Drug action 2 final

phases of digestion

cephalic

gastric

intestinal

cephalic digestion

sight, smell taste, or thought of food stimulate the release of gastric juices

gastric digestion

stomach distends, more release of gastric juices

intestinal digestion

fats and acids prevent the secretion of gastric juices

GI disorders list

peptic ulcers and GERD

chemotherapy-induced emesis

diarrhea

constipation

irritable bowel syndrome

inflammatory bowel disease

peptic ulcer

open sore that develop on the mucosal lining of the stomach and duodenum

causes of peptic ulcer

helicobacter pylori

long-term used of NSAIDS

hyperacidity

hyperchlorhydria

role of NSAID on peptic ulcer disease

COX inhibition
lowered production of protective prostaglandins

systemic effects of NSAD in peptic ulcer

inh COX2

lower prostaglandin

higher GA

lower BF

mucosal damage

topical injury of peptic ulcer NSAID

NSAID WA compared to gastric epithelial cell wall

symptoms of peptic ulcer

periodic pan N/V loss appetite

heart burn

chronic erosion of mucosa perforation of GI wall

Gastrointestinal Esophageal Reflux disease

characterized by heartburn

GERD occurs due to

regurgitation of digestive juices into the esophagus

GERD caused by

inappropriate constriction of the lower esophageal sphincter

things that known to lower esophageal sphincter pressure

coffee, peppermint

alcohol, cigarettes, dopamine, barbs

tx of peptic ulcers

directed toward the source of irritation and pain and allowing mucosal sores to heal

antibiotic tx of H.pylori

combination of at least two antibiotics and bismuth salts

how to detect H.pylori

C13 urea breath test

other methods of detection of H.pylori

stool antigen test

histologic examination of gastric mucosal biopsy

serologic testing for H.pylori

antiulcer drug therapy

reduces gastric acidity

enhances mucosal barrier defenses

involves the use of antisecretory drug and antacids

GERD Drug therapy

suppresses acid promotion

prevents erosion

provides symptomatic relief

lifestyle modification of GI disorders

stop smoking

avoid caffeine or alcohol

lose weight

elevation of head in bed

antihistamine H2 receptor antagonists

reduce interaction between histamine and H2 receptors

clinical indication of H2 receptor antagonists

benign gastric ulcers

duodenal ulcers

GERD

Special hypersecretory conditions

H2 receptor antagonist examples

Cimetidine

ranitidine

Famotidine

Nizatidine

proton pump inhibitor clinical indications

H. pylori

benign gastric ulcers and GERD

MOA of PPIs

block the parietal cell H+/K+ ATPase proton pump by binding covalently with the H+/K+-ATPase enzyme

Proton pump inhibitor examples

Esomeprazole

Omeprazole

Rabeprazole

Lansoprazole

Pantoprazole

Drug interactions omeprazole

affects the absorption of acidic environment dependent drugs

reduces the potency of clopidogrel

Prostaglandins clinical indications

NSAID-induced gastric ulcers

Prostaglandin analogs

a deficiency of prostaglandins is though to be involved in the pathogenies of peptic ulcers

Misoprostol

has both acid inhibitory and mucosal protective properties

MOA of misoprostol

stimulate mucus and bicarbonate secretion and enhance mucosal blood flow

antacids clinical indication

hyperacidity associated with peptic ulcers

MOA of antacids

react with HCl forming water and salts

prolonged use of sodium bicarbonate may result in

metabolic alkalosis

drug interaction of antacids

may affect the absorption and excretion of other drugs

aluminum hydroxide or magnesium hydroxide

reacts with H in stomach to form water

react with bicarbonate in pancreatic secretions and with phosphates in diet to from salts

when antacids containing aluminum or magnesium are taken together

constipation and diarrhea may be avoided

sodium bicarbonate (alka seltzer)

reacts rapidly with HCL to form water carbon dioxide and salt

calcium carbonate (tums)

less soluble than sodium bicarbonate

reacts with gastric acid to produce calcium chloride and carbon dioxide

barrier enhancer sucralfate MOA

forms a protective barrier over damaged mucosa by binding proteins exuded from damaged cells

clinical indication of cuvralfate

short term treatment of duodenal ulcers

drug interactions of sucralfate

decreases bioavailability of digoxin quinolone, ketoconazole, warfarin

two coating agents used in peptic ulcer disease

bismuth subsalicylate

bismuth subcitrate

prokinetic drugs for the management of GERD

metoclopramide

metoclopramide

stimulates contraction of the low esophageal sphincter

treats meal-induced heartburn

treats chemotherapy induced vomitting

hematopoiesis definition

the production of circulating erythrocytes, platelets, and leukocytes

stem cell of the bone marrow

pluripotent hematopoietic stem cells

RBC f(x)

carry oxygen

WBC f(x)

fight infection and help protect against cancer

platelets f(x)

control bleeding

hematopoiesis requirment

essential nutrients

hematopoietic growth factors

causes of anemia

inherited

deficiency

two types of inherited anemia

cooley's anemia

sickle cell anemia

three different deficiency causes of anemia

iron

cyanocobalamin

folic acid

pathophysiology of erythrocytes

sickle cell anemia

thalassemia

deficiency anemias as classified by

shape and color of blood cells

microcytic

unusually small RBC

macrocytic anemia

large RBCs

iron deficiency anemia is

microcytic

ferritin is

iron-binding protein acting as storage site for iron

transferrin is

plasma protein manufacture in the liver

depletion of internal iron stores leads to

iron deficiency

characteristics of iron deficiency

men- internal bleeding strict vegans

women- menstrual blood loss pregnancy

Pica is

condition caused when people consume non nutritional items

chronic iron deficiency results in microcytic

hypochronic anemia

tx of iron deficiency:

hematinics

hematinics are

medications that primarily contain iron compounds

Ferumoxytol

a superparamagnetic iron oxide with a carbohydrate covering for CKD

tx of acute iron toxicity

gastric lavage with deferoxamine mesylate

cobalamin deficiency anemia

occurs when absorption is interrupted

lack intrinsic factor

intestinal tape worm

pernicious anemia may develop

pregnancy, hemorrhage, malignancy, postgastrectomy, liver or renal disease

characteristics of cobalamin deficiency anemia

Myelin sheaths not formed

Nerve degeneration

paresthesia

DNA synthesis

folic acid deficiency

pregnancy

hyperthyroidism

rheumatoid arthritis

erythropoietin is imparied in

patients with chronic renal failure

synthesis proteins mimic erythropoietin are used

to stimulate red blood cell production in erythropoietin deficiency anemia

ESAs

rhEPO

PEG-epoetin beta

NESP

MOA of ESA

stimulate the erythropoietin receptor and inducing erythropoiesis

interference with progenitor cell proliferation and differentiation into mature WBCs

myelosuppression

myelosuppression leads to low neutrophil count

neutropenia

agents that stimulate leukocyte production

filgrastim

PEG-Filgrastim

Sargramostim

low platelet count

thrombocytopenia

Thrombocytopenia is an important adverse effect of

chemotherapeutic agents

thrombopoietin receptor agonists

eltrombopag

romiplostim

bacteria is

a large domain of prokaryotic microorganisms that come in a wide range of shapes and sizes

prokaryotes are

organisms made up of cells that lack a cell nucleus or membrane bound organelles

genetic material in prokaryotes

is not bound within a nucleus

bacteria are divided into two groups

gram positive and gram negative

gram positive cell wall

thick layer of murein

gram negative

thin layer of murein and second lipid bilayer

outer layer of gram negative

LPS

central dogma of molecular biology

describes transcription and translation by which information flows to DNA RNA to protein

differences in bacteria replication

topoisomerase

RNA polymerase

Ribosome

major drug tx focuses on interruption tobacterial

DNA replication

transcription

translation

bacteria chromosomes are usually

circular

topoisomerases conduct the following functions

removing excess DNA supercoils during replication

separating intertwined Progeny DNA by breaking and rotating and religating DNA strands

type 1 topoisomerase

form and reseal single stranded breaks in DNA to decrease positive supercoiling

type II topoismerase

nuclease and ligase operations on both strands of DNA

DNA replication is

semiconservative model