GI

Question 1

what causes most peptic ulcer disease?

Answer 1

h. pylori

Question 2

in a patient with peptic ulcer disease, which pain and fever reducer should we use?

Answer 2

acetaminophen (tylenol)

Question 3

what are the 3 steps in H. pylori that results in destruction of the mucosal layer?

Answer 3

H. pylor produces urease
urease converts to ammonia
ammonia destroys mucosal layer

Question 4

what 6 antibiotics can help eradicate H. pylori?

Answer 4

Clarithromycin
Amoxicillin
Levofloxacin
Metronidazole
Tetracycline

Question 5

how does bismuth subsalicylate help with h. pylori?

Answer 5

it is a heavy metal that is toxic to bacteria

Question 6

2 MOAs of bismuth subsalicylate?

Answer 6

inhibits protein synthesis
disrupts bacterial cell wall

Question 7

which PUD drug class being used with an antibiotic can exacerbate diarrhea and C. difficile,?

Answer 7

proton pump inhibitors

Question 8

what is the typical triple regimen for PUD?

Answer 8

proton pump inhibitor
+
clarithromycin/amoxicillin/levofloxacin/metronidazole

Question 9

what is the quadruple regimen to treat PUD?

Answer 9

proton pump inhibitor
+
bismuth subsalicylate
metronidazole
tetracycline

Question 10

what is a metronidazole alternative to treat PUD?

Answer 10

tinidazole

Question 11

-tidine

Answer 11

H2 receptor antagonists

Question 12

MOA of H2 receptor antagonists

Answer 12

inhibit histamine at H2 receptors on parietal cells = decrease gastric acid production

Question 13

what are the uses of H2 receptor antagonists? (2)

Answer 13

heart burn/acid indigestion
active duodenal ulcers

Question 14

what can H2 receptor antagonists treat when given IV? (2)

Answer 14

stress ulcer
acute GI bleed

Question 15

ADR of H2 receptor antagonists (2)

Answer 15

diarrhea
CNS (dizzy, drowsy, headache)

Question 16

what are 2 instances when H2 receptor antagonists can cause confusion and hallucinations?

Answer 16

in elderly
cimetidine given IV

Question 17

what are 3 ADR specific to oral cimetidine?

Answer 17

gynecomastia
galactorrhea
impotence

Question 18

when are H2 receptor antagonists most effective?

Answer 18

at night

Question 19

which H2 receptor antagonist has the most DDI with P450 since they are all metabolized by the liver?

Answer 19

cimetidine

Question 20

what drugs must we stay away from if giving a patient an H2 receptor antagonist? (7)

Answer 20

macrolides
NSAIDS
codeine
oxycodone
anticoagulants
phenytoin
antidepressants

Question 21

which H2 receptor antagonist is best used in patients with hepatic dysfunction? why?

Answer 21

Nizatidine

renal elimination

Question 22

-prazole

Answer 22

proton pump inhibitors

Question 23

MOA of proton pump inhibitors

Answer 23

inhibit H/K-ATPase pump on surface of gastric parietal cells

Question 24

what are the uses of proton pump inhibitors? (2)

Answer 24

ulcers
GERD

Question 25

what are 4 ADR of proton pump inhibitors?

Answer 25

GI pain constipation C. difficile acid-rebound

Question 26

what is an ADR specific to omeprazole?

Answer 26

dry mouth

Question 27

what 2 drugs have DDI with proton pump inhibitors? what's the enzyme?

Answer 27

clopidogrel diazepam CYP2C19

Question 28

how does a PPI affect Pazopanib when they are used together?

Answer 28

PPI increases PH Pazopanib becomes insoluble (no effect on body)

Question 29

-prazan

Answer 29

acid pump antagonists

Question 30

MOA of acid pump antagonists

Answer 30

inhibit K binding to parietal cell gastric H/K ATPase

Question 31

which drug class does not require activation or an acidic environment to become active form?

Answer 31

acid pump antagonists

Question 32

which acid pump antagonist can be used in combination with amoxicillin and clarithromycin, or amoxicillin monotherapy?

Answer 32

vonoprazan

Question 33

MOA of anticholinergic agents

Answer 33

block Acetylcholine at muscarinic receptors

Question 34

which anticholinergic agents block both M1 and M3 receptors?

Answer 34

dicyclomine propantheline

Question 35

which anticholinergic agents block only the M1 receptor?

Answer 35

pirenzepine telenzepine

Question 36

synthetic prostaglandin analogue that binds to EP3 receptor on parietal cells

Answer 36

misoprostol

Question 37

what are the uses for misoprostol (a synthetic prostaglandin analogue)? (2)

Answer 37

prevent NSAID ulcers 3rd line for duodenal ulcers

Question 38

what are the ADR of misoprostol (a synthetic prostaglandin analogue)? (5)

Answer 38

abortifacient N/V/D cramps (abd/uterine) uterine bleeding

Question 39

what must be used with misoprostol therapy?

Answer 39

contraceptive

Question 40

what are the 2 cytoprotectants?

Answer 40

sucralfate bismuth subsalicylate

Question 41

MOA of sucralfate

Answer 41

forms sticky gel that adheres to ulcer and prevents mucosal sites from further damage

Question 42

what is sucralfate made up of?

Answer 42

aluminum hydroxide + sucrose

Question 43

what are the uses of sucralfate and bismuth subsalicylate? (2)

Answer 43

heal peptic ulcers prevent ulcer relapse

Question 44

what are the 2 ADR of sucralfate?

Answer 44

constipation hypophosphatemia

Question 45

what must be the pH in order for sucralfate to be activated?

Answer 45

pH < 4

Question 46

why must sucralfate be taken at least 30 mins before or after PPI, H2RA, or antacids?

Answer 46

sucralfate is not absorbed

Question 47

DOA of sucralfate?

Answer 47

6 hours

Question 48

name the 3 antacids

Answer 48

maalox mylanta sodium bicarb

Question 49

MOA of antacids?

Answer 49

neutralize acid locally

Question 50

what is the use of antacids?

Answer 50

relieve symptoms of PUD and GERD

Question 51

5 ADR of antacids?

Answer 51

hypercalcemia diarrhea hypermagnesemia constipation hypophosphatemia

Question 52

using antacids decreases the drug absorption of which 2 antibiotic classes?

Answer 52

tetracyclines fluoroquinolones

Question 53

which 2 antacids have a rapid onset?

Answer 53

sodium bicarb magnesium

Question 54

what can be used for GERD to decrease acid content in the mouth?

Answer 54

sodium bicarb mouth rinse

Question 55

-chol

Answer 55

cholinomimetics

Question 56

MOA of cholinomimetics

Answer 56

M2 receptor agonist to increase cholinergic stimulation

Question 57

what are the 2 uses for cholinomimetics?

Answer 57

reduce reflux increase LES tone

Question 58

ADR of cholinomimetics?

Answer 58

Diarrhea Urination Miosis Bradycardia Bronchoconstriction Emesis Lacrimation Sweat Salivation

Question 59

dopamine antagonist that stimulates cholinergic activity in gut walls via D2 receptor antagonism

Answer 59

metoclopramide

Question 60

what are the 2 uses for metoclopramide? (dopamine antagonist)

Answer 60

gastroparesis in diabetics increase gastric emptying

Question 61

what are 5 ADR of metoclopramide? (dopamine antagonist)

Answer 61

dystonia restlessness sedation galactorrhea gynecomastia

Question 62

what is the #1 cause of constipation?

Answer 62

laxatives

Question 63

why should patients be careful with laxatives? (2)

Answer 63

promote K loss = lyte + fluid imbalance decreased peristalsis = longer time to refill rectum

Question 64

bulk-forming laxative that retains water, increases colonic mass, and increases reflex contraction of bowel

Answer 64

methylcellulose bran

Question 65

stool softener that eases passage and prevents straining

Answer 65

docusate

Question 66

which patients should use docusate? (3)

Answer 66

+ hemorrhoids + hernia prior MI

Question 67

osmotic laxative that increases fluid content of stools

Answer 67

lactulose

Question 68

what are 3 enemas?

Answer 68

Mg citrate MgOH (mg hydroxide) NaPO4 (sodium phosphate)

Question 69

cathartic agent that purges intestine of rapid water evacuation

Answer 69

SUTAB

Question 70

cathartic agent that stimulates smooth muscle contraction to promote defecation

Answer 70

bisacodyl

Question 71

ADR of bisacodyl

Answer 71

local irritation of GI mucosa

Question 72

when would we want to use cathartic agents to stimulate defecation?

Answer 72

prior to radiological/sigmoidoscopic exam

Question 73

chloride channel activators that cause Cl to enter the lumen, Na and water follow. (2)

Answer 73

lubiprostone linaclotide

Question 74

what are 3 ADR of chloride channel activators?

Answer 74

headache nausea diarrhea

Question 75

which GI medications have the least effect on electrolytes, including K?

Answer 75

chloride channel activators