179 Questions
What is the major defensive factor that protects the stomach and duodenum from self-digestion?
Mucus
Where is ulceration most common in cases of peptic ulcer disease?
In the lesser curvature of the stomach and the duodenum
What bacterium is primarily responsible for causing most cases of peptic ulcer disease?
Helicobacter pylori
Which condition can severe ulcers from peptic ulcer disease be complicated by?
Hemorrhage
What serves the physiologic role of neutralizing any hydrogen ions that penetrate the mucus in the stomach and duodenum?
Bicarbonate
What promotes healing and greatly reduces the chance of recurrence in peptic ulcer disease when eradicated?
Helicobacter pylori
Which of the following is NOT considered a major aggressive factor in peptic ulcer disease?
Mucus
What is the role of prostaglandins in the gastrointestinal mucosa?
Promote vasodilation to maintain submucosal blood flow
Why is acid necessary for peptic ulcer formation?
Acid directly injures cells of the GI mucosa
What is the primary cause of Zollinger-Ellison syndrome?
Tumor secreting gastrin
What effect does smoking have on ulcer healing and recurrence?
Delays healing and increases recurrence risk
What is the primary goal of drug therapy for peptic ulcers?
Relieve symptoms and prevent complications
Why are antibiotics essential in the treatment of peptic ulcers with H.pylori infection?
To eradicate H.pylori and prevent recurrence
What role do PPIs play in the treatment of PUD?
Reduce gastric acidity
How do NSAIDs contribute to ulcer formation?
Inhibit prostaglandin biosynthesis and suppress mucosal defenses
Why is eradication of H.pylori important for ulcer healing?
To minimize ulcer recurrence
How do drugs promote ulcer healing?
By simply creating conditions conducive to healing
What is the recommended treatment for NSAID-induced ulcers?
Any ulcer medication
Which medication is preferred for treating NSAID-induced ulcers when the offending NSAID cannot be discontinued?
PPIs
What is a method to evaluate ulcer healing according to the text?
Monitoring for relief of pain
What is a non-optimal measure for antiulcer therapy based on the text?
Including dietary changes
Which statement is true regarding alcohol consumption and peptic ulcers according to the text?
Alcohol has no effect on peptic ulcers
Which antibiotic is mentioned as highly sensitive to H.pylori in the text?
Amoxicillin
What is a potential side effect of bismuth therapy mentioned in the text?
Black coloration of the tongue and stool
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
Which factor is NOT mentioned as contributing to transient lower esophageal sphincter (LES) relaxation in severe GERD?
Acid indigestion
What effect does a hiatal hernia have on the occurrence of transient lower esophageal sphincter (LES) relaxations?
Impairs acid emptying from the hernia sack
Which symptom is often associated with severe gastroesophageal reflux disease (GERD)?
Barrett's esophagitis
Why is referral considered for patients with esophageal reflux who do not respond to medications?
To rule out cancer and Barrett's esophagitis
Which aspect is NOT considered when determining the severity of reflux in gastroesophageal reflux disease (GERD)?
Eating habits
What is the principal function of the colon?
Absorb water and electrolytes
What is one symptom that helps define constipation?
Excessive straining
What is a common cause of constipation according to the text?
Dysfunction of the pelvic floor
How do laxatives help patients with cardiovascular diseases?
By reducing the need for strain during defecation
What is a contraindication for using laxatives according to the text?
Fecal impaction or bowel obstruction
How can laxatives be beneficial as an adjunct to anthelmintic therapy?
By helping with stool sample analysis
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
Why was ranitidine taken off the market in April 2020 as mentioned in the text?
Presence of cancer-causing substances in the tablet
What is the next step in pharmacologic management for GERD patients after lifestyle and diet modifications with antacids?
Starting PPI therapy
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
In pediatric patients with GERD, which medication types are available for treatment according to the text?
Antacids and PPIs
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
Which group of laxatives is especially useful when the bowel is being prepared for diagnostic procedures or surgery?
Group I
Which laxative group consists of agents that produce a soft but formed stool within 1 to 3 days?
Osmotic laxatives
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
Which category of laxatives is associated with the potential side effect of esophageal obstruction if swallowed without sufficient fluid?
Bulk-forming laxatives
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
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
What is the primary mechanism of action of lubiprostone in promoting bowel movement?
Activating chloride channels
Why are magnesium salts contraindicated in patients with kidney disease?
Magnesium can accumulate to toxic levels
How does sodium phosphate contribute to acute renal failure in some patients?
Causing dehydration and lowering potassium levels
What is the primary function of plecanatide in regulating intestinal fluid secretion?
Activating guanylate cyclase-C
How do PEG-ELS bowel-cleansing solutions differ from sodium phosphate-based ones?
Do not alter water or electrolyte balance
Why are sodium phosphate cleansers contraindicated in patients with cardiovascular disease?
They exacerbate heart failure and hypertension
What is the mechanism of action of sodium phosphate as an osmotic laxative?
It softens and swells the fecal mass in the colon.
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.
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.
What is a potential severe adverse effect associated with sodium phosphate products?
Hyperphosphatemia leading to renal damage
How does Prepopik differ from PEG-ELS products in preparing for colonoscopy?
Prepopik showed superior results in colon preparation compared to PEG-ELS.
What caution should be taken with people using Prepopik or sodium phosphate products?
Use cautiously in individuals with reduced renal function.
What misconception about bowel movements is highlighted in the text?
A daily bowel movement is necessary for good health.
Why do people sometimes habitually self-prescribe laxatives according to the text?
'Tradition supported by advertising' has led to this habit.
What can strong laxatives potentially do to the entire bowel?
Purge it completely
What is one of the potential serious pathologic changes that can result from laxative abuse?
Electrolyte imbalance
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
What is the recommended initial step to break the laxative habit?
Abrupt cessation of laxative use
What effect can chronic exposure to laxatives have on defecatory reflexes?
Decrease in defecatory reflexes
What should patients be informed about regarding bowel movements after abrupt cessation of laxative use?
Bowel movements will be absent for several days
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
What is a consequence of chronic exposure to laxatives in terms of reliance on them?
Increased reliance on laxatives for normal bowel function
What is the primary function of the vomiting center located in the medulla oblongata?
To coordinate the expulsion of gastric contents during emesis
Which neurotransmitter receptor type is NOT mentioned as a target for antiemetic drugs in the text?
Endorphin receptors
Which drug is specifically noted as the first serotonin receptor antagonist approved for Chemotherapy-Induced Nausea and Vomiting (CINV)?
Ondansetron
What is the primary effect of serotonin antagonists like ondansetron on the body?
To suppress nausea and vomiting
What is the mechanism of action of aprepitant in preventing CINV?
Blockade of neurokinin-1 type receptors
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
Why should ondansetron not be given to patients with long QT syndrome?
It prolongs the QT interval
Which group of drugs is mentioned as effective for treating both inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS)?
Serotonin antagonists
How do glucocorticoids like dexamethasone suppress CINV?
Mechanism is unknown
What is the primary application of lorazepam in CINV suppression?
Sedation and anterograde amnesia
What is the main concern when using promethazine as an antiemetic in young children?
Respiratory depression
How does metoclopramide suppress emesis?
Through the blockade of dopamine receptors
Which drug, related to marijuana, is a synthetic derivative of dronabinol?
Nabilone
What is the primary psychoactive agent in cannabinoids used for medical purposes?
Dronabinol
For treating highly emetogenic drugs, what is the recommended antiemetic regimen?
Aprepitant plus dexamethasone plus a 5-HT3 antagonist
What is the most effective drug for preventing and treating motion sickness?
Scopolamine
What is the severe form of nausea and vomiting during pregnancy characterized by dehydration and weight loss?
Hyperemesis gravidarum
Why may methylprednisolone be considered a last resort for managing nausea and vomiting during pregnancy?
It causes cleft lip with or without cleft palate
What is the potential consequence of using loperamide to manage mild infectious diarrhea?
Prolonging the infection
In the management of traveler's diarrhea caused by E.coli, when is treatment typically considered unnecessary?
When symptoms are mild and self-limited
Which drug is preferred for the prophylaxis of traveler's diarrhea due to E.coli and Vibrio cholerae?
Dukoral
What is the primary symptom that characterizes irritable bowel syndrome (IBS) according to the Rome IV criteria?
Abdominal pain or discomfort
Which drug class has been employed for years to provide symptomatic relief in patients with IBS?
Antispasmodics
What is a common nondrug measure employed in the management of IBS?
Keeping a log to identify trigger foods and stressors
What is the primary purpose of atropine in the combination with diphenoxylate (Lomotil)?
To discourage diphenoxylate abuse
Which symptom results from activation of opioid receptors in the GI tract by opioids?
Reduced frequency of defecation
What is the primary role of diphenoxylate (Lomotil) when used as an antidiarrheal agent?
To provide symptomatic relief without influencing the underlying cause
Why are antihistamines like dimenhydrinate and meclizine less effective than scopolamine for treating motion sickness?
They lead to sedation as a prominent side effect
What distinguishes nonspecific antidiarrheals from specific agents in terms of treating diarrhea?
Nonspecific antidiarrheals act on or within the bowel to provide symptomatic relief
Why are transdermal anticholinergic side effects generally less intense than with oral or subcutaneous dosing?
Transdermal dosing bypasses the blood-brain barrier
What is the main concern when prescribing alosetron for IBS-D in women?
Gastrointestinal toxicity
What qualifies an IBS case as severe according to the text?
Abdominal pain or discomfort causing disability
Which enzyme is involved in the metabolism of alosetron?
Cytochrome P450
Why is alosetron approved only for women with severe IBS-D?
Safety and efficacy have not been demonstrated in men
What is a notable risk associated with the use of alosetron?
Constipation and its complications
Which drugs are specifically approved for IBS according to the text?
Alosetron, eluxadoline, and linaclotide
In what circumstance should prescribers consider a strict risk management program for patients using alosetron?
When patients are non-responsive to conventional treatment
Why is bacterial colonization reduced when patients with concomitant IBS and SIBO are treated with antibiotics?
Antibiotics reduce harmful bacteria
"Less than 5% of IBS cases qualify as severe" implies that most cases of IBS are:
Mild or moderate
Why are safety and efficacy of alosetron not demonstrated in men according to the text?
Lack of pharmacokinetic studies in men
Which part of the GI tract is usually affected by Crohn disease?
Transmural
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.
Which of the following drugs is NOT employed in the treatment of inflammatory bowel disease (IBD)?
Antifungals
What is the main approved indication for using sulfasalazine?
IBD and rheumatoid arthritis
Which of the following symptoms is common in patients with ulcerative colitis but not in Crohn disease?
Rectal bleeding
Which type of ulcers is sulfasalazine most effective against?
Ulcerative colitis ulcers
What is a potential consequence of long-term high-dose therapy with intravenous metoclopramide?
Tardive dyskinesia
How does nitroglycerin ointment relieve pain caused by chronic anal fissures?
By relaxing the internal anal sphincter
What is the main purpose of pancreatic enzymes secreted into the duodenum?
To digest carbohydrates
Which trade name does NOT refer to a preparation of pancreatic enzymes?
Rectiv
What is the primary purpose of emollients in anorectal preparations?
To reduce irritation
Which compound is NOT a common ingredient in anorectal preparations?
Aspirin
How does bicarbonate secretion by the pancreas help protect digestive enzymes?
By neutralizing stomach acid
What symptom is characteristic of deficiency in pancreatic enzymes?
'Fatty stools'
What is a severe adverse effect associated with prolonged use of glucocorticoids in the treatment of ulcerative colitis and Crohn disease?
Adrenal suppression
'Rectiv' is primarily used for relief from which condition?
'Hemorrhoids'
'Preparation H', 'Rectagene', and 'Anusol' are commonly associated with the treatment of which condition?
'Hemorrhoids'
Which immunosuppressant acts faster and is stronger than azathioprine or mercaptopurine in inducing remission for acute, severe ulcerative colitis or Crohn disease?
Cyclosporine
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
Thiopurines, such as azathioprine and mercaptopurine, are generally reserved for patients with ulcerative colitis and Crohn disease who...
fail to respond to glucocorticoids.
Which oral glucocorticoid is specifically approved for mild to moderate Crohn disease that involves the ileum and ascending colon?
Budesonide
What are the major adverse effects associated with thiopurines, such as azathioprine and mercaptopurine?
Pancreatitis and neutropenia
Which medication can promote short-term remission in patients with Crohn disease, reducing the need for glucocorticoids?
Methotrexate
What is the primary purpose of sulfasalazine during pregnancy and lactation?
Relieve symptoms of ulcerative colitis and Crohn disease.
What is the indicated use of oral metoclopramide for diabetic gastroparesis?
Suppress emesis and increase upper GI motility.
Which protein is used to store iron within mucosal cells of the small intestine?
Ferritin
What is the primary impact of iron deficiency on red blood cells?
They become microcytic and hypochromic
Where does most transferrin-bound iron go for incorporation into hemoglobin?
Bone Marrow
What is the main regulator of body iron content through control of intestinal absorption?
Iron uptake levels
In what condition do adults have relatively low daily iron needs compared to infants and children?
Adulthood
What is the daily dietary iron requirement for adult women to replace iron lost through menstruation?
15-18 mg/day
What is the primary role of erythropoietin in the development of red blood cells?
Inducing reticulocyte maturation
Which iron-containing molecule stores oxygen in muscle?
Myoglobin
What is the primary function of reticulocytes in the process of red blood cell development?
Maturing into erythrocytes
Which factors are essential for the synthesis of hemoglobin in red blood cells?
Vitamin B12 and folic acid
In what stage do circulating red blood cells reach full maturity?
Erythrocyte stage
Which component of red blood cells constitutes a smaller amount compared to hemoglobin but is essential for various iron-containing enzymes?
Myoglobin
Which iron salt is recommended as the treatment of choice for iron deficiency anemia?
Ferrous sulfate
What is the primary adverse effect associated with all four types of ferrous iron salts mentioned in the text?
Gastrointestinal disturbances
Which additional laboratory data can help confirm a diagnosis of iron deficiency anemia?
Decreased serum iron content
What is the primary reason for using oral iron over parenteral iron according to the text?
Reduced toxicity risk
Which iron supplement is mentioned in the text as having a reduced risk of toxicity in case of accidental ingestion by children?
Carbonyl iron
What is the objective of iron deficiency anemia therapy according to the text?
To improve hemoglobin and erythrocyte production
Which therapy is indicated for patients with severe neurologic deficits caused by B12 deficiency?
Parenteral cyanocobalamin
What is the primary manifestation of moderate B12 deficiency?
Megaloblasts in the bone marrow
Why is folic acid alone not recommended for the treatment of B12 deficiency?
It can mask the existence of B12 deficiency
What is the primary function of intrinsic factor in the absorption of vitamin B12?
Assisting in the transport of vitamin B12 to tissues
What can happen if folic acid intake ceases suddenly?
Megaloblastic anemia develops rapidly
What is the main consequence of vitamin B12 deficiency on DNA synthesis?
Stops cell growth and division
What is the enterohepatic recirculation responsible for in relation to folate?
Returning folate to the liver for reuse
What is one potential cause of impaired absorption of vitamin B12?
Development of antibodies against the vitamin B12–intrinsic factor complex
How does folic acid differ from vitamin B12 in terms of DNA synthesis?
Folic acid can be activated independently of vitamin B12
Which specific characteristic distinguishes pernicious anemia from other types of anemia?
Large red blood cells
What is the main role of transcobalamin II in the process of vitamin B12 absorption?
Transporting free B12 to tissues
How does vitamin B12 deficiency impact the cells that form the epithelial lining of the mouth, stomach, and intestine?
Inhibits DNA synthesis
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
What is the most common cause of folate deficiency according to the text?
Alcohol use disorder
What is the effect of poor diet on correcting folate deficiency according to the text?
Ingestion of fresh vegetables and fruit juices is sufficient
What is the consequence of indiscriminate use of folic acid according to the text?
Risk of masking vitamin B12 deficiency
Why is oral administration preferred for most patients when treating folic acid deficiency?
It is more effective in correcting malabsorption
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
What is a potential consequence of folic acid deficiency other than megaloblastic anemia?
'Injury to oral and GI mucosa'
Why should prophylactic folate be taken only when clearly appropriate according to the text?
'Folic acid may mask vitamin B12 deficiency'
'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'
What is the recommended initial therapy for folic acid deficiency?
IM injection of folic acid and vitamin B12
How is therapy for folic acid deficiency evaluated according to the text?
Measuring Hgb, Hct, and reticulocyte count
What can be expected within 48 hours if treatment for folic acid deficiency has been effective?
Disappearance of megaloblasts from bone marrow
What is the maintenance dose of folic acid recommended after the initial therapy?
400 µg/day
When should reticulocyte count measurably increase if treatment for folic acid deficiency has been effective?
Within 2 to 3 days
Learn about Peptic Ulcer Disease (PUD) and gastrointestinal (GI) drugs in this informative lecture. Understand the erosion of the esophagus, stomach, and small intestine, complications like hemorrhage and perforation, and the medications used to treat PUD.
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