GI exam 1

NSAIDs are bad for the GI system because of inhibition of...

PGE1 and PGE2

first-line agents for the treatment of IBS in both men and women

antispasmodics (dicyclomine, hycosamine)

anti-TNF mAbs block the endogenous TNF activities, inducing ________________________

apoptosis

first-line treatment of crohn's

aminosalicylates (pentaza, asacol, lialda, rowasa)

second-line drugs for the induction of remission of crohn's

budesonide, methotrexate, azathioprine, 6-mercaptopurine

second-line drugs for the maintenance of crohn's

methotrexate, azathioprine, 6-mercaptopurine

MOA of H2 blockers

block the nocturnal/fasting acid secretion by blocking H2 on parietal cells

MOA of antacids

increases intragastric pH

MOA of PPIs

inhibit acid secretion by antagonizing the H+/K+ ATPase enzyme, antimicrobial

MOA of sucrafalate

provides a physical barrier on GI ulcers

MOA of bismuth compounds

antibacterial and cytoprotective

FDA-approved medication to treat IBS-D in women

alosetron

MOA of alosetron

5-HT3 antagonist

why is diphenoxylate administered w/ atropine?

decreases the abuse potential on the opioid receptor

cephalic phase stimuli cause _____________ activation through the vagus nerve

parasympathetic

MOA of benzamides (metoclopramide/domperidone)

D2 receptor blockade, upper GI stimulation

MOA of phenothiazine (promethazine)

D2 blockade (anti-emetic), antihistamine (sedative)

which two receptors when activated result in the secretion of Cl-rich fluids into the gut and thus increase motility and decrease transit times

CFTR, ClC-2

MOA of lbuprostone, linaclotide

stimulate Cl channel activation and secretion into the intestines

MOA of loperamide

peripheral mu receptor agonist; slows motility, increases fluid absorption

MOA of bulk-forming laxatives (metamucil)

absorb water in the GI tract to move materials through

which trio of medication classes are given in CINV?

corticosteroids, NK1 RA's, 5HT3 antagonists

what "bug" is the primary factor in PUD?

h. pylori

MOA of mesalamines

coat 5ASA with pH-sensitive resins that allow its release in the ileum and proximal colon

according to the Mayo Clinic Rome criteria, the diagnosis criteria for IBS involves the presence of abdominal pain and discomfort lasting on average _____ day per week in the last 3 months

1

__________________ receptors in the GI tract are mostly inhibitory to motility and the upper GI tract

dopamine

in the hospital, may patients are given IV ____________________ to prevent stress-related gastric ulcers

H2 antagonists

MOA of phenothiazines (promethazine)

anti-emetic via dopamine and muscarinic receptor blockade, sedative via antihistamine activity

what two factors account for the vast majority of all peptic ulcers?

h. pylori and nsaids

MOA of chloride channel activators (linaclotide, lubriprisone)

agonism of guanylyl cyclase C on the intestinal epithelial cell surface, activating the CFTR causing Cl secretion into the gut lumen

first line drugs for induction/maintenance of ulcerative colitis

aminosalicylates (pentaza, asacol, lialda, rowasa)

the high lumenal function of the CFTR drives the pH of the duodenum ____________ (higher or lower)

higher

___________________ is a digestive enzyme in the small intestine that may cause pancreatitis, so the body needs protective mechanisms against it

trypsin

mechanisms for pancreatic protection from trypsin include...

granule storage, auto-cleavage, and SPINK1 deactivation

digestive enzymes (aka proteases) are stored in acinar cells and cause _________________ through parasympathetic nervous action

zymogen release

secretin regulates digestive pH through controlling the action of...

CFTR

the major stimulatory regulator of digestive enzymes is...

acetylcholine

nutrition goals should be...

patient specific

______________________ are a quick, simple, noninvasive way to identify malnutrition risk factors in the general population

nutrition screenings

___________________________ include height, weight, waist circumference, limb size, etc.

anthropometric measurements

_______________________ is related to prolonged, inadequate intake of nutrients and proteins

starvation malnutrition

______________________ is related to inflammatory disease states like RA, IBS, and cystic fibrosis

chronic disease-related malnutrition

what medications can contribute to weight gain?

insulin, sulfonylureas, beta-blockers, clozapine, olanzapine, corticosteroids, lithium, anticonvulsants, antiretrovirals

what medications contribute to malnutrition?

stimulants, chemo, antacids, sulfasalazine, metformin

fat soluble vitamins

ADEK

water soluble vitamins

thiamine, C, B, niacin, folic, biotin

what is niacin used for?

dyslipidemia, high TG

what is recommended for women who are trying to conceive or who are pregnant?

folic acid

what is the recommended dose of folic acid?

0.4 mg/day

patients receiving ___________ nutrition must have a functional GI tract

enteral

patients receiving _____________ nutrition do not need a functional GI tract

parenteral

medications _____________ (can/cannot) be administered with enteral nutrition

can

_______________ nutrition requires routine monitoring, including vitals, weight, intake/output, n/v, GRVs, electrolytes, and LFTs

enteral

a variety of enteral nutrition formulations exist to meet patient needs, such as high _____________ or high caloric density

protein

both parenteral and enteral nutrition pose a risk for...

refeeding syndrome

enteral nutrition side effects include...

electrolyte imbalances, glucose-control, refeeding syndrome, tube occlusion, n/v, diarrhea, constipation

large volume resuscitation uses isotonic balanced crystalloid fluids including...

plasma-lyte, lactated ringers

_________ is used for glucose supplementation or hypernatremia

D5W

_________________ is used for hyponatremia and increased intracranial pressure

3% NaCl

____________ should not be utilized for large volume resuscitation and is indicated for hypernatremia

1/2 NS

________________ is an isotonic crystalloid used for fluid resuscitation

NS

albumin and dextran are...

colloids

typically, __________ is not used in patient care due to bleeding risk

dextran

______________ is used with large-volume paracentesis procedures to control third spacing

albumin