NSG 533 Adv Pharm Module 1 EXAM QUESTIONS AND ANSWERS

NSG 533 Adv Pharm Module 1 EXAM QUESTIONS AND ANSWERS Which drug class is most effective in treating erosive lesions:? - ANSWER PPIs Name 4 H2RAs: - ANSWER Cimetidine (Tagamet) Famotidine (Pepcid) Ranitidine (Zantac) Nizatidine (Axid) What is the action of H2RAs? - ANSWER Decrease acid secretion by blocking histamine 2-receptors in gastric parietal cells Name 4 benefits of H2RAs - ANSWER 1. Relieve GERD symptoms 2. Can be administered prophylactically 3. More effective at controlling chronic GERD symptoms than ANTACIDS 4. Intermittent & routine dosing possible based on degree of symptom control needed. Name 2 drawbacks of H2RAs - ANSWER 1. Less effective in controlling chronic GERD symptoms than PPIs 2. Renal elimination may require dose adjustment in kidney dysfunction patients What are the side effects associated with H2RAs? - ANSWER H/A, nausea (Cimetidine), weak inhibitor, common drug interactions, gynecomastia, & Vit B-12 deficiency which affects patients' tolerance Name the benefits of Antacids - ANSWER 1. Useful for intermittent treatment of GERD symptoms 2. Immediate symptom relief 3. Usually well-tolerated What are the drawbacks of Antacids? - ANSWER 1. Requires frequent dosing 2. Aluminum or Magnesium containing antacids may result in electrolyte imbalances esp. in pts. w/renal impairment 3. May interfere w/absorption of fluoroquinolones, tetracyclines, iron products, & thyroid hormones (doses should be several hours apart) What are the side effects of Antacids? - ANSWER May cause Constipation or Diarrhea depending on the formulation used What is the Pharmacological Therapy Effectiveness of Antacids? - ANSWER Antacids briefly neutralize gastric acid but lacks acid-suppressive properties & are inferior to H2RAs What is the Pharmacological Therapy Effectiveness of H2RAs? - ANSWER Histamine2 Receptor Antagonists decrease acid secretion to a lesser extent than PPIs (& are therefore inferior to PPIs) What is the Pharmacological Therapy Effectiveness of PPIs? - ANSWER Proton Pump Inhibitors block the rate-limiting step in acid secretion from gastric parietal cells & block all pathways for gastric acid secretion & therefore are better than H2RAs What is the treatment goal of pharmacological therapy in GERD? - ANSWER Increase the pH of gastric content by; 1) Direct gastric acid neutralization 2) Reduce acid production through inhibiting the stimulation of pathways to decrease GERD symptoms and prevent tissue damage Which Bariatric Surgery is effective in reducing GERD symptoms in obese patients? - ANSWER Roux-en-Y gastric bypass Which Bariatric Surgery is ineffective in reducing GERD symptoms in obese patients? - ANSWER Vertical banded gastroplasty Which is more beneficial in esophagitis symptom control; Omeprazole or Antireflux surgery? - ANSWER In a 7-year follow-up study, Antireflux surgery provided more symptom control in esophagitis patients Name 4 Factors indicating when Antireflux Surgery is an appropriate option for patients w/well documented GERD: - ANSWER 1) S/Es are intolerable/undesired 2) Adherence is a challenge 3) Large Hiatal Hernia is present 4) Refractory GERD symptoms What is Antireflux Surgical Fundoplication? - ANSWER A surgical procedure which increases LES (lower esophageal sphincter) pressures by wrapping the fundus (upper part) of the stomach around the distal end of the esophagus What are LES stimulators? (5/5) - ANSWER Antireflux tx. option & alternative to fundoplication surgery: LES stimulators are surgically inserted to modulate LES pressures and reduce refluxate from the stomach What is LINX? (4/5) - ANSWER Antireflux tx. option & alternative to fundoplication surgery where bands of interlinked titanium beads with magnetic cords are placed around the LES to assist in maintaining LES pressure What is Dor? (3/5) - ANSWER Antireflux fundoplication surgery where the stomach is wrapped around the anterior circumference of the distal esophagus What is Toupet? (2/5) - ANSWER Antireflux fundoplication surgery in which the stomach is wrapped around the posterior circumference of the esophagus What is Nissen? (1/5) - ANSWER Antireflux fundoplication surgery in which the fundus of the stomach is wrapped around the total circumference of the esophagus to increase LES pressure What other lifestyle changes can a patient take to improve reflux? - ANSWER 1) smaller/more frequent meals 2) not eating 3 hours before sleeping 3) avoiding foods & medications that exacerbate GERD 4) Quitting smoking 5) Avoiding alcohol What are the 2 Most Beneficial Lifestyle Changes to improve reflux? - ANSWER 1) Losing weight (especially reducing waist circumference) 2) Elevating HOB if symptoms are worse in recumbent position=decreased contact time w/esophageal mucosa at night What tx options are appropriate for reflux alarm symptoms? - ANSWER 1) Obtain endoscopy w/biopsy to evaluate mucosa 2) If symptoms are relieved w/medication, then consider maintenance therapy for patients w/atypical symptoms, complications, and erosive disease: 2x daily PPI if Reflux Chest Syndrome present 3) Pts who are unresponsive to pharmacological therapy should be evaluated via Manometry &/or Ambulatory Reflux Monitoring Name 6 PPIs - ANSWER 1))Omeprazole (Prilosec) 20 mg 1-2x daily 2)Esomeprazole (Nexium) 20-40 mg. daily