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Chapter 59: Drugs Used in Gastrointestinal Disorders

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?

(A) Alosetron

(B) Cimetidine

(C) Loperamide

(D) Metoclopramide

(E) Sucralfate

Of the drugs listed, only metoclopramide is considered a prokinetic agent (ie, one that increases propulsive motility in the gut). The answer is D. Alosetron is a 5HT3 receptor blocker, cimetidine is a H2 receptor blocker, loperamide is an opioid, and sucralfate forms a protective layer over an ulcer.

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?

(A) Aluminum hydroxide

(B) Diphenoxylate

(C) Magnesium hydroxide

(D) Metoclopramide

(E) Ranitidine

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. Diphenoxylate is an opioid receptor agonist, metoclopramide is a prokinetic agent, ranitidine is a H2 receptor blocker.

A 40-year-old male CEO came to the emergency department with severe burning chest pain radiating to 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?

(A) Cimetidine

(B) Diphenoxylate

(C) Esomeprazole

(D) Metoclopramide

(E) Sulfasalazine

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.

A 25-year-old college student went to student health care center for severe cramps, diarrhea, ...

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