GI Pharm

Question 1

Mnemonic to remember side-effects of aluminum hydroxide

Answer 1

CHOPS

C - constipation
H - hypophosphatemia
O - osteodystrophy
P - proximal muscle weakness
S - seizures

Question 2

prostaglandin E1 analogue that has cytoprotective effects on gastric mucosa?

Answer 2

Misoprostol

Question 3

What Rx is comprised of a mixture of a sugar and a mineral that polymerizes in stomach acid and coats the bed of ulcers to facilitate healing and reduce symptoms?

Answer 3

Sucralfate

Question 4

Answer 4

Active transport - H⁺-K⁺ ATPase (highest concentration gradient in body - 3,000,000:1)

Question 5

ACh mediated acid secretion pathways

Answer 5

Question 6

Tums (calcium carbonate)

Answer 6

C. Constipation

Question 7

Answer 7

C. Sucralfate causes metallic taste
E. Misoprostol can induce cervical dilation/abcominal cramping

Sucralfate has to be taken on an empty stomach

Cimetidine is a potent inhibitor of CYP450s

PPIs cause acid rebound

Question 8

Answer 8

A. Accumulates in canaliculi of parietal cell
C. It inactivates H⁺-K⁺ ATPase

PPIs form sulfhydryl vond with H⁺-K⁺ ATPase

Question 9

Answer 9

A. Clopidogrel

PPIs inhibit CYP2C19, which may reduce activation of clopidogrel (a
prodrug), decreasing its antiplatelet effect.

Question 10

Misoprostol use:

Answer 10

Synthetic prostaglandin E1 (PGE1) analogue used to prevent NSAID-induced ulcers.

Question 11

Answer 11

C. Microaerophillic/anaerobic

The primary enzyme responsible for activating metronidazole in anaerobic organisms is pyruvate:ferredoxin oxidoreductase (PFOR)

Question 12

Adverse effects of cimetidine

Answer 12

• Competes for renal tubular secretion, affecting drugs like procainamide
• CNS effects: Can cause confusion and hallucinations, especially in elderly patients or with IV use.
• Hormonal effects (antiandrogen activity):
  o Gynecomastia and impotence in men.
  o Rarely, galactorrhea in women.

Question 13

Antispasmotic antimuscarinics

Answer 13

-Atropine
-Hyoscyamine
-Dicyclomine

Question 14

Pro-kinetic drug that will worsen parkinsonian symptoms

Answer 14

Metoclopramide

D₂ receptor antagonist

Also has 5-HT3 antagonism and extrapyramidal reactions

Question 15

Sodium phosphate is contraindicated for patient with what condition(s)?

Answer 15

Renal/heart failure

Question 16

Key adverse events of bismuth subsalicylate administration

Answer 16

Dark stool/tongue, salicylism

-avoid in children

Question 17

Octreotide MOA

Answer 17

Somatostatin analog, inhibits GI peptide secretion

Used to Tx carcinoid syndrome, VIPomas

Question 18

Polycarbophil MOA

Answer 18

Adsorbs toxins and fluids in the gut

Bulk-former

Question 19

Adverse side-effects of mineral oil administration

Answer 19

Fat-soluble vitamin malabsorption, lipoid pneumonia

Question 20

Lactulose MOA

Answer 20

Osmotic agent; also lowers blood ammonia in hepatic encephalopathy

Question 21

Lubiprostone MOA

Answer 21

Chloride channel activator → increased intestinal fluid

Question 22

Linaclotide MOA and use case(s)

Answer 22

Guanylate cyclase-C agonist → Cl- secretion

Used to Tx IBS-C

Question 23

Tenapanor MOA and use case(s)

Answer 23

NHE3 inhibitor → increases fluid in intestine

Used to Tx IBS-C

Risk of dehydration in kids

Question 24

Mesalamine use case(s)

Answer 24

Treats irritable bowel disease

Can cause acute intolerance syndrome - D/C

Question 25

Prucalopride MOA

Answer 25

5-HT4 agonist; increases colonic motility

Question 26

Eluxadoline MOA and use case

Answer 26

Mixed opioid receptor modulator Used to Tx IBS-D ## Footnote Pancreatitis, avoid in patients w/o gallbladder

Question 27

Alosetron MOA and use case(s)

Answer 27

5-HT3 antagonist; reduces intestinal hyperactivity Severe IBS-D (women only)

Question 28

Tegaserod MOA and use case(s)

Answer 28

5-HT4 partial agonist; prokinetic Severe IBS-C (off market intermittently)

Question 29

Which of the following antiemetics is associated with a black box warning due to risk of QT prolongation? A. Dronabinol B. Droperidol C. Doxycyline D. Drosperinone

Answer 29

B. **Droperidol** ## Footnote Droperidol is a butyrophenone, the same drug class as the typical antipsychotic agent haloperidol, and acts as a dopamine D2 receptor antagonist

Question 30

Which of the following antiemetics is also used by some patients to stimulate appetite? A. Emtrol B. Dronabinol C. Ondansetron D. Aprepitant

Answer 30

B. **Dronabinol**

Question 31

Which of the following is most likely to increase blood sugar in patients with diabetes? A. Coke syrup B. Promethazine C. Ondansetron D. Prochlorperazine

Answer 31

A. **Coke syrup**

Question 32

Stimulation of which of the following receptors leads to hyperpolarization of cells? A. 5-HT3 receptor B. GABA-a receptor C. Nicotinic receptor at NMJ D. Nicotinic receptor at ganglia

Answer 32

B. **GABA-a receptor**

Question 33

Which action accounts for tardive dyskinesia associated with metoclopramide?

Answer 33

Dopamine antagonist

Question 34

What antiemetic is most likely to be recommended to an elderly patient with Meniere's disease?

Answer 34

Meclizine

Question 35

Which antiemetic is best for preventing delayed nausea and vomiting associated with chemotherapy?

Answer 35

Palonosetron

Question 36

Which type of action does **aprepitant** possess when it exerts its actions as an antiemetic?

Answer 36

Antagonist at a GPCR that uses G_q - blocks the actions of substance P

Question 37

MOA which corticosteroids are thought to have antiemetic properties:

Answer 37

Blocks prostaglandin synthesis

Question 38

Which Rx is likely to be most effective at preventing anticipatory vomiting?

Answer 38

A benzodiazepine

Question 39

why shouldn't potassium be combined with anticholinergic medications

Answer 39

potential for increased risk of gastrointestinal irritation and ulceration.

Question 40

Answer 40

A. Nucleus tractis solitaris

Question 41

What emetic pathway is the nucleus accumbens associated with?

Answer 41

Mesolimbic and mesocortical pathways (highlighted in red) ## Footnote Pathway implicated in psychiatric disorders (i.e. shizophrenia)

Question 42

Answer 42

D. Dronabinol ## Footnote Dronabinol is the principal psychoactive constituent enantiomer form, (−)-trans-Δ9-tetrahydrocannabinol

Question 43

Answer 43

C. Aprepitant | Rolapitant is NK-1 inhibitor for delayed NV

Question 44

Answer 44

D. Metoclopramide