GI Rx

Question 1

Cimetidine

Answer 1

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

Question 2

Ranitidine

Answer 2

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

Question 3

Famotidine

Answer 3

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

Question 4

Nizatidine

Answer 4

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

Question 5

Omeprazole

Answer 5

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

Question 6

Lansoprazole

Answer 6

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

Question 7

Esomeprazole

Answer 7

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

Question 8

Pantoprazole

Answer 8

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

Question 9

Dexlansoprazole

Answer 9

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

Question 10

Bismuth

Answer 10

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

Question 11

Sucrafate

Answer 11

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

Question 12

Misoprostol

Answer 12

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

Question 13

Octreotide

Answer 13

1) acute variceal bleeds, acromegaly, VIPoma, carcinoid tumors 2) long-acting somatostatin analog 3) nausea, cramps, steatorrhea 4) N/A

Question 14

Aluminum hydroxide

Answer 14

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

Question 15

Magnesium hydroxide

Answer 15

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

Question 16

Calcium carbonate

Answer 16

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)

Question 17

Magnesium citrate

Answer 17

1) constipation 2) osmotic laxative: provide osmotic load to draw out H2O 3) diarrhea, dehyration 4) may be abused by bulimics

Question 18

Polyethylene glycol

Answer 18

1) constipation 2) osmotic laxative: provide osmotic load to draw out H2O 3) diarrhea, dehyration 4) may be abused by bulimics

Question 19

Lactulose

Answer 19

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

Question 20

Infliximab

Answer 20

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

Question 21

Sulfasalazine

Answer 21

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

Question 22

Ondansetron

Answer 22

1) control vomiting postoperatively + in pts undergoing CA chemo 2) 5-HT3 antagonist; powerful central-acting antiemetic 3) HA, constipation 4) N/A

Question 23

Metoclopramide

Answer 23

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