GI

Question 1

H2 blockers includ

Answer 1

cimetidine, ranitidine, famotidine, nizatidine

Take H2 blockers before you dine. Think table for 2 to remeber H2

Question 2

Mechanism of H2 blockers:

Answer 2

reversible block of histamine H2 receptors: decraease H+ secretion by pareital cells

Question 3

Use of h2 blockers

Answer 3

peptic ulcer, gastritis, mild esophageal reflux

Question 4

H2 blocker that is potent inhibiotr of cytochrome p450

Answer 4

cimetidine

Question 5

SE of of cimetiddine

Answer 5

antiandrrogenic effects (prolactin release, gynecomastia, impotence), decrease libido in males; cross BBB (confusion, dizziness, headaches) and placenta

Question 6

These two h2 blockers decrease renal excretion of creatinine

Answer 6

cimetidine and ranitidine

Question 7

Proton pump inhibitors

Answer 7

omeprazole, lansoprazole, esomeprazole, pantoprazole, dexlansoprazole

Question 8

mechanism of PPI

Answer 8

irrevsrisbily inhibits H+/K+ ATPase in stomach parietal cells

Question 9

Use of PPI

Answer 9

peptic ucler, esophageal reflux, ZES syndrome, component tof therapy for H. pylori, stress ulcer prophylaxis

Question 10

SE of PPI

Answer 10

Increase risk of C. difficile infection, pneumonia,
Decrease serum Mg+ w long term use
increase risk of osteoporotic fractures

Question 11

Antacid use

Answer 11

aluminum hydroxide, calcium carbonate (tums), magnesium hydroxide

Question 12

can affect absorption, bioavailability, or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying

Answer 12

Antacid use

Question 13

all antacid use can cause

Answer 13

hypokalemia

Question 14

constipation and hypophsophatemia; proximal muscle weakness, osteodystrophy, seizures

Answer 14

aluminum hydroxide

aluMINIMUM amout of feces

Question 15

hypercalcemia (milk-alkali syndrome), rebound acid increase

Answer 15

calcium carbonate

Question 16

diarrhea, hyporeflexia, hypotension, cardiac arrest

Answer 16

Magensium hydroxide

Mg2+ = must go to the bathroom

Question 17

bismuth, sucralfate mechanism

Answer 17

bind to ulcer base, providing physical protection and allowing HCO3- secretion to reestablish pH gradient in mucous layer.

Question 18

require acidic environemnt

Answer 18

bismuth; sucralfate;

usually not given with PPIs/H2 blockers

Question 19

use of bismuth sucralfate

Answer 19

increase ulcer healing

travelers’ diarrhea

Question 20

misoprostol mechanism

Answer 20

PGE1 analog;
Increase production and secretion of gastric mucous barrier
Decrease acid production

Question 21

use of misoprostol

Answer 21

prevention of NSAID induced peptic ulcers (NSAIDS block PGE1 producftion
also used off label for induction of labor (ripens cervix)

Question 22

misoprostol SE

Answer 22

diarrhea, Contraindicated in women of childbearing potential (abortifacient)

Question 23

Octreotide mechanism

Answer 23

long acting somatostatin analog; inhibits secretion of various splanchnic vasodilatory hormones

Question 24

use of octreotide

Answer 24

acute variceal bleeds, acromegaly, VIPoma, carcinoid tumors
also decrease gut motility, blood flow, and endocrine/exocrine pancreatic function (decrease of secretion of pancreatic enzymes into intestine and therefore could aggravate pt’s malabsorptive diarrhea)

Question 25

SE of octreotide

Answer 25

nausea, cramps, steatorrhea | increase risk of cholelithiasis due to CCK inhibition

Question 26

Sulfasalazine mechanism

Answer 26

mechanism: combination of sulfapyridien (antibacterial) and 5-aminosalicylic acid (anti-inflammatory) activated by colonic bacteria inhibiting cytokine, PG, leukotriene synthesis during inflammation

Question 27

Use of sulfasalazine

Answer 27

Ulcerative colitis, Crohn disease (colitis component)

Question 28

SE of sulfasalazine

Answer 28

malaise, nausea, sulfonamide toxicity, reversible oligospermia

Question 29

Loperamide mechanism

Answer 29

agonist at mu opiod receptors; slows gut motility. poor CNS penetration (low addictive potentiaL)

Question 30

loperamide use

Answer 30

didarrhea: decrease volume by slowing intestinal transit time and allowing greater net fluid resorption

Question 31

SE of loperamide

Answer 31

constipation, nausea

Question 32

which hormone increases cholesterol secretion

Answer 32

estrogen

Question 33

ewhich hormone decreases bile acid secretion

Answer 33

progestorne

Question 34

5Ht3 antagnoist; decreases vagal stimulation: powerful central acting antiemetic

Answer 34

Ondansetron

Question 35

Use of ondansetron (like granisetron

Answer 35

control vomiting postop and in pt's undergoing cancer chemotherapy

Question 36

SE of ondansetron

Answer 36

headache, constipation, QT interval prolongation, serotonin syndrome

Question 37

because ondansetron is a 5ht3 receptor antagonist, increases serotoing

Answer 37

serotoniin sydnorme

Question 38

Metoclopramide use

Answer 38

diabetic and postsurgery gastroparesis, antiemetic, persistent GERD; acute migraines

Question 39

mechanism of metoclopramide

Answer 39

D2 receptor antagonist. increase resting tone, contractility, LES tone, motility, promotes gastric emptying. Does not influence colon transport time

Question 40

SE of metoclopramide

Answer 40

increase parkinsonian effects, tardive dyskinesia restlessness, drowsiness, fatigue, depression, diarrhea. drug interaction w digoxin and diabetic agents. Contraindicated in pt's w small bowel obstruction or Parkinson disease (due to D2 receptor blockade)

Question 41

orlistat mechanism

Answer 41

inhibits gastric and pancreatic lipase: decrease breakdown and absorption of dietary fats

Question 42

use of orlistat

Answer 42

weight loss

Question 43

SE of orlistat

Answer 43

Steatorrhea, decreaes absorption of fat soluble vitamines

Question 44

indicated for constipation or patients on opiates requiring a bowel regimen

Answer 44

laxatives

Question 45

Bulk forming laxatives

Answer 45

psyllium , methylcellulose

Question 46

mechanism of bulk forming laxatives

Answer 46

soluble fibers; draw water into gut lumen; forming a viscous liquid that promotes peristalsis

Question 47

SE of bulk forming laxatives

Answer 47

bloating

Question 48

Osmotic laxatives

Answer 48

magnesium hydroxide, magnesium citrate, polyethylene glycol, lactulose

Question 49

mechanism of osmotic laxatives

Answer 49

provide osmotic load to draw water into GI lumen; distending intesitnal wall and increase piristalsis

Question 50

treats hepatic encephalopathy bc gut flora degrade it into metabolites (alctic acid, acetic acid) that promote nitrogen excretion as NH4+

Answer 50

lactulose

Question 51

SE of osmotic laxatives

Answer 51

diarrhea, dehydration; may be abused by bulimics

Question 52

Stimulants (laxatives)

Answer 52

senna

Question 53

mechanism of senna:

Answer 53

enteric nerve stimulation: colonic contraction

Question 54

SE of senna

Answer 54

diarrhea, melanosis coli

Question 55

emollients

Answer 55

docusate

Question 56

mechanism of docusate

Answer 56

osmotic draw into lumen : increase water absoprtion by stool

Question 57

SE of docusate

Answer 57

diarrhea

Question 58

mechanism of aprepitant (like fosaprepitant)

Answer 58

substance P antagnoist. blocks NK1 (neurokin receptors in brain)

Question 59

aprepitant use

Answer 59

antiemetic for chemotherapy induced nausea and vomiting.

Question 60

antimuscarinics and anti histamines are used in what antiemetic scenario

Answer 60

motion sickness | hyperemesis gravidarum

Question 61

chemotehrapy induced emesis; use what drugs

Answer 61

5ht3r antagnoists, dopamaine receptor antagonist | neurokinin 1 recetpro antagnoists