Gobind rai gastrointestinal system
Ondansetron acts by: (PGI June, 2002)(a) Acting on CTZ(b) 5-HT3 antagonism(c) D1 and D2 receptor antagonism(d) Increasing GIT motility(e) Blocking cholinergic receptors
(a) Acting on CTZ ; (b) 5-HT 3 antagonism (Ref: KDT 6/e p646) • Ondansetron blocks the deoplarizing action of serotonin through 5-HT 3 receptors on vagal afferents in the gut as well as in NTS and CTZ. • It do not block dopamine receptors (D 1 and D 2 ) or ACh receptors.
Apart from diarrhea, oral rehydration solution has beenemployed in:(a) Severe vomiting(b) Burn cases(c) Heat stroke(d) Both (b) and (c)
(d) Both (b) and (c) (Ref: KDT 6/e p659) Non-diarrheal uses of ORS include: • Maintenance of hydration in postsurgical, postburn and post-trauma patients • Heat stroke • During changeover from total parenteral nutrition to enteral nutrition.
The inhibition of hydrochloric acid (HCl) secretion byomeprazole occurs within an hour, reaches a peak at 2hours, and plateaus by 4th day. After how many dayswill the secretion gradually normalize:(a) < 24 hours (MH 2008)(b) 1-2 days (c) 3-5 days(d) 6-10 days
3-5 days
Ondansetron acts by inhibiting which of the followingreceptors?(a) 5-HT1 (RJ 2006, 2005)(b) 5-HT2 (TN 2002, Jhankhand 2004, 2005)(c) 5-HT3(d) 5-HT4
5HT 3
Which of the following 5-HT receptors play an important role in causing emesis?(a) 5HT1(b) 5HT2A/2C(c) 5HT3(d) 5HT4
5HT 3
The concentration of sodium ions in the standard WHOoral rehydration solution is:(a) 40 m moles/L(b) 60 m moles/L(c) 90 m moles/L(d) 110 m moles/L
90 mmoles/L (Ref: KDT 6/e p658, 659) Concentration of Na + is 90 mmol/L in standard WHO-ORS whereas it is 75 mmol/L in New formula ORS.
Regarding aprepitant all are true except:(a) Agonist at NK1 receptors (AI 2011)(b) Crosses Blood Brain Barrier(c) Ameliorate nausea and vomiting induced by chemotherapy(d) Metabolized by CYP450 enzymes
Agonist at NK 1 receptors (Ref: Katzung,11/e p1086, Goodman and Gilman, 11/e p650) • Aprepitant is a highly selective NK1 receptor antagonists, orally active, and enter the brain. • It is used in treating and preventing chemotherapy-induced emesis. • It is metabolized by CYP3A4 enzymes and can also inhibit the metabolism of drugs metabolized by this enzyme e.g. warfarin.
Which of the following statements is true about newformula WHO-ORS?(a) It has Na+ ion concentration of 75 mM/L(b) Its glucose concentration is 75 mM/L(c) Its total osmolarity is 245 mOsm/L(d) All of the above
All of the above
Antacid combinations of magnesium and aluminiumsalts are superior to single component preparationsbecause:(a) They have rapid as well as sustained acid neutralizing action(b) They are less likely to affect gastric emptying (c) They are less likely to alter bowel movement(d) All of the above
All of the above (Ref: KDT 6/e p635) • Mg (OH) 2 has a quick onset whereas Al (OH) 3 acts for a long time. • Magnesium salts cause osmotic diarrhea whereas aluminium salts cause constipation. Combination of these two agents minimizes the impact on bowel movements.
Drug used in cancer chemotherapy induced vomitingis?(a) Aprepitant(b) Dexamethasone(c) Ondansetron(d) All of the above
All of the above (Ref: KDT 7/e p876) • Ondansetron is drug of choice for chemotherapy induced vomiting • Dexamethasone, lorazepam and aprepitant are also used for chemotherapy induced vomiting.
The following appears to affect the integrity of theadherent gel of sucralfate interfering with its action:(a) Antacids (TN 1991) (AP 2001)(b) Food(c) Mucin(d) Proteins in foodstuffs
Antacids
All of the following statements about treatment ofdiarrhea are correct except:(a) Opioids delay passage of gut contents by reducingperistalsis(b) Loperamide is an opioid with anti motility action(c) Anti motility drugs are best drugs for infective diarrhea(d) Diphenoxylate overlose can cause respiratory depression
Anti motility drugs are best drugs for infective diarrhea
Which of the following is not the effect of ranitidine ascompared to cimetidine? (MH 2003)(a) Action on H2 receptors(b) Given orally(c) Used with proton pump blockers(d) Anti-androgenic action
Anti-androgenic action
Which drug is given in delayed vomitting after chemotherapy:(a) Metoclopramide(b) Hyoscine(c) Domperiodone(d) Aprepitant
Aprepitant
Which of the following is an antagonist of a peptideand is used to reduce chemotherapy induced nauseaand vomiting?(a) Atrial natriuretic peptide(b) Aprepitant(c) Bradykinin(d) Enalapril
Aprepitant (Ref: Goodman & Gilman 11/e p1005) This drug is an antagonist of substance P. It is particularly useful in delayed phase of chemotherapy induced vomitting.
A patient on cisplatin therapy develops intractablevomiting on the third day of treatment. Agent of choicefor controlling this vomiting is:(a) Aprepitant(b) Ondansetron(c) Metoclopramide(d) Prochlorperazine
Aprepitant (Ref: Katzung 10/e p1027, 1028) Cisplatin induced vomiting has two phases. EarlyPhase: It occurs within first 24 hours. 5 HT 3 antagonists like ondansetron are the agents of choice for this condition. 2. Delayed Phase: Vomiting occurring after 24 hours is less responsive to ondansetron and other drugs. It is best controlled by substance P antagonist like aprepitant.
Not true about the composition of ORS:(a) NaCl -3.5g (Kolkata 2005)(b) KCl -1.5g(c) Bicarbonate -2g(d) Glucose -20g
Bicarbonate -2 g
Drug used in the treatment of gastric ulcer due to H.pylori is: (TN 2006)(a) Anticholinergics(b) Carbenoxolone sodium(c) Bismuth sub citrate(d) Corticosteroid
Bismuth sub citrate
The therapeutic effect of sulfasalazine in ulcerativecolitis is exerted by:(a) Inhibitory action of the unabsorbed drug on the abnormal colonic flora(b) Breakdown of the drug in colon to release 5-aminosalicylic acid which suppresses inflammation locally(c) Release of sulfapyridine having antibacterial property(d) Systemic immunomodulatory action of the drug
Breakdown of the drug in colon to release 5-ASA which suppresses inflammation locally
Gynaecomastia can occur as a side effect of: (a) Bromocriptine (b) Cimetidine (c) Famotidine (d) Levodopa
Cimetidine
Which of the following drugs is not an antiemetic?(a) Ondansetron (AIIMS May, 2007)(b) Domperidone(c) Metoclopramide(d) Cinnarizine
Cinnarizine (Ref: KDT, 6/e p641-642) • Cinnarizine is an anti-vertigo drug. • Metoclopramide and domperidone are antiemetic drugs. These act by blocking D 2 receptors. • Ondansetron is an antagonist of 5 HT 3 receptors. It is the drug of choice for chemotherapy induced vomiting.
All of the following antibiotics have been used intreatment of H.pylori infection, except:(a) Clarithromycin(b) Amoxicillin(c) Metronidazole(d) Ciprofloxacin
Ciprofloxacin
The drugs employed for anti-H. pylori therapy includeall of the following EXCEPT:(a) Ciprofloxacin(b) Clarithromycin(c) Tinidazole(d) Amoxicillin
Ciprofloxacin
A prokinetic drug which lacks D2 receptor antagonisticaction is which one of the following:(a) Metoclopramide(b) Domperidone(c) Cisapride(d) Chlorpromazine
Cisapride
Drug not used in the treatment of H.pylori is:(a) Cisapride(b) Clarithromycin(c) Metronidazole(d) Omeprazole
Cisapride
Which of the following prokinetic drugs has beenimplicated in causing serious ventricular arrhythmias,particularly in patients concurrently receivingerythromycin or ketoconazole?(a) Domperidone(b) Cisapride(c) Mosapride(d) Metoclopramide
Cisapride (Ref: KDT 6/e p645) • Cisapride is a 5HT 4 agonist that can block cardiac K + channels at high concentration. When these are administered with microsomal enzyme inhibitors (like erythromycin or ketoconazole), polymorphic ventricular tachycardia can result. • Mosapride and tegaserod are other 5HT 4 agonists that are devoid of arrhythmogenic action
Drug implicated in prolonging QT interval is:(a) Domperidone (AI 2004)(b) Metoclopramide (RJ 2007)(c) Cisapride(d) Omeprazole
Cisapride (Ref: KDT 6/e p645) Cisapride is a 5HT 4 agonist that is useful as a prokinetic agent. At high plasma concentration, it can block cardiac K + channels leading to polymorphic ventricular tachycardia (torsades de pointes). It is manifested in the ECG as QT prolongation. Therefore, cisapride should not be combined with microsomal enzyme inhibitors like erythromycin and ketoconazole. Other important drugs causing QT prolongation are • Terfenadine • Astemizole • Ziprasidone
Anti emetic action is produced through:(a) Decreased CTZ stimulation (PGI Dec. 2002)(b) H1 agonistic action(c) D1 antagonistic action(d) Olfactory apparatus stimulation(e) 5 HT4 agonistic action
Decreased CTZ stimulation; (e) 5-HT 4 agonistic action (Ref: KDT 6/e p643) The mechanisms of actions of antiemetic drugs are: • Anticholinergic (Inhibit muscarinic M 1 receptors) e.g. hyoscine. • H 1 antihistaminics e.g. promethazine, diphenhydramine, cyclizine. • 5-HT 3 antagonists e.g. ondansetron, Granisetron. Adjuvant antiemetics, e.g. Dexamethasone, benzodiazepines, cannabinoids. • Prokinetics: - 5HT 4 agonists, e.g. cisapride - Motilin agonist, e.g. erythromycin - Somatostatin analogues, e.g. octreotide • CTZ (chemoreceptor trigger zone) contains histamine (H 1 ), dopamine (D 3 ), cholinergic (M), opioid (µ) and serotonin (5-HT 3 ) receptors. Antiemetic acts by inhibiting the receptors at CTZ.
Best for treatment of irritable bowel syndrome withspastic colon is: (MH 2000)(a) Liquid parafin(b) Senna(c) Bisacodyl(d) Dietary fibers
Dietary fibers
A small amount of atropine is added to diphenoxylatein order to:(a) Suppress associated vomiting of gastroenteritis(b) Augment the anti-motility action of diphenoxylate(c) Block side effects of diphenoxylate(d) Discourage overdose and abuse of diphenoxylate
Discourage overdose and abuse of diphenoxylate
Which of the following stool softeners does not interferewith fat absorption?(a) Docussates(b) Phenolphthalein(c) Liquid paraffin(d) Castor oil
Docussates (Ref: KDT 7/e p673-674) • Phenolphthalein and castor oil are stimulant purgatives whereas docussates (DOSS) and liquid paraffin are stool softners. Liquid paraffin may cause deficiency of fat soluble vitamins.
Drug stimulating 5HT4 receptors to act as prokineticagents are all of the following Except:(a) Renzapride (MH 2006)(b) Metoclopramide(c) Domperidone(d) Cisapride
Domperidone
Which antiemetic drug selectively blocks levodopainduced vomiting without blocking its antiParkinsonian action?(a) Metoclopramide(b) Cisapride(c) Domperidone(d) Ondansetron
Domperidone (Ref: KDT 6/e p645) • Levo-dopa induced vomiting is due to stimulation of D 2 receptors in CTZ whereas its antiparkinsonian action is due to agonistic action on D 2 receptors in the nigrostriatal pathway. • Both metoclopramide and domperidone inhibit D 2 receptors in CTZ and thus counteract vomiting induced by l-dopa. • Metoclopramide also crosses BBB and thus abolishes the therapeutic action of l-dopa by inhibiting central D 2 receptors. • Domperidone cannot cross BBB, thus does not interfere with antiparkinsonian action of l-dopa. • Cisapride (5HT 4 agonist) and ondansetron (5HT 3 antagonist) do not affect dopaminergic pathway.
All of the following are true about ondansetron except:(a) Drug of choice for chemotherapy induced vomiting(b) Dopamine antagonist(c) 5HT3 antagonist(d) Used to prevent relapse in alcohol dependence
Dopamine antagonist
Metoclopramide (DPG 2009)(a) Inhibit cholinergic smooth muscle stimulation in thegastrointestinal tract(b) Decrease lower esophageal sphincter pressure (c) Stimulate D2 receptor(d) Enhance colonic motility
Enhances colonic motility (Ref: Katzung 10/e p1021; KDT 6/e p643) • Metoclopramide is a D 2 receptor antagonist that increases cholinergic activity by inhibiting pre-synpatic D 2 receptors in GIT (D 2 receptor stimulation inhibits the release of ACh). • It increase LES tone that is also responsible for anti-emetic action. • It does not significantly increase colonic motility. • But out of the four options, this is the best answer, because although not significantly but it can increase colonic motility, whereas other options are definitely wrong.
Drug of choice for the treatment of peptic ulcer causeddue to chronic use of NSAIDs is:(a) Pirenzepine(b) Loxatidine(c) Misoprostol(d) Esomeprazole
Esomeprazole (Ref: KDT 6/e p632) • Proton pump inhibitors are the drugs of choice for peptic ulcer disease due to any etiology. • Misoprostol is the MOST SPECIFIC drug for the treatment of PUD due to chronic NSAID use because it is a PGE analog.
Which is not an adverse effect of cimetidine?(a) Impotence(b) Gynaecomastia(c) Atrophic gastritis(d) Galactorrhea
Galactorrhea
The success of oral rehydration therapy of diarrheadepends upon which of the following processes in theintestinal mucosa?(a) Sodium pump mediated Na+ absorption(b) Glucose coupled Na+ absorption(c) Bicarbonate coupled Na+ absorption(d) Passive Na+ diffusion secondary to nutrient absorption
Glucose coupled Na + absorption
Esomeprazole acts by inhibiting: (MH 2005)(a) H+K+ ATPase pump(b) H+Na+ ATPase pump(c) H+ pump(d) Any of the above
H + K + ATPase pump
All of the following are effective against cytotoxic druginduced emesis except:(a) Dronabinol(b) Hyoscine(c) Metoclopramide(d) Ondansetron
Hyoscine
Metoclopramide has the following actions EXCEPT:(a) Increase lower esophageal sphincter tone(b) Prokinetic action is blocked by atropine(c) Increase gastric peristalsis(d) Increase large intestinal peristalsis
Increase large intestine peristalsis (Ref: KDT 6/e p643) • Metoclopramide is a prokinetic and anti-emetic drug. It acts by blocking D 2 and 5 HT 3 receptors and stimulating 5-HT 4 receptors. D 2 receptors are normally inhibitory to the release of ACh. Metoclopramide enhances ACh release by blocking these inhibitory D 2 receptors. Due to increased release of ACh, there is increase in gastric motility and LES tone. Prokinetic action can thus be blocked by atropine. • Metoclopramide has no effect on colonic motility.
Which one of the drugs is useful in treating Crohn'sdisease? (Karnataka 2006)(a) Infliximab(b) Azathioprine(c) Tacrolimus(d) Cyclosporine
Infliximab
Ranitidine differs from cimetidine in the followingrespect:(a) It is less potent(b) It is shorter acting(c) It does not have anti-androgenic action(d) It produces more CNS side effects
It does not have anti-androgenic action (Ref: KDT 6/e p629) Cimetidine is rarely used now because: • It is the least potent H 2 blocker • It is a short acting agent • It is a potent inhibitor of microsomal enzymes • It can cause gynaecomastia • It produces more CNS adverse effects
Choose the correct statement about colloidalbismuth subcitrate:(a) It causes prolonged neutralization of gastric acid(b) It has anti H. pylori activity(c) It relieves peptic ulcer pain promptly(d) All of the above are correct
It has anti-H. pylori activity Colloidal bismuth subcitrate forms an acid resistant protective coating over the ulcer base. It also dislodges H.pylori from the surface of gastric mucosa.
The new formula WHO-ORS differs from the olderstandard formula WHO-ORS in the following respect:(a) It has lower Na+ and glucose concentration(b) It has higher K+ concentration(c) It has no basic salt(d) Both (b) and (c) are correct
It has lower Na + and glucose concentration (Ref: KDT 6/e p659) • New formula ORS contains less Na + and glucose than standard formula ORS. • Total osmolality is decreased to 245 mmol/L in New formula WHO ORS.
The following is true of anti-H. pylori therapy EXCEPT:(a) It is indicated in all patients of peptic ulcer(b) Resistance to any single antimicrobial drug developsrapidly(c) Concurrent suppression of gastric acid enhances theefficacy of the regimen(d) Colloidal bismuth directly inhibits H. pylori but haspoor patient acceptability
It is indicated in all patients of peptic ulcer (Ref: KDT 6/e p637, 638) • Triple drug therapy for H. pylori is indicated in those patients in whom infection is detected by urea breath test. Since H. pylori becomes less virulent in the absence of acid, combination with PPI is more effective. • Because resistance can develop to single agents, these are used in combination. • Colloidal bismuth subcitrate dislodges H. pylori but produces metallic taste and blackening of tongue.
Cimetidine inhibits the metabolism of all of thefollowing drugs EXCEPT: (DPG 1997)(a) Phenytoin(b) Warfarin(c) Ketoconazole(d) Diazepam
Ketoconazole (Ref: KDT 6/e p630) Cimetidine is a potent inhibitor of microsomal enzymes. It prolongs the half lives of warfarin, theophylline, phenytoin, oral hypoglycemic agents, alcohol and benzodiazepines.
Drug useful in hepatic encephalopathy is:(a) Magnesium sulphate (DPG 2005)(b) Lactulose(c) Bisacodyl(d) Biphosphonates
Lactulose • Lactulose is a laxative that acts by conversion to short chain fatty acids in the colon. • These fatty acids result in decrease in pH of intestinal juice. • At low pH, ammonia becomes ionized (NH 4 + ) and thus cannot be absorbed.
Which of the following laxatives lowers blood ammonialevel in hepatic encephalopathy?(a) Bisacodyl(b) Liquid paraffin(c) Lactulose(d) Magnesium sulfate
Lactulose (Ref: KDT 6/e p655) Lactulose is degraded to lactic acid that converts NH 3 to NH 4 + . As ionic molecules cannot cross biological membranes, it is not absorbed and is thus excreted.
Which laxative acts by opening of chloride channels?(a) Docusate(b) Anthraquinone(c) Lubiprostone(d) Bisacodyl
Lubiprostone
Drug used in irritable bowel syndrome with constipation is: (AI 2012)(a) Lubiprostone(b) Loperamide(c) Alosetron(d) Clonidine
Lubiprostone (Ref: Katzung 11/e p1080) 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.
Antacid drug that typically causes diarrhea?(a) Sodium bicarbonate (MH 2007)(b) Magnesium hydroxide(c) Calcium bicarbonate(d) Aluminium hydroxide
Magnesium hydroxide
Which one of the following is not an antacid?(a) Magnesium sulfate (TN 2008)(b) Magaldrate(c) Magnesium carbonate(d) Magnesium phosphate
Magnesium sulfate
Which of the following purgative increases the fecal bulkdue to their water absorbing and retaining capacity:(a) Methyl cellulose(b) Lactulose(c) Liquid paraffin(d) Dioctyl sodium sulfosuccinate
Methyl cellulose
Which of the following drugs is not used for motionsickness: (Kolkata 2007)(a) Metoclopramide(b) Cyclizine(c) Cinnarizine(d) Scopolamine
Metoclopramide
Which of the following prokinetic drugs producesextrapyramidal side effects?(a) Metoclopramide(b) Cisapride(c) Domperidone(d) All of the above
Metoclopramide (Ref: KDT 6/e p643, 644) • Metoclopramide and domperidone act by blocking D 2 receptors. • Metoclopramide can cross BBB whereas domperidone cannot. • Therefore, metoclopramide can produce extra-pyramidal adverse effects while domperidone is devoid of it. • Cisapride acts as 5HT 4 agonist. It can cause torsades de pointes.
Choose the antiulcer drug that inhibits gastric acidsecretion, stimulates gastric mucus and bicarbonatesecretion and has cytoprotective action on gastricmucosa:(a) Misoprostol(b) Sucralfate(c) Carbenoxolone sodium(d) Colloidal bismuth subcitrate
Misoprostol
Diarrhea (loose stools) is side effect of: (MH 2006)(a) Omeprazole(b) Sucralfate(c) Metoclopramide(d) Misoprostol
Misoprostol
Most specific drug for the treatment of peptic ulcerdisease due to chronic use of aspirin is:(a) Omeprazole(b) Misoprostol(c) Pirenzipine(d) Ranitidine
Misoprostol
Drug not used in H. pylori is: (AIIMS May 2008)(a) Metronidazole (AIIMS Nov., 2006)(b) Omeprazole(c) Mosapride(d) Amoxicillin
Mosapride Mosapride is a 5-HT 4 agonist used for GERD. Other drugs given in the options are used for H. pylori.
A 46-year-old male presents to OPD with diarrhea andabdominal pain. On investigations, it was found tobe non-infective and you proceed with diphenoxylatetherapy in this patient. Which of the following is theprimary target for the drug you prescribed to this patient?(a) Secretion(b) Digestion(c) Inflammation(d) Motility
Motility (Ref: Katzung 11/e p1080-1081) Diphenoxylate is an opioid; it binds to mu receptors in the GIT and slows motility.
Which one of the following drugs increases gastrointestinal motility?(a) Glycopyrrolate(b) Atropine(c) Neostigmine(d) Fentanyl
Neostigmine
Which of the following agents are useful in medicaltreatment of variceal bleeding? (AI 2011)(a) Octreotide(b) Pantoprazole(c) Somatotropin(d) Dexamethasone
Octreotide
A patient presents with Zollinger-Ellison syndromedue to gastrinoma. He has two bleeding ulcers anddiarrhoea. A drug that irreversibly inhibits the H+/K+ATPase in gastric parietal cells is:(a) Cimetidine (Karnataka 2007)(b) Cisapride(c) Glycopyrrolate(d) Omeprazole
Omeprazole
All are H 2 blocker except: (Jharkhand 2003, 2004)(a) Omeprazole(b) Cimetidine(c) Famatodine(d) Ranitidine
Omeprazole
The most efficacious drug for inhibiting round theclock gastric acid output is:(a) Omeprazole(b) Cimetidine(c) Pirenzepine(d) Misoprostol
Omeprazole
Indicate the drug which does not improve lower esophageal sphincter tone or prevent gastroesophagealreflux, but is used as the first line treatment of gastroesophageal reflux disease:(a) Sodium alginate + aluminium hydroxide gel(b) Omeprazole(c) Mosapride(d) Metoclopramide
Omeprazole (Ref: KDT 6/e p648) Treatment of GERD can be accomplished by • Increasing GI motility with prokinetic drugs (like metoclopramide and mosapride) or • By decreasing gastric acid secretion with PPIs like omeprazole.
Which of the following proton pump inhibitor hasenzyme inhibitory activity? (AI 2010)(a) Rabeprazole(b) Lansoprazole(c) Pantoprazole(d) Omeprazole
Omeprazole (Ref: Katzung 11/e p1075) • Omeprazole and esomeprazole are microsomal enzyme inhibitors. These may decrease the metabolism of diazepam. • Lansoprazole enhances the metabolism of theophylline.
Antiemetic used in vomiting induced by anticancerdrugs is:(a) Ondansetron(b) Cisapride(c) Metoclopramide(d) Trifluopromazine
Ondansetron
The most effective antiemetic for controlling cisplatininduced vomiting is:(a) Prochlorperazine(b) Ondansetron(c) Metoclopramide(d) Aprepitant
Ondansetron (Ref: KDT 6/e p646) 5HT 3 antagonists like ondansetron, granisetron and topisetron are the agents of choice for chemotherapy induced vomiting.
In case of hill journey, antimotion sickness drugs arebest administered at:(a) Twelve hours before commencing journey(b) One hour before commencing journey(c) Immediately after commencing journey(d) At the first feeling of motion sickness
One hour before commencing journey (Ref: KDT 6/e p641) Hyoscine is administered half to one hour before journey for prevention of motion sickness. It has no role once the vomiting starts
Which of the following drugs is not used for H. pyloritreatment? (AI 2007)(a) Oxytetracycline(b) Bismuth compounds(c) Amoxicillin(d) Omeprazole
Oxytetracycline
Which of the following agents is beneficial in NSAIDinduced gastric ulcer? (AI 2007)(a) PGE1 agonist(b) PGE2 agonist(c) PGD2 agonist(d) PGF2α agonist
PGE 1 agonist Misoprostol is a PGE 1 analog useful in peptic ulcer disease.
NSAID induced ulcer are treated by: (RJ 2005)(a) Antacids(b) H2 blockers(c) Misoprostol(d) PPI (proton pump inhibitors)
PPI
Primary role of antacids in peptic ulcer is:(a) Pain relief(b) Ulcer healing(c) H Pylori eradication(d) All of the above
Pain relief
For chemotherapy induced vomiting, 5HT3 antagonisthaving maximum potency is:(a) Ondansetron (AIIMS Nov., 2007)(b) Granisetron(c) Dolasetron(d) Palonosetron
Palonosetron
Which of the following is the most potent 5HT3antagonist?(a) Ondansetron(b) Granisetron(c) Dolasetron(d) Palonosetron
Palonosetron
Aryan, a 14-year-old boy presented with chronicdiarrhea and weight loss. History reveals that he hasrepeated attacks of respiratory tract infections withPseudomonas aeruginosa. His younger brother diedfrom a severe respiratory infection at the age of 7.Which of the following agents is most likely to improvethis patient's condition?(a) Octreotide (b) Pancreatic lipase(c) Metronidazole(d) Loperamide
Pancreatic lipase (Ref: Katzung 11/e p1093) In a young male, a history of recurrent respiratory infections with P. aeruginosa, chronic diarrhea, weight loss, and death of a sibling due to respiratory infection suggests a diagnosis of cystic fibrosis (CF). Chronic diarrhea and weight loss in patients with CF are typically caused by malabsorption secondary to pancreatic insufficiency and can be corrected by pancreatic enzyme supplementation.
M1 blocker used in peptic ulcer disease is:(a) Pirenzepine(b) Pyridostigmine(c) Atropine(d) Oxybutynin
Pirenzepine
The preferred drug for controlling an acute exacerbationof ulcerative colitis is:(a) Prednisolone(b) Sulfasalazine(c) Mesalazine(d) Vancomycin
Prednisolone (Ref: KDT 6th,663) Corticosteroids are the mainstay of treatment of acute exacerbation of ulcerative colitis.
Drug given for metoclopramide induced dystonicreaction is: (MPPG 2002)(a) Pheniramine(b) Promethazine(c) Chlorpromazine(d) Prochlorperazine
Promethazine (Ref: KDT 6/e p157) • "Acute muscle dystonia caused by antiemetic-antipsychotic drugs is promptly relieved by parenteral promethazine or hydroxyzine." This is based on central anti-cholinergic action of the drugs. • Promethazine is a first generation anti-histaminic which has maximum penetration of blood brain barrier and maximum anticholinergic activity.
An anti-emetic drug that also decreases acid secretiondue to its action on H 1 receptors is:(a) Promethazine (AI 2010)(b) Domperidone(c) Metoclopramide(d) Ondansetron
Promethazine (Ref: Katzung 11/e p277) • Promethazine is a first generation H 1 -antihistaminic drug. It is indicated for treatment of allergic reactions. Because of its anticholinegic action and ability to cross blood brain barrier, it can be used as an antiemetic (particularly for • prophylaxis of motion sickness) and as an anti-Parkinsonian drug (particularly in drug induced Parkinsonism). Acid secretion is reduced mainly by H 2 -blocking drugs like ranitidine but even H 1 -anti histaminics can also reduce acid secretion at high doses (due to lack of selectivity at such high dose).
In peptic ulcer, antacids are now primarily used for:(a) Prompt pain relief(b) Ulcer healing(c) Preventing ulcer relapse(d) Control of bleeding from the ulcer
Prompt pain relief
Which group of drugs is most effective for the healingof Non steroidal Anti Inflammatory Drug (NSAID) induced gastric ulcer:(a) Prostaglandin analogues(b) H2-receptor antagonists(c) Proton pump inhibitors(d) Antacids
Proton pump inhibitors
A patient of peptic ulcer was prescribed ranitidineand sucralfate in the morning hours. Why is thiscombination incorrect? (AI 2004) (a) Ranitidine combines with sucralfate and prevents itsaction (b) Combination of these two drugs produces seriousside effects like agranulocytosis (c) Ranitidine increases the gastric pH so sucralfate isnot able to act. (d) Sucralfate inhibits the absorption of ranitidine
Ranitidine increases the gastric pH so sucralfate is not able to act Sucralfate is an ulcer protective agent. It forms a coating over the ulcer base after polymerization. Sucralfate polymerizes only at acidic pH (<4). Ranitidine is an H 2 blocker that reduces the gastric acid secretion. If both of these drugs are combined, action of sucralfate will be abolished due to rise in pH by ranitidine.
Activation of the following type of receptors presenton myenteric neurons by metoclopramide is primarilyresponsible for the enhanced acetylcholine release andimproving gastric motility:(a) Muscarinic M1(b) Serotonergic 5-HT3(c) Serotonergic 5-HT4(d) Dopaminergic D2
Serotonergic 5-HT 4 (Ref: KDT 6/e p646, 647) Gastric motility is increased by ACh. Release of this neurotransmitter is enhanced by 5HT 4 receptor stimulation and 5 HT 3 and D 2 receptor antagonism.
Proton pump inhibitors are most effective when theyare given: (AI 2002) (a) After meals (b) Shortly before meals (c) Along with H2 blockers (d) During prolonged fasting periods
Shortly before meals (Ref: KDT 6/e p632) Proton pump inhibitors are used just before meals. Food stimulates the secretion of gastric acid that will be reduced by PPIs if these are given just before meals.
Bisacodyl is: (UP 2007)(a) Bulk forming(b) Stool softner(c) Stimulant purgative(d) Osmotic purgative
Stimulant purgative
All of the following are true for metoclopramide except:(a) Chemically related to procainamide(b) Speeds gastric emptying(c) Stimulates chemoreceptor trigger zone(d) Blocks D2 receptors
Stimulates chemoreceptor trigger zone
Stimulant purgatives are contraindicated in thefollowing:(a) Bed ridden patients(b) Before abdominal radiography(c) Subacute intestinal obstruction(d) All of these
Subacute intestinal obstruction (Ref: KDT 6/e p655, 656) Stimulant (or irritant) purgatives are contra-indicated in pregnancy and intestinal obstruction (both subacute as well as chronic).
Anti-peptic ulcer drug that can be given in patientswith chronic renal failure (CRF) (MH 2005)(a) Aluminium Hydroxide(b) Magnesium Hydroxide(c) Sucralfate(d) None
Sucralfate
The following anti ulcer drug DOES NOT act byreducing the secretion of or neutralizing gastric acid:(a) Megaldrate(b) Sucralfate (c) Misoprostol(d) Omeprazole
Sucralfate (Ref: KDT 6/e p636) • Megaldrate is an antacid. It acts by neutralizing the gastric acid. • Omeprazole and misoprostol decrease the secretion of gastric acid. • Sucralfate is an ulcer protective agent. It forms the protective coating over the ulcer base.
A patient is taking famotidine, sucralfate and antacidtablets. This treatment is irrational because: (AI 2000) (a) Sucralfate decreases the absorption of famotidine (b) Sucralfate increases the toxicity of famotidine (c) Sucralfate decreases the absorption of antacids (d) Sucralfate polymerizes only when gastric pH is lessthan 4
Sucralfate polymerizes only when gastric pH is less than 4
Sulfa drug used in inflammatory bowel diseaseincludes: (TN 2008)(a) Sulfasalazine(b) Sulfamethoxazole(c) Sulfinpyrazone(d) Sulphadoxine
Sulfasalazine
Despite their short half-lives (2 hrs), proton pumpinhibitors (PPIs) cause a prolonged suppression of acidsecretion (up to 48 h) because: (AIIMS May 2012)(a) They are prodrugs and undergo activation gradually(b) They exit from the plasma and enter acid secretorycanaliculi and stay there, blocking the secretion ofacid for a long time(c) They irreversibly inhibit the proton pump moleculeand hence, acid secretion requires synthesis of newproton pumps(d) They are available as enteric coated capsules, fromwhich drug is gradually released
They irreversibly inhibit the proton pump molecule and hence, acid secretion requires synthesis of new proton pumps (Ref: Rang and Dale 5/e p370-371, Goodman Gilman 12/e p1311-1312) • Proton pump inhibitors (PPIs) are prodrugs that require activation in an acid environment. • After absorption into the systemic circulation, the prodrug diffuses into the parietal cells of the stomach and accumulates in the acidic secretory canaliculi. Here, it is activated by proton-catalyzed formation of a tetracyclic sulfenamide, trapping the drug so that it cannot diffuse back across the canalicular membrane. This preferential accumulation in areas of very low pH, such as occur uniquely in the secretory canaliculi of gastric parietal cells, means that PPI have a specific effect on these cells. • The activated form then binds covalently with sulfhydryl groups of cysteines in the H + , K + -ATPase, irreversibly inactivating the pump molecule. Acid secretion resumes only after new pump molecules are synthesized and inserted into the luminal membrane, providing a prolonged (up to 24- to 48-hour) suppression of acid secretion, despite the much shorter plasma half-lives (0.5-2 hours) of the parent compounds. • Because they block the final step in acid production, the proton pump inhibitors are effective in acid suppression regardless of other stimulating factors. • To prevent degradation of proton pump inhibitors by acid in the gastric lumen, oral dosage forms are supplied in enteric coated formulations. The enteric-coated tablets dissolve only at alkaline pH. • Esomeprazole, pantoprazole and lansoprazole are approved for intravenous administration. • Because an acidic pH in the parietal cell acid canaliculi is required for drug activation and food stimulates acid production, these drugs ideally should be given ~30 minutes before meals. • Because not all pumps or all parietal cells are active simultaneously, maximal suppression of acid secretion requires several doses of the proton pump inhibitors. For example, it may take 2-5 days of therapy with oncedaily dosing to achieve the 70% inhibition of proton pumps that is seen at steady state.
Choose the correct statement about H 2 receptorblockers:(a) They are the most efficacious drugs in inhibiting gastric acid secretion(b) They cause faster healing of duodenal ulcers(c) They prevent stress ulcers in the stomach(d) They afford the most prompt relief of ulcer pain
They prevent stress ulcers in the stomach (Ref: KDT 6/e p631) • H 2 receptor blockers like ranitidine are used to prevent stress ulcers. • Most effective agents for inhibiting acid secretion and treatment of gastric as well as duodenal ulcers are PPIs. • Antacids afford most prompt relief of ulcer pain.
Choose the correct statement about the use of opioidanti-motility drugs in the management of diarrhea:(a) They are used to control diarrhea irrespective of itsetiology(b) They should be used only as a short term measureafter ensuring that enteroinvasive organisms are notinvolved(c) They are used as adjuvant to antimicrobial therapyof diarrhea(d) They are the drug of choice in irritable bowel syndrome diarrhea
They should be used only as a short-term measure after ensuring that enteroinvasive organisms are not involved (Ref: KDT 6/e p663, 664)
Which of the following statements about octreotide istrue? (AIIMS Nov. 2011)(a) Stimulates growth hormone(b) Used in secretory diarrhea(c) Used orally(d) Contraindicated in acromegaly
Used in secretory diarrhea
Which of the following is not used in Crohn's disease?(a) Infliximab(b) Adalimumab(c) Ustekinumab(d) Natalizumab
Ustekinumab (Ref: CMDT 2014 p620) • Ustekinumab is a monoclonal antibody used in psoriasis • Natalizumab can be used in multiple sclerosis and Crohn's disease.
A vitamin that is reducing agent, a property that mayexplain its function is:(a) Nicotinamide(b) Thiamine(c) Vitamin B12(d) Vitamin C
Vitamin C
