Gastrointestinal agents

Question 1

What are the acid modifying agents?

Answer 1

Proton Pump Inhibitors
Histamine Type 2 receptors
Mucosal protectants

Question 2

What are the names of the Proton Pump inhibitors?

Answer 2

omeprazole (Prilosec)
pantoprazole (Protonix)
dexlansoprazole (Dexilant)
esomeprazole (Nexium)
lansoprazole (Prevacid)
rabeprazole (Aciphex)

Question 3

How does omeprazole work?

Answer 3

Irreversibly blocking the hydrogen/potassium adenosine triphosphatase enzyme system

Question 4

What side effects can omeprazole cause?

Answer 4

Hypocalcemia, B12 deficiency, Rebound symptoms, Bone fracture, Interstitial nephritis, and Infections

Question 5

What are the counseling points of omeprazole?

Answer 5

Administer 30 minutes before a meal, ideally breakfast

Question 6

What type of drug is famotidine?

Answer 6

a Histamine receptor 2 antagonist

Question 7

What is the brand name of famotidine

Answer 7

Pepcid

Question 8

What side effects can famotidine cause?

Answer 8

B12 deficiency, Tachyphylaxis, and CNS effects

Question 9

What are the counseling points for famotidine?

Answer 9

• Good to use for occasional episodic heartburn – works quicker than a PPI
• Do not need to take on an empty stomach before a meal

Question 10

What type of drug is sucralfate

Answer 10

mucosal protectant

Question 11

What is the brand name of sucralfate?

Answer 11

Carafate

Question 12

How does sucralfate work?

Answer 12

Forms a complex by binding with positively charged proteins in exudates, forming a viscous paste-like, adhesive substance. This selectively forms a protective coating that acts locally to protect the gastric lining

Question 13

What drugs are the antiemetics?

Answer 13

promethazine (Phenergan)

prochlorperazine (Compazine)

metoclopramide (Reglan)

ondansetron (Zofran)

Question 14

How does promethazine work?

Answer 14

apart of phenothiazine class: Inhibit dopaminergic, histaminic and muscarinic activity in the CTZ

Question 15

When cant you use promethazine?

Answer 15

• Children < 2
• Compromised respiratory function

Question 16

What are the BBW associated with promethazine?

Answer 16

• Respiratory depression: Kids under 2
• Severe tissue injury (IV and SC use not recommended)

Question 17

What side effects can promethazine cause?

Answer 17

*CNS: Drowsiness, dizziness, delirium
* Anticholinergic effects
* Orthostatic hypotension
* Respiratory depression
* Tissue damage
* Extra pyramidal symptoms (EPS)–> involuntary movements that you cannot control
* QTc prolongation

Question 18

How does prochlorperazine work?

Answer 18

apart of phenothiazine class: Inhibit dopaminergic, histaminic and muscarinic activity in the CTZ

Question 19

When can you not use prochlorperazine?

Answer 19

• Children < 2
• Presence of CNS depressants

Question 20

What is the BBW associated with prochlorperazine?

Answer 20

Elderly patients with dementia have an increased risk of death if taking with antipsychotics

Question 21

What are the side effects associated with prochlorperazine?

Answer 21

• CNS: Drowsiness, dizziness, delirium
• Anticholinergic effects
• Orthostatic hypotension
  *Extra pyramidal symptoms (EPS)
• QTc prolongation

Question 22

How does metoclopramide work?

Answer 22

Dopamine antagonist, enhances response to acetylcholine in upper GI tract and blocks signals to CTZ to trigger vomiting

Question 23

When can you not use metoclopramide?

Answer 23

history of dystonic reaction(involuntary contractions of muscles of the extremities, face, neck, abdomen, pelvis, or larynx) when given this med

Question 24

What are the BBW associated with metoclopramide?

Answer 24

Tardive dyskinesia ( an EPS symptom)

Question 25

What are the side effects associated with metoclopramide?

Answer 25

* CNS: Drowsiness, fatigue, dizziness, confusion * Diarrhea * QTc prolongation

Question 26

How does ondansetron work?

Answer 26

5-HT3-receptor antagonist which blocks serotonin, both in gut and centrally in the CTZ

Question 27

What side effects are associated with ondansetron?

Answer 27

* Constipation * CNS: Headache, fatigue * QTc prolongation

Question 28

What type of medication is diphenoxylate/atropine?

Answer 28

antidiarrheal

Question 29

What is the brand name of diphenoxylate/atropine?

Answer 29

Lomotil

Question 30

How does diphenoxylate/atropine work?

Answer 30

Opiate derivative – works on μ and δ receptors in the gut Atropine solely to reduce abuse potential

Question 31

When cant you use diphenoxylate/atropine?

Answer 31

Clostridioides difficile (C.diff), kids under 6

Question 32

What are the side effects of diphenoxylate/atropine?

Answer 32

CNS depression, Atropinism (anticholinergic)

Question 33

What meds can be used for IBS?

Answer 33

dicyclomine (Bentyl) linaclotide (Linzess) lubiprostone (Amitiza) rifaximin (Xifaxan)

Question 34

How does dicyclomine work?

Answer 34

blocks acetylcholine at muscarinic receptors in smooth muscle

Question 35

When cant you use dicyclomine?

Answer 35

Glaucoma

Question 36

What are the side effects of dicyclomine?

Answer 36

*Nausea * Anticholinergic – dizziness, blurred vision, dry mouth

Question 37

How does linaclotide work?

Answer 37

Agonizes guanylate cyclase-C on the luminal surface of intestinal epithelium= ↑ chloride and bicarbonate secretion= intestinal fluid increases and GI transit is accelerated

Question 38

When cant you use linaclotide?

Answer 38

*Kids < 2 * GI obstruction

Question 39

What is the BBW associated with linaclotide?

Answer 39

Serious dehydration in kids < 2

Question 40

What side effects can occur with linaclotide

Answer 40

Diarrhea

Question 41

How does lubiprostone work?

Answer 41

Cl- channel activator – increases intestinal fluid and improves fecal transit

Question 42

When cant you use lubiprostone?

Answer 42

GI obstruction

Question 43

What are the side effects of lubiprostone?

Answer 43

Nausea, diarrhea

Question 44

How does rifaximin work?

Answer 44

inhibits bacterial RNA synthesis by binding to bacterial DNA-dependent RNA polymerase

Question 45

What side effects can rifaximin cause?

Answer 45

Increased risk of resistant infections *Use should be limited to 14 days for IBS*

Question 46

What type of drug is polyethylene glycol?

Answer 46

anti-constipation

Question 47

What is the brand name of polyethylene glycol?

Answer 47

Miralax, Golytely

Question 48

How does polyethylene glycol work?

Answer 48

Osmotic agent – pulls water into stool

Question 49

What are the side effects of polyethylene glycol?

Answer 49

Abdominal cramping, distension, pain, bloating, diarrhea, flatulence

Question 50

What are the counseling points for polyethylene glycol?

Answer 50

dissolve in 4 oz of fluid