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A comprehensive review of key concepts and answers for pharmacology module 7, focusing on the digestive system and related medications. It covers topics such as the release of gastric hormones and enzymes, the causes and treatment of peptic ulcers and gerd, and the mechanisms of action of various medications used in gastrointestinal disorders. Particularly useful for students studying pharmacology or related healthcare fields.
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This exam fully covers all the topics and units in module 7 of BIOD 351 PHARMACOL0GY PORTAGE LEARNING 100% GUARANTEED PASS WITH ALL KEY CONCEPTS OVER 100 QUESTIONS WITH DETAILED ANSWERS BIOD351 (FORMERLY NURS251) PHARMACOLOGY NURS 251 Portage Learning Pharmacology Module 7 Where is histamine released from? Enterochromaffin- like cells (ECL cells). Where is gastrin released from? The G cells. What are the three major neurotransmitters which stimulate the release of Pepsin and HCI? Acetylcholine, gastrin, and histamine.
What chemical mediator is stimulated by the ingestion of food? ACH, which then binds to the receptors on the Chief cells, G-cells, ECL cells, and Parietal cells. What is the cascade response from ACH acting on all these cells? They each release different chemicals as a result of being stimulated by ACH Chief cells - Pepsin G- cells - Gastrin - Gastrin then acts on ECL and Parietal cells ECL cells- Histamine - Histamine then acts on Parietal cells Parietal Cells- HCI What cells does the gastrin act on after being released by the G-cells? It act on the ECL cells and the Parietal cells to release more of their own chemicals, Histamine, and HCI respectively. What cells does histamine act on after being released by the ECL cells? It acts on the Parietal cells to release from HCI.
What is different about the pain response to food between people with stomach ulcers and duodenum ulcers? Food relieves the pain for those with ulcers in the duodenum but has the opposite effects for those with ulcers in the stomach. What is Gastrointestinal Esophageal Reflux Disease (GERD)? It is characterized primarily by the presence of heartburn (painful burning behind the sternum). What causes heartburn? It occurs when stomach acid backs up into the esophagus. The lower esophageal sphincter (LES) loosens and allows gastric acids to go back up into the esophagus. What are the symptoms of GERD? It goes beyond occasional heartburn, ongoing problem often occurring after meals upon lying down. Severe cases can lead to blood loss due to chronic injury to the esophagus. How will a provider treat a peptic ulcer that is caused by the bacteria H. Pylori?
It is commonly treated with either triple therapy, or quadruple therapy depending on severity of symptoms, patient, and provider. What is triple therapy? It is the more common of the two therapies and includes two antibiotics (Amoxicillin, tetracycline, metronidazole, and clarithromycin) + a bismuth salt (Pepto Bismol, and Kaopectate). What does the bismuth salt do as a part of triple therapy? The bismuth salt treatment helps disrupt the bacteria cell wall to prevent further binding. What is quadruple therapy? Is the same as triple therapy except the provider adds a proton pump inhibitor. How long is the treatment regimen for peptic ulcers caused by the bacteria H. Pylori? 8 weeks.
Misoprostol (only synthetic prostaglandin available). How does Misoprostol work? It works by inhibiting histamine counteracting the NDSAID inhibition of prostaglandin synthesis. It is reserved for patients who are at high risk of developing ulcers who must be on NSAID's for a short period of time. What are two things to keep in mind about Misoprostol? It has not been shown to be effective at preventing ulcers in patients who are on chronic NSAID therapy. It is also contraindicated for patients who are pregnant (causes uterine contractions). What are the treatment recommendations for patients with GERD? Drug regimens along with lifestyle changes to help with symptom management. What are the organs of the upper gastrointestinal tract? The mouth, pharynx, esophagus, stomach, duodenum. They work to digest food and absorb nutrients from the digested food.
Where are the hormones and enzymes that help in the digestion process released into? The stomach and the duodenum. What are the two main gastric juices that we need to be aware of? Hydrochloric acid and Pepsin. What does HCI do to help digest food? It aids in the breakdown of food What does Pepsin do to help digest food? It is the primary digestive enzyme and breaks down proteins and polypeptides. Where is pepsinogen released from? The chief cells in the gastric glands.
They work by competitively inhibiting histamine from binding to H receptors in the GI mucosa, resulting in a reduction in the secretion of acid and pepsin. It is used in the short term for benign ulcers and duodenal ulcers, GERD, stress ulcers, gastric irritation for patients who must remain on NSAID therapy. What are some examples of H2 receptor antagonists? Cimetidine Famotidine Nizatidine Ranitidine What are the adverse events for H2 receptor antagonists? headache, constipation, as well as confusion and disorientation for Cimetidine. Cimetidine also interacts with the metabolism of many other drugs while Famotidine and nizatidine does not. No food interactions. What are proton pump inhibitors? They inhibit the exchange of hydrogen and potassium via ATPase exchange which is essential to the production of HCI. They are first line for ulcers. They can be used for both bacterial and acid ulcers. H2 receptor antagonists are only used for ulcer patients who cannot tolerate PPIs.
What are some examples of PPIs? Omeprazole (Prilosec) Lansoprazole (Prevacid) Rabeprazole (Aciphex) Pantoprazole (Protonix) - Rx and GERD only Esomeprazole (Nexium) - GERD and Rx only Dexlansoprazole (Dexilant) - GERD and Rx only What are the drug interactions associated with PPIs? Omeprazole (Prilosec OTC) increases levels of Warfarin, certain seizure medications are effected by Prilosec, it also decreases antiplatelet effects of clopidorgel. All of the PPIs, not just prilosec, do affect absorption of drugs that require and acidic environment. What are the adverse events associated with PPI's? Headache, abdominal pain, diarrhea, nausea, constipation, and with long term use - osteoporosis. Is has also been shown that long term use can lead to GI infections because some of the acid mediated antimicrobial effect is taken away because of the lack of HCI being released.
What is meant by the term peristalsis? It is wavelike movements of the intestines which propel contents toward the rectum. What happens when the digested food reaches the colon? Water and minerals are removed and the remaining waste is compressed into feces. What is diarrhea? Abnormal looseness of the stool or water stool which may be accompanied by a change in stool volume or frequency or both. What is constipation? Frequency of defecation occurs less often than usual or the consistency makes it difficult to defecate. What is IBS?
It is a functional disorder of the colon associated with abdominal pain, cramping, bloating, diarrhea and/or constipation. What is meant by acute diarrhea? It is self limiting (less than 14 days); resolves without complications. What is meant by chronic diarrhea? (longer than 30 days) Large amounts of water and electrolytes are lost leading to dehydration and electrolyte imbalance. What are the common causes of diarrhea? Micro-organisms, side effect of drug therapy, or other contributing medical problems like IBS or Crohn's disease. How do microorganisms cause diarrhea? They invade the GI tract and cause inflammation and irritation. This increases bowl motility in an attempt to eliminate the bacteria. The treatment centers around antibiotics.
Bismuth subsalicylate (Pepto-Bismol) can increase bleeding, constipation, dark stools, confusion, ringing in ears, and metallic taste. What are the drug interactions associated with adsorbent drugs? They are decrease the absorption of other drugs such as digoxin, and hypoglycemic drugs. Warfarin's effects are increased. It is recommended to not take this with food or other drugs that you want to be absorbed into the body. How do anticholinergics work as antimotility drugs against diarrhea? They work by slowing peristalsis by reducing the contractions of the smooth muscle tone in the GI tract. They also dry gastric secretions. Two examples are atropine, hyoscyamine. What are some adverse effects associated with anticholinergic antimotility drugs? They cause urinary retention, impotence, headache, dizziness, anxiety, drowsiness, decrease in heart rate/ blood pressure, dry skin, and blurred vision.
What are some drug interactions with anticholinergics? Antacids decrease their effects. How do opiates work as antimotility drugs? They work on the smooth muscles of the GI tract by inhibiting motility and GI propulsion. Some examples are diphenoxylate with atropine (Lomotil - for more serious conditions), and loperamide (Imodium). What are the adverse effects associated with the antimotility opiates? Drowsiness, dizziness, lethargy, constipation, nausea/ vomiting, low blood pressure, respiratory depression What are the drug interactions for opiate antimotility medication? additive CNS depressant when combined with other depressants such as alcohol, opioids, sedative hypnotics, antipsychotics, and skeletal muscle relaxants. What are probiotics and how are they used to treat diarrhea?
What are some metabolic and endocrine disorders that cause constipation? Diabetes, hypothyroidism, pregnancy, hypercalcemia, hypokalemia. What are some neurogenic disorders that can cause constipation? Neuropathy in the GI tract, MS, Parkinson's disease, spinal cord lesions, strokes. What are the five common drug therapies used to treat constipation? Bulk forming (only class safe for long term use and doesn't lead to dependence), emollient, hyperosmotic, saline, and stimulants. What are bulk forming laxatives? They work similarly to natural fiber by absorbing water into the intestines. They increase bulk, distend the bowel, and promote bowel movement. Some examples are psyllium husk fiber, and methylcellulose. They are used for acute constipation, or to help those with chronic issues or issues from IBS.
What are some adverse effects associated with bulk forming laxatives? Fluid disturbances, electrolyte imbalances, gas, esophageal blockage What are some drug interactions associated with bulk forming laxatives? Decrease in absorption of antibiotics and digoxin, tetracycline, and warfarin. What are stool softener emollients? They work by lowering the surface tension of GI fluids so that more water and fat are absorbed into the stool and intestines. An example is docusate salts (Docusate sodium or calcium). What are the adverse effects and drug interactions associated with emollient? Stomach pain, diarrhea, and cramping, with no known drug interactions. What are the common uses for stool softener emollients? To relieve acute constipation or to help relieve fecal impaction.