Lower GI Pharm

Question 1

Medication used for low acute vomiting from cancer chemotherapy

Answer 1

Dexamethasone

Question 2

When to use Granisteron and Dexamethasone to treat cancer chemotheraphy?

Answer 2

Moderate and high acute vomiting

Question 3

Medication used for mild acute vomiting from cancer chemotherapy

Answer 3

Ondansetron + Dexamethasone

Question 4

3 medications used as prn anti-emetics

Answer 4

1. lorazepam
2. prochlorperazine + dimenhydrinate
3. metoclopramide + dimenhydrinate

Question 5

First line treatment for n/v in pregnancy

Answer 5

Pyridoxine (B6) + Doxylamine (H1 anta)

Question 6

Med reserved for refractory n/v (2nd trimester)

Answer 6

Glucocorticoids

Eg: methylprednisolone

Question 7

After giving pyridoxine and doxylamine, pt still experiences n/v. What’s next?

Answer 7

Add Anti-His

Eg: Dimenhydrinate or Meclizine

Question 8

After adding dimenhydrinate or Meclizine to pregnant pt, but no improvement. What’s next?

Answer 8

D2 antagonist

Eg: Prochlorperazine or Metoclopramide

Question 9

What is the adverse effect of Prochlorperazine or Metoclopramide?

Answer 9

Extrapyramidal signs –> movement disorder

Question 10

Drugs-induced constipation? (5)

Answer 10

1. Anti-M
2. Antacids
3. Calcium channel blocker
4. Opioid
5. 5HT3 anta

Question 11

3 drugs with anti-M side effects inducing constipation?

Answer 11

1. 1st generation anti-H1
2. Tricyclic antidepressants
3. Typical antipsychotic

Question 12

1st line for Constipation medication

Answer 12

Fiber/Bulk-Forming

Eg: Psyllium

Question 13

2nd step for Constipation tx

Answer 13

Add Saline (Osmotic) Cathartics

Question 14

How Saline Cathartics increases peristalsis?

Answer 14

Non-absorbable ions –> osmotic retention of intestinal water

Question 15

Primarily reserved for fecal impaction?

Answer 15

Phosphate enemas

Note: This is Saline Cathartics

Question 16

List 4 examples of Saline Cathartics

Answer 16

1. Milk of magnesia, magnesium citrate
2. Phosphate enemas
3. Polyethylene Glycol
4. Lactulose

Question 17

Use of Milk of magnesia

Answer 17

mild to moderate constipation

Question 18

When should avoid long term milk of magnesia? Why?

Answer 18

1. Renal dysfunction

2. Lead to electrolyte imbalances

Question 19

Polyethylene Glycol - High volume solution

Answer 19

Fill #27

Question 20

Polyethylene Glycol - Smaller volume solution

Answer 20

Fill #27

Question 21

How lactulose increases peristalsis?

Answer 21

Dissacharid metabolized by colonic bacteria to low MW acids –> osmotic diarrhea

Question 22

When to use lactulose?

Answer 22

Alternative for acute constipation - useful in elderly

Question 23

What to try for constipation if fiber/saline fail?

Answer 23

Stimulant - Irritant Laxatives

Question 24

List 3 examples of Stimulant for constipation tx

Answer 24

1. Bisacodyl
2. Senna
3. Castor Oil

Question 25

Bisacodyl

Answer 25

Fill #28