Richburg 2nd lecture

which PPI is a racemic of S and R conformation?

which PPI is a racemic of S and R conformation?

omeprazole

______ is he active compound of PPI

S-isomer

true or false

H-K ATPase is unique to parietal cells

true

explain the MOA of PPI

PPI forms a covalent sulfohydryl bond with H-K ATPase to inhibit its action

true or false

PPI enzymatic inhibition is permanent (meaning that it cannot be reversable)

true

true or false

Esomeprazole is the S-isomer of omeprazole. It has higher efficacy because it has a long transit time, higher AUC, and lesser first-pass

true

true or false

lansoprazole and pantoprazole have little or no significant DDI

true

true or false

antacids can be used as a monotherapy agent in the treatment of GERD

false

IPAN are located at the ________

submucosa

longitudinal cells promote _______

mixing

circular cells promote ________

peristalsis

the enteric nervous system consists of 2 network of neurons. These are:

• myenteric plexus

• submucosal plexus

• meissner’s plexus

• below the epithelium

• regulate secretion, fluid transport and vascular flow

submucosal plexus

• Auerbach’s plexus

• between the circular and longitudinal muscle

• regulates contraction and relaxation of the GI smooth muscle

myenteric plexus

parasympathetic input to GI is ______

excitatory (contraction)

sympathetic input to GI is ________

inhibitory (relaxation)

chemoreceptors are sensitive to _______

• acid

• glucose

• amino acids

sensory receptors are sensitive to ________

stretch and tension

which ENS receptors “taste” the lumenal contents?

chemoreceptors

luminal factors (like 5HT, VIP, etc.) derives from _______

EC cells

• ACh

• tachykinins

• substance P

cause gastric _________

contraction

• NO

• vasoactive intestinal peptide (VIP)

• ATP

• pituitary adenylyl cyclase activating peptide

cause gastric __________

relaxation

what are the primary target of serotonin within the GI tract?

• extrinsic nerves for nausea

• IPAN of the ENS

true or false

serotonin is a paracrine messenger and NT in the GI tract and they do not project to the muscle directly

true

delayed gastric emptying

gastroparesis

increased LES tone that results in dysphagia and regurgitation

achalasia of the esophagus

______ is due to fast GI motility

diarrhea

_______ is due to slow GI motility

constipation

• enhance the coordinated GI motility

• increase LES tone

• benefits for PUD, GERD, NV

• used to treat constipation

prokinetic agents

true or false

erythromycin, an antibiotic, can be used to treat constipation because it activates motilin receptor and increase LES tone

true

true or false

dopamine increase ACh level

false

• 5HT4 agonist

• FDA approved for use in women with IBS-C and men/women with chronic constipation

• stimulate motility and chloride secretion

tegaserod

• D2 receptor antagonist

• also agonize 5HT4 while antagonizing 5HT3

• increased transit time and LES tone

• mostly confined to the upper GI tract

• stimulates antral and small intestine contraction

metoclopramide

• anticholinergic agents that mostly target M3 receptors to increase ACh levels in the synapse

• ADR: bradycardia, flushing, diarrhea, cramps, salivation, blurred vision

neostigmine