Week 7 Exam: NR565 / NR 565 (Latest 2026 / 2027) Advanced Pharmacology Fundamentals | Questions & Answers | 100% Correct | Grade A - Chamberlain

Week 7 Exam: NR565 / NR 565 (Latest 2026 / 2027) Advanced Pharmacology Fundamentals | Questions & Answers | 100% Correct | Grade A - Chamberlain Question: · H2 receptor antagonists Answer o Examples o Which is most likely to interact due to CYP450 enzyme system? Ex. Cimetidine, Famotidine, Nizatidine, Ranitidine Interaction: Cimetidine Question: · Proton Pump Inhibitors Answer o Associated vitamin and/or mineral deficiencies o Short term use increases risk of what? § Symptoms this may be occurring -Decreased absorption of calcium, magnesium, and vitamin B12 has also been associated with long-term PPI use; therefore, PPIs are contraindicated in individuals with hypocalcemia due to complications of bone fractures. -Risk of community-acquired pneumonia (CAP) has been observed with the short-term use of PPI S+S: cough, fever, shaking chills, and shortness of breath. Question: o How to treat moderate to severe GERD Answer Answer Long-term use of PPIs Question: o What medication for GERD to avoid in older adults and why? Answer PPIs are associated with an increased risk for fractures from osteoporosis. PPIs can also cause medication interactions and vitamin or mineral deficiencies. There should be a clear indication for prescribing these medications to this older population. Question: o Treating GERD during pregnancy Answer § Which cytoprotective agents would be used Sucralfate is classified as a Pregnancy Category B agent and is safe to prescribe during pregnancy. Misoprostol is contraindicated as it can cause the death of the fetus Question: When to test for h. Pylori Answer How to treat h. Pylori Prior to starting H2RA and PPI therapy Tx: Amoxicillin, Pepto-Bismol, Clarithromycin, Metronidazole, Tetracycline, Tinidazole Question: · PUD Answer o Lifestyle modifications to support ulcer healing 5-6 small meals Smoking cessation Avoid aspirin and other NSAIDs Anxiety and stress reduction Alcohol cessation Question: · Anti-diarrheal Answer o Which one contradicted in children during or after chickenpox Bismuth subsalicylate (Pepto Bismol) Question: o Patient teaching for ciprofloxacin for traveler's diarrhea Answer Contraindicated for pregnancy As a rule, treatment is unnecessary: infection with E. coli is self-limited and will run its course in a few days. However, if symptoms are especially severe, treat with ciprofloxacin Question: · Anti-diarrheal Answer o Which one associated with gray/black stools and black tongue Bismuth subsalicylate (Pepto Bismol) Question: · Constipation Answer o Lifestyle modifications to suggest prior to treatment o Risks of laxatives during pregnancy o Preferred treatment during breastfeeding -Increase fiber and water intake, and mild exercise -Laxatives should be used with caution during pregnancy (because GI stimulation might induce labor) -Senna is safe for use during breastfeeding Question: o Psyllium Answer § How it works and what to assess for if it doesn't produce a bowel movement MOA- Absorb water, thereby softening and enlarging the fecal mass; fecal swelling promotes peristalsis Assess- Should assess if proper fluid intake was provided, may cause impaction/obstruction if not taken with fluid Question: · Irritable Bowel Syndrome (IBS) Answer o Diagnosis and treatment A diary can be helpful to aid in diagnosis and treatment Question: · Vomiting Answer o How to treat gastroparesis § Black box warning associated with treatment -If someone is vomiting due to gastroparesis, a prokinetic drug(Metoclopramide) is best. -Risk of developing tardive dyskinesia. Question: · Metronidazole Answer Patient teaching needed Metronidazole (Flagyl) is very effective against sensitive strains of H. pylori. Unfortunately, more than 40% of strains are now resistant. The most common side effects are nausea and headache. A disulfiram-like reaction can occur if metronidazole is used with alcohol; hence alcohol must be avoided. Metronidazole should not be taken during pregnancy Question: Definition: Acid reflux/heartburn Answer A burning sensation in the chest + recurrent regurgitation of acidic stomach contents into the mouth or throat; can affect teeth and esophagus Question: Acid reflux/heartburn symptoms Answer Burning sensation in chest, sour taste, stomach/chest pain, sore throat/hoarseness, wheezing/coughing, eroded teeth enamel Question: When is GERD defined Answer If heartburn/acid reflux symptoms interfere with daily life or occur more than 2x/week Question: Defensive factors to protect against ulcers: Mucus Answer Secreted by GI mucosa cells, forms protective barrier against acid and pepsin Question: Defensive factors to protect against ulcers: Bicarbonate Answer Secreted by epithelial cells of stomach/duodenum; most is trapped by mucus layer to neutralize H ions; produced + secreted by pancreas into duodenum Question: Defensive factors to protect against ulcers: Blood flow Answer Essential for maintaining mucosal integrity Question: Defensive factors to protect against ulcers: Prostaglandins Answer Stimulate secretion of bicarb and mucus; promotes vasodilation, helps to maintain blood flow, surpasses secretion of gastric acid Factors that increase the risk of ulcer development Answer H. pylori: can colonize the stomach + duodenum NSAIDs: underlying cause of many ulcers HCL: Absolute requirement for ulcer development Pepsin: enzyme in HCL that can injure unprotected mucosal cells Smoking: delays healing, increases risk of recurrence Therapeutic effect: Proton Pump Inhibitors Answer Most effective for inhibiting acid secretion; bind to gastric PPs, blocking acid production; decreased acid = decreased reflux and GERD symptoms Role of gastric parietal cells Answer Produce + release acid/hydrogen when activated by histamine, gastrin, + acetylcholine; gastric PP moves acid into stomach and k+ into parietal cells; HCL is formed when H+ binds to cl- Other info: PPIs Answer Takes 2-3 days to reach max effect; acid activated; irreversibly block H+ and amount of HCL produced Side effects: PPIs Headache, nausea, diarrhea Long-term use: renal complications, bone fractures, dementia, decreased absorption of ca+, mg+, + B12 Contraindications: PPIs Hypocalcemia; increased risk of CAP with short-term use *Pts. taking NSAIDs can take PPIs for ulcer prophylaxis Medications: PPIs OTC: esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec) RX: dexlansoprazole (dexilant), pantoprazole (protonix), rabeprazole (aciphex) Therapeutic action: Histamine-2 Receptor Antagonists (H2RA) Decreases acid secretion by blocking histamine 2-receptors in gastric parietal cells; provides relief from GERD symptoms; can be used as prophylaxis; more effective than antacids, less than PPIs; Intermittent or fixed dosing Side Effects: H2RAs Headache, nausea Containdications: H2RA Cimetidine: weak inhibitor of CYP450 (warfarin, phenytoin, theophylline, lidocaine, antacids) Famotidine: safe in geriatrics; use caution with renal impairment Nizatidine: may cause asymptomatic v-tach; increase risk of hepatoellular injury Ranitidine + Cimetidine: Increased risk of mental status changes in older adults Medications: H2RAs Cimetidine (Tagamet), famotidine (Pepcid), nizatidine (axid), ranitidine (Zantac) Therapeutic action: Cytoprotective agents Used to treat/prevent ulcer formation Medications: Cytoprotective agents Sucralfate (carafate): pregnancy category B Misoprostol (cytotec): pregnancy category X PPIs can lead to Pneumonia, fractures, rebound acid hyper secretion, hypomagnesemia, diarrhea *Interacts with clopidogrel (plavix) d/t CYP2C19 inhibition H2RAs can lead to Anti-androgenic effects, CNS effects, pneumonia Antacids can lead to Constipation, diarrhea, sodium excess Drug reactions: Antacids Interferes with absorption of other drugs (i.e. sucralfate); separate administration by 1 hour Prescribing considerations: H2RAs Baseline h. pylori, monitor gastric pH (5 or ), use caution with decreased liver or kidney function, report lethargy, somnolence, restlessness, confusion, or hallucinations Prescribing considerations: PPIs Baseline h. pylori and mg+, monitor mg+ level periodically, generally safe, encourage ca+ and vitamin D intake to decrease risk of fractures/osteoporosis Symptoms of hypomagnesemia from PPIs Palpitations, muscle cramps, tremors Peptic Ulcer Disease (PUD) The formation of ulcers in the lining of the stomach and duodenum; stomach = gastric, duodenum = duodenal Characteristics of Gastric ulcers Age 50-70, equal in gender, increased cancer risk, normal or decreased parietal cell mass + acid production, increased gastrin, normal pepsinogen, associated gastritis common, h. pylori present in 60-80%, pain in upper abdomen, antacids cause relief, food causes pain; clinical course is chronic ulcers Characteristics of Duodenal ulcers Age 20-50, more common in men, cancer risk not changed, increased parietal cell mass + acid production, normal gastrin, increased pepsinogen, gastritis not commonly present, h. pylori in 95-100%, pain in upper abdomen, pain from antacids, food causes relief, nocturnal pain common, clinical course is exacerbation + remission pattern PUD therapy: Step 1 Lifestyle modifications, OTC antacids or H2RAs PUD therapy: Step 2 H. pylori testing, PPIs PUD therapy: Step 3 H. pylori treatment, PPI + abx PUD therapy: Step 4 Triple therapy: PPI + clarithromycin or metronidazole + amoxicillin Quadruple therapy: PPI + metronidazole, tetracycline, + bismuth sabsalicylate (2nd-line tx for those that fail 1st-line tx) Levofloxacin-based triple therapy: PPI + levofloxacin + amoxicillin (usually 2nd-line/rescue therapy) PUD treatment follow-up Continue PPIs for 8-12 weeks to promote healing, high-risk patients may require chronic acid suppression therapy; if symptoms don't resolve after exhaustive treatment, refer to gastroenterology Definition: Constipation Unsatisfactory defecation with infrequent stool amounts, difficulty passing stool, or both Definition: Primary + Secondary constipation Primary: can be treated pharmacologically Secondary: focused on addressing underlying condition Constipation in children Delay or avoidance of bowel movements, decreased water absorption = formation of hard stools, less commonly from health/nutrition issues (fear, doesn't want to stop playing, angst of public bathrooms, stress with potty training) Bulk laxatives Polycarbophil, psyllium, methylcellulose Osmotic (Saline) laxatives PEG, magnesium hydroxide/sulfate/citrate, sodium phosphate, lactulose Stimulant laxatives Senna, bisacodyl, castor oil Surfactant laxatives docusate sodium/calcium Other laxatives Lubiprostone, plecanatide, PEG-electrolyte solution Contraindications: Lubricant laxatives Older adults d/t risk of lipoid pneumonia from aspiration; use caution in pregnancy Contraindications: Stimulant laxatives Severe CVD, anal. fissures, abdominal pain/obstruction, N/V with fever Contraindications: Osmotic (saline) laxatives Renal dysfunction, CVD/HF, dehydration, DM-can increase BS, older adults Laxative abuse Associated with belief that more BMs are needed; used to aid weight loss, can lead to health issues/chronic constipation, refer to behavioral health Laxative abuse complications Decreased defecation reflexes, electorally imbalance, dehydration, colitis Antiemetics: Serotonin agonists Block serotonin receptors on vagal afferents + in chemoreceptor trigger zone; used in radiation, chemo, and post-op Antiemetic medications: Serotonin agonists Ondansetron, granisetron, dolasetron, palonosetron Antiemetics: Glucocorticoids MOA is unknown; used in chemo Antiemetic medications: Glucocoricoids dexamethasone, methylprednisolone Antiemetics: Substance P/Neurokinin-1 Antagonists Blocks receptors for substance P/Neurokinin-1 in the brain; used in chemo Antiemetic medications: Substance P/Neuroknin-1 Antagonists Aprepitant, netupittant, palonsetron, fosaprepitant, rolapitant Antiemetics: Phenothiazines Blocks dopamine receptors in the chemoreceptor triggers zone; used in chemo, post-op, general Antiemetic medications: Phenothiazines Chlorpromazine, perphenazine, prochlorperazine, promethazine Antiemetics: Butyrophenones Blocks dopamine receptors in the chemoreceptor trigger zone; used in chemo, post-op, general Antiemetic medications: Butyrophenones Haloperidol, Doperidol Antiemetics: Others Metoclopraimde; blocks dopamine receptors in the chemoreceptor trigger zone; increased GI motility; used in chemo, post-op, general Antiemetics: Cannabinoids MOA unknown; may activate cannabinoid receptors in the vomiting center; used in chemo Antiemetic medications: Cannabinoids Dronabinol, Nabilone Antiemetics: Antihistamines Block H-1/muscarinic receptors from inner ear to vomiting center; used in motion sickness Antiemetic medications: Antihistamines Cyclizine, dimenhydrinate (dramamine), diphenhydramine, hydroxyzine, meclizine Antiemetics: Anticholinergics Scopolamine; blocks H-1/muscarinic receptors from inner ear to committing center; used in motion sickness Diarrhea The passage of loose, watery stool; can also have abdominal cramping + frequent bowel movements Acute: Several days Chronic: longer than 2 weeks; may indicate infection or IBD Causes of diarrhea Virus, bacteria, or parasite (i.e. rotavirus) Antidiarrheals: Opioids Effective for non-infectious diarrhea; low levels that don't create dependence; high, excessive doses can create morphine-like effects Antidiarrheal medications: Opioids Diphenoxylate (lomotil), loperamide (Imodium) Traveler's diarrhea Usually caused by E. coli; resolves spontaneously Traveler's diarrhea treatment Cipro 500mg BID for non-pregnant adults Pepto bismol Antidiarrheals: Bismuth subsalicylate GI upset, diarrhea, heartburn, indegestion Bismuth subsalicylate properties Antibacterial, antisecretory Contraindications: Bismuth subsalicylate Children/teens recovering from chicken pox/flu-like illness due to increased risk of Reye's syndrome; individuals with aspirin hypersensitivity Side effects: Bismuth subsalicylate Gray/back stools, black tongue IBS diagnostic criteria Presence of abdominal pain or discomfort that cannot be explained by structural or chemical abnormalities for at least 12 weeks in the previous year and contain 2 of the following: -Pain related to defection -Onset of pain associated with change in stool freq. -Onset of pain associated with chant in stool consist. 4 Major forms of IBS IBS-D: abdominal pain with diarrhea IBS-C: abdominal pain with constipation IBS-M: abdominal pain with alternating D/C IBS-U: abdominal pain with D/C that doesn't fit well into another category IBS symptom triggers Stress, depression, diet (caffeine, alcohol, fried food, gas-generating vegetables, sorbitol), overproduction of gastric acid, excessive bacterial colonization of the small intestine Non-specific IBS medications: Antispasmodics Hyoscyamine, dicyclomine IBS specific drugs: Alosetron IBS-D in women; selective blockade of 5-HT receptors IBS specific drugs: Eluxadoline, Lubiprostone IBD-D, IBS-C. in women; mu- and kappa- opioid receptor antagonist; selective activation of cL channels in the intestine IBS specific drugs: Linactolide IBS-C; Guaylate cyclase agonist; increased intestinal fluid secretion + motility Definition: IBS Common GI disorder involving motility + sensitivity problems of the large intestine Symptoms: IBS Gas + bloating, abdominal pain, irregular bowel patterns, diarrhea or constipation, mucus around or within stools, heartburn, nausea Goal of treatment: IBS Symptom management, lifestyle choices + medications directed towards symptoms Definition: IBD Chronic disease with no cure that affects both the small + large intestine; includes ulcerative colitis and chrohn's disease Symptoms: IBD Frequent, urgent need to have a bowel movement, abdominal pain + cramping, diarrhea or bloody diarrhea, N/V, unexplained weight loss, malnutrition Goal of treatment: IBD Induce remission by decreasing inflammation that causes the symptoms