Gastrointestinal

Question 1

Cimetidine, Ranitidine, Famotidine, Nizatidine: Family

Answer 1

H2 blockers

Question 2

H2 blockers: Mechanism

Answer 2

Reversible block of H2 receptors decrease H+ secretion by parietal cells

Question 3

H2 blockers: Use (3)

Answer 3

Peptic ulcer
Gastritis
Mild GERD

Question 4

Cimetidine: Side effect (4)

Answer 4

Potent inhibitor of P-450
Antiandrogenic effects
Cross BBB and placenta
Decrease renal excretion of creatinine

Question 5

Ranitidine: Side effect

Answer 5

Decrease renal excretion of creatnine

Question 6

Omeprazole, lansoprazole, esomeprazole, pantoprazole, dexlansoprazole: Family

Answer 6

PPI

Question 7

Proton pump inhibitors: Mechanism

Answer 7

Irreversible inhibit H+/K+ ATPase in parietal cells

Question 8

Proton pump inhibitors: Use (4)

Answer 8

Peptic ulcer
Gastritis
GERD
Zollinger-Ellison

Question 9

Proton pump inhibitors: Side effects (4)

Answer 9

Increased risk of C. difficile infection
Pneumonia
Hip fractures
Decreased Mg2+

Question 10

Bismuth

Answer 10

Mucosal protection

Question 11

Sucralfate

Answer 11

Mucosal protection

Question 12

Bismuth, Sucralfate: Mechanism

Answer 12

Bind to ulcer base and provide physical protection; allow HCO3- secretion to reestablish pH gradient in mucosal layer

Question 13

Bismuth, Sucralfate: Use (2)

Answer 13

Ulcer healing

Traveler’s diarrhea

Question 14

Which should not be used with bismuth/sucralfate?

Answer 14

H2 antagonist (low pH required for polymerization)

Question 15

Misoprostol: Mechanism

Answer 15

PGE1 analog
Increases production and secretion of gastric mucous barrier
Decreases acid production

Question 16

Misoprostol: Use (3)

Answer 16

NSAID-induced peptic ulcer
Maintenance of pDA
Induce labor (ripens cervix)

Question 17

Misoprostol: Side effects (2)

Answer 17

Diarrhea

Abortifacient

Question 18

Octreotide: Mechanism

Answer 18

Long-acting somatostatin analog

Question 19

Octreotide: Use (4)

Answer 19

Acute variceal bleed
Acromegaly
VIPoma
Carcinoid tumors

Question 20

Octreotide: Toxicity (3)

Answer 20

nausea, cramps, stearrhoea

Question 21

Aluminum hydroxide: Use

Answer 21

Antacid

Question 22

Aluminum hydroxide: Side effect (5)

Answer 22

Constipation
Hypophosphatemia (osteodystrophy)
Hypokalemia
Proximal muscle weakness, seizures

Question 23

Magnesium hydroxide: Use (2)

Answer 23

Antacid

Osmotic laxative

Question 24

Magnesium hydroxide (5)

Answer 24

Diarrhea
Hyporeflexia
Hypotension
Cardiac arrest
Hypokalemia

Question 25

Calcium carbonate: Use

Answer 25

Antacid

Question 26

Calcium carbonate: Toxicity (3)

Answer 26

Hypercalcemia Rebound increased acid Chelate and decrease effectiveness of other drugs (tetracycline)

Question 27

Magnesium citrate: Use

Answer 27

osmotic laxative

Question 28

Polyethylene glycol: Use

Answer 28

Osmotic laxative

Question 29

Lactulose: Use (2)

Answer 29

``` osmotic laxative hepatic encephalopathy (lactic acid and acetic acid by gut degradation) to promote nitrogen excretion as NH4+ ```

Question 30

Oxmotic laxatives: Side effects (2)

Answer 30

Diarrhea | Dehydration

Question 31

Infliximab: Mechanism

Answer 31

Monoclonal antibody to TNF-alpha

Question 32

Infliximab: Use (3)

Answer 32

Crohn's disease UC RA

Question 33

Infliximab: Side effects (3)

Answer 33

Infections (latent reactivation of TB) Fever Hypotension

Question 34

Sulfasalazine: Mechanism

Answer 34

Sulfapyridine (antibacterial) and 5-aminosalicylic acid (anti-inflammatory) Activated by colonic bacteria

Question 35

Sulfasalazine: Use

Answer 35

UC | Crohn's

Question 36

Sulfasalazine: Side effects (4)

Answer 36

Sulfonamide toxicity Reversible oligospermia malaise nausea

Question 37

Mesalamine: Family

Answer 37

Sulfasalazine

Question 38

Ondansetron: Mechanism

Answer 38

5-HT3 antagonist; powerful central acting antiemetic

Question 39

Ondansetron: Use (2)

Answer 39

Postop vomiting | Cancer chemo

Question 40

Ondansetron: Side effects (2)

Answer 40

Headache | Constipation

Question 41

Metoclopramide: Mechanism

Answer 41

D2 receptor antagonist in chemoreceptor trigger zone Increase resting tone, contractility, LES tone, motility Does not influence colon transport time

Question 42

Metoclopramide: Use (3)

Answer 42

Diabetic and post-surgery gastroparesis | Antiemetic

Question 43

Metoclopramide: Side effects (4)

Answer 43

Increased parkinsonian effects Diarrhea Restlessness, drowsiness, fatigue, depression, nausea Interaction with digoxin and diabetic agents

Question 44

Metoclopramide is contraindicated in what?

Answer 44

Parkinson | Small bowel obstruction

Question 45

Megastrol acetate: Use

Answer 45

appetite stimulator