Exam 1

Question 1

Cimetidine

1) classification
2) MOA
3) Contra
4) SE
5) Notes

Answer 1

1) H2 antagonist
2) Blocks histamine receptor –> decrease gastric acid secretion
3)
4) gynecomastia + impotence with long-time use (RARE)
5) IV Bolus –> cardiac arrythmias and hypotension
* can add to PPI to reduce nocturnal acid breakthrough, but may decrease efficacy of PPI

Question 2

Ranitidine

1) classification
2) MOA
3) Contra
4) SE
5) Notes

Answer 2

1) H2 antagonist
2) Blocks histamine receptor –> decrease gastric acid secretion
3)
4) Agitation, anemia, confusion, depression (RARE)
5) increase risk of pneumonia
* can add to PPI to reduce nocturnal acid breakthrough, but may decrease efficacy of PPI

Question 3

Omeprazole

1) classification
2) MOA
3) Contra
4) SE
5) Notes

Answer 3

1) PPI
2) Inhibits H/K pump in gastric parietal cells
3) Metabolized by CYP450 –> increase concentrations of diazepam, warfarin, and phenytoin; reduce absorption of ketoconazole; increase absorption of digoxin
4) Diarrhea, nausea, skin rash, dizziness
5) NOT used with H2 Antagonists; NEW - Vitamin B12 deficiency (long-term use)

Question 4

Rabeprazole

1) classification
2) MOA
3) Contra
4) SE
5) Notes

Answer 4

1) PPI
2) Inhibits H/K pump in gastric parietal cells
3) Metabolized by CYP450 –> increase concentrations of diazepam, warfarin, and phenytoin; reduce absorption of ketoconazole; increase absorption of water
4) Headache
5) NOT used with H2 Antagonists; NEW - Vitamin B12 deficiency (long-term use)

Question 5

Sucralfate (= aluminum sucrose sulfate)

1) classification
2) MOA
3) Contra
4) SE
5) Notes

Answer 5

1) Mucosal Protective Agent
2) Binds selectively to necrotic tissue to form a barrier against gastric acid
3) decrease absorption of cimetidine, ciprofloxacin, digoxin, ranitidine ; grapefruit promotes absorption of Al –> contra in renal failure patients
4) constipation, flatulence , dry mouth, diarrhea, nausea
5) Colloidal Bismuth (Pepto-Bismuth) works in same manner
* do NOT give with H2 antagonist (CAN give 2 hours prior)

Question 6

Tums/Maalox/Mylanta

1) classification
2) MOA
3) Contra
4) SE
5) Notes

Answer 6

1) Antacid
2) Contains alkaline ions that neutralizes stomach acid (BRIEFLY after each use)
3) Ingestion of high amounts of calcium + adsorbable alkali –> Milk Alkali syndrome = alkalosis, hypercalcemia, renal impairment

Question 7

Psyllium / Dietary Fiber

1) classification
2) MOA
3) Indication
4) SE
5) Contraindications
6) Notes

Answer 7

• Solid Waste
  1) Bulking Agent
  2) Increases stool weight + fluid retention in stool
  3) Constipation
  4) Flatulence
  5) Debilitated, end-of-life patients
  6) MUST have adequate fluid intake
• increased fiber w/o increased H2O will WORSEN constipation

Question 8

Lactulose / Sorbitol

1) Classification
2) MOA
3) Indication
4) SE
5) Contraindications
6) Notes

Answer 8

*Water content
1) Osmotic laxative = non-absorbable sugar
2) osmotic load in colonic lumen stimulates movement
[bacteria degrade in gut , produces acids –> increases osmotic pressure + acidifies stool –> increases water stool content]
3) Constipation
4) Flatulence / bloating / cramping
5)
6) “Sickly Sweet” taste; requires prescription

Question 9

Magnesium Hydroxide (Milk of Magnesia)

1) Classification
2) MOA
3) Indication
4) SE
5) Contraindications
6) Notes

Answer 9

*Water content
1) Osmotic Laxative = Saline + Magnesium salts
2) osmotic load in the colonic lumen stimulates movement
[osmotically active particles (Mg –> CCK) –> increase intralumen volume –> stimulates intestinal activity)
3) Constipation
4) *mild
5) Renal failure (can cause hypermagnesemia if used too regularly)
6) ions (Mg, salt, etc) can be partially absorbed

Question 10

Magnesium Citrate

1) Classification
2) MOA
3) Indication
4) SE
5) Contraindications
6) Notes

Answer 10

Water content
1) Osmotic Laxative = Saline + Magnesium salts
2) osmotic load in the colonic lumen stimulates movement
[osmotically active particles (Mg –> CCK) –> increase intralumen volume –> stimulates intestinal activity)
HIGH DOSE –> rapid bowel evacuation
3) Bowel prep for endoscopy or surgery
4) Dehydration + electrolyte abnormalities
5) Bowel obstruction, fecal impaction, renal failure (use VERY cautiously in CHF)
6) Ischemic colitis = rare SE

Question 11

Sodium Phosphate

1) Classification
2) MOA
3) Indication
4) SE
5) Contraindications
6) Notes

Answer 11

Water content
1) Osmotic Laxative = Saline + Magnesium salts
2) osmotic load in the colonic lumen stimulates movement
[osmotically active particles (Mg –> CCK) –> increase intralumen volume –> stimulates intestinal activity)
HIGH DOSE –> rapid bowel evacuation
3) Bowel prep for endoscopy or surgery
4) Dehydration + electrolyte abnormalities
5) Bowel obstruction, fecal impaction, renal failure (use VERY cautiously in CHF)
6) Acute phosphate nephropathy = intratubular deposition of calcium phosphate
* can be given rectally as ENEMA

Question 12

Miralax / Glycolax

1) Classification
2) MOA
3) Indication
4) SE
5) Contraindications
6) Notes

Answer 12

*Water content
1) Osmotic laxative = low-dose polyethylene glycol
2) osmotic load in the colonic lumen stimulates movement
[ increases bowel movements + softens stools]
3) Constipation
4)
5)
6) “tasteless” + NO absorption of ions

Question 13

Colyte / Golytely

1) Classification
2) MOA
3) Indication
4) SE
5) Contraindications
6) Notes

Answer 13

*Water content
1) Osmotic Laxative = high-dose polyethylene glycol
2) osmotic load in the colonic lumen stimulates movement
3) Bowel prep for colonoscopy + surgery
4)
5)
6) 1-4 L of volume of prep!
* NO ion absorption; requires a prescription

Question 14

Senna / Bisacodyl

1) Classification
2) MOA
3) Indication
4) SE
5) Contraindications
6) Notes

Answer 14

• Motility
  1) Stimulant Laxative
  2) Stimulates intestinal motility via myenteric plexus
  3) Constipation; prevention of constipation with opiate therapy
  4) Cramping
  5)
  6) Melanosis coli (long-term use)
• Bisacodyl can be given rectally in suppository form

Question 15

Docusate (colase)

1) Classification
2) MOA
3) Indication
4) SE
5) Contraindications
6) Notes

Answer 15

• Lubrication
  1) Detergent Laxative (stool softener)
  2) Surfactant –> increases penetration of fluid in stools
  3) Prevention of hard stool
  4)
  5)
  6) Recent studies have brought its utility into question

Question 16

Glycerin

1) Classification
2) MOA
3) Indication
4) SE
5) Contraindications
6) Notes

Answer 16

• Lubrication
  1) Lubricant
  2) Administered rectally; osmotic + irritant –> stimulates rectal contractions
  3) Fecal impaction
  4)
  5)
  6)

Question 17

Mineral Oil

1) Classification
2) MOA
3) Indication
4) SE
5) Contraindications
6) Notes

Answer 17

• Lubrication
  1) Lubricant
  2) Administered rectally; coats feces –> softens and lubricates feces
  3) Fecal impaction
  4)
  5)
  6) NEVER use oral mineral oil in patients at risk of aspiration (e.g. debilitated patients) –> Lipid pneumonitis

Question 18

Enemas: tap water, sodium phosphate

1) Classification
2) MOA
3) Indication
4) SE
5) Contraindications
6) Notes

Answer 18

1) Large volume enema
2) Increases water content of stool ; distends distal colon; induces peristalsis
3) Fecal impaction
4)
5)
6)

Question 19

Prochlorperazine

1) Classification
2) MOA
3) Indication
4) SE
5) Contraindications
6) Notes

Answer 19

1) Dopamine receptor antagonist
2) Central: blocks D2 in CTZ
Peripheral: blocks GI vagus nerve projecting to the vomiting center
3) Opioid-induced nausea + vomiting
Primary GI disorders = gastroenteritis (inflammation + infection)
4) Extrapyramidal effects (“Parkinsonism”)
Acute dystonic reactions
5)
6)

Question 20

Metoclopramide

1) Classification
2) MOA
3) Indication
4) SE
5) Contraindications
6) Notes

Answer 20

1) Dopamine receptor antagonist
2) Central: blocks D2 in CTZ
Peripheral: blocks D2 in upper GI tract (prokinetic)
3) Moderately emetogenic chemotherapy-induced N/V Postsurgical N/V
Dysmotility of upper GI tract = gastroparesis, gastric stasis
4) Tardive dyskinesia; extrapyramidal effects; acute dystonic reactions
5) Caution w/ Parkinson Disease
6) Black Box Warning: avoid use > 12 weeks –> Tardative Dyskinesia

Question 21

Ondansetron

1) Classification
2) MOA
3) Indication
4) SE
5) Contraindications
6) Notes

Answer 21

1) 5HT-3 Receptor Antagonist
2) Central: blocks D2 in CTZ
Peripheral: blocks 5HT-3 (GI tract) induced transmission of vagal stimulation of vomiting center
3) Highly emetogenic chemotherapy-induced N/V
Radiation-induced N/V
Postoperative N/V
4) QT prolongation , headache
5) Prolonged QT –> Torsades des Pointes
6) Potent anti-emetic

Question 22

Promethazine

1) Classification
2) MOA
3) Indication
4) SE
5) Contraindications
6) Notes

Answer 22

1) Histamine 1 Receptor Antagonist
2) Blocks H1 in vestibular apparatus
3) Motion sickness
4) Sedation
5)
6)

Question 23

Scopolamine

1) Classification
2) MOA
3) Indication
4) SE
5) Contraindications
6) Notes

Answer 23

1) Anticholinergic
2) Blocks cholinergic receptor in vestibular apparatus
3) Motion sickness
4) Delirium, dry mouth, urinary retention
5) Glaucoma
6) Use at end-of-life to dry up oral secretions (“the death rattle”

Question 24

Dexamethasone

1) Classification
2) MOA
3) Indication
4) SE
5) Contraindications
6) Notes

Answer 24

1) Steroids
2) Blocks CNS projections to vomiting center
3) Increasing intracranial pressure
4)
5)
6)

Question 25

Lorazepam 1) Classification 2) MOA 3) Indication 4) SE 5) Contraindications 6) Notes

Answer 25

1) Benzodiazepine 2) Blocks CNS projections to vomiting center 3) Anxiety-induced N/V

Question 26

Chloroquine 1) MOA 2) Stage of life cycle inhibited 3) Use 4) AE 5) children or pregnant? 6) Notes

Answer 26

1) Inhibits heme polymerase --> increases free heme 2) RBC schizont 3) Treatment + chemo-prophylaxis 4) Pruritis (Africans) 5) safe 6) major limitation = resistance

Question 27

Quinine, Quinidine 1) MOA 2) Stage of life cycle inhibited 3) Use 4) AE 5) children or pregnant? 6) Notes

Answer 27

1) Inhibits heme polymerase --> increases free heme 2) RBC schizont 3) Treatment of P. Falciparum 4) Cinchonism ( = tinnitus, headache, neausea, dizziness, flushing, visual disturbances) , hypoglycemia, Blackwater fever 5) Ok (children), Ok if needed (Quinine, pregnant women), Ok but contractions in 3rd semester (Quinidine) 6) ONLY IV Quinidine available in US; DOC for SEVERE malaria; cardiac monitoring recommended; used with a 2nd agent

Question 28

Mefloquin 1) MOA 2) Stage of life cycle inhibited 3) Use 4) AE 5) children or pregnant? 6) Notes

Answer 28

1) Inhibits heme polymerase --> increases free heme 2) RBC schizont 3) Treatment and prophylaxis 4) Neuropsychiatric toxicities (*less common w/ prophylaxis) 5) Safe (children), Ok for prophylaxis but NO for treatment (pregnant women) 6) DOC for chemoprophylaxis in most regions; NOT recommended for treatment of severe malaria

Question 29

Primaquin 1) MOA 2) Stage of life cycle inhibited 3) Use 4) AE 5) children or pregnant? 6) Notes

Answer 29

1) Inhibits heme polymerase --> increases free heme 2) Hypnozoites (dormant in liver), gametocytes 3) Radical cure for P. vivax + ovale 4) Hemolysis in G6PD-Deficiency 5) Ok (children), UNSAFE (pregnant women) 6) Testing for G6P deficiency is recommended

Question 30

Proguanil 1) MOA 2) Stage of life cycle inhibited 3) Use 4) AE 5) children or pregnant? 6) Notes

Answer 30

1) Inhibits plasmodial DHFR 2) RBC schizont, hypnozoite of P.falcip 3) WITH chloroquin or atovaquone for prophylaxis 4) 5) Ok (children), (never given alone) 6)

Question 31

Atovaquone 1) MOA 2) Stage of life cycle inhibited 3) Use 4) AE 5) children or pregnant? 6) Notes

Answer 31

1) Inhibits parasite mitochondrial ETC 2) RBC schizont, hypnozoite of P.falcip 3) WITH proguanil (= Malarone) for prophylaxis 4) GI side effects; contra in severe renal impairment 5) NO (children

Question 32

Doxycycline 1) MOA 2) Stage of life cycle inhibited 3) Use 4) AE 5) children or pregnant? 6) Notes

Answer 32

1) Inhibits protein synthesis in parasite organelles 2) RBC schizont 3) Adjucant treatment of P. falciparum and prophylaxis 4) Photosensitivity, esophagitis 5) NO, NO 6) Used for prophylaxis in areas with high mefloquine resistance (i.e. Southwest Asia)

Question 33

Artemisinin 1) MOA 2) Stage of life cycle inhibited 3) Use 4) AE 5) children or pregnant? 6) Notes

Answer 33

1) Binds iron in malaria pigment, producing free radicals 2) RBC schizont, gametocyte 3) Treatment 4) Potential neurotoxicity (ototoxicity) 5) Probably OK (not approved in US) 6) Used for treatment (Asia/Africa) in combo with other antimalarial agents