Week 7 - Final Review

Question 1

What are some examples of H2 Receptor agonists?

Answer 1

• Cimetidine
• Famotidine
• Nizatidine
• ranitadine

Question 2

Which H2 receptor agonist is most likely to interact due to the CYP450 enzyme system?

Answer 2

Cimetidine

Question 3

What vitamin and mineral deficiencies are PPIs associated with?

Answer 3

• Calcium
• magnesium
• vitamin B12

Question 4

Short term use of PPIs increases the risk for what?

Answer 4

Pneumonia

Question 5

Symptoms that indicate a patient may be developing pneumonia.

Answer 5

• Cough
• SOB
• Fever
• Chest pain
• Aching body
• Fatigue
• Loss of appetite
• wheezing

Question 6

How to treat moderate to severe GERD

Answer 6

PPI

Question 7

What medication for GERD to avoid in older adults and why?

Answer 7

Cimetidine

• Likely CNS effects with renal or hepatic impairment
  —- Causes confusion, hallucinations, CNS depression and excitation

Question 8

How do we treat GERD during pregnancy?

Answer 8

With a cytoprotective agent like sucralfate.

Misoprostol should not be used as it can cause abortion, birth defects and uterine rupture.

Question 9

When should we test a patient for H. pylori?

Answer 9

When you are treating them for GERD and the treatment isn’t working.

Question 10

How do we treat H. pylori?

Answer 10

With two antibiotics and an antisecretory agent
- Amoxicillin
- Clarithromycin
- omeprazole

Question 11

What lifestyle modifications can assist in treating peptic ulcer disease?

Answer 11

• Change eating pattern to 5-6 small meals a day to help reduce fluctuation in gastric acid pH
• smoking cessation
• NSAID and aspirin discontinuance.

Question 12

Which anidiarrheal medication is contraindicated in children or after chickenpox?

Answer 12

Bismuth subsalicylate

Question 13

When prescribing ciprofloxacin for traveller’s diarrhea, what patient teaching should be done?

Answer 13

• 500mg twice a day
• Avoid drinking local water
• Wash food thoroughly

Question 14

Which antidiarrheal medication is associated with gray/black stools and a black tongue?

Answer 14

Bismuth subsalicylate

Question 15

What lifestyle factors should be suggested prior to treatment for constipation?

Answer 15

Increase water intake
Increase intake of high fiber foods
- Spinach
- Broccoli
- Cabbage
- Asparagus
- Brussel sprouts
Increase activity

Question 16

What are the risks of using laxatives during pregnancy?

Answer 16

Use with caution, medications that stimulate the GI tract can induce labor

Question 17

Preferred treatment for constipation during breastfeeding

Answer 17

Senna

Question 18

Psyllium - how does it work and what should you assess for if it doesn’t produce a bowel movement

Answer 18

• Swell in water to form a viscous solution softening fecal mass and increasing bulk
• Assess for signs of a bowel obstruction or fecal impaction if no BM is produced

Question 19

How does a diary help with IBS?

Answer 19

Keeping a food diary can help identify trigger foods to IBS

Question 20

How do we treat gastroparesis?

Answer 20

Is treated with prokinetic agents like metoclopramide which suppresses emesis and increases upper GI motility

Question 21

What is the black box warning for metoclopramide?

Answer 21

May develop tardive dyskinesia (involuntary repetitive movement)

Question 22

What patient teaching is needed for metronidazole?

Answer 22

Do not drink alcohol while taking it, can cause N &V, tachycardia, facial flushing

Question 23

If a mother is taking isoniazid and rifampin can she breastfeed?

Answer 23

Yes, any other drug you would have to weigh benefit vs risk

Question 24

What constitutes drug resistant TB?

Answer 24

Resistant to isoniazide and Rifampin

Question 25

What TB medication is not safe for pregnancy?

Answer 25

Ethambutol shows teratogenesis in animal studies and eye abnormalities in children. Rifabutin is the safest in pregnancy.

Question 26

MOA of Bulk Forming Laxatives

Answer 26

Work much like dietary fiber producing stool in 1-3 days

Question 27

MOA Surfactant

Answer 27

lowers surface tension which facilitates penetration of water into feces

Question 28

MOA Stimulant

Answer 28

Stimulate intestinal motility

Question 29

MOA Osmotic Laxative

Answer 29

High doses are used for bowel prep

Question 30

A patient comes into the clinic with complaints of bloating and abdominal pain for a few weeks. What are appropriate options for treatment?

Answer 30

1. Lifestyle modifications and H2 receptor agonist

Question 31

A patient has tested positive for H.Pylori what are appropriate treatment options?

Answer 31

Start PPI, Start abx for 10-14 days

Question 32

A pregnant woman comes in asking for GERD medication, what can you recommend?

Answer 32

Sucralfate

Question 33

What is the MOA of metoclopramide?

Answer 33

Blockade of dopamine receptors in the CTZ chemoreceptor trigger zone

Question 34

Metoclopramide can be used for...

Answer 34

1.Nausea and vomiting 2.Diabetic gastroparesis 3.Gastroesophageal reflux

Question 35

What patient teaching can a provider give when prescribing a PPI?

Answer 35

1. Hypomagnesemia symptoms: muscle cramps, tremors, and palpitations. 2. Check Mg levels periodically especially in the elderly. 3. Get enough calcium and VIT D. 4. call if having diarrhea (Cdiff)

Question 36

What patient teaching can a provider give when prescribing an H2RA?

Answer 36

Report CNS effects: - lethargy - solmenance - restlessness - confusion - hallucinations. Teach about possible reduced libido, impotenance, gynecomastia, pneumonia. Cimetidine interacts with CYP system so check with pt if they are taking warfarin, phenytoin, theophylline, lidocaine.

Question 37

A patient presents with a complaint of reflux and constipation. He states that he drinks enough water, and admits he has gained 30lbs. He also states that he has been having “reflux” type symptoms. What are your next steps for education?

Answer 37

Educate that weight gain can promote reflux symptoms, ask about any OTC use such as antacids which may cause constipation.

Question 38

Zollinger-Ellison syndrome is due to a _______producing tumor. Treatment is long-term therapy of what medication class?

Answer 38

Gastrin Treatment with PPIs

Question 39

A patient who takes NSAIDS almost daily for arthritic pain and refuses to try another medication is at risk for an NSAID-induced ulcer. The provider states, 1. I will put you on Misoprostol once daily 2. If you reduced the NSAID to 4 times a week, that should help prevent an ulcer 3. I will start you a PPI to prevent an ulcer 4. An H2RA will help prevent an ulcer.

Answer 39

3 --> PPI is the first line of treatment for ulcer prevention Misoprostol can cause diarrhea