Nurs 5334 Exam 3: Diabetes and Thyroid Disorders - Questions and Answers, Exams of Nursing

Download Nurs 5334 Exam 3: Diabetes and Thyroid Disorders - Questions and Answers and more Exams Nursing in PDF only on Docsity! Nurs 5334 Exam 3(150 questions with 100% verified answers) graded A+ What drugs are used to treat gestational diabetes? - correct answer Metformin abd Insulin What A1C value indicates diabetes mellitus? Pre-DM? - correct answer 6.5% or greater is considered diabetes o 5.7-6.4%pre-diabetes What fasting and random values indicate DM? - correct answer Fasting plasma glucose—126 or greater is diabetes. Random (casual) plasma glucose—anything greater than 200 is diabetes What are complications of insulin therapy? - correct answer Hypoglycemia Can develop lipohypertrophy. Accumulation of subcutaneous fat that occurs when it is injected too frequently at the same site. Allergic reactions Characterized by red and intensely itchy welts, breathing becomes difficult If severe allergy develops: Desensitization procedure (small doses to larger doses). Hypokalemia Promotes the uptake of potassium cells and insulin activates a membrane-bound enzyme with sodium potassium and ATPase that pumps potassium into the cells and sodium out insulin drug interactions - correct answer o Hypoglycemicagents Can intensify the hypoglycemia included by insulin Examples: sulfonylureas, glinides, alcohol o Usewithcautionwithhyperglycemicagents Examples: thiazide and glucocorticoids and sympathomimetics What effect do beta blockers have on insulin? - correct answer delay awareness of and response to hypoglycemia by masking the signs that are associated with stimulation of sympathetic nervous system o Impairglycogenolysis o Prevent the bodies counter-regulatory response What are other therapeutic uses besides DM? - correct answer Hyperkalemia o Aids in diagnosis of GH deficiency o Diabeticketoacidosis Insulin dosage must be coordinated with what? - correct answer Carbohydrate intake What is B/P goal in diabetic? - correct answer o To be controlled, within normal 120/80 What medication can be given to decrease risk of diabetic nephropathy? - correct answer ACE inhibitor or ARB Nurs 5334 Exam 3(150 questions with 100% verified answers) graded A+ What role does exercise play in treatment of both type 1 and type 2 DM? - correct answer Exercise increases cellular responsiveness to insulin and increases glucose tolerance o 150 minute per week of moderate intensity exercise is recommended What are the 4 steps in the 4-step approach? - correct answer Step1—diagnosis Lifestyle changes plus metformin o Step2 Lifestyle changes plus metformin and a second drug (sulfonylurea, TZD or a DPP4 inhibitor, a sodium glucose cotransporter or SGLT-2 inhibitor, a glucagon-like peptide 1, or a GLP-1 receptor agonist or basal insulin Second drug choice made considering efficacy, the hypoglycemia risk of the patient, the patient tolerability, and weight-related considerations (some help weight loss, some cause weight gain), cost o Step3 Three drug combination Metformin Plus 2 other drugs from step 2 o Decidedbasedonadrugandpatientspecificconsiderations o Step4 If 3 drug combination that includes basal insulin fails after 3-6 months, more complex insulin regimen Usually in combination with one or more non-insulin medications When a patient is on insulin therapy what are the blood glucose goals before meals? At bedtime? - correct answer Beforemeals—70-130 o Bedtime—100-140 What is the A1C goal? When is goal below 7 not appropriate? - correct answer 7%or below o Those with severe hypoglycemia risk, limited life expectancy ,advanced microvascular or macrovascular complications—not below 7 What are the short acting insulins? Intermediate? Long acting? - correct answer Shortduration:Rapidacting Insulin lispro [Humalog] Insulin aspart [NovoLog] Nurs 5334 Exam 3(150 questions with 100% verified answers) graded A+ o Rosiglitazone [Avandia]: Restricted use o Pioglitazone [Actos] o Can they be used in patient with CHF? No Alpha-glucosidase inhibitors (Acarbose or Precose; Miglitol (glyset)) ~~~~~~~~~~~~~~~~~~~~ What races are these more effective in? - correct answer Latinos and African Americans DPP-4 inhibitors (gliptins) - correct answer MOA—promote glycemic control by enhancing the actions of the incretin hormones and they stimulate glucose dependent release of insulin Suppress your post-prandial release of glucagon What is the % of A1C reduction? - correct answer 0.5% How does colesevelam work in treatment of DM? Bromocriptine? - correct answer Colesevelam—bile acid sequestrant used to lower cholesterol and helps lower blood glucose Many with diabetes also have high cholesterol so 2 birds-1 stone o Bromocriptine—adjunct to diet and exercise (0.5% reduction) Injectables: o Amylin memetics? - correct answer Pramlintide Side effects—hypoglycemia when used with insulin Drug/Drug—insulin o GLP-1 receptor agonists (or incretin mimetics) Can cause medullary thyroid cancer What is treatment of diabetic ketoacidosis (DKA)? Hypoglycemia? - correct answer o Insulin replacement, reverse acidosis with bicarbonate, replace water, sodium, potassium, normalize glucose levels o Hypoglycemia—IV glucose, glucagon is glucose not available What is hyperosmolar hyperglycemia state (HHS)? Nurs 5334 Exam 3(150 questions with 100% verified answers) graded A+ ~~~~~~~~~~ o When does this occur? ~~~~~~~~~~ o Treatment? - correct answer o Large amount of glucose excreted in the urine and results in dehydration and loss of blood volume o Increases blood concentration of electrolytes and nonelectrolytes, particularly glucose and hematocrit ~~~~~~~~~~~~~ Most frequently with type 2 diabetics with acute infection or illness or other stressors ~~~~~~~~~~~~~ Correcting hyperglycemia and dehydration with IV insulin, fluids, and electrolytes What effect does iodine have on thyroid? - correct answer o When iodine availability is low production of thyroid hormones decrease Why is normal thyroid function important in first trimester of pregnancy? How much does requirement unusually increase in pregnant women taking thyroid supplements? - correct answer o Fetus is unable to produce its own hormones, without can result in permanent neuropsychologic deficits o Usually increases as much as 50% When is fetal thyroid gland full functional? - correct answer o 16 weeks If not treated, what does hypothyroidism cause in an infant? - correct answer o Large protruding tongue, potbelly, and dwarfish stature o The development of the nervous system, bones, and teeth is impaired When should treatment be stopped? How long? - correct answer o At 3 years of age for 4 weeks, then TSH is checked o If rise—deficiency is permanent, thyroid replacement needed o If normalize—transient deficiency, no further replacement required Nurs 5334 Exam 3(150 questions with 100% verified answers) graded A+ How is Graves' Disease treated? - correct answer o Surgical removal, destruction of the thyroid tissue, suppression of the thyroid hormone synthesis and/or beta blockers o Non-radioactive iodine can be used to distract the thyroid tissue Thyroid Storm? - correct answer o Hyperthermia, severe tachycardia, restlessness, agitation, tremor o Unconscious, hypotensive, heart failure o Cannot be identified by lab testing, not triggered by a rise in thyroid hormones o Treatment—methimazole, beta blocker, sedation, cooling, glucocorticoids, IV fluids Levothyroxine - correct answer o T4 o Long half life o How should this be taken? In the morning, at least 30 to 60 minutes before breakfast o Side effects—tachycardia, angina tremors o Drug/Drug Warfarin—intensify effects Drugs that reduce absorption H2 receptor blockers, PPIs, cholestyramine, colestipol, Maalox, Mylanta, calcium supplements, iron, magnesium, orlistat Accelerate metabolism Phenytoin, carbamazepine, rifampin, sertraline, phenobarbital Catecholamines—increase cardiac responses Increase requirements of insulin and digoxin How is this dosed? How does dosage differ for someone over 50? 65 and older? Someone with heart disease? Overweight? Underweight? - correct answer 1.6-1.8 mcg/kg/day Obese—go by ideal body weight Underweight—actual weight Older patients with CAD—start with 12.5-25 mcg Nurs 5334 Exam 3(150 questions with 100% verified answers) graded A+ epithelium, the proliferation of the uterine epithelium, and the copious secretion of thickened mucus form the endocervical glands Metabolic effects of Estrogen? - correct answer o Positive effect on bone mass—block bone resorption o Favorable effects on cholesterol levels Decrease LDL, raise HDL o Effect on blood coagulation Increasing the levels of the coagulation factors o Affect glucose homeostasis Increase insulin sensitivity and promote glucose uptake Adverse effects of estrogen? - correct answer o Endometrial hyperplasia and carcinoma o Increase cardiovascular events, N/V, gallbladder disease, jaundice, headache and chloasma Therapeutic uses of Estrogen? - correct answer o Menopausal hormone o Female hypogonadism o Acne SERMS—Selective estrogen receptor modulators - correct answer o drugs that activate estrogen receptors in some tissues and block them in others Why were these developed? - correct answer Provide the benefits of estrogen protection against vaginal atrophy Reduction of LDL cholesterol, but avoiding the drawbacks What is Duavee? - correct answer Conjugated estrogens with bazedoxifene Combine estrogen with an estrogen agonist or antagonist Used for treatment of vasomotor symptoms and osteoporosis in postmenopausal women Bazedoxifene—reduces the risk of excessive growth of the uterine lining that is posed by the estrogen component Nurs 5334 Exam 3(150 questions with 100% verified answers) graded A+ What are noncontraceptive uses for progesterone? - correct answer o Postmenopausal hormone therapy o Dysfunctional uterine bleeding o Amenorrhea o Infertility o Prematurity prevention o Endometrial carcinoma and hyperplasia When is estrogen therapy (ET) alone indicated? Estrogen/Progesterone (EPT)? - correct answer o Estrogen alone—women who have had a hysterectomy o EPT—all other women What are benefits? Risks? - correct answer o Benefits Relief of vasomotor symptoms Management of urogenital atrophy Prevention of osteoporosis and related fractures Cardioprotection Prevention of colorectal cancer Positive effect on wound healing Tooth retention Glycemic control Physiologic doses of estrogen (with or without progestin) Taken to manage symptoms caused by loss of estrogen in menopause Hot flashes, sleep disturbances, urogenital atrophy, bone loss, altered lipid metabolism Use of hormone replacement therapy (HRT) has declined sharply o Risks Cardiovascular events: Myocardial infarction, stroke, pulmonary embolism, and deep vein thrombosis Endometrial cancer Nurs 5334 Exam 3(150 questions with 100% verified answers) graded A+ Breast cancer Ovarian cancer Gallbladder disease Dementia Urinary incontinence What are 3 approved indications? - correct answer o Treatment of moderate to severe vasomotor symptoms associated with menopause o Treatment of moderate to severe symptoms of vulvar and vaginal atrophy associated with menopause o Prevention of postmenopausal osteoporosis Birth Control o What are pharmacologic and nonpharmacologic methods of birth control? - correct answer Pharmacologic methods of contraception Oral contraceptives Etonogestrel implants Injectable medroxyprogesterone acetate Intrauterine devices Vaginal rings Transdermal patches Nonpharmacologic methods of contraception Surgical sterilization (tubal ligation, vasectomy) Mechanical devices (condom, diaphragm, cervical cap) Avoiding intercourse during periods of fertility (calendar method, temperature method, cervical mucus method) How should you select a method? - correct answer Consider effectiveness, safety, personal preference Oral contraceptives o MOA—inhibit ovulation Nurs 5334 Exam 3(150 questions with 100% verified answers) graded A+ Beyaz and Safyral Contain levomefolate (metabolite of folic acid) o Reduce risk for fetal neural tube defects and spinal bifida, if pregnancy should occur despite contraceptive use Natazia Estradiol valerate—prodrug that undergoes rapid conversion to estradiol, does not cause potassium retention Dienogest—fourth gen progestin What are missed dosing schedules for 28-day cycle Ocs? Extended and continuous cycle? - correct answer o 28-day-cycle schedules One or more pills missed first week: Take one pill as soon as possible (ASAP) and continue with the pack; use an additional form of contraception for 7 days One or two pills missed second or third week: Take one pill ASAP and continue with active pills in the pack; skip placebo pills and go straight to a new pack once all the active pills have been taken Three or more pills missed second or third week: Follow instructions given for missing one or two pills; also, use an additional form of contraception for 7 days o Extended cycle and continuous schedules Up to 7 days can be missed with little or no increased risk of pregnancy, provided the pills had been taken continuously for the prior 3 weeks Progestin only: what are drawbacks? Why do most women stop? - correct answer o Less effective and irregular bleeding How is NuvaRing used? - correct answer o Inserted into vagina once a month o Left for 3 weeks then removed and a new ring is inserted 1 week later Long-acting contraceptives - correct answer o Implants—irregular bleeding, can stop period all together o Depot medroxyprogesterone acetate Side effects? Nurs 5334 Exam 3(150 questions with 100% verified answers) graded A+ Menstrual irregularities Bone loss How often are injections given? Every 3 months o IUDs What are the different types and how long can they remain in place? Copper T 380A [ParaGard] - 10 years Levonorgestrel-releasing intrauterine system [Mirena] - 5 years o Spermicides—Chemical surfactants that kill sperm by destroying their cell membrane What are drugs used for medical abortion? - correct answer o Mifepristone (RU 486) with misoprostol What is Plan B? - correct answer o Single high dose tablet, 1.5 mg of levonorgestrel o Must be taken within 72 hours of unprotected intercourse What are the indications of prostaglandins? - correct answer o Induction of abortion for cervical ripening before induction of labor o Control of postpartum hemorrhage What are the therapeutic uses of testosterone? - correct answer o Male hypogonadism o Replacement therapy o Delayed puberty o Replacement therapy in menopausal women o Wasting in patients with acquired immunodeficiency syndrome (AIDS) o Anemias What are adverse effects of Testosterone? - correct answer o Virilization in women, girls, and boys o Premature epiphyseal closure o Hepatotoxicity o Effects on cholesterol levels o Use in pregnancy Nurs 5334 Exam 3(150 questions with 100% verified answers) graded A+ o Prostate cancer o Edema o Abuse potential (athletic performance) What are the preparations? Instructions on use? - correct answer o Preparations Oral androgens: Fluoxymesterone and methyltestosterone Intramuscular testosterone esters Transdermal testosterone patches Transdermal testosterone gels Transdermal testosterone under arms Implantable subcutaneous testosterone pellets Testosterone buccal tablets o Topical Applications Pick the location for application Avoid skin-to-skin contact transfer Wash hands with soap and water after every application Cover application site with clothing once gel is dry Women and children: Avoid contact Swimming and showering—5 to 6 hours after application What are side effects of anabolic steroids? - correct answer o Hypertension, suppression of release of LH and FSH, testicular shrinkage, sterility, gynecomastia, acne, reduction in HDL, increase in LDL o Hepatotoxicity with 17-alpha-alkylated compounds o Renal damage o Psychologic effects Mentally healthy: Minimal impact Psychologically unbalanced: Could intensify aggression Phosphodiesterase type 5 (PDE-5) inhibitors (-afils) - correct answer o Rare side effects? Nurs 5334 Exam 3(150 questions with 100% verified answers) graded A+ GI effects Dizziness Fatigue Coordination problems Confusion Anticholinergic effects—dry mouth, constipation, etc. Severe respiratory depression Severe local tissue injury Drug/Drug - correct answer Alcohol CNS depressants o Second Generation (non-sedating) - correct answer Examples: Cetirizine, fexofenadine, loratadine Fexofenadine [Allegra, Allegra Allergy, Allegra ODT] Uses: Oral therapy of seasonal allergic rhinitis and for chronic idiopathic urticaria Of second-generation antihistamines, offers best combination of efficacy and safety Use with caution in patients with renal impairment Do not take with fruit juice Cetirizine [Zyrtec] Uses: Allergic rhinitis and chronic idiopathic urticaria Food delays absorption More sedating than other second-generation antihistamines but less sedating than first-generation drugs Levocetirizine [Xyzal] Uses: Allergic rhinitis and chronic idiopathic urticaria More sedating than other second-generation antihistamines but less Nurs 5334 Exam 3(150 questions with 100% verified answers) graded A+ sedating than first-generation agents Most common side effects: Drowsiness, fatigue, muscle weakness, dry mouth Avoid alcohol and other CNS depressants Loratadine [Claritin] Use: Seasonal allergic rhinitis Generally, well tolerated Food delays absorption Use with caution in patients with significant hepatic and renal impairment Desloratadine [Clarinex] Uses: Seasonal allergic rhinitis, perennial allergic rhinitis, and chronic idiopathic urticaria Allergic Rhinitis - correct answer o Inflammatory disorder of the upper airway, lower airway, and eyes o Seasonal and perennial o Triggered by airborne allergens o Allergens bind to immunoglobulin E (IgE) on mast cells o Triggers release of inflammatory mediators Histamine, leukotrienes, prostaglandins o Drug Classes used to treat Intranasal glucocorticoids First choice Side effects o Drying of nasal mucosa or sore throat o Epistaxis (nosebleed) o Headache Nurs 5334 Exam 3(150 questions with 100% verified answers) graded A+ o Rarely, systemic effects (adrenal suppression and slowing of linear pediatric growth) Intranasal and oral antihistamines—Azelastine and Olopatadine Best used prophylactically For children over 12 and adults 1-2 weeks to take affects Side effects o Systemic absorption can be sufficient to cause somnolence o Nosebleeds o Anticholinergic effects o Unpleasant taste Intranasal and oral sympathomimetics Reduce nasal congestion (do not reduce rhinorrhea, sneezing or itching) Activate alpha1-adrenergic receptors on nasal blood vessels Adverse effects o Rebound congestion o CNS stimulation o Cardiovascular effects and stroke o Abuse Factors in topical administration o Should not be used longer than 5 consecutive days o Drops or sprays Comparison: Oral versus Nasal o Topical agents act more quickly than oral agents and are usually more effective o Oral agents act longer than topical preparations o Systemic effects occur primarily with oral agents; topical agents Nurs 5334 Exam 3(150 questions with 100% verified answers) graded A+ o Hyperglycemia o Peptic ulcer disease o In young patients: Growth suppression Leukotriene Modifiers - correct answer o In patients with asthma, leukotriene modifiers can reduce bronchoconstriction and inflammatory responses such as edema and mucus secretion o Used 2nd line if cannot tolerate inhaled glucocorticoids o Can cause psychiatric adverse effects Cromolyn - correct answer o Indications Chronic asthma Exercise-induced bronchospasm (EIB) Allergic rhinitis o Adverse effects Safest of all antiasthma medications Cough Bronchospasm Monoclonal Antibody: Omalizumab - correct answer o Indications Patients age 12 years or older with moderate to severe asthma that (1) is allergy related and (2) cannot be controlled with an inhaled glucocorticoid o Adverse effects Injection-site reactions Viral infection Upper respiratory infection Sinusitis Headache Pharyngitis Cardiovascular events Nurs 5334 Exam 3(150 questions with 100% verified answers) graded A+ Malignancy Life-threatening anaphylaxis Bronchodilators - correct answer o SABA—short acting beta agonist PRN to abort an ongoing attack, exercise-induced bronchospasm (take prior to exercise to prevent attack), hospitalized patients undergoing severe acute attack o LABA—long acting beta agonist Long-term control in patients who experience frequent attacks Preferred over SABAs for patients with stable COPD Must always be used with inhaled corticosteroid—if treating asthma o Methylxanthines Theophylline Very narrow therapeutic index (levels of 10-20 mcg/ml) Used in asthma and COPD Maintenance therapy for chronic stable asthma No longer recommended for treatment of COPD o Anticholinergic drugs Ipratropium Short acting Relieves bronchospasms Therapeutic effects begin within 30 secs, reach 50% of maximum in 3 mins and persist about 6 hours Long acting Tiotropium o Maintenance therapy of bronchospasm associated with COPD o Not approved for asthma Aclidinium o Management of bronchospasm associated with COPD Nurs 5334 Exam 3(150 questions with 100% verified answers) graded A+ Umeclidinium o Management of bronchospasm associated with COPD Management of Asthma o Classes of asthma severity o Goal of treatment? o Step wise therapy? o Exacerbation management o Methylxanthines o Anticholinergic drugs - correct answer PRN to abort an ongoing attack, exercise-induced bronchospasm (take prior to exercise to prevent attack), hospitalized patients undergoing severe acute attack ~~~~~~~~~~~~~~~~~~~~~~~~~ Long-term control in patients who experience frequent attacks Preferred over SABAs for patients with stable COPD Must always be used with inhaled corticosteroid—if treating asthma ~~~~~~~~~~~~~~~~~~~~~~~~~ Theophylline Very narrow therapeutic index (levels of 10-20 mcg/ml) Used in asthma and COPD Maintenance therapy for chronic stable asthma No longer recommended for treatment of COPD ~~~~~~~~~~~~~~~~~~~~~~~~~ Ipratropium Short acting Relieves bronchospasms Therapeutic effects begin within 30 secs, reach 50% of maximum in 3 mins and persist about 6 hours Nurs 5334 Exam 3(150 questions with 100% verified answers) graded A+ Stage II: Moderate FEV1/FVC <0.70 50% ≤ FEV1 < 80% Stage III: Severe FEV1/FVC <0.70 30% ≤ FEV1 < 50% Stage IV: Very Severe FEV1/FVC <0.70 FEV1 < 30% or FEV1 < 50% plus chronic respiratory failure Treatment Bronchodilators Glucocorticoids Phosphodiesterase-4 inhibitors ~~~~~~~~~~~~~~~~~~~~ SABA for symptom control all groups Group A: Few symptoms; low risk o First choice: Consider LAMA or LABA o Persistent symptoms: combination LAMA/LABA Group B: Increased symptoms; low risk o First Choice: LAMA OR LABA o Persistent symptoms: combination LAMA/LABA Group C: Few symptoms; high risk o First LAMA o Management of persistent symptoms: LABA/LAMA (preferred) or LABA/IGC Group D: Increased symptoms; high risk Nurs 5334 Exam 3(150 questions with 100% verified answers) graded A+ o First Choice: LAMA; OR LAMA/LABA; OR IGC/LABA o Management of persistent symptoms: LAMA/LABA/IGC If exacerbations persist add Roflumilast, Azithromycin ~~~~~~~~~~~~~~~~~ SABAs (specifically inhaled, either alone or in combination with inhaled anticholinergics) are preferred for bronchodilation during COPD exacerbations Systemic glucocorticoids Antibiotics Supplemental oxygen to maintain an oxygen saturation of 88% to 92% Glaucoma o How do drugs lower intraocular pressure (IOP)? - correct answer Facilitate the aqueous humor outflow and can also reduce aqueous humor production o First line Beta-adrenergic blocking agents Timolol Alpha2-adrenergic agonists Brimonidine (Alphagan) Prostaglandin analogs Latanoprost (Xalatan) o Second line Cholinergic agonists o Beta-Adrenergic Blocking agents 20 Approved for use in glaucoma: Betaxolol, carteolol, levobunolol, metipranolol, and timolol Lower IOP by reducing production of aqueous humor Nurs 5334 Exam 3(150 questions with 100% verified answers) graded A+ Used primarily for open-angle glaucoma Initial therapy and maintenance therapy Which are recommended for patients with asthma? Betaxolol and levobetaxolol o How do prostaglandin analogs work? (prosts) - correct answer Lowers intraocular pressure by facilitating aqueous humor outflow o How do alpha2-adrenergic agonists work? - correct answer Lowers intraocular pressure by reducing aqueous humor production and possibly by increasing outflow Two approved: Apraclonidine and brimonidine o How does pilocarpine work? - correct answer Direct-acting cholinergic agonist that causes miosis and contraction of the ciliary muscle o How do cholinesterase inhibitors work? - correct answer Inhibits the breakdown of acetylcholine and promotes accumulation of acetylcholine at the muscarinic receptors o How do Carbonic anhydrase inhibitors (CAIs) work? - correct answer Reduces intraocular pressure by decreasing production of aqueous humor Cycloplegics and Mydriatics - correct answer o Cycloplegics: paralyze ciliary muscles o Mydriatics: dilate the pupil o Used to measure refraction o Intraocular examination o Treatment of anterior uveitis Allergic conjunctivitis - correct answer o Mast-cell stabilizers o NSAIDS (ketorolac) Side effects with long term use? Cataract, eye infection and elevation of interocular pressure o Ocular decongestants (naphazoline, phenylephrine) Activating alpha one adrenergic receptor on the blood vessels, causing Nurs 5334 Exam 3(150 questions with 100% verified answers) graded A+ Stool test Invasive Endoscopic specimen obtained and evaluated ~~~~~~~~~~~~~~ Minimum of 2 antibiotics prescribed ~~~~~~~~~~~~~~ Amoxicillin Clarithromycin Bismuth compounds Tetracycline Metronidazole Tinidazole ~~~~~~~~~~~~~~ Minimize emergence of resistance ~~~~~~~~~~~~~~ Eradication rates are good with a 10-day course and slightly better with a 14-day course ~~~~~~~~~~~~~~ . Clarithromycin-based triple therapy 1 Standard dose PPI Clarithromycin 500 mg twice daily Amoxicillin 1 Gm twice daily Clarithromycin-based triple therapy 2 Standard dose PPI Clarithromycin 500 mg twice daily Metronidazole 500 mg three times daily Bismuth-based quadruple therapy Nurs 5334 Exam 3(150 questions with 100% verified answers) graded A+ Bismuth subsalicylate 525 mg four times daily Metronidazole 250 mg 4 times daily Tetracycline 500 mg four times daily Standard dose PPI or ranitidine 150 mg twice daily Sequential therapy Standard dose PPI plus amoxicillin 1 gm twice daily for 5 days Followed by standard dose PPI plus clarithromycin 500 mg once daily plus tinidazole 500 mg twice daily for 5 days o What are the adverse effects of cimetidine? - correct answer Antiandrogenic effects CNS effects Pneumonia IV bolus: Can cause hypotension and dysrhythmias o Which drugs need to have reduced doses of cimetidine? - correct answer Warfarin, phenytoin, theophylline, lidocaine o Does ranitidine have fewer side effects than cimetidine? - correct answer Yes o How far apart should cimetidine and antacids be given? - correct answer 1 hour o What is famotidine used to treat? Most common side effect? - correct answer Short-term treatment of gastric/duodenal ulcers Prophylaxis of recurrent duodenal ulcers Treatment of Zollinger-Ellison syndrome and hypersecretory states Treatment of GERD OTC: treatment of heartburn, acid indigestion, sour stomach None, possible increased risk of pneumonia due to elevation of pH o What are the indications for Nizatidine? - correct answer Duodenal/gastric ulcers GERD, heartburn, acid indigestion, sour stomach o What are the side effects of Proton Pump Inhibitors? MOA? - correct answer Suppress secretion of gastric acid Usually none with short term use Nurs 5334 Exam 3(150 questions with 100% verified answers) graded A+ Headache, GI effects, pneumonia Hypomagnesemia Rebound acid hypersecretion C. Diff Gastric cancer o What can long term use cause? - correct answer Osteoporosis, fractures o What effect does it have on magnesium? - correct answer Decrease magnesium leading to hypomagnesemia o What is IV Esomeprazole used for? - correct answer Erosive esophagitis, GERD, duodenal ulcers associated with H. Pylori infection, prophylaxis of NSAID induced ulcers o Lansoprazole? - correct answer Same as above o Dexlansoprazole? - correct answer Treatment and maintenance of healing erosive esophagitis, treatment of symptomatic GERD o Rabeprazole? - correct answer H. Pylori eradication, duodenal ulcers, GERD, hypersecretory states o Pantoprazole? - correct answer Treatment of GERD and hypersecretory states o Sucralfate: MOA? Uses? - correct answer Creates protective barrier for up to 6 hours Acute ulcers and maintenance therapy o Misoprostol: Uses? Pregnancy? - correct answer Only approved is prevention of gastric ulcers caused by long term NSAID therapy Contraindicated during pregnancy o What are 4 antacid families? - correct answer Aluminum Magnesium Calcium Sodium o What are the combo packs for h. pylori treatment? - correct answer - correct answer Helidac