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Questions and Answers
What is a common adverse effect associated with H2 antagonists?
Which of the following conditions is a contraindication for H2 antagonists?
Which of the following H2 antagonists is reported to slow the metabolism of various drugs?
H2 antagonists should be used with caution in which of the following situations?
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What is the primary therapeutic use of H2 antagonists?
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What is the primary therapeutic action of Histamine-2 (H2) antagonists?
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Which condition is NOT an indication for the use of Histamine-2 antagonists?
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What is one of the potential underlying causes of gastrointestinal disorders?
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Which class of drugs forms protective coverings on the GI lining?
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Cimetidine and famotidine are examples of which class of drugs?
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What percentage of hydrochloric acid release is blocked by Histamine-2 antagonists?
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Which of the following agents is NOT used to decrease gastrointestinal secretions?
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Which drug was withdrawn from the market due to safety concerns?
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What is a significant consequence of combining sucralfate with warfarin?
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Which digestive enzyme is specifically indicated for replacement therapy of pancreatic insufficiency?
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What is one of the therapeutic actions of misoprostol?
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What is a contraindication for the use of misoprostol?
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Which of the following is a caution for the use of a saliva substitute?
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Which adverse effect is primarily associated with the use of pancreatic enzymes?
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What component does a saliva substitute contain to aid in dry mouth conditions?
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Which of the following is a primary therapeutic use of misoprostol?
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What is a common side effect of a saliva substitute?
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What must be observed if phenytoin is taken with sucralfate?
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What is the primary action of antacids?
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Which of the following is NOT a therapeutic action of proton pump inhibitors?
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Which condition is a contraindication for the use of GI protectants?
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What is a common adverse effect associated with antacid use?
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Which of the following is a specific indication for proton pump inhibitors?
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What is a potential consequence of frequent antacid use?
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Which of these proton pump inhibitors is known to be acid labile?
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What key action does sucralfate perform in the gastrointestinal system?
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Which adverse effect is commonly associated with proton pump inhibitors?
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Which of the following drugs is classified as a proton pump inhibitor?
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What aspect of antacids could pose a risk to individuals with renal dysfunction?
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What is an adverse effect related to the use of GI protectants?
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Which common condition must be monitored in patients taking proton pump inhibitors?
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What is a significant caution for the use of proton pump inhibitors during pregnancy?
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Study Notes
Understanding Gastrointestinal Secretions
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Drugs affecting GI secretions manage disorders by:
- Decreasing secretory activity
- Blocking the action of secretions
- Protecting the lining from erosion
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Drug classes include:
- Histamine-2 (H2) Antagonists: Cimetidine (Tagamet HB), Famotidine (Pepcid AC), Nizatidine (Axid AR), Ranitidine (Zantac) - Ranitidine withdrawn from the market
- Antacids: Sodium bicarbonate, Calcium carbonate, Magnesium salts, Aluminum salts
- Proton Pump Inhibitors: Omeprazole (Prilosec), Esomeprazole (Nexium), Lansoprazole (Prevacid), Dexlansoprazole (Dexilant), Pantoprazole (Protonix), Rabeprazole (Aciphex)
- Gastrointestinal Protectants: Sucralfate (Carafate)
- Prostaglandins: Misoprostol (Cytotec)
- Digestive Enzymes: Saliva substitute and Pancrelipase (Creon, Pancreaze, Pertzye, Viokace, Zenpep)
Histamine-2 (H2) Antagonists
- Action: Block the release of hydrochloric acid in response to gastrin.
- Therapeutic Actions: Selectively blocks H2 receptors, preventing about 70% of hydrochloric acid release and decreasing pepsin production.
- Indications: Short-term treatment of active duodenal or gastric ulcers, pathological hypersecretory conditions like Zollinger–Ellison syndrome, prevention of ulcers induced by stress or NSAID use, acute upper GI bleeding, treatment of erosive GERD, ulcers caused by H. pylori, relief of heartburn and indigestion.
- Contraindications: Known allergy.
- Cautions: Pregnancy, lactation, hepatic or renal dysfunction, prolonged or continual use.
- Adverse Effects: GI effects, CNS effects, cardiac arrhythmias, hypotension, gynecomastia, impotence.
- Drug-Drug Interactions: Cimetidine slows metabolism of various drugs; Nizatidine and aspirin interactions.
Antacids
- Action: Neutralize stomach acid by direct chemical reaction.
- Indications: Symptomatic relief of upset stomach, relief of symptoms associated with hyperacidity (peptic ulcer, gastritis).
- Contraindications: Allergy.
- Cautions: Conditions exacerbated by electrolyte or acid–base imbalance, electrolyte imbalance, GI obstruction, renal dysfunction, pregnancy, lactation.
- Adverse Effects: Relate to acid–base and electrolyte balance, rebound acidity, alkalosis, hypercalcemia, constipation, diarrhea, hypophosphatemia.
- Drug-Drug Interactions: Affect absorption of many other drugs.
Proton Pump Inhibitors
- Action: Suppress hydrochloric acid secretion into the stomach lumen.
- Therapeutic Actions: Inhibit H+, K+–ATPase enzyme system on gastric parietal cells, blocking final step of acid production.
- Indications: Short-term treatment of active duodenal ulcers, GERD, erosive esophagitis, benign active gastric disease, long-term treatment of pathological hypersecretory conditions, maintenance therapy for erosive esophagitis and ulcers.
- Contraindications: Allergy, concurrent use with medications containing rilpivirine.
- Cautions: Pregnancy, lactation.
- Adverse Effects: Related to effects on H+, K+–ATPase pump, CNS effects, GI effects, upper respiratory tract symptoms, long-term use can increase bone loss and hypertension.
- Drug-Drug Interactions: Benzodiazepines, phenytoin, warfarin, ketoconazole, theophylline, some antiretroviral medications.
Gastrointestinal Protectants
- Action: Coats injured areas in the stomach, preventing further injury from acid.
- Drugs: Sucralfate (Carafate).
- Therapeutic Actions: Forms an ulcer-adherent complex, protecting ulcer sites against acid, pepsin, and bile salts, inhibiting pepsin activity.
- Indications: Treatment of ulcers.
- Contraindications: Allergy, renal failure.
- Cautions: Pregnancy, lactation.
- Adverse Effects: Mostly GI effects (constipation), other effects: dizziness, sleepiness, vertigo, skin rash, back pain.
- Drug-Drug Interactions: Aluminum salts, phenytoin, digoxin, warfarin, fluoroquinolone antibiotics, penicillamine.
Prostaglandins
- **Action**: Protects the stomach lining.
- **Drugs**: Misoprostol (Cytotec).
- **Therapeutic Actions**: Inhibits gastric acid secretion, increases bicarbonate and mucous production.
- **Indications**: Prophylaxis of NSAID-induced gastric ulcers in high-risk patients.
- **Contraindications**: Allergy, pregnancy.
- **Cautions**: Lactation, hepatic or renal impairment.
- **Adverse Effects**: GI effects, GU effects.
Digestive Enzymes
- Action: Substances that break down food into usable nutrients.
- Drugs: Saliva substitute, Pancrelipase.
- Therapeutic Actions: Saliva substitute helps with swallowing in dry mouth, pancreatic enzymes replace digestive enzymes.
- Indications: Replacement therapy.
- Contraindications: Allergy.
- Cautions: Saliva substitute - HF, hypertension, renal failure.
- Adverse Effects: Saliva substitute - complications from electrolyte absorption. Pancrelipase - GI irritation (nausea, abdominal cramps, diarrhea).
Cimetidine (Tagamet HB)
- H2 Antagonist: A prototype for this class.
- Adverse Effects: Known for antiandrogenic effects.
Additional Notes
- Question #1: The correct answer is A. Famotidine.
- Question #2: The statement is True. There is a drug-drug interaction between warfarin and sucralfate.
- Question #3: Cimetidine has been associated with antiandrogenic effects.
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Description
This quiz delves into the various drug classes that affect gastrointestinal (GI) secretions, including Histamine-2 antagonists, antacids, proton pump inhibitors, and more. It covers their mechanisms of action and specific medications within each class, as well as the implications of their use in managing GI disorders. Test your knowledge on these essential pharmacological agents!
