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Pharmacology > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

What are antacids used for?

A

GERD and peptic ulcer disease

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2
Q

What do Calcium based antacids require for absorption?

A

Vitamin D

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3
Q

When using antacids, how long is acidity reduced when the patient is fasting?

A

20-40 minutes

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4
Q

When using antacids, how long is acidity reduced after a meal?

A

2-3 hours

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5
Q

When are calcium based antacids contraindicated?

A

If the patient is hypercalcemic or has renal calculi.

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6
Q

When are magnesium based antacids contraindicated?

A

In patients with renal failure or renal insufficiency

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7
Q

When are Aluminum based antacids contraindicated?

A

In renal patients who are on dialysis

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8
Q

What is a common ADR in Mg-based antacids?

A

Diarrhea

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9
Q

What is a common ADR in Ca and Al based antacids?

A

Constipation

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10
Q

When recommending antacids, what should you consider in regards to sodium content?

A

The sodium content may adversely affect patients with hypertension, CHF, and/or renal failure.

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11
Q

What should you tell patients to do to prevent antacids from affecting the absorption of other medications?

A

Separate antacid administration from other drugs by at least 2 hours.

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12
Q

Besides GERD and PUD, what are some other uses for antacids?

A

Hyperphosphatemia and calcium deficiency

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13
Q

What are some major things to monitor when your patients are taking antacids?

A

Signs of GI bleed, Mg levels in elderly patients

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14
Q

What is the name of the only currently available absorbent antidiarrheal?

A

Bismuth subsalicylate

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15
Q

What are the names of the opioid antidiarrheals?

A

Lomotil, Motofen, and Imodium

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16
Q

What is a major ADR of opioid antidiarrheals, such as Lomotil, Motofen, and Imodium?

A

They can decrease intestinal motility and cause toxic megacolon

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17
Q

For whom is Bismuth subsalicylate contraindicated?

A

Children with viral or flu-like symptoms

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18
Q

For whom are most antidiarrheals contraindicated?

A

Children

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19
Q

What pregnancy category do all antidiarrheals except Imodium fall under?

A

Pregnancy category C

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20
Q

What is the pregnancy category of Imodium?

A

Pregnancy category B

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21
Q

What are some weird ADRs of Bismuth subsalicylate?

A

Black tongue and grey-black stools

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22
Q

What are some major drug interactions to be aware of when prescribing Bismuth subsalicylate?

A

There is a risk of toxicity when it is taken with aspirin, and there is a risk of hypoglycemia when it is taken with insulin or oral hypoglycemics

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23
Q

Which antidiarrheal should be prescribed for acute diarrhea in adults?

A

Any antidiarrheal will work

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24
Q

Which antidiarrheal may be prescribed as an adjunct therapy in patients with bowel disease?

A

Imodium

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25
Q

Which antidiarrheal should be prescribed for chronic infantile diarrhea?

A

Bismuth subsalicylate

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26
Q

Which antidiarrheal should be prescribed for traveler’s diarrhea?

A

Bismuth subsalicylate

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27
Q

What things should you teach to the patient who is taking antidiarrheals?

A

Be alert for rebound constipation, black tongue and stools for those taking Bismuth subsalicylate, Lomotil and Motofen may cause dryness since they have atropine

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28
Q

What are the names of the two major cytoprotective agents?

A

Sulcrafate and Misoprostol

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29
Q

What is the pregnancy category for Sulcrafate?

A

Pregnancy category B

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30
Q

What is the pregnancy category for Misoprostol?

A

Pregnancy category X (abortifacient)

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31
Q

With whom should you prescribe Misoprostol cautiously?

A

Renal patients

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32
Q

What is a common ADR of Sulcrafate?

A

Constipation

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33
Q

What are some common ADRs of Misoprostol?

A

Diarrhea and menstrual problems

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34
Q

What type of antacid does Misprostol interact with and what is the effect?

A

Mg-based antacids and it can cause diarrhea

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35
Q

Which cytoprotective agent should be prescribed if the patient requires NSAID therapy?

A

Misoprostol

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36
Q

How long does it take for the ulcer to heal when a patient is taking Sulcrafate?

A

Up to 8 weeks

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37
Q

At what time of day should patients take Sucralfate?

A

1 hour before meals

38
Q

Should Misoprostol be taken with food?

A

Yes

39
Q

Should Sucralfate be taken with food?

A

No. 1 hour before meals

40
Q

A nurse practitioner is going to prescribe either prochloperazine or promethazine to a patient complaining of nausea and vomiting. With which patient would these be contraindicated?

A

A patient with Parkinson’s disease and children under two years old

41
Q

A nurse practitioner is going to prescribe either prochloperazine or promethazine to a patient complaining of nausea and vomiting. What are some major ADRs that the NP should monitor for?

A

Extra-pyramidal side effects and fatal respiratory depression in children under 2 years old.

42
Q

A nurse practitioner is going to prescribe either diphenhydramine or hydroxyzine to a patient who is complaining of nausea and vomiting. What ADRs should the NP warn the patient about?

A

Drowsiness and anticholinergic effects such as dry mouth, blurred vision, and urinary retention

43
Q

Which patient would be prescribed dronabinol (Marinol)?

A

A cancer patient suffering from nausea and vomiting related to chemotherapy treatment

44
Q

What are some common ADRs associated with dronabinol (Marinol)?

A

Euphoria, depression, dizziness, paranoid thoughts, somnolence, and abnormal thoughts

45
Q

What are some cardiac ADRs associated with dronabinol (Marinol)?

A

Palpitations, tachycardia, and hypotension

46
Q

A nurse practitioner is going to prescribe dronabinol to a patient who is complaining of nausea and vomiting. She should reconsider this prescription if the patient has ______?

A

A seizure disorder

47
Q

What is there a danger of if a patient is taking both promethazine and lithium?

A

There is an increased risk of extra-pyramidal side effects and lithium toxicity may be masked

48
Q

Which antiemetics have a low side effect profile?

A

5-HT3 receptor antagonists such as palonosetron, dolasetron, granisetron, or ondansetron

49
Q

Which antiemetic should be prescribed for motion sickness?

A

An antihistamine such as dimenhydrinate (Dramamine) or meclizine (Antivert)

50
Q

How far in advance of traveling should a patient take an antiemetic?

A

1 to 2 hours before departure

51
Q

What type of drug should be prescribed to the patient who is complaining of vomiting related to gastroparesis?

A

A prokinetic drug (Metoclopramide)

52
Q

What should be monitored with the long-term use of promethazine?

A

A CBC at weeks 4 and 10 of therapy to check for bone marrow depression and blood dyscrasias

53
Q

What are drugs such as Cimetidine, Ranitidine, Famotidine, and Nizatidine used for?

A

NPO patients with gastric acid, prophylaxis and management of ulcers, and GERD

54
Q

What category of drug do Cimetidine, Ranitidine, Famotidine, and Nizatidine fall under?

A

Histamine 2 Receptor Antagonists

55
Q

What is the pregnancy category for H2RAs?

A

Pregnancy category B

56
Q

Which H2RAs are approved for use in children?

A

Ranitidine and famotidine

57
Q

What hormonal ADRs are associated with Cimetidine?

A

Antiandrogenic effects such as gynecomastia and impotence

58
Q

What CNS ADRs are associated with Cimetidine, Ranitidine, Famotidine, and Nizatidine?

A

confusion, agitation, psychosis, depression, and disorientation

59
Q

What hematological ADRs are associated with Cimetidine, Ranitidine, Famotidine, and Nizatidine?

A

Agranulocytosis, granulocytosis, thrombocytopenia, and aplastic anemia

60
Q

How are H2RAs metabolized?

A

Through the liver, which can cause many different drug interactions

61
Q

Should H2RAs be prescribed for peptic ulcer disease?

A

No

62
Q

Should H2RAs be prescribed to patients with renal dysfunction?

A

Yes, but with caution and at a lower dose

63
Q

Should H2RAs be taken with food?

A

Yes

64
Q

What is the only prokinetic drug currently on the market?

A

Metoclopramide

65
Q

What is the black box warning on metoclopramide?

A

Risk for development of tardive dyskinesia

66
Q

With which patients is metoclopramide contraindicated?

A

Patients with GI hemorrhage, mechanical obstruction, new surgery on the GI tract, or perforation

67
Q

What is the pregnancy category for metoclopramide?

A

Pregnancy category B

68
Q

What psychological issue should the NP monitor for in patients taking metoclopramide?

A

Depression and suicidal ideation

69
Q

What should the NP be alert for in diabetic patients taking metoclopramide?

A

Hypoglycemia

70
Q

Which disorders indicate the use of metoclopramide?

A

GERD and diabetic gastroparesis

71
Q

What should the NP monitor in patients taking metoclopramide?

A

Renal function, signs of tardive dyskinesia, depression and suicide ideation

72
Q

At what time of day should patients take metoclopramide?

A

30 minutes before meals

73
Q

With which disorders are proton pump inhibitors (PPIs) indicated?

A

Erosive gastritis, GERD, Zollinger-Ellison syndrome, active PUD, ulcers caused by H. pylori

74
Q

What is an example of a proton pump inhibitor (PPI)?

A

Omeprazole, esomeprazole, lansoprazole, pantoprazole, rabeprazole

75
Q

What is the pregnancy category of PPIs except omeprazole?

A

Pregnancy category B

76
Q

What is the pregnancy category of omeprazole?

A

Pregnancy category C

77
Q

Which PPIs can be used in children as young as 1 year old?

A

Esomeprazole, omeprazole, and lansoprazole

78
Q

Which PPIs cannot be used in children under 12 years old?

A

Pantoprazole and rabeprazole

79
Q

What has long-term PPI use been linked to?

A

Increased risk for osteoporosis and hip fractures

80
Q

Because PPIs decreases gastric acid secretions, patients taking these medications are at a risk develop which insufficiencies?

A

Iron, vitamin B12, and calcium

81
Q

Which drug has a black box warning for patients taking omeprazole?

A

Clopidogrel (Plavix), which has decreased effectiveness when patients are also taking omeprazole

82
Q

A combination of PPIs and ______ are used to treat _____ infections.

A

Antibiotics, H. pylori

83
Q

How long should patients take PPIs when it is prescribed for GERD?

A

8 weeks

84
Q

Which type of laxative is contraindicated in patients with renal dysfunction?

A

Magnesium hydroxide

85
Q

Laxatives are contraindicated in the presence of which disorders?

A

Nausea, vomiting, undiagnosed abdominal pain, suspected bowel obstruction

86
Q

Which laxatives are the drug of choice for rapid response and short term use?

A

Senna, bisocodyl, docusate, magnesium hydroxide

87
Q

Which laxatives are the drug of choice for long term therapy?

A

Psyllium, methylcellulose, polycarbophil

88
Q

Which laxatives are the safest for pregnant patients?

A

Psyllium, methylcellulose, polycarbophil

89
Q

What is the order for prescribing medication in the step up approach for patients with GERD?

A
  1. Antacids
  2. H2RAs
  3. PPIs
90
Q

What is the order for prescribing medication in the step down approach for patients with GERD?

A
  1. PPIs for 8 weeks
  2. if better, switch to H2RAs
    2b. if worse, increase PPI dose

Pharmacology (6 decks)

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