What are the symptoms of Gastroesophageal reflux disease (GERD)?
Show answer
Frequent and persistent heartburn
4
What are the symptoms of Peptic ulcer disease (PUD)?
Show answer
Related to mucosal exposure to gastric acid and pepsin
5
What are antacids and how do they work?
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Antacids neutralize stomach acid, reducing its acidity.
6
What are antisecretory medications and what do they do?
Show answer
Antisecretory medications reduce acid secretion in the stomach.
7
What conditions do acid reducing medications treat?
Show answer
They treat gastroesophageal reflux disorder and peptic ulcer disease.
8
What is the role of carbonic anhydrase (CA) in gastric secretion?
Show answer
CA catalyzes the conversion of carbon dioxide (CO2) and water (H2O) into carbonic acid (H2CO3), which is then converted into hydrogen ions (H+) and bicarbonate ions (HCO3-).
9
What is the 'alkaline tide' in gastric secretion?
Show answer
The 'alkaline tide' refers to the movement of bicarbonate ions (HCO3-) from the blood into the stomach lumen, which helps to neutralize the acidic environment created by hydrogen ions (H+).
10
What is the direct pathway of vagal stimulation for hydrogen ion secretion?
Show answer
The direct pathway involves the vagus nerve stimulating hydrogen ion secretion from parietal cells using acetylcholine as a neurotransmitter.
11
What is the second messenger for gastrin on parietal cells?
Show answer
The second messenger for gastrin on parietal cells is IP3/Ca2+.
12
What are the three factors that can inhibit hydrogen ion secretion in the stomach?
Show answer
Low pH (<3.0) in stomach, Somatostatin, Prostaglandins
13
What are the effects of inhibiting hydrogen ion secretion?
What is the role of the H2 receptor antagonist Cimetidine in the regulation of hydrogen secretion?
Show answer
Cimetidine prevents Histamine signaling by blocking the H2 receptor.
15
Which drug blocks the stimulatory signal from the Vagus nerve mediated by Acetylcholine?
Show answer
Atropine blocks the stimulatory signal from the Vagus nerve mediated by Acetylcholine.
16
What is the mechanism of action of Omeprazole in the regulation of hydrogen secretion?
Show answer
Omeprazole inhibits the hydrogen/potassium pump.
17
What are H2 receptor antagonists/blockers?
Show answer
They are competitive, reversible antagonists of H2 receptors.
18
List the H2 receptor antagonists mentioned in the slide.
Show answer
Cimetidine, Ranitidine, Famotidine, and Nizatidine.
19
What is the effect of cimetidine on the elimination of diazepam?
Show answer
Slowed elimination of diazepam due to inhibition of CYP3A4 by cimetidine
20
What are the adverse effects of cimetidine?
Show answer
Confusion and dizziness
21
What are the oral medications for proton pump inhibitors?
Show answer
Omeprazole, Lansoprazole, Dexlansoprazole
22
What are the IV medications for proton pump inhibitors?
Show answer
Pantoprazole, Esomeprazole
23
What is the fate of oral forms of proton pump inhibitors?
Show answer
Absorbed in inactive form
24
What are the key members of the PPI class?
Show answer
Dexlansoprazole, esomeprazole, lansoprazole, omeprazole, pantoprazole, and rabeprazole
25
Where are PPIs metabolized and how do they travel to their target cells?
Show answer
PPIs are metabolized in the liver and travel through the blood to parietal cells.
26
What is the mechanism of action of PPIs and what do they inhibit?
Show answer
PPIs irreversibly bind to and inhibit H+/K+-ATPase, or proton pumps, found within parietal cells.
27
What are the side effects of Proton Pump Inhibitors (PPIs)?
Show answer
GI disturbance (nausea, abdominal pain, diarrhea), prolonged acid suppression (reduced absorption of iron, calcium, magnesium, and vitamin B12), increased susceptibility to Clostridoides difficile infection, and risk of pneumonia.
28
What is the term for the dry mouth side effect of PPIs?
Show answer
Xerostomia
29
What is the effect of a change in gastric pH on the absorption of certain medications?
Show answer
A change in gastric pH can decrease the absorption of certain medications.
30
Which medications are affected by a change in gastric pH?
Show answer
Digoxin and Ketoconazole are affected by a change in gastric pH.
31
What are the two enzymes involved in the metabolism of warfarin and clopidogrel?
Show answer
CYP450 and CYP2C19 are the enzymes involved in the metabolism of warfarin and clopidogrel.
32
What is the effect of Omeprazole on the metabolism of other medications?
Show answer
Omeprazole may inhibit the metabolism of diazepam, warfarin, and phenytoin.
33
What is the FDA warning regarding the use of Omeprazole with clopidogrel?
Show answer
The FDA warns that Omeprazole could reduce the activation of clopidogrel and its antiplatelet action.
34
What is the therapeutic importance of Diazepam in pre/post-operative sedation for GI ulcer patients?
Show answer
Diazepam produces sedation and suppresses nocturnal secretion of gastric acid.
35
What benzodiazepine antianxiety drugs are suitable for sedation in patients treated with cimetidine or omeprazole?
Show answer
Lorazepam or oxazepam.
36
What are antacids and how do they work?
Show answer
Antacids are weak bases that bind to H+ ions in the stomach, reducing the pH of gastric acid.
37
What are the main uses of antacids?
Show answer
Antacids are mainly used for symptomatic relief in gastroesophageal reflux disease (GERD).
38
What are the potential side effects of calcium carbonate and sodium bicarbonate used as antacids?
Show answer
Calcium carbonate and sodium bicarbonate can cause severe systemic side effects, including milk-alkali syndrome, metabolic alkalosis, hypercalcemia, and renal insufficiency.
39
What is the side effect of aluminum hydroxide?
Show answer
Inhibits smooth muscle contraction in the GI tract, leading to constipation
40
What is the side effect of magnesium hydroxide?
Show answer
Laxative effect, causing diarrhea and hypotension
41
What are the side effects of aluminum hydroxide in healthy individuals?
What are the side effects of magnesium hydroxide in renal insufficiency?
Show answer
Hypermagnesia, hyporeflexia, cardiac arrest
43
What is the effect of antacids on drug interactions?
Show answer
Antacids affect drug interactions by changing gastric and urinary pH.
44
How do antacids impact oral absorption of drugs?
Show answer
Antacids can alter the pH of the stomach and urine, affecting the absorption of acidic and basic drugs.
45
What is the effect of antacids on the absorption of tetracyclines and fluoroquinolones?
Show answer
Antacids impair the absorption of tetracyclines and fluoroquinolones by chelating these medications and increasing the gastric pH.
46
How do antacids affect the absorption of ketoconazole and itraconazole?
Show answer
Antacids prevent the GI absorption of ketoconazole and itraconazole by increasing the pH in the GI tract.
47
What is the trade name of Pilocarpine?
Show answer
Salagen (tablet; 5 mg)
48
What is the trade name of Cevimeline?
Show answer
Evoxac tablet (30 mg)
49
What are sialagogues?
Show answer
Drugs that enhance salivary secretion through promoting the parasympathetic nervous system
50
What is the definition of an anti-sialagogue?
Show answer
A drug that decreases salivary flow.
51
What are the indications for Atropine?
Show answer
1. Anti-secretory agent to reduce salivary and respiratory tract secretion prior to surgery; 2. Anti-spasmodic to relax GI tract; 3. Inhibitory effects in bronchial tissue, salivary, sweat glands, heart.
52
How does Scopolamine differ from Atropine in terms of action on the CNS?
Show answer
Scopolamine has a greater action on the CNS and a longer duration of action than Atropine.
53
What is the mechanism of action of Atropine?
Show answer
Atropine has a high affinity for muscarinic receptors (M1, M2, M3) in the central and peripheral nervous system, thus it can competitively prevent acetylcholine action.
54
Why is Scopolamine not the drug of choice to reduce salivary secretion in a dental setting?
Show answer
Scopolamine may impair psychomotor activity (produce euphoria and sedation), making it unsuitable for reducing salivary secretion in a dental setting.
55
What are the three main pathways that lead to nausea and vomiting?
Show answer
Visceral stimuli, Chemoreceptor trigger zone, and Vestibular input
56
What neurotransmitters are released by visceral stimuli and chemoreceptor trigger zone?
Show answer
Dopamine and serotonin
57
What is the brainstem vomiting center and what does it do?
Show answer
The brainstem vomiting center is located in the lateral medullary reticular formation. It coordinates motor activities associated with nausea and vomiting.
58
What are some neurotransmitters and their receptors that are targets for antiemetic drugs?
Show answer
Targets include serotonin 5-HT3 antagonists, neurokinin antagonists, and cannabinoids.
59
What are the different types of laxatives mentioned in the slide?
What is the difference between laxatives and cathartics?
Show answer
Laxatives ease the passage of fully formed fecal matter from the rectum, while cathartics cause evacuation of the entire colon, usually in the form of watery, unformed stool.
61
What are the effects of bulk-forming agents on the gastrointestinal tract?
Show answer
Absorb water and expand, increasing the bulk of intestinal contents, stimulating peristalsis, and softening stool.
62
What are Opioid Receptor Antagonists and how do they work?
Show answer
Decrease intestinal motility by selectively inhibiting μ-opioid receptors in the GI tract without affecting analgesic actions of opioids in the CNS.
63
What are the examples of Antidiarrheal Agents and how do they work?
Show answer
Kaolin, Bismuth Subsalicylate, Opioids, Diphenoxylate, Loperamide; they soak up excess water or decrease intestinal motility to provide more time for absorption.
64
What is the mechanism of action for bulk-forming laxatives?
Show answer
Increases stool mass and swells and distends the colon
Stimulates enteric nerves and moistens to ease passage
67
What is GERD and how does it affect dental procedures?
Show answer
GERD stands for Gastroesophageal Reflux Disease. It involves the need to recline patients in the dental chair, with some patients requiring a 45-degree angle due to severe GERD. It's important to ask patients about their sleeping positions to manage symptoms.
68
What are the implications of a history of gastric or duodenal ulcer for dental patients?
Show answer
A history of gastric or duodenal ulcer can influence the choice of therapeutic agents and the time of drug administration. Aspirin is contraindicated due to its irritating effect on the gastric mucosa, especially for elderly patients. Acetaminophen is recommended as an alternative.
69
What are the adverse side effects of opioid analgesics on the GI tract?
Show answer
Constipation, nausea, and vomiting
70
What are the adverse effects of aspirin-containing analgesics on the GI system?
Show answer
Gastric distress, fecal blood loss, and ulceration
71
What are the common adverse effects of antibiotics on the GI system, especially broad-spectrum antibiotics?
Show answer
Diarrhea caused by Clostridium difficile overgrowth
72
What is the common name for Bismuth subsalicylate?