Gastrointestinal Medicines

Which of the following statements about antacid ingredients formulated in stomach medicines is correct?

1. Oyster shell (牡蛎, borei) is a crude drug ingredient used for its expected neutralizing action from the magnesium carbonate it contains, and is formulated in stomach medicines as an antacid ingredient.
2. An antacid ingredient is an ingredient that relieves the symptoms of excess stomach acid by stopping the secretion of gastric juice itself.
3. A gastrointestinal medicine mainly composed of antacid ingredients has its neutralizing action against gastric acid further heightened, and its effect strengthened, when used together with a highly acidic food such as a carbonated beverage.
4. Magnesium aluminometasilicate is said to have, in addition to a gastric acid neutralizing action, an action of forming a gelatinous film on the gastric mucosa to protect it.

Which of the following statements about precautions for use and interactions of antacid ingredients is correct?

1. An ingredient containing aluminum is stated to pose no problem with long-term continued use as long as the person is not undergoing dialysis treatment.
2. In a person diagnosed with kidney disease, excretion of inorganic salts such as sodium and magnesium is accelerated, making them less likely to accumulate in the body, so a larger amount than usual becomes necessary.
3. Because ingredients containing calcium or aluminum are also ingredients formulated in laxatives, attention needs to be paid to whether diarrhea symptoms appear with a gastrointestinal medicine containing them.
4. An antacid ingredient is often also formulated in other medicines such as cold remedies and analgesic/antipyretics, and combined use risks causing hypercalcemia, hypermagnesemia, and the like.

Which of the following statements about crude drugs formulated as stomachic ingredients is incorrect?

1. Gentian root (ゲンチアナ, gentian) and gentiana root (龍胆, ryutan) are both used for their expected stomachic action from bitterness.
2. Phellodendron bark (黄柏, obaku) and coptis rhizome (黄連, oren) are both used for their expected stomachic action from bitterness.
3. Cinnamon bark (桂皮, keihi) is a crude drug used for its expected stomachic action from bitterness.
4. Bear bile (熊胆, yutan) is used for its expected stomachic action from bitterness, and is also sometimes formulated as a digestive-aid ingredient.

Which of the following statements about stomachic ingredients acting by a mechanism other than stimulation of taste or smell, and the taking of stomachics, is correct?

1. A stomachic medicine formulated with crude drug ingredients has its effect further heightened when a powder is wrapped in a wafer paper to mask its taste or fragrance before being taken.
2. Magnolia bark (厚朴, koboku), ginger (生姜, shokyo), clove (丁字, choji), and citrus peel (陳皮, chinpi) are all crude drug ingredients used for their expected stomachic action from bitterness.
3. Dried yeast is a stomachic ingredient that heightens stomach function by stimulating taste to reflexively promote secretion of saliva and gastric juice.
4. Carnitine chloride is a type of organic acid present in the living body, and is said to have actions such as promoting gastric juice secretion, heightening gastric motility, and increasing circulating blood flow to the stomach wall.

Which of the following statements about digestive ingredients formulated in stomach medicines is correct?

1. Takadiastase is formulated for the purpose of promoting the separation of bubbles generated in the contents of the digestive tract.
2. Dried bile powder and animal bile are said to have an action that heightens liver function, and are used preferentially, even in a person diagnosed with liver disease, without worsening symptoms.
3. Diastase, lipase, cellulase, and the like are formulated for their expected action of promoting the secretion of bile.
4. Ursodeoxycholic acid and dehydrocholic acid are said to have an action of promoting the secretion of bile (a choleretic action), and are used for their expected effect of aiding digestion.

Which of the following statements about gastric mucosal protective/repair ingredients is incorrect?

1. Aldioxa is a complex of allantoin and aluminum hydroxide, and is known as an ingredient containing aluminum.
2. Sofalcone and teprenone can rarely cause liver dysfunction as a serious side effect, so caution is needed.
3. Because sucralfate is an ingredient containing magnesium, its use needs to be avoided in a person diagnosed with heart disease.
4. Cetraxate hydrochloride is metabolized in the body to produce tranexamic acid.

Which of the following statements about precautions for use of gastric mucosal protective/repair ingredients is correct?

1. Aldioxa can be used without consultation even in a person diagnosed with kidney disease, since it does not readily accumulate in the body.
2. Sodium azulenesulfonate (water-soluble azulene) is a gastric mucosal protective/repair ingredient known to rarely cause liver dysfunction as a serious side effect.
3. For teprenone, other side effects that can appear include abdominal bloating, nausea, abdominal pain, headache, subcutaneous bleeding, constipation, diarrhea, and dry mouth.
4. Cetraxate hydrochloride is used preferentially in a person with a blood clot, since a substance produced from its metabolism in the body has an action that makes blood clots easier to dissolve.

Which of the following statements about antifoaming ingredients and gastric-juice-secretion-suppressing ingredients is incorrect?

1. Pirenzepine hydrochloride is said to show an action that suppresses secretion of gastric juice with almost no effect on motility of the digestive tract, and is an ingredient formulated in gastrointestinal medicines.
2. Dimethylpolysiloxane (also called dimethicone) is an antifoaming ingredient formulated for the purpose of promoting the separation of bubbles generated in the contents of the digestive tract.
3. For a gastrointestinal medicine containing belladonna extract or pirenzepine hydrochloride, combined use with a gastrointestinal antispasmodic/analgesic medicine or a motion-sickness prevention medicine needs to be avoided.
4. Because pirenzepine hydrochloride does not show anticholinergic action, it can be used without any problem even by a person with symptoms of difficulty urinating or a person diagnosed with glaucoma.

Which of the following statements about intestinal-regulating ingredients formulated in intestinal medicines is correct?

1. Live bacterial ingredients such as bifidobacteria and lactomin are formulated for the purpose of adsorbing and expelling harmful substances generated within the intestine.
2. Cassia seed (決明子, ketsumeishi) and geranium herb (ゲンノショウコ, gennoshoko) are crude drug ingredients formulated for their expected laxative action of stimulating the large intestine to promote a bowel movement.
3. Catechu (阿仙薬, asenyaku) is an ingredient intended for a laxative effect, which shows its stimulating action on the large intestine once broken down by intestinal bacteria.
4. Trimebutine maleate is said to act directly on the smooth muscle of the digestive tract, working to promote motility when it has decreased and to suppress it when it has increased.

Which of the following statements about astringent ingredients formulated in antidiarrheal medicines is incorrect?

1. An antidiarrheal medicine mainly composed of astringent ingredients is stated to be preferable to actively use when bacterial diarrhea or food poisoning is suspected.
2. Phellodendron bark (黄柏, obaku) and coptis rhizome (黄連, oren) are used for their expected antibacterial and anti-inflammatory actions, in addition to an astringent action.
3. An ingredient containing bismuth has, in addition to an astringent action of binding with protein in the intestinal mucosa to form an insoluble film, an action that also breaks down harmful substances generated within the intestine.
4. The albumin contained in tannic acid albumin is an ingredient refined from a protein contained in cow's milk (casein), and shows an astringent action.

Which of the following statements about precautions for use of bismuth-containing ingredients such as bismuth subgallate and bismuth subnitrate is correct?

1. There are reports that psychoneurological symptoms appeared with long-term continued use overseas, so it should not be used continuously for 1 week or more.
2. Because transfer into the circulating blood decreases when taken together with alcohol, drinking alcohol at the time of taking is stated to pose no particular problem.
3. Because bismuth that has transferred into the circulating blood never crosses the blood-placenta barrier, it can be used even by a pregnant woman.
4. In a person diagnosed with a gastric or duodenal ulcer, absorption of bismuth from the damaged mucosa decreases, so it can be used safely.

Which of the following statements about loperamide hydrochloride is incorrect?

1. Part of the absorbed component is known to transfer into breast milk, so a woman who breastfeeds should either avoid its use or avoid breastfeeding during the period of use.
2. It is intended for use in diarrhea from overeating or excessive drinking, and diarrhea from getting chilled while sleeping, and is not intended for diarrhea from food poisoning or contaminated water.
3. Because it has an action that stimulates the central nervous system, insomnia can appear as a side effect, so taking it before bedtime should be avoided.
4. It shows an action that decreases intestinal motility, and combined use with a gastrointestinal antispasmodic/analgesic medicine needs to be avoided.

Which of the following statements about intestinal antiseptic ingredients formulated in antidiarrheal medicines is correct?

1. Acrinol is an adsorbent ingredient used for the purpose of adsorbing harmful substances generated from abnormal fermentation and the like within the intestine.
2. Berberine is one of the substances present in the crude drugs phellodendron bark and coptis rhizome, and is said to have both an antibacterial action and an anti-inflammatory action.
3. Berberine tannate is an ingredient that, without being broken down in the digestive tract, shows only an astringent action on the intestinal mucosa in its unchanged form.
4. An intestinal antiseptic ingredient is stated to be preferably taken in advance to prevent diarrhea.

Which of the following statements about adsorbent ingredients and crude drug ingredients formulated in antidiarrheal medicines is incorrect?

1. Natural aluminum silicate, precipitated calcium carbonate, calcium lactate, and the like are formulated for the purpose of adsorbing harmful substances generated from abnormal fermentation and the like within the intestine.
2. Wood creosote produces a laxative action by being broken down by intestinal bacteria to stimulate the large intestine.
3. Wood creosote is also said to have a local anesthetic action when used on the teeth.
4. Kaolin and medicinal charcoal are also used for their expected action of adsorbing harmful substances.

Which of the following statements about castor oil is correct?

1. It is used first for poisoning by a fat-soluble substance, such as when an insecticide or rodenticide has been accidentally swallowed.
2. It is thought that a breakdown product produced by the action of lipase in the small intestine stimulates the small intestine to bring about a laxative action.
3. Because its action is gentle, it is widely used even in an infant under 3 years of age or a pregnant woman.
4. Because the absorbed component does not transfer into breast milk, it can be used without restriction even by a woman who breastfeeds.

Which of the following statements about large-intestine-stimulant laxative ingredients is incorrect?

1. Sennoside is not digested in the stomach or small intestine, but is thought to be broken down by intestinal bacteria residing in the large intestine, with the breakdown products stimulating the large intestine to bring about a laxative action.
2. For an enteric-coated preparation of bisacodyl, taking a gastrointestinal medicine containing an antacid ingredient, or consuming milk, should be avoided within 1 hour before or after taking it.
3. Bisacodyl is thought to stimulate the mucosa of the large intestine, particularly the colon and rectum, to promote a bowel movement, and is also said to have a function that suppresses water absorption in the colon to increase the bulk of the feces.
4. Sodium picosulfate is quickly broken down in the stomach or small intestine, and shows a laxative action by directly stimulating the small intestine.

Which of the following statements about laxative ingredients is correct?

1. Docusate sodium (DSS) raises the osmotic pressure of the intestinal contents, increasing the water content in the feces to stimulate the large intestine and promote a bowel movement.
2. Malt extract directly stimulates the large intestine to promote a bowel movement, so its use needs to be avoided in infants and young children.
3. Carmellose sodium is used for its intended laxative action of absorbing water within the intestinal tract and infiltrating the intestinal contents, increasing the bulk of the feces and softening it.
4. For sodium sulfate, a person diagnosed with kidney disease should consult about its suitability before use, since excretion of inorganic salts is delayed and it risks causing hypermagnesemia.

Which of the following statements about enemas is correct?

1. For an injection-type preparation, attempting a bowel movement immediately after injecting the liquid allows the liquid to spread through the intestine, achieving a sufficient effect.
2. Because an enema carries no risk of being stimulated by sudden movement of the rectum to induce miscarriage or premature birth, it can be safely used even by a pregnant woman or a woman thought to be pregnant.
3. Repeated use should be avoided, since it heightens the sensitivity of the rectum and makes the effect excessively strong.
4. For an enema containing glycerin, there are reports of a drop in blood pressure at the time of a bowel movement causing lightheadedness, and consultation should be sought by an elderly person or a person diagnosed with heart disease.

Which of the following statements about anthelmintic medicines and anthelmintic ingredients is incorrect?

1. Combining multiple anthelmintic medicines is recommended, since it heightens the anthelmintic effect.
2. The parasites targeted by an OTC anthelmintic are roundworm (Ascaris) and pinworm (Enterobius).
3. Pyrvinium pamoate is said to show an insecticidal action by suppressing the respiration and nutrient metabolism of pinworm, and can color the urine or feces red.
4. Piperazine phosphate shows an action that paralyzes the motor muscles of roundworm and pinworm by interfering with acetylcholine transmission.

Which of the following statements about anticholinergic ingredients formulated in gastrointestinal antispasmodic/analgesic medicines is correct?

1. Because the action of suppressing the function of the parasympathetic nervous system is confined to the digestive tract, side effects outside the digestive tract, such as blurred vision or unusual glare from mydriasis, dry mouth, and constipation, are thought never to appear.
2. They promote the reaction between acetylcholine, the parasympathetic transmitter, and its receptor, heightening its function, thereby calming spasms of the digestive tract's smooth muscle such as stomach pain, abdominal pain, and colic.
3. Ingredients formulated include local anesthetic ingredients such as papaverine hydrochloride, ethyl aminobenzoate, and oxethazaine.
4. They interfere with the reaction between acetylcholine, the parasympathetic transmitter, and its receptor, suppressing its function, calming stomach pain, abdominal pain, and colic, and are also used for their expected effect against excess stomach acid and heartburn.

Which of the following statements about side effects and precautions for use of anticholinergic ingredients is incorrect?

1. Side effects such as blurred vision or unusual glare from mydriasis, facial flushing, headache, drowsiness, dry mouth, constipation, and difficulty urinating can appear.
2. Because elderly people often have an underlying disease such as difficulty urinating or glaucoma, and are also generally prone to side effects of dry mouth and constipation, careful use is important.
3. When medicines containing an ingredient with anticholinergic action are used together, the anticholinergic action is heightened, making side effects such as difficulty urinating, blurred vision, unusual glare, headache, drowsiness, dry mouth, and constipation more likely to appear.
4. For belladonna extract, part of the absorbed component transfers into breast milk, risking slowing the infant's pulse, so a woman who breastfeeds should either avoid its use or avoid breastfeeding during the period of use.

Which of the following statements about papaverine hydrochloride and local anesthetic ingredients is correct?

1. Because papaverine hydrochloride shows an action that lowers intraocular pressure, it is said to be suited to a person diagnosed with glaucoma.
2. Papaverine hydrochloride is said to act directly on the smooth muscle of the digestive tract to calm spasms of the stomach and intestine, and unlike anticholinergic ingredients, no action of suppressing gastric juice secretion has been found.
3. Oxethazaine shows only a local anesthetic action, and no action of suppressing gastric juice secretion has been found.
4. Ethyl aminobenzoate needs to have its use avoided in a child under 15 years of age, since it risks causing methemoglobinemia in infants and young children.

Which of the following statements about interactions of gastrointestinal antispasmodic/analgesic medicines and recommending a doctor's visit is incorrect?

1. While a gastrointestinal antispasmodic/analgesic medicine is being used, use of another gastrointestinal antispasmodic/analgesic medicine needs to be avoided.
2. If pain gradually intensifies, appears periodically, is accompanied by vomiting or fever, or an unexplained pain continues for 30 minutes or more, a response such as visiting a medical institution is basically necessary.
3. When pain occurs in the flank accompanied by blood in the urine, a disease of the kidneys or urinary tract is suspected, and using a gastrointestinal antispasmodic/analgesic medicine is not appropriate.
4. For abdominal pain accompanying diarrhea, relief of the pain with a gastrointestinal antispasmodic/analgesic medicine should be prioritized over addressing the diarrhea.

Which of the following statements about kampo formula products used to improve stomach discomfort is incorrect?

1. Anchusan (安中散) is said to be suited to nervous gastritis, chronic gastritis, and gastrointestinal weakness in a person of medium build or below, with a weak abdomen, having stomach pain or abdominal pain, sometimes accompanied by heartburn, belching, stomach heaviness, loss of appetite, nausea, or vomiting.
2. Rikkunshito (六君子湯) is known to rarely cause liver dysfunction as a serious side effect.
3. Heiisan (平胃散) is said to be suited to a person of weak constitution, and does not contain glycyrrhiza among its constituent crude drugs.
4. Ninjinto (人参湯, also called richugan) is said to be suited to gastrointestinal weakness, diarrhea, vomiting, stomach pain, abdominal pain, and acute or chronic gastritis in a person of weak constitution, who tires easily and whose limbs and the like tend to feel cold.

Which of the following statements about kampo formula products used to improve intestinal discomfort is correct?

1. Mashiningan (麻子仁丸) contains glycyrrhiza among its constituent crude drugs and does not contain rhubarb root, so there is no need to avoid combining it with another laxative.
2. Daiokanzoto (大黄甘草湯) can be used regardless of physical constitution, and is said to be suited to relieving symptoms such as constipation and heaviness in the head or flushing accompanying constipation, but is unsuited to a person of weak constitution or a person with a weak digestive system prone to diarrhea, in whom side effects such as diarrhea with intense abdominal pain readily appear.
3. Keishikashakuyakuto (桂枝加芍薬湯) is said to be suited to menstrual irregularity, dysmenorrhea, constipation, and hemorrhoidal disease in a person of medium build or above with lower abdominal pain and a tendency toward constipation, but unsuited to a person of weak constitution or a person with a weak digestive system prone to diarrhea.
4. Even while daiobotanpito (大黄牡丹皮湯) is being used, it is preferable to use another laxative together with it to heighten the effect.