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NURS 5334 > Module 8 > Flashcards

Module 8 Flashcards

1
Q

Gastric acid will activate _____ which is a proteolytic enzyme.

A

Answer: pepsin

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2
Q

True or false, drugs (except antibiotics) do NOT alter the disease process for peptic ulcer disease?

A

True

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3
Q

What PUD drugs work to enhance mucosal defenses (choose all that apply)?

a) bismuth
b) sucralfate
c) antacids
d) misoprostol

A

Answer: b)sucralfate & d)misoprostol

Misoprostol also works to reduce gastric acidity

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4
Q

Which is not a risk factor for PUD?

a) age 60+
b) low-dose NSAIDs
c) alcohol
d) history of ulcers

A

Answer: b & c

Risks include: age 60+, history of ulcers, HIGH dose NSAIDs

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5
Q

What are the preferred prophylactic treatments for PUD (choose all that apply)?

a) H2 blockers
b) PPI
c) antacids
d) sucralfate
e) misoprostol

A

Answer: b)PPI & e)misoprostol

Note: PPIs are preferred over misoprostol

Misoprostol is effective but causes diarrhea

Antacids, sucralfate, H2 blockers are NOT recommended

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6
Q

What is the best treatment for ulcers caused by NSAIDS (choose all that apply)?

a) H2 blockers
b) PPI
c) antacids
d) sucralfate
e) misoprostol

A

Answer: a)H2 blockers & b) PPI

Also removing the offending NSAID if possible.

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7
Q

True or false, asymptomatic patients with H. Pylori should be treated with antibiotics.

A

False. Only symptomatic patients.

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8
Q

What are the “acronyms” for the first line PUD treatments?

A

CAMP & BMTP

Camp= clarithromycin, amoxicillin, metronidazole, and PPI

BTMP= Bismuth, tetracycline, metronidazole, PPI

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9
Q

The treatment of PUD involves at least ____ antibiotics and preferably _____.

A

The treatment of PUD involves at least 2 antibiotics and preferably 3. Note: standard treatment is QUADRUPLE therapy (CAMP, BTMP) for 14 days.

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10
Q

Can an H2 blocker be used in quadruple therapy for PUD?

A

Yes. PPIs & H2 are used in conjunction with 3 antibiotics typically.

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11
Q

What is the MOA of bismuth?

a) reduces volume of gastric juice & H+ ions
b) disrupts cell wall of H. Pylori
c) blocks final common pathway of acid production
d) promotes secretion of bicarbonate

A

Answer: b) disrupts cell wall of H. pylori

It also may inhibit urease activity & prevent H.pylori from attaching to gastric surface

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12
Q

Side effects of Bismuth include (choose all that apply)?

a) pneumonia
b) neurologic injury
c) constipation
d) P450 inhibitor
e) black color of tongue & stool

A

Answer: b) neurologic injury (long term use) & e) harmless black color on tongue and stool

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13
Q

What is the MOA of H2 blockers?

a) reduces volume of gastric juice & H+ ions
b) disrupts cell wall of H. Pylori
c) blocks final common pathway of acid production
d) promotes secretion of bicarbonate

A

Answer: a) reduces volume of gastric juice and hydrogen ion concentration

It also suppresses secretion of gastric acid which promotes ulcer healing. It inhibits the H+/K+/ATPase pump

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14
Q

H2 blockers have what suffix?

A

“-tidine”

Cimetidine, famotidine, nizatidine

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15
Q

PPIs have what suffix?

A

“-prazole”

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16
Q

Which is not a side effect of Famotidine (choose all that apply)?

a) fractures
b) pneumonia
c) P450 inhibitor
d) C. diff
e) antiandrogenic effects

A

Answer: a)fractures & d)C. diff

Fractures & C. diff are associated with PPIs

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17
Q

What is a side effect of Cimetidine?

a) fractures
b) rebound acid hypersecretion
c) prolonged QT
d) hallucinations

A

Answer: d)hallucinations

Cimetidine is an H2 blocker

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18
Q

Which is not an indicated use for H2 blockers (choose all that apply)?

a) gastric/duodenal ulcers
b) GERD
c) inflammatory bowel disorder
d) ICU patients to prevent stress ulcers

A

Answer: c & d

H2 blockers are used for gastric/duodenal ulcers; GERD; and Zollinger-Ellison

ICU patients are given PPIs to prevent ulcers

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19
Q

What medication can decrease the absorption of H2 blockers?

a) PPIs
b) warfarin
c) cimetidine
d) antacids
e) tetracycline

A

Answer: d) antacids

These should be taken 1 hour apart.

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20
Q

What is the MOA for PPIs?

a) reduces volume of gastric juice & H+ ions
b) disrupts cell wall of H. Pylori
c) blocks final common pathway of acid production
d) promotes secretion of bicarbonate

A

Answer: c) blocks final common pathway of gastric acid production

It also inhibits basal and stimulated acid release

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21
Q

True or false, the effects of PPIs last long after they are discontinued.

A

True. They bind irreversibly to enzymes so they have long-lasting effects even when the drug is “gone.”

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22
Q

Which is a side effect of PPIs (choose all that apply)?

a) C. diff
b) antiadrogenic effects
c) P450 inhibitor
d) rebound acid hypersecretion
e) hallucinations

A

Answer: a & d

PPIs can cause: pneumonia, fractures, rebound acid hypersecretion, hypomagnesemia, C. diff.

They can reduce absorption of HIV meds, ketoconazole, & itraconazole

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23
Q

Treatment with PPI should last _______.

A

4-8 weeks ideally but NO MORE than 5 years.

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24
Q

Side effects of PPI include (choose all):

a) low calcium
b) high magnesium
c) low B12
d) C. diff

A

Answer: a,c,d

PPI can cause low calcium, low magnesium, low B12, and C. diff

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25
Q

Sucralfate side effects include:

a) low magnesium
b) C. diff
c) hallucinations
d) constipation

A

Answer: d) constipation

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26
Q

A patient taking sucralfate may have decreased absorption of what other medication in their regimen (choose all that apply):

a) PPIs
b) tetracycline
c) quinolones
d) theophylline

A

Answer: c) quinolones & d)theophylline

Sucralfate decreases the absorption of these drugs, as well as phenytoin, digoxin, and warfarin so these medications should be given 2 HOURS APART from sucralfate.

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27
Q

Uses for Misoprostol include (choose all that apply):

a) GERD
b) Inflammatory bowel disease
c) Prevention of gastric ulcers in patients taking NSAIDs long term
d) abortions

A

Answer: c&d

Misoprostol is used to prevent gastric ulcers from long-term NSAID use and can also cause abortion of pregnancy

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28
Q

What is the MOA of Misoprostol?

a) suppresses secretion of gastric acid
b) decreases submucosal blood flow
c) disrupts the cell wall for H.Pylori
d) reduces volume of gastric juice secreted

A

Answer: a) suppresses secretion of gastric acid

It is also protective of the GI by stimulating the secretion of bicarbonate & mucus. It also maintains submucosal blood flow by vasodilation.

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29
Q

What is a side effect of misoprostol?

a) constipation
b) impaired drug absorption
c) diarrhea
d) rebound acid hypersecretion

A

Answer: c) diarrhea

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30
Q

Aluminum hydroxide causes ________ (diarrhea/constipation) whereas magnesium hydroxide can cause _______ (diarrhea/constipation).

A

Answer: aluminum hydroxide=constipation; magnesium hydroxide=diarrhea

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31
Q

True or false, antacids have the same rate of healing for PUD as H2 blockers.

A

True.

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32
Q

If gastric pH is above ______ (#) then pepsin activity will be decreased.

A

Answer: 5

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33
Q

What is the MOA of antacids:

a) stimulates production of prostaglandins
b) suppresses secretion of gastric acid
c) prevents final step in gastric acid secretion pathway
d) creates a barrier along the GI mucosa

A

Answer: a) stimulates production of prostaglandins (which are GI protective–think about misoprostol which is a “synthetic” prostaglandin)

It also neutralizes acid

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34
Q

Antacids can interact with many medications,but the ones emphasized by the weekly chat for pharmacology were:

a) tetracyclines
b) cimetidine
c) warfarin
d) sucralfate

A

Answer: b)cimetidine & d)sucralfate

Avoid by giving a 1 hour gap between these meds and the antacid

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35
Q

Which is not a trigger for GERD (choose all that apply)?

a) anticholinergic medications
b) alcohol
c) nitrates
d) chemotherapy
e) smooth muscle relaxants

A

Answer: d) chemotherapy

All of the other choices are triggers for GERD. Other triggers include spicy foods, caffeine, & tobacco.

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36
Q

What is the first line treatment for GERD?

a) avoid meals 2-3 hours before bed
b) antacids
c) PPI
d) H2 blockers

A

Answer: a) avoid meals 2-3 hours before bed

Other nonpharmacologic first line options are: elevate HOB; avoid medications which relax the LES (anticholinergic drugs, estrogens, CCB); and lose weight.

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37
Q

Phase 1 treatment for GERD (attempts to lose weight, avoiding meals before bedtime, etc were unsuccessful) [choose all that apply]:

a) lifestyle changes/diet changes
b) antacids
c) PPI
d) H2 blockers

A

Answer: a&b

Phase 1 for GERD: lifestyle changes/diet and antacids

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38
Q

Phase 2 treatment for GERD (lifestyle changes and diet modifications inadequate):

a) antacids
b) PPI
c) H2 blockers

A

Answer: c) H2 blockers

Even though PPI are more effective, there are more risks, so H2 is used before going to a PPI (if needed).

Phase 3 would be a PPI.

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39
Q

What are the two options for patients at phase 3 of GERD treatment (PPIs) if unsuccessful?

a) increase PPI to BID
b) add H2 to the PPI regimen
c) increase PPI to TID for meal coverage
d) refer out

A

Answer: a) increase PPI to BID & d) refer out

Can try either one.

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40
Q

Metoclopramide is used to treat:

a) constipation
b) GERD
c) PUD
d) emesis
e) inflammatory bowel disease
f) hyperemesis gravidarum

A

Answer: b) GERD d) emesis f)hyperemesis gravidarum

It blocks dopamine and works in treating GERD (2nd line agent) and in treating emesis.

Also a 2nd line agent in treating hyperemesis gravidarum after 10 weeks due to increased risk of cleft lip.

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41
Q

Side effects of Metoclopramide include (choose all):

a) tardive dyskinesia
b) P450 induction
c) blood dyscrasias
d) constipation

A

Answer: a) tardive dyskinesia & c) blood dyscrasias

Blood dyscrasias (and anemia) can occur with H2/PPI use.

Cleft lip can occur if given before 10 weeks gestation (2nd line treatment for hyperemesis gravidarum).

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42
Q

What is a side effect of Ondansetron (Serotonin receptor antagonist)?

a) constipation
b) QT prolongation
c) bradycardia
d) electrolyte imbalances

A

Answer: b) QT prolongation

Other SE: headache, diarrhea, dizziness

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43
Q

What is not a side effect of Ondansetron?

a) headache
b) diarrhea
c) dizziness
d) anticholinergic effects

A

Answer: d) anticholinergic effects

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44
Q

True or false, Ondansetron is less effective when combined with dexamethasone.

A

False. It is more effective.

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45
Q

What is the MOA for Ondansetron?

a) blocks neurokinin-1 receptors in CTZ
b) blocks H-1 receptors of neuronal pathway between inner ear and vomiting center of CNS
c) blocks dopamine 2 receptors in CTZ
d) blocks serotonin receptors in CTZ

A

Answer: d) blocks serotonin receptors in the CTZ

Hence, it is a serotonin receptor antagonist.

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46
Q

True or false, glucocorticoids (end “one”) when used for short term relief of nausea and vomiting carry the risk of adrenal suppression.

A

False, with short-term use there are no serious side effects like those you would see with long term use of glucocorticoids (adrenal suppression).

47
Q

What is the MOA for glucocorticoids in relieving nausea and vomiting?

a) unknown MOA
b) blocks H-1 receptors of neuronal pathway between inner ear and vomiting center of CNS
c) blocks dopamine 2 receptors in CTZ
d) blocks serotonin receptors in CTZ

A

Answer: a) MOA unknown

48
Q

Substance P/Neurokinin-1 antagonists have what suffix?

a) one
b) setron
c) azine
d) pitant

A

Answer: d) pitant

Drugs include: Aprepitant, Rolapitant, Netupitant, and Fosaprepitant

49
Q

What statement is not true regarding Aprepitant?

a) it must be combined with other antiemetic drugs
b) it can prevent delayed CINV and acute CINV
c) it works by blocking dopamine 2 receptors in the CTZ
d) it is a substrate/inhibitor/inducer of P450

A

Answer: c) it works by blocking dopamine 2 receptors in the CTZ

The MOA for Aprepitant is by blocking neurokinin-1 type receptors in the CTZ

50
Q

Which drugs used for nausea/vomiting have similar side effect profiles?

a) metoclopramide & lorazepam
b) ondansetron & droperidol
c) aprepitant & dexamethasone
d) promethazine & droperidol

A

Answer: d) promethazine (a phenothiazine) and droperidol (a butyrophenone)

Both have EPS, sedation, and hypotension as possible side effects.

They both block dopamine-2 receptors in the CTZ

51
Q

Which is not a benefit of lorazepam?

a) production of anterograde amnesia
b) suppression of anticipatory emesis
c) help reduce EPS symptoms seen with phenothiazine antiemetics
d) can be provided as monotherapy for the reduction of CINV and surgical emesis/nausea

A

Answer: d) can be provided as monotherapy

Lorazepam should be given in combination to suppress CINV rather than as monotherapy.

52
Q

What is a side effect associated with promethazine (Phenergan)?

a) anticholinergic effects
b) prolonged QT
c) blurred vision
d) increased levels of warfarin

A

Answer: a) anticholinergic effects

53
Q

What is a side effect of Butyrophenones (Haloperidol)?

a) anticholinergic effects
b) prolonged QT
c) blurred vision
d) increased levels of warfarin

A

Answer: b) prolonged QT

54
Q

Dronabinol & Nabilone are what type of drugs used for nausea/vomiting?

A

Cannabinoids

Used in CINV as 2nd line agents due to abuse potential.

55
Q

What medication would be appropriate for chemotherapy which has a low risk of nausea/vomiting?

a) aprepitant
b) ondansetron
c) dexamethasone
d) lorazepam

A

Answer: c) dexamethasone

56
Q

What medication(s) would be appropriate for a chemotherapy drug known to have a moderate/high risk of inducing nausea and vomiting (choose all that apply)?

a) aprepitant
b) lorazepam
c) ondansetron
d) dexamethasone

A

Answer: a, c, & d

A combination works best of aprepitant+dexamethasone+ondansetron

Note: lorazepam can be added to decrease anticipatory emesis/provide amnesia

57
Q

What is considered first-line treatment for hyperemesis gravidarum?

a) ondansetron
b) doxylamine
c) metoclopramide
d) prochlorperazine

A

Answer: b) doxylamine+B6 (Dicletin & Diclegis)

If first line agents fail, then alteratives include: ondansetron, metoclopramide (after 10 weeks gestation), & prochlorperazine

58
Q

What are side effects of Scopolamine?

a) diarrhea
b) QT prolongation
c) dry mouth
d) EPS

A

Answer: c) dry mouth

These are muscarinic antagonist (anticholinergic drugs) so they dry everything up. Can’t see, can’t pee, can’t spit, can’t shit.

59
Q

What is the MOA for antihistamines in preventing motion sickness?

a) blocks neurokinin-1 receptors in CTZ
b) blocks H-1 receptors of neuronal pathway between inner ear and vomiting center of CNS
c) blocks dopamine 2 receptors in CTZ
d) blocks histamine-1 and muscarinic receptors

A

Answer: d) blocks histamine-1 and muscarinic receptors in neuronal pathway connecting the inner ear to the vomiting center

60
Q

Which is not an antihistamine indicated for motion sickness prevention?

a) Cyclizine
b) Meclizine
c) Dimenhydrinate

A

Answer: THEY ARE ALL USED FOR MOTION SICKNESS

61
Q

Side effects of antihistamines (Dimenhydrinate) used for motion sickness include?

a) diarrhea
b) constipation
c) EPS
d) bradycardia

A

Answer: b) constipation

They cause anticholinergic side effects (can’t see, can’t pee, can’t spit, can’t shit)

62
Q

Specific antidiarrheal drugs treat _____ (underlying cause of diarrhea/general targeting of the bowel) whereas nonspecific antidiarrheal drugs treat _____(underlying cause of diarrhea/general targeting of the bowel).

A

Answer: specific antidiarrheals target the underlying cause of diarrhea whereas nonspecific antidiarrheals act on the bowel directly to provide symptomatic relief BUT THEY DO NOT influence underlying cause.

63
Q

What drug is included in the formulation with Lotomil to decrease the abuse potential?

a) narcan
b) methylphenidate
c) atropine
d) epinephrine

A

Answer: c) atropine

64
Q

What bacteria/virus indicates a need for antibiotic treatment of diarrhea (choose all that apply)?

a) E. coli
b) Campylobacter
c) Shigella
d) Rotavirus

A

Answer: b &c

Bacteria which indicate the use for antibiotics include: salmonella, shigella, campylobacter, and clostridium species

65
Q

True or false, mild diarrhea rarely requires medication.

A

True. These are usually self-limited and do not need medications.

66
Q

Diarrhea caused by E. coli should be treated with:

a) supportive therapy (fluids, rest)
b) Loperamide
c) Quinolone
d) Rifamixin

A

Answer: a) supportive therapy

Usually E. Coli diarrhea is self-limited and will run its’ course in a few days.

67
Q

A 35 year old man has severe symptoms of diarrhea due to E. coli. What is an appropriate treatment (choose all that apply)?

a) Azithromycin
b) Loperamide
c) Quinolone
d) Rifamixin

A

Answer: c)quinolone OR d)rifamixin

Quinolones can be used to treat severe symptoms in nonpregnant women & adults. Rifamixin can also be used if patient is not pregnant, febrile, and if stools are not bloody.

68
Q

A 5 year old is having severe symptoms of diarrhea due to E. coli. What is an appropriate treatment?

a) Azithromycin
b) Loperamide
c) Quinolone
d) Rifamixin

A

Answer: a) azithromycin

Children and pregnant women can be treated with azithromycin for severe E. coli associated diarrhea.

69
Q

To prevent travelers’ diarrhea, what are prophylactic options (choose all that apply)?

a) azithromycin
b) loperamide
c) Dukoral
d) Bismuth
e) quinolones

A

Answer: c,d,e

Prophylactic options include vaccination with Dukoral (E. coli & Vibrio protection); and quinolone or Bismuth preparations taken orally as a preventative measure.

70
Q

IBS involves symptoms present for at least ____ weeks in the past year which cannot be explained by structural or chemical abnormalities and has 2/3 of the following symptoms (pain with pooping, onset associated with change in frequency of stool, onset of pain associated with change in consistency).

A

Answer: at least 12 weeks in the last year

71
Q

Which drug classes are not beneficial when treating IBS?

a) bulk-forming agents (Psyllium)
b) antispasmodics (Hyoscyamine/Dicyclomine)
c) antidiarrheals (Loperamide)
d) TCA
e) antihistamines

A

Answer: e) antihistamines

The other drug classes can be beneficial in managing IBS.

Other beneficial drugs include antibiotics and acid suppressants.

72
Q

What drug requires a risk management program including the patient, provider, and pharmacist due to the risks associated with the medication?

a) Eluxadoline
b) Sulfasalazine
c) Infliximab
d) Alosetron

A

Answer: d) alosetron

This drug is used in women ONLY with severe IBS-D who have not responded to other treatment and have been suffering with the condition for at least 6 months.

73
Q

Side effects of Alosetron include (choose all that apply):

a) constipation
b) infection
c) bowel perforation
d) agranulocytosis
e) fractures
f) death

A

Answer: a) constipation, c) bowel perforation, & f) death

The other side effect is ischemic colitis. This drug has a risk management program due to the severe GI toxicity and deaths.

74
Q

Tegaserod is a drug used for short-term management of IBS-C in women under 55. What side effects does this medication have?

a) constipation
b) CV risks
c) osteoporosis
d) agranulocytosis

A

Answer: b) CV risks so it is only used in emergency situations

It cannot be used in women who have a history of CV events.

75
Q

When prescribing Alosetron, the provider needs to remember that this drug:

a) can cause agranulocyctosis so regular CBCs should be obtained
b) will accumulate to toxic levels in renally impaired patients
c) is neurotoxic and early signs include EPS
d) is metabolized by P450

A

Answer: d) is metabolized by P450

This drug can have numerous implications on other drugs metabolized by P450 such as quinolones, cimetidine, clarithromycin, phenobarbitol, etc.

76
Q

True or false, Alosetron can be used to treat IBS in both men and women.

A

False, it is only approved for use in women.

77
Q

Which statement is not true regarding Lubiprostone?

a) it is used in IBS-C
b) women 18 and older can take
c) it carries the risk of bowel perforation
d) it can be used for chronic idiopathic constipation in men too

A

Answer c) it carries the risk for bowel perforation

78
Q

In anemia, iron deficiency is caused by an issue with _______ (poor absorption/increased demand) whereas B12 is usually an issue with _______ (poor absorption/increased demand).

A

Answer:

Iron deficiency=usually due to increased demand
B12 deficiency=usually due to poor absorption

79
Q

Crohn’s disease involves the _____ typically whereas ulcerative colitis involves the _____typically.

A

Crohn’s=transmural inflammation of terminal ileum (usually)

UC=inflammation of mucosa and submucosa of colon & rectum

80
Q

Side effects of sulfasalazine (inflammatory bowel disease drug) include (choose all that apply):

a) nausea
b) rash
c) agranulocytosis
d) opportunistic infections

A

Answer: a,b,c

Sulfasalazine side effects include nausea, rash, fever, arthralgia, agranulocytosis, hemolytic anemia, and macrocytic anemia

81
Q

What labs should be monitored in a patient taking sulfasalazine (inflammatory bowel disease drug)?

a) PT/INR
b) LFT
c) BMP
d) CBC

A

Answer: d) CBC

The drug can cause agranulocytosis, hemolytic anemia and macrocytic anemia

82
Q

True or false, sulfasalazine is useful in severe attacks of ulcerative colitis.

A

False. It is most effective in mild/moderate UC

83
Q

Is Sulfasalazine safe to take during pregnancy and while lactating?

A

Yes. It is used to manage symptoms of UC.

84
Q

Budesonide is considered what class of drugs used for inflammatory bowel disease?

A

Glucocorticoid. Others include hydrocortisone and dexamethasone.

85
Q

Uses for budesonide include:

a) mild- moderate ulcerative colitis (UC)
b) irritable bowel syndrome
c) mild-moderate crohn’s disease
d) PUD

A

Answer: c) mild-moderate Crohn’s disease

86
Q

Side effects of budesonide include (choose all that apply):

a) adrenal suppression
b) increased risk of infection
c) bone marrow suppression
d) osteoporosis

A

Answer: a,b,d

Budesonide is a glucocorticoid used in inflammatory bowel disease. Side effects include osteoporosis, increased risk of infection, and prolonged use can lead to adrenal suppression/ Cushing syndrome.

Thus these drugs are not used for long-term maintenance.

87
Q

Azathioprine & Mercaptopurine are used for what off label purpose (choose all that apply)?

a) ulcerative colitis
b) irritable bowel syndrome
c) crohn’s disease
d) PUD

A

Answer: a)ulcerative colitis and c)crohn’s disease

They can induce and maintain remission in both of these diseases. They work as immunosupressants.

88
Q

Side effects of Mercaptopurine include:

a) neurotoxicity
b) hepatitis
c) Cushing syndrome
d) pancreatitis
e) bone marrow suppression

A

Answer: d)pancreatitis and e) bone marrow suppression

This drug is used as an immunosuppressant in inflammatory bowel disease. Other SE include neutropenia.

89
Q

Cyclosporine used for inflammatory bowel disease carries what side effects (choose all that apply):

a) hepatotoxicity
b) renal impairment
c) neurotoxicity
d) pancreatitis

A

Answer: b&c

SE include renal impairment, neurotoxicity, generalized immunosuppression as these drugs are immunosuppressants.

90
Q

A patient with acute/severe UC or CD which has not responded to glucocorticoids may be a candidate for what medication:

a) PPI
b) aminosalicylates
c) metoclopramide
d) cyclosporine

A

Answer: d) cyclosporine

It is an immunosuppressant which is STRONGER than azathioprine or mercaptopurine and acts FASTER.

IV therapy can induce remission and PO can maintain.

91
Q

Infliximab used in inflammatory bowel disease carries what side effects:

a) opportunistic infections
b) infusion reactions
c) CV reactions
d) lymphoma

A

Answer: all of the above

It is a monoclonal antibody used to treat moderate-severe Crohn’s and UC

92
Q

Drugs for inflammatory bowel disease which aren’t generally used for both conditions include:

Metronidazole & Cipro-used mainly for Crohn’s

Sulfasalazine-used mainly for UC

Budesonide-Crohn’s

A

left blank intentionally

93
Q

A patient taking Infliximab should be monitored with what test frequently?

a) CXR
b) TB test
c) PT/INR
d) EKG

A

Answer: b) TB test

It is a monoclonal antibody used for managing inflammatory bowel disease which can facilitate the emergence of opportunistic infections such as TB.

94
Q

Metoclopramide indications include:

a) GERD
b) PUD
c) hyperemesis gravidarum
d) CINV
e) diabetic gastroparesis

A

Answer: a,c,d,e

Uses include: GERD, CINV, diabetic gastroparesis, and managing hyperemesis gravidarum after 10 weeks gestation.

95
Q

Deficiency of pancreatic enzymes can be caused by:

a) cystic fibrosis
b) pancreatitis
c) pancreatic duct obstruction
d) immunosuppressant drugs
e) bowel resection

A

Answer: a,b,c

Deficiencies can be caused by CF, pancreatitis, pancreatic duct obstruction and pancreatectomy

96
Q

Replacement therapy of pancreatic enzymes includes:

A

Pancrelipase (Creon, Pancreaze, Pertzye, Viokace, Zenpep)

97
Q

Treatment of choice for anal fissures is:

a) topical analgesics
b) nitroglycerin
c) corticosteroids
d) witch hazel

A

Answer: b) nitroglycerin ointment 0.4%

The MOA is by relaxing the internal anal sphincter and the ointment can also be used for hemorrhoids.

98
Q

If RBC production is low, iron needs are _____; and if RBC production is high, iron needs are ______.

A

RBC production low=iron needs are low and vice versa

RBC production will determine the iron needs of the body.

99
Q

True or false, iron deficiency anemia is caused by reduced uptake.

A

False, it is caused by increased demand.

100
Q

Causes of iron deficiency can include (choose all that apply):

a) pregnancy
b) fetal growth
c) infancy and childhood blood volume expansion
d) sprue
e) chronic blood loss

A

Answer: all of the above

Sprue is a malabsorption syndrome that decreases folic acid uptake.

Another cause of iron deficiency due to poor absoprtion would include a gastrectomy.

101
Q

Iron deficiency anemia has RBC which are _______ (macrocytic/microcytic); whereas B12 deficiency and folic acid deficiency can cause _______ (macrocytic/microcytic) anemia.

A

Answer: iron deficiency= microcytic

B12&folic acid deficient=macrocytic and sometimes megablastic (just means has 5+ lobes in nucleus)

102
Q

Labs consistent with anemia include (choose all that apply):

a) low H&H
b) elevated Reticulocytes
c) low iron
d) low RBC
e) elevated serum iron binding capacity

A

Answer: a,c,d,e

Labs consistent with anemia include: reduced RBC, low reticulocyte, low H&H, low iron, increased serum iron binding, and absene of hemosiderin in bone marrow

103
Q

Treatment for iron deficiency anemia includes:

a) ferric salts
b) B12 and iron
c) ferrous sulfate
d) folic acid and iron

A

Answer: c) ferrous sulfate

Other option is carbonyl iron (pure elemental iron)

104
Q

Side effects of ferrous sulfate include:

a) GI upset
b) black colored tongue
c) stained teeth
d) toxicity in children
e) black stool

A

Answer: a,c,d,e

SE: GI upset, black colored stool, staining of teeth, and large amounts can be toxic in children

105
Q

What drugs interact with iron absorption (choose all that apply):

a) fluoroquinolones decrease absorption
b) PPIs decrease absorption
c) tetracyclines decrease absorption
d) vitamin C increases absorption

A

Answer: c&d

Antacids & tetracycline decrease absorption of iron. Vitamin C increases absorption (but increases SE)

106
Q

After initiating iron replacement, what labs should be reevaluated?

a) H&H in 1 week
b) ferritin in 4 weeks
c) Hgb, Hct, ferritin in 4 weeks
d) MCV, H&H, ferritin in 4 weeks

A

Answer: c) H&H and ferritin should be reevaluated in 4 weeks

107
Q

What is true of iron deficient anemia replacement therapy?

a) it will be required for life
b) it can usually stop at 6 months
c) it can be stopped after Hgb is 15
d) after initial injection, treatment with folic acid alone is sufficient

A

Answer: c) it can be stopped after Hgb is about 15

At this point dietary iron is usually sufficient

108
Q

True or false, combining antianemia agents is appropriate for severe anemia.

A

False. It can cause toxicity.

109
Q

Which is not a consequence of B12 deficiency:

a) neurological issues
b) GI disturbances
c) cell division problems
d) immunosuppression

A

Answer: d) immunosuppression

B12 deficiency can cause anemia, neuro issues, demyelination of neurons, GI disturbances, and suppressed division of cells which line the mouth/stomach/intestine which can cause oral ulceration, bleeds, infection, and GI upset.

110
Q

Which of the following statements about B12 is incorrect:

a) it helps convert folic acid to active form
b) it is required for tissues undergoing growth and division
c) deficiencies can impair DNA synthesis
d) treatment with folic acid alone is the preferred treatment method
e) it can cause microcytic anemia

A

Answer: d &e

B12 helps convert folic acid to its’ active form. Thus without B12 we have no “active” folic acid and therefore no DNA synthesis. Treatment is NEVER folic acid alone (it always includes B12). B12 deficiency can cause macrocytic anemia.

111
Q

A deficiency in intrinsic factor will cause what type of anemia?

A

Pernicious anemia

Intrinsic factor is required for B12 to attach to in the stomach. Without intrinsic factor, only 1% of B12 can be absorbed by diffusion which is not sufficient.

112
Q

True or false, B12 deficiency is usually caused by an absorption problem.

A

True

113
Q

Causes of B12 deficiency include (check all that apply):

a) strict vegetarians
b) alcohol
c) absence of intrinsic factor
d) Sprue

A

Answer: a,b,c

B12 deficiency can be caused by: strict vegetarian diet, Celiac disease, alcohol, bariatric surgery (most common cause), antacid use (B12 must have an acidic environment to be absorbed), B12 antibodies, and regional enteritis.

Sprue is seen in folic acid deficiency.

114
Q

Therapy of choice for B12 deficiency (not caused by an intrinsic factor deficiency) is:

a) ferrous sulfate
b) folic acid
c) cyanocobalamin
d) carbonyl iron

A

Answer: c)cyanocobalamin (B12) orally

If severely deficient, IM injection with folic acid can be used.

NURS 5334 (12 decks)

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