GI

Question 1

Antacids: Sodium bicarbonate reacts rapidly with hydrochloric acid (HCl) to produce

Answer 1

carbon dioxide and sodium chloride

Question 2

Antacids: Sodium bicarbonate: Formation of carbon dioxide results in

Answer 2

gastric distention and belching

Question 3

Antacids: Sodium bicarbonate: Unreacted alkali is readily absorbed, potentially causing

Answer 3

metabolic alkalosis when given in high doses or to patients with renal insufficiency

Question 4

Antacids: Sodium bicarbonate: Sodium chloride absorption may exacerbate ____ ____ in patients with heart failure, hypertension, and renal insufficiency.

Answer 4

fluid retention

Question 5

Antacids: Calcium carbonate may cause

Answer 5

belching or metabolic alkalosis

Question 6

Antacids: Excessive doses of either sodium bicarbonate or calcium carbonate with calcium-containing dairy products can lead to

Answer 6

hypercalcemia, renal insufficiency, and metabolic alkalosis (milk-alkali syndrome)

Question 7

Antacids: Magnesium hydroxide or aluminum hydroxide containing products: do not cause

Answer 7

gas, belching

Question 8

Antacids: Magnesium hydroxide or aluminum hydroxide containing products: unabsorbed magnesium salts may cause ___, and aluminum salts may cause ____

Answer 8

diarrhea, constipation

Question 9

Antacids: Magnesium hydroxide or aluminum hydroxide containing products: Both magnesium and aluminum are absorbed and excreted by the kidney: patients with renal insufficiency should

Answer 9

not take these agents long-term

Question 10

Antacids should not be given within 2 hours of doses of

Answer 10

tetracyclines, fluoroquinolones, itraconazole, and iron

Question 11

cimetidine, what group

Answer 11

H2 receptor antagonist

Question 12

ranitidine, what group

Answer 12

H2 receptor antagonist

Question 13

nizatidine, what group

Answer 13

H2 receptor antagonist

Question 14

famotidine, what group

Answer 14

H2 receptor antagonist

Question 15

H2RAs are highly selective and do not affect

Answer 15

H1 or H3 receptors

Question 16

H2 antagonists reduce acid in two ways:

Answer 16

block histamine

block gastrin/ACH

Question 17

Patients may take either antacids or intermittent H2 antagonists for infrequent heartburn or dyspepsia (fewer than ___)

Answer 17

three times per week

Question 18

antacid time of onset verse H2 blockers

Answer 18

antacids are faster

Question 19

antacid duration verse H2 blockers

Answer 19

H2 last longer

Question 20

H2 antagonists may be taken prophylactically

Answer 20

before meals in an effort to reduce the likelihood of heartburn

Question 21

H2RAs Adverse effects

Answer 21

diarrhea, headache, fatigue, myalgias, and constipation

Question 22

PPIs are administered as inactive

Answer 22

prodrugs

Question 23

PPIs: oral products are formulated for delayed release as acid-resistant, enteric-coated capsules or tablets to

Answer 23

protect the acid-labile prodrug from rapid destruction within the gastric lumen

Question 24

PPIs: For children or patients with dysphagia or enteral feeding tubes, capsule formulations (but not tablets)

Answer 24

may be opened and the microgranules mixed with apple or orange juice or mixed with soft foods (eg, applesauce)

Question 25

PPIs should be taken on an empty stomach because

Answer 25

it increases the bioavailability

Question 26

PPIs: have a short serum half-life of about 1.5 hours, but

Answer 26

acid inhibition lasts up to 24 hours

Question 27

PPIs: Because not all proton pumps are inactivated with the first dose of medication, up to ____ medication are required before the full acid-inhibiting potential is reached.

Answer 27

3–4 days of daily

Question 28

PPIs: after stopping the drug, it takes ___ for full acid secretion to return

Answer 28

3–4 days

Question 29

PPIs: Adverse effects

Answer 29

Diarrhea, headache, and abdominal pain

Question 30

PPIs: of note, Acid is important in releasing ___ from food.

Answer 30

vitamin B12

Question 31

PPIs: in addition to B12 deficiency, it can cause

Answer 31

calcium deficiency, so you can break bones easier

Question 32

PPIs: Cases of severe, ____ with secondary hypocalcemia due to PPIs have been reported, possibly due to decreased intestinal absorption.

Answer 32

life-threatening hypomagnesemia

Question 33

another concern about PPI is is that acid is a barrier to

Answer 33

microbes

Question 34

Do PPIs cause adrenocarcinoma

Answer 34

unproven

Question 35

PPIs: Decreased gastric acidity may alter absorption of drugs for which intragastric acidity affects drug bioavailability, eg for k__, i___, d___, a___

Answer 35

ketoconazole, itraconazole, digoxin, and atazanavir. (but since PPIs have short half life, a drug-drug interaction is rare)

Question 36

Omeprazole may inhibit the metabolism of c___, w___, d___, p___

Answer 36

clopidogrel, warfarin, diazepam, and phenytoin.

Question 37

Esomeprazole also may decrease metabolism of d____.

Answer 37

diazepam

Question 38

Lansoprazole may enhance clearance of t____

Answer 38

theophylline

Question 39

Rabeprazole and pantoprazole have no significant

Answer 39

drug interactions.

Question 40

Clopidogrel is a ____ that requires activation by the hepatic P450 CYP2C19 isoenzyme

Answer 40

prodrug

Question 41

PPIs could reduce _____ activation (and its antiplatelet action) in some patients

Answer 41

clopidogrel

Question 42

When PPIs are prescribed to patients taking clopidogrel, agents with minimal CYP2C19 inhibition (____ or ____) may be preferred

Answer 42

pantoprazole, rabeprazole

Question 43

Bismuth Subsalicylate: Over __ of the bismuth appears in the stool

Answer 43

99%

Question 44

Bismuth Subsalicylate: describe how it works

Answer 44

coats ulcers

Question 45

Bismuth Subsalicylate: can also treat

Answer 45

diarrhea and is antimicrobial (especially H pylori)

Question 46

Bismuth Subsalicylate: Although minimal, bismuth is absorbed; it is stored in many tissues and has

Answer 46

slow renal excretion

Question 47

Bismuth Subsalicylate: Adverse effects

Answer 47

- harmless blackening of the stool/tongue, which may be confused with gastrointestinal bleeding. - High doses of bismuth subsalicylate may lead to salicylate toxicity

Question 48

Bismuth Subsalicylate: Bismuth agents should be used for

Answer 48

short periods only and should be avoided in patients with renal insufficiency.

Question 49

Bismuth Subsalicylate: Drug interaction: w___ and D___

Answer 49

warfarin and DOACs (direct oral anticoagulant)

Question 50

H pylori

Answer 50

gram negative causes PUD and a type of lymphoma Has problems with resistance