GI

Question 1

Name the Antiemetic drugs

Answer 1

Ondansterone
(“Ribbon dancer blocking the hammer throw”)

Metoclopramide
(“Tickler blocking the D-rings”)

Meclizine
Diphenhydramine
(“Bee swatters”)

Scopolamine
(“Telescope”)

Aprepitant
(““participants”)

Question 2

Ondansetrone MOA /USE

(“Ribbon dancer blocking the hammer throw”)

Answer 2

antagonizes 5-HT3 receptor on vagal afferents in the GI tract

• treats chemo-induced or post-op vomiting

Question 3

Ondansetron Side Effects

(“Ribbon dancer blocking the hammer throw”)

Answer 3

-can cause constipation
(“Hammer tightening gut”)

-can cause headache and dizziness
(“Hammer hitting head”)

-can prolong the QT interval and induce torsade’s
(“Twisted torsade’s streamer”)

-can cause serotonin syndrome
(“Pile of smiley faces”)

Question 4

Diphenhydramine
Meclizine
MOA

(“Bee Swatters”)

Answer 4

1st generation H1 receptor blockers

• the vestibular system contains H1 histamine receptors coupled to Gq

(“Allergy inducing, Q shaped dandelions”)

• treat vestibular nausea (motion sickness)

Question 5

Scopolamine MOA

(“Telescope”)

Answer 5

blocks M1 muscarinic receptors found in the vestibular system

(“M1 motorcycle parking”)

• treats vestibular nausea (motion sickness)

Question 6

Metcoclopramide MOA

(“Tickler”)

Answer 6

antagonizes D2 receptors in the area postrema
(“Extreme posture 2 D-Ring ropes”)

• treats chemotherapy induced vomiting
• ​**also antipsychotics block D2**

Question 7

Metoclopramide is useful because …

Answer 7

• treats chemotherapy induced vomiting
• has upper GI prokinetic effects
• useful for treatment of delayed gastric emptying due to post- surgical disorders and diabetic gastroparesis

(“Contracted stomach”)

Question 8

metoclopramide (D2 Antagonist) is contraindicated in …

Answer 8

small bowel obstruction
(“Do not obstruct”)

Question 9

Metoclopramide

Side Effects

Answer 9

-can cause diarrhea -prokinetic effects

can cause drowsiness, especially in the elderly
(“Sleeping judge”)

-can cause depression (central D2 blockade)
(“Crying coach”)

-Can cause extrapyramidal effects due to central D2 blockade (dystonia, akathisia, parkinsonian features)
(“EXTRA pyramidal newspaper hat”)

• can cause tardive dyskinesia with chronic use (central D2 blockade), especially in the elderly (“Sticking out tongue”)

-can cause neuroleptic malignant syndrome
(“Now More Spicy chicken”)

-can cause elevated prolactin levels (central D2 blockade), leading to gynecomastia, amenorrhea, and decreased libido
(“Elevated milk release”)

can cause QT prolongation and induce torsade’s
(“Twisted torsade’s streamer”)

(“Mud puddle”)

Question 10

Aprepitant MOA

(“all participants subtance pee check”)

Answer 10

aprepitant antagonizes the NK1 receptors in the area postrema

(“plaNK1 pommel horse”)
(“Extreme posture”)

• treats chemotherapy induced vomiting

Question 11

what are the 2 mechanisms by which acid secretion can be inhibited ?

Answer 11

H2 histamine receptor antagonists
(“2 bee swatters”)

Proton Pump Inhibitors (PPI’s)
(“Girl scout blocking puree pump”)

Question 12

H2 receptor Antagonists MOA
Ranitidine
Nizatidine
Cemitidine
Famotidine

(“Tie dye t-shirt”)

Answer 12

• Inhibit acid secretion by parietal cells
• Vagal stimulation will also stimulate the parietal cell directly to secrete acid during meals and therefore H2 antagonists has only a modest inhibitory effect on acid secretion during and after meals

Question 13

H2 receptor antagonists can treat …

Answer 13

-prevent nocturnal secretion of acid that is largely dependent on histamine

-treat GERD
(“Gargling”)

-treat duodenal ulcers **PPI’s are first line**
(“Ulcerated sidewalk”)

Question 14

Cimetidine

(“Tie dye kid on the cement”)

Answer 14

-H2 blocker with antiandrogenic side effects

-can cause gynecomastia when used long term or in high doses
(“Pot lids on chest”)

-can cause impotence
(“Droopy honey wand”)

-can cause elevated serum prolactin levels
(“Milk shooting from nose”)

-inhibits cytochrome P-450
(“Dented chrome bumper”)

Question 15

Proton Pump Inhibitors (PPI’s)

Pantoprazole
Omeprazole

(“PRIZE”)
MOA

Answer 15

-irreversibly inhibit the H+/K+ ATPase (the final common pathway for H+ secretion)

Question 16

Proton Pump Inhibitors (PPI’s) can treat …

Pantoprazole
Omeprazole

(“PRIZE”)

Answer 16

• first line treatment GERD but PPI’s .
  (“Gargling”)

-faster symptom relief for gastric and duodenal ulcers
(“Ulcerated sidewalk”)

-gastrinoma causing hypersecretion of gastric acid

Zollinger-Ellison syndrome – treat with PPI’s
(“Jumbo gas tank on mower with crab logo”)

-PPI’s treat H.Pylori infection, with clarithromycin or amoxicillin/metronidazole
(“Helicopter hat”)

Question 17

Proton Pump Inhibitors (PPI’s) Adverse Effects…

Pantoprazole
Omeprazole

(“PRIZE”)

Answer 17

• PPI’s increase the risk for C.Diff infection
• Normally inactivated by acidic environment

-increase the risk for respiratory infections (pneumonia)
(“Dirty lung spots”)

-decrease the absorption of Ca2+, Mg2+, and Fe2+ (requires acidic environment)
(“Medals bound to wagon”)

-increase the risk of osteoporotic hip fractures
(due to decreased Ca2+ absorption)
(“Fractured Axel”)

-may worsen osteoporosis (due to decreased Ca2+ absorption)

-can cause hypomagnesia
(“Falling magnets on girl scout”)

(“Chocolate fondue fountain”)

Question 18

Octreotide MOA

(“Octagon shape of stop sign”)

Answer 18

A long acting Somatostatin analoge

• inhibits release of histamine by ECL cells
• ​inhibits the release of gastrin by G cells
  ⇒ and SST receptor (+) gastrinomas

Question 19

Name osmotic laxatives

Answer 19

magnesium hydroxide
magnesium sulfate
magnesium citrate
(“Magnets”)

polyethylene glycol (PEG)
(“PEG drain cover”)

lactulose
(“Relaxulose”)

Question 20

Lactulose can be useful in treatment of…

(“relaxulose”)

Answer 20

hepatic encephalopathy - buildup of ammonia in brain

• intestinal bacteria metabolize lactulose into acidic metabolites → ammonia (NH3) is trapped as ammonium (NH4+) in the acidic lumen and then excreted

(“Cirrhotic liver and brain coral”)

Question 21

laxatives can cause …

Answer 21

diarrhea and dehydration

(“Spoiling mud bath”)

Question 22

Name a bulk forming laxative

(“Bulky seaweed outside of the shop”)

Answer 22

Psyllium

• indigestible hydrophilic colloid􏰀 absorbs water􏰀 → distension→ peristalsis

Question 23

Name a stool softener

Answer 23

Docusate

• surfactant agent that facilitates penetration Of stool by water and lipids

(“Water penetrating a canoe at the DOCK”)

Question 24

Name a stimulant laxative a.k.a cathartic

Answer 24

Senna
(“Stimulating suntan lotion”)

(stimulation of enteric nervous system and colonic secretions)

Question 25

chronic use of senna causes…

Answer 25

melanosis coli → brown pigmentation of the colon

(“Brown gut”)

Question 26

Name Antidiarrheal Agents

(“Muddy slippers left outside”)

Answer 26

Diphenoxylate
(“Dolphins”)

Loperamide
(“Lop-eared rabbit”)

Question 27

Antidiarrheal Agents MOA

(“Utopia”)

Answer 27

Opiate agonists activating mu-opioid receptors in the GI tract and treat diarrhea
(“MUssage”)

opioid agonists (loperamide) increase colonic phasic segmenting activity → 􏰀increased colonic transit time

• Loperamide →does not cross the BBB→ 􏰀no analgesia or potential for addiction
• ​Diphenoxylate some ability to cross the BBB􏰀combines with atropine to prevent abuse

Question 28

antidiarrheal agents are contraindicated in patients with …

Answer 28

-bloody diarrhea or fever (treat the underlying cause)
(“Red stool and inflammatory candles outside door”)

Question 29

Antidiarrheal agents Side Effects

Answer 29

opioids can cause constipation

(“Clogged”)

Question 30

treats the symptoms of secretory diarrhea caused by VIPoma and carcinoid syndrome

(“VIP CUSTOMERS only crab”)

Answer 30

Octreotide

(“STOP sign”)

Question 31

Name Prokinetic Agents

Answer 31

Bethanecol

Neostigmine

Metoclopramide

Arythromycin