Drugs for Upper GI Disorders - French

Question 1

Omeprazole

Answer 1

PPI

Question 2

Lansoprazole

Answer 2

PPI

Question 3

Ranitidine

Answer 3

H2 Antagonist. OTC for acute gastritis.

Question 4

Cimetidine

Answer 4

H2 Antagonist. OTC for acute gastritis.

Question 5

Misoprostol

Answer 5

Prostaglandin analog

Question 6

Sucralfate

Answer 6

Mucosal protective agent

Question 7

Name 4 chemical formulas for antacids.

Answer 7

CaCO3,
Mg(OH)2
Al(OH)3
NaHCO3

Question 8

Metoclopramide

Answer 8

Prokinetic agent AND anti-emetic

Dopamine antagonist that blocks presynaptic inhibition of
ACh release by dopamine at D2 receptors

[As a dopamine antagonist, metoclopramide has additional advantageous effect to relieve nausea and vomiting by block of dopamine receptors in chemoreceptor trigger zone]

Question 9

Ondansetron

Answer 9

Anti-emetic (5HT3 Receptor Agonist)

AND

Dopamine receptor antagonist (anti-emetic)

Question 10

Prochloroperazine

Answer 10

Dopamine receptor antagonist

*anti-emetic

Question 11

Meclizine

Answer 11

Antihistamine, 1st generation

*anti-emetic

Question 12

Diphenhydramine

Answer 12

Antihistamine, 1st gen (Benadryl)

*anti-emetic

Question 13

Dimenhydrinate

Answer 13

Antihistamine, 1st gen (Dramamine)

*anti-emetic

Question 14

Scopolamine

Answer 14

Anticholinergic agent

*anti-emetic

Question 15

Triple Therapy

Answer 15

Clarithromycin
Amoxicillin or Metronidazole
PPI

Question 16

Quadruple Therapy

Answer 16

Bismuth subsalicylate
Metronidazole
Tetracycline
PPI OR H2 Antagonist

Question 17

Sequential Therapy

Answer 17

Amoxicillin-PPI (5 days) THEN

Clarithromycin-Tinidazole-PPI (5 days)

Question 18

Famotidine

Answer 18

H2 Antagonist. OTC for acute gastritis.

Question 19

Nizatidine

Answer 19

H2 Antagonist. OTC for acute gastritis.

Question 20

Name 5 motility drugs. Hint: many of these serve completely different functions, but all increase activity at M3 smooth muscle receptors.

Answer 20

Erythromycin (agonist at motilin receptors)
Metoclopramide (primary motility agent)
Cisapride (primary motility agent–>QT prolongation = almost never used)
Neostigmine (myasthenia gravis Ach esterase inhibitor)
Bethanechol (muscarinic agonist - bladder)

Question 21

This drug blocks serotonin (5-HT3) receptors at chemoreceptor trigger zone (CTZ in
CNS), solitary tract nucleus, and on visceral afferents (GI tract).

Answer 21

Ondansetron (Zofran)

Anti-emetic

**Risk of QT prolongation

Question 22

Name two anti-emetics that work as dopamine receptor antagonists.

Answer 22

Phenothiazines:

Prochlorperazine, Chlorpromazine

Question 23

First line tx for motion sickness?

Answer 23

72 hour transderm scopolamine patch.

Works as an anticholinergic

Question 24

This drug is useful as a prophylactic agent against emesis in patients receiving cancer chemotherapy that have not responded to other anti-emetic therapy. It is rated schedule III.

Not bold

Answer 24

Dronabinol. Likely CB1 agonist (THC analog)

Question 25

This drug has a specific indication for the delayed phase emesis (2-5 days later) associated with the highly emetogenic cisplatin. Given for 3 days at start of therapy. Give the drug and its mechanism of action Not bold

Answer 25

Aprepitant. Substance P agonist. [Block the actions of the neurotransmitter substance P at the neurokinin 1 (NK1) receptor that are mediated via vagal afferent fibers to the solitary tract nucleus and the area postrema.]

Question 26

Discuss the merits/downsides of giving ginger to pregnant women for morning sickness.

Answer 26

Prevents nausea but not vomiting.

Question 27

Discuss the merits/downsides of giving pyridoxine (vitamin b6) to pregnant women for morning sickness.

Answer 27

first-line treatment that is effective in mild to moderate nausea, but no effect on vomiting. Most often used in combination with doxylamine.

Question 28

What is the mechanism of action of doxylamine? Is this a first line treatment?

Answer 28

Doxylamine is first-line agent-and most commonly used. Acts on the vestibular system to decrease stimulation of the vomiting center - as a 1st generation antihistamine it also blocks muscarinic receptors involved in the emetic response. **Maternal side effects include sedation, dry mouth, constipation and lightheadedness.

Question 29

What would you try in a woman with hyperemesis? What is the MOA of this drug?

Answer 29

Metoclopramide. Slightly less favorable safety profile. Mother can also develop tardive dyskinesia.

Question 30

Is Ondansetron used in pregnancy?

Answer 30

Can be. More effective in reducing nausea AND vomiting than doxylamine/pyridoxine. 5HT3 antagonist