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26:GERD & LRD, 27: IBS/UC/CD > GERD/IBS/UC/CD Questions > Flashcards

GERD/IBS/UC/CD Questions Flashcards

0
Q

T/F: GERD may increase the risk for development of chronic disease(s)

A

true

such as asthma

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1
Q

what are some foods that can contribute to GERD?(8)

A
  • Citrus fruits
  • chocolate
  • caffeinated beverages
  • Fried and fatty food
  • mint flavoring
  • spicy food
  • tomato-based foods/sauces
  • garlic and onions
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3
Q

what causes reflux?(3)

A
  • natural body processes fail to prevent backflow
  • pressure in the stomach causes the LES to open and leak back up
  • delayed gastric emptying or transient relaxation of the LES
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4
Q

what does LES stand for?

A

Lower Esophageal Sphincter

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5
Q

T/F: Hiatal Hernia is always a significant risk factor for GERD

A

false

significant risk factor for GERD in persons over 50 years old

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6
Q

what kind of drugs are acid suppressing drugs?(2)

A
  • histamine2 receptor antagonists

- proton pump inhibitors

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7
Q

T/F: infants may have GERD because their digestive system is immature

A

true

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8
Q

what has been found to be linked to more severe esophagitis?

A

large hiatal hernias

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8
Q

what kind of factors contribute to GERD?(6)

A
  1. foods
  2. lifestyle
  3. body position
  4. pregnancy
  5. obesity
  6. Rx and OTC medicines
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10
Q

how can lifestyle be a factor contributing to GERD?(2)

A
  • alcohol consumption

- cigarette smoking

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11
Q

how is body position a contributing factor to GERD?

A

symptoms worsen in a prone position(lying down)

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12
Q

what kind of drugs aggravate GERD?(5)

A
  1. impair peristalsis
  2. delay gastric emptying
  3. decrease esophageal sphincter tone
  4. decrease protective mucosal lining
  5. increase gastric acids
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13
Q

what are some examples of drugs that aggravate GERD?

A
  • Anticholinergics eg., hyoscyamine
  • opioids eg., codeine
  • calcium channel blockers eg., verapamil
  • non-steroidal anti inflammatory drugs(NSAIDS) eg., naproxen
  • xanthines eg.,theophylline
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14
Q

T/F: naproxen is proven safe and effective in the treatment of GERD

A

false

naproxen is a NSAID, which are known to aggravate GERD.

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15
Q

T/F: mint is useful in GERD relief

A

false

mint flavoring is a food factor contributing to GERD

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16
Q

what is an ulcer?

A

an open wound or sore

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17
Q

what kind of ulcer is located in the stomach?

A

gastric ulcer

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18
Q

where would you find a peptic ulcer?

A

it is located in either the stomach or the duodenum

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19
Q

what do you call an ulcer located in the upper region of the small intestine?

A

duodenal ulcer

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20
Q

what are 5 risk factors for peptic ulcer disease?

A
  1. Helicobacter pylori (H. pylori)
  2. Family history of ulcers
  3. living with close relatives who have PUD
  4. age
  5. medicines
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21
Q

does PUD stand for?

A

peptic ulcer disease

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22
Q

T/F: persons over the age of 30 are at higher risk for PUD

A

false

persons older than 50

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23
Q

what kind of medicines are risk factors for PUD?(3)

A
  1. salicylates (aspirin)
  2. NSAIDs (naproxen)
  3. corticosteroids (prednisone)
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24
Q

what is the number one cause of PUD?

A

H. pylori

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25
Q

what is treatment PUD?

A

eliminate H. pylori

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26
Q

what are two treatment strategies for PUD, GERD and LPR?

A
  1. reduce G.I. irritants

2. increase protective factors (mucus secretion by epithelial cells)

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27
Q

T/F: one treatment strategy of PUD, GERD and LPR is to increase protective factors, an example is mucus secretion by squamous cells

A

false

mucus secretion by epithelial cells

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28
Q

what are acid neutralizing drugs?

A

antacids

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29
Q

what are you mucosal protectants?(2)

A
  • prostaglandins

- sucralfate

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30
Q

What are the 5 drug classifications for drugs used in the treatment of GERD and LRD?

A
  1. acid neutralizing drugs
  2. acid suppressing drugs
  3. mucosal protectants
  4. Anti-infectives
  5. Prokinetic drugs
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31
Q

what are anti-infectives use for in the treatment of GERD and LRD?

A

eliminate H. pylori

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32
Q

what is an example of a prokinetic drug?

A

Metoclopramide®

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33
Q

what is the short name for histamine2 receptor antagonists???

A

H2 blockers

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34
Q

what is a common ending for H2-blockers?

A

-tidine

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35
Q

T/F: H2 receptor antagonists are available in by prescription only

A

false

available in RX and OTC strengths

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36
Q

how do histamine2 receptor antagonists work?

A

they block histamine stimulated acid secretion by gastric parietal cells.

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37
Q

what is the most potent H2 receptor agonist?

A

ranitidine

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38
Q

T/F: dry mouth, headache, and constipation are common adverse effects for histamine2 receptor antagonists.

A

false

they are common adverse effects associated with mucosal protectant-sucralfate

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39
Q

what are the adverse reactions of histamine2 receptor antagonist?(7)

A 
dizziness/drowsiness
headache
constipation/diarrhea
nausea
abdominal pain
bloating
Gynecomastia- tagamet
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40
Q

what are some adverse effects of misoprostol?(5)

A
  • abdominal cramps
  • diarrhea
  • menstrual irregularities
  • headache
  • dizziness
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41
Q

T/F: GERD is a motility disorder associated with impaired peristalsis

A

true

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41
Q

T/F: proton pump inhibitors have the common ending -tidine

A

false

have the common ending -prazole

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42
Q

in addition to metoclopramide, what other drug is approved for the treatment of heartburn in Canada?

A

Domperidone®

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44
Q

what do proton pump inhibitors do?(2)

A
  • increase gastric acids

- interfere with the final step in gastric acid production

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45
Q

what drug is approved for prevention of NSAID-induced peptic ulcers?

A

misoprostol

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46
Q

what is sucralfate used for?

A

sucralfate is a mucosal protective agent approved for treatment and maintenance of duodenal ulcers.

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47
Q

how does sucralfate work?

A
  • binds to the ulcerated l area and forms a protective barrier
  • promotes regeneration of stomach epithelial cells
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48
Q

T/F: sucralfate is a weak inhibitor of H. pylori

A

true

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49
Q

what are some adverse effects of sucralfate?(4)

A
  • constipation
  • gas
  • dry mouth
  • headache
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50
Q

T/F: misoprostol is rated category A for pregnancy use.

A

false

contraindicated in pregnancy because it stimulates uterine contractions

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51
Q

is currently the only prokinetic drug approved by the US FDA?

A

Metoclopramide

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52
Q

in what 3 ways does misoprostol help in the treatment of GERD, LRD and PUD?

A
  1. stimulates production of protective mucus and bicarbonate in the stomach
  2. increases regeneration of gastric epithelial cells
  3. enhances blood flow to the stomach
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53
Q

T/F: flatulence, vitamin B12 deficiency, and dizziness or adverse reactions to proton pump inhibitors

A

true

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53
Q

which drug must be dispensed in the manufacturer’s original container?

A

misoprostol

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54
Q

what can chronic exposure to gastric acid and pepsin lead to?(3)

A
  • inflammation
  • ulceration
  • stomach cancer
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56
Q

what are the adverse reactions of prokinetic drugs?(8)

A
  • drowsiness or dizziness
  • bloating
  • abdominal pain
  • constipation or diarrhea
  • restlessness
  • headache
  • skin rash
  • irregular heartbeat
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57
Q

irregular heartbeat and restlessness are adverse reactions to what Drug classification?

A

Prokinetic drugs

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58
Q

T/F: antacids are available by prescription only

A

false

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59
Q

what are the 2 kinds of acid suppressing drugs used in the treatment of PUD, GERD, and LPR?

A
  1. histamine2 receptor antagonists

2. proton pump inhibitors

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60
Q

nausea and vomiting, skin rash, agitation or dark yellow/brown urine are adverse reactions to what Drug classification?

A

proton pump inhibitors

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60
Q

what Drug blocks absorption of drugs taken at the same time?

A

sucralfate

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61
Q

what is an example of a prostaglandin?

A

misoprostol

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62
Q

how do antacids work?

A

neutralize gastric acids and decrease pepsin secretion

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63
Q

diarrhea is an adverse effect of what kind of antacid?

A

magnesium containing

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64
Q

what are the four kinds of antacids?

A
  1. magnesium containing
  2. aluminum containing
  3. calcium containing
  4. sodium bicarbonate
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65
Q

what kind of anti-infectives are used?

A

antimicrobials to eradicate H. pylori infection

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66
Q

what is sodium bicarbonate?

A

baking soda

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66
Q

what are 2 adverse effects of aluminum containing antacids?

A
  1. constipation

2. hypophosphatemia

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68
Q

constipation, hypercalcemia, and kidney stones are adverse effects to what?

A

calcium containing antacids

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69
Q

what is hypophosphatemia?

A

electrolyte disturbance, in which there is abnormally low phosphate levels in the blood

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69
Q

why are anti-infectives prescribed in the treatment of GERD, PUD, And LPR?

A

prescribing combination with drugs that decrease gastric acids and protect the gastric mucosa

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71
Q

T/F: a salad with oil and vinegar dressing is a safe natural alternative for the treatment of GERD

A

false

creamy and oil and vinegar salad dressings should be avoided

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72
Q

what are 4 common anti-infectives prescribed in the treatment of GERD, PUD and LPR?

A
  1. amoxicillin-omeprazole-clarithromycin
  2. amoxicillin-metronidazole-ranitidine
  3. Clarithromycin-omeprazole
  4. amoxicillin-omeprazole
73
Q

_______ is approved for the prevention of NSAID-induced peptic ulcers.

A

misoprostol

74
Q

rebound hyperacidity, metabolic alkalosis, edema and hypertension are adverse effects of what?

A

sodium bicarbonate antacids

75
Q

T/F: fennel tea or chamomile tea have a soothing effect and are a good natural alternative to GERD

A

true

sip slowly

76
Q

T/F: juices are food to avoid

A

true

77
Q

T/F: organic apple cider is a natural alternative in the treatment of GERD

A

true

shake well; pulp contains enzymes to reduce acid

78
Q

T/F: stress and spicy foods can cause ulcers

A

false

however, some foods can aggravate existing GERD

79
Q

what histamine2 receptor antagonists are used in the treatment of GERD?(4)

A
  • cimetidine
  • famotidine
  • nizatidine
  • ranitidine
80
Q

Pepcid Complete belongs to what Drug classification?

A

H2 receptor antagonist combinations

81
Q

T/F: Pepcid Complete is available as an OTC product

A

true

82
Q

what are some unique symptoms of PUD?(3)

A
  • Burning pain in the gut 2-3 hours after a meal
  • weight loss
  • loss of appetite
83
Q

T/F: ranitidine capsules are prescription only

A

true

only 75mg and 150mg tablets are OTC

84
Q

Is nizatidine an OTC product?

A

yes, 75mg tablets (Axid AR) only

85
Q

T/F: ranitidine is up to 10 times more effective than cimetidine

A

true

86
Q

T/F: proton pump inhibitor drugs are more potent than H2 receptor antagonists

A

true

87
Q

what are OTC proton pump inhibitors marketed for the treatment of?

A

heartburn

88
Q

T/F: ant acids are the oldest drugs used for the treatment of GERD and LPR

A

false

GERD and PUD

89
Q

T/F: persons of any age can develop GERD

A

true

90
Q

what is LPR?

A

laryngopharyngeal reflux

91
Q

T/F: GERD, PUD, and LPR are known at chronic state to cause discomfort

A

false
although these diseases initially produce minor discomfort, they may progress into life-threatening hemorrhage or stomach cancer

92
Q

unique symptoms of GERD(8)

A
  • difficulty swallowing
  • dry cough
  • bad breath
  • bloated
  • rumbling noise in stomach
  • belching or burping
  • respiratory problems
  • hoarseness
93
Q

what are some common symptoms of GERD?(5)

A
  • heartburn
  • stomach ache
  • Hunger pains
  • nausea or vomiting
  • chest pain
94
Q

what are some unique symptoms of LPR?(9)

A
  • hoarseness
  • voice fatigue or breaks
  • sore throat
  • excessive phlegm or saliva
  • chronic cough
  • bad breath
  • middle ear infection
  • wheezing
  • chronic sinusitis
95
Q

T/F: red licorice can aggravates GERD

A

false

Red licorice and jellybeans are safe natural alternatives

96
Q

T/F: many prescription and OTC medicines can worsen GERD

A

true

97
Q

what OTC products irritate the esophagus and may cause heartburn?

A

OTC iron and potassium supplements, and NSAIDs

98
Q

what are some less common adverse effects of H2 receptor antagonists?

A
  • skin rash
  • agitation
  • depression
  • hepatitis
  • decreased libido
  • Gynecomastia
99
Q

what drug binds to the ulcerated area and forms a protective barrier, much like a bandage protects a sore?

A

sucralfate

100
Q

name 2 proton pump inhibitor drugs(6)

A
  1. dexlansoprazole
  2. esomeprazole
  3. lansoprazole
  4. omeprazole
  5. pantoprazole sodium, pantoprazole magnesium
  6. rabeprazole
101
Q

_____-containing antacids cause diarrhea; _____-containing antacids cause constipation

A

magnesium ; aluminum or calcium

102
Q

proton pump inhibitors are effective in treating GE already, LPR, and PUD because they ______

A

decrease gastric acid levels

103
Q

which sphincter in the digestive system is affected by GERD?

A

lower esophageal sphincter

104
Q

what is inflammatory bowel disease?

A

chronic disorder of the gastrointestinal tract characterized by inflammation of the intestine and resulting in abdominal cramping and persistent diarrhea

105
Q

what is diarrhea?

A

abnormally frequent passage of loose and watery stools

106
Q

what is irritable bowel syndrome?

A

condition that causes abdominal distress and erratic movement of the contents of the large bowel resulting in diarrhea and/or constipation

107
Q

T/F: inflammatory bowel disease and irritable bowel syndrome are interchangeable terms

A

false

108
Q

what is constipation?

A

abnormally delayed or infrequent passage of dry hardened feces

109
Q

what is a laxative?

A

medicine induces evacuation of the bowel

110
Q

what are some symptoms of Crohn’s disease?

A
  • rectal bleeding
  • skin lesions
  • decreased growth (children)
  • fever
  • arthritis(joint pain)
  • anemia
  • weight loss, loss of appetite
111
Q

define: fistula

A

ulcer that tunnels from the site of origin to surrounding tissues

112
Q

what are the two main types of IBS?

A
  1. ulcerative colitis (UC)

2. Crohn’s disease(CD)

113
Q

T/F: an estimated 20% of people in North America have IBS

A

false

10% to 15%

115
Q

what is Crohn’s disease?

A

irritable bowel disease that produces inflammation and damage anywhere along the G.I. tract

116
Q

what are the four inflammatory diseases of the bowel?

A
  1. ulcerative colitis
  2. Crohn’s disease
  3. ulcerative proctitis
  4. pouchitis
117
Q

T/F: UC only affects the colon and CD can involve any segment of the G.I. tract

A

true

CD may also cause inflammation in the eye, mouth, or some joints

118
Q

how do bulk forming laxatives work?

A

swells in the presence of liquid. Bacteria normally live in the colon and digest cellulose and polysaccharide fibers. As the bacteria colony grows, colonic bulk increases. This causes the bowel to feel full and stimulates evacuation

119
Q

what is the only bulk forming laxative the FDA has approved for treatment of IBS? can it be obtained without a prescription?

A

Polycarbophil; yes

120
Q

what kind of drugs are used in the treatment of IBS?(4)

A
  1. anticholinergic
  2. Fiber supplement
  3. antidiarrheal
  4. laxative
121
Q

what are some adverse reactions of polycarbophil?(6)

A
  • bloating
  • gas
  • abdominal cramps
  • nausea
  • diarrhea or constipation
122
Q

in what dosage form(s) and strength(s) does polycarbophil come in?

A

tablet: 500 mg, 625 mg, 1250 mg chewable

123
Q

why are opioid antidiarrheals administered?

A

to control watery and frequent stools

124
Q

what opioid antidiarrheals are prescribed for the treatment of diarrhea?(3)

A
  1. Difenoxin
  2. diphenoxylate
  3. loperamide
125
Q

T/F: Difenoxin and diphenoxylate are more potent than loperamide

A

false

Difenoxin and loperamide are more potent than diphenoxylate

126
Q

T/F: Difenoxin and diphenoxylate are controlled substances and may produce dependence at high doses

A

true

127
Q

_____ & _____ are the most common side effects of opioid antidiarrheals. they may also cause _____.

A

sedation and dizziness

constipation

128
Q

T/F: loperamide is habit-forming and therefore only available with prescription

A

false

not habit-forming and is available without a prescription

129
Q

what is toxic megacolon?

A

life-threatening condition characterized by a very inflated colon, abdominal distention, and sometimes fever, abdominal pain, or shock

129
Q

why should antidiarrheals be used cautiously for patients with UC?

A

because they can cause toxic megacolon

130
Q

T/F: IBS is sometimes called colitis

A

true

131
Q

when are anticholinergic drugs used in the treatment of IBS?

A

when diarrhea is the primary symptom

132
Q

T/F: anticholinergic agent dicyclomine, may cause hallucinations at high doses

A

true

133
Q

name 3 bowel movement disorders

A
  1. constipation
  2. diarrhea
  3. irritable bowel syndrome (IBS)
134
Q

what is the main complication of diarrhea?

A

dehydration

135
Q

what kind of drugs are used for the treatment of UC and CD?

A

aminosalicylates

136
Q

what are the 3 aminosalicylate anti-inflammatory agents used in the treatment of UC and CD?

A
  1. sulfasalazine
  2. olsalazine
  3. mesalazine
137
Q

what 2 types of drugs are used for the treatment of UC?

A
  1. aminosalicylates

2. corticosteroids

138
Q

what 3 types of drugs are used for the treatment of Crohn’s disease?

A
  1. immunosuppressants
  2. immunomodulators
  3. anti-infectives
    - -corticosteroids and aminosalicylates are also used
139
Q

what are the two routes of administration of corticosteroids in the treatment of UC and CD?

A

by mouth or rectally in the form of an enema or suppository

140
Q

_______is a time-release formulation (of aminosalicylates in treating UC and CD)

A

Pentasa

141
Q

what are the five most common adverse effects of aminosalicylates?

A
  • nausea
  • vomiting
  • heartburn
  • headache
  • watery diarrhea
142
Q

what drug may cause sunburn, impaired folic acids absorption, crystalluria area, and damage to white blood cells (cytopenias)? what classification does it belong to?

A

Sulfasalazine , aminosalicylates

144
Q

what is a common ending for aminosalicylates ?

A

-salazine

145
Q

T/F: common endings for corticosteroids are -sone & -one

A

true

146
Q

oral administration of corticosteroids in the treatment of CD and UC produces _______ effects. common adverse reactions are_______(

A

systemic effect;

osteoporosis, acne, cataracts, poor wound healing, increased risk of infection, and ulceration in the G.I. tract

147
Q

how do glucocorticosteroids work in the treatment of UC and CD?

A

they decrease the synthesis of pro-inflammatory substances such as prostaglandins.

148
Q

T/F: glucocorticosteroids may initially produce muscle weakness.

A

true

this is a serious problem for people with myasthenia gravis given that muscle weakness is a symptom of the disease

149
Q

are there any long-term effects of glucocorticosteroids?

A

May increase the need for potassium; vitamins A, B6, C, D; folate; calcium; zinc; and phosphorus supplementation

150
Q

what is an autoantibody?

A

an abnormal antibody that attacks healthy cells and tissue

151
Q

what 2 Drugs from the drug classification immunomodulators are used for the treatment of CD?

A
  1. infliximab

2. natalizumab

152
Q

what 3 drugs from the drug classification immunosuppressants are used for the treatment of CD?

A
  1. azathioprine
  2. 6-mercaptopurine
  3. methotrexate
153
Q

the immunosuppressants azathioprine, 6-mercaptopurine and methotrexate and classified as _______.

A

antimetabolites

154
Q

what are some adverse reactions of anticholinergics?

A

May produce constipation, difficulty sleeping, dry mouth, change in taste, headache, photophobia, nausea, sexual difficulty, fast or slow heartbeat, urinary retention, dizziness or drowsiness.

154
Q

how are hepatitis B and C commonly transmitted?

A

parenteral contact with infected body fluids

155
Q

why are antimetabolites used in the treatment of CD?

A

to induce remission

156
Q

T/F: TNF levels are increased in Crohn’s disease

A

true

157
Q

Anti-infectives prescribed to treat fistulas include:(5)

A
  1. ampicillin
  2. sulfonamides
  3. cephalosporins
  4. tetracycline
  5. metronidazole
158
Q

what immunomodulator drug package contains FDA required warning that teenage or young adult males with CD or UC may develop a rare form of fatal lymphoma??

A

Infliximab

159
Q

what is a common ending for immunomodulators?

A

-mab

160
Q

what tests may be performed to diagnose UC and CD?(2)

A
  1. colonoscopy

2. sigmoidoscopy

161
Q

name three common symptoms of IBS, UC and CD

A
  1. abdominal pain
  2. diarrhea
  3. cramping
162
Q

which types of hepatitis have a vaccine available for prevention?

A

hepatitis a and hepatitis B

163
Q

an Alster that is located in the upper portion of the small intestine or duodenum is called a(n) _______

A

Duodenal ulcer

164
Q

what is the generic name for the rectally administered corticosteroid?

A

hydrocortisone

165
Q

what food should be avoided so that it does not worsen symptoms of IBS, UC and CD?(5)

A
  • wheat
  • rye
  • barley
  • diary
  • chocolate
166
Q 
The following labels should be applied to prescription vials for which class of drugs used to treat IBS:
"May cause dizziness or drowsiness; avoid driving, avoid alcohol, drink lots of fluids, take on an empty stomach"
A

anticholinergics

166
Q

_______ (drug classification) increase peristalsis, speed gastric emptying, and improve LES tone

A

Prokinetic drugs

167
Q

________ are commonly prescribed to suppress inflammation, reduce flare-ups, and treat pain associated with UC(and CD).

A

Glucocorticosteroids

169
Q

following what kind of diet may reduce symptoms of irritable bowel syndrome??

A

a diet for celiac disease

169
Q

how is hepatitis A usually transmitted?

A

ingestion of contaminated food or water

170
Q

T/F: an infected persons feces are always infectious to other people when they are infected with hepatitis

A

true

172
Q

in how long do symptoms appear after person has been infected with hepatitis?

A

15-180 days

173
Q

what is the volume of acid normally present between meals?

A

1-2 ounces of HCl

174
Q

what lifestyle modifications can be made to lessen the symptoms of IBS?(7)

A
  • eat small meals
  • drink at least 6-8 glasses of water/day
  • avoid alcohol
  • avoid caffeinated beverages
  • limit carbonated beverages
  • avoid foods that worsen symptoms
  • engage in stress reduction activities
179
Q

T/F: delayed release tablets of lansoprazole disintegrate in less than 1 minute

A

true

180
Q

what is a standard used to evaluate the potency of antacids?

A

The acid neutralizing capacity (ANC)

181
Q

what drug is approved for the treatment and maintenance therapy of duodenal ulcers

A

sucralfate

182
Q

_____ is a term used to describe ulcers that are located in either the duodenum or stomach

A

Peptic Ulcer Disease (PUD)

183
Q

what is an ANC?

A

A measure of the ability of an antacid to do the following:

  1. neutralize approx. 1-2 oz hydrochloric acid
  2. raise the pH of the stomach to 3.5 within 10 minutes

26:GERD & LRD, 27: IBS/UC/CD (3 decks)

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