AGNP BOARD EXAM QUESTIONS Prescription Gastroenterology (85 Questions)
Question:
A 45-year-old woman has been taking oral omeprazole (Prilosec) 40 mg twice daily for the
treatment of gastroesophageal reflux. To discontinue the medication the nurse practitioner
would:
advise the patient to stop the medication.
reduce the dose by 50% every other day.
reduce the dose by 50% weekly. Correct
reduce dose by 50% every month.
Explanation:
For patients on a moderate to high dose of a PPI (e.g., omeprazole (Prilosec) 40 mg daily or
twice daily), reduce the dose by 50% every week until the patient is on the lowest dose of the
medication. For patients on twice daily dosing, the initial reduction can be accomplished by
decreasing the dosing to once in the morning before breakfast. Once the patient has completed a
week at the lowest dose, the medication can be discontinued.
Question:
Patients receiving long-term proton pump inhibitors (PPIs) are at increased risk for fractures and:
lower extremity edema.
extraesophageal symptoms.
myocardial infarction. Correct
muscle spasms.
Explanation:
Analysis of patients taking PPIs for long periods of time showed an increased risk of myocardial
infarctions. This is thought to be related to reduced nitric oxide in the blood vessel walls. The
FDA suggests that providers consider periodically obtaining magnesium levels in patients while
they are on a PPI. Increased risk of myocardial infarction has not been associated with histamine
receptor blockers.
Question:
Ondansetron (Zofran) dosage should be adjusted in patients:
with renal insufficiency.
who are pregnant.
who are > 65 years old.
with hepatic impairment. Correct
Explanation:
,Ondansetron (Zofran) is a 5-HT3 receptor antagonist used for the treatment of nausea and
vomiting. Dose limitations are recommended for patients with severe hepatic impairment (Child-
Pugh class C); use with caution in mild-moderate hepatic impairment; clearance is decreased and
half-life increased in hepatic impairment. No dosage adjustment is recommended with renal
insufficiency, pregnancy or in advanced age.
Question:
The antiemetic that does NOT have potential to cause QT prolongation is:
promethazine (Phenergan). Correct
chlorpromazine (Thorazine).
ondansetron (Zofran).
prochlorperazine (Compazine).
Explanation:
Antihistamines such as promethazine and diphenhydramine do not cause QT prolongation.
Dopamine and serotonin antagonists are both associated with QT prolongation. Chlorpromazine
(Thorazine) and prochlorperazine (Compazine) are dopamine antagonists. Ondansetron (Zofran)
is a serotonin antagonist. If a patient has suspected QT interval prolongation or is taking other
medications with which the QT interval prolongation could be additive, a 12-lead EKG is
recommended before treatment is initiated.
Question:
Promethazine (Phenergan), a 1st generation antihistamine, is contraindicated in the presence of:
motion sickness.
sedation.
asthma. Correct
seasonal allergic rhinitis.
Explanation:
Promethazine (Phenergan) is contraindicated in patients with hypersensitivity reaction to
promethazine, other phenothiazines, or any component of the formulation; coma; lower
respiratory tract symptoms, including asthma; children younger than 2 years of age; intra-arterial
or subcutaneous administration.
,Question:
Oral metoclopramide is contraindicated in the patient diagnosed with:
migraines.
epilepsy. Correct
diabetes.
renal impairment.
Explanation:
Metoclopramide (Reglan) is contraindicated in situations when gastrointestinal (GI) motility may
be dangerous, including mechanical GI obstruction, perforation, or hemorrhage;
pheochromocytoma; history of seizure disorder (e.g., epilepsy); and concomitant use with other
agents likely to increase extrapyramidal reactions. Caution is advised in patients with renal
impairment; dosage adjustment may be needed.
Question:
Hyperosmotic agents and saline laxatives should be avoided or used with caution in patients who
have:
chronic constipation.
liver disease.
heart failure. Correct
hypothyroidism.
Explanation:
Hyperosmotic agents and saline laxatives may seriously alter fluid and electrolyte balance. This
increases the risk for dehydration and electrolyte disturbances, especially hypokalemia.
Therefore, the risks versus the benefits should be considered prior to use in patients with heart
failure.
Question:
Corticosteroids, used in the treatment of ulcerative colitis, usually do NOT:
increase the rate of infection.
reduce the effectiveness of vaccines.
increase the effectiveness of antibiotics. Correct
increase the risk of developing osteoporosis.
, Explanation:
Corticosteroids usually do NOT increase the effectiveness of antibiotics; they reduce their
effectiveness. Because they suppress the immune system, they increase the rate of infection,
reduce the effectiveness of vaccines and increase the risk of osteoporosis and fractures due to
loss of calcium with corticosteroids.
Question:
The plasma elimination half-life of esomeprazole (Nexium) is:
1-1.5 hours. Correct
2-3 hours.
3.5-5 hours.
6-8 hours.
Explanation:
The plasma elimination half-life of esomeprazole (Nexium) is approximately 1 to 1.5 hours. Less
than 1% of the parent drug is excreted in the urine. Approximately 80% of an oral dose of
esomeprazole is excreted as inactive metabolites in the urine, and the remainder is found as
inactive metabolites in the feces.
Question:
Proton pump inhibitors (PPIs), such as pantoprazole (Protonix), block gastrointestinal acid
secretion by:
converting cations to anions and pumping from parietal cell to the secretory canaliculus.
prohibiting the pumping of hydrogen ions into the parietal cell.
inhibiting the hydrogen-potassium ATPase transport enzyme. Correct
inhibiting the sodium-potassium ATPase transport enzyme.
Explanation:
The recognition that H-K-ATPase was the final step of acid secretion culminated in the
development of a class of drugs, the proton pump inhibitors (PPIs), which are targeted at
inhibiting this enzyme. They are most effective when the parietal cell is stimulated to secrete
acid postprandially, a relationship that has important clinical implications for timing of
administration. Because the amount of H-K-ATPase present in the parietal cell is greatest after a
prolonged fast, PPIs should be administered before the first meal of the day.
Question:
A 45-year-old woman has been taking oral omeprazole (Prilosec) 40 mg twice daily for the
treatment of gastroesophageal reflux. To discontinue the medication the nurse practitioner
would:
advise the patient to stop the medication.
reduce the dose by 50% every other day.
reduce the dose by 50% weekly. Correct
reduce dose by 50% every month.
Explanation:
For patients on a moderate to high dose of a PPI (e.g., omeprazole (Prilosec) 40 mg daily or
twice daily), reduce the dose by 50% every week until the patient is on the lowest dose of the
medication. For patients on twice daily dosing, the initial reduction can be accomplished by
decreasing the dosing to once in the morning before breakfast. Once the patient has completed a
week at the lowest dose, the medication can be discontinued.
Question:
Patients receiving long-term proton pump inhibitors (PPIs) are at increased risk for fractures and:
lower extremity edema.
extraesophageal symptoms.
myocardial infarction. Correct
muscle spasms.
Explanation:
Analysis of patients taking PPIs for long periods of time showed an increased risk of myocardial
infarctions. This is thought to be related to reduced nitric oxide in the blood vessel walls. The
FDA suggests that providers consider periodically obtaining magnesium levels in patients while
they are on a PPI. Increased risk of myocardial infarction has not been associated with histamine
receptor blockers.
Question:
Ondansetron (Zofran) dosage should be adjusted in patients:
with renal insufficiency.
who are pregnant.
who are > 65 years old.
with hepatic impairment. Correct
Explanation:
,Ondansetron (Zofran) is a 5-HT3 receptor antagonist used for the treatment of nausea and
vomiting. Dose limitations are recommended for patients with severe hepatic impairment (Child-
Pugh class C); use with caution in mild-moderate hepatic impairment; clearance is decreased and
half-life increased in hepatic impairment. No dosage adjustment is recommended with renal
insufficiency, pregnancy or in advanced age.
Question:
The antiemetic that does NOT have potential to cause QT prolongation is:
promethazine (Phenergan). Correct
chlorpromazine (Thorazine).
ondansetron (Zofran).
prochlorperazine (Compazine).
Explanation:
Antihistamines such as promethazine and diphenhydramine do not cause QT prolongation.
Dopamine and serotonin antagonists are both associated with QT prolongation. Chlorpromazine
(Thorazine) and prochlorperazine (Compazine) are dopamine antagonists. Ondansetron (Zofran)
is a serotonin antagonist. If a patient has suspected QT interval prolongation or is taking other
medications with which the QT interval prolongation could be additive, a 12-lead EKG is
recommended before treatment is initiated.
Question:
Promethazine (Phenergan), a 1st generation antihistamine, is contraindicated in the presence of:
motion sickness.
sedation.
asthma. Correct
seasonal allergic rhinitis.
Explanation:
Promethazine (Phenergan) is contraindicated in patients with hypersensitivity reaction to
promethazine, other phenothiazines, or any component of the formulation; coma; lower
respiratory tract symptoms, including asthma; children younger than 2 years of age; intra-arterial
or subcutaneous administration.
,Question:
Oral metoclopramide is contraindicated in the patient diagnosed with:
migraines.
epilepsy. Correct
diabetes.
renal impairment.
Explanation:
Metoclopramide (Reglan) is contraindicated in situations when gastrointestinal (GI) motility may
be dangerous, including mechanical GI obstruction, perforation, or hemorrhage;
pheochromocytoma; history of seizure disorder (e.g., epilepsy); and concomitant use with other
agents likely to increase extrapyramidal reactions. Caution is advised in patients with renal
impairment; dosage adjustment may be needed.
Question:
Hyperosmotic agents and saline laxatives should be avoided or used with caution in patients who
have:
chronic constipation.
liver disease.
heart failure. Correct
hypothyroidism.
Explanation:
Hyperosmotic agents and saline laxatives may seriously alter fluid and electrolyte balance. This
increases the risk for dehydration and electrolyte disturbances, especially hypokalemia.
Therefore, the risks versus the benefits should be considered prior to use in patients with heart
failure.
Question:
Corticosteroids, used in the treatment of ulcerative colitis, usually do NOT:
increase the rate of infection.
reduce the effectiveness of vaccines.
increase the effectiveness of antibiotics. Correct
increase the risk of developing osteoporosis.
, Explanation:
Corticosteroids usually do NOT increase the effectiveness of antibiotics; they reduce their
effectiveness. Because they suppress the immune system, they increase the rate of infection,
reduce the effectiveness of vaccines and increase the risk of osteoporosis and fractures due to
loss of calcium with corticosteroids.
Question:
The plasma elimination half-life of esomeprazole (Nexium) is:
1-1.5 hours. Correct
2-3 hours.
3.5-5 hours.
6-8 hours.
Explanation:
The plasma elimination half-life of esomeprazole (Nexium) is approximately 1 to 1.5 hours. Less
than 1% of the parent drug is excreted in the urine. Approximately 80% of an oral dose of
esomeprazole is excreted as inactive metabolites in the urine, and the remainder is found as
inactive metabolites in the feces.
Question:
Proton pump inhibitors (PPIs), such as pantoprazole (Protonix), block gastrointestinal acid
secretion by:
converting cations to anions and pumping from parietal cell to the secretory canaliculus.
prohibiting the pumping of hydrogen ions into the parietal cell.
inhibiting the hydrogen-potassium ATPase transport enzyme. Correct
inhibiting the sodium-potassium ATPase transport enzyme.
Explanation:
The recognition that H-K-ATPase was the final step of acid secretion culminated in the
development of a class of drugs, the proton pump inhibitors (PPIs), which are targeted at
inhibiting this enzyme. They are most effective when the parietal cell is stimulated to secrete
acid postprandially, a relationship that has important clinical implications for timing of
administration. Because the amount of H-K-ATPase present in the parietal cell is greatest after a
prolonged fast, PPIs should be administered before the first meal of the day.
