GI Drugs

Question 1

calcium carbonate

Answer 1

antacid (buffer)
poorly absorbed
impaired renal function: can build, become toxic
remember chelation
take drugs separate that need acid
side effects: constipation, bloating, farts, etc., kidney stone/hypercalcemia

Question 2

aluminum hydroxide

Answer 2

antacid (buffer)
poorly absorbed
impaired renal function: can build, become toxic
remember chelation
take drugs separate that need acid
side effects: constipating, hypophosphatemia

Question 3

magnesium hydroxide

Answer 3

antacid (buffer)
poorly absorbed
impaired renal function: can build, become toxic
remember chelation
take drugs separate that need acid 
side effects: diarrhea

Question 4

ranitidine

Answer 4

H2 antagonist
For: GERD, PUD, dyspepsia, gastritis, esophagitis, zollinger-ellison syndrome
side effects: diarrhea/constipation, HA, drowsiness, fatigue, muscle pain. Rare: cns side effects
excreted by kidnes
could alter absorption of drugs that require acid
OTC, oral, IV, IM

Question 5

famotidine

Answer 5

H2 antagonist
For: GERD, PUD, dyspepsia, gastritis, esophagitis, zollinger-ellison syndrome
side effects: diarrhea/constipation, HA, drowsiness, fatigue, muscle pain. Rare: cns side effects
excreted by kidnes
could alter absorption of drugs that require acid
OTC, oral, IV

Question 6

nizatidine

Answer 6

H2 antagonist
For: GERD, PUD, dyspepsia, gastritis, esophagitis, zollinger-ellison syndrome
side effects: diarrhea/constipation, HA, drowsiness, fatigue, muscle pain. Rare: cns side effects (elderly) thrombocytopenia (rare)
excreted by kidneys
could alter absorption of drugs that require acid
not available OTC

Question 7

cimetidine

Answer 7

H2 antagonist
For: GERD, PUD, dyspepsia, gastritis, esophagitis, zollinger-ellison syndrome
side effects: diarrhea/constipation, HA, drowsiness, fatigue, muscle pain. Rare: cns side effects
excreted by kidnes
could alter absorption of drugs that require acid
gynecomastia & galactorrhea: this drug inhibits binding of testosterone and inhibits estrodial hydroxylation

Question 8

dexlansoprazole

Answer 8

-prazole suffix
PPI
for: GERD, erosive esophagitis, gstric/duodenal ulcers, H. pylori eradication, zollinger-ellison syndrome, upper GI bleeding
side effects: GI, nausea, ab pain, constipation/diarrhea, gas
chronic use: increase C. diff. & pneumonia
generally well tolerated

Question 9

esomeprazole

Answer 9

-prazole suffix
PPI
for: GERD, erosive esophagitis, gstric/duodenal ulcers, H. pylori eradication, zollinger-ellison syndrome, upper GI bleeding
side effects: GI, nausea, ab pain, constipation/diarrhea, gas
chronic use: increase C. diff. & pneumonia
generally well tolerated
IV formulation available

Question 10

omeprazole

Answer 10

-prazole suffix
PPI
for: GERD, erosive esophagitis, gstric/duodenal ulcers, H. pylori eradication, zollinger-ellison syndrome, upper GI bleeding
Zegerid is a form of omeprazole which is a PPI & bicarb buffer combined which makes it more effective & rapid delivery

Question 11

pantoprazole

Answer 11

-prazole suffix
PPI
for: GERD, erosive esophagitis, gstric/duodenal ulcers, H. pylori eradication, zollinger-ellison syndrome, upper GI bleeding
IV formulations available

Question 12

raberprazole

Answer 12

-prazole suffix
PPI
for: GERD, erosive esophagitis, gstric/duodenal ulcers, H. pylori eradication, zollinger-ellison syndrome, upper GI bleeding

Question 13

misoprostol: prostaglandin analogue

Answer 13

GI cytoprotectant
protects mucosa and maintains blood flow
for: prevention of gastric ulcers do to NSAID’s
side effects: diarrhea (severe) ab cramping
BB warning: not for pregnant women (uterine cramping)
must administer 3-4xday: not good for compliance

Question 14

sucralfate: coating agent

Answer 14

GI cytoprotectant
stress ulcer prevention/recurrence
enhances mucous secretion
1 hour before eating
not absorbed=no systemic effects
can reduce other drugs due to binding in GI tract

Question 15

bismuth: coating agent

Answer 15

GI cytoprotectant
enhances mucous secretion
inhibits H. pylori
used for acute diarrhea, adjunctive therapy for H. pylori & heartburn.
side effects: black tarry stools, discolored tongue, constipation, tinnitus (higher doses)
contra: avoid in kids/teens w/viral infections
assoc w/salicylate & may be RF for Reyes

Question 16

metoclopramide

Answer 16

dopamine antagonist
for: GI motility disorder, GERD, N&V prevention, small bowel intubation
side effects: hyperprolactinemia, extrapyramidal (EPS): tardive dyskinesia
Avoid prolonged tx (>12wks)
CNS effects
contra: GI obstruction or bleeding of perforation

Question 17

loperamide

Answer 17

anti-diarrheal
side effects: constipation, abuse potential, CNS effects
doesn’t penetrate BBB
low solubility so less likely to be abused parenterally

Question 18

diphenozylate/atropine

Answer 18

anti-diarrheal
side effects: constipation, abuse potential, CNS effects
doesn’t penetrate BBB
low solubility so less likely to be abused parenterally

Question 19

difenoximide/atropine

Answer 19

anti-diarrheal
side effects: constipation, abuse potential, CNS effects
doesn’t penetrate BBB
low solubility so less likely to be abused parenterally

Question 20

bismuth

Answer 20

part of the H. pylori quadruple tx protocol
may bind to diarrhea-causing bacteria/toxin and then eliminated through stool.
able to absorbe significant amounts of water.

Question 21

sennosides (stimulants)

Answer 21

laxative
irritates intestinal wall=peristalsis
side effect: diarrhea

Question 22

bisacodyl (stimulant)

Answer 22

laxative
irritates intestinal wall=peristalsis
side effect: diarrhea

Question 23

psyllium (bulk)

Answer 23

laxative

fiber increases bulk of stool & promotes motility

Question 24

magnesium citrate (osmotic)

Answer 24

laxative
electrolytes pull water into stool
can cause electrolyte abnormality: renal concern
onset of action: 30min-6 hrs

Question 25

polyethylene glycol (osmotic)

Answer 25

laxative
pulls water into stool
ab distention, flatulence, improves w/use
must combine w/fluid before ingestion

Question 26

docusate (softener, emollient, lubricant)

Answer 26

laxative
reduces surface tension of oil-water interface of stool resulting in enhanced incorporation of water & fat allowing for stool softening
promote fat/water in stools, lubricate fecal material/intestinal walls

Question 27

mineral oil (softener, emollients, lubricant)

Answer 27

soften fecal contents by coating them

don’t take while reclining: lipid pneumonia from aspiration

Question 28

glycerin (lubricant, osmotic laxative, stool softener)

Answer 28

effect due to local irritant & osmotic effect. increases peristalsis & water content of stool
given rectally
BM in 15min-1 hour

Question 29

methylnaltrexone (peripheral opioid antagonist)

Answer 29

blocks constipation while delivering pain relief

Question 30

lubiprostone

Answer 30

tx for idiopathic constipation in adult (IBS constipation-predominant in female pts)
locally acting chloride channel activator>enhances intestinal fluid secretion>increases motility

Question 31

linaclotide

Answer 31

tx of IBS-C
LAST RESORT
guanylate cyclase-C agonist
contra: don’t use kids 6-17 years, don’t use in pts w/known mechanical GI obstruction
side effects: severe diarrhea, hole or stop

Question 32

dronabinol

Answer 32

cannabinoid
for: N&V assoc w/chemo, anorexia assoc w/weight loss in AIDS pts
side effects: euphoria, drowsiness, impaired sensory perception, tachy
contra: hypersensitivity to sesame oil (dronabinol), serious cardivascular dz, psychiatric disorders, hx of pyschosis

Question 33

nabilone

Answer 33

cannabinoid
for: N&V assoc w/chemo, anorexia assoc w/weight loss in AIDS pts
side effects: euphoria, drowsiness, impaired sensory perception, tachy
contra: hypersensitivity to sesame oil (dronabinol), serious cardivascular dz, psychiatric disorders, hx of pyschosis

Question 34

pancrelipase

Answer 34

PERT
for: enzyme deficiency secondary to CF, chronic pancreatitis, after pancreatectomy, GI bypass surgery, duct obstruction due to tumor
side effects: diarrhea, ab pain, hyperuricosuria or renal stones
contains a mix of amylase, lipase,proteases

Question 35

ondansetron

Answer 35

-setron suffix
serotonin antagonist
antagonist 5HT receptor>slows intestinal transit> decreases N&V
side effects: constipation, HA, lightheadedness

Question 36

granisetron

Answer 36

-setron suffix
serotonin antagonist
antagonist 5HT receptor>slows intestinal transit> decreases N&V
side effects: constipation, HA, lightheadedness

Question 37

alosetron

Answer 37

-setron suffix
serotonin antagonist
antagonist 5HT receptor>slows intestinal transit> decreases N&V
side effects: constipation, HA, lightheadedness
BB warning: ischemic colitis

Question 38

dolasetron

Answer 38

-setron suffix
serotonin antagonist
antagonist 5HT receptor>slows intestinal transit> decreases N&V
side effects: constipation, HA, lightheadedness

Question 39

palonosetron

Answer 39

-setron suffix
serotonin antagonist
antagonist 5HT receptor>slows intestinal transit> decreases N&V
side effects: constipation, HA, lightheadedness

Question 40

scopolamine

Answer 40

anti-emetic
ACh blocker
for: motion sickness

Question 41

diphenhydramine

Answer 41

anit-emetic
H1 receptor blocker
for: N&V, nonproductive cough, allergy sx, sedation

Question 42

meclizine

Answer 42

anti-emetic
H1 receptor blocker
for: N&V, nonproductive cough, allergy sx, sedation

Question 43

promethazine

Answer 43

anti-emetic
H1 receptor blocker
for: N&V, nonproductive cough, allergy sx, sedation

Question 44

prochlorperazine

Answer 44

anti-emetic
neuroleptic agent
for: severe N&V, psychotic disorders, intractable hiccups
NOT FIRST CHOICE