PUD, IBD, NVDC

Question 1

Al(OH)3, Mg(OH)3

Answer 1

Antacids; acute PUD and GERD, SE: Mg causes diarrhea

Question 2

First-line for HP in PUD and MALT lymphoma

Answer 2

Clarithromycin + Amoxicillin (sub for metronidazole if penicillin allergic) + PPI

Question 3

Linaclotide

Answer 3

Guanylate cyclase-C receptor agonist, raises cGMP, activates CFTR to increase chloride secretion into lumen (acts like toxin); chronic constipation

Question 4

Cholestyramine

Answer 4

Binds bile salts and some bacterial toxins; diarrhea caused by excessive bile salts and some bacteria

Question 5

Prochlorperazine, Droperidol, Metoclopramide

Answer 5

D2 receptor antagonists (meto is also muscarinic AGONIST that pushes food away), intended to block DA activation of chemoreceptor trigger zone and vomiting center; postoperative N/V, SE: parkinsonian effects

Question 6

Sucralfate

Answer 6

Viscous gel at acidic pH intended to coat and protect; PUD

Question 7

Azathioprine

Answer 7

after conversion to 6-mercaptopurine in liver inhibits purine synthesis, blocks Rac1 activation; IBD, SE: N/V, leukopenia, thrombocytopenia

Question 8

Metamucil, Fibercon, Citrucel

Answer 8

hygroscopic indigestible fiber; diarrhea/constipation

Question 9

Aprepitant

Answer 9

NK1 receptor antagonist, intended to block substance P activation of vagus nerve and chemoreceptor trigger zone; N/V with chemotherapy/radiation, postoperative N/V

Question 10

Magnesium hydroxide (low dose)

Answer 10

non-absorbable salt for constipation

Question 11

Loperamide

Answer 11

peripheral mu receptor agonist (slows GI motility); traveler’s diarrhea, IBD IBS diarrhea, diarrhea associated with cancer chemo/radiation

Question 12

Infliximab

Answer 12

Ab against TNF-a, and induces apoptosis of inflammatory cells via caspases; IBD, SE: risk of infection

Question 13

Mesalamine (5-ASA)

Answer 13

Cyclooxygenase and 5-lipoxygenase inhibitor, inhibits cytokine, prostaglandin, leukotrine synthesis, modulates B-cell and angiogenesis; IBD

Question 14

Bisacodyl, cascara sagrada, senna

Answer 14

Stimulant cathartic that acts on GI smooth muscle to promote peristalsis; constipation

Question 15

Second-line for HP in PUD and MALT lymphoma

Answer 15

Tetracycline + Metronidazole + Bismuth + PPI

Question 16

Magnesium hydroxide (high dose), Magnesium citrate, magnesium sulfate, sodium phosphate, PEG

Answer 16

non-absorbable salt for bowel prep

Question 17

Mannitol, lactulose, sorbitol

Answer 17

Non-absorbable sugars, constipation

Question 18

Diphenhydramine, Dimenhydrinate, Meclizine

Answer 18

H1 receptor + muscarinic receptor antagonists,quiet vestibular effect on chemoreceptor trigger zone; motion sickness, SE: drowsiness, peripheral anticholinergic actions

Question 19

Misoprostol

Answer 19

PGE2 receptor agonist (PGE1 analog) that replaces prostaglandin eliminated by NSAID use; NSAID induced PUD, SE: diarrhea, abortion

Question 20

Omeprazole, Esomeprazole

Answer 20

Irreversible PPI; PUD, GERD (healing ulcers, not so much curing), Zollinger-Ellison syndrome, SE: Gastric/duodenal infection, fractures with chronic use (hypocalcemia)

Question 21

Cimetidine, Ranitidine

Answer 21

H2 receptor antagonists; PUD and GERD

Question 22

Sulfasalazine, balsalazine

Answer 22

cleaved to mesalamine by gut bacteria, same mechanism; IBD- crohn’s in colon only, SE: (sulfa allergy)

Question 23

Lubiprostone

Answer 23

ClC-2 channel activator (PGE2 analog) increase chloride secretion into lumen (acts like toxin); chronic constipation

Question 24

Budesonide

Answer 24

GR agonist, but poorly absorbed; acute flares of IBD, SE: think Cushings

Question 25

Vedolizumab

Answer 25

Ab against a4b7 integrin, prevents inflammatory cells from invading GI tract; IBD

Question 26

Dexmethasone

Answer 26

Long-acting GR agonist; N/V with chemotherapy/radiation, postoperative N/V

Question 27

Docusate

Answer 27

Stool softner by attracting fat and water to stool; constipation to avoid straining after MI and surgery

Question 28

Ondansetron

Answer 28

5-HT3 receptor antagonist, block serotonin activation of vagus nerve and chemoreceptor trigger zone; N/V with chemotherapy/radiation, postoperative N/V

Question 29

Prednisolone, methylprednisolone

Answer 29

GR agonist; inhibit prostaglandin + leukotriene + inflammatory cytokines, reduce NF-KB, expression, kill proliferating immune cells; acute flareups in IBD, SE: osteoporosis, thin skin, poor wound healing, easy bruising, abdominal fat, buffalo hump, moon face, hyperglycemia

Question 30

Bismuth-subsalicylate, Bismuth-citrate

Answer 30

Kill HP and other bacteria, inhibit PGE-mediated inflammation and intestinal hypermotility, inhibit intestinal secretion; PUD and mild diarrhea

Question 31

Scoplamine

Answer 31

Muscarinic receptor antagonist, quiet vestibular effect on chemoreceptor trigger zone, lipophilic and can pass BBB; motion sickness, SE: drowsiness, peripheral anticholinergic actions