GI/GU Exam 3 Flashcards

1
Q

3 goals of treatment for PUD

A

Alleviate the symptoms
Promote healing
Prevent complications (Hemorrhage/perforation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

We can cure H. pylori ulcers. True or false

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the guideline recommendation for H. pylori antibiotic treatment

A

2 antibiotics combo’d with a proton pump inhibitor or H2 receptor blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Cimetidine brand name

A

Tagamet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Use of Cimetidine (Tagamet) (3)

A

Treats gastric Ulcers
Duodenal ulcers
GERD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

MOA of of Cimetidine

A

Blocks H2 Receptors on parietal cells to decrease acid production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Cimetidine Distribution be aware

A

Can cross BBB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Side affects of Cimetidine? Serious

A

Generally well tolerate- serious can be pneumonia because it increases PH in GI tract (alkaline)- over proliferation of bacteria also in lungs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

“Tidine”

A

All H2 blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

MAR drugs for Tidines

A

Antacids- affects absorption of drug

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

PMH (2) for Cimetidine

A

Renal or hepatic dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Monitor patient and educate patient on what for Cimetidine (3)

A
  • Gastric bleed S/S
  • Respiratory Infection (Pneumonia risk)
  • PUD factors (alcohol, smoking, aspirin/NSAID use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Omeprazole

A

Prilosec- Proton pump inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Use of Omeprazole

A

Gastric and duodenal ulcers, GERD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

MOA of Omeprazole

A

irreversible inhibition of H+K- ATPase (proton pump)- the enzyme that generates gastric acid- final stage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

All proton pump inhibitors end with _____

A

prazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Proton pump inhibitors any common adverse effects?

A

Generally well tolerated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Serious side affects of Omeprazole

A
  • Fractures- decreased CA absorption (Take Vitamin D and Calcium supplement)
  • Rebound Acid Hyper secretion when stop taking the med
  • Hypomagnesemia (General electrolyte concerns)
  • Pneumonia- Just like H2RA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

3 MAR concerns for Omeprazole

A

Diuretics- Electrolyte concerns
Clopidogrel- Drug reaction- causes platelets not to be as sticky
Certain HIV Drugs- HARD NO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Omeprazole administration PO (1)

A

Take the lowest dose for the shortest period of time possible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Patient education for Omeprazole (4)

A
  • S/S of gastric bleeding
  • S/S of hypomagnesemia
  • Limit the factors contributing to PUD (smoke, drink, nsaid, etc)
  • S/S of respiratory infection (pneumonia)

**Same patient monitoring and education as H2 receptor agonists, plus the electrolyte disturbance)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Sucralfate Use and MOA

(My fate is to crate)

A

Duodenal ulcer, sticks to ulcer crates and coats it- protecting it from acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Sucralfate Adverse reaction and drug interaction

A

No serious adverse, can affect absorption of other drugs, separate by 2 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Misoprostol (cytotec) use and MOA

A

Ulcers due to NSAID use and it is the analog of prostaglandin E1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Misoprostol Adverse effects (Hard No 1)

A

Pregnancy- Category X, stimulate uterine contractions

Common- Diarrhea and abdominal cramping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Aluminum hydroxide antacid use, effect on bowel?

A

treat hyperphosphatemia and causes constipation not diarrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Magnesium hydroxide adverse effects and effect on bowel

A

Can cause mag toxicity (CNS depression) in patients with renal impairment- no constipation but causes diarrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Sodium bicarbonate use and effect on bowel

A

Not routinely used for ulcers- used to treat acidosis and to alkalinize urine- systemic effect on PH , releases CO2
NO constipation or Diarrhea effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Differences between Laxative effect and catharsis

A

Laxative- production of soft, formed stool over a day or more- prevent constipation or treat acute or chronic constipation

Catharsis- Evacuation of bowel- poison, parasites, diagnostic study requires empty gut (fast and furious)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Group 1 Laxative Therapeutic Effect

A

Rapid action (2-6 hours), prep for surgery, educate patient on safety (bedside commode and call bell within reach)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Group 2 Therapeutic Effect

A

Intermediate (6-12 hours), semifluid stool

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Group 3 Laxatives Therapeutic Effect

A

Most frequently abused by public (act 1-3 days) soft formed stool, treat constipation or straining

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Contraindications for Laxative Use

A
  • Any appendicitis symptoms, enteritis, diverticulitis, UC
  • obstruction or impaction,
  • habitual use
  • use with caution in pregnancy and lactation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Psyllium brand name, group, what type of agent

A

Metamucil (II), bulk forming

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Psyllium (metamucil) use

A

Preferred temp treatment of constipation, can also slow diarrhea in colostomy and ileostomy patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Psyllium (Metamucil) MOA

A

pull water into stoole (form a gel that swells), provide bulk, pushes on GI to promote peristalsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Psyllium (metamucil) hard no and patient education

A

Esophageal obstruction and tell px to drink plenty of fluids to prevent obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Docusate sodium brand name, Class, type of agent

A

Colace (III), surfactant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Docusate sodium (Colace) Use

A

Prevent constipation, common in hospital for immobile patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Colace MOA

A

Pull water and fat into stool, prevent reabsorption of water by intestines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Colace adverse?

A

Minimal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Castor oil group

A

I

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Bisacodyl Use

A

Opioid constipation and slow intestinal transit time constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

MOA of bisacodyl

A

Stimulate intestinal motility and increase water and electrolytes that stay in the GI tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Route of bisacodyl (treat from attic and basement)

A

Oral and rectal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Bisacodyl Group type of agent

A

II, stimulant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Osmotic laxatives (I and II)

A
Magnesium salts (mag citrate) (1) or
Polyethylene glycol ( Peg - Miralax) (II)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Use of Miralax

A

Chronic constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Use of Magnesium salts or Mag Citrate

A

Bowel prep, evacuation of parasites or poison

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Adverse effects of osmotic laxatives

A

dehydration and hypermagnesemia in renal impaired

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Lactulose Use

A

osmotic laxative, used for individuals who have high ammonia levels- liver failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Mineral oil use

A

Laxative used for lubrication for fecal impaction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Mineral oil adverse effect

A

Lipid pneumonia, deposit of mineral oil in the liver, anal leakage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Glycerin Suppository use

A

Osmotic agent laxative, softens impacted feces and can stimulate rectal contraction- effects 30 minutes after insertion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Ondansetron Brand name and class

A

Zofran

Serotonin antagonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Use of Ondansetron (CPR)

A

Chemo, postoperative, radiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

MOA of Ondansetron

A

Block serotonin receptors on vagal afferents and in chemoreceptor trigger zone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Serious side effect of Ondansetron

A

Prolonged QT Interval

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Prochlorperazine (AZINE) class of anti-emetic

A

Dopamine antagonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Prochlorperazine use (CPG)

A

chemo, post op, general

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

MOA of Prochlorperazine

A

Block dopamine receptors in CTZ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Adverse effects of Prochlorperazine

A

Anti-cholinergic effects. hypotension, sedation, tardive dyskinesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Cannabinoids Drug name

A

Dronabinol (Marinol)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Use for Marinol

A

Chemo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Marinol moa

A

Activate cannabinoid receptors associated with vomiting center, trigger appetite

66
Q

Scopolamine (Transderm scop) Drug class

A

Anticholinergic

67
Q

Scopolamine use

A

motion sickness

68
Q

MOA of scopolamine

A

Block muscarinic receptors in the pathway from the inner ear to vomiting center

69
Q

Dimenhydrinate drug class

A

Antihistamine

70
Q

Use of dimenhydrinate

A

Motion sickness

71
Q

MOA of dimenhydrinate

A

Block H1 receptors and muscarinic receptors in the pathway from the inner ear to the vomiting center

72
Q

Two types of anti-diarrheals

A

Specific and non-specific

73
Q

Diphenoxylate with Atropine brand name

A

Lomotil

74
Q

Loperamide brand name

A

Imodium

75
Q

Lomotil and Imodium used for

A

Non-specific antidiarrheal agent

76
Q

Why is atropine added to opioid antidiarrheal agent

A

Will minimize abuse, blocks cholinergic receptors (parasympathetic system)

77
Q

MOA of opioid antidiarrheal agents

A

activate opioid receptors in the GI tract (Mu receptors)

Lehman terms- they slow motility and allow more time for absorption

78
Q

Inflammatory Bowel Diseases 2 types

A

Crohns Disease or Ulcerative colitis

79
Q

Irritable Bowel Syndrome types

A

Most common disorder of the GI tract, crampy abdominal pain
IBS-C (Constipation)
IBS-D (Diarrhea)
IBS-M (Mixed)

80
Q

Nonspecific drugs for Irritable bowel syndrome

A

Antispasmodics
Bulk-forming agents
Antidiarrheals
Tricyclic Antidepressants

81
Q

Alosteron Moa and use

A

Selective blockade of 5-HT3 receptors- specific anti-diarrheal for irritable bowel syndrome

82
Q

Alosetron Adverse Effect

A

Overshoot mark

Constipation (Ischemic colitis)

83
Q

Metoclopramide Brand name

A

Reglan

84
Q

Metoclopramide Use

A

Diabetic gastroparesis (Diabetetic peristalsis due to poor perfusion to GI tract) or GERD

85
Q

MOA of Metoclopramide

A

Emesis- Blocks dopamine and serotonin in the CTZ

GI- enhances actions of Acetylcholine, promoting peristalsis

86
Q

Adverse effects of Metoclopramide long term and high dose

A

Long term: irreversible tardive dyskinesia

High-dose therapy: Sedation and diarrhea are common

87
Q

What percentage of vitamins do we actually take in orally vs urinate out

A

10% taken in and 90% is urinated out

88
Q

Difference between fat soluble and water soluble vitamins

A

Fat soluble stored in fat- take week to months to eliminate

Water soluble- quickly secreted, deficiencies are noted quickly

89
Q

List fat soluble vitamins (Any adverse to any?)

A

Vitamins A, D, K, E

Only vitamin A reaches toxic level, highly teratogenic in excess

90
Q

Water Soluble Vitamins List

A

B1, B2, B3, B6, B9, B12, Vitamin C

91
Q

Vitamin deficiencies are often the result of 4 common factors

A
  • Fad diets
  • Alcohol/drug abuse
  • Poverty
  • Prolonged parenteral feedings
92
Q

Vitamin B1 also called? Used for what

A

Thiamine, often added to IV bags (banana bags)

Malnutrition and chronic alcoholics

93
Q

Vitamin B3 (Niacin) Used for

A

High doses used to reduce cholesterol- risks often outweigh benefits

94
Q

Vitamin B9 Folic Acid Use

A

Deficiency is rare. Often given to

  • Malnourished
  • Chronic Alcoholics
  • Megaloblastic anemias
  • Pregnancy to prevent neural tube injury
95
Q

Vitamin B12 Use

A

Gastric bypass surgery patients and pernicious anemia
Gastric Bypass patients don’t have sufficient parietal cells to secrete intrinsic factor which allows B12 to be absorbed in small intestine

96
Q

Vitamin C use

A

wound healing, iron absorption, acidifies urine

97
Q

Vitamin D

A

Calcium absorption

98
Q

Vitamin K use and who is deficient of this, reversal agent for..

A

Clotting and bone health.

reversal agent for warfarin (coumadin)

99
Q

Patient Education on Minerals

A
  • Only take when prescribed via provider
  • All minerals taken in excess are toxic
  • micro minerals- iron and zinc
100
Q

Assessments prior to Potassium replacement therapy

A

Serum K and cardiac rhythm status

101
Q

PMH/MAR for Potassium replacement therapy

A
ACE inhibitors
Potassium sparing diuretics (spironalactone) 
Hypoaldosteronism
Renal dysfunction
Slowed GI transit times (PO)
102
Q

Administration of Potassium

A

PO: sprinkles, tablet (do not crush), liquid (heavily flavored)
Take with water or meals to avoid GI upset
IV: Never IV push
PIV- 10mEq/hour
Central line- 20-40 mEq/hour
Burning at site- dilate with normal fluids and slow admin

103
Q

Eval and intervention of potassium replacement therapy

A

Reassess the client 5-10 minutes after beginning infusion- assess for discomfort and and IV patency

104
Q

Hyperkalemia patient treatment

A

Diuretic (lasix)- pee it out
IV push- Insulin and dextrose 50%, goes from blood to cell- Potassium/insulin groupie
Kayexalate (oral or rectal)- Dont absorb, dumps sodium to pick up potassium and then excrete through stool

105
Q

Magnesium controls what

A

the availability of acetylcholine in the neuromuscular junction

106
Q

MAR awareness for Magnesium sulfate (IV) or Mg Oxide (PO)

A

Drugs that cause CNS depression

107
Q

PMH/MAR for Magnesium

A

MAR: CNS Depression drugs
Renal dysfunction
slowed GI transit time (PO),
HARD NO: Serious cardiac disease

108
Q

Reversal agent for mag toxicity

A

Calcium gluconate

109
Q

Call bell light for mag administration why

A

Laxative effects of PO Magnesium

110
Q

Admin routes of Magnesium

A

PO, Slow IV infusion

Never IV PUSH

111
Q

Iron Supplement used for

A

Anemia only for iron deficiency, so evaluate type of anemia

112
Q

Take Iron with what vitamin

A

Vitamin C to aid absorption

113
Q

Avoid taking iron with these drugs that can affect absorption

A
1- antacids,
2- antibiotics (some)
3- proton pump inhibitors
4- parkinsons drugs
5 - calcium supps
114
Q

Patient education for Iron supplement

A
  • avoid taking with calcium containing foods (milk and eggs) also caffeine beverages
  • If liquid, dilute liquid and take with a straw as it can stain teeth
  • take between meals
  • Dark green or black stools- harmless side effect
115
Q

Ferrous Dextran is what

A

IV Iron supplement

116
Q

Enteral nutrition use

A

Patient who has working GI system, unable to take PO

117
Q

Contraindications for Enteral Nutrition

A

Major GI issues (peritonitis, any obstruction, intractable diarrhea)

118
Q

Enteral Nutrition (Tube feeding patients) need what

A

Free water order

Contains carbs, proteins, lipids, vitamins/minerals

119
Q

Complications of Enteral Nutrition

A

Aspiration (pneumonia), N/V, diarrhea, metabolic complications: refeeding syndrome (huge electrolyte shifts)- Band of Brothers, clogged feeding tube

120
Q

Stop tube feed minimum of ____ minutes before and after med administration

A

15 minutes

121
Q

For drug administration into tube feed, check what? do what to drug? flushing?

A
  • check compatibility, crush the drug, administer
  • 30ml flush at the beginning
  • 5ml flush between each drug to asses reaction.
  • 30 ml flush at end of administering all drugs
122
Q

What to do with elixir drugs in tube feeding patient

A

Its hypertonic, so always dilute prevent GI upset

123
Q

Parenteral Nutrition Use two types

A

IV nutrition
Patient cannot tolerate enteral feedings.
TPN: Central line access
PPN: Peripheral access

124
Q

Mechanical, Metabolic, Infectious Complications with Parenteral Nutrition

A

Mechanical: Issues related to central line placement
Metabolic: Fluid overload, refeeding syndrome, electrolyte imbalance (CHECK ORDER AND VERIFY NUTRIENTS)
Infectious: High glucose content, susceptible to infections from bacterial proliferation

125
Q

Bethanechol Brand name

A

Urecholine

126
Q

Bethanechol Use and MOA

A

Promotes Peeing- Promotes parasympathetic nervous system- rest and digest

  • Relaxes the trigone and sphincter
  • contracts the detrusor
127
Q

How long to feel effects of Bethanechol (Urecholine)

A

30-60 minutes

128
Q

Assess what prior to giving Bethanechol

A

BP and HR, current urine output

129
Q

Hard nos of Bethanechol

A

Hyperthyroidism, hypotensive or bradycardic patients, small bowel or urinary tract obstructions
This drug promotes rest/digest

130
Q

Take Bethanechol with or without food

A

One hour before or after food or can cause N/V

131
Q

Reversal agent for Muscarinic poisoning

A

Atropine- for parasympathetic nervous system

132
Q

Cholinergic Muscarinic Antagonist Drug

A

Oxybutynin (Ditropan XL)

133
Q

Oxybutynin Use and MOA

A

urinary incontinence, blocks paraysmpathetic or muscarinic receptors of the urinary tract

  • contracts the trigone and sphincter
  • relaxes the detrusor
134
Q

Hard nos for Oxybutynin

A

Glaucoma, severely decreased gastric motility

135
Q

Adverse effect of Oxybutynin

A

Anti-cholinergic effects

Beers Criteria, constipation, blurred vision, photophobia (no constriction, dry mouth)

136
Q

Patient education on oxybutynin

A

Chew gum for dry mouth, wear sunglasses (pupils are dilated, blocking the parasympathetic), avoid hazardous activities for problems with vision, avoid heat because it might be hard to sweat.

137
Q

PMH for Oxybutynin and MAR

A

Hyperthyroid, myasthenia gravis, Parkinsons

- Anticholinergic drugs (SSRIS, tricyclics)

138
Q

Distribution of Oxybutynin

A

Can cross BBB

139
Q

Sildenafil Brand name

A

Viagra

140
Q

Sildenafil use

A

Erectile dysfunction and pulmonary arterial hypertension

141
Q

Sildenafil MOA

A

Prevents cGMP from converting to GMP

142
Q

Oral peak with Sildenafil

A

Peak effects in 60 minutes on empty stomach, high fat meal-2 hours

143
Q

Adverse effects of Sildenafil

A

Hypotension, priapism

Rare effects- Sudden hearing loss, and Vision eye issues

144
Q

Hard no of Sildenafil med

A

Nitrates

145
Q

Dont take this with any boner meds

A

Grapefruit juice

146
Q

Two types of BPH Mechanical Vs Dynamic

A

Overgrowth of epithelial cells- mechanical obstruction blocking the urethra
Overgrowth of smooth muscle cells- dynamic obstructing, constricting

147
Q

Finasteride (proscar) treats what

A

Enlarged prostate due to epithelial growth, low dose for male pattern baldness

148
Q

MOA of Finasteride (Proscar)

A

Prevents formation of active form of testosterone in the prostate, promotes regression of epithelial tissue

149
Q

Adverse effects of Proscar

A

Category X for pregnancy- glove the nurses giving this

- Gyno and reduced ejaculate volume in some

150
Q

If taking Proscar and PSA (Prosthetic Serum antigen levels) don’t decrease what are you thinking

A

Evaluate patient for prostate cancer

151
Q

Tamsulosin brand name

A

Flomax

152
Q

Tamsulosin Use

A

Used for mild prostatic enlargement, does not reduce prostate size, allow muscle to relax and urine to pass through

153
Q

Flomax MOA

A

Blockade of A1 receptors relaxes smooth muscle in bladder neck and prostate, must be taken lifelong

154
Q

Flomax Adverse effects

A

Common headache and dizziness, abnormal ejaculation (failure, reduced volume)

155
Q

Flomax taking with heart drugs?

A

Other A1 receptor blockers can cause hypotension and drop BP

156
Q

What is focus of care for individuals with inflammatory bowel disease?

A

antibiotics, anti-inflammatory, and immunosuppressants

157
Q

Preferred drug combo for ulcers due to H pylori

A

Clarithromycin+amoxicillin and a PPI

158
Q

Prokinetic Agent: Metoclopramide (Reglan)

Oral use vs. IV use

A

Oral: diabetic gastroparesis or GERD
IV: N/V, difficult NG placement, diagnostic procedures of GI tract

159
Q

Physostigmine use

A

a medication most commonly used to manage and treat antimuscarinic toxicity and glaucoma

160
Q

Would want to be aware if you were giving patient viagra with PMH of

A

Hypo or hypertension, heart failure, unstable angina, recent MI or CVA

161
Q

Specific anti-diarrheal drugs are used for ____

A

used to treat diarrhea due to infectious process