Gastrointestinal

Question 1

Deferoxamine

Answer 1

Iron chelator

IV, iron poisoning

Question 2

Deferasirox

Answer 2

Iron chelator

Oral, iron poisoning

Question 3

Cimetidine

Answer 3

H2 blocker
Reversible block of H2 receptors, leading to decreased H secretion by parietal cells
Peptic ulcer, gastritis, mild esophageal reflux
Potent inhibitor of CYP450 (DDIs), antiandrogenic effects (prolactin release, gynecomastia, impotence, decreased libido), crosses BBB (confusion, dizziness, headaches) and placenta. Decreases renal excretion of creatinine.

Question 4

Ranitidine

Answer 4

H2 blocker
Reversible block of H2 receptors, leading to decreased H secretion by parietal cells
Peptic ulcer, gastritis, mild esophageal reflux
Decreases renal excretion of creatinine.

Question 5

Famotidine

Answer 5

H2 blocker
Reversible block of H2 receptors, leading to decreased H secretion by parietal cells
Peptic ulcer, gastritis, mild esophageal reflux
Relatively free of side effects

Question 6

Nizatidine

Answer 6

H2 blocker
Reversible block of H2 receptors, leading to decreased H secretion by parietal cells
Peptic ulcer, gastritis, mild esophageal reflux
Relatively free of side effects

Question 7

Omeprazole

Answer 7

Proton pump inibitor
Irreversibly inhibits H/K ATPase in stomach parietal cells
Peptic ulcer, gastritis, esophageal reflex, Zollinger-Ellison syndrome
Increased risk of C. difficile infection, pneumonia. Hip fractures, decreased serum Mg with long term use.

Question 8

Lansoprazole

Answer 8

Proton pump inibitor
Irreversibly inhibits H/K ATPase in stomach parietal cells
Peptic ulcer, gastritis, esophageal reflex, Zollinger-Ellison syndrome
Increased risk of C. difficile infection, pneumonia. Hip fractures, decreased serum Mg with long term use.

Question 9

Esomeprazole

Answer 9

Proton pump inibitor
Irreversibly inhibits H/K ATPase in stomach parietal cells
Peptic ulcer, gastritis, esophageal reflex, Zollinger-Ellison syndrome
Increased risk of C. difficile infection, pneumonia. Hip fractures, decreased serum Mg with long term use.

Question 10

Pantoprazole

Answer 10

Proton pump inibitor
Irreversibly inhibits H/K ATPase in stomach parietal cells
Peptic ulcer, gastritis, esophageal reflex, Zollinger-Ellison syndrome
Increased risk of C. difficile infection, pneumonia. Hip fractures, decreased serum Mg with long term use.

Question 11

Dexlansoprazole

Answer 11

Proton pump inibitor
Irreversibly inhibits H/K ATPase in stomach parietal cells
Peptic ulcer, gastritis, esophageal reflex, Zollinger-Ellison syndrome
Increased risk of C. difficile infection, pneumonia. Hip fractures, decreased serum Mg with long term use.

Question 12

Bismuth

Answer 12

Bind to ulcer base, providing physical protection and allowing HCO3 secretion to re-establish pH gradient in mucous layer
Increased ulcer healing, travelers diarrhea

Question 13

Sucralfate

Answer 13

Bind to ulcer base, providing physical protection and allowing HCO3 secretion to re-establish pH gradient in mucous layer
Increased ulcer healing, travelers diarrhea

Question 14

Misoprostol

Answer 14

PGE1 analog. Increases production and secretion of gastric mucous barrier, decreases acid production
Prevention of NSAID-induced peptic ulcers (NSAIDs block PGE1 production), maintenance of a PDA. Also used to induce labor.
Diarrhea. Contraindicated in women of childbearing potential (abortifacient).

Question 15

Octreotide

Answer 15

Long-acting somatostatin analog
Acute variceal bleeds, acromegaly, VIPoma, carcinoid tumors
Nausea, cramps, steatorrhea

Question 16

Aluminum hydroxide

Answer 16

Antacid
Can affect absorption, bioavailability, or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.
Hypokalemia, constipation, hypophosphatemia, proximal muscle weakness, osteodystrophy, seizures

Question 17

Calcium carbonate

Answer 17

Antacid
Can affect absorption, bioavailability, or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.
Hypokalemia, hypercalcemia, rebound acid increases, chelate and decrease effectiveness of other drugs (e.g. tetracycline)

Question 18

Magnesium hydroxide

Answer 18

Antacid, osmotic laxative
Hydroxide binds and neutralizes H ions/provides osmotic load to draw water out
Heartburn, constipation
Can affect absorption, bioavailability, or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying. Hypokalemia, diarrhea, dehydration, abuse potential (bulimics), hyporeflexia, hypotension, cardiac arrest

Question 19

Magnesium citrate

Answer 19

Osmotic laxative
Provides osmotic load to draw water out
Constipation
Diarrhea, dehydration, abuse potential (bulimics)

Question 20

Polyethylene glycol

Answer 20

Osmotic laxative
Provides osmotic load to draw water out
Constipation
Diarrhea, dehydration, abuse potential (bulimics)

Question 21

Lactulose

Answer 21

Osmotic laxative
Provides osmotic load to draw water out. Gut flora degrade it into metabolites (lactic acid, acetic acid) that promote nitrogen excretion as NH4
Constipation, hepatic encephalopathy
Diarrhea, dehydration, abuse potential (bulimics)

Question 22

Infliximab

Answer 22

Monoclonal antibody to TNFα
Crohn disease, ulcerative colitis, rheumatoid arthritis, ankylosing spondylitis, psoriasis
Infection (including reactivation of latent TB), fever, hypotension

Question 23

Sulfasalazine

Answer 23

Combination of sulfapyridine (antibacterial) and 5-aminosalicylic acid (anti-inflammatory). Activated by colonic bacteria
Ulcerative colitis, Crohn disease
Malaise, nausea, sulfonamide toxicity, reversible oligospermia

Question 24

Ondansetron

Answer 24

5-HT3 antagonist
Decreases vagal stimulation. Power central-acting anti-emetic.
Control vomiting postoperatively and in patients undergoing cancer chemotherapy
Headache, constipation

Question 25

Metoclopramide

Answer 25

D2 receptor antagonist.
Increases resting tone, contractility, LES tone, motility. Does not influence colon transport time
Diabetic and post-surgery gastroparesis, antiemetic
Increases parkinsonian effects. Restlessness, drowsiness, fatigue, depression, nausea, diarrhea. Drug interaction with digoxin and diabetic agents. Contraindicated in patients with small bowel obstruction or Parkinson disease (D2 receptor blockade)