GI part 2

Question 1

what should you tell patients to avoid during and 48 hours post treatment with metroniddszole ?

Answer 1

ALCOHOL

Question 2

how can you minimize the reoccurence of h.pylori?

Answer 2

stop taking nsaids, smoking, and minimize use of alcohol

Question 3

when would you confirm eradication of h.pylori and how would you do it?

Answer 3

you would only do this in complicated: bleeding, perforated, structured patients or those with refractory ulcers

its not advised to test in someone who remains asymptomatic

follow up testing can be done ONE MONTH after stopping treatment

Question 4

true or false

serology testing is NOT recommended for confirming the eradication of h.pylori infection as antibodies last for many many months

Answer 4

true

Question 5

what is Quadruple therapy treatment for h.pylori?

Answer 5

PPI (lanzoprazole, exomeprazole - ZOLE)
bismuth subsalicylate (pepto)
metronidazole 250-500
tetracycline 500mg

OR

PPI
Metronidazole
Clarithromycin
Amoxicillin

10-14 days

Question 6

what are the options for triple therapy?

Answer 6

1. PPI
2. Metronidazole
3. Clarithromycin

OR

1. PPI
2. Clarithromycin
3. amoxiciilin

14 days

Question 7

How would you diagnose infant colic using ROME IV criteria

Answer 7

its a diagnosis of exclusion

infant less than 5 months of age with recurring prolonged episodes of crying irritability and fussiness that cant be explained

OR ANOTHER DEFINITION

Crying for more than 3 hours per day 3 days per week

Question 8

What diagnostic tests would you order for infant colic?

Answer 8

its a dignosis of exclusion so you are ruling out redflags

No tests would be ordered on an infant who is gaining weight and has a normal physical exam

other wise consider urinalysis and stool for occult blood to rule out cow milk allergy

Question 9

What pharm therapies are approvd for colic?

Answer 9

1. sucrose
2. Ovol
3. Probiotics (BIogaia) SPECIFICALL THIS PROBIOTIC Lactobacillus reuteri

Question 10

what are the side effects of long term use of PPI

Answer 10

c.diff
bone fractures
low vitamin levels
pneumonia

Question 11

What tips would you reccomend to stop your PPI?

Answer 11

1. diet and lifestyle
2. lower your PPI dose for 2-4 weeks
3. Stop your PPI and try antacids like tums PRN or H2
4. use PPI PRN only

Question 12

With Digoxin what medications can increase or decrease its levels?

Answer 12

Calcium channel blocker NifediPINE increases dig levels
Advil INCREASES dig levels
Zantac (H2 receptor) increases dig levels

Tums DECREASES dig levles

Question 13

what high risk conditions required long term PPI use?

Answer 13

barrets esophagitis
Chronic oral corticosteroid or NSAID use
Grade C/D esophagitis
Documented GI bleet
Dual antiplatlet therapy with prior upper GI bleed

Question 14

Are coticosteroids safe to use during pregnancy for treatment of IBD

Answer 14

yes as long as the pros out weigh the cons, in the first trimester it might be linked to clef lip, but it is still considered safe to use

Question 15

is methotrexate safe to use during pregnancy for IBD treatment

Answer 15

no its teratogenic, stop 3-6 months prior to trying to conceive and do not use during breastfeeding

this is an immune modulator

Question 16

A baby born to a other who is hep B carrier should start hep B immunizations at what age?

Answer 16

at birth

Question 17

sucessful treatment of H.pylori will result in ulcer healing and prevent the development of recurrent PUD ( in the absence of concomiant ASA or NSAID use)

Answer 17

true

Question 18

what non pharm techniques can you use to cope with an inconsolable baby crying during colic

Answer 18

• use headphones as a distraction while staying close
• put the baby in a safe place and take a few steps back for one minute
• check the intensity of your emotions and stay calm
• ensure that yourself and the baby are okay, NO pain NOT hungry

Question 19

what is a common side effect from a PPI

Answer 19

diarrhea

Question 20

what is a common side effect from H2 receptor antagonist

Answer 20

diarrhea
constipation
headache

Question 21

what instructions would you provide your patient regarding the use of a PPI administration?

Answer 21

food decreases its efficacy so take it on an empty stomach. They are taken on a daily basis, not as needed for heart burn

take on an empty stomach 1/2 to 1 hour before a meal

Question 22

who would you prescribe a prophylactic antibiotic treatment for travellers diarrhea?

Answer 22

only someone with comorbind disease

Question 23

when should an NP avoid prescribing an anticholinergic-antihistamin for nausea ?

Answer 23

in men with Bprostate hypertrophy! (BPH) it can worsen urinary retention

Question 24

what is the recommended treatment for mild hypovolemia

Answer 24

oral fluids like water,juices, and tea

suprisingly not electrolyte replacement products?

Question 25

what non antibiotic can a NP recommed to people who want to prevent travelers diarrhea

Answer 25

Pepto-bismol (suprisingly not the vaccine Dukarol)

Question 26

what is considered chronic hepatitis and which ones are usually the culprit?

Answer 26

Chronic viral hepatitis is greater than 6 months often caused by Hepb and HepC

Question 27

What lab values would tell you if someone has ACUTE HEPATITIS B?

Answer 27

anti-HBc Igm would be positive (this finding represents an acute infection) HBsAg (HBV surface antigen): this positive results indicates an acute or chronic HB infection anti-HBc igM (positive) & HBsAG (POSITIVE) = acute hep b

Question 28

what lab values would differentiate acute hep b from chronic?

Answer 28

HBsAG (hep b surface antigen) Anti-HBc total - appears when exposed and lasts for life, this will differentiate person who develop immunity from vaccination ( test would be negative) or prior infection (test would be positive) HBsAg POSITIVE + anti-HBc total (POSITIVE)

Question 29

what lab values would tell you if someone has acute hep A?

Answer 29

anti-HAV igM (positive) this indicates acute infection ps. anti-HAV IgG just represents immunity from vaccine or previous exposure to memorize the difference think igM= MORNING !! you got it RIGHT THIS MORNING ITS ACUTE

Question 30

How would you differentiate acute hep c from chronic hep c

Answer 30

first off, its rare for hep C to even be identified acutley. There are two tests. anti-HCV (antibody to hep C) - after an exposure it will be negative for up to 6 weeks, but then will remain positive for life. HCV RNA- this indicates the start of an acute infection in acute hep C you will have anti-HCV negative HCV RNA positive in chronic HCV anti-HCV positive HCV RNA positive