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Chapter 59: Drugs Used in Gastrointestinal Disorders

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A 55-year-old woman with type 1 diabetes of 40 years’ duration complains of severe bloating and abdominal distress, especially after meals. Evaluation is consistent with diabetic gastroparesis. Which of the following is a prokinetic drug that could be used in this situation?

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(A) Alosetron

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(B) Cimetidine

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(C) Loperamide

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(D) Metoclopramide

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(E) Sucralfate

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Of the drugs listed, only metoclopramide is considered a prokinetic agent (ie, one that increases propulsive motility in the gut). The answer is D.

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A patient who is taking verapamil for hypertension and angina has become constipated. Which of the following drugs is an osmotic laxative that could be used to treat the patient’s constipation?

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(A) Aluminum hydroxide

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(B) Diphenoxylate

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(C) Magnesium hydroxide

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(D) Metoclopramide

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(E) Ranitidine

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A laxative that mildly stimulates the gut would be most suitable in a patient taking a smooth muscle relaxant drug such as verapamil. By holding water in the intestine, magnesium hydroxide provides additional bulk and stimulates increased contractions. A helpful mnemonic is magnesium “magnifies” stool, aluminum hALts the stool. The answer is C.

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A 40-year-old male CEO came to the emergency department with severe burning chest pain radiating into his neck. His electrocardiogram was normal and test for troponin was negative. A diagnosis of GERD was made and he was sent home with a prescription for a drug that inhibits stomach acid. Which of the following is a drug that irreversibly inhibits the H+/K+ ATPase in the parietal cells?

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(A) Cimetidine

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(B) Diphenoxylate

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(C) Esomeprazole

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(D) Metoclopramide

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(E) Sulfasalazine

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Esomeprazole, the (S) isomer of omeprazole, is a prodrug converting spontaneously in the parietal cell canaliculus to a sulfonamide that irreversibly inactivates the proton pump. The answer is C.

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Which drug is most likely to be useful in the treatment of inflammatory bowel disease?

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(A) Diphenhydramine

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(B) Diphenoxylate

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(C) Mesalamine

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(D) Ondansetron

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(E) Ursodiol

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