GI Drugs II

Question 1

Lifestyle changes to treat GERD

Answer 1

Elevation of the head of the bed
Avoidance of food or liquids 2-3 hr before bedtime
Avoidance of fatty or spicy foods
Avoidance of cigarettes, alcohol
Weight loss
Liquid antacid (aluminum hydroxide-magnesium hydroxide) 30 ml 30 minutes after meals and at bedtime
Pregnancy

Question 2

*Treatment of GERD WITHOUT esophagitis

Answer 2

1. Antacids w. Simethicone (Gaviscon)
   2.Promotility drugs
   Cisapride - cardiac/sudden death
   *Metoclopramide
2. H2-receptor blockers
3. PPI (H/K ATPase inhibitors)

Question 3

*Treatment of GERD WITH esophagitis

Answer 3

1. endoscopy first
2. double dose of H2 blocker
3. combine H2 blocker and promotility
4. PPI instead
5. reflux surgery

Question 4

NOT HIGH YIELD

Treatment of Vomiting (and gastroparesis)

Answer 4

***Serotonin receptor antagonists - ONDANSETRON (zofran)
side effect: somnolence

2. Phenothiazines - neuroleptics -
   prochlorperazine and promethazine
   **causes extrapyramydal symptoms (Torticolis and Tardive Dyskinesia)
3. Benzamide Derivatives - not used
4. Tetrahydrocannabinol (THC) - marijuana - affects the CRTZ in the central

Question 5

NOT HIGH YIELD

Treatment of Gastroparesis (presents as vomiting)

Answer 5

Esp in diabetics

1. Metoclopromide (Promotility drugs)
2. pacemaker

Question 6

NOT HIGH YIELD

Treatment of Diarrhea

Answer 6

1. prolong GI secretion and decrease GI motility
2. atropine sulfate - anticholinergics that relax all bowel sm. muscle
3. opioids - Loperamide (for Travelers Diarrhea), Lomotil (Diphenoxylate) - DO NOT GIVE TO KIDS
4. Colloids and pectins - Metamucil, Kaopectate
5. antibiotics if infectious process

Question 7

*NOT HIGH YIELD**

Treatment of Constipation

Answer 7

Laxatives or cathartics

1. irritant or stimulants (castor oil, cascara, senna)
2. osmotic cathartics
3. Milder: bulk-forming/fiber supplements - psyllium
4. Lubricants or fecal softeners

Question 8

*Treatment of ACUTE Inflammatory Bowel Disease—U.C.

Answer 8

1. anti-inflammatory for Ulcerative Colitis
Mesalamine 
**Sulfasalazine**
Olsalazine
Corticosteroids
Antibiotics

Question 9

*Treatment of CHRONIC Inflammatory Bowel Disease (both Crohns and U.C.)

Answer 9

Immunosuppressants -
1. Azathioprine
2. Infliximab (Remicade) - binds and neutralizes TNFalpha
3. Cyclosporine
4. Corticosteroids
Antibiotics

Question 10

NOT HIGH YIELD

Treatment of IBS

Answer 10

Diarrhea prediminant–5HT Antagonists
Constipation predominant—5HT Agonists
»>no serotonin meds used today. Opiods, anticholinergics, antidepressants