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Questions and Answers
What is the primary action of H2 antagonists in treating ulcer disease?
What is the primary action of H2 antagonists in treating ulcer disease?
Which of the following drugs is specifically eliminated by the kidneys?
Which of the following drugs is specifically eliminated by the kidneys?
What adverse effect is specifically associated with long-term use of cimetidine?
What adverse effect is specifically associated with long-term use of cimetidine?
Which H2 antagonist is considered the prototype?
Which H2 antagonist is considered the prototype?
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What is a common gastrointestinal side effect of H2 antagonists?
What is a common gastrointestinal side effect of H2 antagonists?
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Which of the following H2 antagonists is approved for use in children ages 1 to 16?
Which of the following H2 antagonists is approved for use in children ages 1 to 16?
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Which side effects can occur with high levels of H2 antagonists?
Which side effects can occur with high levels of H2 antagonists?
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What caution should be considered when prescribing H2 antagonists?
What caution should be considered when prescribing H2 antagonists?
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What is the main action of the drugs that block acid production in the stomach?
What is the main action of the drugs that block acid production in the stomach?
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Which condition is NOT treated with proton pump inhibitors?
Which condition is NOT treated with proton pump inhibitors?
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How quickly do proton pump inhibitors reach peak levels in the body?
How quickly do proton pump inhibitors reach peak levels in the body?
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What is a common central nervous system side effect of proton pump inhibitors?
What is a common central nervous system side effect of proton pump inhibitors?
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What adverse effect is associated with long-term use of proton pump inhibitors?
What adverse effect is associated with long-term use of proton pump inhibitors?
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Which proton pump inhibitor is preferred for children under 18 years?
Which proton pump inhibitor is preferred for children under 18 years?
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What common adverse effect may occur in the gastrointestinal system due to proton pump inhibitors?
What common adverse effect may occur in the gastrointestinal system due to proton pump inhibitors?
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Why are laxative drugs commonly abused?
Why are laxative drugs commonly abused?
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Which of the following is a common adverse effect of frequent laxative use?
Which of the following is a common adverse effect of frequent laxative use?
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What can excessive laxative use potentially lead to?
What can excessive laxative use potentially lead to?
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Which laxative works by pulling fluid into the lumen of the small intestine?
Which laxative works by pulling fluid into the lumen of the small intestine?
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What is NOT a central nervous system effect commonly associated with laxative use?
What is NOT a central nervous system effect commonly associated with laxative use?
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Which laxative type increases motility by enhancing bulk and stimulating local receptors?
Which laxative type increases motility by enhancing bulk and stimulating local receptors?
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In which condition are bulk laxatives contraindicated?
In which condition are bulk laxatives contraindicated?
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What is the effect of polyethylene glycol-electrolyte solution on patients with a history of seizures?
What is the effect of polyethylene glycol-electrolyte solution on patients with a history of seizures?
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What type of agent is magnesium citrate considered?
What type of agent is magnesium citrate considered?
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What are the most common gastrointestinal adverse effects associated with bulk laxatives?
What are the most common gastrointestinal adverse effects associated with bulk laxatives?
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What is the primary function of docusate as a laxative?
What is the primary function of docusate as a laxative?
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Which adverse effect is less likely to occur with lubricant laxatives compared to stimulants?
Which adverse effect is less likely to occur with lubricant laxatives compared to stimulants?
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What form is glycerin used in for its laxative effects?
What form is glycerin used in for its laxative effects?
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What contraindications are associated with the use of lubricant laxatives?
What contraindications are associated with the use of lubricant laxatives?
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What common CNS effects may accompany laxative use?
What common CNS effects may accompany laxative use?
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What type of laxative stimulates the nerve plexus in the intestinal wall?
What type of laxative stimulates the nerve plexus in the intestinal wall?
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How does mineral oil function as a laxative?
How does mineral oil function as a laxative?
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Which laxative is commonly used when a thorough evacuation of the intestine is desirable?
Which laxative is commonly used when a thorough evacuation of the intestine is desirable?
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What is a potential issue associated with the use of mineral oil?
What is a potential issue associated with the use of mineral oil?
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Which laxative is considered milder than castor oil and is typically used for overnight effects?
Which laxative is considered milder than castor oil and is typically used for overnight effects?
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Why are laxatives contraindicated in patients with acute abdominal disorders?
Why are laxatives contraindicated in patients with acute abdominal disorders?
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What is one of the adverse effects associated with laxative use?
What is one of the adverse effects associated with laxative use?
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Which laxative should be avoided during pregnancy due to its potential to induce premature labor?
Which laxative should be avoided during pregnancy due to its potential to induce premature labor?
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Which of the following laxatives is least likely to be absorbed into the system?
Which of the following laxatives is least likely to be absorbed into the system?
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In which condition should laxatives be used with caution due to the risk of electrolyte changes?
In which condition should laxatives be used with caution due to the risk of electrolyte changes?
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Study Notes
Chapter 9: Gastrointestinal System
- This chapter covers drugs used to treat ulcer disease, constipation, and related topics.
Drugs Used to Treat Ulcer Disease
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Histamine-2 Antagonists: These drugs selectively block H2 receptors on parietal cells.
- This prevents gastrin release, which reduces histamine release.
- It ultimately blocks hydrochloric acid production and decreases pepsin production.
- H2 receptor sites are also in the heart, and high drug levels can cause cardiac arrhythmias.
- Examples include cimetidine (Tagamet, Tagamet HB), famotidine (Pepcid, Pepcid AC), nizatidine (Axid), and ranitidine (Zantac).
- Specific uses and special considerations for each drug are provided.
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Pharmacokinetics:
- Cimetidine, ranitidine, and famotidine are available in oral and parenteral forms.
- Nizatidine is available only in oral form.
- Cimetidine (prototype) is associated with antiandrogenic effects like gynecomastia and galactorrhea.
- It is metabolized in the liver and can slow the metabolism of other drugs. It's excreted in urine.
- Ranitidine and famotidine are more potent, longer-acting, and don't have the same antiandrogenic effects or marked slowing of metabolism as cimetidine. They are also metabolized in the liver and excreted in urine.
- Famotidine is approved for use in children aged 1 to 16 years.
- Nizatidine is similar to ranitidine in its effects but is eliminated by the kidneys, with no first-pass liver metabolism. It's the drug of choice for patients with liver dysfunction.
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Contraindications and Cautions:
- Use caution during pregnancy or lactation due to potential fetal/newborn effects.
- Exercise caution with hepatic or renal dysfunction as it may affect drug metabolism and excretion.
- Note adverse effects like diarrhea, constipation, CNS effects, cardiac arrhythmias, and hypotension. Also, long-term cimetidine use can cause gynecomastia and impotence.
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Proton Pump Inhibitors (PPIs):
- Specifically inhibit the H+, K+-ATPase enzyme system.
- This lowers gastric acid levels in the stomach.
- Recommended for short-term treatment of active duodenal ulcers, GERD, erosive esophagitis and benign, active gastric ulcers. Also for long-term treatment of certain pathological conditions.
- Used as maintenance therapy for healing, and in combination with amoxicillin and clarithromycin for H. pylori infection treatment.
- Several examples like dexlansoprazole, esomeprazole, lansoprazole, omeprazole, pantoprazole, and rabeprazole are listed, with their indications for use.
- Pharmacokinetics and safety considerations for these drugs are also discussed.
- Note adverse effects like GI effects, CNS effects, upper respiratory symptoms, and possible effects like bone loss, low calcium/magnesium levels, and C. difficile diarrhea/pneumonia in long-term use..
Drugs Used in the Treatment of Constipation
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Laxatives:
- Used for short-term relief of constipation.
- Available as OTC preparations.
- Overuse can lead to chronic intestinal disorders.
- Types include chemical stimulants (irritate GI lining), bulk stimulants (bulk up stool), and lubricants (facilitate movement).
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Chemical Stimulants:
- Directly stimulate nerve plexus in intestinal wall.
- Examples include castor oil, bisacodyl, cascara, and senna. Important to note their specific effects and situations where they are recommended.
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Bulk Stimulants:
- Increase intestinal motility by increasing fluid and bulk in intestinal contents.
- Examples include lactulose, magnesium citrate/hydroxide, polyethylene glycol-electrolyte solution, and psyllium. Note different types and how they work.
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Lubricants:
- Ease defecation without stimulating GI tract movement.
- Examples include mineral oil, docusate, and glycerin. Note these are used for lubrication.
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Pharmacokinetics and Contraindications:
- The methods of absorption, and excretion are described for each drug class.
- Notes are included about contraindications, such as cautions with acute abdominal disorders, pregnancy, and lactation.
- Potential for adverse effects such as diarrhea and abdominal cramping are also discussed.
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Description
This quiz tests your knowledge on H2 antagonists and proton pump inhibitors (PPIs) in treating ulcer disease. Questions include drug actions, side effects, and specific usage in children. Assess your understanding of these critical medications in gastroenterology.