Test #3 Flashcards
GI/ ABO
A 55-year-old woman with type 1 diabetes of 40 yrs’ duration complains of severe bloating and abdominal distress, especially after meals. Evaluation is consistent with diabetic gastroparesis. Which of the following is a prokinetic drug that could be used in this situation?
(A) Alosetron
(B) Cimetidine
(C) Loperamide
(D) Metoclopramide
(E) Sucralfate
Of the drugs listed, only metoclopramide is considered a prokinetic agent (ie, one that increases propulsive motility in the gut). The answer is D.
A patient who is taking verapamil for hypertension and angina has become constipated. Which of the following drugs is an osmotic laxative that could be used to treat the patient’s constipation?
(A) Aluminum hydroxide
(B) Diphenoxylate
(C) Magnesium hydroxide
(D) Metoclopramide
(E) Ranitidine
A laxative that mildly stimulates the gut would be most suitable in a patient taking a smooth muscle relaxant drug such as verapamil. By holding water in the intestine, magnesium hydroxide provides additional bulk and stimulates increased contractions. A helpful mnemonic is magnesium “magnifies” stool, aluminum hALts the stool. The answer is C
Which drug is most likely to be useful in the treatment of inflammatory bowel disease?
(A) Diphenhydramine
(B) Diphenoxylate
(C) Mesalamine
(D) Ondansetron
(E) Ursodiol
Mesalamine is a form of 5-aminosalicylic acid that is active in the large intestine and thereby provides a local anti-inflammatory effect that is useful in inflammatory bowel disease. The answer is C.
A 34-year-old woman has irritable bowel syndrome with diarrhea that is not responsive to conventional therapies . Despite the small risk of severe constipation and ischemic colitis, the patient decides to begin therapy with alosetron. Alosetron has which of the following receptor actions?
5-HT 3 receptor antagonist
(B) 5-HT 4 receptor agonist
(C) D2 receptor antagonist
(D) NK1 receptor antagonist
(E) Muscarinic receptor antagonist
Alosetron is a medication primarily used for the treatment of irritable bowel syndrome (IBS) with diarrhea. Its mechanism of action is as a 5-HT 3 receptor antagonist.
So, the correct answer is:
(A) 5-HT 3 receptor antagonist.
On your way to an examination, you experience the vulnerable feeling that an attack of diarrhea is imminent. If you stopped at a drugstore, which one of the following antidiarrheal drugs could you buy without a prescription even though it is related chemically to the strong opioid analgesic meperidine?
Aluminum hydroxide
(B) Diphenoxylate
(C) Loperamide
(D) Magnesium hydroxide
(E) Metoclopramide
The antidiarrheal drug that is related chemically to the strong opioid analgesic meperidine and is available over the counter is Loperamide.
So, the correct answer is:
(C) Loperamide.
A 45-year-old man with a duodenal ulcer was treated with a combination of drugs intended to heal the mucosal damage and to eradicate Helicobacter pylori. Which of the following antibacterial drugs is used commonly to eradicate intestinal Helicobacter pylori?
(A)Cefazolin
(B) Ciprofloxacin
(C) Clarithromycin
(D) Clindamycin
(E) Vancomycin
The macrolide antibiotic clarithromycin is commonly used in antibiotic regimens designed to treat duodenal ulcers caused by H pylori. The other antibiotics that are used include amoxicillin, tetracycline, and metronidazole. Bismuth also has an antibacterial action. The answer is C.
A patient is receiving highly emetogenic chemotherapy for metastatic carcinoma. To prevent chemotherapy -induced nausea and vomiting, she is likely to be treated with which of the following?
(A) Levodopa
(B) Methotrexate
(C) Misoprostol
(D) Ondansetron
(E) Sucralfate
The 5-HT3 receptor antagonists are highly effective at preventing chemotherapy-induced nausea and vomiting, which can be a dose-limiting toxicity of anticancer drugs. The answer is D. ZOFRAN
Management of steatorrhea is best accomplished by the use of this agent.
(A) Mineral oil
(B) Omeprazole
(C) Ondansetron
(D) Pancrelipase
(E) Sucralfate
The management of steatorrhea, which is often due to insufficient pancreatic enzyme activity leading to fat malabsorption, is best accomplished with Pancrelipase, a pancreatic enzyme replacement therapy.
So, the correct answer is:
(D) Pancrelipase.
This is a small molecule that polymerizes in stomach acid and coats the ulcer bed, resulting in accelerated healing and reduction of symptoms.
(A) Mineral oil
(B) Omeprazole
(C) Ondansetron
(D) Pancrelipase
(E) Sucralfate
The small molecule that polymerizes in stomach acid, coats the ulcer bed, and promotes healing is Sucralfate.
So, the correct answer is:
(E) Sucralfate.
A 45-year-old male who is obese presents to his primary care physician complaining of postprandial epigastric pain. The pain does not appear after every meal. He has noticed the pain especially after eating spicy food and oatmeal. He is not currently taking any medications. Which of the following drugs prevents acid secretion by antagonizing a receptor?
Aluminum hydroxide
Fexofenadine
Misoprostol
Omeprazole
Ranitidine
The drug that prevents acid secretion by antagonizing a receptor is Ranitidine. Ranitidine is an H2 receptor antagonist that decreases stomach acid production.
So, the correct answer is:
Ranitidine.
A 37-year-old man complains of chest pain after meals. He says this pain has gone on for a few months and gets only minimal relief from antacid tablets. The physician prescribes a drug that will decrease the amount of acid secreted by binding to and inhibiting an ATPase on the luminal surface of parietal cells. Which of the following drugs works by this mechanism?
Atropine
Cimetidine
Misoprostol
Octreotide
Omeprazole
The drug that decreases the amount of acid secreted by binding to and inhibiting an ATPase on the luminal surface of parietal cells is Omeprazole. Omeprazole is a proton pump inhibitor (PPI) that blocks the proton pump, effectively reducing gastric acid secretion.
So, the correct answer is:
Omeprazole.
A 27-year-old man complains of occasional heartburn. His physician makes a few suggestions of diet and lifestyle changes he could make as well as some medications he can take for symptom management. The patient decides to try a magnesium hydroxide (MgOH) preparation. Which of the following is a side effect of MgOH that the physician should warn him about?
Constipation
Diarrhea
Headache
Impotence
Seizures
A common side effect of magnesium hydroxide (MgOH) is diarrhea. Magnesium hydroxide acts as an osmotic laxative and can lead to increased stool fluidity.
So, the correct answer is:
Diarrhea.
A 42-year-old woman with irritable bowel syndrome with diarrhea predominance presents to her primary care physician for treatment. The physician suggests an exercise regimen, dietary modifications, and a bulk laxative. The likely mechanism of action of this agent would involve which of the following?
Gel formation in the intestine
Neuromodulation of the S3 nerve root
Nonabsorbable salt
Osmotic laxative
Stimulation of the cholinergic nervous system
The likely mechanism of action of a bulk laxative is gel formation in the intestine. Bulk laxatives absorb water to form a gel-like substance, which increases stool bulk and promotes bowel movements.
So, the correct answer is:
Gel formation in the intestine
A 49-year-old man with a history of peptic ulcer disease and gastroesophageal reflux disorder is being treated with cimetidine for approximately 20 years. He now complains of breast swelling and breast discharge. What is the most likely explanation for these findings?
Abscess
Antiandrogenic effect
Inflammatory response
Neoplastic process
Overwhelming edema
The most likely explanation for the breast swelling and breast discharge in this patient who has been on cimetidine long-term is the antiandrogenic effect of the drug. Cimetidine can lead to gynecomastia due to its ability to block androgen receptors and inhibit testosterone action, resulting in an imbalance of estrogen and testosterone.
So, the correct answer is:
Antiandrogenic effect.
A 67-year-old woman with known peptic ulcer disease found at endoscopy to be on maintenance treatment with misoprostol at 125% of the recommended dose. The rationale behind this dose is to maximize which of the following?
Decrease in gastric acid secretion
Improve bicarbonate balance
Improve gastric emptying
Improve sphincter tone of the lower esophagus
Lower gastric luminal pressures
The rationale behind using misoprostol at a higher dose in this patient would be to maximize the decrease in gastric acid secretion. Misoprostol is a prostaglandin analog that not only helps protect the gastric mucosa but also reduces gastric acid secretion, which is important in the management of peptic ulcer disease.
So, the correct answer is:
Decrease in gastric acid secretion
A 78-year-old woman with osteoporosis and occasional gastroesophageal reflux presents to her primary care physician for follow up. Physical examination of the heart, lungs, and abdomen are unremarkable. Which of the following agents would be best to treat both of her underlying conditions?
Aluminum hydroxide
Calcium carbonate
Magnesium hydroxide
Sodium bicarbonate
Warm milk
The best agent to treat both osteoporosis and occasional gastroesophageal reflux in this patient would be Calcium carbonate.
Calcium carbonate serves as both an antacid to relieve gastroesophageal reflux symptoms and as a calcium supplement to help manage osteoporosis.
So, the correct answer is:
Calcium carbonate.
A 47-year-old man with a history of NSAID-induced ulcers has been placed on sucralfate. He has been on the medicine for 1 year and does complain of intermittent chest pressure after meals. Upper endoscopy is performed. Which of the following findings is most likely to occur?
Duodenitis
Duodenal perforation
Gastric ulcers that appear unhealed
Normal gastric epithelium
Normal lower esophageal epithelium
In a patient who has been on sucralfate for a prolonged period, the most likely finding upon upper endoscopy would be normal gastric epithelium. Sucralfate is used to coat and protect the mucosa, leading to healing of ulcerated areas, and it generally does not cause gastric ulcers or significant mucosal damage itself.
So, the correct answer is:
Normal gastric epithelium
A 43-year-old man with a history of peptic ulcer disease has developed hypersensitivity to H2 blockers. He now complains of worsening of his dyspepsia. Physical examination reveals mild tenderness on the midepigastric region. If misoprostol is prescribed to this patient, which of the following mechanisms of action would be most plausible for this agent?
Enhance mucosal resistance
Inhibition of gastrin secretion
Inhibition of proton pump secretion
Inhibition of somatostatin release
Inhibition of uric acid secretion
If misoprostol is prescribed to this patient, the most plausible mechanism of action for this agent would be to enhance mucosal resistance. Misoprostol is a prostaglandin E1 analog that increases the production of mucus and bicarbonate, enhances mucosal blood flow, and provides a protective effect on the gastric mucosa.
So, the correct answer is:
Enhance mucosal resistance
A 24-year-old man complains of recurring episodes of bloody diarrhea and abdominal pain. A flexible sigmoidoscopy reveals pseudopolyps and erythematous, friable mucosa. One of the drugs given to this patient is diphenoxylate. How could diphenoxylate help this patient?
Antimicrobial effects
Blocks TNF-a signaling
Inhibition of dihydrofolate reductase
Inhibition of phospholipase A2
Slows peristalsis
Diphenoxylate is an opioid antidiarrheal medication that primarily acts by slowing peristalsis in the gastrointestinal tract. This action helps reduce the frequency and urgency of bowel movements, making it beneficial for managing diarrhea.
So, the correct answer is:
Slows peristalsis.
A 64-year-old woman is hospitalized for COPD exacerbation. While in the hospital, she becomes constipated. She also takes metoprolol for hypertension and mirtazapine for depression. The physician gives her docusate. Which of the following adverse reactions is most likely to occur as a result of docusate administration in this patient?
Cardiac arrhythmia
Diarrhea
Hypertension
Rash
Worsening depression
The most likely adverse reaction that can occur as a result of docusate administration is diarrhea. Docusate is a stool softener that helps to prevent constipation by making stools easier to pass, but excessive use can lead to diarrhea.
So, the correct answer is:
Diarrhea.
A 58-year-old male is hospitalized for COPD exacerbation. While in the hospital, he becomes constipated. He has a history of hyperlipidemia and gout. The physician gives him docusate. How does docusate work to relieve constipation.
Binds water in the lumen
Increases chloride secretion into the gut lumen
Increases water absorption by the stool
Irritation of the bowel mucosa to stimulate peristalsis
Stimulation of the myenteric plexus
Docusate works to relieve constipation by binding water in the lumen, which helps to soften the stool and make it easier to pass. It acts as a surfactant, allowing for the mixing of stool with water.
So, the correct answer is:
Binds water in the lumen.
A researcher is creating a novel medication to act at M1 receptors. This agent will likely have which of the following augmentative effects on target organs?
Cardiac muscle contractility
Constipation
Diarrhea
Gastric acid secretion
Stroke volume
An agent acting at M1 receptors, which are muscarinic acetylcholine receptors primarily found in the central nervous system and gastric parietal cells, is likely to have an augmentative effect on gastric acid secretion. Stimulation of M1 receptors generally enhances gastric motility and acid secretion.
So, the correct answer is:
Gastric acid secretion
A 34-year-old man with a sacral spinal cord injury has neurogenic bowel. He is on a bowel regimen that involves periodic bowel cleansing with soapsuds enemas. He is given a trial of bethanechol for this condition. Which of the following adverse events must his treating physician be aware of?
Bronchodilation
Diarrhea
Dry mouth
Dry skin
Sigmoid colonic stasis
Bethanechol is a cholinergic medication that can stimulate gastrointestinal motility. The most likely adverse event that the treating physician must be aware of is diarrhea. This is due to the stimulation of the muscarinic receptors in the gastrointestinal tract, which can increase secretions and motility.
So, the correct answer is:
Diarrhea.
A 45-year-old man who is obese complains of postprandial epigastric pain. The pain does not appear after every meal. He has noticed the pain especially after eating spicy foods. He is not currently taking any medications. You suspect gastroesophageal reflux disease (GERD) and want to try a drug that will lower the amount of acid in his stomach. Which of the following drugs chemically elevates the pH?
Aluminum hydroxide
Fexofenadine
Misoprostol
Omeprazole
Ranitidine
The drug that chemically elevates the pH in the stomach by neutralizing gastric acid is Aluminum hydroxide. Aluminum hydroxide is an antacid that works by directly neutralizing stomach acid, thereby increasing the pH.
So, the correct answer is:
Aluminum hydroxide.
