PC707 Module 3-GI Exam Questions With Verified Answers

Antacids Examples - Answer Calcium carbonate (Tums, Rolaids), Sodium bicarbonate (Alka Seltzer), Magnesium (Milk of Magnesia), Aluminum (Amphogel), Bismuth subsalicylate (Pepto-Bismol) Antacid Indications - Answer Dyspepsia Acts immediately but weaker and short-lived Antacid MOA - Answer Neutralize hydrochloric acid in the stomach, thereby increasing gastric pH above 4.0 Patient Teaching for Antacids - Answer Be sure to separate antacids from other medications by 2 hours Avoid sodium bicarbonate in pregnancy for risk of fetal alkalosis and/or fluid overload Antacid Safety Concerns - Answer Sodium bicarbonate may contribute to HTN Sodium-based antacids should be avoided in patients with cardiovascular disease Magnesium-containing antacids may cause diarrhea, contraindicated in renal insufficiency, may decrease absorption of warfarin (Coumadin) Bismuth subsalicylate contraindicated during pregnancy, lactation, in children <12 y/o H2RA Examples - Answer Cimetidine (Tagamet), famotidine (Pepcid, Zantac 360), nizatidine (Axid) H2RA Indications - Answer Gastric and duodenal ulcers H2RA MOA - Answer Blocks H2 receptors to reduce the volume of gastric acid (onset of action slower than antacids but faster than PPIs - moderate acid reduction) H2RA Safety Concerns - Answer Cimetidine is a potent CYP inhibitor, many D2D interactions (warfarin, theophylline, phenytoin, opioids) Potential pneumonia Ranitidine (original Zantac) pulled off market d/t carcinogens, new formulation is famotidine PPI Examples - Answer Omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole (Prevacid), pantoprazole (Protonix) PPI Indications - Answer Gastric and duodenal ulcers Most effective at suppressing acid but the slowest onset of action compared to antacids and H2RAs PPI MOA - Answer Prodrug inhibition of the proton pumps that secrete gastric acid PPI Safety Concerns - Answer Fractures Pneumonia Acid rebound C. diff Can reduce the absorption of drugs that rely on acid Prostaglandin Analog Example - Answer Misoprostol (Cytotec) Prostaglandin Analog Indication - Answer Prevention of GI ulcers related to long-term NSAID use Prostaglandin Analog MOA - Answer Protects gastric mucosa by binding to prostaglandin receptors. This inhibits gastric acid secretion and increases mucus production Prostaglandin Analog Safety Concerns - Answer Causes uterine contractions, therefore Category X (contraindicated) in pregnancy **Off-label use for induction of labor** Mucosal Protectant Example - Answer Sucralfate (Carafate) Mucosal Protectant Indication - Answer Antiulcer Mucosal Protectant MOA - Answer Creates a protective barrier against pepsin and gastric acid Prokinetic Example - Answer Metoclopramide (Reglan) Prokinetic Indication - Answer Sometimes used for relief of heartburn during pregnancy Emesis post-op Chemotherapy Toxins Prokinetic MOA - Answer Dopamine antagonist promotes gastric emptying and tones lower esophageal sphincter Prokinetic Safety Concerns - Answer Chronic use of metoclopramide (Reglan) associated with tardive dyskinesia Prolonged QT Bulk-Forming Laxative Examples - Answer Methylcellulose, psyllium Bulk-Forming Laxative Indication - Answer Constipation Methylcellulose good in pregnancy Bulk-Forming Laxative MOA - Answer Absorb water, soften and enlarge fecal mass, and promote peristalsis Patient Teaching for Bulk-Forming Laxatives - Answer Take with a full glass of water to avoid esophageal obstruction Bulk-Forming Laxative Safety Concerns - Answer **Contraindicated in patients with undiagnosed abdominal pain, nausea, vomiting, or suspected bowel obstruction** Do not use if there is a narrowing of the intestinal lumen Surfactant Laxative Examples - Answer Docusate sodium, docusate calcium, mineral oil Surfactant Laxative Indication - Answer Constipation Surfactant Laxative MOA - Answer Softens stool and causes the secretion of water and electrolytes into the intestines, and decreases surface tension Surfactant Laxative Safety Concerns - Answer **Contraindicated in patients with undiagnosed abdominal pain, nausea, vomiting, or suspected bowel obstruction** Frequent use of mineral oil can deplete fat-soluble vitamins (A, D, E, K) Stimulant Laxative Examples - Answer Bisacodyl, senna, castor oil Stimulant Laxative Indications - Answer Use in treatment of opioid-induced constipation Treatment of constipation in an individual with slowed transit time (paraplegia, quadriplegia) Stimulant Laxative MOA - Answer Stimulate intestinal motility and increase the amount of water and electrolytes in the intestinal lumen