GI Drugs

Question 0

Docusate/ colace

Answer 0

Stool softener
Constipation, hemorrhoids, prophylaxis for pts who should not strain
Anionic surfactant 
May cause: Gas, bloating or cramping
PO- caps or liquid, PR suppository
1-3 day onset

Question 1

Psyllium/ Metamucil

Answer 1

Fiber laxative
Constipation, irritable bowel, reduction of colon cancer risk, reduction of cholesterol levels
Soluble & insoluble fiber
PO- powder, caps, wafers

Question 2

Magnesium hydroxide/ milk of magnesia

Answer 2

Hydrating/ osmotic laxative
Mg salts are poorly absorbed- act as osmotic agent to draw water into lumen
Electrolyte imbalances are greater risk in pts with renal dz
PO- chew tabs, caps, liquid
6hrs for onset

Question 3

Biscodyl/ dulcolax

Answer 3

Stimulant laxative
Inc. intestinal motility
SE: diarrhea, abd. Cramping, sweating, possible laxative dependence
PO- 2-6 hrs for onset

Question 4

Loperamide/ Imodium

Answer 4

Anti-diarrheal analog of meperidine
For acute diarrhea, management of chronic diarrhea in pts with IBD
Diminished peristalsis via activation of opiate receptors in GI- works on myenteric plexus not CNS.
SE: dizziness, HA

Question 5

For all laxatives:

Answer 5

Do not use if obstruction suspected, always work from the bottom up!

Question 6

For all anti-diarrheal meds:

Answer 6

Do not use if bacterial or parasitic infx suspected- fever present
Do not use in severe cases of colitis- may cause toxic mega colon

Question 7

Diphenoxylate with atropine/ lomotil

Answer 7

Anti diarrheal- for acute diarrhea
Causes decreased peristalsis because:
Diphenoxylate is a morphine analog
Atropine is and ACH inhibitor
SE: dry mouth, urinary retention, BPH in men
Take no longer than 48hrs w/o consulting physician

Question 8

Bismuth subsalicylate- pepto-bismol

Answer 8

Anti-microbial, anti-inflammatory

May cause black tongue & stool

Question 9

Other anti diarrheal meds

Answer 9

Kaolin & pectin- kaopectate

Opiates & synthetic opiates

Question 10

Meclizine/ antivert

Answer 10

Anti- emetic, sedating antihistamine
H1 histamine blocker
For mild to moderate nausea

Question 11

Metoclopramide/ reglan

Answer 11

Antiemetic, pro-kinetic
Increases peristalsis in jejunum & duodenum, inc. gastric tone & amplification of contractions
Mild-moderate nausea, gastric stasis- gastric surgery, DM, GERD
CI in parkinsons pts - may worsen sxs!

Question 12

Ondansetron/ zofran

Answer 12

Antiemetic
Severe nausea
Block serotonin receptor sites(5HT3)
IV given as adjuvunct care to chemo tx- prophylaxis

Question 13

Corticosteroids

Answer 13

Unknown MOA

for chemo induced nausea

Question 14

Marijuana

Answer 14

Marinol

Mild-moderate nausea

Question 15

Syrup of ipecac

Answer 15

Emetic- induces vomiting
Stimulation of medullary chemoreceptor trigger zones
Local irritant to GI tract
SE: abd mm spasm, dizziness, dehydration
PO- onset of eyes is in 10-30 min- give with large amounts of water

Question 16

Triple therapy for PUD

Answer 16

PPI + 2 abx- blocks acid secretion for mucosal healing
Bismuth subsalicylate + 2 abx- damages H. pylori cell wall, reduces adherence to mucosa
Abx options: amoxicillin, erythromycin, clairithromycin, tetracycline, metronidazole

Question 17

Dosing for triple therapy PUD

Answer 17

Omeprazole (Prilosec) 20mg BID
Amoxicillin (Amoxil) 1gm BID
Clarithromycin (Biaxin) 500mg QD
                     -OR-
Metronidazole (Flagyl) 500mg QD

Question 18

Calcium carbonate/ tums

Answer 18

Relief of gastric acid irritation
Neutralizes stomach acid, reduces inflammation of stomach lining
May cause constipation
May disrupt the absorption of nutrients due to change in stomach pH

Question 19

Ranitidine/ Zantac

Answer 19

H2 histamine receptor antagonist
Gastritis, PUD, GERD
Blocks histamines on parietal cells- dec acid production

Question 20

Omeprazole/ Prilosec

Answer 20

PPI
Gastritis, GERD, PUD 
Inhibits H/K pumps of parietal cells= dec acid secretion
HA, dizziness, diarrhea
2-8 wks for GERD
1-2 wks for PUD 
OTC- 5mg
Rx- 10, 20, 40mg

Question 21

Esomerazole/ nexium

Answer 21

PPI

Enantiomer of Prilosec

Question 22

5-ASA/ mesalamine

Answer 22

Aminosalicylate- pro drug- absorbed in SI
For IBD
Inhibition of leukotriene production
Anti-prostaglandin & anti-oxidant effects
N/V, diarrhea, abd. Pain, possible nephrotoxicity
PO, IM, IV
PR suppository for distal UC

Question 23

Metronidazole/ flagyl

Ciprofloxacin/ ciprofloxin

Answer 23

Antibiotics for crohn’s

Question 24

Rifaximin/ ixifaxin

Answer 24

Approved for traveler’s diarrhea

Investigating use for SIBO, IBD, IBS

Question 25

Prednisone

Answer 25

Synthetic glucocorticoid/corticosteroid
Immunosuppression
Prodrug- converted to prednisolone in the liver
Affects gene transcription- stimulate or repress protein synthesis
Short course- 10 days or less
PO, IM, IV, PR
Onset 12-18 hrs

Question 26

Budenoside/ entocort

Answer 26

Synthetic glucocorticoid
Mild-moderate crohn’s
Delayed release in ilieum

Question 27

Azthioprine/ immuran

Answer 27

Immunomodulator
IBD, AI, RA,most transplant, chemo
Inhibits purine synthesis- anti proliferative effect, apoptosis of T cells

Question 28

Infliximib/ remicade

Answer 28

Immunomodulator, human/murine chimeric monoclonal Ab - TNF inhibitor
IBD, RA, psoriasis, AI
Inhibits pro inflammatory cytokine TNF-α
Potential reactivation of HEP B or TB. T cell lymphoma or drug induced lupus
No oral activity - IM or SQ depots only

Question 29

Probiotics

Answer 29

Live organisms thought to be beneficial to host organism

Question 30

Prebiotics

Answer 30

Non-digestible food ingredients that stimulate growth/activity of gut bacteria