GI 2

Question 1

most cases of diarrhea are acute and self-limiting; what’s the duration and common causes (3)?

Answer 1

< 2 weeks
bacterial/viral infection
antibiotics = C. diff
food poisoning (salmonella, E. coli)

Question 2

what are the 3 therapeutic goals for diarrhea?

Answer 2

decrease fluid/electrolyte imbalance
decrease peristalsis
increase absorption

Question 3

anti-motility agent that stimulates mu receptor on enteric nerves, inhibiting acetylcholine release and decreasing peristalsis

Answer 3

loperamide

Question 4

what are 2 ADR of loperamide at high doses?

Answer 4

dizziness
drowsiness

Question 5

what are 3 uses for loperamide?

Answer 5

diarrhea
traveler’s diarrhea
diarrhea component of IBS

Question 6

what anti-motility agent is opioid-like?

Answer 6

loperamide

Question 7

what are the 4 mu opioid receptor agonists? how do they work as anti-motility agents?

Answer 7

codeine
morphine
tincture of opium
diphenoxylate

act on mu receptor in bowel to decrease peristalsis

Question 8

what are the ADR of mu opioid receptor agonists? (2)

Answer 8

CNS effects
abuse potential

Question 9

what is the name of the anticholinergic used as a anti-motility agent?
how does it work?

Answer 9

atropine + diphenoxylate

atropine decreases the abuse potential of diphenoxylate

Question 10

what kind of anti-diarrheal agents bind or neutralize bacterial toxins, like E. coli?

Answer 10

absorbents

Question 11

what is an absorbent use for diarrhea and symptomatic relief?

Answer 11

bismuth subsalicylate (pepto-bismol)

Question 12

how do the different components of bismuth subsalicylate work as anti-diarrheal agents?

Answer 12

bismuth coats irritated intestinal mucosa
salicylate decreases Cl secretion

Question 13

what are the symptoms of salicylate toxicity? (2)

Answer 13

N/V
tinnitus

Question 14

what is the tablet version of bismuth subsalicylate?

Answer 14

kaopectate

Question 15

what can be used to replace normal colonic microflora to restore intestinal function and suppress growth of pathogenic bacteria?
what’s the specific name?

Answer 15

probiotics
lactobacillus acidophilus

Question 16

when should probiotics be used?

Answer 16

after antibiotic use

Question 17

when should diarrhea be treated?

Answer 17

if present over 2-3 days

Question 18

what should not be used in patients with shigella infection?

Answer 18

loperamide

Question 19

in management of diarrhea, what can be used for associated N/V?

Answer 19

promethazine

Question 20

what is the most common organism associated with traveler’s diarrhea?

Answer 20

E. coli

Question 21

what are the 3 treatment steps for management of traveler’s diarrhea?

Answer 21

rehydration
bismuth subsalicylate
loperamide

Question 22

what should be added to pepto and loperamide regimen if a patient has severe traveler’s diarrhea + bloody, febrile, or persistent?

Answer 22

antibiotics

Question 23

what antibiotic is indicated in an adult with traveler’s diarrhea?

Answer 23

fluoroquinolone

Question 24

what antibiotic is indicated in a child with traveler’s diarrhea?

Answer 24

trime-sulfa

Question 25

disturbed interaction of intestine, brain, and ANS that results in altered bowel motility, leading to recurrent lower abdominal pain and bloating.

Answer 25

irritable bowel syndrome

Question 26

what can be used for the pain component of IBS by relieving smooth muscle spasms?

Answer 26

anticholinergic: dicyclomine

Question 27

what should be used for the diarrhea component of IBS?

Answer 27

loperamide

Question 28

what can be used for the constipation component of IBS? (3)

Answer 28

fiber stool softeners Cl channel activators: lubiprostone or linaclotide

Question 29

inflammation or chronic swelling of the intestines that is associated with ulcerative colitis and crohn's disease

Answer 29

IBD

Question 30

what are the 3 treatment options for mild symptoms of IBD?

Answer 30

5-ASA olsalazine sulfasalazine (5-ASA + sulfapyridine)

Question 31

MOA of 5-ASA?

Answer 31

inhibits leukotriene

Question 31

MOA of olsalazine?

Answer 31

converted into 5-ASA in large intestine inhibits leukotriene

Question 32

2 ADR of sulfasalazine?

Answer 32

crystalluria (drink water to prevent) hypersensitivity

Question 33

what is the treatment for moderate symptoms of IBD?

Answer 33

corticosteroids

Question 34

what are the 2 treatment options for active and chronic symptoms of IBD?

Answer 34

immunosuppressants (thiopurines) biologics

Question 35

name the 2 thiopurines used as immunosuppressants for active and chronic symptoms of IBD

Answer 35

azathioprine mercaptopurine

Question 36

name 2 immunosuppressants used for active and chronic symptoms of IBD

Answer 36

methotrexate cyclosporine

Question 37

what should be monitored in a patient taking an immunosuppressant for IBD? (2)

Answer 37

WBCs RBCs

Question 38

how do biologics/anti TNF-alpha antibodies provide management of IBD? (2)

Answer 38

decrease symptoms heal mucosal ulcers

Question 39

what are 3 drug classes and 1 drug used for chemotherapy induced emesis?

Answer 39

5-HT3 antagonists NK1 antagonists D2 antagonists dexamethasone

Question 40

which phase of CINV is the central pathway via chemoreceptor trigger zone associated with?

Answer 40

delayed phase (more than 24 hrs after chemo)

Question 41

which phase of CINV is the peripheral pathway via chemoreceptor trigger zone associated with?

Answer 41

acute phase (1-2 hrs after chemo)

Question 42

what drug class is used for the management of central pathway/delayed phase CINV?

Answer 42

NK1 receptor antagonists

Question 43

what drug class is used for the management of peripheral pathway/acute phase CINV?

Answer 43

5-HT3 antagonists

Question 44

-pitant

Answer 44

NK1 receptor antagonists

Question 45

2 uses for NK1 receptor antagonists?

Answer 45

high/moderately emetogenic drugs postop N/V

Question 46

4 ADR of NK1 receptor antagonists?

Answer 46

headache constipation fatigue loss of appetite

Question 47

-setron

Answer 47

5-HT3 antagonists

Question 48

3 uses for 5-HT3 antagonists?

Answer 48

postop N/V post-radiation N/V N/V in pregnancy (off-label)

Question 49

5 ADR of 5-HT3 antagonists?

Answer 49

headache abdominal discomfort constipation rash/allergy (after IV) QT prolongation (esp dolasetron)

Question 50

what can be used for anticipatory CINV?

Answer 50

lorazepam

Question 51

dopamine D2 antagonist that increases gastric emptying

Answer 51

metoclopramide

Question 52

ADR of metoclopramide? (2)

Answer 52

movement disorders (crosses BBB) tardive dyskinesia (black box warning)

Question 53

what is the FDA rule when using metoclopramide?

Answer 53

do not use for more than 12 weeks/3 months

Question 54

drug class that is a potent D2 antagonist, an antimuscarinic and an H1 antagonist

Answer 54

phenothiazines

Question 55

-azine

Answer 55

phenothiazines

Question 56

-peridol

Answer 56

butyrophenones (antipsychotic)

Question 57

what is the use of butyrophenones?

Answer 57

prophylactic management of postop N/V

Question 58

name the H1-receptor antagonists (5)

Answer 58

meclizine cyclizine promethazine dimenhydrinate diphenydramine

Question 59

what is the use of H1 receptor antagonists?

Answer 59

motion sickness

Question 60

what is promethazine (H1 receptor antagonist) used for? (2)

Answer 60

space motion sickness pregnancy

Question 61

anticholinergic that blocks muscarinic receptors in the vestibular nuclei

Answer 61

scopolamine

Question 62

what is the use for scopolamine? administration?

Answer 62

motion sickness transdermal

Question 63

MOA of cannabinoids?

Answer 63

THC stimulates CB1 and prevents emesis

Question 64

name the 2 cannabinoids

Answer 64

dronabinol nabilone

Question 65

use for cannabinoids?

Answer 65

adjunctive in CINV

Question 66

ADR of cannabinoids?

Answer 66

psychoactive