GI Pharm

Question 1

Migraine neurotransmitter and recommended antiemetic

Answer 1

Dopamine

HA + Nausea => Metoclopramide (Reglan) or Prochlorperazine (Compazine)

Nause => oral Reglan, Compazine, Zofran

Question 2

Vestibular nausea neurotransmitter and antiemetic

Answer 2

Histamine, acetylcholine

Antihistamines and anticholinergics

Question 3

Pregnancy neurotransmitter and antiemetic

Answer 3

Unknown neurotransmitter

Promethazine (Phenergan) 1st line

Serotonin antagonist and corticosteroids 2nd line

Question 4

Gastroenteritis neurotransmitter and antiemetic

Answer 4

Dopamine, serotonin

Dopamine antagonists 1st line

Serotonin antagonists 2nd line

Question 5

Post-op N/V neurotransmitters and antiemetic

Answer 5

Dopamine, serotonin

Prevention => serotonin antagonist, dexamethasone

Treatment => dopamine antagonists, serotonin antagonists, dexamethasone

Question 6

Antacids

Answer 6

Magnesium salts (Maalox, Almag)

Aluminum salts (Acid-gone, Gaviscon)

Calcium carbonate (Tums, Rolaids, Alka-mints)

Use caution with renal insufficiency

Question 7

H2 Blockers

Answer 7

-tidine

Treat PUD, GERD, manage dyspepsia - block histamine receptor on parietal cell

Cimetidine has a lot of side effects - don’t want to use

Don’t take w/ other antacids or meds

Question 8

Proton Pump Inhibitors

Answer 8

-prazoles

Treat all acid-related disease

Irreversibly binds and blocks proton pump to block acid secretion

Long-term therapy increases risk of infection, fracture, malabsorption (B12, Magnesium, Iron)

Question 9

PPI highest and lowest DI

Answer 9

Pantoprazole has lowest amount of drug interactions

Omeprazole/esomeprazole have highest number

-also BBW for use with clopidogrel

Question 10

Sulcrafate (Carafate)

Answer 10

Prevent chemical mucosal damage and heals chronic ulcers

Watch for Aluminum toxicity, don’t give with aluminum-based antacids in renal failure pts OR with citrate in normal kidneys -50X absorption

Question 11

Bismuth

Answer 11

Suppress H. pylori infection

No effect if not H. pylori

Question 12

Misoprostol (Cytotec)

Answer 12

Prevent and treat NSAID-induced ulcers

No 1st line, Pregnancy X - BBW miscarriage

Question 13

Prokinetic

Answer 13

Metaclopramide (Reglan)

1st line for gastroparesis < 12 weeks

Also short-term antiemetic (5-HT3)

Irreversible Tardive Dyskinesia with chronic use

Lots of DI

Question 14

Antiemetics

Answer 14

Anticholinergics -> M1

Antihistamines -> H1

Dopamine receptor antagonists -> D2 at least

Serotonin 5HT3 Antagonists -> 5HT3

Question 15

Anticholinergics

Answer 15

Scopolamine

M1

Used for motion sickness - transdermal patch

Question 16

Antihistamines

Answer 16

H1 blockers

Used for motion sickness

Cause sedation

Question 17

Dopamine receptor antagonists

Answer 17

Phenothiazines (Phenergan, Compazine)

Benzamides (Metachlopramide, Trimethobenzamide)

Question 18

Phenothiazines

Answer 18

Phenergan, Compazine (also an antihistamine)

D2, H1, M1 antagonists

SE: Tardive dyskinesia, anticholinergic SE

Caution w/ elderly, CNS depressants, seizures, liver dysfunction

Question 19

Benzamides

Answer 19

Metoclopramide (Reglan)

-D2, weak 5HT3 block w/ high dose

Trimethobenzamide (Tigan)

-Works centrally in medulla oblongata -> less SE and most potent antiemetic

Question 20

Serotonin 5HT3 Antagonists

Answer 20

Ondanetron (Zofran)

Central 5HT3 blockage

Great for post-op/chemo-induced nausea, not great for vertigo

Question 21

Infectious Antidiarrheal Empiric therapy

Answer 21

PO fluoroquinolones - Ciprofloxacin 500 mg BID 3-5 days

PO Macrolides - Azithromycin 500 mg qd 3 days