Lippincott Chapter 31: Gastrointestinal and Antiemetic Drugs Flashcards
31.1 A 68-year-old patient with cardiac failure is diagnosed
with ovarian cancer. She begins using cisplatin but
becomes nauseous and suffers from severe vomiting.
Which of the following medications would be most
effective to counteract the emesis in this patient without
exacerbating her cardiac problem?
A. Droperidol.
B. Dolasetron.
C. Prochlorperazine.
D. Dronabinol.
E. Palonosetron.
Correct answer = E. Palonosetron is a 5-HT3
antagonist that
is effective against drugs with high emetogenic activity, such
as cisplatin. Although dolasetron is also in this category, its
propensity to affect the heart makes it a poor choice for this
patient. Droperidol also affects the heart and now is gener-
ally a second-line drug used in combination with opioids
or benzodiazepines. The antiemetic effect of prochlorpera-
zine, a phenothiazine, is most beneficial against anticancer
drugs with moderate to low emetogenic properties.
31.2 A 45-year-old woman complains of persistent heartburn
and an unpleasant, acid-like taste in her mouth. The
clinician suspects that she has gastroesophageal reflux
disease and advises her to raise the head of her bed
6 to 8 inches, not to eat for several hours before retiring,
and to eat smaller meals. Two weeks later, she returns
and says the symptoms have subsided slightly but still
are a concern. The clinician will likely prescribe which
one of the following drugs?
A. An antacid such as aluminum hydroxide.
B. Dicyclomine.
C. An antianxiety agent such as alprazolam.
D. Esomeprazole.
Correct answer = D. It is appropriate to treat this patient
with a proton-pump inhibitor (PPI) to reduce acid produc-
tion and promote healing. An H2
-receptor antagonist might
also be effective, but the PPIs are preferred. An antacid
would decrease gastric acid, but its effects are short lived
compared to those of the PPIs and H2
-receptor inhibitors.
Dicyclomine is an antimuscarinic drug and would decrease
acid production, but it is not as effective as the PPIs or the
H2
-receptor inhibitors. An antianxiety agent might have
antiemetic action but would have no effect on the acid
production.
31.3 A couple celebrating their 40th wedding anniversary are
given a trip to Peru to visit Machu Picchu. Due to past
experiences while traveling, they ask their doctor to
prescribe an agent for diarrhea. Which of the following
would be effective?
A. Omeprazole.
B. Loperamide.
C. Famotidine.
D. Lorazepam.
Correct answer = B. Loperamide is the only drug in this set
that has antidiarrheal activity. Omeprazole is a proton-pump
inhibitor, famotidine antagonizes the H2
receptor, and loraz-
epam is a benzodiazepine that is a sedative and an anxio-
lytic agent.
31.4 A 27-year-old woman who is 34 weeks pregnant is on
bed rest and visits her obstetrician. During the visit, she
informs her physician that she has been experiencing
mild constipation. Which of the following medications
will most likely be recommended to her?
A. Castor oil.
B. Docusate.
C. Mineral oil.
D. Loperamide.
Correct answer = B. Although its effects are not immediate,
docusate may be used for mild constipation and is generally
considered safe in pregnancy. Castor oil should not be used
in pregnancy because of its ability to cause uterine contrac-
tions. Mineral oil should not be used in bedridden patients
due to the possibility of aspiration. Loperamide is used for
diarrhea, not constipation
31.5 Which of the following drugs has been known to cause
discoloration of the tongue?
A. Amoxicillin.
B. Omeprazole.
C. Bismuth compounds.
D. Lubiprostone.
Correct answer = C. Bismuth compounds may cause a
black discoloration of the tongue. The other agents have not
been associated with this effect.
31.6 A patient is receiving treatment with lorazepam prior to
chemotherapy to help reduce her anticipatory nausea
and vomiting. Which of the following should generally
be avoided in this patient?
A. Docusate.
B. Ondansetron.
C. Polyethylene glycol.
D. Ethanol.
Correct answer = D. Ethanol combined with benzodiaz-
epines, particularly at high doses, may produce uncon-
sciousness, respiratory depression, and even death. The
other drugs listed here have not shown a specific drug inter-
action with benzodiazepines.
31.7 All of the following drugs are generally well tolerated for
the treatment of constipation except:
A. Castor oil.
B. Methylcellulose.
C. Polyethylene glycol.
D. Docusate.
Correct answer = A. Castor oil can produce severe cramp-
ing, which makes it difficult to tolerate for many, including the
elderly. The other three choices are generally well tolerated.
31.8 An elderly woman with a recent history of myocardial
infarction is seeking a medication to help treat her
occasional heartburn. She is currently taking several
medications, including aspirin, clopidogrel, simvastatin,
metoprolol, and lisinopril. Which of the following choices
should be avoided in this patient?
A. Calcium citrate.
B. Famotidine.
C. Omeprazole.
D. Ranitidine.
E. Calcium carbonate.
Correct answer = C. Omeprazole may possibly decrease
the efficacy of clopidogrel because it inhibits the conversion
of clopidogrel to its active form
31.9 Extrapyramidal symptoms (EPS) have been associ-
ated with which of the following drugs?
A. Metoclopramide.
B. Alprazolam.
C. Aprepitant.
D. Loperamide.
Correct answer = A. Only metoclopramide has been associ-
ated with EPS. This is due to its ability to inhibit dopamine
activity.
31.10 Which of the following medications for gastrointestinal
problems is contraindicated in pregnancy?
A. Calcium carbonate.
B. Famotidine.
C. Lansoprazole.
D. Misoprostol.
Correct answer = D. Misoprostol is contraindicated in preg-
nancy because it may stimulate uterine contractions. The
other medications may be used during pregnancy for the
treatment of heartburn (common in pregnancy) or peptic
ulcer disease.
