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A patient who takes nonsteroidal anti-inflammatory drugs (NSAIDs) for arthritis asks the
provider what can be done to prevent ulcers.
Which medication should the provider discuss with the patient? - ANSWERProton pump
inhibitors
Pts taking NSAIDs should also use proton pump inhibitors for ulcer prophylaxis
A patient is diagnosed with peptic ulcer disease (PUD). The patient is otherwise healthy.
The provider learns that the patient does not smoke and that he drinks one or two
glasses of wine with meals once a week.
Which drugs should the provider prescribe? - ANSWERAmoxicillin, clarithromycin,
omeprazole
Regimen recommended for the t of PUD is 2 abx and an antisecretory agent
A long-term patient of yours recently had stents placed in her left anterior descending
artery (LAD). Her cardiologist put her on clopidogrel. She has been taking omeprazole
for years for acid indigestion, and her cardiologist told her it has a drug interaction with
her new medication. She agrees to change drugs for her heartburn.
What drug should the provider prescribe? - ANSWERFamotidine (pepsid) 2 mg QD
Famotidine suppresses acid production by blocking the H2A pathway
A patient reports taking an oral bisacodyl laxative for several years. The provider has
suggested discontinuing the laxative, but the patient is unsure how to do this.
What should the provider tell the patient to do? - ANSWERStop taking the laxative
immediately and expect no stool for several days
A provider is taking a history on a clinic patient who reports being constipated. Upon
further questioning, the provider learns that the patient's last stool was four days ago;
that it was of normal, soft consistency; and that the patient defecated without straining.
The patient's abdomen is not distended, and bowel sounds are present. The patient
reports usually having a stool every one to two days.
What should the provider do? - ANSWERAsk about recent food and fluid intake
Constipation cannot only be defined by the frequency of bowel movements because this
varies from one individual to another.
, Constipation is defined in terms of a variety of symptoms, including hard stools,
infrequent stools, excessive straining, prolonged effort, and unsuccessful or incomplete
defecation
Common cause of constipation is diet
A patient who has traveler's diarrhea asks the provider about using loperamide to stop
the symptoms.
What should the provider tell the patient about this drug? - ANSWERLoperamide use
may prolong symptoms by slowing peristalsis
Loperamide is a nonspecific antidiarrheal that slows peristalsis, which may delay transit
of the causative organism and prolong the infection
Insulin glargine is prescribed for a hospitalized patient who has diabetes.
When should this drug be administered? - ANSWEROnce daily at bedtime
Insulin glargine is indicated for once-daily SQ administration to tx adults and children
with type 1 DM and adults with type 2 DM
Once-daily injection should be given at bedtime
A patient with type 1 diabetes who takes insulin reports taking propranolol for
hypertension.
Why should this be a concern? - ANSWERBeta-blockers can mask the symptoms of
hypoglycemia
BB can delay awareness of and response to hypoglycemia by masking signs associated
with stimulation of the sympathetic nervous system (Tachycardia, palpitations) that
hypoglycemia normally causes.
BB impairs glycogenolysis, which is one means by which the body can counteract a fall
in blood glucose: therefore can worsen insulin-induced hypoglycemia
The provider assesses a newly diagnosed patient for short-term complications of
diabetes.
What should this assessment include? - ANSWEREval of hyperglycemia,
hypoglycemia, and ketoacidosis are all short-term complications
Long term complications are: arterial insufficiency, atherosclerosis, peripheral
neuropathy
Which agent works to reduce hyperglycemia in people with T1DM by increasing
endogenous GLP-1? - ANSWERSaxagliptin
What is dulaglutide? - ANSWERA GLP-1 receptor agonist