Ch 80 Other GI Drugs

Question 1

Emesis results from activation of the vomiting center, which receives its principal stimulatory inputs from the (3).

Answer 1

chemoreceptor trigger zone (CTZ), cerebral cortex, and inner ear

Question 2

___ are the most effective antiemetics available.

Answer 2

Serotonin antagonists, such as ondansetron [Zofran]

Question 3

__ is the first member of a new class of drugs: the substance P/neurokinin1 receptor antagonists.

Answer 3

Aprepitant (an antiemetic)

Unlike most antiemetics, aprepitant can prevent delayed chemotherapy-induced nausea and vomiting (CINV) as well as acute CINV.

Question 4

To suppress __, a combination of drugs is more effective than monotherapy.

Answer 4

CINV

Question 5

For patients receiving highly emetogenic chemotherapy, the preferred antiemetic regimen consists of three drugs:

Answer 5

aprepitant, a glucocorticoid (e.g., dexamethasone), and a serotonin antagonist (e.g., ondansetron).

Question 6

For management of CINV, antiemetics are more effective

when given __.

Answer 6

before chemotherapy (to prevent emesis) than when given after chemotherapy (in an effort to stop ongoing emesis).

Question 7

__ develop in about 75% of pregnant patients, especially during the first trimester.

Answer 7

Nausea and vomiting

Question 8

First-line therapy for pregnancy-related nausea and vomiting consists of two drugs: __.

Answer 8

doxylamine plus vitamin B6 (pyridoxine)

Question 9

__ are the most effective antidiarrheal agents available.

Answer 9

Opioids (e.g., diphenoxylate)

Question 10

Traveler’s diarrhea can be treated with (3).

Answer 10

loperamide (a nonspecific antidiarrheal drug), a fluoroquinolone antibiotic (e.g., ciprofloxacin), or azithromycin (for children and pregnant women).

Question 11

___ is the most common disorder of the GI tract.

Answer 11

Irritable bowel syndrome (IBS)

Question 12

Three drugs are FDA approved for IBS:

Answer 12

alosetron, linaclotide, and lubiprostone

Question 13

__ is approved for IBS-D in women.

Benefits derive from blocking 5-HT3 receptors on neurons that innervate the viscera.

Answer 13

Alosetron

Question 14

Alosetron can cause (2).

Answer 14

ischemic colitis and severe constipation.

Colitis and complications of constipation have led to hospitalization, blood transfusion, surgery, and death.

Question 15

__ is approved for IBS-C in adults.

Constipation is treated through indirect stimulation of the secretion of chloride and bicarbonate into the intestinal lumen.

Answer 15

Linaclotide

Question 16

___ is approved for IBS-C in women.

Benefits derive from activating (opening) chloride channels in the intestine.

Answer 16

Lubiprostone

Question 17

Inflammatory bowel disease—ulcerative colitis and Crohn’s disease—is treated with 5 classes of drugs:

Answer 17

aminosalicylates (e.g., sulfasalazine, mesalamine),
glucocorticoids (e.g., dexamethasone, budesonide),
immunosuppressants (e.g., azathioprine, mercaptopurine),
immunomodulators (e.g., infliximab, certolizumab), and
antibiotics (e.g., metronidazole, ciprofloxacin).

Question 18

Metoclopramide, a prokinetic agent, has two beneficial actions:

Answer 18

It increases upper GI motility and suppresses emesis.

Question 19

__ is used to reduce the intensity and duration of
oral mucositis in patients with hematologic malignancy
undergoing intensive radiochemotherapy.

Answer 19

Palifermin