GI Drugs Flashcards
A 55-year-old woman with type 1 diabetes of 40 yrs’ duration complains of severe bloating and abdominal distress, especially after meals. Evaluation is consistent with diabetic gastroparesis. Which of the following is a prokinetic drug that could be used in this situation?
(A) Alosetron (B) Cimetidine (C) Loperamide (D) Metoclopramide (E) Sucralfate
Of the drugs listed , only metoclopramide is considered a prokinetic agent (ie, one that increases propulsive motility in the gut). The answer is D.
A patient who is taking verapamil for hypertension and angina has become constipated. Which of the following drugs is an osmotic laxative that could be used to treat the patient’s constipation?
(A) Aluminum hydroxide (B) Diphenoxylate (C) Magnesium hydroxide (D) Metoclopramide (E) Ranitidine
A laxative that mildly stimulates the gut would be most suitable in a patient taking a smooth muscle relaxant drug such as verapamil. By holding water in the intestine, magnesium hydroxide provides additional bulk and stimulates increased contractions. The answer is C.
Which drug accumulates in parietal cell canaliculi and undergoes conversion to a derivative that irreversibly inhibits H+/ K+ ATPase?
(A) Cimetidine (B) Diphenoxylate (C) Esomeprazole (D) Metoclopramide (E) Sulfasalazine
Esomeprazole, the (S) isomer of omeprazole, is a prodrug converting spontaneously in the parietal cell canaliculus to a sulfonamide that irreversibly inactivates the proton pump. The answer is C.
Which drug is most likely to be useful in the treatment of inflammatory bowel disease?
(A) Diphenhydramine (B) Diphenoxylate (C) Mesalamine (D) Ondansetron (E) Ursodiol
Mesalamine is a form of aminosalicylate that releases 5-aminosalicyclic acid in the large intestine and thereby provides a local anti-inflammatory effect that is useful in inflammatory bowel disease. The answer is C.
A 34-year-old woman has irritable bowel syndrome with diarrhea that is not responsive to conventional therapies . Despite the small risk of severe constipation and ischemic colitis, the patient decides to begin therapy with alosetron. Alosetron has which of the following receptor actions?
(A) 5-HT 3 receptor antagonist (B) 5-HT 4 receptor agonist (C) D2 receptor antagonist (D) NK1 receptor antagonist (E) Muscarinic receptor antagonist
Serotonin plays a major regulatory role in the enteric nervous system, and the potent 5-HT 3 receptor antagonist alosetron has shown efficacy in treating women with IBS that is accompanied by diarrhea. The answer is A
On your way to an examination, you experience the vulnerable feeling that an attack of diarrhea is imminent. If you stopped at a drugstore, which one of the following antidiarrheal drugs could you buy without a prescription even though it is related chemically to the strong opioid analgesic meperidine?
(A) Aluminum hydroxide (B) Diphenoxylate (C) Loperamide (D) Magnesium hydroxide (E) Metoclopramide
Aluminum hydroxide is constipating but is not related chemically to meperidine; magnesium hydroxide is a strong laxative . The 2 antidiarrheal drugs that are structurally related to opioids are diphenoxylate and loperamide. Loperamide is available over-the-counter; diphenoxylate is mixed with atropine alkaloids, and the product (Lomotil, others) requires a prescription. The answer is C
A 45-year-old man with a duodenal ulcer was treated with a combination of drugs intended to heal the mucosal damage and to eradicate Helicobacter pylori. Which of the following antibacterial drugs is used commonly to eradicate intestinal Helicobacter pylori?
(A) Cefazolin (B) Ciprofloxacin (C) Clarithromycin (D) Clindamycin (E) Vancomycin
The macrolide antibiotic clarithromycin is commonly used in antibiotic regimens designed to treat duodenal ulcers caused by H pylori. The other antibiotics that are used include amoxicillin, tetracycline, and metronidazole. Bismuth also has an antibacterial action. The answer is C
A patient is receiving highly emetogenic chemotherapy for metastatic carcinoma. To prevent chemotherapy -induced nausea and vomiting, she is likely to be treated with which of the following?
(A) Levodopa (B) Methotrexate (C) Misoprostol (D) Ondansetron (E) Sucralfate
The 5-HT 3 receptor antagonists are highly effective at preventing chemotherapy -induced nausea and vomiting, which can be a dose-limiting toxicity of anticancer drugs. The answer is D
Management of steatorrhea is best accomplished by the use of this agent.
(A) Mineral oil (B) Omeprazole (C) Ondansetron (D) Pancrelipase (E) Sucralfate
Steatorrhea is due to decreased fat absorption as a result of inadequate pancreatic secretion of lipase. The answer is D
This is a small molecule that polymerizes in stomach acid and coats the ulcer bed, resulting in accelerated healing and reduction of symptoms.
(A) Mineral oil (B) Omeprazole (C) Ondansetron (D) Pancrelipase (E) Sucralfate
Sucralfate is a small molecule that polymerizes in stomach acid and forms a protective coat over the ulcer bed. The answer is E
A 45-year-old male who is obese presents to his primary care physician complaining of postprandial epigastric pain. The pain does not appear after every meal. He has noticed the pain especially after eating spicy food and oatmeal. He is not currently taking any medications. Which of the following drugs prevents acid secretion by antagonizing a receptor?
Aluminum hydroxide Fexofenadine Misoprostol Omeprazole Ranitidine
The answer is E: Ranitidine
A 37-year-old man complains of chest pain after meals. He says this pain has gone on for a few months and gets only minimal relief from antacid tablets. The physician prescribes a drug that will decrease the amount of acid secreted by binding to and inhibiting an ATPase on the luminal surface of parietal cells. Which of the following drugs works by this mechanism?
Atropine Cimetidine Misoprostol Octreotide Omeprazole
The answer is E: Omeprazole
A 27-year-old man complains of occasional heartburn. His physician makes a few suggestions of diet and lifestyle changes he could make as well as some medications he can take for symptom management. The patient decides to try a magnesium hydroxide (MgOH) preparation. Which of the following is a side effect of MgOH that the physician should warn him about?
Constipation Diarrhea Headache Impotence Seizures
The answer is B: Diarrhea
A 42-year-old woman with irritable bowel syndrome with diarrhea predominance presents to her primary care physician for treatment. The physician suggests an exercise regimen, dietary modifications, and a bulk laxative. The likely mechanism of action of this agent would involve which of the following?
Gel formation in the intestine Neuromodulation of the S3 nerve root Nonabsorbable salt Osmotic laxative Stimulation of the cholinergic nervous system
The answer is A: Gel formation in the intestine
A 49-year-old man with a history of peptic ulcer disease and gastroesophageal reflux disorder is being treated with cimetidine for approximately 20 years. He now complains of breast swelling and breast discharge. What is the most likely explanation for these findings?
Abscess Antiandrogenic effect Inflammatory response Neoplastic process Overwhelming edema
The answer is B: Antiandrogenic effect
A 67-year-old woman with known peptic ulcer disease found at endoscopy to be on maintenance treatment with misoprostol at 125% of the recommended dose. The rationale behind this dose is to maximize which of the following?
Decrease in gastric acid secretion Improve bicarbonate balance Improve gastric emptying Improve sphincter tone of the lower esophagus Lower gastric luminal pressures
The answer is A: Decrease in gastric acid secretion
A 78-year-old woman with osteoporosis and occasional gastroesophageal reflux presents to her primary care physician for follow up. Physical examination of the heart, lungs, and abdomen are unremarkable. Which of the following agents would be best to treat both of her underlying conditions?
Aluminum hydroxide Calcium carbonate Magnesium hydroxide Sodium bicarbonate Warm milk
The answer is B: Calcium carbonate
A 47-year-old man with a history of NSAID-induced ulcers has been placed on sucralfate. He has been on the medicine for 1 year and does complain of intermittent chest pressure after meals. Upper endoscopy is performed. Which of the following findings is most likely to occur?
Duodenitis Duodenal perforation Gastric ulcers that appear unhealed Normal gastric epithelium Normal lower esophageal epithelium
The answer is C: Gastric ulcers that appear unhealed
A 43-year-old man with a history of peptic ulcer disease has developed hypersensitivity to H2 blockers. He now complains of worsening of his dyspepsia. Physical examination reveals mild tenderness on the midepigastric region. If misoprostol is prescribed to this patient, which of the following mechanisms of action would be most plausible for this agent?
Enhance mucosal resistance Inhibition of gastrin secretion Inhibition of proton pump secretion Inhibition of somatostatin release Inhibition of uric acid secretion
The answer is A: Enhance mucosal resistance
A 24-year-old man complains of recurring episodes of bloody diarrhea and abdominal pain. A flexible sigmoidoscopy reveals pseudopolyps and erythematous, friable mucosa. One of the drugs given to this patient is diphenoxylate. How could diphenoxylate help this patient?
Antimicrobial effects Blocks TNF-a signaling Inhibition of dihydrofolate reductase Inhibition of phospholipase A2 Slows peristalsis
The answer is E: Slows peristalsis
A 64-year-old woman is hospitalized for COPD exacerbation. While in the hospital, she becomes constipated. She also takes metoprolol for hypertension and mirtazapine for depression. The physician gives her docusate. Which of the following adverse reactions is most likely to occur as a result of docusate administration in this patient?
Cardiac arrhythmia Diarrhea Hypertension Rash Worsening depression
The answer is B: Diarrhea
A 58-year-old male is hospitalized for COPD exacerbation. While in the hospital, he becomes constipated. He has a history of hyperlipidemia and gout. The physician gives him docusate. How does docusate work to relieve constipation.
Binds water in the lumen
Increases chloride secretion into the gut lumen
Increases water absorption by the stool
Irritation of the bowel mucosa to stimulate peristalsis
Stimulation of the myenteric plexus
The answer is C: Increases water absorption by the stool
A researcher is creating a novel medication to act at M1 receptors. This agent will likely have which of the following augmentative effects on target organs?
Cardiac muscle contractility Constipation Diarrhea Gastric acid secretion Stroke volume
The answer is D: Gastric acid secretion
A 34-year-old man with a sacral spinal cord injury has neurogenic bowel. He is on a bowel regimen that involves periodic bowel cleansing with soapsuds enemas. He is given a trial of bethanechol for this condition. Which of the following adverse events must his treating physician be aware of?
Bronchodilation Diarrhea Dry mouth Dry skin Sigmoid colonic stasis
The answer is B: Diarrhea
A 45-year-old man who is obese complains of postprandial epigastric pain. The pain does not appear after every meal. He has noticed the pain especially after eating spicy foods. He is not currently taking any medications. You suspect gastroesophageal reflux disease (GERD) and want to try a drug that will lower the amount of acid in his stomach. Which of the following drugs chemically elevates the pH?
Aluminum hydroxide Fexofenadine Misoprostol Omeprazole Ranitidine
The answer is A: Aluminum hydroxide
A 19-year-old male presents to the emergency room with a broken ankle after a fall. He is given hydrocodone for the pain and, soon after, his stomach becomes upset. He has vomited once. The patient is given ondansetron to treat his nausea. What is the mechanism of the action of ondansetron?
5-HT3 antagonist D2-receptor antagonist H2-receptor inhibitor Serotonin-norepinephrine reuptake inhibitor Substance P antagonist
The answer is A: 5-HT3 antagonist
A 37-year-old female with mild arthritis presents to the clinic for follow-up. She states that she is doing much better because of doubling her dose of ibuprofen. Some days, she even triples her dose throughout the day. The physician warns the patient about peptic ulcers and bleeding from taking too much ibuprofen. She is offered alternatives, but the patient refuses because the ibuprofen works so well. What is the most appropriate therapy for this patient to prevent peptic ulcers.
Bismuth Famotidine Lansoprazole Misoprostol Pirenzepine
The answer is D: Misoprostol
A 48-year-old male presents to the emergency department with chest pain for the past 2 days. The pain is nonradiating and burning in nature. An ECG is normal, and serial troponins are negative. The physician makes the diagnosis of GERD. What is the most potent therapy for the prevention of GERD?
Bismuth Famotidine Misoprostol Omeprazole Pirenzepine
The answer is D: Omeprazole
A 21-year-old man presents to his primary care physician with 6 weeks of painful, bloody stools. Flexible sigmoidoscopy reveals erythema and friability with pseudopolyps. Which drug used for ulcerative colitis is made of two identical smaller molecules linked together with an azo bond?
Azathioprine Cyclosporine Sulfasalazine Mesalamine Olsalazine
The answer is E: Olsalazine
A 58-year-old man with a history of occasional GERD presents to the clinic with diarrhea for the past 3 months. He has not been sick and feeling quite well otherwise. Further history uncovers that 3 months ago, he switched the type of antacid he uses for reflux. He stopped the antacid and calls back 1 month later, saying he has not had diarrhea since then. Which of the following antacids was most likely causing the patient’s diarrhea?
Aluminum hydroxide Bismuth Calcium carbonate Magnesium hydroxide Sodium bicarbonate
The answer is D: Magnesium hydroxide
A 37-year-old man complains of chest pain after meals. He says this pain has gone on for a few months, and he gets only minimal relief from antacid tablets. The physician prescribes a drug that will decrease the amount of acid secreted by blocking histamine receptor. Which of the following drugs works by this mechanism?
Atropine Ranitidine Misoprostol Octreotide Omeprazole
The answer is B: Ranitidine
A 24-year-old G1P1 woman presents to the emergency department days after giving birth to her first child. She lost a large amount of blood during birth. Her hemoglobin level is 12.5 g/dL (normal is 12.1 to 15.1 g/dL). Her gynecologist prescribes ferrous sulfate to help raise her hemoglobin levels. Which of the following is a common side effect of this medication
Constipation Diarrhea Hypercoagulability Hypotension Seizures
The answer is A: Constipation
