GI Top 300: Final Exam

What is the brand for Diphenoxylate/Atropine?

Lomotil

What is the drug class for Diphenoxylate/Atropine?

- Antidiarrheal

- Schedule V controlled substance (C-V)

What are the dosage forms for Diphenoxylate/Atropine?

- Oral tablet

- Oral solution

What are the on-label uses for Diphenoxylate/Atropine?

Diarrhea

What are the off-label uses for Diphenoxylate/Atropine?

None

What is the MOA for Diphenoxylate/Atropine?

- Diphenoxylate is a synthetic opioid (meperidine congener) that slows GI motility

- High doses can produce systemic opioid effects

- Atropine is added in subtherapeutic amounts to discourage abuse

What are the boxed warnings for Diphenoxylate/Atropine?

None

What are the contraindications for Diphenoxylate/Atropine?

- Hypersensitivity to diphenoxylate or atropine

- Diarrhea caused by enterotoxin-producing bacteria

- Pseudomembranous enterocolitis

- Obstructive jaundice

Is Diphenoxylate/Atropine safe for pregnancy/lactation?

Pregnancy: low risk

Lactation: toxic

What are the adverse effects for Diphenoxylate/Atropine?

- Abdominal discomfort

- Nausea

- Vomiting

What is the brand for Rifaximin?

Xifaxan

What is the drug class for Rifaximin?

Antibiotic, Miscellaneous

What are the dosage forms for Rifaximin?

Oral tablet

What are the on-label uses for Rifaximin?

- Hepatic encephalopathy prevention

- IBS without constipation

- Traveler's diarrhea

What are the off-label uses for Rifaximin?

Recurrent C. difficile infection

What is the MOA for Rifaximin?

- Semisynthetic derivative of rifampin

- Binds to bacterial DNA-dependent RNA polymerase

- Inhibits bacterial RNA synthesis

- Has activity against E. coli

What are the boxed warnings for Rifaximin?

None

What are the contraindications for Rifaximin?

Hypersensitivity

Is Rifaximin safe for pregnancy/lactation?

Pregnancy: risk

Lactation: compatible

What are the adverse effects for Rifaximin?

- Edema

- Dizziness

- Ascites

- Nausea

What is the brand for Linaclotide?

Linzess

What is the drug class for Linaclotide?

Guanylate Cyclase-C Agonist

What are the dosage forms for Linaclotide?

Capsule

What are the on-label uses for Linaclotide?

- Chronic idiopathic constipation

- Irritable bowel syndrome with constipation (IBS-C)

- Functional constipation in children 6-17 years old

What are the off-label uses for Linaclotide?

Treatment-refractory opioid-induced constipation

What is the MOA for Linaclotide?

- Agonizes guanylate cyclase-C receptors in the intestinal epithelium

- Increases chloride and bicarbonate secretion

- Increases intestinal fluid

- Hastens GI transit

What is the boxed warning for Linaclotide?

Risk of serious dehydration in children

What are the contraindications for Linaclotide?

- Children

Is Linaclotide safe for pregnancy/lactation?

Pregnancy: compatible

Lactation: compatible

What are the adverse effects for Linaclotide?

Diarrhea

What is the brand for Lubiprostone?

Amitiza

What is the drug class for Lubiprostone?

Chloride Channel Activator

What are the dosage forms for Lubiprostone?

Capsule

What are the on-label uses for Lubiprostone?

- Chronic idiopathic constipation

- IBS with constipation (IBS-C) in females >18 years old

- Opioid-induced constipation

What are the off-label uses for Lubiprostone?

IBS with constipation (IBS-C) in males >18 years old

What is the MOA for Lubiprostone?

- Activates chloride channels on the apical surface of the intestine

- Increases intestinal fluid secretion

- Improves fecal transit

- In opioid-induced constipation, chloride channel activation bypasses the antisecretory effects of opioids

What are the boxed warnings for Lubiprostone?

None

What are the contraindications for Lubiprostone?

- Hypersensitivity

- Bowel obstruction

Is Lubiprostone safe for pregnancy/lactation?

Pregnancy: compatible

Lactation: compatible

What are the adverse effects for Lubiprostone?

- Headache

- Nausea

- Diarrhea

What is the brand for Ondansetron?

Zofran

What is the drug class for Ondansetron?

- Antiemetic

- 5-HT3 receptor antagonist

What are the dosage forms for Ondansetron?

- Tablet

- ODT

- Oral Solution

What are the on-label uses for Ondansetron?

- Chemotherapy-induced nausea and vomiting

- Postoperative nausea and vomiting prevention

- Radiation-induced nausea and vomiting

What are the off-label uses for Ondansetron?

Severe hyperemesis associated with pregnancy

What is the MOA for Ondansetron?

- Selectively blocks 5-HT3 serotonin receptors

- Acts both peripherally and centrally in the chemoreceptor trigger zone

- Prevents serotonin-mediated activation of the vomiting reflex

What are the boxed warnings for Ondansetron?

None

What are the contraindications for Ondansetron?

- Hypersensitivity to ondansetron

- Concomitant use with apomorphine

Is Ondansetron safe for pregnancy/lactation?

Pregnancy: risk

Lactation: compatible

What are the adverse effects for Ondansetron?

- Constipation

- Diarrhea

- Headache

- Fatigue

What is the brand for Prochlorperazine?

Compazine

What is the drug class for Prochlorperazine?

- Phenothiazine

- Dopamine D2 receptor antagonist

What are the dosage forms for Prochlorperazine?

- Tablet

- Rectal Suppository

What are the on-label uses for Prochlorperazine?

Nausea and vomiting

What are the off-label uses for Prochlorperazine?

None

What is the MOA for Prochlorperazine?

- Blocks dopamine D2 receptors

- Belongs to the phenothiazine class

- Produces antiemetic effects by decreasing dopaminergic stimulation of the vomiting center

What is the boxed warning for Prochlorperazine?

Increased mortality in elderly patients with dementia-related psychosis

What are the contraindications for Prochlorperazine?

- Hypersensitivity to phenothiazines

- Bone marrow depression

- Children

Is Prochlorperazine safe for pregnancy/lactation?

Pregnancy: compatible

Lactation: toxic

What are the adverse effects for Prochlorperazine?

Somnolence

What is the brand for Promethazine?

Phenergan

What is the drug class for Promethazine?

- Phenothiazine Antihistamine

- H1 receptor antagonist

What are the dosage forms for Promethazine?

- Oral tablet

- Oral syrup

- Oral solution

- Rectal suppository

What are the on-label uses for Promethazine?

Nausea and vomiting

What are the off-label uses for Promethazine?

None

What is the MOA for Promethazine?

- Competitively blocks histamine H1 receptors

- Has sedative, antiemetic, antimotion sickness, and anticholinergic effects

- Does not block histamine release

- Has no dopaminergic activity

What is the boxed warning for Promethazine?

Risk of fatal respiratory depression in children

What are the contraindications for Promethazine?

- Hypersensitivity to promethazine

- Asthma

- Children

Is Promethazine safe for pregnancy/lactation?

Pregnancy: compatible

Lactation: compatible

What are the adverse effects for Promethazine?

- Somnolence

- Xerostomia