Biopharm exam 5 (Altered GI anatomy)

higher, 250ml

stomach capacity is _______ than ______ ml

1

fasted stomach ph

pyloric sphincter

stomach empties into duodenum via the

Duodenum

stomach contents mix with pancreatic juice and bile in the

higher

meals stimulate _______bile and pancreatic juice secretion

~25 cm

the duodenum is

2.5 m

the jejunum is

duodenum; decreases

number of SLC uptake transporters per cm^2 is highest in the ______ and _____ through the SI.

lowest; increases

number of ABC efflux transporters per cm^2 is ________ in the duodenum and _____ through the SI.

highest; lowest

stomach contents enter SI where SLC density is ________ and ABC density is _______

normal GI tract anatomy and physiology

oral drug product design is based on ________

false

T/F: drug absorption cannot be different in patients with non-normal anatomy and physiology

gastric banding

______ is surgical placement of a collar around the upper part of the stomach.

collar tension; esophagus; stomach

_______ is adjusted to restrict the flow of ingested material from the ______ to the main part of _____

restrictive

gastric banding is a _____ procedure

decrease; decreasing

gastric banding is intended to _______ the rate of food intake by ______ the stomach opening size.

false (its intended to make patients feel full after a small meal)

T/F: gastric banding is intended to make patients feel hungry even after a small meal

false (its completely reversible)

T/F: gastric banding is irreversible.

true

T/F: gastric banding has no effect on stomach structure, motility, or acid secretion

true

T/F: the pyloric sphincter remains intact and functions normally after gastric banding

false (it has no effect on any of these)

T/F: gastric banding has significant effects on small intestine structure, secretions, transporters, pH, or mucosal enzymes.

true

T/F: Gastric banding has no effect on where bile or pancreatic secretions entering the small intestine

false (it has no effect on large intestine structure)

T/F: gastric banding has significant effects on large intestine structure

true

T/F: after gastric banding, a patient may not be able to drink 8 oz of water at one time.

true

T/F: a patient after gastric banding surgery is at greater risk for esophagitis than a normal person

2, 4, low solubility

drug classes ___ and __ are more likely to be affected by gastric banding surgery patients because they have ______

decreases

slower disintegration ______ the rate of drug particles being available to dissolve

false (slower)

T/F: after gastric banding procedure, tablets and capsules may disintegrate faster than a normal GI person.

increase

in patients with the gastric band procedure, slow dissolution may ______ tmax as compared to a normal GI person.

stoma

depending on how much water the patient can drink at one time, large tablets/capsule can block _____

1. pain and esophageal reflux

2. slowed tablet/capsule disintegration and dissolution

3. delayed tablet or capsule movement to distal pouch and slow emptying of drug into duodenum

blocked stoma can cause

1. drugs that must be taken with a high fat meal to be absorbed

2. Extended release tablets and capsules

drugs that are not appropriate for a patient with a gastric band include

false

T/F: most ER tablets can be safely crushed for administration

true

T/F: some ER capsules cannot be safely opened for administration

true

T/F: some ER capsules containing ER beads can be safely opened for administration, if the patient does not chew or crush the beads

stomach

the anatomic and physiologic changes caused by the gastric band are limited to the _____

1. small intestine A&P

2. large intestine A&P

3. bile composition or secretion

4. pancreatic juice composition or sectrion

the gastric band hardware implanted in the patient has no direct or indirect effect on

true

T/F: Since the gastric band has no effect on the large intestine, the large intestine is generally considered insignificant for absorption of immediate release oral products in patients with a gastric band just like it is in patients with normal GI tract anatomy and physiology

1. lower bile secretion in the fed state due to lower calorie intake

2. lower pancreatic juice secretion in the fed state due to lower calorie intake

Patients are recommended to adopt lifestyle changes after gastric banding, so the specific effects of the gastric band procedure and expected patient lifestyle changes on oral drug absorption may include:

sleeve gastrectomy

______ is surgical removal of the greater curvature of the stomach

false (most of it is removed)

T/F: only a small portion of the stomach is removed by sleeve gastrectomy

restrictive

sleeve gastrectomy is a _______ procedure.

false

sleeve gastrectomy is completely reversible.

100 ml

stomach capacity is reduced to approximately ______ after sleeve gastrectomy.

5 or higher

fasted pH may be ______ after sleeve gastrectomy.

acid producing cells

most _____ are removed after sleeve gastrectomy.

true

T/F: pH may be lower as patient recovers from sleeve gastrectomy.

stomach motility

_______ changes after sleeve gastrectomy due to cutting and removal of most of the stomach muscle by the sleeve gastrectomy procedure.

churning/mixing

______ may not be as forceful after sleeve gastrectomy as it is in a normal GI person

slower (fasted pH is now 5 or higher)

after a patient receives a sleeve gastrectomy procedure weak base drugs may dissolve _______ than in normal GI person.

faster (fasted pH is 5)

after a patient receives a sleeve gastrectomy procedure weak acid drugs may dissolve _______ than in normal GI person.

true

T/F: there are no specific drugs or dosage forms that are inappropriate for patient after sleeve gastrectomy.

less intense

Churning/mixing function ________ than normal GI person after Sleeve gastrectomy

slower, later, lower

tablet and capsule disintegration may be _______ after sleeve gastrectomy which may cause ______ tmax and ______ F.

slow, larger particles, non-disintegrating ER tablets

in patients with sleeve gastrectomy procedure, less forceful contractions may _____ GER. especially for ______ and ______.

esophagus; distal jejunum

roux-en-Y gastric bypass is a major surgical procedure that involves creating a small pouch where the upper stomach is connected to _______ and connecting the pouch to the _______

15-50ml

Roux-en-Y gastric bypass the pouch is approximately

connected to the intestine

in Roux-en-Y gastric bypass, the main part of the stomach is stapled off and left

true

T/F: in Roux-en-Y gastric bypass, the duodenum is completely bypassed

1/3 to 1/2

in Roux-en-Y gastric bypass, _______ of jejunum is bypassed

false

T/F: there is a sphincter between the stomach pouch and jejunum is Roux-en-Y gastric bypass

true

T/F: bile and pancreatic secretions do not mix with ingested food or drugs until much later in the jejunum after RGB

restrictive and irreversible

RGB is ______ and _______

malabsorptive

RGB is ______

significantly decreased

the SI surface area available to ingested food and drug is ______ after RGB

high

______ SLC density in duodenum and upper jejunum is bypassed after RGB

Low

_______ ABC density in duodenum and upper jejunum is bypassed after RGB

intentionally decreased

ability to absorb nutrients is _______ after RGB

decreased

ability to absorb drugs is _______ after RGB.

15-50, full stomach

there is a ______ml pouch instead of _____ after RGB.

smaller

patient will have _____ volume of water for disintegration and dissolution after RGB.

true

T/F: patient may not be able to drink 8 oz of water at a time after RGB

little, if any

the stomach provides _____ mechanical mixing after RGB

little if any

there is ______ acid secretion in the pouch after RGB

true

T/F: fasting pH may be 5 or higher after RGB

true

T/F: there is no sphincter between the stomach pouch and intestine after RGB

proportional

gastric emptying rate is _______ to the volume of liquid consumed after RGB

jejunum

tablet and capsule disintegration most likely occurs in the _______ after RGB

false (it occurs in the jejunum)

T/F: dissolution probably occurs in the duodenum after RGB

zero time

solids probably have _______ for dissolution before reaching SI after RGB.

at the same time

dissolution and absorption occur _____ after RGB

pH and water volume

the absorption rate depends on _____ and ____ in the SI after RGB

1. substuting a liquid product

2. crush tablets or open capsules

3. substitute a different drug that may be absorbed better

4. consider a different route of administration

if absorption of a drug is too slow, or F is too low after RGB, healthcare providers may consider

decreased

the SI length is _____ after RGB

duodenum, jejunum

______ and part of ____ are removed from absorption process after RGB

a-b

highest density of _____ transporters is bypassed after RGB

b-a

lowest density of ______ transporters is bypassed after RGB

poorly

drugs that need uptake transporters may be _______ absorbed after RGB

highest; duodenum

intestinal Cyp enzymes appear to be _______ in the ______

better

drugs that exhibit significant mucosal presystemic metabolism may be _______ absorbed than normal GI after RGB

mix with; y junction

bile and pancreatic juice _______ingested contents at the _____ after RGB. and patients ate instructed to adopt a low fat and low calorie diet

false (it is not clear)

T/F: food effect on pancreatic juice secretion is clear after RGB

lower

Fed bile secretion appears to be _______ than a normal GI person after RGB

less than

solubilization by bile and fat digestion products appears to be _______ normal GI patients after RGB

shorter

SITT is ____ after RGB

true

T/F: drugs that must be taken with a high fat meal for reliable absorption may not be appropriate for patients after RGB

1. switch from solid to liquid dosage form (crush tablets, open capsules )

2. consider alternative routes of administration

3. switch ER to IR if possible

4. choose a drug that exhibits minimal presystemic metabolism in normal GI

if you suspect poor absorption of a particular drug after RGB, then reasonable approaches to improve therapy after RGB would include

less

SITT being shorter in RGB patients causes _____ time and surface area for absorption of slow transport drugs after RGB

false (may not be appropriate)

T/F: ER products are always appropriate for patients after RGB