Pharm

Question 1

When do we administer prokinetics?

Answer 1

10-15 minutes before meals and beofre bedtime (if symptoms persist)

Question 2

Drug: Metoclopramide
MOA
Indication
SE

Answer 2

M: D2 antagonist - increases esophageal peristaltic amplitude
I: GERD, gastroparesis, dyspepsia (nonulcer), reflux esophagitis, lactation stimulation
SE: dystonia, tarditive dyskinesia, gynecomastia
BBW: Depression, Extrapyramidal FX, Parkinsonian-like Sx, Tarditive dyskinesia, Neuroleptic malignant syndrome

Question 3

Drug: Segaserod
MOA
Indication
SE

Answer 3

M: 5HT4 receptor partial agonist
I: IBS w/ constipation
SE: Abd. pain, intestinal ischemia

Question 4

Drug: Cisapride
MOA
Indication
SE

Answer 4

Drug: Cisapride
MOA: 5HT4 receptor agonist
Indication: GERD, gastroparesis
SE: QT prolongation

Question 5

Drug: Erythromycin
MOA
Indication
SE

Answer 5

Drug: Erythromycin
MOA: Motilin receptor agonist - stim. cholinergic and noncholinergic pathways to stim. motility
Indication: gastroparesis, acute upper GI hemorrhage to promote gastric emptying of blood before endoscopy
SE: rapid tolerance

Question 6

Drug: Lubiprostone
MOA
Indication
SE

Answer 6

Drug: Lubiprostone
MOA: Cl- channel activator in small intestine
Indication: constipation due to opioids or IBS
SE: Bowel obstrxn
Contra: obstrxn

Question 7

Drug: Alvimopan
MOA
Indication
SE

Answer 7

Drug: Alvimopan
MOA: Selective antagonist of cloned mu-opioid receptor
Indication: accelerate time to upper/lower GI recovery following large/small bowel resection… post-operative ileus
SE: hepatic impairment, ESRD, obstrxn

Question 8

Drug: Methylnaltrexone
MOA
Indication
SE
Contra

Answer 8

Drug: Methylnaltrexone
MOA: opioid antagonist (mu)
Indication: constipation from opioids
SE: withdrawal from opioids, perforation, diarrhea, hyperhidrosis, flushing
Contras: Obstrxn

Question 9

Drug: Bethenachol
MOA
Indication
SE
OD
Contras

Answer 9

Drug: Bethenachol
MOA: stims M3- gastric motility/tone increases
Indication: post-op ileus, post-partum urinary retention, neurogenic atony of bladder
SE: cholinergic Sx - treat with atropine
Contras: Hyperthyroid, peptic ulcer, asthma, bradyardia, etc.

Question 10

Drug: Neostigmine
MOA
Indication
SE

Answer 10

Drug: Neostigmine
MOA: competitive cholinesterase inhibitor
Indication: reversal of NMJ blockade after surgery, and acute large bowel distention (Ogilvie’s disease - aka pseudo-obstrxn)
SE: cholinergic tox

Question 11

Drug: Renzaprine
MOA
Indication
SE
OD
Contras

Answer 11

Drug: Renzaprine
MOA: Binds 5HT4 agonist/5HT3 antagonist - Gastroprokinetic agent, antiemetic
Indication: IBS w/ constipation
No longer in development

Question 12

Drug: Glycerin suppository
MOA
Indication

Answer 12

Drug: glycerin suppository
MOA: stool softener like docusate
Indication: children for constipation

Question 13

Drug: lactulose and sorbitol
MOA
Indication
SE

Answer 13

MOA: colonic acidifier,
Indication: hepatic encephalopathy
SE: distention, flatulance, diarrhea, fluid loss, hypokalemia/hypernatremia

Question 14

Drug: Methylcellulose
MOA
Indication

Answer 14

Drug: Methylcellulose
MOA: Not absorbed - attracts water - bulkier stool
Indication: constipation, diverticulosis, hemorrhoids, IBS

Question 15

Drug: PEG
MOA
Indication

Answer 15

Drug: PEG
MOA: osmotic sugar - better than lactulose (no cramping/gas)
Indication: constipation

Question 16

Drug: Sodium phosphate
MOA
Indication
SE

Answer 16

Drug: Sodium phosphate
MOA: osmotic agent
Indication: constipation
SE: hyperphosphatemia, hypocalcemia, hypernatremia, hypokalemia

Question 17

Drug: castor oil
MOA
Indication

Answer 17

Drug: castor oil
MOA: converted to ricinoleic acid
Indication: constipation

Question 18

Drug: cascara
MOA
Indication
Contras

Answer 18

Drug: cascara
MOA: unknown - irritant
Indication: constipation
Contras: intestinal blockage and inflammatory diseases (Crohn’s, UC, IBS)

Question 19

Drug: mineral oil
MOA
Indication
SE
OD
Contras

Answer 19

Drug: mineral oil
MOA: lubricant laxative
Indication: fecal impaction in kids/adults
SE: aspiration can cause lipid penumonitis, impaired fat soluble vitamins

Question 20

Drug: Simethicone
MOA
Indication

Answer 20

Drug: Simethicone
MOA: breaks up gas bubbles in gut
Indication: gas

Question 21

Drug: Charcoal
MOA
Indication
SE
Contras

Answer 21

Drug: mineral oil
MOA: binds shit
Indication: poisoning, diarrhea
SE: constipation, black stools
Contras: do not take with other meds - decreases efficacy

Question 22

Drug: Agalsidase beta (Beano)
MOA
Indication
SE
OD
Contras

Answer 22

Drug: Agalsidase beta (Beano)
MOA: alpha galactosidase A reduces globo-triacosylceramide (GL-3) deposition in endothelium of capillaries
Indication: Fabry disease, gas (Beano)
SE: Anaphylaxis, allergic rxn (angioedema included)

Question 23

What is beta galactosidase?

Answer 23

Lactase

Question 24

Drug: Pancrelipase
MOA
Indication
SE
Contras

Answer 24

Drug: Pancrelipase
MOA: Digest fats, proteins, starch by replacing lipase, amylase, protease
Indication: CF, pancreatitis (alcoholism), post-pancreatectomy, post-GI bypass
SE: NVD, hyperuricosuria, hyperuricemia, colonic strictures (high doses)
Contras: allergic to pork

Question 25

Drug: Ursodiol
MOA
Indication
SE
Contras

Answer 25

Drug: Ursodiol
MOA: hydrophilic bile acid derived from cholesterol
Indication: primary biliary cirrhosis (antimitochondrial)
SE: GI problems, edema, jaundice, myalgia, alopecia, pruritis
Contras: complete biliary obstrxn