Term
| What 3 conditions are indicated for initial management with antacids? |
|
Definition
1. Reflux Esophagitis
2. Peptic Ulcer
3. Hyper-acidity |
|
|
Term
| Are antacids indicated first-line for GERD? |
|
Definition
|
|
Term
| What is the mechanism of action of antacids on hydrochloric acid? |
|
Definition
| They neutralize gastric hydrochloric acid by combining with it to form salt and water |
|
|
Term
| Do antacids protect the lining of the stomach? |
|
Definition
|
|
Term
| What population should not use antacids with a magnesium base? |
|
Definition
1. Patients in renal failure
2. Children |
|
|
Term
| Guideline 1 discusses empirical therapy with antacids. What 3 products do patients use OTC for their own "patient directed therapy"? |
|
Definition
1. Antacids
2. H2 Receptor Agonists
3. Proton pump inhibitors |
|
|
Term
| How long should "Patient-directed therapy" be used? |
|
Definition
|
|
Term
| According to the treatment guideline III, acid suppression is the mainstay of treatment for GERD, What is the first-line drug recommended by this evidence-based guideline? |
|
Definition
|
|
Term
| What is the mechanism of action of PPI's? |
|
Definition
| They inhibit the acid secretory pump embedded in the parietal cells by altering Hydrogen and potassium ATPase thus decreasing gastric fluid |
|
|
Term
| What is the mechanism of action of H2 receptor blockers for the treatment of GERD? |
|
Definition
| They reversibly inhibit histamine (and others) at the H2 receptor on the gastric parietal cells. |
|
|
Term
| When should GERD medications be taken? |
|
Definition
H2 blockers: (BID after meals, QHS if 1x dose)
PPI: 30-60 minutes prior to meals with water |
|
|
Term
| Initially, how long should your patient with GERD symptoms be treated with a prescription? |
|
Definition
|
|
Term
| List 4 non-pharmacologic treatments for relief of acid reflux or GERD. |
|
Definition
1. Encourage high fiber intake
2. Discourage smoking
3. Decrease caffeine intake
4. Weight loss
5. Smaller meals
6. Stress management |
|
|
Term
| If your empiric treatment fails after 2 months, what is the next appropriate step? |
|
Definition
| Consult a Gastroenterologist. |
|
|
Term
Can we prescribe:
1. Antacids?
2. H2 Blockers?
3. PPI's? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| What does H. Pylori cause? |
|
Definition
1. 95% of duodenal ulcers
2. 80% of gastric ulcer |
|
|
Term
|
Definition
1. Omperazole 20 mg PO BID
2. Clarithromycin 500 mg PO BID
3. Amoxicillin 1 gram BID
(x 10 days) |
|
|
Term
| H. Pylori treatment if allergic to PCN: |
|
Definition
1. Omperazole 20 mg PO BID
2. Clarithromycin 500 mg PO BID
3. Flagyl |
|
|
Term
| What does of H2 blockers do you use for your geriatric patient? |
|
Definition
| Half the normal adult dose. |
|
|
Term
| What dose of PPI do you use for the geriatric patient? |
|
Definition
| The same as the adult dose. |
|
|
Term
| What pregnancy category are H2 blockers? |
|
Definition
|
|
Term
| What pregnancy category are PPIs? |
|
Definition
|
|
Term
| List the 5 categories of laxatives: |
|
Definition
1. Bulk laxatives
2. Emollients/ Stool softeners
3. Osmotic laxatives
4. Saline laxatives
5. Stimulants |
|
|
Term
| Mechanism of action of Bulk laxatives |
|
Definition
Swell in water to form a gel that absorbs water and expands, thus increasing peristalsis
(Metamucil) |
|
|
Term
| Mechanism of action of emollients/stool softeners |
|
Definition
Lowers surface tension and inhibits fluid and electrolyte absorption
(Colace) |
|
|
Term
| Osmotic laxatives mechanism of action |
|
Definition
Largely non-absorb-able sugars that cause water to move from the tissue to the bowel which increases bulk leading to increased peristalsis.
(Lactulose) |
|
|
Term
| Mechanism of action of stimulants |
|
Definition
Stimulants have a direct action on intestinal mucosa and/or nerve plexus
(Dulcolax and Sennokot) |
|
|
Term
| Mechanism of Action of Saline Laxatives |
|
Definition
Saline laxatives attract and retain water in the bowel and increase intra-luminal pressure
(Milk of magnesia) |
|
|
Term
| What is the main reason that stimulant laxatives should be avoided if possible? |
|
Definition
| They can worsen constipation if used chronically. |
|
|
Term
| List 3 classes of medications that contribute to constipation |
|
Definition
1. Seizure medications
2. Analgesics
3. Iron products |
|
|
Term
| What are the 2 nonpharmacologic treatments recommended for constipation? |
|
Definition
1. Adequate fiber and fluid
2. Exercise |
|
|
Term
| Your patient is pregnant and constipated. What would you recommend for her? |
|
Definition
1. Exercise, increasing fluid and fiber
2. If that does not work, lactulose |
|
|
Term
RED FLAG WARNING:
What is the danger of giving oral laxatives to a patient with bowel obstruction? |
|
Definition
| Ruptured bowel/appendicitis |
|
|
Term
| Your patient is a 5 year-old who has intermittent and persistent bouts of constipation. What would you order? |
|
Definition
| Lactulose 1 ml/kg/day twice a day as needed |
|
|
Term
| Your patient comes to your clinic with diarrhea that has been bloody for over 5 days. What should you do? |
|
Definition
|
|
Term
| List 5 Causes of diarrhea |
|
Definition
1. IBS
2. Malignancy
3. Mal absorption
4. Fecal impaction
5. Radiation |
|
|
Term
| List the mechanism of action of opioid anti-diarrheal meds- Name one. |
|
Definition
| Lomotil: It acts on the smooth muscle of the GI tract inhibiting GI motility much like morphine. |
|
|
Term
| What is the mechanism of action of an absorbent? List 1. |
|
Definition
| Kaopectate. Absorbents reduce the intestinal motility, increasing absorption of fluid. In infectious diarrhea, it binds bacteria and toxins in the GI tract. |
|
|
Term
| Who publishes guidelines on the management of acute diarrhea in children? |
|
Definition
|
|
Term
| What is the primary non-pharmacologic intervention to treat diarrhea |
|
Definition
|
|
Term
| Are anti-diarrheals recommended in young children? |
|
Definition
|
|
Term
| What are 3 indications for anti-emetic medications? |
|
Definition
1. N&V
2. Vertigo
3. Motion sickness |
|
|
Term
| List 2 classes of medications commonly used for anti-emetics |
|
Definition
1. Anti-domaminergics -Phenergan
2. Anti-cholinergics - Antivert
(3. SH2 3 Receptor agonists)- Zofran |
|
|
Term
| What is the mechanism of action of Phenergan? |
|
Definition
| Phenergan blocks D2 dopamine receptors in the brain (esp in the CTZ).It also has anticholinergic and anti-histamine effects |
|
|
Term
| What is the mechanism of action of Zofran? |
|
Definition
| Selectively inhibits type 3 seratonin receptors that exhibit anti-emetic activity. |
|
|
Term
True or False:
Reglan is safe to use in all populations and has few side effects and/or drug interactions. |
|
Definition
|
|
Term
What are the pregnancy categories of the following drugs:
1. Reglan
2. Phenergan
3. Zofran |
|
Definition
1. Reglan- B
2. Phenergan- C
3. Zofran- B |
|
|
Term
TRUE OR FALSE:
Phenergan can be prescribed safely to children under 6. |
|
Definition
|
|
Term
TRUE OR FALSE:
Phenergan can be presecribed safely to children under 6. |
|
Definition
|
|
Term
| What classification of medications are indicated for the treatment of IBS? |
|
Definition
| Anti-spasmodic agents (Bentyl) |
|
|
Term
| What is the mechanism of action of anti-spasmodic agents? |
|
Definition
| Anti-spasmodic agents decrease GI motility by relaxing smooth muscle tone (it competes with acetylcholine for receptors @ post-ganglionic fibers of the PNS) |
|
|
Term
| List 3 contraindications for the use of Bentyl |
|
Definition
1. Glaucoma
2. Myasthenia Gravis
3. Tachcardia |
|
|
Term
| Misoprostol (Cytotec) reduces the risk of NSAID-incuded ulcers (present in Arthrotec). What pregnancy category is Cytotec? |
|
Definition
|
|
Term
| Can you order misoprostol alone according to the Ohio Board of Nursing formulary? |
|
Definition
|
|
Term
| The drug of choice for Ulcerative Colitis includes sulfasalzine. Can you prescribe this? |
|
Definition
|
|
Term
| You are a new NP practicing in a primary care clinic. Your first patients are triplets that are 15 months old. They have lots of "gas". What do you prescribe? |
|
Definition
| Simethicone 20 mg (0.3 ml)4 times daily after meals or with formula. |
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