GI Pharm

Question 1

cimetidine toxicity

Answer 1

potent inhibitor of cytochrome P-450
Antiandrogenic effects (prolactin release, gynecomastia, impotence, dec. libido in males)
Crosses BBB for confusion, dizziness, and HA and also crosses placenta
along with ranitidine, dec. renal excretion of creatinine

Question 2

PPI MOA

Answer 2

inhibits H/K ATPase

Question 3

PPI toxicities

Answer 3

C. diff, PNA, hip fractures, dec. serum Mg with long-term use

Question 4

bismuth, sucralfate MOA

Answer 4

binds to ulcer base, providing physical protection and allowing bicarb secretion to reestablish pH gradient in the mucous layer. Use in travelrs diarrhea and inc. ulcer healing.

Question 5

misoprostol MOA

Answer 5

PGE1 analog, inc. gastric mucous barrier and dec. acid production.

Question 6

misoprostol use

Answer 6

prevents NSAID induced ulcers; maintenance of PDA; induces labor by ripening cervix, can cause diarrhea, is an abortafacient

Question 7

octreotide use

Answer 7

acute variceal bleeds, acromegaly, VIPoma, and carcinoid tumors.

Question 8

octreotide toxicity

Answer 8

nausea, cramps, steatorrhea

Question 9

all antacids can cause

Answer 9

hypokalemia

Question 10

aluminum hydroxide toxicity

Answer 10

constipation and hypophosphatemia; proximal muscle weakness, osteodystrophy, seizures

Question 11

calcium carbonate

Answer 11

hypercalcemia, rebound acid inc., can chelate drugs like tetracycline

Question 12

magnesium hydroxide

Answer 12

diarrhea, hyporeflexia, hypotension, cardiac arrest (Mg: Must Go to bathroom)

Question 13

lactulose forms what in the gut

Answer 13

lactic acid and acetic acid to trap nitrogen as NH4+

Question 14

infliximab MOA

Answer 14

anti-TNFalpha monoclonal antibody

Question 15

Infliximab clinical use

Answer 15

crohns, ulcerative colitis, RA, ankylosing spondylitis, psoriasis

Question 16

sulfasalazine MOA

Answer 16

combo of sulfapyridine (antibacterial) and 5-aminosalicylic acid (anti-inflammatory). activated by colonic bacteria.

Question 17

sulfasalazine use

Answer 17

IBD

Question 18

sulfasalazine toxicity

Answer 18

malaise, nausea, sulfonamide toxicity, reversible oligospermia

Question 19

ondansetron MOA

Answer 19

5-HT3 antagonist; dec. vagal stimulation, central acting

Question 20

ondansetron toxicity

Answer 20

HA and constipation

Question 21

metoclopramide MOA

Answer 21

D2 receptor antagonist, inc. resting tone, contractility, LES tone, motility. Does not influence colon transport time.

Question 22

metoclopramide use

Answer 22

diabetic and post-surgery gastroparesis, antiemetic

Question 23

Metoclopramide toxicity

Answer 23

inc. parkinsonian effects. Restlessness, drowsiness, fatigue, depression, nausea, diarrhea. Interacts with digoxin and diabetic agents. Contraindicated in small bowel obstruction or Parkinsons disease (D1-receptor blockade)