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NURS 572 Advanced Pharmacotherapeutics UofA Nursing > GI Meds > Flashcards

GI Meds Flashcards

1
Q

Which finding would alert the APN to discontinue use of cimetidine for an adult patient?

  1. Mental status changes
  2. Occasional headaches
  3. Dry mouth
  4. Has daily bowel movements
A
  1. Reversible CNS adverse reactions (e.g., mental confusion, agitation, psychosis, depression, and disorientation) have also occurred with this drug.
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2
Q

Omeprazole may increase the risk of all of the following except:
A. Clostridium difficile infection
B. H. pylori infection
C. Osteoporosis
D. Respiratory infection

A

B. H. pylori. PPIs are part of the triple therapy tx for h. pylori which thrives in an acidic environment.

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3
Q

Which drug is considered the first line Tx for GERD, gastric ulcers, and duodenal ulcers?

A. famotidine
B. fluconazole
C. loratadine
D. omeprazole

A

D. Omeprazole. It’s site of action is the actual site of gastric acid production, the H+/K+ ATPase proton pump, providing a complete blockade of gastric acid production.

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4
Q

Which of the following adverse events is LEAST likely to result from cimetidine use?

A. Gynecomastia and galactorrhea
B. Impotence
C. Ischemic stroke in patient who uses warfarin for chronic anticoagulation.
D. Severe dry mouth and dizziness in patient who takes amitriptyline for depression.

A

C. Ischemic stroke. Because of cimetidine is an H2 receptor blocker which inhibits CYP450, it will prolong the half-life of warfarin, causing a SE of bleeding, not clotting, which would be the cause of a thromboembolism.

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5
Q

A patient with mild GERD is started on _______ first.
Question 1 options:

a) Lactulose
b) Histamine-2 receptor antagonists
c) Proton pump inhibitors (PPIs)
d) Antiemetic

A

B. H2rB

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6
Q

An elderly person has been prescribed lactulose for treatment of chronic constipation. Monitoring with long-term treatment would include:
Question 3 options:

a) Bone mineral density for osteoporosis
b) Electrolytes, including potassium and chloride
c) Liver function
d) Blood pressure

A

B.

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7
Q

Gastroesophageal reflux disease (GERD) may be aggravated by the following medication that affects lower esophageal sphincter (LES) tone:
Question 2 options:

a) Furosemide
b) Estrogen
c) Metoclopramide
d) Senna

A

B. Estrogen

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8
Q

Which of the following is a proton pump inhibitor (PPI)

Question 4 options:

a) Famotidine (Pepcid)
b) Ondansetron (Zofran)
c) Esomeprazole (Nexium)
d) Bismuth Subsalicylate (Pepto Bismol)

A

C. esomeprazole

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9
Q

Extrapyramidal symptoms (EPS) have been associated with which of the following drugs?

Question 5 options:

a) Sucralfate
b) Metoclopramide
c) Senna
d) Fiber

A

B.

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10
Q

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?
Question 6 options:

a) Patients with kidney stones
b) Patients with diabetes
c) Patients with heartburn
d) Postmenopausal women

A

A.

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11
Q

An acceptable first-line treatment for peptic ulcer disease with positive Helicobacter pylori (H. pylori) test is:
Question 7 options:

a) PPI bid plus clarithromycin plus amoxicillin for 14 days
b) PPI bid for 12 weeks until healing is complete
c) Histamine-2 receptor antagonists for 4 to 8 weeks
d) PPI bid and levofloxacin for 14 days

A

A. Triple therapy is PPI + clarithromycin + amoxicillin

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12
Q

Patients who are on chronic long-term proton pump inhibitor therapy require monitoring for:
Question 8 options:

a) Folate deficiency
b) Iron deficiency anemia, vitamin B12 and calcium deficiency
c) Hypokalemia
d) Elevated uric acid levels leading to gout

A

B. Malabsorption of nutrients with long-term use

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13
Q

Which of the following drugs has been known to cause discoloration of the tongue?

Question 9 options:

a) Omeprazole
b) Bismuth subsalicylate
c) Calcium citrate
d) Citalopram

A

B.

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14
Q

Which of the follow is true about Loperamide. Loperamide:

Question 10 options:

a) Can be given to patients of all ages, including infants and children, for calcium deficiency.
b) Is the treatment of choice for the diarrhea associated with E. coli
c) Is used for the treatment of duodenal ulcers.
d) Slows gastric motility and reduces fluid and electrolyte loss from diarrhea

A

D.

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15
Q

Both loperamide and diphenoxylate act as opioid agonists to prevent and treat diarrhea. Which of the following best characteristics the difference between these two medications?

A. Loperamide increases phasic segment contractions of the colon, while diphenoxylate increases peristaltic contractions of the colon.
B. Unlike diphenoxylate, loperamide, is often combined with atropine.
c. In the gastrointestinal tract, loperamide acts as an agonist at the Mu opioid receptors, while diphenoxylate acts at the K opioid receptors.
D. Loperamide does not readily cross the blood-brain barrier, but, at higher doses, diphenoxylate can.

A

D. loperamide has a lower potential of abuse, but all opioid drugs have some potential, especially when combined with CYP450 inhibitors or P-glycoprotein inhibitor.

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16
Q

A 20-yr-old female college student with diarrhea-predominant IBS is brought to the ER by her roommates. She is confused and agitated. Her skin is flushed and she is hyperthermic and tachycardic. Her mucous membranes are dry and her pupils are dilated. Which of the following antidiarrheal agents is most likely responsible?

A. diphenoxylate
B. diphenoxylate-atropine
C. loperamide
D. bismuth subsalicylate

A

B. The symptoms are consistent with ingestion of diphenoxylate-atropine, she is exhibiting signs of antimuscarinic toxicity including altered mental status, fever, tachycardia, flushing, dry mucous membranes, and dilated pupils. These are caused by large doses of atropine that are meant to dissuade patients from abusing diphenoxylate.

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17
Q

A patient presents to clinic with dark, nearly black stools. Guaiac is negative. Which antidiarrheal agent is likely responsible for this finding?

A. bismuth subsalicylate
B. eluxadoline
C. loperamide
D. diphenoxylate

A

A.

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18
Q

Which of the following medications is contraindicated in patients who present with bloody diarrhea or fever?

A. bismuth subsalicylate
B. loperamide
C. diphenoxylate
D. All of the above.

A

D. All of the above. Bloody diarrhea and fever are likely caused by an underlying inflammatory, infectious, or traumatic process that needs management first.

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19
Q

Which finding in the patient’s health history would alert the APN to the potential for development of gastroesophageal reflux disease (GERD)?

  1. Appendectomy
  2. Hypotension
  3. Pneumonia
  4. Meclizine
A
  1. Meclizine. Uremia associated with renal failure can disrupt the gastric mucosa leading to GERD.
20
Q

The APN must be sure to educate the patient about ways to avoid constipation when they are taking which drug?

  1. Psyllium
  2. Magnesium hydroxide
  3. Calcium carbonate
  4. Metoclopramide
A
  1. Calcium-based antacids can cause constipation. Magnesium-based antacids cause diarrhea. Psyllium is a bulk-forming laxative and will treat constipation, not cause it. Proton pump inhibitors (PPIs) typically cause diarrhea, if anything. Metoclopramide is a prokinetic agent used to increase peristalsis.
21
Q

Traveler’s diarrhea is common in people who journey to high-risk areas such as Central and South America. Which medications are specifically indicated for traveler’s diarrhea?

  1. Bismuth subsalicylate and alosetron
  2. Loperamide and kaolin-pectin
  3. Crofelemer and bismuth subsalicylate
  4. Bismuth subsalicylate and loperamide
A
  1. These are the only drugs indicated for traveler’s diarrhea.
22
Q

The APN is considering treatment options for a patient with diabetic gastroparesis. Which clinical fact about this patient would cause the APN to prescribe half the normal dose of metoclopramide?

  1. The patient’s serum creatinine is 1.1.
  2. The patient’s creatinine clearance is 32 mL/minute.
  3. The patient has diabetic neuropathy in both feet.
  4. The patient has abdominal bloating and nausea after eating.
A
  1. Metoclopramide is excreted mainly by the kidney, so the patient must have a reduced dose if the creatinine clearance is less than 40 mL/minute.
23
Q

The APN is assessing a 6-year-old boy who has Down syndrome. His mother states that he is starting to get over a severe bout of flu but now has diarrhea. She asks what can be prescribed to stop the diarrhea. Which regimen would the APN order?

  1. Oral rehydration therapy (ORT)
  2. Loperamide orally after each loose stool
  3. Diphenoxylate with atropine orally once daily
  4. Bismuth subsalicylate orally after each loose stool
A
  1. Antidiarrheals are contraindicated in most children. ORT is the standard of care. Bismuth subsalicylate is contraindicated for children or teenagers recovering from flulike illness or chickenpox or for children under age 12. Diphenoxylate and atropine are contraindicated for children under 12 and those with Down syndrome.
24
Q

A patient with chronic renal failure is on dialysis three times a week. He frequently complains of dyspepsia and has been receiving aluminum hydroxide orally several times a day for the past 2 years. Why would this be of grave concern to the APN?

  1. Aluminum hydroxide can worsen renal failure.
  2. Aluminum hydroxide frequently causes diarrhea.
  3. Prolonged use of aluminum hydroxide can cause metabolic acidosis.
  4. Aluminum hydroxide can cause dialysis osteomalacia.
A
  1. Prolonged use can cause or worsen the osteomalacia commonly seen in dialysis patients.
25
Q

The APN is prescribing a proton pump inhibitor (PPI) for treatment of a gastroesophageal reflux disease (GERD) based on presenting symptoms. Which reason best identifies why the APN selected this medication?

  1. It reduces acid secretion.
  2. It increases gastric emptying time.
  3. There are no reported side effects.
  4. It requires short-term therapy.
A
  1. PPIs are standard first-line therapy for GERD and decrease acid secretion by almost 100%. PPIs improve esophageal healing to about 80%.
26
Q

Which dietary selection should the APN provide to a patient with a history of gastroesophageal reflux disease (GERD) to decrease occurrence of attacks?

  1. Follow a low-fat diet.
  2. Chew gum in between meals to cleanse the palate.
  3. Increase carbohydrate (CHO) and fiber in the diet.
  4. Limit alcohol intake to 1 drink per day.
A
  1. Fatty foods lead to decreased gastric emptying, which can increase the likelihood of GERD attacks.
27
Q

Which medication gives short-term relief of dyspepsia by directly increasing the pH of the gastric contents?

  1. Pantoprazole
  2. Sucralfate
  3. Calcium carbonate
  4. Diphenoxylate with atropine
A
  1. Calcium carbonate is an antacid and directly neutralizes acid in the stomach.
28
Q

Considering eradication rates, adverse effects, antimicrobial resistance, and patient compliance, which regimen is most appropriate for treatment of H. pylori-induced peptic ulcer disease (PUD)?

  1. Clarithromycin, amoxicillin, and a proton pump inhibitor (PPI)
  2. Tetracycline, metronidazole, and a proton pump inhibitor (PPI)
  3. Clarithromycin, tetracycline, and a histamine-2 (H2) blocker
  4. Metronidazole, amoxicillin, and a histamine-2 (H2) blocker
A
  1. This regimen has fewer adverse effects, less antibiotic resistance, and good to excellent eradication rates.
29
Q

A 70-year-old male patient on the medical floor tells the APN that he has frequent heartburn but that his wife has brought in Alka-Seltzer from home. Which fact about the patient would be a contraindication for this over-the-counter (OTC) medication?

  1. The patient has been admitted for an exacerbation of congestive heart failure.
  2. The patient was diagnosed with benign prostatic hypertrophy (BPH) 3 years ago.
  3. The patient has had intermittent episodes of asthma over the past 20 years.
  4. The patient has occasional constipation and takes bisacodyl once or twice a week.
A
  1. Alka-Seltzer (sodium bicarbonate) contains a significant amount of sodium, which will lead to fluid retention and a corresponding increase in preload, thus increasing myocardial workload and exacerbating the heart failure.
30
Q

When treating a patient with a duodenal ulcer, the APN should consider which action to be the priority?

  1. Advise the patient to stop smoking.
  2. Eradicate infection of H. pylori.
  3. Advise the patient to avoid spicy foods.
  4. Evaluate the patient for infection with methicillin-resistant S. aureus (MRSA).
A
  1. Most duodenal ulcers are caused by H. pylori, so the priority is to eradicate the infection.
31
Q

A patient in the emergency department (ED) has been prescribed ondansetron for nausea. The APN understands that this medication works by which mechanism?

  1. Blocking dopamine receptors in the chemoreceptor trigger zone
  2. Blocking histamine1 receptors in the gastrointestinal (GI) tract
  3. Blocking serotonin on vagal nerve terminals
  4. Stimulating gastric emptying and peristalsis
A

3.

32
Q

The APN understands that loperamide works by which mechanism?

  1. Supplying missing bacteria to the gastrointestinal (GI) tract
  2. Decreasing gastric and bowel motility
  3. Coating the walls of the gastrointestinal (GI) tract and binding to toxins
  4. Stimulating peristalsis and gastric motility
A
  1. Loperamide binds to the opiate receptors of the intestine, leading to a decrease in gastric and intestinal motility.
33
Q

Patients with uncomplicated peptic ulcer disease or mild gastroesophageal reflux disease (GERD) may benefit from taking antacids daily. Which instruction should the APN give the patient regarding an antacid suspension?

  1. Take the antacid suspension 1 to 3 hours after meals and at bedtime.
  2. Take the suspension immediately before eating.
  3. Take the antacid once a day just before going to bed.
  4. Take the antacid suspension along with morning medications.
A
  1. Taking the antacid 1 to 3 hours after eating will prolong the antacid effect. Antacids will be effective for only approximately 40 minutes if taken before eating. The medication needs to be taken after food when the stomach is most acidic. Antacids can alter the absorption and bioavailability of medications when taken at the same time.
34
Q

Which dietary instructions should the APN provide to a patient who has a history of gastroesophageal reflux disease (GERD)?

  1. Up to 1 alcoholic drink per day is allowed.
  2. Use peppermint/spearmint gum to mask the taste of food.
  3. Drinking caffeinated beverages is allowed.
  4. Limit high-fat and/or high-carbohydrate food sources.
A
  1. Patients should limit tobacco, alcohol, peppermint, chocolate, and foods with high concentrations of fat or carbohydrate, as they all decrease LES tone, which can lead to GERD. Alcohol, caffeine, and peppermint/spearmint should be limited in the diet as it can decrease LES tone.
35
Q

Which timeframe is typically used for triple drug therapy used to treat peptic ulcer disease (PUD) for an adult patient with no known allergies?

  1. 7 to 14 days
  2. 10 to 14 days
  3. 3 days
  4. 1 month
A
  1. Usual first-line therapy is 10 to 14 days to treat PUD.
36
Q

A patient in the emergency room (ER) has been prescribed prochlorperazine for nausea. By which mechanism of action does this medication work?

  1. Blocking dopamine receptors in the chemoreceptor trigger zone (CTZ)
  2. Blocking histamine1 receptors in the gastrointestinal (GI) tract
  3. Blocking serotonin on vagal nerve terminals
  4. Stimulating gastric emptying and peristalsis
A
  1. The medication is a phenothiazine and therefore works by blocking dopamine receptors.
37
Q

A 65-year-old female patient in generally good health requests information regarding the amount of calcium she should take daily as a supplement to prevent osteoporosis. Which amount would the APN recommend?

  1. 500 mg/day
  2. 1,000 mg/day
  3. 1,500 mg/day
  4. 2,500 mg/day
A
  1. This is the correct daily dose for a postmenopausal woman. Doses higher than 2,000 mg/day are not recommended because of an increased risk of adverse effects.
38
Q

An otherwise healthy patient reports having occasional dyspepsia and asks which product is best. Considering the acid-neutralizing capacity (ANC) of various antacids, the APN is most likely to recommend which product?

  1. An antacid that contains only calcium carbonate, such as Tums
  2. A combination product with aluminum hydroxide and magnesium hydroxide, such as Mylanta
  3. A product high in sodium bicarbonate, such as Alka-Seltzer
  4. A combination product with calcium carbonate and magnesium hydroxide, such as Rolaids
A
  1. This combination has the highest ANC and is available under many brand names.
39
Q

The APN is reviewing a patient’s current medications, including over-the-counter (OTC) medications, with him. The patient has dyspepsia and takes Tums (calcium carbonate). Which statement by the patient indicates that the patient understands how best to take this medication?

  1. “I take it when I have my spinach salad for lunch.”
  2. “I take it with a glass of orange juice.”
  3. “I take it just before I eat my breakfast cereal.”
  4. “I take it along with my regular medications in the morning.”
A
  1. Acidic fruit juice may improve absorption of calcium-based antacids. Spinach contains large amounts of oxalic acid, which decreases absorption of calcium. Cereals and bran contain phytic acid, which decreases absorption of calcium-based antacids. Antacids bind with many other drugs, decreasing their absorption.
40
Q

A patient consults the APN because of concerns about repeated bouts of vertigo and nausea. The patient asks whether anything can be prescribed to help. Which medication would be most appropriate for this patient?

  1. Prochlorperazine 10 mg oral tablet
  2. Aprepitant 40 mg capsule
  3. Meclizine 25 mg oral tablet
  4. Dolasetron 100 mg tablet
A
  1. Meclizine. Antihistamines act on the vestibular system and chemoreceptor trigger zone (CTZ) and thus are good for vertigo and its associated nausea. Prochlorperazine is not usually effective for treating vertigo.
41
Q

A student APN is giving a presentation to her classmates about gastroesophageal reflux disease (GERD). Which piece of information should be included?

  1. “GERD is uncomfortable for the patient but will not cause lasting damage.”
  2. “Most patients complain of retrosternal pain radiating downward to the abdomen.”
  3. “Older adults may have few symptoms, despite having significant disease.”
  4. “Dysphagia with GERD indicates that the patient has esophageal cancer.”
A
  1. Decreased gastric acid secretion and decreased pain perception occur in older adults. GERD can lead to basal cell hyperplasia and cancer. The pain is substernal and radiates upward. Dysphagia warrants more investigation but is not necessarily due to cancer.
42
Q

An older adult has been taking metoclopramide for a few months and presents for a follow-up office visit. Which finding should alert the APN to discontinue the drug?

  1. Potassium level 2.8 mEq/L
  2. Sodium level 140 mEq/L
  3. Temperature 99. 2 degrees Fahrenheit
  4. Pulse 88
A
  1. Hypokalemia is a contraindication to use of metoclopramide.
43
Q

A patient comes to the clinic complaining of a 2-day history of diarrhea. He receives two tablets of diphenoxylate HCl with atropine sulfate to take orally as needed for each loose stool. The APN should inform him that he might have which symptom(s)?

  1. A slower heart rate than normal
  2. The need to urinate frequently
  3. An increase in appetite
  4. Drowsiness and dizziness
A
  1. Diphenoxylate with atropine may cause sedation and possibly dizziness.
44
Q

Pernicious anemia can develop in patients having long-term treatment with which class of drugs?

  1. Histamine2 receptor antagonists (H2RAs)
  2. Proton pump inhibitors (PPIs)
  3. Antacids
  4. Prokinetic agents
A
  1. Total suppression of gastric acid long term can lead to a lack of intrinsic factor, which is also secreted by the parietal cells. Intrinsic factor is needed to facilitate absorption of vitamin B12. Pernicious anemia results from a deficiency state related to vitamin B12.
45
Q

A 56-year-old male patient with diabetes has been taking a proton pump inhibitor (PPI) daily as prescribed for gastroesophageal reflux disease (GERD) but still has significant acid reflux. Which medication could be prescribed to increase gastric emptying and help improve his symptoms?

  1. Metoclopramide
  2. Famotidine
  3. Prochlorperazine
  4. Sucralfate
A
  1. Metoclopramide is a prokinetic agent and can be used as adjunctive therapy in patients who do not respond to PPIs alone.
46
Q

Evidence-based practice (EBP) research indicates that which regimen is most effective for treating ulcers?

  1. Monotherapy with antibiotics
  2. Monotherapy with proton pump inhibitors (PPIs)
  3. Triple or quadruple therapy
  4. Antibiotic with proton pump inhibitor
A
  1. Regimens include triple or quadruple drug therapy with a variety of drugs. All include a twice-daily dose of a PPI. The most popular antibiotics are clarithromycin (Biaxin) and amoxicillin.

NURS 572 Advanced Pharmacotherapeutics UofA Nursing (19 decks)

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