4. PROTON PUMP
INHIBITORS
1) Most effective Antisecretory drug
2) Half life =30-120min
3) Duration of action = >24hrs
4) Even though PPIs have a short half life but their duration of action is more
since they binds with receptors irreversibly and takes around 24hrs for
new receptors to form. Thus these are known as Hit and Run Drugs
5) Should be given 30 minutes prior to taking food so that when food is
ingested they should be available at the site of action.
STEP TO PG-MD/MS DR.AKIF A.B
6. PROTON PUMP
INHIBITORS
DRUG FEATURES
Lansoprazole -PPI of choice in pregnancy
- Enzyme Inhibitor
Omeprazole - Both Enzyme inducer(CYP1A2)
and Enzyme Inhibitor(CYP2C19)
Pantoprazole
Rabeprazole -most potent and fastest acting.
STEP TO PG-MD/MS DR.AKIF A.B
9. S/E of PROTON PUMP
INHIBITORS
1) Acid is required for proper digestion of food. So when acid is decreased
food is not digested properly and leads to:
1) Nausea
2) Flatulence
3) Constipation/ Diarrhoea
2) Pseudomembranous colitis :Decrease in acid leads to survival of bacterias
and leads to infection.
3) Hypergastrinemia
STEP TO PG-MD/MS DR.AKIF A.B
10. Chronic S/E of PROTON
PUMP INHIBITORS
-Decrease acid impairs absorption of calcium , Iron, Magnesium and Vitamin B12.
1) Osteoporosis
2)Anemia
3)Hypomagnesemia
STEP TO PG-MD/MS DR.AKIF A.B
11. DRUG INTERACTIONS
OF PPIs
CYP2C9 enzyme activates clopidogrel
PPIs inhibits CYP2C9
Thus PPIs shouldnât be combined with Clopidogrel
Since it will decrease the activation of clopidogrel
And its Antiaggregant effect.
STEP TO PG-MD/MS DR.AKIF A.B
12. ENZYME INDUCERS
G =Griseofulvin
P = Phenytoin
R = Rifampicin
S = Smoking
Cell = Carbamazepine
Phone = Phenobarbitone
STEP TO PG-MD/MS DR.AKIF A.B
13. ENZYME INHIBITORS
Vitamin = Valproate
K =ketoconazole
Can = Cimetidine
Cause = Ciprofloxacin
Enzyme =Erythromycin
Inhibition =Isoniazid
STEP TO PG-MD/MS DR.AKIF A.B
14. 1. Which of the following drugs is not used for H. pylori treatment? (LQ)
A Oxytetracycline
B Bismuth compounds
C Amoxicillin
D Mosapride
STEP TO PG-MD/MS DR.AKIF A.B
15. Ans. D Mosapride
Mosapride is a 5-HT4 agonist used in GERD. Rest of all drugs are used in H.Pylori
Drugs used against H. Pylori are:
1. Amoxicillin
2. Clarithromycin
3. Tetracycline
4. Metronidazole /Tinidazole
5. Bismuth subsalicylate
6. Omeprazole/ Lansoprazole
Monotherapy has failed in treatment of H. Pylori infections. Hence, multidrug regimens
given for 7-14 days are generally used.
STEP TO PG-MD/MS DR.AKIF A.B
16. Anti-H.pylori Agents
Triple Therapy Quadruple therapy
PPI OD PPI BD
Clarithromycin Metronidazole
Metronidazole or
Amoxicillin or
Tetracycline
Tetracycline
Bismuth Subsalicylate
- Given for 14days
STEP TO PG-MD/MS DR.AKIF A.B
17. 2. All are antiemetic except (DNB Dec 2009)
A Domperidone
B Metoclopramide
C Cinnarizine
D Ondansetron
STEP TO PG-MD/MS DR.AKIF A.B
19. Class of emetics Example
Anticholinergics Hyoscine, Dicyclomine
H1 antihistaminics
Promethazine, Diphenhydramine, Meclizine,
Dimenhydrinate, Cyclizine,
Neuroleptics
Chlorpromazine, Prochlorperazine,
Haloperidol,
etc.
Prokinetic drugs
Metoclopramide, Domperidone, Ciaspride,
Mosapride
5-HT 3 antagonists Ondansetron, Granisetron
Substance-P/Neurokinin Receptor Antagonist
(used inchemotherapy induced vomitting)
Aprepitant
Adjuvant antiemetics
Dexamethasone, Benzodiazepines,
Cannabinoids
STEP TO PG-MD/MS DR.AKIF A.B
20. 3. Most potent anti-emetic is: (DNB June 2010)
A Ondansetron
B Granisetron
C Dolasetron
D Palonosetron
STEP TO PG-MD/MS DR.AKIF A.B
21. Ans. D Palonosetron
5HT3 antagonist potency sequence {Mnemonics: PGOD}:
Palonosetron>Granisetron>Odansetron>Dolasetron
-5HT3 Receptor is present at CTZ area and its inhibition
prevents vomiting
STEP TO PG-MD/MS DR.AKIF A.B
22. Type of vomiting DOC
Early onset chemotherapy
Induced vomiting
Ondansetron
Late onset chemotherapy
Induced vomiting
Aprepitant
Motion sickness Scopalamine
>Hyoscine/Dicyclomine
Morning Sickness Pyridoxine + Doxylamine
STEP TO PG-MD/MS DR.AKIF A.B
23. 4. We have two patients. One requires suppression of emesis caused by an
anticancer drug that causes a high incidence and severity of vomiting (highly
emetogenic drug). Another patient has severe diabetic gastroparesis and
gastroesophageal reflux, which requires relief. Which one drug would be suitable
for both indications (assuming no specific contraindications)? (LQ)
A Diphenoxylate
B Dronabinol
C Loperamide
D Metoclopramide
STEP TO PG-MD/MS DR.AKIF A.B
24. Ans. D Metoclopramide
a. Metoclopramide has clinically useful antiemetic and prokinetic actions and
would be suitable for either of the patients described in the question.
b. The antiemetic effect arises from blockade of dopamine (and, probably,
serotonin) receptors in the brainâs chemoreceptor trigger zone (CTZ).
c. The enhanced gastric and upper intestinal motility probably reflects an
enhancement of the expected effects of ACh on muscarinic receptors found on
longitudinal smooth muscle in the GI tract.
d. Metoclopramide raises the lower esophageal sphincter tone and relaxes
the pyloric sphincter, which hastens gastric emptying.
e. This helps explain its beneficial effects in both gastroparesis and GERD.
Importantly, the drug should not be given along with atropine because of its
cholinergic properties.
STEP TO PG-MD/MS DR.AKIF A.B
25. -Acts by stimulating A-ch which increases motility and peristalsis of GIT
-A-ch stimulates GI Motility
-Dopaminergic(D2) and serotonergic (5HT4) neurons acts by forming synapse with
cholinergic neurons
-D2 is an Inhibitory neuron
-5HT4 is an stimulatory neuron.
-CCK and motilin are other receptors which increases GI motility
-Prokinetics acts by inhibiting D2 receptor and stimulating 5HT4, Motilin
and CCK.
STEP TO PG-MD/MS DR.AKIF A.B
27. D2 Antagonists
-Prokinetic effect
-Extra effects :
1) Antiemetic : Due to D2 antagonist effect at CTZ area
2) Increases Lower Esophageal Sphincter
3) Increases Gastric motility and emptying
4) Increases small intestinal motility
5) No effect on Large Intestine
STEP TO PG-MD/MS DR.AKIF A.B
28. - Prokinetic agent
-D2 Antagonist
-Also 5HT3 antagonist and 5HT4 agonist
-Uses : 1) Gastroparesis : Since it increases Gastric motility
2) GERD : Since it increases LES pressure
3) Post op Ileus : Since it increases motility of small intestine
4) Hiccups
-It is lipid soluble drug. Hence easily crosses BBB and due to D2 Antagonism
it causes Hyperprolactinemia, Extrapyramidal S/E.
STEP TO PG-MD/MS DR.AKIF A.B
29. -Exclusively D2 receptor Antagonism
-Lipid insoluble drug. Hence doesnât crosses BBB
-Doesnât cause Hyperprolactinemia, Extrapyramidal S/E.
-Uses similar to Metoclopromide
STEP TO PG-MD/MS DR.AKIF A.B
30. 5. A patient presents with severe abdominal pain. Endoscopy reveals several
benign ulcers in the antral mucosa of the stomach. When therapy is started,
which will provide the fastest relief of the discomfort with just a single dose?
(AIPG 2010)
A Antacids
B Ranitidine
C Misoprostol
D Omeprazole
STEP TO PG-MD/MS DR.AKIF A.B
31. Ans. A Antacids
a. The typical symptoms of acid-peptic disease are caused by acid.
b. Although antacids seem to have no ability to accelerate ulcer healing, they act
almost instantaneously to neutralize acid (provided adequate dosages are given),
thereby relieving pain and other discomforts that are due to the acid in a matter
of a minute or so.
c. All the other drugs can, to varying degrees, suppress gastric acid secretion and
ultimately get the patient near or to a âno acid, no painâ state. However, it takes
some time (variable, but clearly longer than it takes for an antacid to work) for
other medications to be absorbed and reach blood levels sufficient to suppress
acid production and then reduce symptoms.
STEP TO PG-MD/MS DR.AKIF A.B
32. Traditional and obsolete Now being used
Calcium carbonate Combination of Aluminium
and Magnesium salt
Sodium bicarbonate
- Calcium carbonate and Sodium bicarbonate is not being used due to risk of
MILK-ALKALI Syndrome.
-Aluminium salts causes Constipation and Magnesium salts causes
Diarrhoea. Hence both are combined to counteract their extra effects.
-Aluminium hydroxide is absolutely C.I in Renal failure
-Magnesium hydroxide can decrease absorption of fat soluble vitamins.
Hence should be avoided in elderly patients.
STEP TO PG-MD/MS DR.AKIF A.B
34. 6. Which of the following drug is not a gastrokinetic
drug:
A Erythromycin
B Domperidone
C Cisapride
D Ampicillin
STEP TO PG-MD/MS DR.AKIF A.B
35. Ans. D Ampicillin
GASTROKINETIC DRUGS:
Metoclopramide
Domperidone
Cisapride
Erythromycin (via motilin receptors)
*Prokinetic drugs act by promoting gastric motility, increase gastric
emptying, prevent the retention and reflux of gastric contents and thus
provide symptomatic relief.
STEP TO PG-MD/MS DR.AKIF A.B
36. 7. Misoprostol is a: (DNB June 2012)
A Prostaglandin E1 analogue
B Prostaglandin E2 analogue
C Prostaglandin antagonist
D Antiprogestin
STEP TO PG-MD/MS DR.AKIF A.B
37. Ans. A Prostaglandin E1 analogue
Prostaglandin Analogues:
MOA
It is a synthetic analogue of PGE1. It produces significant reduction of basal and
food stimulated acid secretion. It is rapidly absorbed undergoes extensive first
pass metabolism. Peak effect seen in 60 min and lasts for 3 hours.
INDICATION
The primary use of PG analogue is in the prevention of NSAID associated
gastrointestinal injury and blood loss. Especially in patients in which NSAIDS
can not be stopped.
CONTRAINDICATION
Inflammatory bowel disease
ADVERSE EFFECTS
N/V, diarrhea, abdominal cramps. It can cause bleeding and abortion in
pregnancy
STEP TO PG-MD/MS DR.AKIF A.B
39. 8. Which one of the following drugs increases gastrointestinal motility? (LQ)
A Glycopyrrolate
B Atropine
C Neostigmine
D Fentanyl
STEP TO PG-MD/MS DR.AKIF A.B
40. Ans. C Neostigmine
Anticholinesterase drugs increase the level of ACh by protecting it from hydrolysis.
Neostigmine is an anticholinesterase drug.
Fentanyl:
a. It is an opioid analgesic which leads to constipation by:
b. Direct action on GIT/CNS increases tone and segmentation but decreases
propulsive movement.
c. Spasm of pyloric / ileo-caecal and anal sphincters.
d. Decrease in all GIT secretions.
f. Central action causing inattention to defecation reflex.
Glycopyrrolate :
a. Anticholinergic drug. Hence decreases Gastric motility
b. Potent anti secretory
c. Potent antibradycardia drug
d. Lack of central action
e. Used in preanesthetic medication
STEP TO PG-MD/MS DR.AKIF A.B
41. ANTICHOLINERGICS IN PEPTIC
ULCER DISEASE
1) Pirenzepine
2) Telenzepine
-Decreases Acid secretion by Inhibiting M1 Receptors
-Not being used much because of other better drugs.
STEP TO PG-MD/MS DR.AKIF A.B
42. 9. Drug implicated for prolonging QT interval in a premature baby is:
(AIIMS Nov 2010)
A Domperidone
B Metoclopramide
C Cisapride
D Omeprazole
STEP TO PG-MD/MS DR.AKIF A.B
43. Ans. C Cisapride
Drugs causing prolonged QT interval / Torsades de pointes
Antiarrhythmic Antihistaminics CYP 3A4
inhibitors
Others
Quinidine
Amiodarone
Procainamide
Disopyramide
Terfenadine
Astemizole
Ketoconazole
Fluconazole
Imipramine
Amitriptyline
Erythromycin
Haloperidol
Cisapride
STEP TO PG-MD/MS DR.AKIF A.B
44. 10. Which of the following is false regarding metoclopramide: (AIIMS May 2009)
A Extrapyramidal side effects
B Promotes gastric motility
C Milk secretion
D Stimulates chemo trigger zone
STEP TO PG-MD/MS DR.AKIF A.B
45. Ans. D Stimulates chemo trigger zone
b. It speeds gastric emptying by increasing gastric peristalsis and relaxing
pylorus and first part of duodenum. It directly acts on CTZ and blocks it.
c. It is a dopamine (D2) receptor blocker and produces extrapyramidal side
effects and hyperprolactinemia.
STEP TO PG-MD/MS DR.AKIF A.B
46. 11) Dimethyl polysiloxane acts as: (LQ)
A Defoaming agent
B Local antacids
C Systemic antacids
D Ulcer healing agents
STEP TO PG-MD/MS DR.AKIF A.B
47. Ans. A Defoaming agent
Dimethyl Polysiloxane (Simethicone) is a silicon polymer, which reduces
surface tension and collapses the froth (antifoaming agent).
It is not absorbed from intestine and is pharmacologically inert.
It reduces flatulence.
STEP TO PG-MD/MS DR.AKIF A.B
48. 12) Proton pump inhibitors are most effective when: (LQ)
A Given after prolonged fasting
B Along with an H2 blocker
C Given with meals
D Given before meals
STEP TO PG-MD/MS DR.AKIF A.B
49. Ans. D Given before meals â
Proton pump inhibitors are most effective when taken
immediately before a meal, preferably with the morning
meal.
STEP TO PG-MD/MS DR.AKIF A.B
50. PROTON PUMP
INHIBITORS
1) Most effective Antisecretory drug
2) Half life =30-120min
3) Duration of action = >24hrs
4) Even though PPIs have a short half life but their duration of action is more
since they binds with receptors irreversibly and takes around 24hrs for
new receptors to form. Thus these are known as Hit and Run Drugs
5) Should be given 30 minutes prior to taking food so that when food is
ingested they should be available at the site of action.
STEP TO PG-MD/MS DR.AKIF A.B
51. 13. Ondansetron is a potent: (DNB Dec 2012)
A
Antiemetic
B
Anxiolytic
C
Analgesic
D
Antidepressant
STEP TO PG-MD/MS DR.AKIF A.B
52. Ans. A Antiemetic
a. Ondansetron is a competitive, highly selective antagonist of 5-hydroxy
tryptamine (serotonin) subtype-3 (5HT3) receptors.
b. Ondansetron is indicated for the prevention of nausea and vomiting
associated with initial and repeat courses of moderately of highly emetogenic
cancer chemotherapy, including high-dose cisplatin.
STEP TO PG-MD/MS DR.AKIF A.B
53. 14. Which one of the following drugs has been shown to offer protection from
gastric aspiration syndrome in a patient with symptoms of reflux? (LQ)
A Ondansetron
B Metoclopramide
C Sodium citrate
D Atropine
STEP TO PG-MD/MS DR.AKIF A.B
54. Ans. B Metoclopramide
a. Metoclopramide has been used in patients with gastroesophageal reflux
disease (GERD); it can produce symptomatic relief without necessarily
promoting healing of associated esophagitis.
b. Metoclopramide is indicated more often in symptomatic patients with
gastroparesis, in whom it may cause mild to moderate improvement in gastric
emptying.
STEP TO PG-MD/MS DR.AKIF A.B
55. 15. The two most common ingredients in over-the-counter antacid combination
products are a magnesium salt and an aluminum salt. The rationale for this
particular combination is that: (LQ)
A. Al salts counteract the gastric mucosal-irritating effects of Mg salts
B. Al salts require activation by an Mg-dependent enzyme
C. Mg salts cause a diuresis that helps reduce systemic accumulation of the Al salt
by increasing renal Al excretion
D. Mg salts tend to cause a laxative effect that counteracts the tendency of an Al
salt to cause constipation
STEP TO PG-MD/MS DR.AKIF A.B
56. Ans. D Mg salts tend to cause a laxative effect that counteracts the tendency of
an Al salt to cause constipation.
a. Magnesium salts used alone tend to cause a laxative effect. (Indeed, at dosages
higher than those used for acid neutralization, magnesium salts are used for
their laxative or cathartic effects.) Aluminum (and calcium) antacids, given
alone, tend to cause constipation. Combining a magnesium salt with an
aluminum (and/or calcium antacid) is an often successful approach to
minimizing antacid-induced changes of net gut motility
STEP TO PG-MD/MS DR.AKIF A.B
57. 16. A 55-year-old woman with insulin-dependent diabetes of 40 years' duration
complains of severe bloating and abdominal distress, especially after meals.
Evaluation is consistent with diabetic gastroparesis. The drug you would be most
likely to recommend is (AIPG 2011)
A.Docusate
B.Dopamine
C.Loperamide
D.Metoclopramide
E.Sucralfate
STEP TO PG-MD/MS DR.AKIF A.B
58. Ans. D Metoclopramide
Of the drugs listed, only metoclopramide is considered a
prokinetic agent, i.e. one that increases propulsive motility in
the gut.
STEP TO PG-MD/MS DR.AKIF A.B
59. - Prokinetic agent
-D2 Antagonist
-Also 5HT3 antagonist and 5HT4 agonist
-Uses : 1) Gastroparesis : Since it increases Gastric motility
2) GERD : Since it increases LES pressure
3) Post op Ileus : Since it increases motility of small intestine
4) Hiccups
-It is lipid soluble drug. Hence easily crosses BBB and due to D2 Antagonism
it causes Hyperprolactinemia, Extrapyramidal S/E.
STEP TO PG-MD/MS DR.AKIF A.B
60. 17.A patient who must take verapamil for hypertension and angina has become
severely constipated. Which of the following drugs would be most suitable as a
cathartic? (LQ)
A
Aluminum hydroxide
B
Diphenoxylate
C
Magnesium hydroxide
D
Metoclopramide
E
Mineral oil
STEP TO PG-MD/MS DR.AKIF A.B
61. Ans. C) Magnesium hydroxide
A cathartic that mildly stimulates the gut would be most suitable in a patient
taking a smooth muscle relaxant drug such as verapamil.
Magnesium hydroxide, by holding water in the intestine, provides additional
bulk and stimulates increased contractions.
STEP TO PG-MD/MS DR.AKIF A.B
62. 18. Your cousin is planning a three-week trip overseas and asks your advice
regarding medications for traveler's diarrhea. A drug suitable for noninfectious
diarrhea is
A
Aluminum hydroxide
B
Diphenoxylate
C
Magnesium hydroxide
D
Metoclopramide
E
Mineral oil
STEP TO PG-MD/MS DR.AKIF A.B
63. Ans. B Diphenoxylate
Diphenoxylate and Ioperamide are the traditional traveler's antidiarrheal
drugs.
Diphenoxylate requires a prescription in the USA but is less expensive than
loperamide.
STEP TO PG-MD/MS DR.AKIF A.B
65. LOPERAMIDE
-Opioid
-Mu receptor antagonist
-Decreases intestinal motility
-Increases anal sphincter pressure
-DOC in :
1) Irritable Bowel Sx
2) Ironitecan induced Diarrhea
-Also used in Travellerâs Diarrhea
-C.I : 1) Children <2yrs
2) Inflammatory Bowel Sx
STEP TO PG-MD/MS DR.AKIF A.B
66. OCTREOTIDE
-Somatostatin analog
-Inhibits secretion of various hormones in GIT like Serotonin, Gastrin ,VIP etc.
which leads to decrease GI Secretion and Motility.
-DOC in: HIV associated Diarrhea
-Other uses : 1) Secretory diarrhea
2) chemotherapy induced diarrhea
STEP TO PG-MD/MS DR.AKIF A.B
67. 19. Which of the following drugs or drug groups is not useful in the prevention
of nausea and vomiting induced by cancer chemotherapy (LQ)
A
Dexamethasone
B
Dronabinol
C
Ketanserin
D
Ondansetron
E
Phenothiazines
STEP TO PG-MD/MS DR.AKIF A.B
68. Ans. C Ketanserin
Ketanserin is an inhibitor of 5-HT 2 receptors and has no antiemetic action. All
of the other drugs listed are useful in preventing chemotherapy-induced nausea
and vomiting.
STEP TO PG-MD/MS DR.AKIF A.B
70. 20. On your way to an examination you experience that vulnerable feeling that
an attack of diarrhea is imminent. If you stopped at a drugstore, you could buy
this antidiarrheal drug without a prescription even though it is related
chemically to the strong opioid-analgesic meperidine (AIPG 2009)
A
Aluminum hydroxide
B
Diphenoxylate
C
Loperamide
D
Magnesium hydroxide
E
Metoclopramide
STEP TO PG-MD/MS DR.AKIF A.B
71. Ans. C Loperamide
a. Aluminum hydroxide is constipating but is not related chemically to
meperidine; magnesium hydroxide is a strong laxative.
b. The two antidiarrheal drugs that are structurally related to opioids are
diphenoxylate and loperamide.
c. Loperamide is available over-the-counter; diphenoxylate is mixed with atropine
alkaloids, and the product (Lomotil, others) requires a prescription.
STEP TO PG-MD/MS DR.AKIF A.B
72. 21. PPI with CYPP450 enzyme inhibiting activity (LQ)
A
Omeprazole
B
Rabeprazole
C
Esomeprazole
D
Pantoprazole
STEP TO PG-MD/MS DR.AKIF A.B
73. Ans. A Omeprazole
a. Omeprazole has maximum enzyme inhibiting action on CYPP450 among PPI.
The drug can inhibit metabolism of warfarin and therefore can lead to
bleeding. Pantoprazole is claimed to have lesser possibility of drug
interactions and stable pharmacokinetics.
b. Rabeprazole has best 24 hours pain relief and the drug has marginally better
efficacy than other proton pump inhibitors. Esomeprazole is an optical isomer of
omeprazole
STEP TO PG-MD/MS DR.AKIF A.B
74. 22) Which of the following drug is wrong about proton pump inhibitors (AIIMS
Nov 2010)
A
Pro-drugs
B
Short acting
C
Long acting
D
High first pass metabolism
STEP TO PG-MD/MS DR.AKIF A.B
75. Ans. B Short acting
a. These act by blocking the enzyme Na+K+ ATPase.
b. The drugs are well absorbed orally and in the apex of parietal canaliculi; these
drugs get converted into their active moiety.
b. The drugs have high first pass metabolism. They form a covalent bond with
their target. Perhaps, that is the reason of their long duration of action.
STEP TO PG-MD/MS DR.AKIF A.B
76. PROTON PUMP
INHIBITORS
1) Most effective Antisecretory drug
2) Half life =30-120min
3) Duration of action = >24hrs
4) Even though PPIs have a short half life but their duration of action is more
since they binds with receptors irreversibly and takes around 24hrs for
new receptors to form. Thus these are known as Hit and Run Drugs
5) Should be given 30 minutes prior to taking food so that when food is
ingested they should be available at the site of action.
STEP TO PG-MD/MS DR.AKIF A.B
77. S/E of PROTON PUMP
INHIBITORS
1) Acid is required for proper digestion of food. So when acid is decreased
food is not digested properly and leads to:
1) Nausea
2) Flatulence
3) Constipation/ Diarrhoea
2) Pseudomembranous colitis :Decrease in acid leads to survival of bacterias
and leads to infection.
3) Hypergastrinemia
STEP TO PG-MD/MS DR.AKIF A.B
78. Chronic S/E of PROTON
PUMP INHIBITORS
-Decrease acid impairs absorption of calcium , Iron, Magnesium and Vitamin B12.
1) Osteoporosis
2)Anemia
3)Hypomagnesemia
STEP TO PG-MD/MS DR.AKIF A.B
79. 23. Drug used in irritable bowel syndrome with consti- pation is (AI 2012)
A Lubiprostone
B Loperamide
C Alosetron
D Clonidine
STEP TO PG-MD/MS DR.AKIF A.B
80. Ans. A Lubiprostone
Lubiprostone acts by stimulating Cl channel opening in the intestine, increasing
liquid secretion in gut and decreasing transit time, therefore used for chronic
constipation.
It has also been approved for constipation dominant irritable bowel syndrome in
women.
STEP TO PG-MD/MS DR.AKIF A.B
82. Probiotics Bifidobacterium
Saccharomyces
Lactobacillus
Prebiotics Psyllium husk, bran, methyl cellulose
Symbiotics Combination of Pro and Prebiotics
Stimulants Bisacodyl, cascara , senna
Osmotic agents Lactulose, sorbitol, mannitol
Stool softeners Docusate sodium and calcium
Mineral oils
Chloride secretory drugs Lubiprostone, Linaclotide
STEP TO PG-MD/MS DR.AKIF A.B
83. PROBIOTICS
-Live organisms that provides benefit to health when taken in adequate amounts.
Bifidobacterium
Saccharomyces
Lactobacillus
STEP TO PG-MD/MS DR.AKIF A.B
84. PREBIOTICS
-Food ingredients that is composed of oligosaccharides, not digestable by humans,
but has a beneficial effect on growth of organisms.
Psyllium husk
Bran
methyl cellulose
STEP TO PG-MD/MS DR.AKIF A.B
86. STIMULANTS
Bisacodyl
cascara
senna
-These irritates colon by inducing inflammation and thus leads to water and solute
accumulation.
-Takes 5-6hrs to act
-Absolutely C.I in Intestinal Obstruction
-Cascara and senna can cause Melanosis coli
STEP TO PG-MD/MS DR.AKIF A.B
87. OSMOTIC AGENTS
Lactulose
Sorbitol
mannitol
-These are non digestible sugars metabolised into short chain fatty acids
which are Osmotic and draws water into intestinal lumen.
-Lactulose when metabolised into Short chain fatty acids makes intestinal pH
acidic which turns ammonia into polar ammonium and facilitates its excretion.
Hence used in Hepatic Encephalopathy.
STEP TO PG-MD/MS DR.AKIF A.B
88. STOOL SOFTENERS
1) Docusate sodium and calcium ; These are surfactants and softens stools by
decreasing Surface tension
2)Mineral oils : They directly enters stools and softens them.
STEP TO PG-MD/MS DR.AKIF A.B
89. 26) Which of the following agents are useful in medical treatment of variceal
bleeding? (AI 2011)
A
Octreotide
B
Pantoprazole
C
Somatotropin
D
Dexamethasone
Flip
STEP TO PG-MD/MS DR.AKIF A.B
90. Ans. A Octreotide
Management of Variceal Bleeding
A. Prevention of re-bleeding
¡ Non-selective beta blockers (e.g. propanolol)
¡ Variceal band ligation
B. Management of acute bleed
¡ Stabilize with fluids and blood
¡ Octreotide
¡ Vasopressin (Not preferred now)
¡ Balioon tamponade:
1. Sengstaken-Blackmore
2. Minnesota Tube
¡ Variceal ligation
¡ Variceal sclerotherapy
STEP TO PG-MD/MS DR.AKIF A.B
91. -Made of Sucrose + Aluminium Hydroxide
-acid stimulates its cross linking which produces a polymer which covers
the ulcer site
-Given on empty stomach before meals
-Antacids shouldnât be given along with it since acid is required
for its function. Thus a minimum of 30 minutes gap should be
maintained between antacids and sucralfate.
-S/E : MC: Constipation
STEP TO PG-MD/MS DR.AKIF A.B
92. These physically binds with ulcer and promotes mucin and bicarbonate production.
-Uses : 1) Anti H.pylori agent
2) Anti secretory hence used in Travellerâs diarrhea
-S/E : constipation and black discolration of tongue and stools
STEP TO PG-MD/MS DR.AKIF A.B
93. -Ranitidine
-Cimetidine = Shortest acting
-Famotidine = Longest acting
-DOC for Prophylaxis of Aspiration Pneumonia in patients undergoing
Surgery.
- Maximum ulcer healing effect is seen after 8 weeks.
STEP TO PG-MD/MS DR.AKIF A.B
94. 1) Enzyme Inhibitor
2) Anti androgenic actions
3) Gynecomastia and impotence in males
4) Hyperprolactnemia
5) Galactorrhea in females
6) Tolerance
7) hepatotoxicity
STEP TO PG-MD/MS DR.AKIF A.B
96. Anti integrin
drugs
Anti âTNF
drugs +/-
Azathioprine
Mesalamine
CyclosporineAzathioprine
ResistanceDependence
Steroids
Mesalamine
Severe
Mild/
Moderate
MaintenanceInduction
Ulcerative
colitis
NR
NR
NR
STEP TO PG-MD/MS DR.AKIF A.B
97. Anti integrin
drugs
Anti âTNF
drugs +/-
Azathioprine
Steroids
Severe
Mild/
Moderate
MaintenanceInduction
Crohnâs
disease
Anti
TNF@
NR
NR âNo Response
STEP TO PG-MD/MS DR.AKIF A.B