18. GI Drugs

Question 1

A 55 year old man eats a big bowl of chili for lunch and then starts to have fits of heartburn. He grabs a fist full Aluminum hydroxide tablets. What side effect is most likely to occur?

A. Belching 
B. Metabolic alkalosis 
C. Galactorrhea 
D. Diarrhea 
E. Constipation 

RFA

Answer 1

Ans. E. Constipation- Aluminum hydroxide is an antacid and can cause constipation. Think Aluminum is a metal so clogs you ups .

A. & B. Belching and metabolic alkalosis- These are both side effects of Calcium carbonate. Think carbonate carbonation bubbles belching.

C. Galactorrhea- is a side effect of Cimetidine a H2 receptor antagonist

D. Diarrhea- this is side effect of Magnesium hydroid ( usually combine with Aluminum hydroxide so there is no net change of bowel movement)

Question 2

A 56 year old man is comes to the doctor with complaints of pain in stomach, weight loss, heartburn and frequent nausea. Testing is done notable for a positive urease breath test. His current medication are Lisinopril, Nifedipine, Clopidogrel and Metformin. The doctor has now prescribed clarithromycin and amoxicillin what else should be give to the patient for his treatment?

A. Ranitidine 
B. Rabeprazole
C. Omeprazole 
D. Cimetidine 
E. Esomeprazole 

RFA

Answer 2

Ans. B Rabeprazole- the patient is taking Clopidogrel a prodrug that requires activation of P450 CYP2C19 Rabeprazole and pantoprazole have minimal CY2C19 inhibition so would be prefered over other PPIs

A. Ranitidine- is a second generation ( no CNS adverse effects) H2 receptor Antagonist would be given for moderate GERD and peptic ulcers not due to H. pylori

C. Omeprazole- is a PPI and would treat the H. Pylori infection but also would inhibit Clopidogrel by CYP2C19 activation

D. Cimetidine- is H2 receptor antagonist so wouldn’t treat H. Pylori ulcers and also has the most side effects of any H2 receptor antagonist

E. Esomeprazole-s a PPI and would treat the H. Pylori infection but also would inhibit Clopidogrel by CYP2C19 activation