PC 707 LATEST EVALUATION ALL QUESTIONS
AND ANSWERS SURE A+
✔✔What is the step-wise approach to managing GERD? - ✔✔-lifestyle changes--
>antacids-->H2 blockers-->PPIs for 8 weeks then reassess to possibly wean-->if
erosive esophagitis/Barrets continue on PPI and reassess every 6-12 months with
potential referral-->if no response to PPI refer to GI specialist
-important to remember--symptom severity dictates where you start in the treatment*
✔✔Quadruple therapy is the new recommendation in the treatment for H. Pylori except
in the rare case that: - ✔✔-local clarithromycin resistance rates are less than 20%
-resistance rates are very important to consider when prescribing antibiotics*
✔✔Are PPIs safe in pregnancy and lactation? - ✔✔-limited data available but data is
reassuring and indicates no teratogenicity
-animal studies of Prilosec* have showed teratogenic effects but was not found in
subsequent studies
-only use if other choices do not work
-potentially reassess for reasons H2 blockers and antacids didn't work and reconsider
lifestyle
-mixed safety in lactation--best to avoid if possible
✔✔What are some lifestyle changes that can help with constipation? - ✔✔-increased
fiber intake
-fluids
-regular exercise
-set consistent bowel habits
✔✔What is the first line treatment for constipation if lifestyle changes do not work?
(Non-pregnant patient) - ✔✔-hyperosmotic laxatives--safer profile
✔✔What are the different classes of laxatives? - ✔✔-osmotic
, -bulk-forming
-surfactant
-stimulant
-"lubricant"--glycerin suppositories
-"others"--lactulose & mineral oil
✔✔Contraindications for use of any class of laxatives: - ✔✔-undiagnosed abdominal
pain, nausea, vomiting, or suspected bowel obstruction
-symptoms could indicate appendicitis, regional enteritis, diverticulitis, ulcerative colitis,
or bowel obstruction*
✔✔Why is bowel obstruction a contraindication for using laxatives? - ✔✔-increasing
peristalsis could cause bowel perforation*
✔✔What are the different types of osmotic laxatives? What are the common side
effects? - ✔✔-sodium & magnesium salts
-polyethylene glycol (PEG) "Miralax"
-->cramping, bloating, flatulence
✔✔Osmotic laxatives work by: - ✔✔-drawing water into the intestinal lumen
-water accumulation causes fecal mass to soften, swell, and stretch on the intestinal
wall increasing peristalsis
✔✔How long does it take for osmotic laxatives to work? - ✔✔-low doses 6-12 hours
-high doses 2-6 hours
✔✔What is an off label use for lactulose? - ✔✔-hepatic encephalopathy secondary to
liver disease
-can also help excrete ammonia
✔✔Risks of oral sodium phosphate salt laxative? - ✔✔-potential acute phosphate
nephropathy--acute or irreversible renal damage
--->increased risk in those >55, dehydration, hx kidney issues, delayed bowel emptying,
active colitis, takes diuretics, ACEs, ARBs, NSAIDs
-more than one dose in 24 hours of OTC version may cause harm to kidneys & heart
and potentially lead to death
✔✔What are osmotic laxatives used often for prior to surgery? - ✔✔-bowel preps
✔✔What are bulk-forming laxatives? - ✔✔-psyllium (Metamucil)
-made of polysaccharides & cellulose which is non-digested or absorbed
-acts as "fiber" in the diet
-swells in water to form a gel which softens fecal mass & creates bulk
AND ANSWERS SURE A+
✔✔What is the step-wise approach to managing GERD? - ✔✔-lifestyle changes--
>antacids-->H2 blockers-->PPIs for 8 weeks then reassess to possibly wean-->if
erosive esophagitis/Barrets continue on PPI and reassess every 6-12 months with
potential referral-->if no response to PPI refer to GI specialist
-important to remember--symptom severity dictates where you start in the treatment*
✔✔Quadruple therapy is the new recommendation in the treatment for H. Pylori except
in the rare case that: - ✔✔-local clarithromycin resistance rates are less than 20%
-resistance rates are very important to consider when prescribing antibiotics*
✔✔Are PPIs safe in pregnancy and lactation? - ✔✔-limited data available but data is
reassuring and indicates no teratogenicity
-animal studies of Prilosec* have showed teratogenic effects but was not found in
subsequent studies
-only use if other choices do not work
-potentially reassess for reasons H2 blockers and antacids didn't work and reconsider
lifestyle
-mixed safety in lactation--best to avoid if possible
✔✔What are some lifestyle changes that can help with constipation? - ✔✔-increased
fiber intake
-fluids
-regular exercise
-set consistent bowel habits
✔✔What is the first line treatment for constipation if lifestyle changes do not work?
(Non-pregnant patient) - ✔✔-hyperosmotic laxatives--safer profile
✔✔What are the different classes of laxatives? - ✔✔-osmotic
, -bulk-forming
-surfactant
-stimulant
-"lubricant"--glycerin suppositories
-"others"--lactulose & mineral oil
✔✔Contraindications for use of any class of laxatives: - ✔✔-undiagnosed abdominal
pain, nausea, vomiting, or suspected bowel obstruction
-symptoms could indicate appendicitis, regional enteritis, diverticulitis, ulcerative colitis,
or bowel obstruction*
✔✔Why is bowel obstruction a contraindication for using laxatives? - ✔✔-increasing
peristalsis could cause bowel perforation*
✔✔What are the different types of osmotic laxatives? What are the common side
effects? - ✔✔-sodium & magnesium salts
-polyethylene glycol (PEG) "Miralax"
-->cramping, bloating, flatulence
✔✔Osmotic laxatives work by: - ✔✔-drawing water into the intestinal lumen
-water accumulation causes fecal mass to soften, swell, and stretch on the intestinal
wall increasing peristalsis
✔✔How long does it take for osmotic laxatives to work? - ✔✔-low doses 6-12 hours
-high doses 2-6 hours
✔✔What is an off label use for lactulose? - ✔✔-hepatic encephalopathy secondary to
liver disease
-can also help excrete ammonia
✔✔Risks of oral sodium phosphate salt laxative? - ✔✔-potential acute phosphate
nephropathy--acute or irreversible renal damage
--->increased risk in those >55, dehydration, hx kidney issues, delayed bowel emptying,
active colitis, takes diuretics, ACEs, ARBs, NSAIDs
-more than one dose in 24 hours of OTC version may cause harm to kidneys & heart
and potentially lead to death
✔✔What are osmotic laxatives used often for prior to surgery? - ✔✔-bowel preps
✔✔What are bulk-forming laxatives? - ✔✔-psyllium (Metamucil)
-made of polysaccharides & cellulose which is non-digested or absorbed
-acts as "fiber" in the diet
-swells in water to form a gel which softens fecal mass & creates bulk
