Module 4 Chapter 66 Other GI Drugs

Question 1

zofran common side effects

Answer 1

headache
diarrhea
dizziness
prolongs QT

Question 2

zofran is more effective when combined with

Answer 2

dexamethasone

Question 3

Aprepitant (emend) is approved for

Answer 3

preventing post-op n/v (PONV) and CINV (chemo induced n/v)

has to be given with another antiemetic (glucocorticoid such as dexamethasone) or serotonin antagonist (zofran)

Question 4

suffix for Substance P/Neurokinin-1 Antagonist

Answer 4

-pitant

aprepitant
rolapitant
netupitant
fosaprepitant

Question 5

adverse effects of Aprepitant (emend)

Answer 5

combining with zofran and dex - more fatigue and asthenia (muscle weakness), dizziness, diarrhea
and transient elevation of circulation aminotransferases ->could indicate liver injury

Question 6

Drug interactions for Aprepitant (emend)

Answer 6

inducer of CYP

inhibitors (itraconazole, ritonavir) can raise levels of aprepitant

can also raise levels of chemo cancer drugs

can raise levels of glucocorticoids to prevent CINV

can induce CYP2d6
decrease levels of warfarin, ethinyl estradiol (birth control)

Question 7

what benzodiazepine is used for antiemetic in CIMV

Answer 7

lorazepam (ativan)

Question 8

Promethazine (phenergan) side effecct

Answer 8

resp depression

local tissue injury

Question 9

what 2 Butyrophenones are used as antiemetics

used for

side effects

Answer 9

Haloperidol (haldol)
droperidol

used for postop n/v and emesis caused by cancer therapy

extrapyramidal reactions
sedation
hypotension

droperidol - QT prolongation

Question 10

what prokinetic agent used for an antiemetic

used in

Answer 10

Metoclopramide (Reglan)

suppress postop nausea/vomiting as well as emesis caused by anticancer drugs, opioids, toxins and radiation

Question 11

chemotherapy is associated with 3 types of emesis

Answer 11

anticipatory

acute

delayed

Question 12

emesis that begins within minutes to a few hours after receiving chemotherapy and often resolves within 24 hours

Answer 12

acute emesis

Question 13

emesis that develops a day or more after drug administration

Answer 13

delayed emesis

Question 14

when are antiemetics more effective in CINV

Answer 14

more effective prevention than at suppressing

Question 15

the current regimen of choice for a pt taking highly emetogenic drugs consists of 3 agents

Answer 15

aprepitant
dexamethasone
5HT3 antagonist (ie) ondansetron and palonosetron)

Question 16

a severe form of n/v of pregnancy (NVP) , characterized by dehydration, ketonuria, hypokalemia, loss of 5% or more of body weight

Answer 16

hyperemesis gravidarum

Question 17

nondrug measures for managing NVP

Answer 17

eating small portions of food throughout the day

avoid odors, foods and supplements that can trigger NVP (fatty foods, spicy foods, iron tablets)

use of alternative treatments such as acupuncture and ginger

Question 18

first line therapy for NVP consists of what

Answer 18

2 drug combo

doxylamine plus vit B6 (pyridoxine) - the combo is sold as Diclegis

Question 19

other drugs for NVP is

Answer 19

prochlorperazine
metoclopramide
zofran

Question 20

age for Promethazine

Answer 20

2 and older

Question 21

dronabinol in kids?

Answer 21

yes for n/v

Question 22

chenodiol in pregnancy

Answer 22

no, contraindicated

Question 23

what for gi safe in breastfeeding

Answer 23

prochlorperazine and promethazine safe for short term - observe infant for sedation

Question 24

what to avoid in breastfeeding

Answer 24

metoclopramide
dronabinol
droperidol

Question 25

gi meds to avoid in older adults

Answer 25

benzodiazepines scopolamine metoclopramide

Question 26

drug for motion sickness

Answer 26

Scopalamine

Question 27

antihistamines for motion sickness

Answer 27

dimenhydrinate (dramamine) meclizine (antivert) cyclizine (cyclivert)

Question 28

what drug class is the most effective antidiarrheal agents why

Answer 28

opioids - decrease intestinal motility which allows more time for absorption of fluids and electrolytes

Question 29

In pt with IBD, opioids may cause

Answer 29

toxic megacolon

Question 30

what opioid preps are approved for diarrhea

Answer 30

diphenoxylate (lomotil) imodium (loperamide) difenoxin paregoric opium tincture

Question 31

when taken orally in antidiarrheal doses, diphenoxylate affects the CNS in what way

Answer 31

no cns effects

Question 32

Lomotil is Diphenoxylate in combo with what drug

Answer 32

atropine

Question 33

Lomotil is a schedule

Answer 33

V

Question 34

Loperamide (imodium) is schedule

Answer 34

not regulated

Question 35

what infectious diarrhea needs abx

Answer 35

Salmonella shigella Campylobacter Clostridium species

Question 36

causative organism for travelers diarrhea

Answer 36

E coli

Question 37

for travelers diarrhea do you need an antibiotic

Answer 37

self limited, run its course in a few days however if symptoms are esp severe, treat with fluoroquinolone - ciprofloxacin adults azithromycin is drug of choice for children and pregnant women rifaximin may also be used as long as pt is not pregnant or febrile with non-bloody stools

Question 38

abx for travelers diarrhea in adults

Answer 38

fluoroquinolone such as ciprofloxacin

Question 39

abx for travelers diarrhea for children and pregnant women

Answer 39

azyithromycin

Question 40

antidiarrheal for mild symptoms of travelers diarrhea

Answer 40

loperamide but if you slow peristalsis, you will delay export of the offending organism thereby prolonging the infection

Question 41

how do you avoid getting travelers diarrhea

Answer 41

avoid local drinking water and carefully washing foods fluoroquinolones for prophylaxis but non generally recommended can be vaccinated against some pathogens to protect against diarrhea caused by E coli and vibrio cholerae

Question 42

c. diff is a gram

Answer 42

gram positive anaerobic bacillus

Question 43

symptoms of c diff

Answer 43

abd discomfort nausea fever diarrhea ``` toxic megacolon pseudomembranous colitis colon perforation sepsis death ```

Question 44

IBS is defined by

Answer 44

Rome IV criteria for at least 12 weeks in the previous year abd pain and discomfort that cannot be explained by structural or chemical abnormalities and at least 2 of listed features p. 611

Question 45

ibs symptom triggers

Answer 45

``` stress depression dietary factors including caffeine alcohol fried foods high fat foods gas generating veggies such as beans, brocolli, cabbage - too much sorbitol (found in chewing gum and some diet products) ```

Question 46

Ibs helpful tips

Answer 46

smaller more frequent meals increase fluid increase fiber

Question 47

what drug classes for IBS

Answer 47

antispasmodics (hyoscyamine and dicyclomine) bulk forming agents (psyllium and polycarbophil) antidiarrheals (loperamide) tricyclic antidepressants (TCAS)

Question 48

Bismuth subsalicylate has the side effect of

Answer 48

black tongue and stools | harmless

Question 49

Sulfasalazine does what for UC

Answer 49

reduces inflammation

Question 50

Alosetron can cause

Answer 50

ischemic colitis (intestinal damage secondary to reduced blood flow) and complication of constipation have led to hospitalization, blood tx, surgury, death

Question 51

alosetron is contraindicated in

Answer 51

``` chronic constipation intestinal obstruction toxic megacolon gi perf adhesions chrohn Uc diverticulitis ```