NURS 8024 PHARM EXAMINATION SHEET 2025/2026
QUESTIONS WITH SOLUTIONS GRADED A+
✔✔Absorption/Action of PPIs - ✔✔*Coating is removed* in the alkaline duodenum, and
the prodrug, a weak base, is absorbed and transported to the parietal cell canaliculus →
Converted to the active form
All PPIs inhibit both basal and stimulated gastric acid secretion by > 90%
• Onset of gastric acid suppression w/i 1 to 2 hrs post first dose of lansoprazole and
slightly earlier with omeprazole
✔✔Metabolism/Actions of PPIs - ✔✔
✔✔Therapeutic uses of PPIs - ✔✔• Superiority of PPIs over H2 antagonists for gastric
acid suppression and healing peptic ulcers - preferred therapy
• Preferred drugs for treating erosive esophagitis, active duodenal ulcer, long-term tx of
pathologic hypersecretory conditions
• Approved for the treatment of GERD.
• *Studies demonstrate that PPIs reduce bleeding risk from *aspirin and other NSAID
related ulcers
• Used w/ ATB in treatment of H. pylori related disease
✔✔PPIs should be taken - ✔✔30 minutes before breakfast (or largest meal of the day)
✔✔If taken with a PPI For best effect an H2 receptor antagonist should be taken -
✔✔well before a PPI
H2 Receptors reduce activity of the proton pump
✔✔Concerns r/t long term use of PPIs - ✔✔• Increased gastric bacterial concentration
→ Possible higher risk of aspiration pneumonia
• *Higher risk of CKD (chronic kidney disease)*
• Prolonged tx w/ PPIs and H2 antagonists, can cause low vitamin B12 - (acid required
for B12 absorption)
• 2-3 x increased risk for hospital & community-acquired Clostridium difficile infection in
patients taking PPIs
✔✔Plavix and use of PPIs - ✔✔Decreased efficacy
✔✔Omeprazole inhibits the metabolism of - ✔✔warfarin, phenytoin,
diazepam, and cyclosporine
✔✔Use of PPIs increases the risk for - ✔✔osteoporosis
• Modest increase in the risk of hip fracture
• Prolonged increase in gastric pH increases potential for incomplete absorption of
calcium carbonate products
,• Option would be to use *calcium citrate* as a source of calcium by patients taking
prolonged acid-suppressing medications
• Absorption of the citrate salt is not affected by gastric pH
✔✔Indications for H2 Receptor antagonist meds - ✔✔• Duodenal ulcer treatment and
maintenance
• Gastric ulcer treatment
• Gastroesophageal reflux disease (GERD)
• Pathologic hypersecretory conditions
✔✔Indications for use of PPIs - ✔✔Gastric and duodenal ulcers
• GERD
• Pathologic hypersecretory conditions
• *Helicobacter pylori*
✔✔gastroesophageal reflux disease (GERD) - ✔✔develops when reflux of stomach
contents causes
symptoms or complications
Symptoms: *Heartburn, dyspepsia* "Atypical" symptoms: asthma, chronic cough,
chronic laryngitis, sore throat, chest pain & sleep disturbances
✔✔Pathophysiology of GERD - ✔✔• Delayed gastric emptying → common after meals
and when reclining
• Increased acidity
• Loss of lower esophageal sphincter (LES) tone
• Loss of secondary peristalsis w/ LES relaxation
• Hiatal hernia
• Truncal obesity → presumably due to ↑ intra-abdominal pressure
✔✔Non-pharmacologic treatment of GERD - ✔✔• Untreated →→ severe esophagitis &
Barrett esophagus
• Treatment
• Nonpharmacologic- avoid ETOH, caffeine, cigarettes
• No food 3-4 hrs prior to bedtime
• Eating smaller meals
• Avoid acidic foods (citrus, tomatoes, coffee, spicy foods)
• Avoid foods that precipitate reflux (fatty foods, chocolate, peppermint, alcohol)
• Weight loss
• Nocturnal symptoms → elevate HOB
✔✔Treatment of GERD with mild or intermittent symptoms - ✔✔• Antacids
• H2-blockers if symptoms last >2 hours or occur at night
• OTC doses usually are sufficient
,✔✔Treatment of GERD with moderate symptoms - ✔✔• Symptoms that occur several
times a week or daily
• PPI daily or prescription-strength H2-blocker bid
• Treatment should continue for 4 to 8 weeks
✔✔Treatment of GERD with severe symptoms and erosive disease - ✔✔• PPI daily,
may increase to bid × 8 to 12 weeks
• Repeat endoscopy is not required if patient responds to treatment
• Relapse rate is about 80% (usually w/i 3 months)
• Requires maintenance therapy
• If no response, refer to surgery
• Promotility drugs are not recommended for GERD unless no response to therapy with
a PPI or H2RA
• Sucralfate
✔✔Major causative factors of peptic ulcer disease - ✔✔• NSAIDS use
• Gram-negative Helicobacter pylori infection
• increased hydrochloric acid secretion
• inadequate mucosal defense against gastric acid.
✔✔3 steps to treatment of peptic ulcer disease - ✔✔1) eradicating the H. pylori infection
2) reduction of gastric acid secretion (H2blockers and PPIs)
3) agents that protect gastric mucosa from damage (misoprostol and sucralfate)
✔✔Optimal treatment for peptic ulcer disease with H. Pylori requires - ✔✔Antibiotic Rx:
document infection w/ H. pylori via endoscopic biopsy of gastric mucosa or including
serologic tests, urea breath tests
✔✔Eradicating H. Pylori with PUD results in - ✔✔rapid healing, low recurrence rates of
PUD
✔✔Antibiotic treatment for H. Pylori - ✔✔use multiple antibiotics; *single ATB much less
effective (20 to 40 %), results in antimicrobial resistance and is absolutely not
recommended*
✔✔Major factors in diarrhea - ✔✔Increased motility of the GI Tract, decreased
absorption
✔✔used as temporary adjunct tx in acute non-specific & functional chronic diarrhea -
✔✔Anti-diarrheal agents
✔✔anti-diarrheal drugs include - ✔✔antimotility agents, adsorbents, & drugs that modify
fluid and electrolyte transport
, ✔✔Anti-diarrheal drugs should not be used - ✔✔in patients w/ bloody diarrhea, high
fever, or systemic toxicity
✔✔Indications for anti-diarrheal meds - ✔✔• Acute Nonspecific Diarrhea
• Chronic Diarrhea (IBS or IBD)
• Treatment of Acute or Traveler's Diarrhea
• Mild to Moderate Diarrhea
✔✔Antisecretory agents - ✔✔• bismuth subsalicylate (Pepto-Bismol)
• Bismuth may exert antimicrobial effects
• Salicylate provides antisecretory effects
✔✔Adsorbents - - ✔✔Kaopectate; *Kaolin (naturally occurring hydrated magnesium
aluminum silicate), combined with *pectin (indigestible carbohydrate derived from
apples)
• absorbs bacterial toxins and fluid in infectious diarrhea
• → decreased stool liquidity
• Reduce motility and adsorbs fluid
✔✔Two drugs widely used to treat diarrhea - ✔✔Antimotility agents:
- diphenoxylate & atropine (Lomotil)
- loperamide (Imodium)
*Both have opioid-like actions on the gut, decreases peristalsis*
✔✔Lomotil formulated with atropine - ✔✔reduce the likelihood of abuse
• No analgesic effects @ antimotility doses
✔✔Antimotility Agents ADEs - ✔✔drowsiness, abdominal cramps, and dizziness
Can contribute to toxic megacolon,
• should not be used in young children or in pts w/ severe colitis
✔✔Clostridium Difficile (Infectious diarrhea) - ✔✔• Gm-positive spore-forming anaerobe,
toxin-mediated Dx
• Associated w/ broad-spectrum antimicrobials
• Occurs during or soon after antimicrobial Tx
• ↑ risk- elderly, cancer, surgical Pts, frequent laxatives, use of PPIs
✔✔Treatment of C. Difficile - ✔✔• Stop offending antimicrobial
• 1st line- Metronidazole (250 mg po qid or 500 mg tid) mild to moderate CDI
• Nonresponsive to metronidazole →Vancomycin (125 mg po qid)
• Probiotics may be added
• Nonpharmacologic
• Maintain hydration
• Relapsing C difficile → Fecal microbiota transplantation
QUESTIONS WITH SOLUTIONS GRADED A+
✔✔Absorption/Action of PPIs - ✔✔*Coating is removed* in the alkaline duodenum, and
the prodrug, a weak base, is absorbed and transported to the parietal cell canaliculus →
Converted to the active form
All PPIs inhibit both basal and stimulated gastric acid secretion by > 90%
• Onset of gastric acid suppression w/i 1 to 2 hrs post first dose of lansoprazole and
slightly earlier with omeprazole
✔✔Metabolism/Actions of PPIs - ✔✔
✔✔Therapeutic uses of PPIs - ✔✔• Superiority of PPIs over H2 antagonists for gastric
acid suppression and healing peptic ulcers - preferred therapy
• Preferred drugs for treating erosive esophagitis, active duodenal ulcer, long-term tx of
pathologic hypersecretory conditions
• Approved for the treatment of GERD.
• *Studies demonstrate that PPIs reduce bleeding risk from *aspirin and other NSAID
related ulcers
• Used w/ ATB in treatment of H. pylori related disease
✔✔PPIs should be taken - ✔✔30 minutes before breakfast (or largest meal of the day)
✔✔If taken with a PPI For best effect an H2 receptor antagonist should be taken -
✔✔well before a PPI
H2 Receptors reduce activity of the proton pump
✔✔Concerns r/t long term use of PPIs - ✔✔• Increased gastric bacterial concentration
→ Possible higher risk of aspiration pneumonia
• *Higher risk of CKD (chronic kidney disease)*
• Prolonged tx w/ PPIs and H2 antagonists, can cause low vitamin B12 - (acid required
for B12 absorption)
• 2-3 x increased risk for hospital & community-acquired Clostridium difficile infection in
patients taking PPIs
✔✔Plavix and use of PPIs - ✔✔Decreased efficacy
✔✔Omeprazole inhibits the metabolism of - ✔✔warfarin, phenytoin,
diazepam, and cyclosporine
✔✔Use of PPIs increases the risk for - ✔✔osteoporosis
• Modest increase in the risk of hip fracture
• Prolonged increase in gastric pH increases potential for incomplete absorption of
calcium carbonate products
,• Option would be to use *calcium citrate* as a source of calcium by patients taking
prolonged acid-suppressing medications
• Absorption of the citrate salt is not affected by gastric pH
✔✔Indications for H2 Receptor antagonist meds - ✔✔• Duodenal ulcer treatment and
maintenance
• Gastric ulcer treatment
• Gastroesophageal reflux disease (GERD)
• Pathologic hypersecretory conditions
✔✔Indications for use of PPIs - ✔✔Gastric and duodenal ulcers
• GERD
• Pathologic hypersecretory conditions
• *Helicobacter pylori*
✔✔gastroesophageal reflux disease (GERD) - ✔✔develops when reflux of stomach
contents causes
symptoms or complications
Symptoms: *Heartburn, dyspepsia* "Atypical" symptoms: asthma, chronic cough,
chronic laryngitis, sore throat, chest pain & sleep disturbances
✔✔Pathophysiology of GERD - ✔✔• Delayed gastric emptying → common after meals
and when reclining
• Increased acidity
• Loss of lower esophageal sphincter (LES) tone
• Loss of secondary peristalsis w/ LES relaxation
• Hiatal hernia
• Truncal obesity → presumably due to ↑ intra-abdominal pressure
✔✔Non-pharmacologic treatment of GERD - ✔✔• Untreated →→ severe esophagitis &
Barrett esophagus
• Treatment
• Nonpharmacologic- avoid ETOH, caffeine, cigarettes
• No food 3-4 hrs prior to bedtime
• Eating smaller meals
• Avoid acidic foods (citrus, tomatoes, coffee, spicy foods)
• Avoid foods that precipitate reflux (fatty foods, chocolate, peppermint, alcohol)
• Weight loss
• Nocturnal symptoms → elevate HOB
✔✔Treatment of GERD with mild or intermittent symptoms - ✔✔• Antacids
• H2-blockers if symptoms last >2 hours or occur at night
• OTC doses usually are sufficient
,✔✔Treatment of GERD with moderate symptoms - ✔✔• Symptoms that occur several
times a week or daily
• PPI daily or prescription-strength H2-blocker bid
• Treatment should continue for 4 to 8 weeks
✔✔Treatment of GERD with severe symptoms and erosive disease - ✔✔• PPI daily,
may increase to bid × 8 to 12 weeks
• Repeat endoscopy is not required if patient responds to treatment
• Relapse rate is about 80% (usually w/i 3 months)
• Requires maintenance therapy
• If no response, refer to surgery
• Promotility drugs are not recommended for GERD unless no response to therapy with
a PPI or H2RA
• Sucralfate
✔✔Major causative factors of peptic ulcer disease - ✔✔• NSAIDS use
• Gram-negative Helicobacter pylori infection
• increased hydrochloric acid secretion
• inadequate mucosal defense against gastric acid.
✔✔3 steps to treatment of peptic ulcer disease - ✔✔1) eradicating the H. pylori infection
2) reduction of gastric acid secretion (H2blockers and PPIs)
3) agents that protect gastric mucosa from damage (misoprostol and sucralfate)
✔✔Optimal treatment for peptic ulcer disease with H. Pylori requires - ✔✔Antibiotic Rx:
document infection w/ H. pylori via endoscopic biopsy of gastric mucosa or including
serologic tests, urea breath tests
✔✔Eradicating H. Pylori with PUD results in - ✔✔rapid healing, low recurrence rates of
PUD
✔✔Antibiotic treatment for H. Pylori - ✔✔use multiple antibiotics; *single ATB much less
effective (20 to 40 %), results in antimicrobial resistance and is absolutely not
recommended*
✔✔Major factors in diarrhea - ✔✔Increased motility of the GI Tract, decreased
absorption
✔✔used as temporary adjunct tx in acute non-specific & functional chronic diarrhea -
✔✔Anti-diarrheal agents
✔✔anti-diarrheal drugs include - ✔✔antimotility agents, adsorbents, & drugs that modify
fluid and electrolyte transport
, ✔✔Anti-diarrheal drugs should not be used - ✔✔in patients w/ bloody diarrhea, high
fever, or systemic toxicity
✔✔Indications for anti-diarrheal meds - ✔✔• Acute Nonspecific Diarrhea
• Chronic Diarrhea (IBS or IBD)
• Treatment of Acute or Traveler's Diarrhea
• Mild to Moderate Diarrhea
✔✔Antisecretory agents - ✔✔• bismuth subsalicylate (Pepto-Bismol)
• Bismuth may exert antimicrobial effects
• Salicylate provides antisecretory effects
✔✔Adsorbents - - ✔✔Kaopectate; *Kaolin (naturally occurring hydrated magnesium
aluminum silicate), combined with *pectin (indigestible carbohydrate derived from
apples)
• absorbs bacterial toxins and fluid in infectious diarrhea
• → decreased stool liquidity
• Reduce motility and adsorbs fluid
✔✔Two drugs widely used to treat diarrhea - ✔✔Antimotility agents:
- diphenoxylate & atropine (Lomotil)
- loperamide (Imodium)
*Both have opioid-like actions on the gut, decreases peristalsis*
✔✔Lomotil formulated with atropine - ✔✔reduce the likelihood of abuse
• No analgesic effects @ antimotility doses
✔✔Antimotility Agents ADEs - ✔✔drowsiness, abdominal cramps, and dizziness
Can contribute to toxic megacolon,
• should not be used in young children or in pts w/ severe colitis
✔✔Clostridium Difficile (Infectious diarrhea) - ✔✔• Gm-positive spore-forming anaerobe,
toxin-mediated Dx
• Associated w/ broad-spectrum antimicrobials
• Occurs during or soon after antimicrobial Tx
• ↑ risk- elderly, cancer, surgical Pts, frequent laxatives, use of PPIs
✔✔Treatment of C. Difficile - ✔✔• Stop offending antimicrobial
• 1st line- Metronidazole (250 mg po qid or 500 mg tid) mild to moderate CDI
• Nonresponsive to metronidazole →Vancomycin (125 mg po qid)
• Probiotics may be added
• Nonpharmacologic
• Maintain hydration
• Relapsing C difficile → Fecal microbiota transplantation
