PathoPharm II Exam 3 GI/GU/Endo

Digestive system function

breaks down food, absorbs nutrients, and removes waste

Gi tract structure

mucosa, submucosa, muscularis, serosa

Small intestine

duodenum, jejunum, ileum; break down, absorb nutrients, pass on waste

Large intesine/colon

remove water, electrolytes, move waste

Liver function

produces bile

Portal HTN

liver cirrhosis, obstruction in porta vein and shunting of blood through esophageal and splenic venous system

Varices

overstretching and rupture of esophageal vein

Hepatic encephalopathy

liver failure, build up of ammonia

Symptoms of hepatic encephalopathy

confusion, sweet/rusty breath, tremors, coma, death, lactulose

Ascites

fluids collect in the peritoneal cavity, end stage liver failure

Anorexia

loss of appetite

Nausea and vomiting

emesis, forceful emptying of stomach content (chyme); medulla oblongata

Causes of N/V

vestibular stimulation in middle ear (motion), stimulation of CTZ (drugs/toxins), release of dopamine/serotonin

Travelers diarrhea

E coli, if longer than 3-5 days or fever, fluoroquinolones

Purpose of antidiarrheals

decrease hyper motility

Caution for antidiarrheals

not be used longer than 2 days or if fever is present

Types of antidiarrheals

diphenoxylate plus atropine, loperamide

Abdominal pain

visceral, somatic, referred

Chyme

mixture of enzymes and partially-digested food

Motility

moving food through GI

Segmentation

churning and mixing of intestinal contents mainly in small intestine

Peristalsis

involuntary, wave like muscular contraction that propels food through the GI

Gastroparesis

muscles weakened, slower gastric emptying

Intestinal microbiome

collection of microorganisms in the intestine

Nonpharm tx for N/V

weak tea, flat soda, gelatin, pedialyte, gatorade, crackers, dry toast, BRAT diet

Number 1 tx for N/V

fluid and electrolyte replacement

Glucocorticoids example

dexamethasone, methylprednisone

Glucocorticoids action

anti-inflammatory effect

Glucocorticoids use

N/V from chemo, IV short-term for minimal side effects

Substance P/neurokinin antagonist example

aprepitant

Substance P/neurokinin1 antagonists action

block action of substance P, a neuropeptide that transmits N/V signals in the brain

Substance P/neurokinin1 antagonists use

N/V from chemo

Serotonin antagonists example

ondansetron (zofran), granisetron

Serotonin antagonists action

block serotonin receptors in CTZ, block afferent vagal nerve terminals in upper GI

Serotonin antagonists use

N/V from chemo, post-op N/V

Serotonin antagonists side effects

headache, diarrhea, dizziness, fatigue

Dopamine antagonists examples

prochlorperazine, promethazine

Dopamine antagonists action

suppress N/V by blocking dopamine/serotonin receptors in CTZ, augments action of acetylcholine, promotes gastric motility and empyting

Dopamine antagonists use

post op N/V secondary to anesthesia, chemo, radiation sickness

Dopamine antagonists side effects

sedation, avoid alcohol, tardiye dyskinesia, extrapyramidal syndrom (EPS)

What to do to minimize EPS with Dopamine antagonists

administer as an antihistamine (diphenhydramine)

Cannabinoids example

dronabinol

Cannabinoids action

block serotonin receptors in CTZ

Cannabinoids use

N/V from chemo, appetite stimulant

Cannabinoids contraindications

psychiatric disorders

Cannabinoids side effects

mood changes, euphoria, depersonalization, nightmares, confusion, memory lapse, dry mouth, tachycardia, manic psychosis

Anticholinergics example

scoplamine

Anticholinergics action

decrease stimulation of CTZ and vestibular pathways

Anticholinergics use

motion sickness

Anticholinergics side effects

drowsiness, dry mouth, blurred vision, tachycardia, constipation, urinary retention

Anticholinergics should not be used in patients with...

glaucoma

Antihistamines examples

dimenhydrinate, hydroxyzine, diphenhydramine, meclizine

Antihistamines action

inhibit vestibular stimulation in middle ear

Antihistamines use

prevent motion sickness, alleviate N/V during pregnancy

Antihistamines side effects

drowsiness, dry mouth, constipation, urinary retention

Take Antihistamines ____ before travel

30 min

Antihistamines should not be used in patients with....

glaucoma

Benzodiazepines example

lorazepam

Benzodiazepines action

Interacts with neurotransmitter GABA to reduce neuron excitability

Benzodiazepines use

reduce anxiety, treat insomnia

Bulk-forming laxatives example

methylcellulose, psyllium

Bulk-forming laxatives action

increase bulk and peristalsis, promote large soft stools

Bulk-forming laxatives administration

mix in glass of water or juice, stir and drink, follow with full glass of water

Bulk-forming laxatives side effects

cramps, N/V, flatus, diarrhea

Insufficient fluid with Bulk-forming laxatives causes...

intestinal obstruction

Surfactant laxatives example

docusate sodium

Surfactant laxatives action

lower surface tension of stool, soften feces for easier passage

Surfactant laxatives use

prevent constipation, decrease straining during defecation

Surfactant laxatives side effects

N/V, mild abdominal cramping

Surfactant laxatives contraindications

un-dx abdominal pain, inflammatory GI disorders, spastic colon, bowel obstruction, pregnancy

Osmotic laxatives examples

lactulose, magnesium hydroxide, polyethylene glycol (PEG)

Lactulose use

liver failure, clears ammonia

Magnesium hydroxide use

general population, cleared for procedure, empyies bowel

Polyethylene glycol (PEG) use

clears bowel, renal failure and HF, drink gallon of fluid, no fluid exchange, isotonic in GI

Osmotic laxatives use

low dose to prevent painful elimination, high dose to prep prior to surgery

Osmotic laxatives side effects

fluid/electrolyte imbalance, hypotension, cramps, N/V, diarrhea

Osmotic laxatives contraindication

patients with HF (alt PEG)

Stimulant laxatives example

bisacodyl, senna

Stimulant laxatives use

bowel prep for diagnostics or surgery

Stimulant laxatives side effects

cramps, N/V, reddish brown urine, fluid/electrolyte imbalances

Stimulant laxatives contraindications

fecal impaction, intestinal obstruction, appendicitis

Diphenoxylate plus atropine

antidiarrheal

Loperamide

antidiarrheal

Paregoric

pain-killing drug

Upper GI bleed

bright red, dark tarry stool, occult blood

Melena

dark tarry stool

Lower GI bleed

bright red bleeding

Obstruction

prevents normal flow of chyme through lumen

Hiatal hernia

bulging of abdominal structure into thoracic cavity

Hiatal hernia symptoms

heartburn, GI pain, dysphagia, regurgitation

Hiatal hernia tx

proton pump inhibitors (PPI), antacids

Gastric reflux disease (GERD)

inflammation of esophageal mucosa caused by reflux of gastric acid content into the esophagus

GERD pain

does not get better after eating

GERD tx

promote gastric emptying, metoclorpramide for motility, PPI

Peptic ulcer disease (PUD)

break or ulceration in protective mucosal lining

PUD symptoms

gnawing, aching pain

PUD pain

gets better after eating

Histamine2 blockers examples

famotidine, cimetidine, and nizatidine

Histamine2 blockers action

reduce gastric acid

Histamine2 blockers side effects

headache, diarrhea, constipation