GI Pharmacology 2

Question 1

Class: Serotonin Blocker

Answer 1

Ondansetron (Zofran)

Question 2

Ondansetron MOA

Answer 2

Blocks serotonin receptors in the trigger zone in the brain and in the afferent vagal nerves in the stomach and small intestines

Question 3

Ondansetron Route

Answer 3

PO or IV

Question 4

Ondansetron Uses + AE

Answer 4

N/V esp. w/chemo/radiation

AE: Usually mild headache, diarrhea, dizziness
-Serotonin Syndrome: be aware of drugs that affect serotonin

Question 5

Antihistamines

Answer 5

dimenhydrinate (Dramamine)

meclizine (Antivert)

hydroxyzine (Vistaril)

Question 6

Antihistamines MOA

Answer 6

Blocks the release of histamine H1 receptors in the inner ear

Question 7

Antihistamines Indication

Answer 7

Dizziness and nausea: antiemetic and antivertigo associated with motion sickness

Question 8

Antihistamines AE

Answer 8

Sedation, drowsiness, dizziness, and ANTICHOLINERGIC effect
FALL RISK!

Given IM, Never IV

Question 9

Dopamine Antagonist: Prokinetic agent

Answer 9

metoclopramide (Reglan)

Question 10

metoclopramide (Reglan): MOA

Answer 10

Blocks dopamine receptors, increases the tone of lower esophageal sphincter (GERD)
Increases peristalsis in both the stomach and the intestine (Diabetic gastroparesis)

Question 11

metoclopramide (Reglan): Indication

Answer 11

N/V associated with chemo/radiation/opioids, GI motility issues (CF), and paralytic ileus

Question 12

metoclopramide (Reglan): SE

Answer 12

SEDATION
Severe: Extrapyramidal (EPS)
restlessness, neuroleptic malignant syndrome

Question 13

Extrapyramidal (EPS) from Dopamine Antagonist (metoclopramide (Reglan)

Answer 13

Drug induced movements:

1. Akathisia: may feel restless, tense, constant desire to move
2. Acute dystonia: involuntary muscle contractions
3. Parkinsonism: tremors, rigid muscles in limbs
4. Tardive dyskinesia: repetitive involuntary facial movements
5. Neuroleptic malignant syndrome

Question 14

Drug therapy for Diarrhea

Answer 14

diphenoxylate with atropine (Lomotil)

loperamide (Imodium)

Question 15

loperamide + diphenoxylate: MOA

Answer 15

decrease intestinal peristalsis, reduce the intestinal effluent

AE: drowsiness and constipation

Question 16

loperamide + diphenoxylate: AE

Answer 16

AE: drowsiness and constipation

• Fall and driving precautions esp. with other CNS depressants
• Anticholinergic effects of atropine

Serious: cardiac arrest/arrhythmias (bradycardia)

Question 17

Class: 5-Aminosalicylates

Answer 17

Sulfasalazine (Azulfidine)

Question 18

Sulfasalazine (Azulfidine) MOA

Answer 18

A sulfonamide antibiotic that converts in the intestine into 5-aminosalicyclic acid and sulphapyridine.

Sulphapyridine has no therapeutic effect for IBD and because of its SE some patients prefer mesalamine alone

Question 19

Sulfasalazine (Azulfidine): Indication

Answer 19

Mild to moderate IBD

Question 20

Sulfasalazine (Azulfidine): SE

Answer 20

Nausea, fever, rash, headache, and hematologic disorders.

Precaution: do NOT give to patients who are allergic to SULFA drugs or who have certain types of anemias
-Caution for use in patients with many diseases

Question 21

Class: DMARDs Disease modifying antirheumatic drug

Answer 21

infliximab (Remicade)

Question 22

infliximab (Remicade): MOA

Answer 22

Monoclonal antibody which neutralizes TNF-alpha (inflammatory mediator)

Question 23

infliximab (Remicade): Indications

Answer 23

Lots! Inflammatory Bowel Disease (IBD)

Route: given through infusion

Question 24

infliximab (Remicade): SE

Answer 24

IMMUNE SUPRESSION
-infection, cancer, heart failure, infusion reactions, neutropenia

-Often require therapeutic drug monitoring and biomarker monitoring for inflammation (CRP)