 Polyethylene glycol

o Osmotic laxative hence similar to pathophysiology of lactose intolerance

o How do they aid in bowel movement? Attracts water to the intestinal lumen 
distention of intestinal wall and increasing peristalsis
o How is lactose absorbed in normal people? Broken down into glucose and
galactose by brush border enzyme (lactase)
 Rifaximin in hepatic encephalopathy
o MoA when used to treat hepatic enceph? Decreased intraluminal ammonia
production
 Hepatic enceph: accumulation of ammonia because liver is unable to
convert it urea
 Another source of ammonia: intestinal bacteria
 MoA of Rifaximin: non-absorbable antibiotic used to alter GI flora to
decrease intestinal production and absorption of ammonia
o MoA of lactulose?
 In hepatic enceph: Increase conversion of ammonia to ammonium ions
(ionic cannot cross cellular barriers)  decreasing reabsorption and
increasing excretion of ammonia (acidifies GIT)
 In constipation: osmotic laxative
o MoA of rifaximin in traveler’s diarrhea? It is a rifamycin (inhibiting bacterial RNA
synthesis through binding with DNA-dependent RNA polymerase)
 Case of acute angioedema (HPN stage II)
o Recently diagnosed with hypertension, lips looked puffy
o First-line pharmacologic tx for HPN: thiazides, ACEis, ARBs
 ACE inhibitors are associated with angioedema. How do they cause
angioedema? Bradykinin accumulation (vasodilator and increases
vascular permeability)
o Management: discontinue offending drug
 Ventricular arrhythmia in a case of MI? Lidocaine
o Class IB antiarrhythmics – preferentially bind to inactivated sodium channels
 Sodium channels in ischemic myocardium is predominantly inactivated
 Other drugs: mexiletine, tocainide, phenytoin
o Class III prolongs QT interval, predisposing to torsades de pointes
 Px about to go ex-lap with warfarin intake
o Antidotes: urgent – FFP, if it can wait – vitamin K
o Goal: reverse anticoagulation since the patient will be undergoing surgery
 Case of meningitis with aplastic anemia after treatment
o Assuming no penicillin hypersensitivity, drug regimen for bacterial meningitis in
this age group? Vancomycin PLUS Ceftriaxone
o What secondary drug was used that caused aplastic anemia? Chloramphenicol
 Starting etanercept
o TNF-alpha inhibitors: acts as a decoy receptor for TNF-alpha
 Leads to impaired T cell mediated immunity  reactivation of TB, fungal
infections, and atypical mycobacterial infections
 How do we screen for latent TB?
o TNF antagonists: Infliximab, adalimumab

 Nocardiosis
o Weakly acid-fast, gram positive with branching filamentous rods
 Filamentous and acid-fast? Think Nocardia. If anaerobe, Actinomyces
o Risk factors: DM and immunocompromised state
o Drug of choice: TMP-SMX
 Duration of therapy? 2 months
o If actinomyces: DOC is PenG
 Osteoporosis
o Drug that prevents further bone resorption and reduces risk of developing breast
CA? SERM (raloxifene)
o How do SERMs increase risk of endometrial CA? Stimulates estrogen receptors 
endometrial hyperplasia
 Raloxifene increases risk? No. Selective in bones.
o How do SERMs cause hypercoagulable state? Yes due to increased estrogen