NSG 533 Module 1 Flashcards
Mr. Jones is a 66-year-old obese male who has recently been prescribed omeprazole 20 mg daily. When should this medication be ideally taken?
2 hours prior to eating
30 minute before eating
With a meal
30-60 minutes after a meal
30 minute before eating
PPIs like omeprazole are generally dosed 30 minutes or so before meals; this is a recommendation for greatest efficacy, not an absolute (example, if a patient likes to get up and eat right away upon rising, the medication will still likely be beneficial, but may not have a maximal effect).
Which supplement may be necessary for a patient taking long-term pantoprazole?
Potassium
Thiamine
Vitamin B12
Zinc
Vitamin B12
It is ideal to use PPIs like pantoprazole short term if possible due to the increased risk of osteoporosis, low magnesium, and B12 deficiency if used long term.
Giving levothyroxine with which medication would cause a significant reduction in absorption and increase the risk for hypothyroid symptoms?
Esomeprazole
Famotidine
Sucralfate
Cimetidine
Sucralfate
Sucralfate has numerous drug-binding interactions in the gut and can reduce the concentrations of many medications such as levothyroxine. Because of this, administer other medications 2 hours before giving sucralfate.
Which medication acts on opioid receptors in the gut to help manage diarrhea?
Atropine
Cholestyramine
Dicyclomine
Loperamide
Loperamide
Loperamide acts on opioid receptors in the intestines and slows peristalsis (GI movement) and thus helping diarrhea symptoms. Cholestyramine bulks up the stool in helping diarrhea. Dicyclomine and atropine are both anticholinergic medications and would cause constipation via that mechanism.
Mr. Farwell takes numerous medications and has many medical conditions. Some of his medications include seizure medications, warfarin, and levothyroxine. He has been having diarrhea. Which medication for diarrhea would be most likely to cause binding interactions?
Bismuth subsalicylate
Loperamide
Cholestyramine
Dicyclomine
Cholestyramine
Cholestyramine has lots of binding interactions with other medications that can reduce absorption; be very careful with sensitive drugs like warfarin, levothyroxine, seizure medications. Administration of other medications should ideally take place 2 hours before or 6 hours after. It would also be important to monitor appropriate labs (i.e. INR, TSH, and seizure medication levels) as indicated.
Mr. Moeller is taking dicyclomine for IBS with predominant diarrhea. His past medical history includes osteoarthritis, BPH, GERD, and seasonal allergies. What condition is most concerning in relation to dicyclomine?
GERD
BPH
Osteoarthritis
Seasonal allergies
BPH
Anticholinergic medications like dicyclomine can contribute to urinary retention which is a complication of BPH. This would be the most concerning risk associated with dicyclomine in this patient scenario.
What is the primary mechanism of action for ondansetron?
- Opioid agonist activity
- Inhibition of neurokinin-1 receptor which can help stimulate antiemetic activity in the brain
- Blocks dopamine and serotonin receptors in chemoreceptor zone (CRZ), lends to relief of nausea/vomiting
- Blocks serotonin at 5HT3 receptors; acts centrally in the chemoreceptor trigger zone
Blocks serotonin at 5HT3 receptors; acts centrally in the chemoreceptor trigger zone
Ondansetron blocks serotonin at 5HT3 receptors; acts centrally in the chemoreceptor trigger zone.
Mr. Manning reports that he noticed some involuntary facial movements. Which of his GI medications would be most likely to cause this adverse effect?
Metoclopramide
Ondansetron
Pantoprazole
Aprepitant
Metoclopramide
Metoclopramide has dopamine-blocking activity like antipsychotics, so it can cause movement disorders like EPS and tardive dyskinesia.
In a patient who is at risk for QTc prolongation from ondansetron, which of the following assessments would be most appropriate?
EEG
EKG
CBC
LFTs
EKG
Monitoring an EKG would be the most important monitoring parameter in a patient who is at risk for QTc prolongation and torsades de pointes. Ondansetron has been associated with this risk.
Your patient is taking Tums on a routine basis at meals for heartburn symptoms. Which antibiotic would be most likely to have concentrations reduced if taken at the same time as Tums?
Ciprofloxacin
Nitrofurantoin
Amoxicillin
Ceftriaxone
Ciprofloxacin
Ciprofloxacin would be the most significantly bound medication by calcium products like Tums. Concentrations will be reduced and the patient would be at risk for antibiotic failure if these medications were coadministered.
p______________ (psych drug class)
(chlorperazine, proclorperazine, promethazine). Can cause hyperprolactinemia and extrapyrimidal symptoms (like lip smacking, etc).
phenothiazines
