Term
| 1. What adverse effects occur with the antinausea agents that inhibit dopamine receptors? |
|
Definition
| Extrapyramidal symptoms such as dytonia, akathisia, tardive dyskinesia |
|
|
Term
| 2. What are common anticholinergic adverse effects? |
|
Definition
| Dry mouth, blurred vision, constipation, urinary retention, increased appetite |
|
|
Term
| 3. Which medications for constipation are also used as adjunct therapy for hyperlipidemia? |
|
Definition
|
|
Term
| 4. Which of the antinausea agents is also used to treat GERD and diabetic gastroparesis? |
|
Definition
| Metoclopramide-in addition to inhibition dopamine receptors and decreasing nausea, it stimulates cholinergic receptors, increases gastric emptying and decreases lower esophageal sphincter tone |
|
|
Term
| 5. Due to its long half-life, which of the 5HT3 receptor antagonists should be given a maximum of once every seven days? |
|
Definition
| Palonosetron-like other 5HT3 antagonists, it inhibits serotonin receptors in the GI tract and chemoreceptor trigger zone in the brain, thus decreasing nausea. Unlike other 5HT3 receptor antagonists, it is eliminated renally and has very prolonged half-life |
|
|
Term
| 6. Which of the 5HT3 receptor antagonists can interact with agents that inhibit or induce the CYP3A4 enzyme system? Name some agents that can induce CYP3A4 and some agents that can inhibit CYP3A4 and what effect you would expect them to have on these 5HT3 antagonists: |
|
Definition
Ondansetron and dolasetron
Agents that inhibit 3A4 include erythromycin, azole antifungals, cimetidine, HVI protease inhibitors-these agents would increase levels of ondansetron and dolasetron
Agents that induce 3A4 include rifampin, Phenobarbital, carbamazepine, phenytoin-these agents would decrease levels of ondansetron and dolasetron |
|
|
Term
| 7. Which class of anti-nausea agents is most useful in the treatment of anticipatory nausea and vomiting? |
|
Definition
|
|
Term
| 8. Which agent used for constipation should not be administered at bedtime due to risk of aspiration and lipid pneumonitis? |
|
Definition
|
|
Term
| 9. What class of agents for constipation work by drawing water into the intestinal lumen increasing intraluminal pressure? |
|
Definition
|
|
Term
| 10. What is the most common GI adverse effect of magnesium-containing agents? |
|
Definition
|
|
Term
| 11. What is the most common GI adverse effect of calcium-containing agents? |
|
Definition
|
|
Term
| 12. Which GI agents can decrease the absorption of fluoroquinolones and tetracylines and what is the mechanism of this interaction? |
|
Definition
| Magnesium, aluminum, calcium-containing agents; divalent and trivalent cations such as these, can chelate (bind) with the fluoroquinolones/tetracylines, thus decreasing the absorption and efficacy of these agents. |
|
|
Term
| 13. Which agent used to treat constipation is also used to treat hepatic encephalopathy and what is the mechanism for this use? |
|
Definition
| Lactulose, decreases pH, prevents diffusion of ammonia and facilitates its excretion into the stool |
|
|
Term
| 14. What are some contraindications to the antidiarrheal agents? |
|
Definition
| Contraindicated in patients with bloody diarrhea, high fever (ie > 30C), toxigenic strains of E. coli, or C-dif colitis. In general, should be used with caution in patients with a potential infectious etiology of their diarrhea. |
|
|
Term
| 15. Which of the antidiarrheal agents should be used with caution in patients on warfarin or heparin due to increased risk of bleeding? |
|
Definition
| Bismuth-subsalycilate-due to salycilate component |
|
|
Term
| 16. What class of medications should be used with caution with antidiarrheal agents due to risk of severe constipation? |
|
Definition
| Opioid analgesics since these agents are commonly associated with constipation |
|
|
Term
| 17. How would you comparatively rate the antacids, proton pump inhibitors, and the H-2 bockers in their ability to increase gastric pH? |
|
Definition
| Antacids < H-2 blockers < proton pump inhibitors (this coincides with the usual stepwise approach to their recommended use in dyspepsia) |
|
|
Term
| 19. Which of the H-2 blockers is most likely to interact with agents metabolized by they CYP3A4 enzyme? |
|
Definition
|
|
Term
| 20. Which of the agents used in the management of dyspepsia/ulcers is unique in that it does not raise gastric pH? |
|
Definition
|
|
Term
| 21. Describe nonpharmacologic therapies for the management of GERD: |
|
Definition
| ecrease fat intake, increase head of bed by six inches, stop smoking, decrease weight, wait at least 3 hours prior to lying down after eating, avoid large meals, avoid bothersome foods (ie caffeine, peppermint, chocolate, citrus, alcohol, tomatoes) |
|
|
