GI Drugs

Which best describes the mechanism of peppermint oil in IBS? A. 5-HT3 antagonist B. Calcium channel blocker C. μ-opioid agonist D. Chloride channel activator

B. Calcium channel blocker

Peppermint oil improves which symptoms? A. Only constipation B. Only diarrhea C. Pain, bloating, diarrhea, constipation D. Only nausea

C. Pain, bloating, diarrhea, constipation

Most common adverse effect of peppermint oil? A. Constipation B. Dyspepsia C. Hypertension D. Sedation

B. Dyspepsia

TCAs mechanism in IBS? A. Increase serotonin B. Block muscarinic/acetylcholine/histamine receptors C. Activate chloride channels D. Antibiotic

B. Block muscarinic/acetylcholine/histamine receptors

TCAs are most useful in which IBS subtype? A. IBS-C B. IBS-D C. IBS-M D. IBS-A

B. IBS-D

TCA boxed warning? A. Hepatotoxicity B. QT prolongation C. Increased suicidality D. Dehydration

C. Increased suicidality

Typical TCA dosing for IBS? A. 50–100 mg daily B. 25 mg BID C. 5–10 mg qHS D. 100 mg TID

C. 5–10 mg qHS

Dicyclomine MOA? A. Opioid agonist B. Antispasmodic inhibiting acetylcholine C. GC-C agonist D. Sodium blocker

B. Antispasmodic inhibiting acetylcholine

Dicyclomine primary use? A. Long-term control B. Short-term pain relief C. Diarrhea only D. Constipation only

B. Short-term pain relief

Dicyclomine safety profile? A. Minimal AE B. No contraindications C. Anticholinergic effects D. Safe in glaucoma

C. Anticholinergic effects

Dicyclomine dosing? A. 2 mg daily B. 20–40 mg QID C. 100 mg BID D. 550 mg TID

B. 20–40 mg QID

Loperamide MOA? A. Central opioid B. Peripheral opioid agonist C. Serotonin antagonist D. Chloride activator

B. Peripheral opioid agonist

Loperamide does NOT improve? A. Stool frequency B. Stool consistency C. Bloating D. Fluid absorption

C. Bloating

Loperamide use? A. First-line B. After diet PRN C. Severe only D. Constipation only

B. After diet PRN

Loperamide dosing? A. 2 mg after meals B. 10 mg qHS C. 2 mg 45 min before meals D. 100 mg daily

C. 2 mg 45 min before meals

Eluxadoline MOA? A. μ-agonist δ-antagonist B. μ-antagonist C. 5-HT3 antagonist D. Antibiotic

A. μ-agonist δ-antagonist

Eluxadoline improves? A. Constipation B. Pain and stool consistency C. Bloating only D. Nausea

B. Pain and stool consistency

Eluxadoline dosing? A. 550 mg TID B. 100 mg BID with food C. 8 mcg BID D. 3 mg daily

B. 100 mg BID with food

Eluxadoline contraindication? A. HTN B. >3 drinks/day C. GERD D. Anemia

B. >3 drinks/day

Eluxadoline use? A. First-line B. After OTC/diet fail C. Surgery only D. IBS-C

B. After OTC/diet fail

Rifaximin MOA? A. Serotonin block B. Inhibit bacterial RNA synthesis C. Opioid agonist D. Sodium blocker

B. Inhibit bacterial RNA synthesis

Rifaximin improves? A. Diarrhea only B. Constipation only C. Bloating, stool, pain D. Nausea

C. Bloating, stool, pain

Rifaximin dosing? A. 100 mg daily B. 550 mg TID x14 days C. 3 mg daily D. 50 mg BID

B. 550 mg TID x14 days

Rifaximin use? A. Mild IBS-D B. Moderate-severe after failure C. IBS-C D. GERD

B. Moderate-severe after failure

Alosetron MOA? A. Opioid agonist B. 5-HT3 antagonist C. Chloride activator D. Antibiotic

B. 5-HT3 antagonist

Alosetron effect? A. Increase motility B. Decrease motility/secretions C. Kill bacteria D. Increase acid

B. Decrease motility/secretions

Alosetron use? A. All IBS B. Men IBS-C C. Women severe IBS-D D. GERD

C. Women severe IBS-D

Alosetron dosing? A. 3 mg daily B. 0.5 mg BID C. 50 mg BID D. 550 mg TID

B. 0.5 mg BID

Alosetron boxed warning? A. Pancreatitis B. Ischemic colitis C. Liver failure D. QT prolongation

B. Ischemic colitis

Lubiprostone MOA? A. Opioid B. Chloride channel activator C. Serotonin block D. Sodium inhibitor

B. Chloride channel activator

Lubiprostone effect? A. Acid ↑ B. Fluid & motility ↑ C. BP ↑ D. HR ↑

B. Fluid & motility ↑

Lubiprostone use? A. IBS-D B. IBS-C women ≥18 C. GERD D. IBS-M

B. IBS-C women ≥18

Lubiprostone dosing? A. 8 mcg BID B. 100 mg BID C. 3 mg daily D. 550 mg TID

A. 8 mcg BID

Lubiprostone position? A. First-line B. After diet/OTC fail C. Inpatient only D. Pediatric

B. After diet/OTC fail

Linaclotide MOA? A. Chloride activator B. GC-C agonist C. Opioid D. Antibiotic

B. GC-C agonist

Linaclotide effect? A. Motility ↓ B. Fluid/motility ↑ pain ↓ C. Acid ↓ D. Diarrhea only

B. Fluid/motility ↑ pain ↓

Linaclotide use? A. IBS-D B. IBS-C/CIC C. GERD D. Ulcer

B. IBS-C/CIC

Linaclotide dosing? A. 290 mcg daily before breakfast B. 8 mcg BID C. 50 mg BID D. 550 mg TID

A. 290 mcg daily before breakfast

Linaclotide position? A. First-line B. After diet/OTC fail C. Inpatient D. Elderly

B. After diet/OTC fail

Plecanatide MOA? A. Opioid B. GC-C agonist C. Antibiotic D. H2 blocker

B. GC-C agonist

Plecanatide effect? A. Fluid ↓ B. Fluid/motility ↑ pain ↓ C. Acid ↓ D. Nausea only

B. Fluid/motility ↑ pain ↓

Plecanatide use? A. IBS-D B. IBS-C/CIC C. GERD D. Gastritis

B. IBS-C/CIC

Plecanatide dosing? A. 3 mg daily B. 8 mcg BID C. 100 mg BID D. 550 mg TID

A. 3 mg daily

Plecanatide position? A. First-line B. After linaclotide/lubiprostone fail C. Pediatric D. Inpatient

B. After linaclotide/lubiprostone fail

Linaclotide/Plecanatide contraindication? A. Elderly B. <6 years old C. Pregnancy D. Diabetes

B. <6 years old

Tenapanor MOA? A. Opioid B. NHE3 inhibitor C. Serotonin D. Chloride

B. NHE3 inhibitor

Tenapanor use? A. IBS-D B. IBS-C last-line C. GERD D. Ulcer

B. IBS-C last-line

Tenapanor position? A. First B. Second C. Last-line D. OTC

C. Last-line

Tenapanor dosing? A. 50 mg BID B. 8 mcg BID C. 3 mg daily D. 550 mg TID

A. 50 mg BID

Tenapanor boxed warning? A. Ischemic colitis B. Severe dehydration pediatrics C. Liver failure D. QT prolongation

B. Severe dehydration pediatrics

Tenapanor adverse effect? A. Constipation B. Diarrhea C. Bradycardia D. Hypoglycemia

B. Diarrhea

Vonoprazan MOA? A. PPI B. Potassium-competitive acid blocker C. H2 blocker D. Antacid

B. Potassium-competitive acid blocker

Vonoprazan use? A. Respond to PPIs B. Cannot tolerate/respond to PPIs C. IBS-C D. IBS-D

B. Cannot tolerate/respond to PPIs

Vonoprazan pharmacology? A. Needs active pumps B. Slower onset C. Longer half-life, more potent D. Less effective

C. Longer half-life, more potent