GI Pharmacology and Therapeutics Quiz
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Questions and Answers

What is the definition of GERD?

GERD is caused by the retrograde movement of stomach contents into the esophagus due to lower esophageal sphincter (LES) dysfunction.

Which of the following are symptoms of GERD? (Select all that apply)

  • Chest Pain (correct)
  • Regurgitation (correct)
  • Heartburn (correct)
  • Chronic Cough (correct)
  • Laryngitis (correct)

    • What are some risk factors for GERD? (Select all that apply)

  • Smoking (correct)
  • Pregnancy (correct)
  • Citrus
  • Caffeine
  • Obesity (correct)
  • Chocolate
  • Alcohol Use (correct)
  • Spicy Foods

    • Which of the following medications are used to manage GERD?

    <p>Calcium Channel Blockers (A), NSAIDS (B), Bisphosphonates (C)</p> Signup and view all the answers

    What are some lifestyle modifications that can help manage GERD?

    <p>Weight Loss (B), Avoiding Late Meals (C), Reducing Triggers (D), Elevating Head of Bed (E)</p> Signup and view all the answers

    What is the first-line medication for moderate to severe GERD symptoms?

    <p>PPIs (B)</p> Signup and view all the answers

    Long-term PPI use is recommended for all cases of GERD?

    <p>False (B)</p> Signup and view all the answers

    What is the mechanism of action of antacids?

    <p>Antacids neutralize stomach acid.</p> Signup and view all the answers

    Which of the following are examples of antacids? (Select all that apply)

    <p>Tums (B), Mylanta (E), Maalox (F)</p> Signup and view all the answers

    What is the mechanism of action of H2 Receptor Antagonists (H2 Blockers)?

    <p>H2 Blockers block histamine on parietal cells, reducing acid production.</p> Signup and view all the answers

    Which of the following are examples of H2 Receptor Antagonists (H2 Blockers)? (Select all that apply)

    <p>Famotidine (B), Ranitidine (C), Tagamet (E), Pepcid (G)</p> Signup and view all the answers

    What is the mechanism of action of Proton Pump Inhibitors (PPIs)?

    <p>PPIs irreversibly inhibit the H+/K+ ATPase (proton pump) in parietal cells, reducing acid production.</p> Signup and view all the answers

    Which of the following are examples of PPIs? (Select all that apply)

    <p>Prilosec (A), Protonix (B), Esomeprazole (C), Omeprazole (D), Lansoprazole (E), Nexium (F), Pantoprazole (G), Prevacid (H)</p> Signup and view all the answers

    What is the mechanism of action of prokinetic agents?

    <p>Prokinetic agents improve motility and LES tone, promoting gastric emptying.</p> Signup and view all the answers

    Which of the following are examples of prokinetic agents? (Select all that apply)

    <p>Domperidone (A), Metoclopramide (B), Erythromycin (C), Reglan (D)</p> Signup and view all the answers

    What is the definition of peptic ulcer disease (PUD)?

    <p>Peptic ulcers are mucosal erosions in the stomach or duodenum due to acid-pepsin activity.</p> Signup and view all the answers

    What are the main causes of peptic ulcer disease (PUD)? (Select all that apply)

    <p>Zollinger-Ellison Syndrome (A), H. pylori infection (B), NSAID use (C), Stress (D)</p> Signup and view all the answers

    What are some complications of peptic ulcer disease (PUD)? (Select all that apply)

    <p>Bleeding (A), Gastric outlet obstruction (B), Perforation - a hole in the lining of the stomach or duodenum (C)</p> Signup and view all the answers

    H. pylori testing is recommended for all patients diagnosed with PUD.

    <p>True (A)</p> Signup and view all the answers

    Which of the following are management guidelines for PUD? (Select all that apply)

    <p>Use PPI prophylaxis in patients on long-term NSAIDs (A), Avoid smoking and alcohol (B), Discontinue NSAIDs if possible (C), Switch to COX-2 inhibitors if necessary (D), Maintain a healthy weight (E)</p> Signup and view all the answers

    What is the function of the gastric acid pump?

    <p>The gastric acid pump actively secretes hydrogen ions (H+) into the stomach, combining with chloride ions (Cl-) to form HCl.</p> Signup and view all the answers

    What are the main stimulants that activate the gastric acid pump? (Select all that apply)

    <p>Gastrin (A), Acetylcholine (D), Histamine (E)</p> Signup and view all the answers

    What is the mechanism of action of PPIs?

    <p>PPIs inhibit the H+/K+ ATPase enzyme in gastric parietal cells, reducing stomach acid production.</p> Signup and view all the answers

    What are some common medications for GERD, Peptic Ulcer Disease, Zollinger-Ellison Syndrome, and NSAID-induced ulcers? (Select all that apply)

    <p>Nexium (A), Lansoprazole (B), Esomeprazole (E), Omeprazole (G), Prevacid (H), Prilosec (I), Protonix (K), Pantoprazole (L)</p> Signup and view all the answers

    What are some adverse effects of PPIs? (Select all that apply)

    <p>Potential kidney injury (A), B12 deficiency (B), Hypomagnesemia (C), C. difficile infection (D), Increased risk of fractures (E)</p> Signup and view all the answers

    When should the lowest effective dose of a PPI be used?

    <p>All of the above (D)</p> Signup and view all the answers

    Long-term PPI use in patients without a clear indication is recommended.

    <p>False (B)</p> Signup and view all the answers

    What is the mechanism of action for histamine H2 blockers?

    <p>Histamine H2 blockers block histamine H2 receptors on gastric parietal cells, decreasing acid secretion.</p> Signup and view all the answers

    Which of the following are common medications for histamine H2 blockers? (Select all that apply)

    <p>Nizatidine (A), Ranitidine (B), Cimetidine (C), Famotidine (D), Zantac (E)</p> Signup and view all the answers

    What are the indications for histamine H2 blockers? (Select all that apply)

    <p>Nocturnal Acid Suppression (A), Mild Heartburn (B), Peptic Ulcer Disease (C), GERD (D)</p> Signup and view all the answers

    Which of the following adverse effects are associated with cimetidine? (Select all that apply)

    <p>Drug interactions via CYP450 inhibition (A), Gynecomastia (B), CNS effects in elderly patients with renal impairment (C), Rare dizziness (D), Headaches (E)</p> Signup and view all the answers

    What are the prescribing pearls for H2 blockers? (Select all that apply)

    <p>Combine with PPIs for breakthrough nighttime symptoms (A), Preferred for on-demand relief of symptoms (B), Use cautiously in elderly patients (C), Adjust dose in renal impairment (D)</p> Signup and view all the answers

    Match the features of PPIs and H2 blockers.

    <p>PPIs = Fractures, C. diff risk H2 Blockers = CNS effects in elderly</p> Signup and view all the answers

    What is the mechanism of action for histamine H2 blockers (e.g., ranitidine, famotidine)?

    <p>Histamine H2 blockers inhibit histamine receptors on parietal cells, decreasing acid secretion.</p> Signup and view all the answers

    For which conditions are H2 blockers effective? (Select all that apply)

    <p>Occasional heartburn (A), Mild GERD (B), Nocturnal acid suppression (C), Duodenal ulcers (short-term use) (D)</p> Signup and view all the answers

    What are the advantages of H2 blockers?

    <p>H2 blockers have a faster onset of action (30-60 minutes), and are generally less potent than PPIs.</p> Signup and view all the answers

    What is the dosage example of famotidine for GERD?

    <p>Famotidine 20 mg BID or 40 mg QHS for GERD.</p> Signup and view all the answers

    What is the mechanism of action for proton pump inhibitors (e.g., omeprazole, pantoprazole)?

    <p>Proton pump inhibitors irreversibly inhibit H+/K+ ATPase, suppressing gastric acid production.</p> Signup and view all the answers

    For which conditions are PPIs first-line treatment? (Select all that apply)

    <p>Erosive esophagitis (A), Zollinger-Ellison syndrome (B), Peptic ulcer disease (PUD) (C), Severe GERD (D)</p> Signup and view all the answers

    PPIs are effective in treating H. pylori-associated ulcers?

    <p>True (A)</p> Signup and view all the answers

    What are the advantages of PPIs?

    <p>PPIs provide longer-lasting acid suppression (up to 24 hours).</p> Signup and view all the answers

    What is the dosing example for omeprazole?

    <p>Omeprazole 20 mg QD, 30 minutes before breakfast.</p> Signup and view all the answers

    What are some key prescribing points for H2 Blockers? (Select all that apply)

    <p>Tailor therapy duration (B), Short-term or as-needed use for mild/moderate cases (C)</p> Signup and view all the answers

    What are some key prescribing points for PPIs? (Select all that apply)

    <p>Long-term or severe cases (A), Prescribe before meals for maximum effectiveness (B), Consider tapering to avoid rebound acid hypersecretion (C), Tailor therapy duration (e.g., 8 weeks for GERD, lifelong for Zollinger-Ellison syndrome) (D)</p> Signup and view all the answers

    A 45-year-old man presents with occasional heartburn, especially after large meals. He has no history of esophageal injury or ulcer. Which medication would you prescribe?

    <p>Famotidine 20 mg once or twice daily as needed.</p> Signup and view all the answers

    A 60-year-old woman has been diagnosed with erosive esophagitis confirmed by endoscopy. What is the best treatment?

    <p>Omeprazole 20-40 mg QD for 8 weeks.</p> Signup and view all the answers

    A 50-year-old man with a history of GERD takes famotidine but reports persistent symptoms that wake him up at night. What is the next step?

    <p>Switch to a PPI, such as esomeprazole 20-40 mg QD before breakfast.</p> Signup and view all the answers

    A patient with peptic ulcer disease caused by H. pylori is starting treatment. Which medication should be included?

    <p>Pantoprazole 40 mg BID as part of triple therapy.</p> Signup and view all the answers

    A 35-year-old man asks for advice on managing his nighttime GERD symptoms. He has already tried lifestyle modifications. Which option is best?

    <p>Famotidine 20 mg QHS or as needed.</p> Signup and view all the answers

    What is the definition of antacids?

    <p>Antacids are over-the-counter medications that neutralize gastric acid, providing symptomatic relief from heartburn and dyspepsia.</p> Signup and view all the answers

    What are the key factors of antacids? (Select all that apply)

    <p>Side effects (A), Rapid onset of action (B), Neutralizing capacity (D)</p> Signup and view all the answers

    What is the mechanism of action of sodium bicarbonate?

    <p>Sodium bicarbonate reacts with gastric acid to produce carbon dioxide and sodium chloride, rapidly increasing gastric pH.</p> Signup and view all the answers

    What is the mechanism of action of calcium carbonate?

    <p>Calcium carbonate neutralizes gastric acid, producing calcium chloride and CO2.</p> Signup and view all the answers

    What is the mechanism of action of magnesium hydroxide?

    <p>Magnesium hydroxide neutralizes gastric acid without producing CO2.</p> Signup and view all the answers

    What is the mechanism of action of aluminum hydroxide?

    <p>Aluminum hydroxide neutralizes gastric acid and may bind bile salts, offering some protection to the gastric mucosa.</p> Signup and view all the answers

    What is the purpose of combination products in antacids?

    <p>Combination products combine magnesium (to offset constipation) and aluminum (to offset diarrhea) for balanced effects.</p> Signup and view all the answers

    What are the main categories of medications used for treating gastrointestinal disorders?

    <p>The main categories of medications used for treating gastrointestinal disorders are antacids, PPIs, H2 Blockers, prokinetic agents, and anti-diarrheals.</p> Signup and view all the answers

    Match the features of different medication categories with their respective characteristics.

    <p>Antacids = Tums, Maalox PPIs = Omeprazole, Pantoprazole H2 Blockers = Famotidine, Ranitidine</p> Signup and view all the answers

    What is the definition of anti-diarrheal medications?

    <p>Anti-diarrheal medications are used to reduce the frequency and urgency of bowel movements, manage dehydration, and improve patient comfort in various diarrheal conditions.</p> Signup and view all the answers

    What are the common conditions treated with anti-diarrheal medications? (Select all that apply)

    <p>Diarrhea from short bowel syndrome or malabsorption (A), Acute non-infectious diarrhea (B), Traveler's diarrhea (C), Radiation- or chemotherapy-induced diarrhea (D), Chronic diarrhea (E), Diarrhea from inflammatory bowel disease (IBD) (F)</p> Signup and view all the answers

    What is the mechanism of action for opiate receptor agonists?

    <p>Opiate receptor agonists activate mu-opioid receptors in the GI tract, slowing intestinal motility and allowing more time for water absorption.</p> Signup and view all the answers

    Which of the following are examples of opiate receptor agonists? (Select all that apply)

    <p>Lomotil (A), Loperamide (B), Imodium (C), Diphenoxylate/Atropine (D)</p> Signup and view all the answers

    What is the mechanism of action for bile acid binders?

    <p>Bile acid binders bind bile acids in the gut, reducing their diarrheal effect.</p> Signup and view all the answers

    Which of the following are examples of bile acid binders? (Select all that apply)

    <p>Colestipol (A), Cholestyramine (B)</p> Signup and view all the answers

    What is the mechanism of action for antisecretory agents?

    <p>Antisecretory agents reduce intestinal fluid secretion.</p> Signup and view all the answers

    Which of the following are examples of antisecretory agents? (Select all that apply)

    <p>Pepto-Bismol (A), Bismuth Subsalicylate (B), Octreotide (C)</p> Signup and view all the answers

    What is the mechanism of action for mixed mechanism agents?

    <p>Mixed mechanism agents act on opioid receptors (mu and kappa agonist, delta antagonist) to reduce bowel motility.</p> Signup and view all the answers

    Which of the following is an example of a mixed mechanism agent? (Select all that apply)

    <p>Eluxadoline (A), Viberzi (B)</p> Signup and view all the answers

    Study Notes

    GI Pharmacology and Therapeutics

    • GERD is caused by the retrograde movement of stomach contents into the esophagus due to lower esophageal sphincter (LES) dysfunction.
    • Symptoms include heartburn, regurgitation, chest pain, chronic cough, and laryngitis.
    • Risk factors include obesity, smoking, alcohol use, dietary triggers (spicy foods, caffeine, citrus, chocolate), and pregnancy.
    • Medications like NSAIDs, calcium channel blockers, and bisphosphonates can contribute to GERD.
    • Guidelines for management include lifestyle modifications (weight loss, elevating head of bed, avoiding late meals, reducing triggers), a step-up therapy approach starting with H2 blockers for mild cases and progressing to PPIs for moderate to severe symptoms, and maintenance therapy involving long-term PPI use only for severe erosive esophagitis or Barrett's esophagus.
    • Medication choice depends on symptom severity and frequency.

    Antacids

    • Mechanism: Neutralize stomach acid.
    • Examples: Tums (calcium carbonate), Maalox, Mylanta.
    • Best use: Mild and occasional heartburn; short-term relief.
    • Limitations: Not suitable for chronic/severe GERD, may interfere with medication absorption.

    H2 Receptor Antagonists (H2 Blockers)

    • Mechanism: Block histamine on parietal cells, reducing acid production.
    • Examples: Famotidine (Pepcid), Ranitidine (withdrawn), Cimetidine (Tagamet).
    • Best use: Mild to moderate GERD symptoms; effective for nocturnal acid suppression.
    • Limitations: Tolerance develops with long-term use, less effective than PPIs for healing esophagitis.

    Proton Pump Inhibitors (PPIs)

    • Mechanism: Irreversibly inhibit H+/K+ ATPase in parietal cells, reducing acid production.
    • Examples: Omeprazole (Prilosec), Esomeprazole (Nexium), Pantoprazole (Protonix), Lansoprazole (Prevacid).
    • Best use: First-line for moderate to severe GERD and erosive esophagitis; long-term control in chronic GERD.
    • Limitations: Takes 1-4 days for full effect; long-term use risks include vitamin B12 deficiency, hypomagnesemia, osteoporosis, and increased risk of infections.

    Prokinetic Agents

    • Mechanism: Improve motility and LES tone, promoting gastric emptying.
    • Examples: Metoclopramide (Reglan), Domperidone (not available in all countries).
    • Best Use: Adjunct in GERD with delayed gastric emptying.
    • Limitations: Metoclopramide has significant side effects (e.g., tardive dyskinesia).

    Alginates

    • Mechanism: Form a viscous barrier that floats on stomach contents, reducing reflux.
    • Examples: Gaviscon.
    • Best Use: Adjunct for symptomatic relief in mild GERD.

    Peptic Ulcer Disease (PUD)

    • Definition: Mucosal erosions in the stomach or duodenum due to acid-pepsin activity.
    • Causes: H. pylori infection, NSAID use, stress, Zollinger-Ellison Syndrome.
    • Complications: Bleeding, perforation, gastric outlet obstruction.
    • Management: H. pylori testing, PPI prophylaxis in patients on long-term NSAIDs, discontinue NSAIDs if possible, switch to COX-2 inhibitors if required.
    • Treatment Principles: Reduce gastric acid to allow ulcer healing.

    Triple Therapy:

    • PPI + Amoxicillin + Clarithromycin
    • Duration: 10-14 days
    • Alternative for penicillin-allergic patients: Replace Amoxicillin with Metronidazole.

    Quadruple Therapy:

    • PPI + Bismuth subsalicylate + Metronidazole + Tetracycline
    • Duration: 10-14 days
    • Often used where clarithromycin resistance is high, or after failure of triple therapy.

    Gastric Acid Pump

    • Location: parietal cells of the stomach lining.
    • Function: actively secretes hydrogen ions (H+) into the stomach, combining with chloride ions (Cl-) to form hydrochloric acid (HCl).

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