exam 4 pharm nurs 615-latest update
metoclopramide - CORRECT ANSWERS-in the improvement of GERD this medication
produces a dose related increase in LESP. these effects begin at doses as low as 5 mg.
(LESP: lower esophageal sphincter pressure)
step down approach - CORRECT ANSWERS-This approach to the treatment of GERD
begins with a standard dose of PPI daily for 8 weeks. If the symptoms have not
resolved, then the dose of the PPI is doubled for another 4-8 weeks. After 4 weeks a
lower dose of PPI is tried; if no relief after 8 weeks of twice daily PPI, then referral to a
GI doctor is warranted. The goal is to step down to the lowest PPI dose or transition to a
H2RA blocker if symptoms are not relieved
step up approach - CORRECT ANSWERS-This approach to the treatment of GERD
begins with lifestyle modifications and OTC antacids, followed by H2RA blockers and
PPI's. If symptoms are refractory after 4-8 weeks of treatment, or if endoscopy shows
evidence of erosive disease, then PPI's become central management. First, once daily
and if symptoms continue then twice daily.. This is best with patients with mild disease
or occasional symptoms
Peptic Ulcer Disease with positive H. Pylori - CORRECT ANSWERS-First line treatment
for this disease includes triple therapy with a PPI twice a day, Amoxicillin 1 gm twice
daily and Clarithromycin 500mg twice daily for 7-14 days. Treatment is suggested for 10
days to 2 weeks. Patients with a PCN allergy can substitute metronidazole for
amoxicillin
miralax - CORRECT ANSWERS-this medication can be given concurrently for children
to treat constipation along with potential need for behavior modification as appropriate
stimulant laxatives - CORRECT ANSWERS-bowel dependency may occur if used long
term with these medications
phenothiazine antiemetics - CORRECT ANSWERS-block dopamine receptors in the
chemo trigger zone
-promethazine
-prochlorperazine
These medications antagonize dopaminergic D2 receptors in various pathways to the
CNS. The D2, or dopamine blockade, results in antipsychotic, antiemetic, and other
effects.
docusate sodium - CORRECT ANSWERS-incorporates water and lipids into stool and
reduce surface tension
, proton pump inhibitors - CORRECT ANSWERS-these work irreversibly by combing the
H+-K+-ATPase proton pump which. This reduced blood flow to stomach and decreases
pepsin secretin and lipase serum
(suppresses gastric acid secretion by inhibiting the parietal cell)
ondansetron (zofran) - CORRECT ANSWERS-elective 5-HT3-receptor antagonist,
blocking serotonin, both peripherally on vagal nerve terminals and centrally in the
chemoreceptor trigger zone
misoprostol (cytotec) - CORRECT ANSWERS-contrainidicated in pregnancy or those in
child bearing age as they cause a 70% incidence of abortion
loop diuretics - CORRECT ANSWERS-can lead to the excretion of up to 20 to 25
percent of filtered sodium [1,10]. They act in the medullary and cortical aspects of the
thick ascending limb, including the macula densa cells in the early distal tubule.
appear to compete for the chloride site on this carrier, thereby diminishing net
reabsorption
loop diuretics - CORRECT ANSWERS-furosemide, bumetadine, torsemide
thiazide diuretics - CORRECT ANSWERS-primarily inhibit sodium transport in the distal
tubule the connecting segment at the end of the distal tubule and possibly the cortical
collecting tubule
thiazide diuretics - CORRECT ANSWERS-hydrochlorthiazide
potassium sparing diuretics - CORRECT ANSWERS-act in the principal cells in the
cortical collecting tubule
decrease the number of open sodium channels in the principal cells by two different
mechanisms
-Amiloride and triamterene
-spironolactone
acetazolamide - CORRECT ANSWERS-inhibits the activity of carbonic anhydrase,
which plays an important role in proximal bicarbonate, sodium, and chloride
reabsorption. As a result, this agent produces both NaCl and NaHCO3 loss
mannitol - CORRECT ANSWERS-nonreabsorbable sugar alcohol that acts as an
osmotic diuretic, inhibiting sodium and water reabsorption in the proximal tubule and
more importantly the loop of Henle
hydrochlorothiazide - CORRECT ANSWERS-for tx of mild htn started at a low dose of
12.5 mg and increased to 25 g
furosemide - CORRECT ANSWERS-for tx of moderate to severe with dose from 20mg
to 40 mg
metoclopramide - CORRECT ANSWERS-in the improvement of GERD this medication
produces a dose related increase in LESP. these effects begin at doses as low as 5 mg.
(LESP: lower esophageal sphincter pressure)
step down approach - CORRECT ANSWERS-This approach to the treatment of GERD
begins with a standard dose of PPI daily for 8 weeks. If the symptoms have not
resolved, then the dose of the PPI is doubled for another 4-8 weeks. After 4 weeks a
lower dose of PPI is tried; if no relief after 8 weeks of twice daily PPI, then referral to a
GI doctor is warranted. The goal is to step down to the lowest PPI dose or transition to a
H2RA blocker if symptoms are not relieved
step up approach - CORRECT ANSWERS-This approach to the treatment of GERD
begins with lifestyle modifications and OTC antacids, followed by H2RA blockers and
PPI's. If symptoms are refractory after 4-8 weeks of treatment, or if endoscopy shows
evidence of erosive disease, then PPI's become central management. First, once daily
and if symptoms continue then twice daily.. This is best with patients with mild disease
or occasional symptoms
Peptic Ulcer Disease with positive H. Pylori - CORRECT ANSWERS-First line treatment
for this disease includes triple therapy with a PPI twice a day, Amoxicillin 1 gm twice
daily and Clarithromycin 500mg twice daily for 7-14 days. Treatment is suggested for 10
days to 2 weeks. Patients with a PCN allergy can substitute metronidazole for
amoxicillin
miralax - CORRECT ANSWERS-this medication can be given concurrently for children
to treat constipation along with potential need for behavior modification as appropriate
stimulant laxatives - CORRECT ANSWERS-bowel dependency may occur if used long
term with these medications
phenothiazine antiemetics - CORRECT ANSWERS-block dopamine receptors in the
chemo trigger zone
-promethazine
-prochlorperazine
These medications antagonize dopaminergic D2 receptors in various pathways to the
CNS. The D2, or dopamine blockade, results in antipsychotic, antiemetic, and other
effects.
docusate sodium - CORRECT ANSWERS-incorporates water and lipids into stool and
reduce surface tension
, proton pump inhibitors - CORRECT ANSWERS-these work irreversibly by combing the
H+-K+-ATPase proton pump which. This reduced blood flow to stomach and decreases
pepsin secretin and lipase serum
(suppresses gastric acid secretion by inhibiting the parietal cell)
ondansetron (zofran) - CORRECT ANSWERS-elective 5-HT3-receptor antagonist,
blocking serotonin, both peripherally on vagal nerve terminals and centrally in the
chemoreceptor trigger zone
misoprostol (cytotec) - CORRECT ANSWERS-contrainidicated in pregnancy or those in
child bearing age as they cause a 70% incidence of abortion
loop diuretics - CORRECT ANSWERS-can lead to the excretion of up to 20 to 25
percent of filtered sodium [1,10]. They act in the medullary and cortical aspects of the
thick ascending limb, including the macula densa cells in the early distal tubule.
appear to compete for the chloride site on this carrier, thereby diminishing net
reabsorption
loop diuretics - CORRECT ANSWERS-furosemide, bumetadine, torsemide
thiazide diuretics - CORRECT ANSWERS-primarily inhibit sodium transport in the distal
tubule the connecting segment at the end of the distal tubule and possibly the cortical
collecting tubule
thiazide diuretics - CORRECT ANSWERS-hydrochlorthiazide
potassium sparing diuretics - CORRECT ANSWERS-act in the principal cells in the
cortical collecting tubule
decrease the number of open sodium channels in the principal cells by two different
mechanisms
-Amiloride and triamterene
-spironolactone
acetazolamide - CORRECT ANSWERS-inhibits the activity of carbonic anhydrase,
which plays an important role in proximal bicarbonate, sodium, and chloride
reabsorption. As a result, this agent produces both NaCl and NaHCO3 loss
mannitol - CORRECT ANSWERS-nonreabsorbable sugar alcohol that acts as an
osmotic diuretic, inhibiting sodium and water reabsorption in the proximal tubule and
more importantly the loop of Henle
hydrochlorothiazide - CORRECT ANSWERS-for tx of mild htn started at a low dose of
12.5 mg and increased to 25 g
furosemide - CORRECT ANSWERS-for tx of moderate to severe with dose from 20mg
to 40 mg
