NURS 5334 Test Bank Exam 1,2,3 & Final Exam Advanced Pharmacotherapeutics Updated 2023, Exams of Nursing

Download NURS 5334 Test Bank Exam 1,2,3 & Final Exam Advanced Pharmacotherapeutics Updated 2023 and more Exams Nursing in PDF only on Docsity! NURS 5334 Test Bank Exam 1,2,3 & Final Exam Advanced Pharmacotherapeutics Updated 2023- 2024 New Latest Version with All Questions from Actual Exam and 100% Correct Verified Answers What is maximum amount of Sumatriptan that can be taken in 1 day? A. 100 mg B. 200 mg C. 300 mg D. 400 mg ------- Correct Answer -------- B. 200 mg Which of the following medications is used for opioid abuse? A. Naloxone B. Naltrexone C. Disulfiram D. Nalbuphine ------- Correct Answer -------- B. Naltrexone Euphoria induced by morphine: A. an exaggerated sense of well-being caused by the activation of mu receptors B. an exaggerated sense of well-being caused by the activation of kappa receptors C. an exaggerated sense of well-being caused by the activation delta receptors D. Occurs when morphine is taken in absence of pain ------- Correct Answer -------- A. an exaggerated sense of well-being caused by the activation of mu receptors Which of the following medications is given nasally for migraines? A. Nalbuphine B. Butorphanol C. Topiramate D. Buprenorphine ------- Correct Answer -------- B. Butorphanol The ability of the anesthetic to penetrate the axon membrane is determined by 3 properties. What are they? A. Molecular size B. Protein binding potential C. Lipid solubility D. Degree of ionization at tissue pH E. Water solubility F. Degree of blood flow ------- Correct Answer -------- A. Molecular size C. Lipid solubility D. Degree of ionization at tissue pH Which of the following medications will not cause rebound headaches from overuse? A. Propranolol B. Sumatriptan C. Acetaminophen D. Ibuprofen ------- Correct Answer -------- A. Propranolol Which of the following is best option for menstrual migraine? A. Sumatriptan at onset B. Propranolol as preventive C. Low dose estrogen about 3 days prior to menses D. Sertraline about 3 days prior to menses. ------- Correct Answer -------- C. Low dose estrogen about 3 days prior to menses Which of the following foods can trigger migraines? A. Shell fish B. Hot dog C. Watermelon D. Peanuts ------- Correct Answer -------- B. Hot dog Which of the following medications is a Serotonin 1B1D receptor agonist? A. Sumatriptan B. Ergotamine C. Topiramate D. Amitriptyline ------- Correct Answer -------- A. Sumatriptan Butterbur can help as preventive for migraine therapy. Which of the following side effects may occur? • A. Renal failure B. Liver damage C. Anemia D. Thrombocytopenia ------- Correct Answer -------- B. Liver damage What are the 3 main classes of opioid receptors? ------- Correct Answer -------- Mu Kappa Delta Which of the following will reverse the effects caused by opioid agonists? A. Naloxone B. Meperidine C. Epinephrine D. Diphenhydramine ------- Correct Answer -------- A. Naloxone Which of the following medications are used to treat OIC? Check all that apply. A. Ducolax B. Naloxegol C. Methylinaltrexone In pediatric patients gastric acidity does not reach adult values for ______ ------- Correct Answer -------- 2 Years The principles underlying complication to drug therapy in the elderly include___, ____, ____, and ____. ------- Correct Answer -------- altered pharmacokinetics, multiple and severe illnesses, multiple-drug therapy, and poor adherence. Altered absorption of drugs in the elderly may result in____drug response ------- Correct Answer -------- Delay The four major factors that can alter drug distribution in the elderly include _, _, _, and _? ------- Correct Answer -------- increased body fat, decreased percentage of lean body mass, decreased total body water, and reduced concentration of serum albumin. The most important cause of adverse drug reactions in the elderly is___. ------- Correct Answer -------- drug accumulation secondary to reduced renal excretion. In the elderly, the proper index of renal function is____. ------- Correct Answer -------- creatinine clearance or GFR Name factors underlying the increase in adverse reactions in the geriatric population: --- ---- Correct Answer -------- • Polypharmacy • Severe illness, • multiple pathologies, • greater use of drugs that have a low therapeutic index • Inadequate supervision • Poor patient adherence Jane is on etanercept for RA. The NP knows: A. This drug suppresses the immune system B. This drug boosts the immune system C. This drug decreases risk for infection D. This drug decreases risk for cancer ------- Correct Answer -------- A. This drug suppresses the immune system What is first line treatment for gout? A. Colchicine B. Indomethiacin C. Febuxostat D. Probenecid ------- Correct Answer -------- B. Indomethacin When would you initiate a uricosuric medication? A. more than 3 gout attacks per year B. more than 2 gout attacks per year C. more than 1 gout attack per year D. with the first attack of gout ------- Correct Answer -------- A. more than 3 gout attacks per year Prior to starting antidepressants, patients should have laboratory testing to rule out: A. Hypothyroidism B. Anemia C. Diabetes D. Low estrogen levels ------- Correct Answer -------- A. Hypothyroidism A 32 year old male is starting paroxetine for depression. He is complaining of not being able to obtain an erection. What can the NP do to help. A. Change SSRIs B. Decrease the dose of paroxetine C. Add bupropion D. Add another SSRI ------- Correct Answer -------- C. Add bupropion A six year old is being treated with ethosuximide. She should be monitored for: A. Increased seizure activity; this drug can induce seizures B. Renal dysfunction C. Blood dyscrasias which are uncommon but possible D. Hepatoxicity ------- Correct Answer -------- C. Blood dyscrasias which are uncommon but possible Sandy is taking lamotrigine for seizures and wants an rx for OCPs which can interact with lamotrigine and cause: A. Contraceptive failure B. Weight gain C. Reduced lamotrigine levels, requiring an increase in the dose of lamotrigine. D. Increase in estrogen metabolism requiring higher estrogen containing OCPs ------- Correct Answer -------- C. Reduced lamotrigine levels, requiring an increase in the dose of lamotrigine. The tricyclic antidepressants should be prescribed cautiously in patients with: A. CAD B. Eczema C. Asthma D. Diabetes ------- Correct Answer -------- A. CAD What "onset of action symptoms" should be reviewed with patients who have been newly prescribed an SSRI? A. They will have insomnia for a week. B. They can feel a bit of nausea, but this resolves in about 1 week. C. They will have a huge increase in appetite D. They will not dream. ------- Correct Answer -------- B. They can feel a bit of nausea, but this resolves in about 1 week. Jaycee has been on Escitalopram for a year and is willing to try tapering off the SSRI. What is the initial dosage adjustment when starting to taper off antidepressants? A. Change dose to every other day dosing for a week B. Reduce dose by 50% for 3-4 days C. Reduce dose by 50% every other day • D. Escitalopram can be stopped abruptly due to it's long half life ------- Correct Answer -- ------ B. Reduce dose by 50% for 3-4 days One major drug used to treat bipolar disease is Lithium. Because lithium has a narrow therapeutic range, it is important to recognize symptoms of toxicity, such as: A. Orthostatic hypotension B. Agitation and irritability C. Drowsiness and nausea D. Painful urination ------- Correct Answer -------- C. Drowsiness and nausea Monitoring of a patient on Gabapentin to treat seizures includes: A. Routine therapeutic drug levels every 3-4 months B. Assessing for dermatologic conditions such as Steven's Johnson Syndrome C. Routine electrolytes, especially in hot weather D. Recording seizure frequency, duration, and severity ------- Correct Answer -------- D. Recording seizure frequency, duration, and severity Sam, aged 65, is started on L-dopa for his PD. He asks why this is necessary. You respond: A. L-dopa is neuroprotective B. The primary goal of therapy is to replace depleted stores of dopamine C. This is the only drug that can provide symptomatic benefit D. This is the initial monotherapy drug ------- Correct Answer -------- B. The primary goal of therapy is to replace depleted stores of dopamine A 55 y/o patient develops Parkinson's disease characterized by unilateral tremors only. The NP will refer the patient to a neurologist and should expect initial treatment to be: A. Levodopa B. Carbidopa C. Ropinirole D. Carbidopa/Levodopa ------- Correct Answer -------- C. Ropinirole Inattention and a sleep wake cycle disturbance are the hallmark symptoms of ? A. Dementia B. AD C. PD D. Delirium ------- Correct Answer -------- D. Delirium 3 types of information needed for neuropharmacologic drugs: ------- Correct Answer ----- --- • Type or types of receptors through which the drug acts • Normal response to the activation of those receptors (agonist vs antagonist) Muscarinic antagonists function ------- Correct Answer --------- selectively block the effects acetylcholine at muscarinic receptors Muscarinic antagonists are also known as ------- Correct Answer --------- parasympatholytic drugs, antimuscarinic drugs, muscarinic blockers or anticholinergic drugs Atropine function ------- Correct Answer --------- Increases HR Decrease secretions relax bronchi decrease tone of detrusor decrease tone & motility of GI mydriasis (pupil dilation) Atropine uses ------- Correct Answer --------- preanesthetic eye disorders bradycardia intestinal hypermotility asthma muscarinic agonist poisoning Atropine side effects ------- Correct Answer --------- dry mouth blurred vision increase IOP urinary retention constipation tachycardia asthma Atropine can me used to treat _______ but can also worse _______ by thickening and drying bronchial secretions causing plugging ------- Correct Answer --------- Asthma Anticholinergic drugs for overactive bladder ------- Correct Answer --------- oxybutynin (Ditropan) Darifenacin Solifenacin Tolterodine Fesorterodine Trospium Oxybutynin (Ditropan) ------- Correct Answer --------- anticholinergic side effects Darifenacin ------- Correct Answer --------- greatest M3 selectivity can reduce OAB symptoms while having no effects of M1 receptors in brain or M2 receptors in the heart Darifenacin can cause ------- Correct Answer --------- dry mouth and constipation Solifenacin ------- Correct Answer --------- similar to darifenacin but can cause prolonged QT at high doses Tolterodine ------- Correct Answer --------- nonselevtive fewer anticholinergic effects prolongs QT Fesoterodine & Trospium ------- Correct Answer --------- nonselective Scopolamine ------- Correct Answer --------- Muscarinic Antagonist used for motion sickness Ipratropium bromide ------- Correct Answer --------- used to treat asthma, COPD and rhinits Antisecretory Anticholinergics ------- Correct Answer --------- Glycopyrrolate (excessive salivation) mepenzolate methscopolamine propanthelne dicylomine (IBS) Cholinesterase inhibitors ------- Correct Answer --------- Reversible: Neostigmine (manage myasthenia graves by strengthening muscles), Physostigmine (treats muscarine antagonist poisoning) Nonreversible : highly toxic (use in insecticides) Adrenergic agonists function ------- Correct Answer --------- turn on Sympathetic NS Alpha 1 receptor activation ------- Correct Answer --------- vasoconstriction mydriasis Alpha 2 receptor activation ------- Correct Answer --------- control norepinephrine please, reduces sypatheric outflow to the heart, relieves pain Beta 1 receptor activation ------- Correct Answer --------- Inotropic effects used for shock enhance AV node conduction Beta 2 receptor activation ------- Correct Answer --------- bronchodilations uterine relaxation Epinephrine receptor specificity ------- Correct Answer --------- alpha 1 and 2, beta 1 and 2 Norepinephrine receptor specificity ------- Correct Answer --------- alpha 1, alpha 2, beta 1 (used in cardiac arrest and hypotensive states) Isoproterenol receptor specificity ------- Correct Answer --------- beta 1 and beta 2 (use for AV block and cardiac arrest) Dopamine receptor specificity ------- Correct Answer --------- beta 1, alpha 1 (used in shock) Doutamine receptor specificity ------- Correct Answer --------- beta 1 (used in Heart failure) Phenylephrine receptor specificity ------- Correct Answer --------- alpha 1 (nasal congestion, epistaxis, pupil dilation) albuterol receptor specificity ------- Correct Answer --------- beta 2 (asthma) ephedrine receptor specificity ------- Correct Answer --------- alpha 1, alpha 2, beta 1, beta 2 (bronchodilation) Adrenergic antagonists functions ------- Correct Answer --------- To rest or turn off sympathetic NS Therapeutic uses of alpha 1 blockade ------- Correct Answer --------- BPH raynauds pheochromocytoma adverse effects of alpha 1 blockade ------- Correct Answer --------- orthostatic hypotension, reflex tachycardia, nasal congestion, inhibition of ejaculation Na retention Off times in PD can be helped by ------- Correct Answer --------- dopamine agonsists COMT inhibitors MAO-B inhibitors Depression in PD treated with ------- Correct Answer --------- Amitriptlyne SSRI will cause psychosis Alzheimers ------- Correct Answer --------- ACH levels 90% below normal Drugs in alzheimers ------- Correct Answer --------- slow loss of memory and cognition and prolong independent function Cholinesterase inhibitors (drugs for Alzheimers) ------- Correct Answer --------- Donepezil galantamine rivastigmine memantine (only 4 drugs approved for alzheimers treatment) Drugs for muscle spasms ------- Correct Answer --------- Diazepam Cyclobenzaprine Tizanidine Metaxalone (least sedating) Chlorzoxazone (all carry risk for dependence) seizure drugs ------- Correct Answer --------- Phenytoin Fosphenytoin carbamazepine valproic acid ethosuximate phenobartial primidone oxcarbazepine lamotrigine gabapentin pregabalicn lyrica levetiracetam topiramate tigabine zonisamide felbamate lacosamide rufinamide vigabatrin ezogabine phenytoin ------- Correct Answer --------- partial and tonic-clonic seizures gingival hyperplasia corrected with folic acid .5 mg/day and good dental hygiene decreases effects of oral contraceptives, warfarin, and glucocorticoids increases levels of diazepam, isoniazid, cimetidine, alcohols, and valproic acid fosphenytoin ------- Correct Answer --------- prodrug of phenytoin converts to phenytoin when metabolized carbamazepine ------- Correct Answer --------- pharmacogenomics is used major CYP 3A4 inhibitor used for bipolar and seizures decreases effect of OCP bone marrow suppression, leukopenia, anemia, throbocytopenia BBW: aplastic anemia SJS decreases warfarin levels levels increase w grapefruit juice ethosuximate ------- Correct Answer --------- drug of choice for absence seizures blood dycrasias rare but possible phenobarbital ------- Correct Answer --------- not used as often anymore controlled substance IV addictive primidone ------- Correct Answer --------- works with all seizures except absesce Lamotrigine ------- Correct Answer --------- SJS estrogen lowers levels of this med gabapentin ------- Correct Answer --------- dizziness and drowsiness dose 4-5 times daily neuropathic pain, migraine, fibromyalgia, hot flashes pregabalin lyric ------- Correct Answer --------- controlled level V expensive decreases dizziness and fog oaf gabapentin diabetic neuropathy topiramate ------- Correct Answer --------- seizures bipolar migraine neuropathic pain binge eating alcohol and cocaine dependence first generation antipsychotics ------- Correct Answer --------- extrapyramidal symptoms second generation antipsychotics ------- Correct Answer --------- weight gain Haloperidol ------- Correct Answer --------- 1st gen antipsychotic Given PO or IM Fluphenazine low potency Chlorpromazine (Thorazine) ------- Correct Answer --------- 1st gen antipsychotic Clozapine ------- Correct Answer --------- 2nd gen antipsychotic oldest drug w most side effects BBW: agranulocytosis DM Dyslipidemia Weight Gain Risperidone ------- Correct Answer --------- 2nd generation antipsychotic Schizophrenia & Bipolar extrapyramidal SE at high doses Paliperidone ------- Correct Answer --------- 2nd gen antipsychotic Schizoaffective disorder long acting injectable available metabolized by kidney Olanzapine (Zyprexa) ------- Correct Answer --------- 2nd gen antipsychotic sedation weight gain DM Ziprasidone (Geodon) ------- Correct Answer --------- 2nd gen antipsychotic causes prolonged QT Quetiapine (Seroquel) ------- Correct Answer --------- 2nd gen antipsychotic schizophrenia, major depression, mania, sedation and cataracts tremor ataxia high urine output clonic movements seizures hypotension coma death Antiepileptic drugs ------- Correct Answer --------- Valproate carbamazepine lamotrigine Carbamazepine ------- Correct Answer --------- Antiepileptic target level 4-12 mcg/ml reduces symptoms and protects against recurrence of mania and depression Lamotrigine ------- Correct Answer --------- antiepileptic indicated for long term use antipsychotics ------- Correct Answer --------- all 5 used to control symptoms acutely used long term for mood stabilizers benefit patients with or without psychotic symptoms can be combined with mood stabilizer SE is weight gain benzodiazepines used for ------- Correct Answer --------- anxiety insomnia seizure disorders muscle spasm ETOH withdrawal periop if using for sleep- diazepam is long acting anxiety use short acting- lorazepam and alprazolam SE of benzos ------- Correct Answer --------- tolerance/dependence CNS depression anterograde amnesia sleep while driving respiratory depression Barbiturates have _____ subclasses ------- Correct Answer --------- 3 subclasses of barbiturates ------- Correct Answer --------- ultrashort acting (thiopental) short to intermediate acting (seobarbital) long acting (phenobarbital) SE of barbiturates ------- Correct Answer --------- tolerance physical dependence Uses of barbiturates ------- Correct Answer --------- seizure disorders induction of anesthesia insomnia 6 benzodiazepines approved for anxiety ------- Correct Answer --------- alprazolam lorazepam diazepam chlordiazepoxide clorazepate oxazepan buspirone used to treat ------- Correct Answer --------- anxiety w no abuse potential, slow acting SSRIs ------- Correct Answer --------- escitalopram citalopram fluxetine fluvoxamine paroxetine sertraline SNRI ------- Correct Answer --------- venlafaxine duloxetine (cymbalta) ADHD treatment ------- Correct Answer --------- stimulatants- release norepi and dopamine by inhibiting reuptake nonstimulants TCAs Atomexetine (Straterra) Bupropion types of stimulants for ADHD ------- Correct Answer --------- methylphendiate dexmethylphenidate dextroamphetamine amphetamine mixture (Adderall) pemoline Inotropes affect ------- Correct Answer --------- contractility Chronotropes affect? ------- Correct Answer --------- heart rate dronotropes affect ------- Correct Answer --------- conduction Types of diuretics ------- Correct Answer --------- thiazide, loop, potassium sparing, osmotic types of loop diuretics ------- Correct Answer --------- Lasix Ethacrynic acid (edecrin) Bumetanide Torsemide loop diuretics work in... ------- Correct Answer --------- the ascending loop of hence to block sodium and chloride reabsorption Diuretics can cause ------- Correct Answer --------- ototoxicity hypovolemia hypotension hypokalemia hyperuricemiahyperglycemia disruption of lipid metabolism Thiazide diuretics ------- Correct Answer --------- Hydrochlorothiazide (HCTZ) Metolazone Chorthalidone Thiazide diuretics do ------- Correct Answer --------- increase renal excretion of sodium, chloride, potassium and water work in distal convoluted tubule Thiazide diuretics used in ------- Correct Answer --------- HTN edema diabetes insipidous osmotic diuretics ------- Correct Answer --------- mannitol mannitol function ------- Correct Answer --------- reduce ICP given parenterally Potassium sparing diuretics ------- Correct Answer --------- Aldosterone antagonists such as: Spironolactone Esplerenone Uses of K-sparing Diuretics ------- Correct Answer --------- HTN PVD PAH Choice drugs for CHF ------- Correct Answer --------- spironolactone ACE/ARB BB all prolong life in CHF Ivabradine (Corlanor) ------- Correct Answer --------- for pt with EF<35% in NSR with HR 70 or greater on max tolerated BB or contraindication to BB use. Dopamine in the kidneys ------- Correct Answer --------- dilates renal blood vessels dobutamine ------- Correct Answer --------- inotropic used in end stage CHF Phosphodiesterase Inhibitors ------- Correct Answer --------- Milrinone Reserved for pt w sever reduction in CO with creased organ perfusion Digoxin is a __________ inotrope ------- Correct Answer --------- positive Digoxin increase ------- Correct Answer --------- CO Digoxin has _________ benefits ------- Correct Answer --------- neurohormonal Digoxin has ______ therapeutic range and __________ drug interactions ------- Correct Answer --------- narrow many CHF Stage A ------- Correct Answer --------- No symptoms of HF no structural of functional cardiac abnormalities Have risk factors for HF Management for stage A ------- Correct Answer --------- risk reduction CHF Stage B ------- Correct Answer --------- known structural or functional heart disease strongly associated w development of CHF no S/S present Management of Stage B ------- Correct Answer --------- prevent development of symptoms Treat: stage a + ACE/ARB BB if decrease EF or MI CHF stage C ------- Correct Answer --------- symptoms of CHF structural heart disease Management of stage C ------- Correct Answer --------- relieve pulmonary and peripheral congestive symptoms improve functional capacity and QOL slow cardiac remodeling and progression of LV dysfunction prolong life Drugs for stage C ------- Correct Answer --------- diuretics ACE/ARB aldosterone antagonists BB Digoxin Isosorbide dinitrate/hydralazine Drugs to AVOID in stage C ------- Correct Answer --------- Antidysrhythmic agens CCB NAIDS ASA CHF stage D ------- Correct Answer --------- marked symptoms advanced structural heart disease repeated hospitalization heart transplant of LVAD is best solution Management of stage D ------- Correct Answer --------- control fluid retention Drugs for stage D ------- Correct Answer --------- loop diuretic dopamine,dobuamine drugs to avoid in stage D ------- Correct Answer --------- BB Drugs for Afib ------- Correct Answer --------- restore rhythm & control rate BB Diltiazem or Verapamil Drugs for Aflutter ------- Correct Answer --------- Cardioversion with ibutilide flecainide propafenone amiodarone dronedarone sotalol dofetilide Drugs for SVT ------- Correct Answer --------- IV BB or CCB Adenosine Drugs for Sustained V Tach ------- Correct Answer --------- amiodarone lidocaine procainamide Long term: sotalol, amiodarone Vaughan Williams Classification ------- Correct Answer --------- the system most commonly used to classify antidysrhythmic drugs Class I ------- Correct Answer --------- Sodium channel blockers class IA ------- Correct Answer --------- Quinidine Procainamide Disopyramide class IB ------- Correct Answer --------- Lidocaine Mexiletine Phenytoin Class IC (can create new arrhythmias) ------- Correct Answer --------- flecainide propafenone Class II ------- Correct Answer --------- Beta blockers (esmolol, acebutolol, sotolol and propranolol) Class III ------- Correct Answer --------- potassium channel blockers (amiodarone, dronedarone, stall, dofetilide, ibutilide) Class IV ------- Correct Answer --------- Calcium Channel Blockers Verapamil Diltiazem Other Antidysrhythmic Drugs ------- Correct Answer --------- Adenosine Digoxin Drugs types for cholesterol ------- Correct Answer --------- HMg-CoA reductase inhibitors bile acid sequestrants ezetimibe HMG-CoA Reductase Inhibitors ------- Correct Answer --------- Statins Anticoagulants ------- Correct Answer --------- LMW Heparin Warfarin Direct Thrombin Inhibitors Factor Xa Inhibitors AFIB commonly associated with ------- Correct Answer --------- mitral regurgitation STEMI treatment ------- Correct Answer --------- O2 MS (decrease pain and increase vasodilation, reduce preload) BB (reduce cardiac pain, infarct size, short term mortality) Nitro (dc preload and O2 demand, increase blood flow, limit infarct size, increase LV function) Reperfusion with STEMI ------- Correct Answer --------- BB, ACE Statin and ASA for life Antiplatelets for stents ------- Correct Answer --------- 3mo to 1yr 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 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] Insulin glulisine [Apidra] o Shortduration:Sloweracting Regular insulin [Humulin R, Novolin R] o Intermediateduration Neutral protamine Hagedorn (NPH) insulin Insulin detemir [Levemir] o Longduration Insulin glargine When are short duration insulins used? ------- Correct Answer -------- Administered in association with meals to control the post-prandial rise in blood glucose between meals and at night When are intermediate insulins needed? ------- Correct Answer -------- Administer 2-3 times daily to provide glycemic control between meals and during the night How long is duration of glargine? Levemir? Degludec? ------- Correct Answer -------- Glargine—up to 24 hours o Levemir Low dose (0.2 units/kg)—12 hours High doses (0.4 units/kg)—20-24 hours o Degludec—up to 42 hours What are routes of administration? Which can be inhaled? ------- Correct Answer -------- SQ injection IV infusion. Inhalation—Afrezza, meal time insulin Typical insulin dosing for type 1? Type 2? ------- Correct Answer -------- Total doses may range from 0.1 unit/kg body weight to more than 2.5 units/kg Type1 Initial doses typically range from 0.5-0.6 units/kg per day Type2 Initial doses range from 0.2-0.6 units/kg per day Dosage increased or decreased according to carb intake, activity What are the 3 dosing schedules? ------- Correct Answer -------- o Twice daily dosing o Intensive basal/bolus strategy o Continued subcutaneous insulin How does metformin work? ------- Correct Answer -------- o Inhibits glucose production in the livero Reduces glucose absorption in the guto Sensitizes insulin receptors in target tissues (fat and skeletal muscle) thus increase glucose uptake and response to whatever insulin is available Metformin What are side effects? BB warning? ------- Correct Answer -------- o GI effects—diarrhea o Lactic acidosis 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 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 Elderly—start low and go slow Younger than 3 months—10 to 15 mcg/kg/day Children (3-5 months)—8 to 10 mcg/kg/day Children (6-11 months)—6 to 8 mcg/kg/day Children 1-5 years—5 to 6 mcg/kg/day Children 6-12—4 to 5 mcg/kg/day Liotrix—a mixture of synthetic T4 plus synthetic T3 in a 4:1 fixed ratio ------- Correct Answer -------- o Because levothyroxine alone produces the same ratio of T4 to T3, Liotrix offers no advantage over levothyroxine for most indications Armour—consists of desiccated animal thyroid glands. ------- Correct Answer -------- o Standardization is based on content of iodine, levothyroxine, and liothyronine. o The ratio of levothyroxine to lipthyronine is not less than 5:1 o Thyroid is available in tablets (15-300 mg) Methimazole—used in hyperthyroidism ------- Correct Answer -------- o Cell form of therapy for Graves' disease o Adjunct to radiation therapy until the effects of radiation become manifested o Suppresses the thyroid hormone synthesis in preparation for thyroid gland surgery o Thyrotoxic crisis Propylthiouracil ------- Correct Answer -------- o Inhibits thyroid hormone synthesis o Second line for graves o Short half-life o Full benefits—6 to 12 months o Uses—graves', adjunct therapy to radiation, preparation for thyroid gland surgery, thyrotoxic crisis o Adverse effects—agranulocytosis, severe liver damage o Pregnancy? Crosses the placenta less and concentrations in breastmilk are lower than methimazole Radioactive Iodine 131 (lugol solution) ------- Correct Answer -------- o Effect on the thyroid is destruction of thyroid tissue by emission of beta particles o Advantages—low cost; spared the risk, discomfort, and experience of thyroid surgery; death is extremely rare; no tissue other than thyroid is injured o Disadvantages—treatment is delated, taking several months to become maximal; treatment is associated with significant incidents of delayed hypothyroidism from destruction of thyroid tissue (need levothyroxine) o Diagnostic uses? Hyperthyroidism, hypothyroidism, and goiter o Pregnancy—contraindicated o What are indications for Lugol solution? ~~~~~~~~~~~~~~~~~~~ o Side effects? Brassy taste, burning sensation in the mouth and throat, soreness of the teeth and gums, frontal headache, coryza, salvation and skin eruptions ------- Correct Answer -------- Adults with hyperthyroidism Patients who have not responded adequately to anti-thyroid drugs or subtotal thyroidectomy Thyroid cancer ~~~~~~~~~ Brassy taste, burning sensation in the mouth and throat, soreness of the teeth and gums, frontal headache, coryza, salvation and skin eruptions What are stages of menstrual cycle? ------- Correct Answer -------- o Follicular phase o Luteal phase o Full cycle about 28 days What are estrogen effects on primary and secondary sex characteristics? ------- Correct Answer -------- o Influence the physiologic processes related to reproduction o Affects the ductal growth in the breasts, the thickening and cornification of the vaginal 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 2 nd gen—levonorgestrel and norgestrel 3 rd gen—desogestrel and norgestimate 4 th gen—dienogest and drospirenone Combination Ocs o Adverse effects? o Noncontraceptive uses? o What drugs reduce the effects? o What drugs effects are decreased by OCs? o What are drugs whose effects are increased by Ocs? o What are unique properties of Beyaz and Safyral? Natazia? ------- Correct Answer ----- --- Thyrombolytic disorders Increase risk—heavy smoking, a history of thrombo embolism, thrombophilias Hypertension Cancer Stroke in patients with migraine Teratogenic effects Abnormal uterine bleeding Use in pregnancy and lactation Benign hepatic adenoma Glucose intolerance ------------------- Decrease risks of ovarian cancer, endometrial cancer, ovarian cysts, pelvic inflammatory disease, benign breast disease, iron deficiency anemia, and acne Favorable effect on menstrual cycles Diminished cramps; lighter, shorter, more predictable flow -------------------- Rifampin Ritonavir Antiepileptic drugs St. John's wort ~~~~~~~~~~~~~~~~~~~ Warfarin Insulin Oral hypoglycemics ~~~~~~~~~~~~~~~~~~~~~ Several agents, including theophylline, tricyclic antidepressants, diazepam, and chlordiazepoxide ~~~~~~~~~~~~~~~~~~~~ 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? 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 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 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 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 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 usually elicit these responses only when dosage is higher than recommended o Rebound congestion is common with prolonged use of topical agents but rare with oral agents o Montelukast ------- Correct Answer -------- Benefits derive from blocking binding of leukotrienes to their receptors o Omalizumab ------- Correct Answer -------- Is a monoclonal antibody directed against IgE, an immunoglobulin (antibody) that plays a central role in the allergic release of inflammatory mediators from mast cells and basophils? Used for asthma and allergic rhinitis Cough o What are the nonopioid antitussives? ------- Correct Answer -------- Dextromethorphan Diphenhydramine Benzonatate (Tessalon) o Opioid antitussives ------- Correct Answer -------- Codeine and hydrocodone o How does Benzonatate work? ------- Correct Answer -------- Structural analog of two local anesthetics, tetracaine and procaine, and I suppress cough by decreasing the sensitivity of the respiratory tract stretch receptors. o What are the expectorants? ------- Correct Answer -------- Guaifenesin (Mucinex) o What are the inhaled mucolytics? ------- Correct Answer -------- Hypertonic saline and acetylcysteine Cold o Do cold remedies work? ------- Correct Answer -------- No, can make it worse by thickening the secretions Convenient May contain ingredients that a patient does not even really need o What are AAP recommendations? ------- Correct Answer -------- Restricting the use of these medications to children older than six Asthma/COPD o What is the pathophysiology of asthma and COPD? ------- Correct Answer -------- Asthma—result from a combination of inflammation and bronchoconstriction, so treatment must address both components Symptoms of COPD result largely from two pathologic processes: Chronic bronchitis and emphysema o How do they differ? ------- Correct Answer -------- Asthma—immune mediated airway inflammation is the cause COPD—cause is cigarette smoking o What are the 3 delivery systems for inhaled treatments? ------- Correct Answer -------- Metered dosed inhalers Respimat—soft mist inhalers Dry powder inhalers (DPIs) Nebulizers o What are the anti-inflammatory agents used? ------- Correct Answer -------- Glucocorticoids (budesonide and fluticasone) MOA—suppress inflammation Considered the most effective antiasthma drugs available Decrease synthesis and release of inflammatory mediators Reduce infiltration and activity of inflammatory cells Decrease edema of the airway mucosa Adverse effects? ------- Correct Answer -------- Adrenal suppression Oropharyngeal candidiasis Dysphonia Adverse effects of oral forms? ------- Correct Answer -------- Short-term therapy—none Long-term therapy o Adrenal suppression o Osteoporosis o Hyperglycemia 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 ------- Correct Answer -------- Intermittent Mild persistent Moderate persistent Severe persistent ~~~~~~~~~~~~~~~~~~~~~ Reduce impairment and reduce risk Prevent chronic and troublesome symptoms Reduce use of SABAs for symptoms relief to two days a week or less Maintain normal pulmonary function Maintain normal activities Meeting patient and family expectations regarding asthmas care Prevent recurrent exacerbations Minimize need for ER visits or hospitalizations Prevent progressive loss of lung functions Provide maximal benefits with minimal adverse effects ~~~~~~~~~~~~~~~~~~~~~ Step chosen for initial therapy is based on pretreatment classification of asthma severity Moving up or down a step is based on ongoing assessment of asthma control 6 steps No daily medication needed, SABAs PRN Low dose inhaled corticosteroid plus SABA Low doses inhaled corticosteroid plus LABA or medium dose inhaled glucocorticoid (and SABA as well) Medium dose inhaled glucocorticoid plus LABA plus SABA High dose inhaled glucocorticoid steroids plus LABA plus SABA High-dose inhaled glucocorticoids plus LABA plus oral glucocorticoids plus SABA ~~~~~~~~~~~~~~~~~~~~~ Important to reduce exposure to allergens and triggers Sources of allergens: House dust mites, pets, cockroaches, mold Factors that can exacerbate asthma: Tobacco smoke, wood smoke, household sprays Management of COPD o What is the FEV1/FVC that indicates COPD? o What are the stages of severity of COPD? Treatment of each? o Classifications: o Exacerbation management ------- Correct Answer -------- Less than 0.7 ~~~~~~~~~~~~~~~~~~ Stage I: Mild: FEV1/FVC <0.70 FEV1 ≥ 80% predicated 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 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 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? 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 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 Pylera Prevpac Laxative o What are indications and contraindications? ------- Correct Answer -------- Indications: Obtain fresh stool sample Empty bowel before treatment or procedure Expel dead parasites after treatment Modify effluent from ileostomy or colostomy Constipation (multiple causes) Prevent fecal impaction in bedridden patients Remove poisons Contraindications Abdominal pain, nausea, cramps, or other symptoms of appendicitis, reginal enteritis, diverticulitis, or ulcerative colitis Acute surgical abdomen Fecal impaction or bowel obstruction Habitual use Use with caution in pregnancy and lactation o What effects can laxatives have on pregnancy? ------- Correct Answer -------- Induce labor o What are the 4 classifications of laxatives? How quickly does each classification work? ------- Correct Answer -------- Bulk-forming laxatives Psyllium [Metamucil] 1-3 days Surfactant laxatives Docusate sodium [Colace] 1-3 days Stimulant laxatives Bisacodyl [Dulcolax] 6-12 hours Osmotic laxatives Milk of magnesia (MOM) Low dose—6-12 hours High dose—2-6 hours o What are causes and consequences of laxative abuse? ------- Correct Answer -------- Causes 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 Consequences Diminished defecatory reflexes, leading to further reliance on laxatives Electrolyte imbalance, dehydration, colitis