GI - PCL 470Y TERM TEST 1 Wednesday November 10th 9AM EX 300 Start time ~60 points 50 MC 50 Short Answer Case study Apply integrate think logically

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PCL 470Y TERM TEST 1 Wednesday, November 10 th 9AM @ EX 300 • Start time. .. • ~60 points – 50% MC & 50% Short Answer • Case study • Apply, integrate, think logically – MOA, therapeutic use, adverse effects, drug interactions • Generic names, “concepts” from SGS • Differences, similarities (PK, PD, Physiology)
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GI Pharmacotherapy What is something to be aware of during use of GI medications?
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Acid-Peptic Disorders: Common Complaints: dyspepsia (belching, nausea, early satiety, abdominal bloating/distention) heartburn abdominal pain Disorders include: peptic ulcer or gastroduodenal ulcer disease (PUD) gastroesophageal disease (GORD,GERD) gastroduodenal injury acid hypersecretory conditions (e.g., Zollinger-Ellison syndrome) drug induced mucosal injury (NSAIDS) stress ulcers
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Accessed March 11, 2007 at http://www.patienthealthinternational.com/article/501915.aspx Overview of„Normality‟
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Accessed March 12, 2007 at http://www.vivo.colostate.edu/hbooks/pathphys/digestion/stomach/anatomy.gif I.(Patho)physiology of Acid-Peptic Disorders • secretory epithelial cells of the stomach: – mucous cells (alkaline protective mucous) – parietal cells (hydrochloric acid) – chief cells (pepsin, a proteolytic enzyme) – G cells (gastrin, a hormone) • acid released by 3 secretagogues : – histamine – acetylcholine – gastrin • acid release in 3 phases: – cephalic – gastric – intestinal
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Non-Pharmacologic Therapy of Acid-Peptic Disorders • lifestyle changes (↓stress, ↓ smoking) • dietary changes (↓ caffeine, ↓alcohol, avoid eating late at night) • weight loss • elevation of head and torso • BUT … most need medication(s)
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Rabeprazole Can Overcome the Impact of CYP2C19 Polymorphism on Quadruple Therapy 1. Why was it important that this study looked at ITT and PP analysis? 2. What are the MOA of drugs used in standard triple therapy? 3. Why did the HeterEM/PM group have a greater eradication rate? 4. How do Rabeprazole and Esomeprazole differ? Did the authors correlate the differs in regards to CYP polymorphism- and why is this question important?
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1A. Peptic Ulcer Disease (PUD) • aggressive factors – acid – pepsin – bile – Drugs – H. pylori infection (DU and GU) • protective factors – pH < 2 – mucosal barrier – cellular regeneration – secretin – gastric acid release inhibitors which cAMP GIP • CCK somatostatin prostaglandins EGF Accessed March 14, 2007 at http://www.nexium.net/hcp/InPepticUlcerDisease/Nexium-esomeprazole-in- Helicobacter-pyloriassociat.aspx?mid=18&c=helicobacter- pylori&gclid=CKj2w7js9IoCFSGNQAodc1t3mw
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IB. Gastroesophageal Reflux Disease (GERD) • stomach acid content travels backwards into the gullet … esophageal lining may ulcerate • main symptom is heartburn • other symptoms: regurgitation, chest pain, dysphagia, hoarseness • stomach may not empty quickly enough • LES mechanism not adequate • Aggressive factors similar to PUD
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II. Drug Treatment of Acid-Peptic Disorders 1. PPIs reduce acid production 2. Anti-microbials eradicate H. pylori
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This note was uploaded on 12/03/2010 for the course PHAMACOLOG pcl470 taught by Professor Arnot during the Fall '10 term at University of Toronto- Toronto.

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GI - PCL 470Y TERM TEST 1 Wednesday November 10th 9AM EX 300 Start time ~60 points 50 MC 50 Short Answer Case study Apply integrate think logically

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