1 receptor antagonists

306

What is a 1st generation H1 receptor antagonist used for N/V?

diphenhydramine

307

What are some 2nd generation H1 antagonists used in the treatment of N/V?

  • loratadine
  • cetirizine
308

What is a 3rd generation H1 antagonist used in the treatment of N/V?

Fexofenadine

309

H1 antagonists acting on endothelial cells leads to the release of what?

NO --> causing vasodilation

310

Which generation of H1 antagonists are non-selective and bind to multiple receptors therefore increasing the risk of AE?

1st generation

311

1st generation H1 antagonists do NOT act on which receptors?

  • DA
  • H2
    • does not help with the reduction of acid secretion
312

Motion sickness mediated N/V primarily is associated with which receptors?

  • H1
  • M1
313

Which drug is also known as "truth serum" if injected?

Scopalamine

314

List some common phenothiazines used in treating N/V:

  • promethazine
  • chlorpromazine
  • prochlorperazine
315

Which phenothiazine is a H1 receptor antagonist with some M antagonist activity, weak D2 antagonist?

Promethazine

316

What is the brand name of promethazine?

Phenergan

317

Which phenothaizines used to treat N/V are D2 antagonists?

  • chlorpromazine
  • prochlorperazine
318

What is the brand name of chlorpromazine?

Thorazine

319

What is the brand name of prochlorperazine?

Compazine

320

H1 receptor antagonists block N&V through the what?

NTS (and possibly CTZ)

321

D2 receptor antagonists block N&V through the what?

CTZ

322

Which drug blocks D2 receptors in the CTZ and is considered an anti-emetic?

Metoclopramide

323

What is the brand name of Metoclopramide?

Reglan

324

List some indications for metoclopramide:

  • GERD
  • Diabetic gastroparesis
  • N/V
325

List the 3 ways 5HT3 antagonists work to treat N/V:

  1. Blocking 5-HT3 in stomach/SI --> inhibits the vagal and sympathetic afferents from sending their signals to the NTS
  2. Blocking 5HT3 in the CTZ --> inhibits the CTZ from sending signals to the NTS
  3. Blocking 5HT3 in the NTS --> inhibits the NTS from signaling the vomiting (emetic) center
326

What is the brand name of ondansetron?

Zofran

327

What is the brand name of granisetron?

Kytril

328

What is the brand name of palonosetron?

Aloxi

329

What is the brand name of dolasetron?

Anzemet

330

True or False: 5-HT3 antagonists are safe, well-tolerated, and have few AE.

True

331

NK1 receptor antagonists are particularly used to treat which N/V?

Chemotherapy-Induced N&V (CINV)

332

NK1 receptors are associated with which neurocrine hormone?

Sub P

333

List some common NK1 receptor antagonists used to treat N/V:

  • aprepitant
  • fosaprepitant
334

What is the brand name of aprepitant?

Emend

335

Which NK1 receptor antagonist comes in an injection formulation?

fosaprepitant

336

List some common AE associated with NK1 receptor antagonists:

  • fatigue
  • constipation
  • diarrhea
  • headache
337

What is a common corticosteroid that may be used to treat N/V?

Dexamethasone

338

True or False: The MOA of corticosteroids having an anti-emetic effect is unknown.

True

339

What is used prophylactically for CINV when other agents not effective?

Synthetic marijuana

340

Which drug is synthetic THC?

Dronabinol

341

What is the brand name of dronabinol?

Marinol

342

Which drug is similar in structure to dronabinol, but is more potent?

Nabilone

343

What is the brand name of nabilone?

Cesamet

344

Both dronabinol and nabilone affect which receptors in the brain and GI system?

CB1

345

True or False: CB1 receptors are one of the most common Gi coupled receptors in the brain.

True

346

The CB2 receptor is mostly important in what system?

immune system

347

Cannabis/Synthetic Cannabinoids reduce the ability of which neurotransmitters to induce N/V?

  • DA
  • 5-HT
348

List some SE associated with cannabis/synthetic cannabinoids:

  • Complex effects on CNS
    • a central sympathomimetic effect (tachycardia)
    • mood changes
    • euphoria
    • paranoid reactions
    • withdrawal reaction following abrupt D/C
349

CB1 receptors are located in which centers associated with N/V?

  • CTZ
  • NTS
  • Vomiting center
350

In the ENS, CB1 inhibits the release of what?

ACh (therefore inhibiting movement)

351

CB1 is believed to effect the release of what from EC cells?

5-HT

352

True or False: Overall, the anti-emetic effect related to cannabis and synthetic cannabinoids is likely to be CNS related.

True

353

Which drug is a non-selective D2 receptor antagonist used off-label for CINV and PONV?

Olanzapine (non-selective --> blocks many different receptors)

354

What is the brand name of olanzapine?

Zyprexa

355

Olanzapine (Zyprexa) is an antipsychotic used in the treatment of which disorders?

  • schizophrenia
  • bipolar disorder