B5 GI-Renal Pharmacology Final Exam with Correct Answers

B5 GI-Renal Pharmacology Final Exam Promoters of Gastric Acid Secretion - - Ach from vagus n (PS) - Hist from enterochromaffin-like (ECL) cells - Gastrin from G cells Inhibitors of Gastric Acid Secretion - - Somatostatin from delta cells - PGE2 from gastr muc Pathophysiology & Common Sx of GERD - AKA acid reflux, heartburn - Pathophys = stom cont/gastr ac reflux into esoph --> sx+complics; maybe by decr LES press/musc tone --> treat by 1). incr LES press, 2). decr stom ac secr - Common Sx = heartburn, hypersal, ac regurg, acidic taste Alarm Sx & Complications of GERD - - Alarm sx = CP, dysphag, odynoph, anemia, GIB, wt loss - Complics = esoph eros, strics, bl, Barrett's esoph, adenocarc (rare) 2 Types of GERD - - Eros reflux dis = sx w/ muc dam - Non-eros reflux dis (NERD) = sx w/o muc dam Foods/Beverages Worsening GERD Sx by Decr LES Pressure - - fatty meal - carminatives (ie. peppermint, spearmint) - choc - coffee, cola, tea - garlic - onions - chili peppers - EtOH esp wine Meds Worsening GERD Sx by Decr LES Pressure - - Antichols - Barbs - Caffeine - Dihydropyridine CCBs - Dopa - Estrogen - Nic - Nitrates - Progesterone - Tetracyc - Theophylline Foods & Drugs Worsening GERD Sx by being Direct Irritants to Esophageal Mucosa - - Spicy foods - Orange juice - Tomato juice - Coffee - Tobacco B5 GI-Renal Pharmacology Final Exam - Asp - Bisphosphonates - NSAIDs - Fe - Quinidine - Potassium chloride Non-pharmacological Treatments for GERD - - Lifestyle mods = wt loss if overwt; elev head of bed, avoid meals >2-3hr before bed if nocturnal sx; psych stress red; avoid smoking, trig foods+meds - Surg = laparoscopic fundoplic, gastric bypass in obes gen not rec if not resp to PPIs Pharmacologic Treatment Options for GERD - - Antacids --> neutr stom ac - Hist-2 R Antags (H2RAs, ie. Cimetidine) --> block H2 rec basolat memb --> (-) adenylyl cyclase, (-) cAMP --> (-) prot pump activ - PPIs (ie. Omeprazole) --> prev ac secr by dir block H+ chann - Sucralfate & Bismuth comps --> prot coat over ulcers - Misoprostol --> stim PGE2 rec --> (+) Gi prot --> (-) AC & cAMP Pharmacological Treatment Guidelines for GERD - - initial self-treat w/ OTC antac/PPI/H2RA - further treat if alarm sx, recur sx >2wks lifestyle mods/self-treat - Pref empir ther = 8wks PPI QD - Maint/Cont ther if recur sx >8wks PPI/eros esoph/BE --> PPI BID if unresp to QD, H2RA if NERD but less effec than PPI