pr20
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A 41-year old diabetic woman presents to her physician complaining of gastrointestinal distress and heart burn,particularly after meals.Which of the following drugs should her physician prescribe to relieve her symptoms?
A. Omeprazole
B. Diphenoxylate
C. Famotidine
D. Prochlorperazine
E. Sucralfate
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| jean robert
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A
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| nerve09
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A.
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| pr20
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Even i've chosen A,but the answer was given different.
Any more guesses?
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| Tiff
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C. Famotidine
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| jean robert
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E
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| SILVER
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famotidine
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| pr20
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Someone wanna give a last shot?
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| SILVER
DoWhatYouGotToDo!
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well, with everything given a , all that's left is diphenoxylate and prochlorperazine--so it's one of them.
hope you have a complete expln. for all the choices 
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| pr20
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The correct answer is D.
Prochlorperazine is an antiemetic agent that acts as a D2-receptor antagonist at the CTZ in the medulla.Although this woman's heartburn may cause her to feel nauseous,this symptom would be relieved by treating the underlying motility problem.
Patients with diabetes may have damage to the nerves innervating their viscera,resulting in gastroparesis(loss of motility of the esophagus and stomach).This loss of motility causes delayed gastric emptying,bloating,and nausea,and gastrointestinal reflux disease(GERD).Dopamine antagonists,such as metaclopramide,enhance lower esophageal sphincter(LES)tone and prevent symptoms and complications of GERD(i.e.,barett esophagitis)
Omeprazole(choice A) is a PPI used for the treatment of ulcers.
Diphenoxylate(choice B),which is structurally related to meperidine,is an antidiarrheal agent.By diminishing gastric motility even further,diphenoxylate would likely exacerbate this woman's symptoms.
Famotidine(choice C) is an H2-receptor antagonist that inhibits histamine-induced gastric acid scretions.Excessive gastric acid secretion does not underline this patient's problems.
Sucralfate(choice E),or aluminium sucrose sulfate,is a poorly soluble agent that polymerizes in the acid environment of the stomach.The polymer then binds to ulcerated tissue and protects if from pepsin-mediated protein hydrolysis and damage by acid.However,there is no indiaction that this woman has ulcer disease.
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| SILVER
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interesting
thanks
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| new_n_lost
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But guys for GERD (from any cause) H2 blockers are the first line of agents. So i sort of dont get the answer
Lets Discuss.
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| pr20
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This question is from Kaplan Qbook.
Even i was not satisfied with the answer and was stunned to know that prochlorperazine can be used in this way.
Anyway lets discuss treatment of GERD and this is what i know.....
Life style modifications and dietary modifications should be considered first before starting drugs.
Proton pump inhibitors(PPI's) are the drugs of choice for all but mild cases.
Antacids or H2 blockers can be used to treat mild GERD cases without any inflammation and complications(like ulcers,erosions,strictures,barett esophagitis,etc.)
Surgery is the last option when symptoms persist inspite of lonterm drug therapy or when there are severe complications like scarring,bleeding or pulmonary complications which require surgery to correct them.
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| pr20
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Missed one last point----Prokinetic drugs can be used in patients having motility problems but they are usually not the first line of drugs used in GERD due to their enormous side effects.
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| pr20
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Please add further inputs....
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| SILVER
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i guess the point they're trying to make is that the treatment should be considered in relevance to the fact that she has diabetes. so while in a person with no other illness and just GERD--H2 makes sense......however, in this patient's case her diabetes has to be factored in--so dopamine antagonist.
in the words of our mod: my 2 cents............
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Expecting the world to treat you fairly because you are a good person, is like expecting the lion not to attack you because you are a vegetarian.
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| pr20
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Diabetes can cause gastroparesis and prokinetic agents(like metaclopramide)can be used to increase the tone of the LES and make the stomach empty quicker.In diabetic patients metaclopramide can be effective when used along with the H2 blockers.But even in diabetics prokinetic agents are not the first choice for treating GERD because PPI's usually work better and have fewer side effects.
Am i missing something?
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| SILVER
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i agree with you and this is how we've learned the treatment for GERD. but what's confusing is how they're restricting the use of PPIs to ulcers only. and their explanation that "excessive gastric acid secretion does not underlie this patient's problem" is extremely confusing because isn't that what GERD is all about--excessive gastric acid that gets refluxed?! 
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Expecting the world to treat you fairly because you are a good person, is like expecting the lion not to attack you because you are a vegetarian.
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| SILVER
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so in a way they're saying, so what if she has excessive gastric acid, let her have it, we'll just give her something so that it doesn't reflux. that doesn't make sense. shouldn't the aim be to reduce her excessive secretion in addition to relieving the gastroparesis??
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Expecting the world to treat you fairly because you are a good person, is like expecting the lion not to attack you because you are a vegetarian.
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| pr20
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Even im not able to understand what exactly the explanation to that question means.
Hopefully controversial questions like these are not asked in the USMLE exam
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