GI deck 2

Question 1

antihistamines use with caution in

Answer 1

elderly - anticholinergic properties

Question 2

Antihistamine ADR

Answer 2

Drowsiness

Anticholinergic effects of dry mouth, blurred vision, and urinary retention

Question 3

Phenothiazines ADR

Answer 3

Drowsiness
EPS, such as dystonia, akathisia, and tardive dyskinesia
Promethazine: fatal respiratory depression in children younger than 2 years of age

Question 4

Scopolamine ADR

Answer 4

Dry mouth

Withdrawal symptoms

Question 5

Cnnibinoid dronabionl ADR

Answer 5

Euphoria, depression, dizziness, paranoid thoughts, somnolence, and abnormal thoughts
Cardiac effects: palpitations, tachycardia, and hypotension
Seizure and seizure-like activity have been reported

Question 6

5-HT3 receptor antagonists - ADR

Answer 6

Constipation, headache, fatigue, dizziness, and diarrhea

Rare cases of tachycardia, bradycardia, hypotension, and heart rate-corrected QT interval prolongation

Question 7

Phenothiazines and lithium: may increase

Answer 7

eps

Question 8

Phenothiazines and lithium: may mask

Answer 8

LITHIUM TOXICITY

Question 9

Nausea and vomiting - Drugs used

Answer 9

5-HT3 receptor antagonists

Phenothiazines

Question 10

Phenothiazines are not used in

Answer 10

children

Question 11

Dronabinol is only for use in

Answer 11

in chemotherapy-associated nausea and vomiting, and for appetite stimulation.

Question 12

Motion sickness drug used

Answer 12

anti-histamines

Question 13

vomiting caused by gastroparesis drug used

Answer 13

prokinetic drug

Question 14

Motion Sickness drug is most effective when given

Answer 14

prophylactically

Question 15

Scopolamine patch – very effective but

Answer 15

apply approx. 12-24 hours before motion sickness triggering event. This is RX only

Question 16

Other use for scopolamine can be to prevent

Answer 16

nausea from anesthesia apply 12-24 hours before surgery when pts have severe N/V from anesthesia.

Question 17

Antihistamines are other main group that can help motion sickness- examples

Answer 17

examples Bonine (meclizine), Dramamine (dimenhydrinate)

Question 18

Histamine 2 Receptor Antagonists inhibit

Answer 18

acid secretion gastric parietal cells blocks histamine at histamine 2 receptors

Question 19

Histamine 2 Receptor Antagonists reduce acid by

Answer 19

35 - 50 %

Question 20

Histamine 2 Receptor Antagonists examples

Answer 20

cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid)

Question 21

H2RA caution in

Answer 21

renal and liver impairment, can have CNS adverse reactions – although not common could be serious but is reversible

Question 22

Famotidine approved for

Answer 22

infant and children as young as neonates, ranitidine approved for children 1 month to 16 years

Question 23

Cimetidine has the most

Answer 23

interactions with foods/drugs
Indications/Clinical use: GERD, Heartburn, PUD - can be used as maintenance therapy after PPI therapy, Ok for longer term use

Question 24

What interferes with absorption of H2RA

Answer 24

Smoking does interfere with absorption of this drug

Question 25

Prokinetic agents stimulate

Answer 25

motility of the GI tract without stimulating gastric, biliary, or pancreatic secretions

Question 26

only drug in prokinetic class

Answer 26

metoclopramide

Question 27

Prokinetic pharmcodynamics

Answer 27

Metoclopramide stimulates motility in the upper GI tract. Metoclopramide also has some actions similar to the phenothiazines and dopamine antagonists.

Question 28

Metoclopramide (reglin) also has some actions

Answer 28

similar to the phenothiazines and dopamine antagonists.

Question 29

Metoclopramide has a Black Box warning

Answer 29

due to risk of developing tardive dyskinesia

Question 30

Prokinetics are contraindicated in gastrointestinal

Answer 30

hemorrhage, mechanical obstruction, new surgery on the GI tract, or perforation.

Question 31

Prokinetic use cautiously in

Answer 31

hemorrhage, mechanical obstruction, new surgery on the GI tract, or perforation.

Question 32

Prokinetic ADR

Answer 32

``` Tardive dyskinesia Depression, dizziness Diarrhea Hypoglycemia in patients with diabetes Rare: galactorrhea, amenorrhea, gynecomastia, impotence secondary to hyperprolactinemia ```

Question 33

Prokinetics Drugs - Interactions

Answer 33

Additive CNS depression occurs when used with other CNS depressants. Increased risk of EPS occurs with other drugs that have the potential for EPS. Drugs with anticholinergic effects reverse the action of metoclopramide.

Question 34

Prokinetic drug clinical use

Answer 34

GERD, diabetic gastroparesis | Monitor – renal function, new-onset movement disorder, depression or suicidal ideation

Question 35

proton pump inhibitors suppress

Answer 35

gastric acid secretion, can reduce secretion of acid as much as 90%

Question 36

PPI are all acid-

Answer 36

are acid-labile, most formulated as enteric coated capsules

Question 37

PPI are overall safe but

Answer 37

safe drug, use with caution in hepatic dysfunction and elderly – no dosage adjustments are recommended

Question 38

PPI are safe in what

Answer 38

pregnancy but always weigh risks benefits

Question 39

PPI should only be used

Answer 39

short term

Question 40

PPI long term use is not advised due to

Answer 40

to PPIs causing nutrient deficiencies with iron, B12 and calcium absorption interference. Long term can lead to increased risk for fracture.

Question 41

PPI long term use increases

Answer 41

risk for chronic kidney disease

Question 42

PPI long term use have increased risk of

Answer 42

infection from C diff, Salmonella, Campylobacter as the decrease in stomach acid decreases the bodies natural defenses against antimicrobial

Question 43

PPI long term use also shows intrease risk of

Answer 43

gastric cancers because of chronic atrophic gastritis

Question 44

All PPIs may interfere with

Answer 44

oral administered drugs – see drug interactions table in text

Question 45

PPI clincal indications

Answer 45

Duodenal and gastric ulcers, GERD

Question 46

PPI some times are used long term but

Answer 46

rarely and usually only with hypersecratory conditions such as Zollinger-Ellison syndrome

Question 47

Average recommended treatment duration for PPI

Answer 47

4 to 8 weeks