NURS 5334 UTA ADVANCED PHARMACOLOGY QUIZ 3 (400 QUESTIONS WITH 100% CORRECT ANSWERS) LATES, Exams of Nursing

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How do drugs lower IOP? - Answer Facilitate aqueous humor outflow Reduce aqueous humor production First-line dx therapy for glaucoma? - Answer Beta-adrenergic blocking agents Alpha2-adrenergic agonists Prostaglandin analogs Second-line dx therapy for glaucoma? - Answer Cholinergic agonists How do Beta blocking drugs work in glaucoma? - Answer Reduce IOP by reducing production of AH How do Alpha agonists work in glaucoma? - Answer Reduce IOP by reducing production of AH and increasing outflow How do Prostaglandins work in glaucoma? - Answer Reduce IOP by increasing AH outflow Beta blocker drugs for glaucoma - Answer Betaxolol Carteolol Levobunolol Metipranolol Timolol *used for open-angle glaucoma Cardioselective beta blockers for asthma patients? - Answer Betaxolol Levobetaxolol What are the prostaglandin drugs? - Answer Latanoprost Travoprost Bimatoprost Tafluprost 2 approved alpha2-adrenergic agonist drugs for glaucoma? - Answer Apraclonidine: for short-term therapy Brimonidine: First line dx for long-term tx How does Pilocarpine work? - Answer Direct acting cholinergic agonist that causes: -Miosis -Contraction of the ciliary muscle Pilocarpine used for? - Answer Second-line dx for open-angle glaucoma Emergency tx of acute angle-closure glaucoma How does Echothiophate work? - Answer Miosis Focus lens for near vision Reduction of IOP *inhibits breakdown of ACh How does Carbonic Anhydrase Inhibitors (CAIs) work? - Answer reduces IOP by decreasing production of AH Dorzolamide Acetazolamide Methazolamide Cycloplegics do what? - Answer Paralyze ciliary muscles Mydriatics do what? - Answer Dilate the pupil Cycloplegics and Mydriatics uses - Answer Adjunct to measurement of refraction Intraocular examination Intraocular surgery Tx of anterior uveitis Mast-cell stabilizers MOA (for allergic conjunctivitis) - Answer Prevent release of inflammatory mediators NSAIDs: Ketorolac (Toradol) used for? - Answer Treatment of allergic conjunctivitis H1 antagonists are used for what? - Answer Used for tx of mild allergic disorders H2 antagonists are used for what? - Answer Used for tx of gastric and duodenal ulcers Bronchitis symptoms and treatment - Answer 99% of time is viral S/S of cough May last long time about 3 mos. DON'T need antibiotics (viral); it'll go away May give cough syrup + codeine or tesslon perrles H1 antagonists 1st generation (sedating) therapeutic use? - Answer Mild allergy Severe allergy Motion sickness (Promethazine, Dimenhydrinate) Insomnia (Diphenhydramine) Common cold H1 antagonists (1st generation) AE? - Answer Sedation (less w/2nd & 3rd) Nonsedative CNS effects (dizzy, fatigue, confusion, coordination problems) GI effects (N/V, loss of appetite, constipation) Anticholinergic effects Hallucinations in children Dry mouth, constipation H1 antagonists (2nd generation) drugs? - Answer Certirizine Fexofenadine Loratadine Levocetirizine Desloratadine Drug classes used to treat allergic rhinitis? - Answer Glucocorticoids (intranasal) Antihistamines (oral & intranasal) Sympathomimetics (oral a& intranasal) Intranasal Glucocorticoids - Answer Rhinocort Fluticasone Propionate Triamcinolone *First choice in tx & prevention of rhinitis Intranasal Antihistamines? - Answer Azelastine Olopatadine Intranasal sprays are best used as? - Answer Prophylaxis May cause rebound rhinorrhea; don't use for longer than 3-4 days May take 1-2 weeks to take effect; use oral meds if pt is symptomatic Montelukast (singulair) adverse effect? - Answer Psych issues> educate the patient Dextromethorphan and abuse - Answer In high dose may cause euphoria; abused for this effect Guaifenesin - Answer Expectorant Thins respiratory secretions Helps w/blocked up nose Stimulates the flow of respiratory tract secretions What is the AAP recommendation for Cold remedies? - Answer Restrict use of cough & cold medicines to children older than 6 years What are the anti-inflammatory agents used in Asthma/COPD? - Answer Glucocorticoids (principle drug) Leukotriene Modifiers Cromolyn Inhaled glucocorticoids adverse effects - Answer Oropharyngeal candiadiasis Dysphonia Adrenal suppression Slow growth in children & adolescents Promote bone loss Increased risk of cataracts & glaucoma Oral glucocorticoids adverse effects - Answer Long term use: Adrenal suppression Osteoporosis Hyperglycemia Peptic ulcer disease Young patients: growth suppresion Leukotriene modifiers - Answer In asthma patient: Reduce bronchoconstriction & inflammatory responses like edema & mucus secretion Used as 2nd-line therapy (if inhaled can't be used) AE: Neuropsychiatric (depression, suicidal thinking & behavior) Leukotriene Modifier drugs - Answer Zileuton (Zyflo) Zafirlukast (Accolate) Montelukast (Singulair) Cromolyn used for? - Answer Prophylaxis, not quick relief Cromolyn adverse effects - Answer Safest of all antiasthma medications Cough Bronchospasm Omalizumab indication - Answer Moderate to severe asthma *administered subQ injection Omalizumab adverse effects - Answer Injection site reactions Viral infection Upper resp. infection Sinusitis HA Pharyngitis CV events Malignancy Life-threatening ANAPHYLAXIS (BBW) SABA Indications for Use - Answer -asthma PRN -exercise induced asthma -COPD -acute respiratory illness (hospitalized pt) SABA drugs - Answer Albuterol Levalbuterol *All stages: FEV1/FVC <0.70 COPD stage treatment - Answer Stage 1: SABA PRN or SAAC Stage: 2: SABA PRN or SAAC; LABA Stage 3: SABA PRN or SAAC; LABA; IGC (if repeated exacerbations) Stage 4: SABA PRN or SAAC; LABA; IGC (if repeated exacerbations); long term O2 tx SAAC (short acting anticholinergic) drugs - Answer Ipratropium Combivent COPD and pulm. rehab - Answer All stages should have pulmonary rehab to improve exercise tolerance How do you manage COPD exacerbation? - Answer SABA Systemic glucocorticoids Antibiotics: esp. for smokers Supplemental O2 for keep sat 88-92% menstrual cycle phases - Answer Follicular Phase: first half of cycle (day 1-14) Luteal Phase: second half of cycle Full cycle takes 28 days estrogen and sex characteristics - Answer Reproductive tract & secondary sex charac. Estrogens influence: -Ductal growth in breast -Thickening & cornification of vaginal epithelium -Proliferation of uterine epithelium -Copious secretion of thickened mucus from endocervical glands Estrogen metabolic actions - Answer Positive effect on bone mass-blocks bone resorption Favorable effects on cholesterol levels Blood coagulation Glucose homeostasis: promote glucose uptake Estrogen AE - Answer Endometrial hyperplasia & carcinoma Promotes existing breast cxr Ovarian cxr CV events Nausea Increase risk of blood clots others: Gallbladder dx, jaundice, HA, chloasma Menopause female w/uterus - Answer Needs estrogen AND progesterone (estrogen can thicken lining of uterus> hyperplasia> high risk of endometrial cxr) Menopause female w/out uterus - Answer Needs estrogen only Estrogen and menopause - Answer If started early> pt gets bone & cardiac benefits w/out cardiac risks Optimal time for hormone replacement - Answer About 5 years Give lowest dose to control vasomotor symptoms Don't start w/hormone if pt on menopause over 5 yrs> at risk for clots Estrogen therapeutic uses - Answer Menopausal hormone Female hypogonadism Acne Estrogens are major substrates of - Answer CYP1A2 and CYP3A4 Interacts w/ antiseizure, warfarin, etc. Selective Estrogen Receptor Modulators (SERMs) - Answer Tamoxifen Toremifene Raloxifene *Benefits of estrogen while avoiding drawbacks Duavee (conjugated estrogens/bazedoxifene) treats - Answer vasomotor symptoms osteoporosis in postmenopausal women good for preventing breast cxr Progestins: Therapeutic Uses - Answer postmenopausal hormone therapy amenorrhea infertility prematurity prevention endometrial carcinoma and hyperplasia SSRI's can help with - Answer vasomotor symptoms of menopause Noncontraceptive Benefits of OCs - Answer Decreases risk of iron deficiency anemia and acne Diminished cramps: lighter, shorter, predicable flow Helps with PCOS Drugs that reduce effects of OCs - Answer Rifampin Ritonavir Antiepileptic drugs St. John's wort Drugs whose effects are reduced by OCs - Answer Warfarin Insulin Oral hypoglycemics Drugs whose effects are increased by OCs - Answer Theophylline Tricyclic antidepressants Diazepam Chlordiazepoxide Beyaz and Safyral - Answer Contain levomefolate (folic acid) Reduces risk of fetal neural tube defects Good opt. for women who plan to get pregnant androgen therapeutic uses - Answer Male hypogonadism Replacement therapy Delayed puberty Replacement therapy in menopausal women Wasting of muscle in AIDs Anemias androgens adverse effects - Answer Premature epiphyseal closure Hepatotoxicity Decrease HDL, increase LDL Prostate cxr Edema (salt & water retention) Abuse potential TSH low, Free T3/T4 high Hyperthyroidism treatment - Answer Surgical removal of thyroid tissue Destruction of thyroid tissue Suppression of thyroid hormone synthesis Beta Blockers Nonradioactive iodine Thyrotoxic Crisis (Thyroid Storm) treatment - Answer Methimazole Beta blocker Sedation, cooling, glucocorticoids, IV fluids Levothyroxine - Answer Synthetic prep of thyroxine (T4) Half-life: 7 days (no need to recheck for about 6 wks) Levothyroxine administration - Answer Take in the morning at least 30 to 60 min. before breakfast Levothyroxine adverse effects - Answer Tachycardia Angina Tremors Can intensify effects of warfarin *** too much causes osteoporosis Drugs that reduce levothyroxine absorption (dx/dx interaction) - Answer H2 receptor blockers PPI Sucralfate Cholestyramine Colestipol Maalox Mylanta Calcium Supplement Iron and magnesium Orlistat Drugs that accelerate levothyroxine metabolism - Answer Phenytoin Carbamazepine Rifampin Sertraline Phenobarbital Levothyroxine and warfarin - Answer Levothyroxine accelerates degradation of Vit. K> effects of warfarin are increased; reduce warfarin dose Levothyroxine and Catecholamines - Answer TH increase cardiac responsiveness to catecholamines increasing risk of dysrhythmias Levothyroxine adult dose - Answer Healthy: 1.6-1.8 mcg/kg/day Obese dose: use ideal body weight Underweight: dose by actual weight Levothyroxine dose for 50 year old - Answer 50 mcg/day Levothyroxine dose for 65 y.o. +/or heart dx - Answer 25 mcg/day Levothyroxine dose for 85 y.o. & heart dx - Answer 12.5 mcg/day Thyroid consists of - Answer desiccated animal thyroid glands Thyroid ratio is - Answer ratio of levothyroxine to liothyronine is not less than 5:1 Methimazole - Answer First line dx for hyperthyroidism Monitor liver enzymes Less liver damage than PTU Doesn't destroy existing stores of TH More dangerous than PTU for lactation and FIRST trimester pregnancy> Neonatal hypothyroidism Agranulocytosis: Most dangerous toxicity Propylthiouracil (PTU) - Answer Inhibits thyroid hormone synthesis Second line dx for Graves dx Crosses placenta less readily than Methimazole SEVERE liver damange* PTU therapeutic uses - Answer Graves dx Adjunct to radiation therapy Prep for thyroid gland surgery Thyrotoxic crisis Radioactive Iodine-131 - Answer Contraindicated in pregnancy Tx is delayed, may take several months for effect tx: hyperthyroidism, hypothyroidism, and goiter Strong iodine solution (Lugol's solution) - Answer Suppress thyroid fxn in prep for thyroidectomy Lugol solution adverse effects - Answer Brassy taste Burning sensation in mouth and throat Soreness of teeth & gums Frontal HA Coryza Salivation Various skin eruptions Diabetes in pregnancy - Answer Insulin is preferred, metformin is commonly ok for DM2 A1C for diabetes - Answer 6.5 or more AIC for prediabetes - Answer 5.7-6.4 Fasting plasma glucose diabetes - Answer ≥ 126 mg/dL Fasting plasma glucose prediabetes - Answer 100-125 mg/dL Casual plasma glucose and oral glucose tolerance test (OGTT) diabetes - Answer 200 or more Prediabetes treatment - Answer treat with lifestyle changes Exercise and Diabetes - Answer -increases cellular responsiveness to insulin -increases glucose tolerance Insulin to carb intake - Answer coordinate insulin dose to carb intake BP should stay at or below what? - Answer 140/90 Thazolidinediones drugs (glitazones) - Answer Rosiglitazone Pioglitazone Alpha-glucosidase drugs - Answer Acarbose Miglitol Alpha-glucosidase and race - Answer Effective among Latinos and Blacks DPP-4 inhibitors (gliptins) - Answer Saxagliptin Alogliptin Sitagliptin DPP-4 inhibitors AE - Answer UTI Sodium Glucose Co-Transporter-2 (SGLT2) Inhibitors - Answer Canagliflozin Dapagliflozin *block reabsorption of filtered glucose, stopping glucosuria SGLT2 inhibitors and loop diuretics - Answer risk of dehydration and hypotension Colesevelam - Answer lowers plasma cholesterol and lowers BS: Tx's DM2 Colesevelam AE - Answer constipation Bromocriptine - Answer Treats DM2 as adjunct to diet and exercise Previously used for Parksinsons May be used as mono therapy or combined w/ metformin, sulfonylurea, or other oral DM med GLP-1 receptor agonists (noninsulin injectable dx) - Answer Exenatide Liraglutide AKA incretin memetics GLP-1 MOA - Answer Slow gastric emptying Stimulate glucose-dependent release of insulin Inhibit postprandial release of glucagon Suppresses appetite Amylin mimetics (noninsulin injectable dx) - Answer Pramlintide AE: injection site rxn DKA treatment - Answer Insulin replacement Bicarbonate for acidosis Water and sodium replacement Potassium replacement Normalization of glucose levels HHS treatment - Answer Correct hyperglycemia and dehydration w/ IV insulin, fluids and electrolytes What is HHS? - Answer Large amount of glucose excreted in urine HHS caused by - Answer Most frequently w/ DM2 with: Acute infection Acute illness Other stress Treatment for severe hypoglycemia - Answer Preferred tx: IV glucose Glucagon used if IV glucose not available 3 factors that regulate calcium? - Answer Parathyroid hormone Vit D Calcitonin Where's most calcium stored? - Answer Bone (98%) What are osteoblasts? - Answer Bone building cells What are osteoclasts? - Answer Bone-destroying cells How much bone is replaced every year? - Answer 25% trabecular bone (spongy) 3% of cortical bone (compact) What's normal serum calcium? - Answer 10 mg/dL (2.5 mmol/L, 5 mEq/L) Where's calcium absorbed? - Answer Small intestine *increased by PTH & vit. D *glucocorticoids decrease absorption Where's calcium excreted? - Answer Primarily renal Small amount lost in breast milk *reduced by PTH, vit D, & thiazide diuretics (hydrochlorothiazide) *increased by loop diuretics (furosemide), calcitonin, loading w/Na What role does PTH play in calcium? - Answer Ca lvls high> PTH suppressed Ca lvls low> PTH released PTH promotes: Ca resorption from bone Tubular reabsorption of Ca Activation of Vit D> ^ absorption of Ca from intestine Vit D role and Calcium? - Answer Increases calcium resorption from bone Decreases calcium excretion by the kidney Increases calcium absorption from the intestine Elevates plasma levels of phosphate, whereas PTH reduces levels of phosphate. Calcitonin role & calcium? - Answer Released from the thyroid gland when calcium levels in the blood rise too high Lowers calcium levels by inhibiting resorption of calcium from bone and increasing calcium excretion by the kidney Does not influence calcium absorption Hypercalcemia causes - Answer Cancer Hyperparathyroidism Vitamin D intoxication Sarcoidosis Use of thiazide diuretics Hypercalcemia tx? - Answer Drugs that promote urinary excretion of calcium Drugs that decrease mobilization of calcium from bone Drugs that decrease intestinal absorption of calcium Drugs that form complexes with free calcium in the blood IV saline followed by diuresis with a loop diuretic What lab tests done to check Vit D levels? Normal value? - Answer Serum concentration of 25-hydroxyvitamin D (25-[OH]D) Target level of 25-(OH)D is usually 30 to 60 ng/mL Vit D as a hormone? - Answer With sufficient exposure to sunlight, the body can manufacture all the vitamin D it needs. Activated vitamin D then travels to various sites in the body (bone, intestine, kidney) to exert regulatory actions. Also like other hormones, vitamin D undergoes feedback regulation: Ca low> Vit D increases; Ca high> activation of Vit D decreases Vit D toxicity? - Answer Early symptoms: Weakness, fatigue, nausea, vomiting, anorexia, abdominal cramping, constipation Later symptoms: Kidney function is affected, resulting in polyuria, nocturia, and proteinuria Neurologic: Seizures, confusion, ataxia Cardiac dysrhythmia Coma Calcium deposition in soft tissues which damages heart, blood vessels, and lungs Decalcification of bone with very large doses of vitamin D Calcitonin therapeutic uses? - Answer Osteoporosis Paget disease Hypercalcemia Calcitonin MOA? - Answer Inhibits the activity of osteoclasts Decreases bone resorption Inhibits tubular resorption of calcium Increases calcium excretion Calcitonin administration? Cancer? - Answer Intranasal dosing. Studies demonstrate increase in malignancies assoc. w/ nasal administration. Biphosphonates therapeutic use? - Answer Postmenopausal osteoporosis Osteoporosis in men Glucocorticoid-induced osteoporosis Paget disease of bone Hypercalcemia of malignancy Biphosphonates MOA? - Answer Inhibit bone resorption by decreasing the activity of osteoclasts Biphosphonates 4 major AE? - Answer Ocular inflammation Osteonecrosis of the jaw (ONJ) Atypical femur fractures Atrial fibrillation (A-fib) How should biphosphonates be taken? - Answer Empty stomach in AM Full glass of water Standing or sitting upright 30-60 min: stay upright, no food or drink (including meds & diet supplement) Biphosphonate drugs? - Answer Risedronate Ibandronate Tiludronate Zoledronate Risedronate use - Answer Postmenopausal/male/glucocorticoid-induced osteoporosis Paget's disease Ibandronate use? - Answer Post-menopausal osteoporosis Tiludronate use? - Answer Paget's disease Zoledronate use? - Answer 1. postmenopausal osteoporosis: *prevention AND treatment 2. Pagets and hypercalcemia of malignancy (HCM) 3. glucocorticoid- induced osteoporosis 4. osteoporosis in men 5. Multiple myeloma or metastatic bone lesions from solic tumors SERMs: Raloxifine MOA? - Answer Binds to estrogen receptors Raloxifine AE? - Answer Thromboembolic events, such as deep vein thrombosis (DVT), pulmonary embolism, stroke, and fetal harm SERMs: Teriparatide 3 indications? - Answer Treatment of osteoporosis in postmenopausal women Tx of osteoporosis in men Tx of glucocorticoid induced osteoporosis (GIOP) SERMs: Denosumab 3 indications? - Answer Osteoporosis in postmenopausal women and in men at high risk for fractures Bone loss in women and men receiving certain anticancer therapy Prevention of skeletal-related events in patients with bone metastases from solid tumors SERMs: Cinacalet MOA? - Answer Increases the sensitivity of calcium- sensing receptors to activation by extracellular calcium Suppresses PTH secretion Cinacalet indications? - Answer Approved for primary hyperparathyroidism and secondary hyperparathyroidism (caused by CKD) Cinacalet AE? - Answer Nausea Vomiting Diarrhea Hypocalcemiass Dx used to tx hypercalcemia? - Answer Glucocorticoids Gallium nitrate Biphosphonates Inorganic phosphates Edetate disodium Dapsone & acne - Answer Used for tx of leprosy W/acne tx> modest decrease in inflammation & # of lesions AE: oiliness, peeling, dryness, erythema Topical drugs for acne - Answer Retinoids Azelaic acid Retinoids - Answer For acne tx Reduce inflammation & improve penetration of other agents Azelaic acid - Answer Topical keratolytic dx for mild-mod. acne Suppresses growth of P. acnes Decrease proliferation of keratinocytes> decreases thickness of stratum corneum Acne oral antibx agents of choice? - Answer Doxycycline Minocycline Acne: Isotretinoin AE? (oral dx) - Answer Nosebleeds, inflammation of lips, dryness or itching of the skin, nose and mouth; skin rash, HA, hair loss, peeling of skin, sun sensitivity, Elevated trigs Which OC are effective for acne? - Answer Estrostep Ortho Tri-Cyclen Beyaz YAZ Spironolactone and acne? - Answer Spironolactone [Aldactone] blocks a variety of steroid receptors, including those for aldosterone and sex hormones Organic sunscreens? - Answer Also known as chemical screens Absorb UV radiation and then dissipate it as heat Inorganic sunscreens? - Answer Also known as physical screens Scatter UV radiation Titanium oxide and zinc oxide What does SPF address? - Answer SPF is an index of protection against ultraviolet B (UVB) radiation SPF does not address ultraviolet A (UVA) protection Are numbers of protection lineal? - Answer Relationship between SPF and protection against sunburn is not linear (SPF 30 is not twice as much protection as SPF 15) New sunscreen labeling rules? - Answer FDA released new rules for labeling sunscreens. Under these rules, the label must indicate (1) the range of UV radiation protection and (2) the degree of water/sweat resistance. As in the past, labels will continue to indicate the SPF. Peak hours for sun? - Answer 10am-4pm Topical dx for psoriasis tx? - Answer Glucocorticoids Vit. D analogs > Calcipotriene > Calcitriol Vit. A derivative > Tazarotene Anthralin Tars Systemic tx dx for psoriasis? - Answer Methotrexate Acitretin Glucocorticoids Cyclosporine Should psoriasis systemic dxs be prescribed by NP? - Answer No, only by dermatologist How effective is photochemotherapy? - Answer Pts respond very well Long lasting remission of 2-4 mos Dx used to tx Actinic Keratoses (AK)? - Answer Fluorouracil Diclofenac sodium Imiquimod Aminolevulinic acid + blue light Dangers of AK? - Answer Half of all skin cancers in the United States begin as AKs Eczema: 2 topical immunosuppresants - Answer Tacrolimus Pimecrolimus Tacrolimus & pimecrolimus dangers? - Answer Both dx have risk of skin cancer & lymphoma Topical tx for venereal warts? (by provider) - Answer Podophyllin Bichloracetic acid (BCA) Trichloroacetic acid (TCA) Venereal warts dx tx (at home)? - Answer Imiquimod Podofilox Kunecatechins Kunecatechins and HIV/genital herpes patient? - Answer Not recommeded; safety and efficacy not established Common warts drugs? - Answer Salicylic acid Podophyllin Podofilox Imiquimod Trichloroacetic acid Topical fluorouracil Antiperspirants vs. Deodorants? - Answer Antiperspirants: Reduce flow of eccrine sweat by 20-50% Deodorants: inhibit growth of surface bact. that degrade sweat to odor; don't suppress sweat formation Organism that causes seborrheic dermatitis? - Answer Pityrosporum ovale Topical dx used to tx seborrheic dermatitis? - Answer Ketoconazole (cream/foam/gel) 2 dx used for hair loss? - Answer Topical minoxidil Finasteride Lactation: 500 mcg Child-bearing age: 400-800 mcg Folic acid dietary sources - Answer -All foods Good sources include peas, lentils, oranges, whole-wheat products, asparagus, beets, broccoli, and spinach. Also, many grain products (e.g., cereals, bread, pasta, rice, flour) are now fortified with folic acid. Folic acid deficiency and fetus? - Answer Neural tube defects (e.g., spina bifida, anencephaly) Folic acid deficiency consequences? - Answer Megaloblastic anemia Leukopenia, thrombocytopenia, injury to the oral and GI mucosa May increase the risk of colorectal cancer and atherosclerosis Folic acid dx treatment? (inactive form) - Answer Inactive form: Folacin, folate, pteroylglutamic acid, or folic acid Folic acid dx treatment? (active form) - Answer Active form: Leucovorin calcium, folinic acid, or citrovorum factor Folate lab check after starting tx? - Answer Check H/H at week 1 & wk 8 Laxative indications? - Answer Obtain fresh stool sample Empty bowel before treatment or procedure Expel dead parasites after treatment Modify effluent from ileostomy or colostomy Constipation (multiple causes, including pregnancy and opioid use) Prevent fecal impaction in bedridden patients Remove poisons Laxative and pregnancy? - Answer Use with caution in pregnancy and lactation (because GI stimulation might induce labor) and during lactation (because the laxative may be excreted in breast milk). Laxative contraindications - Answer Abdominal pain, nausea, cramps, or other symptoms of appendicitis, regional enteritis, diverticulitis, or ulcerative colitis Acute surgical abdomen Fecal impaction or bowel obstruction Habitual use What are 4 classifications of laxatives? - Answer 1. Bulk-forming laxatives a. Psyllium [Metamucil] 2. Surfactant laxatives a. Docusate sodium [Colace] 3. Stimulant laxatives a. Bisacodyl [Dulcolax] 4. Osmotic laxatives a. Milk of magnesia (MOM) How quickly does laxatives work? - Answer Bulk-forming: (act slow) 1-3 days Surfactant: (act slow) 1-3 days Stimulant: 6-12 hrs Osmotic: (high dose) 2-6 hrs; (low dose) 6-12 hrs Causes of laxative abuse - Answer Misconception that bowel movements must occur daily Can perpetuate their own use Bowel replenishment after evacuation can take 2 to 5 days; often mistaken for constipation Consequence of laxative abuse - Answer Diminished defecatory reflexes, leading to further reliance on laxatives Electrolyte imbalance, dehydration, colitis Antiemetic: Serotonin receptor antagonists drugs - Answer Ondansetron Granisetron Dolasetron Palonsetron Serotonin receptor antagonist dx MOA? - Answer Blocks type 3 serotonin receptors on afferent vagal nerve Serotonin receptor antagonist indication? - Answer CINV Prevent N/V associated w/ radiotherapy & anesthesia Serotonin receptor antagonist AE? - Answer Headache, diarrhea, dizziness, prolonged QT interval, risk of torsades de pointes Antiemetic drug classes - Answer Serotonin receptor antagonists Glucocorticoids P/Neurokinin 1 antagonists Benzodiazepines Dopamine antagonists Butyrophenones Metoclopramide Antiemetic: Glucocorticoid drugs? - Answer Methylprednisolone Dexamethasone Antiemetic: P/neurokinin-1 antagonist dx? - Answer Aprepitant Rolapitant Netupitant Fosaprepitant Antiemetic: Benzodiazepine dx? - Answer Lorazepam (Ativan) Antiemetic: Dopamine antagonist dx? - Answer Phenothiazine (Prochlorperazine) Promethazine Antiemetic: Butyrophenones dx? - Answer Haloperidol Droperidol whats hyperemesis gravidarum? - Answer Severe form of N/V: Dehydration, ketonuria, hypokalemia, and loss of 5% or more of body weight How should N/V be managed in pregnancy? (nondrug) - Answer Nondrug measures include (1) eating small portions of food throughout the day; (2) avoiding odors, foods, and supplements that can trigger NVP (e.g., fatty foods, spicy foods, iron tablets); and (3) use of alternative treatments, such as acupuncture and ginger. N/V pregnancy first line drug? - Answer Doxylamine plus Vit. B6 -Diclectin *Azathiopine *Mercaptopurine Metoclopramide (Reglan) use? - Answer PO: Diabetic gastroparesis and suppression of gastroesophageal reflux IV: Suppression of postoperative nausea and vomiting, suppression of CINV, facilitation of small bowel intubation, and facilitation of radiologic examination of GI tract Metoclopramide AE? - Answer High-dose therapy: Sedation, diarrhea common Long-term high-dose therapy: Can cause irreversible tardive dyskinesia (TD) Palifermin use? - Answer Decreases oral mucositis (OM) Stimulates proliferation, differentiation, & migration of epithelial cells What are defense factors for PUD? - Answer Mucus Bicarbonate Sufficient blood flow to cells of GI mucosa Prostaglandins What are causes of PUD? (aggressive factors) - Answer H. pylori NSAIDs gastric acid pepsin smoking 3 ways antiulcers drugs work? - Answer Eradicate H. pylori Reduce gastric acidity (antisecretory agents, misoprostol) Enhance mucosal defenses (sucralfate, misoprostol) Treatment of H.pylori ulcers? - Answer Antibiotics (min. of 2): -Clarithromycin -Amoxicillin -Bismuth -Metronidazole -Tetracycline -Tinidazole Antisecretory agents -help w/healing Treatment of NSAID ulcers? - Answer PPI preferred H2 blockers Stop NSAIDs if possible *Misoprostol is effective> may cause diarrhea *Antacids, Sucralfate not recommended Risk factors for NSAID ulcers? - Answer Over 60 years old Hx of ulcers High dose NSAID therapy How is ulcer healing monitored? - Answer Radiologic or endoscopic exam Breath test Serologic tests Stool test Microscopic observation of stained biopsy sample What level does gastric pH need to be to decrease pepsin activity? - Answer To avoid activation of pepsin, raise gastric pH above 5 Ulcers and diet? - Answer "ulcer diet" does not accelerate healing Eat 5-6 small meals/day to reduce pH fluctuations Ulcer nondrug therapy? - Answer Avoid: Smoking Aspirin Other NSAIDs Alcohol Stress What are 3 types of H. pylori testing? - Answer Breath test Serologic test Stool test PUD: Clarithromycin drug - Answer Suppresses growth of H. pylori by inhibiting protein synthesis AE: nausea, diarrhea, distortion of taste (metallic) PUD: Bismuth compounds drug AE? - Answer Harmless black color of tongue & stool Long-term: Possible risk of neurologic injury PUD: Tetracycline AE - Answer Don't use in pregnancy or young children Stain developing teeth PUD: Metronidazole AE - Answer Avoid alcohol: Disulfiram-like reaction Avoid in pregnancy Goal of Ulcer treatment? - Answer Minimize emergence of resistance (use at least 2 antibx) How long should ulcer tx be? - Answer Good w/10-day course & better w/14-day course 4 ulcer antibiotic regiments: - Answer 1. Clarithromycin-based triple therapy: a. Clarithromycin b. Amoxicillin c. PPI 2. Clarithromycin-based triple therapy: a. PPI b. Clarithromycin c. Metronidazole 3. Bismuth-based quadruple therapy: a. Bismuth subsalicylate b. Metronidazole c. PPI or ranitidine 4. Sequential therapy: a. PPI plus amoxicillin for 5 days followed by b. PPI plus clarithromycin + tinidazole for 5 days Tx of Gerd: step therapy - Answer 1. Antacids 2. H2 blockers 3. PPI 4. PPI twice daily