Pharma Facts

GIT IMPORTANT POINTs

GI hormones: gastrin, CCK, GIP
-release, stimuli, action Gastrin
-stomach G cells (antrum) of parietal cells
-stimuli: protein, stomach distension, Ach
-action: stomach acid and motility

CCK
-SI parietal cells
-stimuli: FAs, peptides
-action: protein ezymes, gall bladder contractions

GIP
-SI parietal cells
-stimuli: acid
-action: inhibits stomach acid, boosts insulin

Smooth muscle contractile patterns: tonic, peristalsis, segmentation tonic: sustained smooth muscle contraction in sphincters

peristalsis: rapid waves of contraction pushes food to distal end

segmentation: back and forth mixing movement, slows food

Things that promote gastric emptying: -gastric distention
-fluidity of chymes
stimuli: gastrin, vagus nerve

Inhibition of gastric emptying: ENTEROGASTRONES from the SI:
secretin: bicarbonate
CCK: pancreatic enzymes, bile
GIP: decr stomach acid, insulin

Four conditions that influence absorption: permeability: water vs lipid soluble, large vs small, water itself
surface area: villi, micro villi
enterocyte replacement: produced in crypts, migrate up villi
luminal conditions: optimal pH for enzymes

Enzymes in carb digestion: maltase
sucrase
lactase
isomaltase

Enzymes in protein digestion:
stimuli, release, action Pepsin:
-simuli: gastrin, vagus
-stomach chief cels
-action: bd polypeptides

Pancreatic enzymes:
-enteropeptidase in brush border convert trypsin
-trypsin converts itself and chymotrypsin, elastase

Aminopeptidases:
-brush border and intracellular
-cleave single amino acids for di/tripeptides

Water soluble vs fat-soluble vitamins Water soluble:
-Vitamins B, C, folate
-require intrinsic factor from SI parietal cells

Fat-Soluble:
-Vitamins A, D, E, K
-diffuse passively

Gastric acid secretagogues:
(stimulate gastric acid production in the stomach) Acetylcholine
-vagus nerve
-action: gastrin, histamine release

Histamine
-Ach, gastrin stimuli
-from ECL cells (enterochromaffin-like)
-action: bind to H2 receptors on stomach parietal cells, cause H release

Gastrin
-Ach stimuli, gastric distention, protein
-action: histamine release, stomach motility

Mechanisms for mucosal protection Tight junctions: acid cannot penetrate
Mucus: secreted by surface and neck cells
Bicaronate: neutralizes acid
Prostaglandins:
-decreases acid secretion
-cytoprotective
-fluid secretions

Secretions of duct and acinar cells of the pancreas duct:
-exocrine (nerve) secretions
-bicarbonate

acinar:
-CCK: stimuli by FAs, peptides,
-an enterogastrone
-secrete pancreatic enzymes

GERD gastroesophageal reflux disease
-heartburn
-caused by poor tone of LES

Dumping Syndrome -caused by rapid movement of high-osmolarity chyme out of the stomach
-causes fluid secretion, low BP, and diarrhea

Pancreatitis -inflammation of the pancreas
-block pancreatic enzyme secretion, causing maldigestion and malabsorption

Celiac's disease -gluten allergy
-causes decrease in surface area of the upper small intestine by destruction of enterocytes/villi

Chron's disease -caused by inflammation of the lower small intestine (ileum)
-can be caused by malabsorption of bile salts after fat digestion, which enter the colon and cause colonic irritation, fluid secretion, and diarrhea

Pernicious Anemia -caused by lack of intrinsic factor secreted from stomach parietal cels, resulting in malabsorption of vitamin B12
-results in impaired RBC formation, and nerve health

Peptic Ulcers -H.pylori bacteria can survive the acidic environment of the stomach, by producing urease enzymes that create ammonia (basic), protective shell around it
-causes inflammation in the stomach, creating ulcers

Cystic Fibrosis -defect CFTR, preventing Cl transport into the lumen
-less fluid secretion, and more mucus
-blocks pancreatic enzymes secretion, resulting in maldigestion

Pharma Facts

For drugs that require administration
on an empty stomachStop enteral feeding for 1-2 hrs before and after dosing if the tube is placed in the stomach Levothyroxine (Eltroxin),Rifampin (Rimactane)
Phenytoin (Epilog) and carbamazepine (Tegretol),Warfarin (Marevan),Floroquinolones ,Theophylline

Warfarin
Vitamin K directly blocks warfarin’s effects when given in doses of 140
to 500 mcg/day.Foods rich in Vit K : green tea, green vegetables (broccoli, spinach and lettuce), liver, lentils, peas, cauliflowerand cabbage)
Floroquinolones
Bind with divalent cations ( calcium and Magnesium )and should not
be given within 2 hours before or after them.

Drugs may affect GIT absorption of other medications
Sodium bicarbonate caps
May reduce absorption of ketoconazole,digoxin and iron.(space 2 hrs before and after).
Succralfate (Gastrofait)
May reduce absorption of phenytoin,digoxin,tetracyclines ,quinolones ,salicylate ,allopurinol and theophylline .(space 2 hrs).

reduce absorption of levothyroxine (Eltroxin) ,spacing is ineffective so we should use other agent for stress ulcer prophylaxis.
Antacids
(Al containing antacids) ex: Mucogel,Epicogel May reduce absorption of phenytoin,digoxin,tetracyclines ,quinolones ,iron,ACE inhibitors ,acetaminophen, NSAIDs ,allopurinol and theophylline .(space 2 hrs).

reduce absorption of levothyroxine (Eltroxin) ,spacing is ineffective so we should use other agent for stress ulcer prophylaxis.
Calcium containing antacids (Ca carbonate (calcimate))
Ca carbonate reduce assorption of tetracyclines , floroquinolones,phenytoin,iron,ACE inhibitors ,acetaminophen and levothyroxine (space 2 hrs).
sodium polystyrene sulfonate (sorbisteril):
separate dosing from other orally administered medicines by at least 3 hours. That time should be increased to 6 hours for patients with gastroparesis or other conditions resulting in delayed emptying of food from the stomach into the small intestine.
Osmolality
Many commercial liquids have
osmolalities well over 1000
mOsm/kg.. Diarrhea,
cramping, abdominal distention,
and vomiting may occur after
administration of hyperosmolar
products through the feeding
tube.

Aluminium hydroxide (Mucogel) syrup,Acyclovir syrup,Azithromycin (Zithromax) syrup,Carbamazepine (Tegretol) syrup,Dexamethasone syrup,Digoxin syrup,Diphenhydramine (Avil) syrup,Ibuprofen (Brufen) syrup, (Gaptin ) syrup.
Ferrous sulphate syrup.Fluconazole (Diflucan) syrup.Furosemide (Lasix) syrup.
Lactulose syrup.Leviteracetam (Tiratam) syrup.Metochlopramide (Prempran) syrup.
Potassium chloride syrup.Phenytoin (Epilog) syrup.Trimethoprime-sulphamethoxazole (Sutrim) syrup.

These effects may be
reduced by diluting medication
with by ratio1:5 or 1:10 of sterile water
before administration.
Inactive ingredients or excipients
in liquid products may also cause side effects when given enterally.
-Many sweeteners, including sorbitol,mannitol, lactose, saccharin,
and sucrose, may cause or worsen diarrhea in up to 50% of patients.
Syrups have sorbitol:
Tegretol (carbamazepine),Trimethoprime-sulfamethoxazole(sutrim),Ranitidine (Zantac),Valproic acid (Depakine),Domperidone(Motilium)

Pharma Facts

100 important points of physiology 
1. Potassium is mainly regulated by - Aldosterone.
2. Tip of scapula at level – T7.
3. Oblique fissure of the lung at level - T3 to T6 Costochondral.
4. Decussating of medial lemniscuses - Internal Arcuate Fibers.
5. Superficial temporal artery relation with which nerve - Auriculotemporal nerve.
6. Correct about Thyroid gland - lymph drainage to deep cervical lymph nodes.
7. Anemic hypoxia occur in – Methemoglobulenemia. 
8. In cerebral circulation brain arteries - Do not anastomose once entered in the brain (controvertial).
9. Phase 1 of transformation of drug metabolism – Oxidation.
10. Standard deviation shows - Variability of individual observation.
11. Counseling in patients is - To help themselves.
12. A young girl who is going to die and asks you “Am I going to die?” Doctor response should be – “What your parents have told you?”
13. In whole wheat – Thiamine.
14. Cholesterol enriched diet – Egg.
15. Origin of peroxisomes – SER.
16. Organelle where protein combines with carbohydrates, packed and released - Golgi complex.
17. Correct about DNA – Euchromatin is transcriptionally active.
18. ADPKD associated with – Renal failure (vs) Cerebral haemorrhage (controversial) here most probable Renal failure.
19. Cause of delay in healing – Infections.
20. PaO2 decreased, PCO2 increased, hydrogen ion increased; manifestation (looked like kind of COPD) – Hypoventilation.
21. PCO2 31, HCO3 19, pH increased (Metabolic alkalosis scenario) - Hyperventilation
22. Person with tachycardia, and heat intolerance with low level of TSH, on giving TRH; level of TSH and thyroid hormones increases. Diagnosis – Hyperthyroidism with thyroid problem.
23. Origin of oxytocin and ADH – Hypothalamus.
24. Difference between systemic and pulmonary circulation - Low resistance in pulmonary circulation.
25. Mean systemic filling pressure is regulated by - Venous return.
26. Systolic pressure is directly related to which one of the following – Renin.
27. ADH responds to – Osmolarity.
28. Osmoreceptors – ADH.
29. Right border of heart on X-ray also visible a part of – SVC.
30. In MI sensitive cardio marker – Tropinin T.
31. Diabetic nephropathy investigation - Urine albumin.
32. Young boy with generalized edema and proteinuria - Lesion of basement membrane.
33. Lesion of parasympathetic system affects mostly - GI muscles.
34. Stress hormone of our body - ACTH.
35. S2 sound heard on - Closure of aortic and pulmonary valve.
36. A patient with history hemorrhage (trauma) receives a bag stored for 2 weeks mainly contains – RBCs.
37. Due to inspiration – Decreased negative intrapleural pressure.
38. Important buffer of blood - HCO3-.
39. Max increase in ECF due to infusion of - Hypertonic NaCl.
40. Auscultation of tricuspid valve best heard at – Right lower end of the body of sternum.
41. GVE vagus nerve for preganglionic fiber arises from – Dorsal nucleus.
42. Thorn prick in left lower limb caused abscess - Staph aureus.
43. Diabetic female after abdominal surgery; dyspnea and cough - Pulmonary embolism.
44. MCC of pulmonary embolism – DVT.
45. Typhoid fever 1st week test – Blood culture
46. Typhoid fever 2nd week test – Blood culture and Widal test.
47. Typical feature of falciparum - Black water fever.
48. Alcoholic patient with deranged LFTs; on biopsy – Mallory bodies. 
49. Councilman bodies seen in – Apoptosis.
50. Natural self-defense against tumors – Apoptosis.
51. P53 gene absent results in - cell survival.
52. Pain mediator - Bradykinins.
53. Metaplasia – Functional change in cells.
54. Female with infection of HPV, comes after 2 years, Pap smear shows prominent nucleoli and increased nucleus size – Dysplasia.
55. Gas exchange occur - Simple squamous epithelial layer.
56. Patient with granulomatous disease, biopsy done. Microscopic finding that suggests TB – Epitheloid cells.
57. The spindle fibers will decrease in discharge of impulses when - Muscle contracts (vs) When efferent gamma discharge occurs. (controversial) here most probable “muscle contracts”
58. Diagnosis for leprosy, initial investigation - Nasal scrapping.
59. Benign neoplasm – Adenoma.
60. 3 germ layers tumor – Teratoma.
61. When adrenalin release from medulla, causes vasodilation by acting on - Beta 2 adrenergic receptors.
62. Increased GFR and increased plasma flow occur due to - Dilation of afferent arteriole.
63. Charateristic of cerebellar lesion - Dymetria
64. Emax of a drug depends on – Efficacy
65. Study in which every person of a population has equal chances of being selected – Random sampling.
66. Amniocenthesis is done - After 14th weeks.
67. 1st response against acute inflammation in tissue – Macrophages.
68. In dark granules containing cells; IgE attaches to – Basophils.
69. Opsonization - C3b.
70. Exudate - more than 3g of proteins.
71. About active transport of drug all are true except - All drugs pass via active transport.
72. Pulmonary artery supply to – Alveoli.
73. Muscles of back innervated by - Dorsal rami.
74. In young boy dyspnea produced on lying - Retrosternal goiter.
75. Most important cause of bronchogenic cancer – Smoking.
76. Edema caused by - Increased hydrostatic pressure.
77. Edema caused by - Lymphatic blockage.
78. BP 210/180mmHg and creatinine 8% damaged part – Juxtaglomerular apparatus.
79. Female with blood group A, have 2 children; one with O and other with AB, blood group of father is – B.
80. Genetically true hermaphrodite – XX/XY.
81. DNA replication occur in – Interphase.
82. Glycogenolysis caused by deficiency of which hormone - Insulin
83. Investigation for liver amoebic abscess – Serology.
84. Surgery of submandibular gland; nerve damaged - marginal mandibular branch of facial.
85. On posterior surface of oblique and transversalis fascia - Arcuate line. 
86. Aspirin overdose causes – Coma.
87. Cardiac output measurement via thermodilution – Temperature change downstream with CO.
88. Father with defective gene on one autosomal chromosome, develops disease later in his life; chances of getting disease in children – Half of the children will be affected.
89. If left circumflex artery occluded - Infarction of left atrium and left ventricle.
90. MCC of multiple fractures in adult – Osteoporosis.
91. Patient with fracture of many bones and low BP immediate treatment - Volume replacement.
92. Most common fracture of long bone - Tibia.
93. Collagen fibers – Eosin stain
94. Gamma efferent supply to – Intrafusal muscle spindles.
95. Micturition – Self generating.
96. Hallmark of HIV – Proliferation of virus in T-Cells.
97. 1g protein gives energy – 4 kcalories.
98. Isotonic and isometric contraction difference is that isotonic contraction – consumes more phosphate bond.
99. Autonomic nervous system – parasympathetic increase salivary secretion.
100. Protrusion of mandible – Lateral pterygoid.