p.6
Categories of GI Drugs
What off-label use does Misoprostol have?
To treat gastric ulcers when patients cannot take other medications.
p.7
Cautions and Contraindications for GI Drugs
What is recommended for pregnant women regarding medication use?
They should avoid medications unless attempting to induce labor or terminate pregnancy.
p.16
Antiemetics and Their Mechanisms
What are the potential side effects of high doses of antidopaminergics?
Extrapyramidal reactions such as tremors, difficulty walking, and muscular rigidity.
p.8
Agents for Inflammatory Bowel Disease (IBD)
What are the main clinical features of IBD?
Abnormal defecation, which may be predominantly constipation or diarrhea.
p.14
Laxatives and Their Types
What is the action of glycerin rectal suppositories?
They usually cause evacuation of the colon within 15 to 60 minutes.
p.6
Categories of GI Drugs
What is Misoprostol (Cytotec) primarily used for?
To inhibit gastric acid secretion and protect the mucosa from irritants like NSAIDs.
p.3
H2 Blockers and Their Uses
What are H₂ blockers?
Antagonists that reduce gastric acid secretion by blocking histamine receptors in the stomach.
p.14
Laxatives and Their Types
How do osmotic laxatives work?
They draw water from tissues into feces and reflexively stimulate evacuation.
p.15
Cautions and Contraindications for GI Drugs
What are common side effects of lubiprostone?
Nausea, diarrhea, headache, abdominal bloating or pain, and flatulence.
p.13
Cautions and Contraindications for GI Drugs
What should be avoided when using stool softeners?
Stool softeners that also contain stimulant laxatives, such as Peri-Colace and Senokot-S.
p.5
Mechanism of Action of Antacids
What causes GERD?
Excessive reflux of acidic gastric contents into the esophagus.
p.10
Categories of GI Drugs
What are some brand names for Bismuth subsalicylate?
Kaopectate and Pepto-Bismol.
p.1
Categories of GI Drugs
What are some common components found in antacid products?
Aluminum, calcium, magnesium, and sodium.
p.1
Mechanism of Action of Antacids
What is the primary function of antacids?
To work against excessive acid production and reduce harmful effects.
p.1
Mechanism of Action of Antacids
What common conditions do antacids relieve?
Indigestion, heartburn, and sour stomach.
p.16
Antiemetics and Their Mechanisms
Which two antidopaminergic agents are commonly used for nausea and vomiting?
Prochlorperazine (Compazine) and promethazine (Phenergan).
p.8
Agents for Inflammatory Bowel Disease (IBD)
What is inflammatory bowel disease (IBD)?
A chronic condition causing inflammation in the lining of the GI tract, including Crohn’s disease and ulcerative colitis.
p.9
Agents for Inflammatory Bowel Disease (IBD)
How do salicylates reach their target areas in the gastrointestinal tract?
They are designed to reach the ileum and colon by passing the stomach and upper intestines.
p.10
Cautions and Contraindications for GI Drugs
Who should avoid using Bismuth subsalicylate?
Children under 12, teenagers recovering from chickenpox or influenza, and those with salicylate hypersensitivity.
p.6
Cautions and Contraindications for GI Drugs
In which patients is Misoprostol particularly beneficial?
Debilitated patients, older adults, or those with a history of gastric ulcers.
p.10
Categories of GI Drugs
What is Bismuth subsalicylate commonly used for?
It has mucosal protective, antacid, and anti-inflammatory effects.
p.12
Laxatives and Their Types
What is the primary purpose of laxatives?
To promote evacuation of the intestine and treat constipation.
p.2
Categories of GI Drugs
Which types of antacids are most commonly used?
Magnesium and/or aluminum antacids.
p.6
Categories of GI Drugs
How is Misoprostol used during pregnancy?
To induce labor or terminate pregnancy.
p.13
Laxatives and Their Types
What do saline laxatives promote?
Secretion of water into the intestinal lumen.
p.3
H2 Blockers and Their Uses
Why are H₂ blockers not considered first-line treatment?
Because they do not provide 24-hour relief and PPIs are preferred unless they cannot be taken.
p.5
Proton Pump Inhibitors (PPIs)
What is Omeprazole used for?
Short-term treatment of GERD, gastric and duodenal ulcers, erosive esophagitis, and heartburn.
p.13
Cautions and Contraindications for GI Drugs
What are some side effects of prolonged use of saline laxatives?
Electrolyte imbalance, CNS symptoms, edema, and complications in cardiac, renal, and hepatic functions.
p.6
Mechanism of Action of Antacids
What effect do NSAIDs have that can lead to ulcers?
They inhibit the mucosal layer from forming and irritate the gastric lining.
p.8
Agents for Inflammatory Bowel Disease (IBD)
What is the goal of treatment for IBD?
To minimize inflammation and muscle spasms in the colon and reduce the severity of symptoms.
p.13
Laxatives and Their Types
How do emollients promote stool movement?
By softening and coating the stool.
p.5
Mechanism of Action of Antacids
What are the common symptoms of GERD?
Heartburn and acid regurgitation.
p.10
Cautions and Contraindications for GI Drugs
What are common side effects of Bismuth subsalicylate?
Transient constipation, discoloration of tongue and stool, and ringing in ears.
p.17
Cautions and Contraindications for GI Drugs
What are some cautions or contraindications for antiemetics?
Children and adolescents, pregnancy and lactation, debilitated or older adult patients, angle-closure glaucoma, prostatic hypertrophy, cardiac arrhythmias or hypertension, seizure disorders, and COPD/asthma.
p.15
Cautions and Contraindications for GI Drugs
What cautions or contraindications apply to lubiprostone?
Severe diarrhea, bowel obstruction, renal or hepatic impairment, pregnancy, and breastfeeding.
p.11
Cautions and Contraindications for GI Drugs
What are common side effects of probiotics?
Mild digestive issues such as gas and bloating.
p.2
Cautions and Contraindications for GI Drugs
What are potential side effects of frequent antacid use?
Constipation, diarrhea, electrolyte imbalance, urinary calculi, renal complications, osteoporosis, belching, and flatulence.
p.17
Cautions and Contraindications for GI Drugs
What drugs can prolong the QT interval and interact with antiemetics?
Antiarrhythmics, tricyclic antidepressants, phenothiazines, atypical antipsychotics, and certain antibiotics.
p.3
H2 Blockers and Their Uses
What are the two H₂ blockers currently available for use?
Cimetidine and famotidine.
p.12
Laxatives and Their Types
Who are stool softeners particularly recommended for?
Pregnant or nursing women and children with hard, dry stools.
p.16
Antiemetics and Their Mechanisms
What are common side effects of serotonin-receptor antagonists?
Headache, dizziness, drowsiness, and diarrhea.
p.1
Categories of GI Drugs
What are the eight categories of gastrointestinal (GI) drugs based on their mechanism of action?
Antacids, drugs for ulcers and GERD, GI antispasmodics, agents for inflammatory bowel disease, antidiarrheal agents, antiflatulents, laxatives and cathartics, antiemetics.
p.11
Cautions and Contraindications for GI Drugs
What are the cautions or contraindications for using Lomotil or Imodium?
Diarrhea caused by infection or poisoning, fever over 101°F, young children under 3 years, pregnancy, Clostridium difficile colitis, obstructive jaundice, and older adults.
p.17
Cautions and Contraindications for GI Drugs
What are common side effects of antidopaminergics?
Confusion, anxiety, restlessness, sedation, drowsiness, vertigo, weakness, headache, diarrhea, and depression (with Reglan).
p.7
Cautions and Contraindications for GI Drugs
Who should avoid using certain medications unless they can use effective contraceptives?
Women of childbearing age.
p.17
Cautions and Contraindications for GI Drugs
What specific reactions can occur with antidopaminergics in children and older adults?
Extrapyramidal reactions (involuntary movements).
p.5
Mechanism of Action of Antacids
What serious complications can arise from GERD?
Esophageal stricture, pulmonary aspiration, and esophageal cancer.
p.14
Laxatives and Their Types
What are some side effects of osmotic laxatives?
Nausea, vomiting, flatulence, and abdominal cramps.
p.16
Antiemetics and Their Mechanisms
Why is promethazine preferred for preoperative or postoperative nausea?
It is usually the drug of choice for preventive antiemetic effect.
p.9
Agents for Inflammatory Bowel Disease (IBD)
What are glucocorticoids used for in the context of IBD?
To treat moderate to severe active forms of IBD in patients inadequately controlled with salicylates.
p.15
Mechanism of Action of Antacids
How does Naloxegol work?
It selectively inhibits mu-receptors in the stomach, reducing opioid-induced delay in GI transit time.
p.5
Proton Pump Inhibitors (PPIs)
What long-term risks are associated with PPI use in older adults?
Increased risk of vitamin B12 deficiency, low magnesium levels, and fractures.
p.11
Agents for Inflammatory Bowel Disease (IBD)
What are probiotics?
Living microorganisms that can alter a patient’s intestinal flora and may provide benefits in various gastrointestinal diseases.
p.13
Laxatives and Their Types
What is the typical administration method for mineral oil?
Orally or as an oil-retention enema (60-120 mL).
p.10
Cautions and Contraindications for GI Drugs
Which medications can interact with Bismuth subsalicylate?
Warfarin, aspirin, methotrexate, quinolones, and tetracyclines.
p.13
Cautions and Contraindications for GI Drugs
What is the recommended frequency for taking saline laxatives?
Only infrequently in single doses unless directed by a physician.
p.2
Categories of GI Drugs
What are some common combinations of antacids used?
Maalox, Gelusil, and Mylanta.
p.8
Agents for Inflammatory Bowel Disease (IBD)
Is there a cure for IBD?
No, treatment focuses on symptom control and improving quality of life.
p.12
Laxatives and Their Types
What do bulk-forming laxatives do?
They soften the stool by absorbing water and increase fecal mass to facilitate defecation.
What is Lomotil?
A product combining diphenoxylate with atropine, classified as a Schedule C-V controlled substance.
p.11
Agents for Inflammatory Bowel Disease (IBD)
Where else can probiotic bacteria be found?
In yogurt (like Activia) and other dairy foods.
p.11
Agents for Inflammatory Bowel Disease (IBD)
How should patients choose an appropriate probiotic?
By using a trial and error method.
p.15
Antiemetics and Their Mechanisms
What type of drugs are used for prophylaxis of motion sickness?
Anticholinergic drugs such as dimenhydrinate (Dramamine) or scopolamine.
p.15
Antiemetics and Their Mechanisms
How should the Transderm-Scop patch be applied for motion sickness?
Applied behind the ear 4 hours before anticipated exposure to motion.
p.14
Laxatives and Their Types
What are common side effects of stimulant laxatives?
Abdominal cramps, discomfort, nausea, rectal and/or colonic irritation, loss of normal bowel function, electrolyte disturbances, dehydration, and discoloration of urine with senna.
p.8
Cautions and Contraindications for GI Drugs
What conditions are cautions or contraindications for dicyclomine?
Glaucoma (narrow angle), unstable cardiac disease, obstructive gastrointestinal disease, ulcerative colitis, obstructive uropathy, myasthenia gravis, and lactation.
p.16
Antiemetics and Their Mechanisms
What is the primary action of antidopaminergics?
They interfere with the stimulation of the chemoreceptor trigger zone (CTZ) in the brain, blocking messages to the gastrointestinal tract.
p.11
Agents for Inflammatory Bowel Disease (IBD)
What can disrupt the body's naturally occurring gut flora?
Antibiotics, other drugs, excess alcohol, stress, certain diseases, or exposure to toxic substances.
p.9
Agents for Inflammatory Bowel Disease (IBD)
What are the two main salicylates used in the management of Crohn’s disease and ulcerative colitis?
Mesalamine (Asacol, Rowasa) and sulfasalazine (Azulfidine).
p.6
Cautions and Contraindications for GI Drugs
What are common side effects of Cytotec?
Diarrhea, nausea, and abdominal pain.
p.7
Cautions and Contraindications for GI Drugs
What should patients undergoing ulcer therapy avoid?
Cigarette smoking, as it decreases the effectiveness of medicines.
What is the mechanism of action for opiate agonists like diphenoxylate with atropine?
They slow intestinal motility, allowing for more reabsorption of fluid and solidifying feces.
p.11
Agents for Inflammatory Bowel Disease (IBD)
What is Saccharomyces boulardii used for?
It is a probiotic used to prevent diarrhea, often started within 3 days of antibiotic initiation.
p.14
Laxatives and Their Types
What is the mechanism of action of Lubiprostone (Amitiza)?
It increases intestinal fluid secretion by activating specific chloride channels in the intestinal epithelium.
p.15
Antiemetics and Their Mechanisms
What are antiemetics used for?
Prevention or treatment of nausea, vomiting, vertigo, or motion sickness.
p.16
Antiemetics and Their Mechanisms
Name three serotonin-receptor antagonists.
Ondan-setron (Zofran), granisetron (Sancuso), and dolasetron (Anzemet).
p.7
Agents for Inflammatory Bowel Disease (IBD)
What role does Helicobacter pylori play in gastrointestinal health?
It is involved in the development of gastritis, gastric and duodenal ulceration, and gastric cancer.
p.9
Agents for Inflammatory Bowel Disease (IBD)
How does Linaclotide work?
By activating GC-C receptors, increasing fluid secretion and bowel motility.
p.8
Cautions and Contraindications for GI Drugs
What are common side effects of dicyclomine in older adults?
Dry mouth, constipation, blurred vision, dizziness, drowsiness, urinary retention, tachycardia, palpitations, and confusion.
p.6
Categories of GI Drugs
What is a prophylactic use of Misoprostol?
To prevent NSAID-induced ulcers.
p.14
Cautions and Contraindications for GI Drugs
What cautions or contraindications apply to stimulant laxatives?
Acute abdominal pain, ulcerative colitis, children, pregnant and lactating women, and long-term use.
p.12
Laxatives and Their Types
What are cathartics?
Cathartics, or purgatives, promote rapid evacuation of the intestine and alter stool consistency.
p.3
H2 Blockers and Their Uses
How are H₂ blockers typically dosed for long-term relief?
Twice daily or at bedtime.
p.11
Agents for Inflammatory Bowel Disease (IBD)
What is Lactobacillus acidophilus used for?
Treatment of simple uncomplicated diarrhea caused by antibiotics, infection, irritable colon, colostomy, or amebiasis.
p.17
Cautions and Contraindications for GI Drugs
What can increase the risk of movement disorders in children and adolescents?
Use of antidopaminergics.
What is Naloxegol (Movantik) used for?
Treatment of constipation caused by chronic or acute opioid use.
p.16
Antiemetics and Their Mechanisms
What is a significant caution when administering promethazine?
It should never be given subcutaneously due to the risk of serious tissue injury.
p.2
Cautions and Contraindications for GI Drugs
What conditions should caution the use of antacids?
Heart failure, chronic kidney disease, cirrhosis of the liver, dehydration, and electrolyte imbalance.
p.15
Antiemetics and Their Mechanisms
What is Meclizine (Antivert) used for?
Prevention and treatment of nausea, vomiting, and/or vertigo associated with motion sickness.
p.2
Mechanism of Action of Antacids
What is the general duration of action for antacids?
Antacids have a short duration of action, requiring frequent administration.
p.3
H2 Blockers and Their Uses
What conditions are H₂ blockers used to treat?
Acid indigestion, heartburn, GERD, esophagitis, and prevention of duodenal ulcer recurrence.
p.4
H2 Blockers and Their Uses
What is the recommended timing for taking H2 blockers when used with proton pump inhibitors?
The blocker is usually given at bedtime.
p.17
Cautions and Contraindications for GI Drugs
What interactions can potentiate the sedative effects of antiemetics?
CNS depressants, including tranquilizers, hypnotics, analgesics, antipsychotics, alcohol, and muscle relaxants.
p.13
Laxatives and Their Types
What conditions should stimulant laxatives be used for?
When rapid, thorough emptying of the bowel is required, such as before surgical or radiological examinations.
p.16
Antiemetics and Their Mechanisms
What is the role of metoclopramide (Reglan) in gastrointestinal treatment?
It is an antiemetic and a stimulant of upper gastrointestinal motility, used for gastric stasis and GERD.
p.9
Agents for Inflammatory Bowel Disease (IBD)
What are some side effects of monoclonal antibodies?
Upper respiratory infections, injection site pain, urinary tract infections, and allergic reactions.
p.3
H2 Blockers and Their Uses
What is the purpose of the combination medication Duexis?
To treat arthritis and rheumatoid arthritis while protecting against stomach ulcers caused by NSAIDs.
p.12
Cautions and Contraindications for GI Drugs
What is a common side effect of stool softeners?
Occasional mild, transitory gastrointestinal cramping or rash.
p.8
Cautions and Contraindications for GI Drugs
What interactions can occur with dicyclomine?
Phenothiazines (decreased antipsychotic effectiveness), tricyclic antidepressants (increased anticholinergic side effects), and opiate agonists (additive depressive effects on GI motility or bladder function).
p.5
Proton Pump Inhibitors (PPIs)
What type of drug is Omeprazole?
A gastric antisecretory agent (proton pump inhibitor or PPI).
p.12
Laxatives and Their Types
What are the seven categories of laxatives?
Bulk-forming laxatives, stool softeners, emollients, saline laxatives, stimulant laxatives, osmotic laxatives, and chloride channel activators.
p.1
Cautions and Contraindications for GI Drugs
What potential side effects can result from prolonged use of antacids?
Flatulence, metabolic alkalosis, electrolyte imbalance, constipation, and kidney stones.
p.5
Proton Pump Inhibitors (PPIs)
What are some side effects of PPIs?
Diarrhea, constipation, nausea, vomiting, and abdominal pain.
p.9
Agents for Inflammatory Bowel Disease (IBD)
Do oral glucocorticoids require direct contact with inflamed intestinal tissue to be effective?
No, they do not require direct contact.
p.13
Cautions and Contraindications for GI Drugs
What is a potential risk of long-term use of stimulant laxatives?
Laxative dependence and loss of normal bowel function.
p.13
Laxatives and Their Types
What is the onset of action for stimulant laxatives?
0.25 - 8 hours, depending on the preparation.
p.9
Agents for Inflammatory Bowel Disease (IBD)
What is a significant risk associated with monoclonal antibodies?
Increased risk of serious infections such as tuberculosis and invasive fungal infections.
p.3
Cautions and Contraindications for GI Drugs
What caution should be taken when prescribing H₂ blockers?
They may need dose and/or frequency adjustments in patients with renal disease.
p.6
Cautions and Contraindications for GI Drugs
When should therapy with Cytotec begin to minimize menstrual irregularities?
On the second or third day of the next normal menstrual period.
p.11
Cautions and Contraindications for GI Drugs
Who should avoid Lactobacillus probiotics?
Individuals with high fever, weakened immune systems, sensitivity to milk products, long-term use without physician direction, and those with prosthetic heart valves.
p.1
Cautions and Contraindications for GI Drugs
What factors influence the choice of a specific antacid preparation?
Palatability, cost, adverse effects, sodium content, and neutralizing capacity.
p.15
Antiemetics and Their Mechanisms
What does emesis refer to?
The action or process of vomiting.
p.16
Antiemetics and Their Mechanisms
What are serotonin-receptor antagonists primarily used for?
They are used for the prevention and treatment of postoperative nausea and vomiting (PONV) and chemotherapy-induced nausea and vomiting (CINV).
p.7
Agents for Inflammatory Bowel Disease (IBD)
What are the side effects of sucralfate?
Rare, but constipation can occur occasionally.
p.2
Cautions and Contraindications for GI Drugs
When should antacids not be taken in relation to certain medications?
Within 2 hours of administering anti-infectives, digoxin, salicylates, and bisphosphonates.
What is dicyclomine (Bentyl) used for?
Treatment of irritable bowel syndrome and other functional disturbances of GI motility.
p.7
Cautions and Contraindications for GI Drugs
How should antacids be administered in relation to other medications?
At least 2 hours away from other drugs, especially antibiotics.
p.14
Laxatives and Their Types
What is a potential side effect of high doses of polyethylene glycol (Miralax)?
Electrolyte imbalances such as hyponatremia and hypokalemia.
p.5
Proton Pump Inhibitors (PPIs)
How do PPIs interact with H₂ blockers?
H₂ blockers decrease PPI effectiveness.
p.17
Cautions and Contraindications for GI Drugs
What are the symptoms of serotonin syndrome?
Muscle rigidity, increased temperature, changes in blood pressure, confusion, and potentially death.
p.12
Cautions and Contraindications for GI Drugs
What are some cautions for using bulk-forming laxatives?
Patients with acute abdominal pain, partial bowel obstruction, dysphagia, or esophageal obstruction.
p.9
Agents for Inflammatory Bowel Disease (IBD)
What is Linaclotide (Linzess) indicated for?
IBD with severe constipation.
p.7
Agents for Inflammatory Bowel Disease (IBD)
What is the mechanism of action of sucralfate (Carafate)?
It forms a paste that adheres to the mucosa, protecting the ulcer from irritation.
What are common side effects of Lomotil?
Anticholinergic effects such as drying of secretions, blurred vision, urinary retention, and confusion.
p.17
Cautions and Contraindications for GI Drugs
What effect does metoclopramide have on other antiemetics?
It antagonizes their stimulant effects on the GI tract.
How do GI anticholinergics like dicyclomine work?
By decreasing motility (smooth muscle tone) in the GI tract.
p.9
Agents for Inflammatory Bowel Disease (IBD)
What is the role of monoclonal antibodies in treating IBD?
They are used to treat refractory and severe cases of Crohn’s disease and other forms of IBD.
p.2
Mechanism of Action of Antacids
How do antacids affect the absorption of other medications?
They may either increase or decrease the absorption.
p.4
H2 Blockers and Their Uses
Which medication is mentioned as having interactions with cimetidine and phenytoin?
Tricyclic antidepressants.
p.3
H2 Blockers and Their Uses
What are some common side effects of H₂ blockers?
Diarrhea, dizziness, rash, headache, and mild gynecomastia with cimetidine.
p.14
Laxatives and Their Types
How quickly do most patients experience a bowel movement after taking Lubiprostone?
Within 24 hours of the first dose.
What is the primary use of Loperamide (Imodium)?
It is used to treat diarrhea and is available in various forms, mostly OTC.
p.4
H2 Blockers and Their Uses
What is a common side effect of high doses of Zantac?
Increased blood concentrations of certain medications.
p.9
Agents for Inflammatory Bowel Disease (IBD)
What is a key characteristic of Linaclotide regarding absorption?
It is not absorbed systemically, limiting side effects to the gastrointestinal system.
