Week 7 - Final Review Flashcards
What are some examples of H2 Receptor agonists?
- Cimetidine
- Famotidine
- Nizatidine
- ranitadine
Which H2 receptor agonist is most likely to interact due to the CYP450 enzyme system?
Cimetidine
What vitamin and mineral deficiencies are PPIs associated with?
- Calcium
- magnesium
- vitamin B12
Short term use of PPIs increases the risk for what?
Pneumonia
Symptoms that indicate a patient may be developing pneumonia.
- Cough
- SOB
- Fever
- Chest pain
- Aching body
- Fatigue
- Loss of appetite
- wheezing
How to treat moderate to severe GERD
PPI
What medication for GERD to avoid in older adults and why?
Cimetidine
- Likely CNS effects with renal or hepatic impairment
—- Causes confusion, hallucinations, CNS depression and excitation
How do we treat GERD during pregnancy?
With a cytoprotective agent like sucralfate.
Misoprostol should not be used as it can cause abortion, birth defects and uterine rupture.
When should we test a patient for H. pylori?
When you are treating them for GERD and the treatment isn’t working.
How do we treat H. pylori?
With two antibiotics and an antisecretory agent
- Amoxicillin
- Clarithromycin
- omeprazole
What lifestyle modifications can assist in treating peptic ulcer disease?
- Change eating pattern to 5-6 small meals a day to help reduce fluctuation in gastric acid pH
- smoking cessation
- NSAID and aspirin discontinuance.
Which anidiarrheal medication is contraindicated in children or after chickenpox?
Bismuth subsalicylate
When prescribing ciprofloxacin for traveller’s diarrhea, what patient teaching should be done?
- 500mg twice a day
- Avoid drinking local water
- Wash food thoroughly
Which antidiarrheal medication is associated with gray/black stools and a black tongue?
Bismuth subsalicylate
What lifestyle factors should be suggested prior to treatment for constipation?
Increase water intake
Increase intake of high fiber foods
- Spinach
- Broccoli
- Cabbage
- Asparagus
- Brussel sprouts
Increase activity
What are the risks of using laxatives during pregnancy?
Use with caution, medications that stimulate the GI tract can induce labor
Preferred treatment for constipation during breastfeeding
Senna
Psyllium - how does it work and what should you assess for if it doesn’t produce a bowel movement
- Swell in water to form a viscous solution softening fecal mass and increasing bulk
- Assess for signs of a bowel obstruction or fecal impaction if no BM is produced
How does a diary help with IBS?
Keeping a food diary can help identify trigger foods to IBS
How do we treat gastroparesis?
Is treated with prokinetic agents like metoclopramide which suppresses emesis and increases upper GI motility
What is the black box warning for metoclopramide?
May develop tardive dyskinesia (involuntary repetitive movement)
What patient teaching is needed for metronidazole?
Do not drink alcohol while taking it, can cause N &V, tachycardia, facial flushing
If a mother is taking isoniazid and rifampin can she breastfeed?
Yes, any other drug you would have to weigh benefit vs risk
What constitutes drug resistant TB?
Resistant to isoniazide and Rifampin
What TB medication is not safe for pregnancy?
Ethambutol shows teratogenesis in animal studies and eye abnormalities in children.
Rifabutin is the safest in pregnancy.
MOA of Bulk Forming Laxatives
Work much like dietary fiber producing stool in 1-3 days
MOA Surfactant
lowers surface tension which facilitates penetration of water into feces
MOA Stimulant
Stimulate intestinal motility
MOA Osmotic Laxative
High doses are used for bowel prep
A patient comes into the clinic with complaints of bloating and abdominal pain for a few weeks. What are appropriate options for treatment?
- Lifestyle modifications and H2 receptor agonist
A patient has tested positive for H.Pylori what are appropriate treatment options?
Start PPI, Start abx for 10-14 days
A pregnant woman comes in asking for GERD medication, what can you recommend?
Sucralfate
What is the MOA of metoclopramide?
Blockade of dopamine receptors in the CTZ chemoreceptor trigger zone
Metoclopramide can be used for…
1.Nausea and vomiting
2.Diabetic gastroparesis
3.Gastroesophageal reflux
What patient teaching can a provider give when prescribing a PPI?
- Hypomagnesemia symptoms: muscle cramps, tremors, and palpitations.
- Check Mg levels periodically especially in the elderly.
- Get enough calcium and VIT D.
- call if having diarrhea (Cdiff)
What patient teaching can a provider give when prescribing an H2RA?
Report CNS effects:
- lethargy
- solmenance
- restlessness
- confusion
- hallucinations.
Teach about possible reduced libido, impotenance, gynecomastia, pneumonia.
Cimetidine interacts with CYP system so check with pt if they are taking warfarin, phenytoin, theophylline, lidocaine.
A patient presents with a complaint of reflux and constipation. He states that he drinks enough water, and admits he has gained 30lbs. He also states that he has been having “reflux” type symptoms. What are your next steps for education?
Educate that weight gain can promote reflux symptoms, ask about any OTC use such as antacids which may cause constipation.
Zollinger-Ellison syndrome is due to a _______producing tumor. Treatment is long-term therapy of what medication class?
Gastrin
Treatment with PPIs
A patient who takes NSAIDS almost daily for arthritic pain and refuses to try another medication is at risk for an NSAID-induced ulcer. The provider states,
- I will put you on Misoprostol once daily
- If you reduced the NSAID to 4 times a week, that should help prevent an ulcer
- I will start you a PPI to prevent an ulcer
- An H2RA will help prevent an ulcer.
3 –> PPI is the first line of treatment for ulcer prevention
Misoprostol can cause diarrhea
