GI: Medications

Question 1

Magnesium Hydroxide with Aluminum Hydroxide (Maalox, Mylanta)

Answer 1

Antacid; deactivates pepsin, which increases gastric pH; give 2 hours after meals and at bedtime; do not give within 1-2 hours of other medications

Question 2

Aluminum Hydroxide (Amphojel)

Answer 2

Antacid; deactivates pepsin, which increases gastric pH; give 1 hour after meals and at bedtime; do not give within 1-2 hours of other medications

Question 3

What’s the difference between antacids that contain aluminum versus ones that contain magnesium?

Answer 3

Aluminum causes constipation, magnesium causes diarrhea; Magnesium contraindicated in renal and cardiac failure

Question 4

Ranitidine (Zantac)

Answer 4

H2 antagonist; blocks histamine receptors in parietal cells, which decreases gastric acid secretion

Question 5

Famotidine (Pepcid)

Answer 5

H2 antagonist; blocks histamine receptors in parietal cells, which decreases gastric acid secretion

Question 6

Nizatadine (Axid)

Answer 6

H2 antagonist; blocks histamine receptors in parietal cells, which decreases gastric acid secretion

Question 7

Omeprazole (Prilosec)

Answer 7

PPI; suppresses gastric acid secretion

Question 8

Pantoprazole (Protonix)

Answer 8

PPI; suppresses gastric acid secretion; IV form is not compatible with most other drugs; SR, used for duodenal ulcers

Question 9

Rabeprazole (Aciphex)

Answer 9

PPI; suppresses gastric acid secretion; SR, used for duodenal ulcers

Question 10

Esomeprazole (Nexium)

Answer 10

PPI; suppresses gastric acid secretion; give 1 hour before meals

Question 11

Misoprostol (Cytotec)

Answer 11

Prostaglandin analog; decreases gastric acid secretion, increases resistance to mucosal injury from NSAIDs; not to be used with magnesium containing antacids (both cause diarrhea)

Question 12

What’s the drug class of choice for treating patients with acid-related disorders?

Answer 12

PPIs

Question 13

Why should PPIs not be used for a prolonged period of time?

Answer 13

They may contribute to osteoporotic-related fractures

Question 14

Sucralfate (Carafate)

Answer 14

Mucosal barrier fortifier; forms protective coat to prevent further digestive action of pepsin, gastric acid

Question 15

Psyllium Hydrophilic Mucilloid (Metamucil)

Answer 15

Bulk-forming laxative; take at mealtime with glass of water

Question 16

Loperamide (Imodium)

Answer 16

Antidiarrheal

Question 17

Clarifenacin (Enablex)

Answer 17

Muscarinic-receptor antagonist; inhibits intestinal motility

Question 18

Festoterodine (Toviaz)

Answer 18

Muscarinic-receptor antagonist; inhibits intestinal motility

Question 19

5-fluorouracil (5-FU)

Answer 19

Chemotherapy; used for colorectal cancer

Question 20

Diphenoxylate Hydrochloride with Atropine Sulfate (Lomotil)

Answer 20

Antidiarrheal; reduces GI motility; not for elderly, may contribute to falls; not for gastroenteritis, must get virus or bacteria out of GI system

Question 21

Dicyclomine Hydrochloride (Bentyl)

Answer 21

Anticholinergic; inhibits gastric motility

Question 22

Sulfasalazine (Azulfadine)

Answer 22

Aminosalicylate (5-ASA); inhibits prostaglandins to reduce inflammation; contraindicated with sulfonamide allergies and thiazide diuretics; may cause hemolytic anemia, agranulocytosis

Question 23

Mesalamine (Asacol, Pentasa, Rowasa)

Answer 23

Aminosalicylate (5-ASA); inhibits prostaglandins to reduce inflammation

Question 24

Olsalazine (Dipentum)

Answer 24

Aminosalicylate (5-ASA); inhibits prostaglandins to reduce inflammation

Question 25

Balsalazide (Colazal)

Answer 25

Aminosalicylate (5-ASA); inhibits prostaglandins to reduce inflammation

Question 26

Prednisone (Deltasone)

Answer 26

Glucocorticoid; can cause hyperglycemia, osteoporosis, peptic ulcer disease, increased risk for infection

Question 27

Infliximab (Remicade)

Answer 27

Immunomodulator; reduces activity of tumor necrosis factor (TNF) to decrease inflammation; used in combination with glucocorticoids for treatment of UC or Crohn's; avoid crowds, anyone with infection; parenteral only

Question 28

Adalimumab (Humira)

Answer 28

Immunomodulator; reduces activity of tumor necrosis factor (TNF) to decrease inflammation; used in combination with glucocorticoids for treatment of UC or Crohn's; avoid crowds, anyone with infection; provide teaching for subcutaneous injection

Question 29

Natalizumab (Tysabri)

Answer 29

Immunomodulator; reduces activity of tumor necrosis factor (TNF) to decrease inflammation; for use in Crohn's; avoid crowds, anyone with infection; parenteral only; report cognitive/motor/sensory changes immediately

Question 30

Certolizumab Pegol (Cimzia)

Answer 30

Immunomodulator; reduces activity of tumor necrosis factor (TNF) to decrease inflammation; for use in Crohn's; avoid crowds, anyone with infection; parenteral only

Question 31

What types of medications are avoided for a patient with diverticulitis?

Answer 31

Laxatives & enemas because they increase intestinal motility, causing increased inflammation

Question 32

Furosemide (Lasix)

Answer 32

Loop diuretic; causes potassium loss

Question 33

Spironolactone (Aldactone)

Answer 33

Potassium-sparing diuretic

Question 34

Propranolol (Inderal)

Answer 34

Beta-blocker; decreases HR and hepatic venous pressure gradient to decrease GI bleed

Question 35

Octreotide (Sandostatin)

Answer 35

Synthetic somatostatin; reduces portal pressure to decrease GI bleed

Question 36

Terlipressin

Answer 36

Vasopressin; reduces portal pressure to decrease GI bleed

Question 37

Lactulose (Evalose, Heptalac)

Answer 37

Laxative; promotes excretion of ammonia in stool

Question 38

Pancrelipase (Creon)

Answer 38

Pancreatic enzyme replacement therapy (PERT); do not crush or chew; if capsules must be opened for difficulty swallowing, mix in applesauce; do not mix with high protein food because enzymes will dissolve

Question 39

Orlistat (Xenical)

Answer 39

Anorectic; suppresses appetite, inhibits lipase for partial digestion of triglycerides (decreased calories); causes GI symptoms unless fat is reduced below 30% of daily food intake

Question 40

Phentermine (Adipex-P)

Answer 40

Sympathomimetic; suppresses appetite in hypothalamus