Pharmacology Test Ii Jv

Front 1

What is the most common cause of upper GI bleeds?

Back 1

Peptic Ulcer Disease

Front 2

Peptic ulcer disease is often accompanied by?

Back 2

Dyspepsia

Front 3

What drug combo can you use to eradicate HP infection?

Back 3

Antibiotic and acid suppression or antacid combination

Front 4

What drug can enhance gastric mucosa?

Back 4

Sulcrafate

Front 5

H2 RA's are taken how often?

Back 5

Twice daily for 8-12 weeks

Front 6

PPI's are taken how often?

Back 6

once daily 8-12 weeks

Front 7

Discontinuation of what class of drugs will assist in improving PUD?

Back 7

NSAIDS

Front 8

Sucralfate improves mucosal defense but may impede what?

Back 8

Endoscopic exam

Front 9

What prophylactic drug can increase prostaglandin defense?

Back 9

Misoprostol 200mg QID with meals

Front 10

What class of drugs decrease gastric acid?

Back 10

PPI's at standard doses or H2RA's at high doses

Front 11

What drug or combo should you add concomittantly while reducing NSAIDs dose?

Back 11

PPI or misoprostol

Front 12

Celecoxib, Rofecoxib, and Valdecoxib are what class of drugs?

Back 12

Highly selective COX-2 inhibitors

Front 13

Name 3 relative selective COX 2 agents.

Back 13

Acetaminophen, salsalate, etodolac

Front 14

Is an empiric therapy recommended for management of active HP induced ulcers? What is?

Back 14

No, Multi-drug regimen (two, three, or four drug regimen)

Front 15

Why is a multi drug regimen chosen? (name a couple)

Back 15

1. Anticipated patient adherence
2. Eradication rates
3. Least potential for adverse effects
4. Previous treatment failures
5. Potential drug interactions.

Front 16

In dual drug therapy, Clarithromycin can be combined w/ what 2 drug/drug class?

Back 16

PPI or Rantidine

Front 17

Amoxicillin can be combine with what drug class?

Back 17

PPI

Front 18

What causes poor eradication rates?

Back 18

Resistance

Front 19

When using triple drug therapy, PPI based should include what combo? For how long?

Back 19

2 antibiotics and 1 PPI. 10-14 days

Front 20

Give an example of a triple drug therapy PPI based combo.

Back 20

Amoxicillin & Clarithromycin or metronidazole and any of the zoles: esomeprazole

Front 21

When using triple drug therapy, RBC based, what drug classes should be considered?

Back 21

2 antibiotics and rantidine (400mg) bid x 14 days.

Front 22

Give an example of a triple drug therapy combination.

Back 22

Clarithromycin plus amoxicillin or
metronidazole and rantidine
or tetracycline and rantidine

Front 23

In quadruple drug therapy, what class of drug is added to the combination of antibiotic and H2RA or PPI?

Back 23

Bismuth subsalicylate-based (BSS) and 2 antibiotics like metronidazole PLUS amoxicillin, metronidazole or tetracycline

Front 24

What is the % of the US population that is affected by GERD?

Back 24

20%

Front 25

Does quadruple Drug therapy have a good or poor compliance rate?

Back 25

Poor: too many drugs!

Front 26

What is the mechanism of GERD?

Back 26

A defective lower esophageal sphincter pressure

Front 27

What causes excess gastric volume, pylorus obstruction pregnancy, tight clothing?

Back 27

Increased intra-abdominal pressure

Front 28

In GERD, is their an increase in tone, or a loss of tone?

Back 28

GERD occurs due to a loss of tone in the esophageal sphincter

Front 29

What are some names of drugs that can increase risk of GERD?

Back 29

Anticholinergics, antiparkinsonian, CCB, Benzodiazipines, Estrogens, progesterones, Narcotics, NSAIDS, Nicotine, Nitrates, xanthines

Front 30

Your patient presents with the following symptoms: Hoarseness, weightloss, wheezing, bleeding, and non-cardiac chest pains. What are these symptoms characteristic of?

Back 30

Atypical symptoms of GERD

Front 31

Name some typical symptoms of GERD.

Back 31

Belching, heartburn, regurgitation of gastric contents, hypersalivation.

Front 32

Visible damage to the mucosa upon endoscopy can be seen as a complication of untreated GERD. What is this disease called?

Back 32

Erosive esophagitis and strictures

Front 33

Metaplasia resulting in replacement of stratified squamous epithelium with columnar glandular cells may occur with untreated GERD. What is this disease called?

Back 33

Barretts esophagus

Front 34

What condition may predispose a patient as much as 24%, to esophageal cancer?

Back 34

Untreated GERD that has lead to Barretts esophagus

Front 35

Esophageal adenocarcinoma risk is 8x higher in patients with what symptoms?

Back 35

Heartburn, regurgitation or both alteast once a week.

Front 36

Out of 13,900 annual diagnoses of esophageal adenocarcinoma,how many are expected to die?

Back 36

13,000

Front 37

What is the 5 year survival rate with esophageal adenocarcinoma?

Back 37

13%

Front 38

What is the cornerstone of therapy for esophageal adenocarcinoma?

Back 38

Acid suppresion with medication management

Front 39

Metoclopramide binds to what type of receptor and is considered what type of agent?

Back 39

Dopamine antagonist; prokinetic agent

Front 40

What is the MOA of metoclopramide?

Back 40

1. Increased gut motility 2. increased LES resting tone

Front 41

CNS depressants like ETOH and benzodiazipines can cause drug interactions with what agents?

Back 41

Prokinetic agents

Front 42

Your patient presents with a history of seizures, and bowel obstruction, a pheochromoctoma, what drug should be avoided in this patient?

Back 42

Metoclopramide?

Front 43

The combination of insulin and metoclopromide can cause what?

Back 43

Altered food absorption

Front 44

The use of metoclopramide can cause what type of SE in the pediatric and elderly patient population?

Back 44

Parkinsonian syndrome

Front 45

What are the MOA of antacids?

Back 45

They neutralize pH of stomach acid within the lumen

Front 46

What are some adverse effects of antacids?

Back 46

Diarrhea or constipation, mineral deficiencies and gastric acid rebound with chronic use, acid base disturbances and electrolyte imbalances in renal insufficiency

Front 47

Are there any absolute contraindication to antacids?

Back 47

No

Front 48

Anatacids have many drug interactions with what medications?
What do these drugs do?

Back 48

Tetacyclines, quinolones, antibiotics, ketoconazole, digoxin, indomethacin, ferrous sulfate, isoniazid. Decrease absorption

Front 49

What is the drawback to antacids?

Back 49

Frequent adminstration q1-2hrs

Front 50

What is the MOA of H2 receptor antagonist?

Back 50

Decrease acid secretion by competitive inhibition of histamine receptors in gastric parietal cells

Front 51

What is a contraindication for H2 receptor antagonists?

Back 51

Renal insufficiency

Front 52

Drugs like warfarin, theophylline, diazepam, phenytoin, metronidazole, propanolol all do what when combining them with an H2 antagonist?

Back 52

They increase the effects of the drugs; cimetidine increases rantidine

Front 53

What are some draw backs to H2 antagonist? (2)

Back 53

Tachyphylaxis, increase CNS effects in elderly

Front 54

In stage I management of GERD, antacids like tums, maalox, gaviscon, or what other drug class can be initiated?

Back 54

H2 RA's or omeprzole

Front 55

In stage II -III, what medication would you place your patient on?

Back 55

H2RA's or PPIs

Front 56

When do you treat empiracally?

Back 56

For typical symptoms

Front 57

For moderate to severe symptoms of GERD, what drug class should you start your patient on?

Back 57

PPI's

Front 58

What prostaglandin analog, inhibits acid and protects mucosa, reducing ulcers related to NSAIDS?

Back 58

Misoprostol

Front 59

What GU SE does misoprostol cause?

Back 59

Uterine contractions!

Front 60

Bismuth compound can reduce stool requency, and does what to ulcers?

Back 60

Coats them

Front 61

What drug can blacken stool and tongue?

Back 61

Colloidal bismuth compund or Bismuth subsalicylate

Front 62

What are some CNS SE of bismuth?

Back 62

Ataxia, H/A, confusion, seizures

Front 63

An example of a bulk forming laxative that absorbs water, and promotes peristalsis is?

Back 63

Psyllium

Front 64

What type of laxative may lead to dependence? Give some examples of these.

Back 64

Stimulants like aloe, senna, castor oil

Front 65

Your patient has just taken senna and aloe. When do you anticipate a BM?

Back 65

6-12 hours

Front 66

MOM, sorbitol, and lactulose are all what type of laxatives?

Back 66

Osmotic laxatives

Front 67

When is the onset of action typically seen in osmotic laxatives?
Caution with what?

Back 67

1-3 hours. Caution with electrolyte abnormalities

Front 68

Polyethylene glycol is used prior to procedures. How is it mixed and administered?

Back 68

4 liters of fluid over 2-4 hours

Front 69

Castor oil is considered what type of laxative?

Back 69

A stimulant

Front 70

Mineral oil is considered what type of laxative?

Back 70

stool softner

Front 71

Stool softners on a long term use can affect what nutritional status?

Back 71

Impair absorption of fat soluble vitamins (ADEK)

Front 72

Antidiarrhearls have what type of effect? What receptors do they inhibit?

Back 72

Opiod effects. They inhibit cholinergic receptors

Front 73

Somatostatin AKA ___ is a naturally occuring peptide in the GI tract.

Back 73

Octreotide

Front 74

What are some clinical uses for octreotide?

Back 74

1. Inhibitor of endocrine tumor effects, 2. Diarrhea; at low doses stimulates motility, and high doses inhibits motility
3. GI bleed

Front 75

What are some adverse effects of octreotide?

Back 75

Fat soluble vitamin deficiency
Gallstones
Hypothyroidism
Bradycardia

Front 76

Where in the world is the highest rate of IBD? (Crohns and UC)

Back 76

Scandinavia
Great Britian
North America

Front 77

Rectal bleeding is a common symptom of which IBD?

Back 77

Crohns

Front 78

Skin lesions and eye involvement is seen in which IBD?

Back 78

UC

Front 79

Which IBD involves the ENTIRE GI tract?

Back 79

Crohns

Front 80

Which IBD involves the rectum and colon only?

Back 80

UC

Front 81

Aminosalicylates like Mesalamine has antiinflammatory properties and contains what?

Back 81

5 ASA only

Front 82

Which aminosalicylate comes in enema form?

Back 82

Rowasa 4g/60ml q 8hrs

Front 83

Azathioprine/Imuran is considered what class of drug?

Back 83

An immunosuppressant

Front 84

Azathioprine decrease metabolism of what?

Back 84

Purines

Front 85

What is important to teach patients about Azathioprine?

Back 85

That response may take several months.

Front 86

Because Azathioprine is an immunosuppresant drug, what are some adverse effects?

Back 86

Rash, nausea, diarrhea, and neutropenia

Front 87

6-MP is a cell cycle specific antineoplastic drug that may also take several months to work. What are SE?

Back 87

Similar to Azathioprine; rash, nausea, diarrhea, neutropenia

Front 88

6 bloody stools a day, and signs of toxicity is a ___ stage in UC.

Back 88

Severe

Front 89

<4 stools and no systemic disturbance
>4 stools/day min systemic disturbance

Back 89

Mild
moderate

Front 90

Hypoalbuminuria, leukocytosis, fever and tachycardia are all signs and symptoms of what disease process?

Back 90

Toxic megacolon

Front 91

What is toxic megacolon?

Back 91

Acute dilation of colon-severe attack of colitis

Front 92

Aminosalicylate and metronidazole are the treatment for mild ___

Back 92

CD

Front 93

For mild UC, what 2 other treatments can be used

Back 93

Steroid enema and oral steroids

Front 94

What are the 2 symptoms that differ between UC and CD?

Back 94

In UC, eye involvement and skin lesions may be involved.

Front 95

Azathiorprine, oral steroid, 6-MP, Methotextrate, and infliximab are the treatment regimen for moderate?

Back 95

CD (MIA O6)

Front 96

What is the treatment regimen for moderate UC?

Back 96

None

Front 97

IV steroids, IV cyclosporines and surgery are the treatment regimens for severe?

Back 97

BOTH CD and UC

Front 98

Zelnorm is considered the ___ line treatment option for IBS?

Back 98

3rd

Front 99

What receptors does Zelnorm bind to?

Back 99

Selective serotonin AGONIST (5HT4)

Front 100

Zelnorm is used only on what gender?

Back 100

Female

Front 101

What are some complicated side effects of zelnorm?

Back 101

Abdominal pain, and increased risk of cholecystectomies, diarrhea, H/A

Front 102

Zelnorm is contraindicated in whom?

Back 102

Renal or hepatic impairment, gallbladder disorders and bowel obstruction

Front 103

Your pt presents to the office with c/o IBS. You want to order a first line treatment for her. What would you recommend?

Back 103

1 TBS of fiber with EACH meal

Front 104

Your pt with IBS has tried fiber, and now is wanting something more. What can you recommend as 2nd line treatment?

Back 104

A laxative or an antispasmodic

Front 105

If your pt has diarrhea IBS, what can you offer as first line management?

Back 105

Diet modications like lactose free, caffeine free

Front 106

Loperamide and other antispasmodics are considered what line management in diarrhea IBS?

Back 106

2nd line management

Front 107

Adminstering alosetron in the management of Diarrhea IBS, 3rd line treatment can increase the incidence of?

Back 107

Perforarted bowel

Front 108

Zelnorm/Tegaserod differs from Alosetron because Alosetron is a selective serotonin ___.

Back 108

Antagonist
Zelnorm is a serotonin agonist

Front 109

What is a major SE of Alosetron?

Back 109

Severe constipation with bowel obstruction!!!!

Front 110

Immodium, Lomotil, and cholestyramine are all used for the maangement of?

Back 110

Diarrhea predominant IBS

Front 111

Lomotil/Dipendoxylate with atropine cause what types of SE?

Back 111

Anticholinergic side effects: blurred vision, Dry mouth, etc.

Front 112

Bentyl and Hyoscyamine are used for the the ___ managment of IBS.

Back 112

Pain management of IBS

Front 113

Low dose of TCA or SSRI are used for what 2 things?

Back 113

To relieve pain and diarrhea.

Front 114

TCA should be avoided in patients who are?

Back 114

TCA=C=Constipated

Front 115

Bentyl reduces fluid in the bowel because it acts as an?

Back 115

Anticholinergic

Front 116

The release of serotonin as well as the stimulation of the chemoreceptors ,vestibular, and stress can all induce what?

Back 116

Vomitting

Front 117

What antiemetic agents are used for acute chemotherapy associated N/V and post op or post radiation N/V

Back 117

Serotonin 5HT3 ANTAGONSIT

Front 118

Which 5HT3 antagonist has the longest half life?

Back 118

Palonesetron (lon 1/2 life)

Front 119

5HT3 antagonist can cause what cardiac complication?

Back 119

QT Prolongation

Front 120

Ondansetron, Granisetron and dolasetron have a short or long 1/2 life?

Back 120

GOD a short life...1/2 life that is :)

Front 121

Neurokinin receptor antagonist like Aprepitatn, commonly used with cisplatin permeates the ___ __ ___ and inhibits what?

Back 121

Neuro=blood brain barrier, and inhibits CYP 450 metabolism

Front 122

Inhibition of CYP450 metabolism with increase or decrease INR if on warfarin?

Back 122

Inhibit=decrease INR

Front 123

Phenothiazines and Butyrophenones are antipsychotics, and inhibit both ___ and ___ receptors.

Back 123

Dopamine and muscarinic receptors

Front 124

Inhibition of dopaminergic receptors like with the use of phenothiazine, butyrophenones , prochorperazine, promethazine, droperidol, all can cause hypotension, prolong QT, and?

Back 124

cause Extrapyramidal SE

Front 125

What antiemetic causes QT prolongation the most?

Back 125

Droperidol

Front 126

Metoclopramide, a benzamide, blocks what receptors?
What are potential SE due to these receptor blockers?

Back 126

Dopamine receptor blockers.
EPS is a SE

Front 127

Dronabinol is a ___ aka as an antiemetic and an ___ stimulant.

Back 127

Cannibinnoid. Appetite stimulant

Front 128

SE of cannabinoids like Dronabinol are euphoria, dysphoria, sedation, hallucination, increased appetite and?

Back 128

Dry mouth