Pharm GI

Question 1

Proton pump MOA

Answer 1

cAMP

Question 2

Antacids

Answer 2

• Aluminum Hydroxide - constipation

- Magnesium hydroxide - diarrhea

Question 3

Antacid interaction with mucosa

Answer 3

Protect through stimulation of prostaglandins production

Question 4

Antacid regime for PUD

Answer 4

1-3hr after meals and at bedtime

Question 5

H2-R antagonist

Answer 5

Cimetidine

Question 6

Cimetidine interaction

Answer 6

CYP 450 (warfarin, phenytoin, theophylline)

Question 7

Cimetidine SE

Answer 7

• CNS confusion (elderly)

- drowsy, fatigue

Question 8

Antacid & H2 ant. indication

Answer 8

-GERD less than 3 times a week

Question 9

Disorder nothing will work for

Answer 9

Non-ulcer dyspepsia

Question 10

PPI

Answer 10

Omeprazole

Question 11

PPI journey

Answer 11

prodrug in intestinal lumen

• protonated and concentrated in parietal cells canaliculi
• Active thiophilic sulfonamide

Question 12

PPI MOA

Answer 12

Irreversible (covalent disulfide) block of H/K ATPase

Question 13

PPI regime

Answer 13

1hr before meal

Question 14

PPI metabolism

Answer 14

• t1/2 1.5hr
• duration 24hr
• first pass metabolism

Question 15

PPI contraindication

Answer 15

Severe liver disease only

first-pass metabolism

Question 16

Recurrence after PPI discontinuation

Answer 16

80% within 6 months

Question 17

Peptic ulcer Tx

Answer 17

PPI (6 weeks)

Clarithromycin/Amoxicillin (2 weeks)

Question 18

PPI doesn’t work for

Answer 18

• Nonulcer dyspepsia

- Prevention of stress gastritis

Question 19

PPI SE

Answer 19

• Diarrhea
• B12 & mineral malabsorption
• Salmonella, shigella infection

Question 20

-Sucralfate-

Answer 20

Sucrose/aluminum hydroxide

-Prevent bleeding in stress-related gastritis

Question 21

-Misoprostol-

Answer 21

Prostaglandin E1 analog

• Increase mucosal blood flow, stimulate good stuff
• Prevent alcohol & NSAID ulcers

Question 22

-Bismuth Subsalicylate-

Answer 22

• Direct antimicrobial against h.pylori

- Bind enterotoxins

Question 23

-Bismuth-
SE
CI

Answer 23

• Tongue and stool blackening

- CI with renal insufficiency

Question 24

-Metoclopramide-
Class
Indication
MOA

Answer 24

Prokinetic
GERD, antinausea (D2), delayed gastric emptying
5HT4 enteric neuron agonist -> Ach release

Question 25

-Metoclopramide- | SE

Answer 25

CNS extrapyramidal manifestations (use short term)

Question 26

First line constipation Tx

Answer 26

Diet, fluid, fiber, avoid drugs

Question 27

MgO (magnesium oxide)

Answer 27

Osmotic laxative for acute constipation

Question 28

-Docusate-

Answer 28

Laxative - allow water and lipids to penetrate stool

Question 29

Antidiarrheals

Answer 29

Don't use for bloody diarrhea, high fever, systemic toxicity

Question 30

-Loperamide-

Answer 30

Opioid antidiarrheal - Doesn't cross BBB, no abuse - Inhibits presynaptic cholinergic nerves

Question 31

-Ocreotide-

Answer 31

Antidiarrheal - Somatostatin - Inhibit secretory diarrhea - Tx VIPoma and carcinoid tumor

Question 32

-Lomotil-

Answer 32

Antidiarrheal | -Opiod (diphenoxylate) and atropine

Question 33

-Alosetron-

Answer 33

Irritable Bowel Syndrome (severe, second line Tx) | -5-HT3 antagonist

Question 34

-Sulfasalazine- Indication MOA SE

Answer 34

Ulcerative Colitis - 5-ASA (Aminosalicylic acid) - Nausea, bone marrow suppression, hypersensitivity rxn

Question 35

-Azathioprine-

Answer 35

Immunosuppressant for IBD -6-Mercaptopurine SE: Bone marrow suppression, hypersensitivity

Question 36

-Methotrexate-

Answer 36

Crohn's disease | -SE: Bone marrow suppression

Question 37

Enhance safety of glucocorticoids for IBD

Answer 37

Administer folate supplements

Question 38

-Inflimixab-

Answer 38

Bind TNF-a (pro TH1 cytokine)

Question 39

-Odansetron-

Answer 39

Anti-emetic for chemotherapy - 5-HT3 antagonist - Doesn't block D-R

Question 40

-Aripepitant-

Answer 40

Anti-emetic for chemotherapy | -NK1 (neurokinin) receptor antagonist

Question 41

-Promethazine-

Answer 41

Anti-emetic for migraines | -D2-R antagonist

Question 42

-Droperidol-

Answer 42

Anti-emetic for surgery | -D2-R antagonist