Upper GI & Anti-emetics

Question 1

Promethazine: MOA (2)

Answer 1

MOA: D2 antagonist with some-anti-muscarinic

Question 2

Promethazine: uses (2)

Answer 2

Motion sickenss

Migraines

Question 3

Metoclopramide: MOA (2)

Answer 3

D2 antagonist

high dose = 5HT- antagonist

Question 4

Metoclopramide: uses (2)

Answer 4

gastroparesis (prokinetic)

nausea

Question 5

Metoclopramide: ADEs (4)

Answer 5

1. causes Extrapyramidal sx (Neuroleptic Malignant Syndrome)
2. Sedation/drowsiness
3. prolactinemia (gynecomastia, galactorrhea)
4. QTc prolongation

Question 6

Promethazine ADE

Answer 6

causes Extrapyramidal sx

Question 7

Metoclopramide: Cix? why?

Answer 7

Do not use in small bowel obstruction - can increase risk of perforation

Question 8

Aprepitant: MOA (where it acts in brain, receptor, and how)

Answer 8

• Antagonists at neurokinin1 (NK 1) receptors in the CTZ/ Area postrema
• substance P antagonist

Question 9

Aprepitant: how is it dosed

Answer 9

used with a steroid and another anti-emetic

Question 10

Aprepitant use?

Answer 10

Post-operative nausea.

Question 11

Aprepitant ADE and why?

Answer 11

may decrease effects of warfarin

-it is an inducer of CYP2C9 (which metabolizes warfarin)

Question 12

Odansetron: MOA

Answer 12

5HT3 antagonist

Question 13

Odansetron: use

Answer 13

chemo-therapy induced nausea

Question 14

Odansetron ADEs (2)

Answer 14

QTc prolongation
Serotonin syndrome (when used with other drugs that increase serotonin)

Question 15

SX of serotonin syndrome (4)

Answer 15

rigidity, tremor, hyperthermia, confusion

Question 16

ADE: Magnesium, Aluminum respectively

Answer 16

Mg = diarrhea
Aluminum = constipation

Question 17

1st Gen H1 blocker that is combined with vitmain B6 to prevent morning sickness

Answer 17

Doxylamine

Question 18

Haloperidol: MOA, uses (2),

Answer 18

D2 receptor antagonist,

Uses: antipsychotic, motion sickness

Question 19

Haloperidol ADE

Answer 19

sedation

prolactinemia

Question 20

1st Gen H1 blocker good for vestibular nausea

Answer 20

Meclizine:

Question 21

Aprepitant: MOA,

Answer 21

NK1 receptor/ substance P blocker

Question 22

Aprepitant: Use with what for what

Answer 22

used with steroids for chemotherapy nausea prevention

Question 23

Aprepitant ADE

Answer 23

drug-drug effects (via CYP)

Question 24

Methylprenisolone: What is it, use?

Answer 24

Glucocorticoid

combo with anti-emetics for chemotherapy-nausea prevention

Question 25

PPIs: first line for what? (3)

Answer 25

PUD, Zollinger-Ellison syndrome NSAID gastritis

Question 26

PPIs: ADEs (3)

Answer 26

increased risk for osteoporosis, C. diff colitis, nosocomial PNA

Question 27

WHat do PPIs end in? anti-fungal ending?

Answer 27

``` anti-fungal = -azole PPI = -prazole ```

Question 28

dimenhydramine MOA, use, ADE and mechanism

Answer 28

H1 blocker, motion sickness, dry mouth etc (via muscarinic antagonism)

Question 29

Which is the longer-acting benzo and what is it used for

Answer 29

Diazepam - anti-anxiety effects are used for anticipatory nausea (chemo)

Question 30

Misoprostol MOA-

Answer 30

Prostaglandin E1 agonist that inhibits gastric acid secretion and stimulates secretion of mucus and bicarbonate by epithelial cells. --> cytoprotective!

Question 31

Misoprostol: uses

Answer 31

PUD and also for prevention of gastric ulcers for patients that are on long-term NSAIDs. (NSAIDs block PGE1 production)

Question 32

Misoprostol: ADE and cix

Answer 32

diarrhea, cix in pregnancy (abortifactant)

Question 33

Scopolamine: MOA (exact receptor), use

Answer 33

anti-muscarinic (M1 receptor), treats vestibular nausea

Question 34

scopolamine ADEs, administration (3)

Answer 34

dry mouth, blurred vision, drowsiness, | administered: oral, IV, patch

Question 35

Calcium carbonate MOA, ADE (2)

Answer 35

neutralizes stomach acid, hypercalcemia, rebound acid production

Question 36

Octerotide uses (4) administered (2)

Answer 36

``` VIPomas gastrinomas carcinoid tumors esophageal varices administered: IV, SQ ```

Question 37

octreotide MOA

Answer 37

inhibits gastrin release (from G cells) | inhibits Histamine release from ECL cells

Question 38

dronabinol: MOA

Answer 38

THC analog.

Question 39

Dronabinol ADEs. Worse in what pop? Paired with what to help

Answer 39

dry mouth, vertigo, dizziness, disorientation, worse in elderly paired with Haldol

Question 40

Ranitidine, dosing, 2nd line for what (3)

Answer 40

2x/day | 2nd line for NSAID-induced gastritis, gastrinomas, PUD

Question 41

Sulcrafate MOA, ADE

Answer 41

coats stomach to protect from acid | ADE: prevents medication absorption

Question 42

What merits a biopsy: signs of an ulcer or GERD

Answer 42

signs of an ulcer

Question 43

What is the treatment for H. Pylori infx

Answer 43

PPI plus 2 ABX

Question 44

H2 blockers treat what (2)

Answer 44

Treat dyspepsia and GERD

Question 45

Vagus nerve releases what?

Answer 45

GRP, ACh

Question 46

GRP has what effect

Answer 46

acts directly on G cells to release gastrin

Question 47

Gastrin has what effects?

Answer 47

stimulates ECL cells to release histamine | acts directly on parietal cell CCKb receptor