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Retired NBME 24 Answers

nbme24/Block 1/Question#39 (reveal difficulty score)
A 40-year-old man with AIDS develops severe ...
Somatostatin ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: pharm repeat

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 +11  upvote downvote
submitted by โˆ—neonem(629)
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Somatostatin is normally secreted by D cells in the pancreatic islets and GI mucosa. It basically blocks everything GI-related ("encourages somato-stasis"): decreased gastric acid & pepsinogen secretion, decreased pancreatic and small intestine fluid secretion, decreased gallbladder contraction, decreased insulin & glucagon release.

Decreasing gastrin release blocks the increase of GI motility (increased GI motility is the inherent problem of diarrhea).

The drug in the question is probably octreotide.

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cassdawg  Just to add because I was trying to dissect exactly the diarrhea cause: AIDS patients can get refractory diarrhea for a variety of reasons, most commonly cryptosporidium enteritis and CMV colitis or just in general from HIV enteropathy. Octreotide has been used as a treatment for such refractory diarrhea due to the mechanisms mentioned above (https://pubmed.ncbi.nlm.nih.gov/1814331/) +4



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submitted by โˆ—namesthegame22(13)
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Also noteworthy: Somatostatin analogs, such as octreotide, inhibit the release of VIP and counteract its effects.

Used to treat VIPoma: VIP is released by parasympathetic ganglia and leads to the increased secretion of water and electrolytes by the intestines as we as the increased relaxation of smooth muscle fibers in the gastrointestinal tract. Excess production results in profound fluid and electrolyte secretion into the gastrointestinal tract, severe watery diarrhea, electrolyte disturbances, achlorhydria, alkalosis, flushing, and vasodilation.

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