Questions and Case Studies: H2 Blockers, GERD Medication and Domperidone

00:01 Okay, let's go on to some questions. H2D2, these are not the drugs you are looking for.

00:08 Now, if you don't get the joke, you probably have a social life. Let's move on to the question.

00:12 The following statements pertain to H2 blockers. Pick the false statement.

00:16 A, the H2 blockers are more potent and more effective than the antacids.

00:21 B, they irreversibly inactivate the H/K ATPase pump.

00:27 C, cimetidine has antiandrogenic actions at high doses.

00:31 Or D, they inhibit absorption of drugs like ketoconazole.

00:36 Remember that H2 blockers do not irreversibly inactivate the hydrogen-potassium ATPase pump.

00:44 That distinction lies with the proton pump inhibitors.

00:49 Let's move on to another question.

00:52 An 80 year old male with chronic constipation presents with severe gastroesophageal reflux after a large turkey dinner.

01:00 The best choice for acute treatment in this individual is? Aluminium hydroxide? Magnesium oxide? Calcium carbonate? Sodium bicarbonate? Or metoclopramide? Good, you chose magnesium oxide.

01:21 So when you are looking at these agents, remember that aluminium oxide, which is also known as Maalox, can be constipating.

01:28 This guy already has constipation so maybe it's not a great choice.

01:31 Calcium carbonate and sodium bicarb are weaker antacids.

01:35 Calcium carbonate is found in Tums for example, and sodium bicarb is found in a lot of those effervescent tablets that you buy over the counter.

01:45 Metoclopramide is a promotility agent, but not an effective antacid.

01:50 So it's not treating both problems. The answer here is going to be B, magnesium oxide.

01:56 It's also called Milk of Magnesia. It has laxative effects, anti-acid effects, and it's also quite soothing on the elderly bowel.

02:04 All right, let's look at another case here.

02:08 A 55 year old male has diabetic enteropathy with poor bowel function.

02:13 He was placed on some Domperidone.

02:15 The following statements are true except, so pick the false statement.

02:21 A, metoclopramide and domperidone are both D2 blockers.

02:26 B, domperidone crosses the blood brain barrier.

02:30 C, metoclopramide and domperidone may be used in the gastroparesis of neurologic origin.

02:36 And D, metoclopramide may cause Parkinsonian symptoms.

02:42 Fabulous, you picked B, domperidone crosses the blood brain barrier.

02:47 Remember that this is incorrect.

02:49 Domperidone does not cross the blood brain barrier, metoclopramide crosses the blood brain barrier, and can actually act as an anti-emetic. Domperidone doesn't.