GIT Drugs

Question 1

What are the antacids?

Answer 1

Sodium Bicarbonate (rapid)
Calcium Carbonate (slower than NaHCO3)
Magnesium Hydroxide
Aluminum Hydroxide

Question 2

Which of the following is true of H2-receptor antagonists?
A. Inhibits only the active secretion of HCl
B. Commonly given one daily
C. Poor effect on nocturnal acid secretion
D. Markedly suppressed impact on meal-stimulated secretion (Gastrin and ACh mediated)

Answer 2

A.
→ Marked effect on nocturnal acid secretion (Histamine-dependent)
▪ At midnight (around 2100h), effect of H2 blockers ceases, meaning here is no increase in acid
→ Modest or less impact on the meal-stimulated secretion (Gastrin and Ach mediated)
→ Inhibits only the ACTIVE secretion of HCl (during mealtimes)
→ Commonly given twice daily

Question 3

Which of the following is true of Proton-pump inhibitor?
A. Shorter effect than H2-receptor antagonists
B. Commonly given twice daily
C. Decreased effect on nocturnal acid secretion
D. Markedly suppressed impact on meal-stimulated

Answer 3

D.
→ Markedly suppress meal-stimulated secretion
→ Nocturnal acid secretion
→ No acid formation
• “We can say that PPI is better than H2-blockers” (Doc Gundao, 2022)
→ Effect of PPIs are longer
→ Preference over PPI than H2 blockers and antacids in current therapy
▪ More cost-effective and higher patient compliance
▪ Only given once a day, usually 30 minutes before breakfast

Question 4

When should Proton-pump inhibitors be given?

Answer 4

30 minutes before breakfast, OD

Question 5

T/F:
Effect of antacids are more rapid and longer than H2-blockers

Answer 5

False: Antacids are rapid but short-lived (1-2hours)

Question 6

Which of the following is best prescribed for Peptic Ulcer Disease?
A. Maalox
B. Ranitidine
C. Omperazole
D. Sodium Bicarbonate

Answer 6

C. Omeprazole

Question 7

Which of the following may be prescribed for nocturnal suppression of acid in uncomplicated gastric and duodenal ulcers?
A. Maalox
B. Ranitidine
C. Omperazole
D. Sodium

Answer 7

B.
see Katzung 1626

Question 8

Which of the following is best prescribed for peptic ulcers caused by aspirin or NSAIDs?
A. Maalox
B. Ranitidine
C. Omperazole
D. Sodium

Answer 8

C. For patients with ulcers caused by aspirin or other NSAIDs, the NSAID should be discontinued. If the NSAID must be continued for clinical reasons despite active ulceration, a PPI should be given instead of an H2 antagonist to more reliably promote ulcer healing.

Question 9

Which of the following no longer play a significant role in the treatment of Peptic Ulcer disease caused by H. pylori?
A. Maalox
B. Ranitidine
C. Omperazole
D. Sodium

Answer 9

B.

Question 10

Confusion, hallucinations, agitation may occur in patients in the intensive care unit who are elderly or who have renal or hepatic dysfunction with the administration of which of the following medications?
A. nizatidine
B. esomperazole
C. cimetidine
D. sucralfate

Answer 10

C. cimetidine

Question 11

Which of the following is not a usual effect of the administration of cimetidine?
A. inhibits binding of dihydrotestosterone to androgen receptors
B. galactorrhea in women
C. gynecomastia in men
D. mental status changes in ambulatory patients

Answer 11

D.

Question 12

Less CYP interaction occurs with the following H2 blockers except?
A. ranitidine
B. cimetidine
C. nizatidine
D. famotidine

Answer 12

B.

Question 13

Which of the following H2 blockers does not inhibit gastric first-pass metabolism of ethanol in women?
A. ranitidine
B. cimetidine
C. nizatidine
D. famotidine

Answer 13

D. famotidine

Question 14

Which of the following is best given for patients with hepatic conditions?
A. ranitidine
B. cimetidine
C. nizatidine
D. famotidine

Answer 14

C. Nizatidine has less first pass effect

Question 15

Which of the following is not indicated for GERD?
A. Omeprazole
B. Lansoprazole
C. Aripiprazole
D. Rabeprazole

Answer 15

C. is an anti-psychotic drug

Question 16

Best therapeutic regimen for H. pylori-associated ulcers

Answer 16

a PPI twice daily; clarithromycin, 500 mg twice daily; and either amoxicillin, 1 g twice daily, or metronidazole, 500 mg twice daily.

Question 17

A patient taking Lansoprazole should be monitored for possible deficiency of which of the following?
A. Fe
B. Mg
C. Ca
D. Vit B12
E. AOTA

Answer 17

E.

Question 18

Which of the following PPIs may be given in patients taking Clopidogrel?
A. Rabeprazole
B. Pantoprazole
C. Lansoprazole
D. A and B
E. AOTA

Answer 18

D. both don’t have significant drug interactions

Question 19

Which of the following PPIs is known to inhibit the metabolism of clopidogrel, warfarin, diazepam, and phenytoin?
A. Omeprazole
B. Esmoprazole
C. Lansoprazole
D. Rabeprazole

Answer 19

A.
Omeprazole may inhibit the metabolism of clopidogrel, warfarin, diazepam, and phenytoin. Esomeprazole may also decrease metabolism of diazepam. Lansoprazole may enhance clearance of theophylline. Rabeprazole and pantoprazole have no significant drug interactions

Question 20

Which of the following is best given for an ICU patient with gastric ulcers to prevent GI bleeding and nosocomial infections?
A. Sucralfate
B. Omperazole
C. Ranitidine
D. Maalox

Answer 20

A.

Question 21

What are the main prostaglandins synthesized by the human gastrointestinal mucosa?

Answer 21

PG E and F

Question 22

Which of the following does not describe Misoprostol?
A. It stimulated mucus and bicarbonate secretion
B. It enhances mucosal blood flow
C. It requires does reduction in patients with renal insufficiency
D. It’s a methyl analog of PGE1
E. It is used for NSAID-induced peptic ulcers

Answer 22

C. Although it is excreted in the urine, dose reduction is not needed in patients with renal insufficiency.

Question 23

A G2P1 (1001) PU 18 weeks AOG has been having heartburn, which among the following should NOT be given?
A. Calcium carbonate
B. Famotidine
C. Lansoprazole
D. Misoprostol

Answer 23

D. is a Category X since it’s an abortifacient

Question 24

A 35-year-old writer came in for consult at your clinic for routine physical examination. He informs you that he will be traveling to Palawan the following week and is concerned about developing Traveler’s diarrhea. Which of the following agents can you recommend for prophylaxis against?
A. Bismuth subsalicylate
B. Liraglutide
C. Octreotide
D. Simethicone

Answer 24

A. reduces stool frequency and liquidity in acute diarrhea AND
“has direct antimicrobial effects and binds enterotoxins”

Question 25

Which of the following bismuth compounds is available only as a combination prescription product that also contains metronidazole and tetracycline for the treatment of H pylori?
A. Bismuth subsalicylate
B. Bismuth subcitrate
C. Bismuth potassium
D. AOTA

Answer 25

B.

Question 26

Which of the following ion secretion is prevented by Bismuth salicylate?
A. Na+
B. K+
C. H+
D. Cl-

Answer 26

D. Cl
(other inhibited: PG)

Question 27

Which of the following may be a manifestation of bismuth subsalicylate toxicity?
A. Tinnitus
B. Ataxia
C. Headaches
D. Confusion
E. Seizures

Answer 27

A. Prolonged usage of some bismuth compounds may rarely lead to bismuth toxicity, resulting in encephalopathy (ataxia, headaches, confusion, seizures). However, such toxicity is not reported with bismuth subsalicylate or bismuth citrate. High dosages of bismuth subsalicylate may lead to salicylate toxicity.

Nausea, vomiting, diaphoresis, and tinnitusare the earliest signs and symptoms of salicylate toxicity. Other early symptoms and signs are vertigo, hyperventilation, tachycardia, and hyperactivity.

Question 28

Acute colonic pseudo-obstruction (Ogilvie’s syndrome) isa disorder characterized by acute dilatation of the colon in the absence of an anatomic lesion that obstructs the flow of intestinal contents. What is the DOC and route?

Answer 28

Intravenous Neostigmine