ABSTRACT
Match the drug from the list above with the mode of action/indication below:
1 Serotonin (5HT3) receptor blockade 2 Symptomatic treatment of acute diarrhoea 3 Maintenance of remission of ulcerative colitis 4 Chemotherapy for patients with advanced or metastatic
adenocarcinoma of the pancreas 5 Chronic hepatitis C
ANSWERS: see page 121
249 a) True See Fig. 2 b) True c) True d) True e) True
2 is an important gastroprotective mediator. b) It inhibits secretion of acid, promotes secretion of protective c) False mucus and causes vasodilation of submucosal blood d) True vessels e) True
251 a) False Helicobacter pylori is strongly linked to the development b) True and recurrence of duodenal ulcer. Possible linkage to c) True gastric carcinoma is under investigation d) False e) False
252 a) False – Non-steroidal anti-inflammatory drug (NSAID), ulcerogenic
b) True – More effective in preventing recurrence of duodenal ulcers than H2 blockers
c) False – Ulcerogenic d) True – H2 blocker e) True
253 a) False Antacids are available without prescription and produce b) False prompt but transient pain relief in patients with peptic c) True ulceration. Aluminium salts cause constipation d) False e) True
254 a) True Chronic cimetidine therapy causes reversible b) False gynaecomastia in 0.1-0.2 per cent of patients. It is c) True generally well tolerated. Cimetidine blocks the tubular d) True secretion of creatinine e) True
255 a) True Eradication should be confirmed, preferably by urea breath b) True test at a minimum of four weeks post treatment c) True d) True e) True
256 a) True All the H2-receptor blockers currently available in the UK are b) True effective in peptic ulceration and are well tolerated. There c) True is most experience with cimetidine and ranitidine d) False e) True
257 a) True Omeprazole, a proton pump inhibitor, is effective in b) True reducing gastric acid secretion and in spite of its short half-life c) True only has to be administered once daily since it acts d) True irreversibly e) False
b) narrow therapeutic index this is clinically significant c) False d) True e) True
259 a) True There are currently five proton pump inhibitors licensed in b) True the UK: esomeprazole, omeprazole, lansoprazole, c) True pantoprazole and rabeprazole d) True e) False
260 a) True Misoprostol inhibits gastric acid secretion, causes b) False vasodilatation in the submucosa and stimulates production c) True of protective mucus. It contracts uterine muscle and causes d) True abortion e) True
261 a) True Several studies show bismuth chelate to be as active as b) True cimetidine in the healing of duodenal and gastric ulcers c) True after 4-8 weeks of treatment. It is, however, associated with d) False frequent minor adverse effects. Ranitidine bismuth chelate can e) True be substituted for a proton pump inhibitor as part of ‘triple
therapy’ for the eradication of H. pylori
262 a) False Sucralfate, a basic aluminium salt, becomes a sticky b) True adherent paste in the presence of acid which retains antacid c) True efficacy and apparently coats the floor of ulcer craters d) False e) True
263 a) True – Muscarinic antagonist; NB: anticholinergic side-effects b) True – H1 blocker minor antimuscarinic action c) True – H1 blocker minor antimuscarinic action d) False – Dopamine receptor antagonist e) False – Chlorpromazine is not used for motion sickness
264 a) False Cyclizine is an H1 blocker with additional antimuscarinic b) True actions. Its indications are nausea, vomiting, vertigo, c) False motion sickness and labyrinthine disorders d) True e) True
265 a) False – Relatively ineffective in motion sickness and other forms of centrally mediated vomiting
b) False c) True – Increases the rate of absorption of oral drugs d) True e) True – Effective in some patients in preventing cisplatin-induced
nausea and vomiting
3-receptor antagonist b) – Is used orally, rectally and intravenously c) True d) False e) False – Causes constipation
267 a) True – Correction of dehydration, nutritional and electrolyte imbalance are life-saving
b) False – Because of side-effects c) True – Some systemic absorption may occur d) False – May precipitate paralytic ileus and megacolon e) False – A high-fibre diet and bulk-forming drugs are useful in
adjusting faecal consistency
268 a) True – Broken down to 5-aminosalicylate and sulfapyridine b) True c) False d) True e) True
269 a) True Adverse effects are more common in slow acetylators. Any b) True patient who is receiving aminosalicylates must be advised c) True to report unexplained bleeding, bruising, purpura or d) True malaise e) True
270 a) False – This describes olsalazine b) True c) False – But is contraindicated in salicylate hypersensitivity d) False e) True – Contraindicated in renal impairment
271 a) True Infliximab, a monoclonal antibody which inhibits TNF, is b) False licensed for the management of severe active Crohn’s c) False disease and moderate to severe ulcerative colitis in patients d) True who are refractory to or intolerant of corticosteroids and e) False conventional immunosuppressants
272 a) True The cause of any change in bowel habit should be b) True determined before laxatives are used c) False d) False e) False
273 a) False Lactulose is a disaccharide which is broken down in the b) False colon by bacteria to unabsorbed organic anions which c) True retain fluid in the gut lumen d) False e) False
b) Chapter 34. Loperamide rarely causes CNS effects. c) False However, co-administration with quinidine, a known d) False inhibitor of the P-glycoprotein transmembrane pump, is e) False associated with respiratory depression independent of
changes in plasma concentration indicating increased CNS penetration
275 a) True See Textbook of Clinical Pharmacology and Therapeutics, b) True Chapter 34. Prophylactic broad-spectrum intravenous c) True antibiotics are commonly used, especially if there is d) True evidence of infection (e.g. spontaneous peritonitis). e) True Intravenous acetylcysteine is also used but its precise
value is yet to be fully confirmed
276 a) True See Textbook of Clinical Pharmacology and Therapeutics, b) False Chapter 34. Terlipressin is a derivative of vasopressin c) False (antidiuretic hormone). Octreotide is an analogue of d) True somatostatin e) False
277 a) False – Usually mild and asymptomatic increase in transaminases b) False – Hepatic fibrosis/cirrhosis c) True – Rare now that low-dose oestrogens are more commonly
prescribed d) True – Associated with fever, abdominal pain and pruritus e) True – Usually transient
278 a) True – A lipase inhibitor. Adverse effects include rectal leakage and oily faeces
b) True – Sibutramine inhibits the reuptake of noradrenaline and serotonin. It is not licensed for use for longer than 1 year
c) False – Transient weight loss secondary to fluid loss d) False – Inhibits 5HT2 receptors, increases appetite and causes
weight gain e) False – Although dexamphetamine decreases appetite, it has
considerable abuse potential. This and adverse effects which include insomnia, restlessness, convulsions, tachycardia, hypertension severely limits its use to specialist treatment of narcolepsy and attention deficit disorder
279 a) False Rimonabant is an oral, selective, cannabinoid CB1 receptor b) False antagonist which is used as an adjunct to diet to achieve c) False weight loss. It is not licensed for use for longer than 2 years d) True e) True
280 ALIMENTARY SYSTEM
1 F Ondansetron is a 5HT3 antagonist which is very effective in the prevention and treatment of acute nausea and vomiting secondary to cytotoxic chemotherapy and radiotherapy as well as following abdominal surgery.
