GI drugs

Question 1

<p>Cimetidine</p>

Answer 1

<p>1) peptic ulcer, gastritis, mild esophageal reflux

2) H2 blocker: reversibly blocks histamine H2 receptor --> decr H+ secretion by parietal cell
3) potent cyt P450 inhibitor (Rx interactions); anti-androgenic effects (prolactin release, gynecomastia, impotence, decr libido in males); can X BBB (confusion, dizziness, HA) + placenta; decr renal exretion of Cr
4) N/A</p>

Question 2

<p>Ranitidine</p>

Answer 2

<p>1) peptic ulcer, gastritis, mild esophageal reflux

2) H2 blocker: reversibly blocks histamine H2 receptor --> decr H+ secretion by parietal cell
3) decr renal exretion of Cr
4) N/A</p>

Question 3

<p class=”large” style=”text-align:center”;>Famotidine</p>

Answer 3

<p class=”large” style=”text-align:center”;>1) peptic ulcer, gastritis, mild esophageal reflux

2) H2 blocker: reversibly blocks histamine H2 receptor –> decr H+ secretion by parietal cell
3) decr renal exretion of Cr
4) N/A</p>

Question 4

<p>Nizatidine</p>

Answer 4

<p>1) peptic ulcer, gastritis, mild esophageal reflux

2) H2 blocker: reversibly blocks histamine H2 receptor --> decr H+ secretion by parietal cell
3) decr renal exretion of Cr
4) N/A</p>

Question 5

<p>Omeprazole</p>

Answer 5

<p>1) peptic ulcer, gastritis, esophageal reflux, Zollinger-Ellison syn

2) proton pump inhibitor: irreversibly inhibits H+/K+ ATPase in stomach parietal cells
3) incr risk fo C. difficile infct + pneumonia; hip fractures; decr serum Mg2+ w/ long-term use
4) N/A</p>

Question 6

<p class=”large” style=”text-align:center”;>Lansoprazole</p>

Answer 6

<p class=”large” style=”text-align:center”;>1) peptic ulcer, gastritis, esophageal reflux, Zollinger-Ellison syn

2) proton pump inhibitor: irreversibly inhibits H+/K+ ATPase in stomach parietal cells
3) incr risk fo C. difficile infct + pneumonia; hip fractures; decr serum Mg2+ w/ long-term use
4) N/A</p>

Question 7

<p>Esomeprazole</p>

Answer 7

<p>1) peptic ulcer, gastritis, esophageal reflux, Zollinger-Ellison syn

2) proton pump inhibitor: irreversibly inhibits H+/K+ ATPase in stomach parietal cells
3) incr risk fo C. difficile infct + pneumonia; hip fractures; decr serum Mg2+ w/ long-term use
4) N/A</p>

Question 8

<p class=”large” style=”text-align:center”;>Pantoprazole</p>

Answer 8

<p class=”large” style=”text-align:center”;>1) peptic ulcer, gastritis, esophageal reflux, Zollinger-Ellison syn

2) proton pump inhibitor: irreversibly inhibits H+/K+ ATPase in stomach parietal cells
3) incr risk fo C. difficile infct + pneumonia; hip fractures; decr serum Mg2+ w/ long-term use
4) N/A</p>

Question 9

<p>Dexlansoprazole</p>

Answer 9

<p>1) peptic ulcer, gastritis, esophageal reflux, Zollinger-Ellison syn

2) proton pump inhibitor: irreversibly inhibits H+/K+ ATPase in stomach parietal cells
3) incr risk fo C. difficile infct + pneumonia; hip fractures; decr serum Mg2+ w/ long-term use
4) N/A</p>

Question 10

<p>Bismuth</p>

Answer 10

<p>1) incr ulcer healing, traveler's diarrhea

2) bind ulcer base to provide physical protection + let HCO3- secretion re-establish pH gradient in mucus layer
3) N/A
4) N/A</p>

Question 11

<p class=”large” style=”text-align:center”;>Sucrafate</p>

Answer 11

<p class=”large” style=”text-align:center”;>1) incr ulcer healing, traveler’s diarrhea

2) bind ulcer base to provide physical protection + let HCO3- secretion re-establish pH gradient in mucus layer
3) N/A
4) N/A</p>

Question 12

<p>Misoprostol</p>

Answer 12

<p>1) prevent NSAID-induced peptic ulcers; maintenance of patent ductus arteriosus; also induce labor (ripens cervix)

2) PEG1 analog: incr production + secretion of gastric mucus barrier; decr acid production
3) diarrhea; contraindicated in women of childbearing age (abortifacient)
4) N/A</p>

Question 13

<p class=”large” style=”text-align:center”;>Octreotide</p>

Answer 13

<p class=”large” style=”text-align:center”;>1) acute variceal bleeds, acromegaly, VIPoma, carcinoid tumors

2) long-acting somatostatin analog
3) nausea, cramps, steatorrhea
4) N/A</p>

Question 14

<p>Aluminum hydroxide</p>

Answer 14

<p>1) esophageal reflux dz's

2) antacid
3) can affect absorption, bioavail or urinary excretion of other Rx by altering gastric + urinary pH or by delaying gastric emptying; hypokalemia; constipation + hypophosphatemia; proximal musc weakness; osteodystrophy; seizures
4) N/A</p>

Question 15

<p class=”large” style=”text-align:center”;>Magnesium hydroxide</p>

Answer 15

<p class=”large” style=”text-align:center”;>1) esophageal reflux dz’s, constipation

2) antacid; osmotic laxative: provide osmotic load to draw out H2O
3) can affect absorption, bioavail or urinary excretion of other Rx by altering gastric + urinary pH or by delaying gastric emptying; hypokalemia; diarrhea; hyporeflexia; hypotension; cardiac arrest; diarrhea, dehydration
4) may be abused by bulimics</p>

Question 16

<p>Calcium carbonate</p>

Answer 16

<p>1) esophageal reflux dz's

2) antacid
3) can affect absorption, bioavail or urinary excretion of other Rx by altering gastric + urinary pH or by delaying gastric emptying; hypokalemia; hypercalcemia; rebound incr in acid
4) can chelate + decr effectiveness of other Rx (ie, tetracycline)</p>

Question 17

<p class=”large” style=”text-align:center”;>Magnesium citrate</p>

Answer 17

<p class=”large” style=”text-align:center”;>1) constipation

2) osmotic laxative: provide osmotic load to draw out H2O
3) diarrhea, dehyration
4) may be abused by bulimics</p>

Question 18

<p class=”large” style=”text-align:center”;>Polyethylene glycol</p>

Answer 18

<p class=”large” style=”text-align:center”;>1) constipation

2) osmotic laxative: provide osmotic load to draw out H2O
3) diarrhea, dehyration
4) may be abused by bulimics</p>

Question 19

<p>Lactulose</p>

Answer 19

<p>1) constipation; hepatic encephalopathy

2) osmotic laxative: provide osmotic load to draw out H2O; gut flora degrades this Rx into metabolites (lactic acid, acetic acid) that promote nitrogen excretion as NH4+
3) diarrhea, dehyration
4) may be abused by bulimics</p>

Question 20

<p class=”large” style=”text-align:center”;>Infliximab</p>

Answer 20

<p class=”large” style=”text-align:center”;>1) Crohn’s dz, ulcerative colitis, rheumatoid arthritis

2) monoclonal ab to TNF-alpha
3) infct (including reactivation of latent TB); fever; hypotension
4) N/A</p>

Question 21

<p>Sulfasalazine</p>

Answer 21

<p>1) ulcerative colitis, Crohn's dz

2) combo of sulfapyridine (antibacterial) + 5-aminosalicylic acid (5-ASA, anti-inflammatory); activated by colonic bacteria (cleaves bond)
3) malaise; nausea; sulfonamide toxicity; reversible oligospermia
4) N/A</p>

Question 22

<p class=”large” style=”text-align:center”;>Ondansetron</p>

Answer 22

<p class=”large” style=”text-align:center”;>1) control vomiting postoperatively + in pts undergoing CA chemo

2) 5-HT3 antagonist; powerful central-acting antiemetic
3) HA, constipation
4) N/A</p>

Question 23

<p>Metoclopramide</p>

Answer 23

<p>1) DM, post-sx gastroparesis, antiemetic

2) D2 receptor antagonist: incr resting tone, contractility, LES tone, motility; doesn't influence colon transport time
3) incr parkinsonian effects; restlessness; drowsiness; fatigue; depression; nausea; diarrhea; contraindicated in pts w/ small bowel obstruction or Parkinson's dz
4) Rx interaction w/ digoxin + DM agents</p>