20: Drugs affecting the Gastrointestinal system

Question 1

1. Many patients self-medicate with antacids. Which patients should be counseled to not take calcium carbonate antacids without discussing it with their provider or a pharmacist first?
2. Patients with kidney stones
3. Pregnant patients
4. Patients with heartburn
5. Postmenopausal women

Answer 1

1. Patients with kidney stones

Question 2

2. Patients taking antacids should be educated regarding these drugs, including letting them know that:
3. They may cause constipation or diarrhea
4. Many are high in sodium
5. They should separate antacids from other medications by 1 hour
6. All of the above

Answer 2

4. All of the above

Question 3

3. Kelly has diarrhea and is wondering if she can take loperamide (Imodium) for the diarrhea. Loperamide:
4. Can be given to patients of all ages, including infants and children, for viral gastroenteritis
5. Slows gastric motility and reduces fluid and electrolyte loss from diarrhea
6. Is the treatment of choice for the diarrhea associated with E. coli 0157
7. May be used in pregnancy and by lactating women

Answer 3

2. Slows gastric motility and reduces fluid and electrolyte loss from diarrhea

Question 4

4. Bismuth subsalicylate (Pepto Bismol) is a common OTC remedy for gastrointestinal complaints. Bismuth subsalicylate:
5. May lead to toxicity if taken with aspirin
6. Is contraindicated in children with flu-like illness
7. Has antimicrobial effects against bacterial and viral enteropathogens
8. All of the above

Answer 4

4. All of the above

Question 5

5. Hannah will be traveling to Mexico with her church group over spring break to build houses. She is concerned she may develop traveler’s diarrhea. Advice includes following normal food and water precautions as well as taking:
6. Loperamide four times a day throughout the trip
7. Bismuth subsalicylate with each meal and at bedtime
8. A prescription for diphenoxylate with atropine to use if she gets diarrhea
9. None of the above

Answer 5

2. Bismuth subsalicylate with each meal and at bedtime

Question 6

6. Josie is a 5-year-old patient who presents to the clinic with a 48-hour history of nausea, vomiting, and some diarrhea. She is unable to keep fluids down and her weight is 4 pounds less than her last recorded weight. Besides IV fluids, her exam warrants the use of an antinausea medication. Which of the following would be the appropriate drug to order for Josie?
7. Prochlorperazine (Compazine)
8. Meclizine (Antivert)
9. Promethazine (Phenergan)
10. Ondansetron (Zofran)

Answer 6

4. Ondansetron (Zofran)

Question 7

7. Jim presents with complaints of “heartburn” that is minimally relieved with Tums (calcium carbonate) and is diagnosed with gastroesophageal reflux disease (GERD). An appropriate first-step therapy would be:
8. Omeprazole (Prilosec) twice a day
9. Ranitidine (Zantac) twice a day
10. Famotidine (Pepcid) once a day
11. Metoclopramide (Reglan) four times a day

Answer 7

2. Ranitidine (Zantac) twice a day

Question 8

8. Patients who are on chronic long-term proton pump inhibitor therapy require monitoring for:
9. Iron deficiency anemia, vitamin B12 and calcium deficiency
10. Folate and magnesium deficiency
11. Elevated uric acid levels leading to gout
12. Hypokalemia and hypocalcemia

Answer 8

1. Iron deficiency anemia, vitamin B12 and calcium deficiency

Question 9

9. Sadie is a 72-year-old patient who takes omeprazole for her chronic GERD. Chronic long-term omeprazole use places her at increased risk for:
10. Megaloblastic anemia
11. Osteoporosis
12. Hypertension
13. Strokes

Answer 9

1. Megaloblastic anemia

Question 10

10. Patrick is a 10-year-old patient who presents with uncomfortable constipation. Along with diet changes, a laxative is ordered to provide more rapid relief of constipation. An appropriate choice of medication for a 10-year-old child would be:
11. PEG 3350 (Miralax)
12. Bisacodyl (Dulcolax) suppository
13. Docusate (Colace) suppository
14. Polyethylene glycol electrolyte solution

Answer 10

2. Bisacodyl (Dulcolax) suppository

Question 11

11. Methylnaltrexone is used to treat constipation in:
12. Patients with functional constipation
13. Patients with irritable bowel syndrome-associated constipation
14. Children with encopresis
15. Opioid-associated constipation

Answer 11

4. Opioid-associated constipation

Question 12

12. An elderly person has been prescribed lactulose for treatment of chronic constipation. Monitoring with long-term treatment would include:
13. Electrolytes, including potassium and chloride
14. Bone mineral density for osteoporosis
15. Magnesium level
16. Liver function

Answer 12

1. Electrolytes, including potassium and chloride