Pharm Chapter 22

Therapeutic agents for the gastrointestinal system

Absorption

Movement of nutrients, fluids, and medications from the gastrointestinal tract into the bloodstream

process of absorbing or being absorbed

Amino acids

Molecules that are the building blocks of proteins

organic compounds that serve as the building blocks of proteins

Antiemetics

medications that prevent or reduce nausea and vomiting

Carbohydrates

organic compounds that provide energy to the body

Chemical compounds composed of carbon, hydrogen, and oxygen atoms in a ratio of 1:2:1.

sugars, glycogen, starches, and cellulose

Chyme

semi-liquid mixture of partially digested food, enzymes, and gastric juices that is formed in the stomach during the digestive process

Digestion

process of breaking down food into smaller molecules that the body can absorb and use for energy, growth, and repair

mechanical, chemical, and enzymatic action of breaking food into molecules for metabolism

Emesis

medical term for vomiting

Excretion

Elimination of waste products mainly through stools and urine

Fistulae

Permanent abnormal connection or passage that forms between two body parts, like an organ and another organ or the skin's surface

Ingestion

process of taking something into the body through the mouth, either by swallowing food and drink or by other means like absorbing substances

Taking in food, liquid, or other substances (e.g., medications)

Peristalsis

involuntary series of muscle contractions and relaxations that push food and waste through your digestive tract

Tubular muscle contraction and relaxation of the esophagus, stomach, and intestines to move substances through the gastrointestinal tract

Surface area

total area of the outside surfaces of a three-dimensional object

Extent of an object’s surface in contact with its surroundings

Appendicitis

inflammation of the appendix, a small, finger-shaped organ attached to the large intestine

Constipation

bowel movements are infrequent, hard, or difficult to pass

Difficult or infrequent defecation, often accompanied by dry hard stools and/or sluggish bowel activity

Diarrhea

frequent, loose, and watery bowel movements

Duodenal ulcer

sore or erosion that develops in the lining of the duodenum, the first part of the small intestine

Caused by Helicobacter pylori infection, peptic ulcer, and NSAIDs,

characterized by abdominal pain, nausea and vomiting, and dark blood in the stools

Celiac disease

autoimmune disease in which people cannot eat gluten because it will damage their small intestine

body's immune system mistakenly attacks the lining of the small intestine when it comes into contact with gluten, a protein found in wheat, rye, and barley.

Crohn’s disease

chronic inflammatory bowel disease (IBD) that affects the gastrointestinal (GI) tract

causes inflammation and ulcers in any part of the GI tract, from the mouth to the anus

Congenital or acquired chronic inflammation of colon and terminal ileum characterized by abdominal pain, weight loss, and diarrhea

Gastric ulcer

Open sores in lining of stomach; can be caused by H. pylori infection, NSAIDs, or hypersecretory diseases

characterized by abdominal pain, nausea and vomiting, and dark blood in the stools

Gastritis

inflammation of the stomach lining,

also known as the gastric mucosa.

Gastroesophageal reflux disease (GERD)

Backflow of gastric juices that enter the esophagus,

stomach contents flow back up into the esophagus,

characterized by dysphagia and chest and back pain

Hiatal hernia

condition where part of the stomach pushes through an opening (hiatus) in the diaphragm, the muscle that separates the chest from the abdomen

Defect in the diaphragm that allows a portion of the stomach to pass through the diaphragm opening into the chest cavity

can cause the stomach to bulge into the chest cavity.

Inflammatory bowel syndrome (IBS)

chronic gut disorder that causes symptoms like abdominal pain, cramping, bloating, gas, and changes in bowel habits, such as diarrhea, constipation, or both.

Unlike Inflammatory Bowel Disease (IBD), IBS does not cause visible damage or inflammation to the intestines. 

considered a disorder of the brain-gut axis, where there is an issue with how the brain and gut communicate,

syndrome of the large intestine with no known cause

Intrinsic factor (IF)

protein made by stomach cells that is essential for absorbing vitamin B12 from food

important protein that helps the body absorb vitamin B12

Irritable bowel disease (IBD)

chronic condition that causes inflammation in the digestive tract, leading to symptoms like abdominal pain, diarrhea, and fatigue

IBD involves inflammation

can cause irreversible damage to the digestive tract.

two main types of IBD are Crohn's disease and ulcerative colitis.

Laryngopharyngeal reflux (LPR)

term used when liquid backs up the esophagus

when stomach contents flow back up the esophagus to the throat and voice box,

causing symptoms like a chronic cough, throat clearing, hoarseness, and a sensation of a lump in the throat. 

often called "silent reflux" because it typically doesn't cause heartburn or indigestion

Lipids

group of organic compounds that are insoluble in water, including fats, oils, and waxes.

vital component of living cells, where they serve as a way to store energy, form cell membranes, and act as signaling molecules

also known as fat

Peptic ulcer

open sore or erosion that develops in the lining of the stomach (gastric ulcer) or the first part of the small intestine (duodenal ulcer)

ulcer in the lining of the stomach, duodenum, or esophagus

Peptic ulcer disease (PUD)

painful sores or ulcers in the lining of the stomach or first part of the small intestine, called the duodenum

Reflux

To flow back or return

Stomatitis

inflammation of the mouth, which can cause redness, swelling, and painful sores or ulcers

an disrupt a person's ability to eat, talk, and sleep

Ulcer

open sore or break in the lining of an organ or tissue

impedes the organ of which that membrane is apart from continuing its normal functions

Ulcerative colitis

chronic inflammatory bowel disease (IBD) that causes inflammation and ulcers in the lining of the large intestine (colon)

chronic inflammation of the colon

Villus

microscopic, finger-like or hair-like projections that line the inner surface of the small intestine, or a small vascular protrusion

help absorb nutrients from digested food into the bloodstream.

Xerostomia

condition characterized by dry mouth.

Dry mouth

1. Auxiliary organs to the gastrointestinal (GI) system include all those listed EXCEPT the:

a. pancreas.

b. liver.

c. gallbladder.

d. appendix.

d. appendix.

2. The function of the small intestine is to:

a. transport food.

b. complete the digestion of food.

c. breaks up food particles

d. regulates blood glucose levels.

b. complete the digestion of food.

3. The pH of the stomach is acidic, and its function is to:

a. help in digestion by breaking down the chemicals in food.

b. help food move through the intestines.

c. help the absorption of food in the stomach.

d. help in metabolism.

a. help in digestion by breaking down the chemicals in food.

4. The pyloric sphincter is located ________ and allows chyme to pass when ________.

a. at the top of the stomach; relaxed

b. at the base of the stomach; tense

c. at the opening of the small intestine; tense

d. at the opening of the small intestine; relaxed (opened)

d. at the opening of the small intestine; relaxed (opened)

5. Bile is made by the ______ and stored by the ______.

a. gallbladder; liver

b. liver; gallbladder

c. pancreas; gallbladder

d. liver; pancreas

b. liver; gallbladder

6. Excretion takes place mainly in the:

a. stomach.

b. small intestine.

c. large intestine.

d. rectum.

d. rectum.

7. A person diagnosed with gastroesophageal reflux disease (GERD) may receive which of the following medications?

a. Calcium carbonate

b. Famotidine

c. Omeprazole

d. All options are correct

d. All options are correct

8. Which of the following medications would not be used to prevent emesis?

a. Pepto-Bismol

b. Meclizine

c. Docusate sodium

d. Pepto-Bismol and docusate sodium

d. Pepto-Bismol and docusate sodium

9. A patient wishing to purchase a bulk-forming laxative would select:

a. Colace.

b. Metamucil.

c. MiraLAX

d. Sennakot

b. Metamucil.

10. Peptic ulcer disease (PUD) is associated with:

a. Helicobacter pylori.

b. GERD.

c. nonsteroidal anti-inflammatory drugs.

d. Helicobacter pylori and nonsteroidal anti-inflammatory drugs

d. Helicobacter pylori and nonsteroidal anti-inflammatory drugs

1. Absorption primarily takes place in the:

A. Stomach

B. Large intestine

C. Pancreas

D. Small intestine

D. Small intestine

2. This digestive juice is produced by the liver and stored in the gallbladder to help the body absorb fats and fat-soluble vitamins:

A. Saliva

B. Bile

C. Chyme

D. Lipase

B. Bile

3. Which of the following is not a common condition that affects the gastrointestinal system?

A. Heartburn

B. Appendicitis

C. Constipation

D. Diarrhea

B. Appendicitis

4. First-line recommendations for H. pylori in patients who are allergic to penicillin include:

A. A proton pump inhibitor (PPI), clarithromycin, and metronidazole

B. A PPI, clarithromycin, and amoxicillin

C. A PPI, bismuth salicylate, tetracycline, and metronidazole

D. Bismuth salicylate, clarithromycin, and metronidazole

A. A proton pump inhibitor (PPI), clarithromycin, and metronidazole

5. The patient must read and sign a patient–physician agreement form before receiving a prescription for:

A. Dulcolax (bisacodyl)

B. Tigan (trimethobenzamide)

C. Lotronex (alosetron)

D. Reglan (metoclopramide)

C. Lotronex (alosetron)

6. Which of the following is a prescription drug for diarrhea?

A. Pepto-Bismol (bismuth subsalicylate)

B. Lomotil (diphenoxylate/atropine)

C. Metamucil (psyllium)

D. Imodium AD (loperamide)

B. Lomotil (diphenoxylate/atropine)

7. Aluminum can cause:

A. Flatulence

B. Diarrhea

C. Heartburn

D. Constipation

D. Constipation

8. Mylicon (simethicone) is indicated for:

A. Flatulence

B. Diarrhea

C. Heartburn

D. Constipation

A. Flatulence

9. If a patient is vomiting, the physician may prescribe:

A. Axid (nizatidine)

B. Colace (docusate)

C. Compazine (prochlorperazine)

D. Lomotil (diphenoxylate/atropine)

C. Compazine (prochlorperazine)

10. If a chemotherapy patient has chemotherapy-induced vomiting, the physician may prescribe:

A. Zofran (ondansetron)

B. Dramamine (meclizine)

C. Movantik (naloxegol)

D. Amitiza (lubiprostone)

A. Zofran (ondansetron)

1. The _____________ intestinal pH allows for proper nutrient absorption.

alkaline

2. Hyperacidity ___________ such as antacids, histamine-2 blockers, and PPIs help alleviate heartburn, upset stomach, and gastroesophageal reflux disease.

treatments

3. Laxatives and antidiarrheals can speed up or slow the passage of contents through the ____________ to treat acute or chronic constipation and diarrhea.

bowels

4. Immunosuppressants and corticosteroid anti-inflammatories serve to treat ___________ bowel conditions such as Crohn’s disease and ulcerative colitis.

inflammatory

5. Combinations of ____________and acid reducers are used to treat the Helicobacter pylori organisms often found in gastric and duodenal ulcers.

antibiotics

6. PPIs are used mainly to treat _____________ and _____________ ulcers.

GERD

peptic

7. Resting and drinking clear fluids such as Pedialyte until the _____________ subsides are commonly suggested to prevent dehydration and electrolyte loss.

diarrhea

8. Opioid pain medications, antidepressants, anticonvulsants, calcium channel blockers, and aluminum-containing antacids can cause _____________.

constipation

9. Poor food _____________ causes flatulence as undigested food reaches bacteria in the small intestine or colon.

absorption

10. A common side effect of chemotherapy is ____________.

emesis

1. List two drugs that antacids will interact with and prevent proper absorption.

Doxycycline and ciprofloxacin

2. List three non-drug treatments to treat peptic ulcer disease (PUD).

Hand washing, avoid long-term NSAID use, smoking cessation, eating a bland diet, removing aggravating foods, and/or decreasing stress.

3. Explain the difference between irritable bowel syndrome (IBS) and irritable bowel disease (IBD).

The primary difference between irritable bowel syndrome (IBS) and inflammatory bowel disease is that IBS is not considered a disease or involves inflammation. IBS is a functional disorder with no known structural cause.

4. List two non-drug treatments for diarrhea.

Resting and drinking clear fluids (e.g., oral rehydrating solutions such as Pedialyte) until diarrhea subsides are commonly suggested to prevent dehydration and electrolyte loss.

5. List the vitamins and minerals that can interact with the absorption of medications in the gastrointestinal tract.

Any drug that can change the pH in the GI or enzymes released will affect absorption.

1. It has been stated that you must chew your food “32 times.” How does not chewing your food affect digestion in the stomach?

Digestion starts in the mouth with chewing and saliva. It helps break down food before reaching the stomach. Improperly chewed food can hurt the esophagus and create extra work for the stomach to break down.

2. A hectic and stressful lifestyle can contribute to many “stomach problems” such as indigestion and acid reflux. What lifestyle changes can be made to reduce these problems?

Reducing stress, changing diet, exercise, etc.

3. What constitutes good oral hygiene? Is flossing that important? How can flossing impact the gastrointestinal system?

Good oral hygiene may include brushing and flossing regularly. Flossing is important to help remove small food particles between the teeth. When these food particles are not removed, they can begin to rot (form bacteria), which causes gingivitis. These same bacteria can travel through the GI system with possible GI system effects.

4. Chemotherapy and radiation can have many adverse effects on patients, including gastrointestinal system effects (eating, swallowing, saliva production). What prescription and over-the-counter (OTC) products are available to help with these unwanted effects? As a pharmacy technician, how could you help support these patients?

Chemotherapy can cause saliva to stop being produced. This side effect causes poor appetite and difficulty eating because proper digestion is not initiated. Many OTC products are available to help with saliva production. A pharmacy technician can learn about how chemotherapy affects the GI system, the products available in OTC to help, and alert the pharmacist to counsel and help the patient.