Peptic Ulcer Disease and GI Drugs Lecture

Play an AI-generated podcast conversation about this lesson

What is the major defensive factor that protects the stomach and duodenum from self-digestion?

Bicarbonate

H. pylori

Nonsteroidal antiinflammatory drugs

Mucus (correct)

Where is ulceration most common in cases of peptic ulcer disease?

In the lesser curvature of the stomach and the duodenum (correct)

In the small intestine

In the greater curvature of the stomach

In the esophagus

What bacterium is primarily responsible for causing most cases of peptic ulcer disease?

Salmonella

Streptococcus

E. coli

Helicobacter pylori (correct)

Which condition can severe ulcers from peptic ulcer disease be complicated by?

Hemorrhage Signup and view all the answers

What serves the physiologic role of neutralizing any hydrogen ions that penetrate the mucus in the stomach and duodenum?

Bicarbonate Signup and view all the answers

What promotes healing and greatly reduces the chance of recurrence in peptic ulcer disease when eradicated?

Helicobacter pylori Signup and view all the answers

Which of the following is NOT considered a major aggressive factor in peptic ulcer disease?

Mucus Signup and view all the answers

What is the role of prostaglandins in the gastrointestinal mucosa?

Promote vasodilation to maintain submucosal blood flow Signup and view all the answers

Why is acid necessary for peptic ulcer formation?

Acid directly injures cells of the GI mucosa Signup and view all the answers

What is the primary cause of Zollinger-Ellison syndrome?

Tumor secreting gastrin Signup and view all the answers

What effect does smoking have on ulcer healing and recurrence?

Delays healing and increases recurrence risk Signup and view all the answers

What is the primary goal of drug therapy for peptic ulcers?

Relieve symptoms and prevent complications Signup and view all the answers

Why are antibiotics essential in the treatment of peptic ulcers with H.pylori infection?

To eradicate H.pylori and prevent recurrence Signup and view all the answers

What role do PPIs play in the treatment of PUD?

Reduce gastric acidity Signup and view all the answers

How do NSAIDs contribute to ulcer formation?

Inhibit prostaglandin biosynthesis and suppress mucosal defenses Signup and view all the answers

Why is eradication of H.pylori important for ulcer healing?

To minimize ulcer recurrence Signup and view all the answers

How do drugs promote ulcer healing?

By simply creating conditions conducive to healing Signup and view all the answers

What is the recommended treatment for NSAID-induced ulcers?

Any ulcer medication Signup and view all the answers

Which medication is preferred for treating NSAID-induced ulcers when the offending NSAID cannot be discontinued?

PPIs Signup and view all the answers

What is a method to evaluate ulcer healing according to the text?

Monitoring for relief of pain Signup and view all the answers

What is a non-optimal measure for antiulcer therapy based on the text?

Including dietary changes Signup and view all the answers

Which statement is true regarding alcohol consumption and peptic ulcers according to the text?

Alcohol has no effect on peptic ulcers Signup and view all the answers

Which antibiotic is mentioned as highly sensitive to H.pylori in the text?

Amoxicillin Signup and view all the answers

What is a potential side effect of bismuth therapy mentioned in the text?

Black coloration of the tongue and stool Signup and view all the answers

What is the primary cause of changes in the esophageal mucosa in gastroesophageal reflux disease (GERD)?

Contact of acid stomach contents with the esophageal mucosa Signup and view all the answers

Which factor is NOT mentioned as contributing to transient lower esophageal sphincter (LES) relaxation in severe GERD?

Acid indigestion Signup and view all the answers

What effect does a hiatal hernia have on the occurrence of transient lower esophageal sphincter (LES) relaxations?

Impairs acid emptying from the hernia sack Signup and view all the answers

Which symptom is often associated with severe gastroesophageal reflux disease (GERD)?

Barrett's esophagitis Signup and view all the answers

Why is referral considered for patients with esophageal reflux who do not respond to medications?

To rule out cancer and Barrett's esophagitis Signup and view all the answers

Which aspect is NOT considered when determining the severity of reflux in gastroesophageal reflux disease (GERD)?

Eating habits Signup and view all the answers

What is the principal function of the colon?

Absorb water and electrolytes Signup and view all the answers

What is one symptom that helps define constipation?

Excessive straining Signup and view all the answers

What is a common cause of constipation according to the text?

Dysfunction of the pelvic floor Signup and view all the answers

How do laxatives help patients with cardiovascular diseases?

By reducing the need for strain during defecation Signup and view all the answers

What is a contraindication for using laxatives according to the text?

Fecal impaction or bowel obstruction Signup and view all the answers

How can laxatives be beneficial as an adjunct to anthelmintic therapy?

By helping with stool sample analysis Signup and view all the answers

What is the first-line intervention in the management of GERD according to the text?

Elevating the head of the bed and avoiding meals before bedtime Signup and view all the answers

Why was ranitidine taken off the market in April 2020 as mentioned in the text?

Presence of cancer-causing substances in the tablet Signup and view all the answers

What is the next step in pharmacologic management for GERD patients after lifestyle and diet modifications with antacids?

Starting PPI therapy Signup and view all the answers

What is the main concern with prolonged use of PPIs for treating GERD as mentioned in the text?

Risk of hypomagnesemia and community-acquired pneumonia Signup and view all the answers

In pediatric patients with GERD, which medication types are available for treatment according to the text?

Antacids and PPIs Signup and view all the answers

What distinguishes a cathartic effect from a laxative effect as mentioned in the text?

Laxative effect refers to prompt bowel evacuation while catharsis is stool softening Signup and view all the answers

Which group of laxatives is especially useful when the bowel is being prepared for diagnostic procedures or surgery?

Group I Signup and view all the answers

Which laxative group consists of agents that produce a soft but formed stool within 1 to 3 days?

Osmotic laxatives Signup and view all the answers

Which laxative group widely used in patients with diverticulosis and irritable bowel syndrome consists of natural or semisynthetic polysaccharides and celluloses derived from grains and plant materials?

Surfactant laxatives Signup and view all the answers

Which category of laxatives is associated with the potential side effect of esophageal obstruction if swallowed without sufficient fluid?

Bulk-forming laxatives Signup and view all the answers

Laxative salts like sodium phosphate and magnesium hydroxide belong to which group of laxatives that draw water into the intestinal lumen to soften the fecal mass and stimulate peristalsis?

Group III Signup and view all the answers

Which laxative group, acting on the colon to produce a semifluid stool within 6 to 12 hours, is widely used yet has few legitimate applications?

Group II Signup and view all the answers

What is the primary mechanism of action of lubiprostone in promoting bowel movement?

Activating chloride channels Signup and view all the answers

Why are magnesium salts contraindicated in patients with kidney disease?

Magnesium can accumulate to toxic levels Signup and view all the answers

How does sodium phosphate contribute to acute renal failure in some patients?

Causing dehydration and lowering potassium levels Signup and view all the answers

What is the primary function of plecanatide in regulating intestinal fluid secretion?

Activating guanylate cyclase-C Signup and view all the answers

How do PEG-ELS bowel-cleansing solutions differ from sodium phosphate-based ones?

Do not alter water or electrolyte balance Signup and view all the answers

Why are sodium phosphate cleansers contraindicated in patients with cardiovascular disease?

They exacerbate heart failure and hypertension Signup and view all the answers

What is the mechanism of action of sodium phosphate as an osmotic laxative?

It softens and swells the fecal mass in the colon. Signup and view all the answers

How do sodium phosphate laxatives differ from PEG-ELS products in terms of adverse effects?

Sodium phosphate products can cause electrolyte imbalances and kidney damage. Signup and view all the answers

What is the purpose of drinking a large volume of clear fluid before, during, and after dosing with sodium phosphate products?

To prevent dehydration caused by the laxative. Signup and view all the answers

What is a potential severe adverse effect associated with sodium phosphate products?

Hyperphosphatemia leading to renal damage Signup and view all the answers

How does Prepopik differ from PEG-ELS products in preparing for colonoscopy?

Prepopik showed superior results in colon preparation compared to PEG-ELS. Signup and view all the answers

What caution should be taken with people using Prepopik or sodium phosphate products?

Use cautiously in individuals with reduced renal function. Signup and view all the answers

What misconception about bowel movements is highlighted in the text?

A daily bowel movement is necessary for good health. Signup and view all the answers

Why do people sometimes habitually self-prescribe laxatives according to the text?

'Tradition supported by advertising' has led to this habit. Signup and view all the answers

What can strong laxatives potentially do to the entire bowel?

Purge it completely Signup and view all the answers

What is one of the potential serious pathologic changes that can result from laxative abuse?

Electrolyte imbalance Signup and view all the answers

Why might a laxative user think that constipation has returned after taking strong laxatives?

As a result of the inability to replenish the bowel content immediately Signup and view all the answers

What is the recommended initial step to break the laxative habit?

Abrupt cessation of laxative use Signup and view all the answers

What effect can chronic exposure to laxatives have on defecatory reflexes?

Decrease in defecatory reflexes Signup and view all the answers

What should patients be informed about regarding bowel movements after abrupt cessation of laxative use?

Bowel movements will be absent for several days Signup and view all the answers

How does strong laxative use set the stage for a repeating cycle of purging according to the text?

By leading to the belief that constipation has returned Signup and view all the answers

What is a consequence of chronic exposure to laxatives in terms of reliance on them?

Increased reliance on laxatives for normal bowel function Signup and view all the answers

What is the primary function of the vomiting center located in the medulla oblongata?

To coordinate the expulsion of gastric contents during emesis Signup and view all the answers

Which neurotransmitter receptor type is NOT mentioned as a target for antiemetic drugs in the text?

Endorphin receptors Signup and view all the answers

Which drug is specifically noted as the first serotonin receptor antagonist approved for Chemotherapy-Induced Nausea and Vomiting (CINV)?

Ondansetron Signup and view all the answers

What is the primary effect of serotonin antagonists like ondansetron on the body?

To suppress nausea and vomiting Signup and view all the answers

What is the mechanism of action of aprepitant in preventing CINV?

Blockade of neurokinin-1 type receptors Signup and view all the answers

Why are serotonin receptor antagonists considered effective against nausea and vomiting induced by radiation therapy?

By blocking specific receptors involved in the emetic response triggered by radiation therapy Signup and view all the answers

Why should ondansetron not be given to patients with long QT syndrome?

It prolongs the QT interval Signup and view all the answers

Which group of drugs is mentioned as effective for treating both inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS)?

Serotonin antagonists Signup and view all the answers

How do glucocorticoids like dexamethasone suppress CINV?

Mechanism is unknown Signup and view all the answers

What is the primary application of lorazepam in CINV suppression?

Sedation and anterograde amnesia Signup and view all the answers

What is the main concern when using promethazine as an antiemetic in young children?

Respiratory depression Signup and view all the answers

How does metoclopramide suppress emesis?

Through the blockade of dopamine receptors Signup and view all the answers

Which drug, related to marijuana, is a synthetic derivative of dronabinol?

Nabilone Signup and view all the answers

What is the primary psychoactive agent in cannabinoids used for medical purposes?

Dronabinol Signup and view all the answers

For treating highly emetogenic drugs, what is the recommended antiemetic regimen?

Aprepitant plus dexamethasone plus a 5-HT3 antagonist Signup and view all the answers

What is the most effective drug for preventing and treating motion sickness?

Scopolamine Signup and view all the answers

What is the severe form of nausea and vomiting during pregnancy characterized by dehydration and weight loss?

Hyperemesis gravidarum Signup and view all the answers

Why may methylprednisolone be considered a last resort for managing nausea and vomiting during pregnancy?

It causes cleft lip with or without cleft palate Signup and view all the answers

What is the potential consequence of using loperamide to manage mild infectious diarrhea?

Prolonging the infection Signup and view all the answers

In the management of traveler's diarrhea caused by E.coli, when is treatment typically considered unnecessary?

When symptoms are mild and self-limited Signup and view all the answers

Which drug is preferred for the prophylaxis of traveler's diarrhea due to E.coli and Vibrio cholerae?

Dukoral Signup and view all the answers

What is the primary symptom that characterizes irritable bowel syndrome (IBS) according to the Rome IV criteria?

Abdominal pain or discomfort Signup and view all the answers

Which drug class has been employed for years to provide symptomatic relief in patients with IBS?

Antispasmodics Signup and view all the answers

What is a common nondrug measure employed in the management of IBS?

Keeping a log to identify trigger foods and stressors Signup and view all the answers

What is the primary purpose of atropine in the combination with diphenoxylate (Lomotil)?

To discourage diphenoxylate abuse Signup and view all the answers

Which symptom results from activation of opioid receptors in the GI tract by opioids?

Reduced frequency of defecation Signup and view all the answers

What is the primary role of diphenoxylate (Lomotil) when used as an antidiarrheal agent?

To provide symptomatic relief without influencing the underlying cause Signup and view all the answers

Why are antihistamines like dimenhydrinate and meclizine less effective than scopolamine for treating motion sickness?

They lead to sedation as a prominent side effect Signup and view all the answers

What distinguishes nonspecific antidiarrheals from specific agents in terms of treating diarrhea?

Nonspecific antidiarrheals act on or within the bowel to provide symptomatic relief Signup and view all the answers

Why are transdermal anticholinergic side effects generally less intense than with oral or subcutaneous dosing?

Transdermal dosing bypasses the blood-brain barrier Signup and view all the answers

What is the main concern when prescribing alosetron for IBS-D in women?

Gastrointestinal toxicity Signup and view all the answers

What qualifies an IBS case as severe according to the text?

Abdominal pain or discomfort causing disability Signup and view all the answers

Which enzyme is involved in the metabolism of alosetron?

Cytochrome P450 Signup and view all the answers

Why is alosetron approved only for women with severe IBS-D?

Safety and efficacy have not been demonstrated in men Signup and view all the answers

What is a notable risk associated with the use of alosetron?

Constipation and its complications Signup and view all the answers

Which drugs are specifically approved for IBS according to the text?

Alosetron, eluxadoline, and linaclotide Signup and view all the answers

In what circumstance should prescribers consider a strict risk management program for patients using alosetron?

When patients are non-responsive to conventional treatment Signup and view all the answers

Why is bacterial colonization reduced when patients with concomitant IBS and SIBO are treated with antibiotics?

Antibiotics reduce harmful bacteria Signup and view all the answers

"Less than 5% of IBS cases qualify as severe" implies that most cases of IBS are:

Mild or moderate Signup and view all the answers

Why are safety and efficacy of alosetron not demonstrated in men according to the text?

Lack of pharmacokinetic studies in men Signup and view all the answers

Which part of the GI tract is usually affected by Crohn disease?

Transmural Signup and view all the answers

What is the main difference in the location of inflammation between Crohn disease and ulcerative colitis?

Crohn disease affects the transmural layers, while ulcerative colitis affects the mucosa and submucosa. Signup and view all the answers

Which of the following drugs is NOT employed in the treatment of inflammatory bowel disease (IBD)?

Antifungals Signup and view all the answers

What is the main approved indication for using sulfasalazine?

IBD and rheumatoid arthritis Signup and view all the answers

Which of the following symptoms is common in patients with ulcerative colitis but not in Crohn disease?

Rectal bleeding Signup and view all the answers

Which type of ulcers is sulfasalazine most effective against?

Ulcerative colitis ulcers Signup and view all the answers

What is a potential consequence of long-term high-dose therapy with intravenous metoclopramide?

Tardive dyskinesia Signup and view all the answers

How does nitroglycerin ointment relieve pain caused by chronic anal fissures?

By relaxing the internal anal sphincter Signup and view all the answers

What is the main purpose of pancreatic enzymes secreted into the duodenum?

To digest carbohydrates Signup and view all the answers

Which trade name does NOT refer to a preparation of pancreatic enzymes?

Rectiv Signup and view all the answers

What is the primary purpose of emollients in anorectal preparations?

To reduce irritation Signup and view all the answers

Which compound is NOT a common ingredient in anorectal preparations?

Aspirin Signup and view all the answers

How does bicarbonate secretion by the pancreas help protect digestive enzymes?

By neutralizing stomach acid Signup and view all the answers

What symptom is characteristic of deficiency in pancreatic enzymes?

'Fatty stools' Signup and view all the answers

What is a severe adverse effect associated with prolonged use of glucocorticoids in the treatment of ulcerative colitis and Crohn disease?

Adrenal suppression Signup and view all the answers

'Rectiv' is primarily used for relief from which condition?

'Hemorrhoids' Signup and view all the answers

'Preparation H', 'Rectagene', and 'Anusol' are commonly associated with the treatment of which condition?

'Hemorrhoids' Signup and view all the answers

Which immunosuppressant acts faster and is stronger than azathioprine or mercaptopurine in inducing remission for acute, severe ulcerative colitis or Crohn disease?

Cyclosporine Signup and view all the answers

Which drug, a monoclonal antibody designed to neutralize TNF-α, is indicated for moderate to severe Crohn disease and ulcerative colitis but has potential serious adverse effects like infections and infusion reactions?

Infliximab Signup and view all the answers

Thiopurines, such as azathioprine and mercaptopurine, are generally reserved for patients with ulcerative colitis and Crohn disease who...

fail to respond to glucocorticoids. Signup and view all the answers

Which oral glucocorticoid is specifically approved for mild to moderate Crohn disease that involves the ileum and ascending colon?

Budesonide Signup and view all the answers

What are the major adverse effects associated with thiopurines, such as azathioprine and mercaptopurine?

Pancreatitis and neutropenia Signup and view all the answers

Which medication can promote short-term remission in patients with Crohn disease, reducing the need for glucocorticoids?

Methotrexate Signup and view all the answers

What is the primary purpose of sulfasalazine during pregnancy and lactation?

Relieve symptoms of ulcerative colitis and Crohn disease. Signup and view all the answers

What is the indicated use of oral metoclopramide for diabetic gastroparesis?

Suppress emesis and increase upper GI motility. Signup and view all the answers

Which protein is used to store iron within mucosal cells of the small intestine?

Ferritin Signup and view all the answers

What is the primary impact of iron deficiency on red blood cells?

They become microcytic and hypochromic Signup and view all the answers

Where does most transferrin-bound iron go for incorporation into hemoglobin?

Bone Marrow Signup and view all the answers

What is the main regulator of body iron content through control of intestinal absorption?

Iron uptake levels Signup and view all the answers

In what condition do adults have relatively low daily iron needs compared to infants and children?

Adulthood Signup and view all the answers

What is the daily dietary iron requirement for adult women to replace iron lost through menstruation?

15-18 mg/day Signup and view all the answers

What is the primary role of erythropoietin in the development of red blood cells?

Inducing reticulocyte maturation Signup and view all the answers

Which iron-containing molecule stores oxygen in muscle?

Myoglobin Signup and view all the answers

What is the primary function of reticulocytes in the process of red blood cell development?

Maturing into erythrocytes Signup and view all the answers

Which factors are essential for the synthesis of hemoglobin in red blood cells?

Vitamin B12 and folic acid Signup and view all the answers

In what stage do circulating red blood cells reach full maturity?

Erythrocyte stage Signup and view all the answers

Which component of red blood cells constitutes a smaller amount compared to hemoglobin but is essential for various iron-containing enzymes?

Myoglobin Signup and view all the answers

Which iron salt is recommended as the treatment of choice for iron deficiency anemia?

Ferrous sulfate Signup and view all the answers

What is the primary adverse effect associated with all four types of ferrous iron salts mentioned in the text?

Gastrointestinal disturbances Signup and view all the answers

Which additional laboratory data can help confirm a diagnosis of iron deficiency anemia?

Decreased serum iron content Signup and view all the answers

What is the primary reason for using oral iron over parenteral iron according to the text?

Reduced toxicity risk Signup and view all the answers

Which iron supplement is mentioned in the text as having a reduced risk of toxicity in case of accidental ingestion by children?

Carbonyl iron Signup and view all the answers

What is the objective of iron deficiency anemia therapy according to the text?

To improve hemoglobin and erythrocyte production Signup and view all the answers

Which therapy is indicated for patients with severe neurologic deficits caused by B12 deficiency?

Parenteral cyanocobalamin Signup and view all the answers

What is the primary manifestation of moderate B12 deficiency?

Megaloblasts in the bone marrow Signup and view all the answers

Why is folic acid alone not recommended for the treatment of B12 deficiency?

It can mask the existence of B12 deficiency Signup and view all the answers

What is the primary function of intrinsic factor in the absorption of vitamin B12?

Assisting in the transport of vitamin B12 to tissues Signup and view all the answers

What can happen if folic acid intake ceases suddenly?

Megaloblastic anemia develops rapidly Signup and view all the answers

What is the main consequence of vitamin B12 deficiency on DNA synthesis?

Stops cell growth and division Signup and view all the answers

What is the enterohepatic recirculation responsible for in relation to folate?

Returning folate to the liver for reuse Signup and view all the answers

What is one potential cause of impaired absorption of vitamin B12?

Development of antibodies against the vitamin B12–intrinsic factor complex Signup and view all the answers

How does folic acid differ from vitamin B12 in terms of DNA synthesis?

Folic acid can be activated independently of vitamin B12 Signup and view all the answers

Which specific characteristic distinguishes pernicious anemia from other types of anemia?

Large red blood cells Signup and view all the answers

What is the main role of transcobalamin II in the process of vitamin B12 absorption?

Transporting free B12 to tissues Signup and view all the answers

How does vitamin B12 deficiency impact the cells that form the epithelial lining of the mouth, stomach, and intestine?

Inhibits DNA synthesis Signup and view all the answers

Why is it recommended that all women of reproductive age consume 400 to 800 µg of supplemental folic acid daily?

To avoid neural tube defects in early pregnancy Signup and view all the answers

What is the most common cause of folate deficiency according to the text?

Alcohol use disorder Signup and view all the answers

What is the effect of poor diet on correcting folate deficiency according to the text?

Ingestion of fresh vegetables and fruit juices is sufficient Signup and view all the answers

What is the consequence of indiscriminate use of folic acid according to the text?

Risk of masking vitamin B12 deficiency Signup and view all the answers

Why is oral administration preferred for most patients when treating folic acid deficiency?

It is more effective in correcting malabsorption Signup and view all the answers

What is the primary difference between correcting folate deficiency due to poor diet and malabsorption?

'Ingestion of one serving of a fresh vegetable or one glass of fruit juice a day will often suffice' in poor diet cases Signup and view all the answers

What is a potential consequence of folic acid deficiency other than megaloblastic anemia?

'Injury to oral and GI mucosa' Signup and view all the answers

Why should prophylactic folate be taken only when clearly appropriate according to the text?

'Folic acid may mask vitamin B12 deficiency' Signup and view all the answers

'The modality for treating folic acid deficiency should be matched with the cause.' What does this mean when addressing poor diet as a cause?

'Diet alone can correct the deficiency' Signup and view all the answers

What is the recommended initial therapy for folic acid deficiency?

IM injection of folic acid and vitamin B12 Signup and view all the answers

How is therapy for folic acid deficiency evaluated according to the text?

Measuring Hgb, Hct, and reticulocyte count Signup and view all the answers

What can be expected within 48 hours if treatment for folic acid deficiency has been effective?

Disappearance of megaloblasts from bone marrow Signup and view all the answers

What is the maintenance dose of folic acid recommended after the initial therapy?

400 µg/day Signup and view all the answers

When should reticulocyte count measurably increase if treatment for folic acid deficiency has been effective?

Within 2 to 3 days Signup and view all the answers