NSg 533 COMPREHENSIVE PATHOPHYSIOLOGY EXAM 2025 – QUESTIONS ANSWERED AND EXPLAINED

1. Serotonin antagonists - ANSWER ondansetron, granisetron, dolasteron, palonosetron tx CINV, PONV well tolerated SEs: HA, somnolence, diarrhea, constipation dose related QT changes 2. Palonosetron - ANSWER prevents acute/delayed CINV longer serum half life than serotonin atagonists lasts 40 hrs has a higher binding affinity 3. Serotonin Antagonist half life - ANSWER 4-9 hrs 4. Palonosetron half life - ANSWER 40 hrs 5. Neurokinin receptor antagonists - ANSWER aprepitant, netupitant, rolapitant 6. Aprepitant - ANSWER prevents acute/delayed CINV when used with: 5-HT3 antagonist and corticosteroid has numerous drug interactions 7. Netupitant - ANSWER only available as combo product with palonosetron: Akynzeo prevents acute/delayed CINV 8. Akynzeo - ANSWER netupitant and palonestron for CINV 9. Rolapitant - ANSWER oral formulation given as single dose d/t long elimination half life 10. Olanzapine - ANSWER antipsychotic used as combo therapy to prevent CINV when used for short term tx is well tolerated sedation only adverse effect 11. Acute CINV - ANSWER within 24 hours after chemo 12. Delayed CINV - ANSWER >24 hrs after chemo 13. Anticipatory CINV - ANSWER before chemo 14. Minimal Chemo CINV Risk - ANSWER No tx, no prophylaxis 15. Prophylaxis for minimal risk CINV - ANSWER single dose of 5-HT3 antagonist or 8mg of dex 16. Acute tx of moderate risk CINV - ANSWER 5-HT3 antagonist + dexamethasone 17. Delayed tx of moderate risk CINV - ANSWER dex days 2 & 3 for agents with known risk for delayed CINV 18. Acute tx of High Risk CINV - ANSWER NK1 receptor antagonist 5 HT3 dex olanzapine 19. Delayed tx of High Risk CINV - ANSWER if aprepitant continue days 2 & 3 continue dex days 2-4 for non AC highly emetogenic regimens olanzapine days 2-4 20. PONV Risk Factors - ANSWER Female, nonsmoking status, hx of PONV or motion sickness, anesthetic factors, surgical factors 21. Apfel risk score - ANSWER allows practioners to predict pt risk of experiencing PONV 22. 1st step in preventing PONV - ANSWER reducing baseline risk factors when appropriate 23. Effective med combination for PONV prevention - ANSWER 5-HT3 antagonist + droperidol or dex 24. Pregnancy unique quantification of emesis score - ANSWER score used to determine severity of NVP 6 of < : mild 7-12 : mod 13 + : severe 25. 1st line therapy for NVP - ANSWER Pyridoxine (vit. B6) 10 25 mg 4x/day alone OR with an antihistamine Diclegis & Bonjesta 26. When does ondansetron cross the placenta - ANSWER during the 1st trimester 27. Methylprednisolone pregnancy RF - ANSWER associated with oral clefts in fetus during use in 1st trimester, should be avoided during 1st 10 weeks of gestation 28. 1st line tx for pts w/ motion sickness N/V that cannot tolerate PO - ANSWER scopolamine TD 29. FGIDs - ANSWER functional gastrointestinal disorders characterized by persistent and recurring GI symptoms d/t abnormal GI tract function but without structural or biochemical abnormalities 30. OIC - ANSWER defined as a change from baseline bowel habits and patters after initiating opioid therapy 31. Primary/Idiopathic constipation is categorized as - ANSWER NTC, STC, DD 32. NTC - ANSWER colonic motility unchanged, pts experience hard stools despite normal movements 33. STC - ANSWER motility is decreased or caloric intake is inadequate, resulting in infrequent, harder and drier stools 34. Causes of DD - ANSWER inadequate relaxation of muscles or paradoxical contractions of the pelvic diaphragm, perineal membrane and pelvic floor and external anal sphincter during defecation 35. CIC - ANSWER chronic constipation without an identifiable cause 36. Alarm/Red flag findings of constipation - ANSWER worsening constipation, sudden change in bowel habits after age 50, rectal bleeding w no hemorrhoids/fissures, unintentional weight loss, anemia 37. Nonpharm therapy for constipation - ANSWER lifestyle/dietary mods, elevate feet during BM, increase dietary fiber intake (20-30g/day) 38. High fiber foods - ANSWER beans, whole grains, bran cereals, asparagus, brussels, cabbage, carrots 39. Soluble fiber - ANSWER dissolved by water, forms a gel that slows digestion. Found in lentils, apples, nots, flaxseed, psyllium 40. Insoluble fiber - ANSWER does NOT dissolve in water, remains mostly intact as it decreases the time for food and feces to traverse the intestines, adds bulk to diet and helps prevent constipation beneficial effects of bulk forming and osmotic products can be expected within - ANSWER 24-72 hrs 41. Fluid intake for men - ANSWER 3.7L/day 42. Fluid intake for women - ANSWER 2.7L/day 43. Primary pharm agent for relief of constipation - ANSWER oral laxatives 44. Pts w OIC who are refractory to traditional laxatives should be treated w - ANSWER μ-opioid receptor antagonists (mu) 45. naldemedine, naloxegol, methylnaltrexone 46. Bulk producers MOA - ANSWER act by swelling in intestinal fluid, forming a gel that aids in fecal elimination and promoting peristalsis may cause gas, bloating, distention, abd cramping 47. Bulk forming or fiber laxatives - ANSWER must be taken with sufficient water to avoid becoming lodged in esophagus and producing obstruction or worsening constipation 48. Bulk producers are derived - ANSWER naturally (psyllium) semisynthetic (polycarbophil) synthetic (methylcellulose) fiber supplements 49. Osmotics/osmolar sugars - ANSWER lactulose, sorbital, glycerin 50. Osmotics MOA - ANSWER cause water to enter the lumen of the colon, may stimulate peristalsis 51. Lactulose MOA - ANSWER Acidifies colonic contents, increases water content of stool, & softens stool 52. glycerin - ANSWER causes local irritation and possesses hyperosmotic action, may be given rectally 53. sorbitol - ANSWER can cause intestinal irritation and may affect blood glucose levels in DM 54. Osmotic agent SEs - ANSWER gas, abd cramping, bloaring 55. Polyethylene Glycol (PEG) 3350 - ANSWER Miralax, used to tx occasional constipation and expected to produce a BM in 1-3 days 56. PEG 3350 w electrolytes - ANSWER GoLYTELY, colyte used for acute complete bowel evacuation prior to GI exam can cause N and distention 57. Lubricant laxatives - ANSWER coat the stool, allow it to be expelled more easily mineral oil 58. Stimulant Laxatives - ANSWER bisacodyl, senna, castor oil selective action on the nerve plexus of intestinal smooth muscle leading to enhanced motility 59. Enteric coated bisacodyl tablets - ANSWER should be swallowed whole to avoid gastric irritation and V Ingestion should be avoided within 1-2 hours of antacid, H2RAs, PPIs and milk 60. Onset of rectal stimulant laxatives is - ANSWER more rapid 61. Short term relief of constipation with this stimulant laxative - ANSWER sodium picosulfate dulcolax pico 62. castor oil - ANSWER stimulant laxative pregnancy category x; associated w uterine contractions and rupture 63. emollients - ANSWER act by increasing surface wetting action of the stool leading to a softening effect reduce friction and make stool easier to pass less effective in treating long duration constipation 64. Saline agents - ANSWER salts of sodium, magnesium, phosphate pull water into lumen of intestines resulting in increased enteral pressure 65. mag and phosphate salts may accumulate in pts with - ANSWER renal dysfunction 66. principal concerns w sodium phosphate derivatives include - ANSWER dehydration, hypernatremia, hyperphosphatemia, acidosis, hypocalcemia, and worsening renal function 67. who should be advised to avoid saline agents - ANSWER older pts, pts w HF and renal dysfunction 68. Typical GERD symptoms - ANSWER - heartburn - hyper-salivation - regurgitation - belching 69. Atypical GERD symptoms - ANSWER -non-allergic asthma, chronic cough, hoarseness, pharyngitis, chest pain, dental erosions 70. -may be the only symptoms present 71. Alarm GERD symptoms - ANSWER dysphagia, odynophagia, weight loss, bleeding 72. Patient directed therapy for GERD with antacids - ANSWER Maalox, Gaviscon, Tums 73. Maalox - ANSWER magnesium hydroxide/aluminum hydroxide w simethicone 74. 10-20 mL prn, after meals, HS 75. Gaviscon - ANSWER Antacid/alginic acid 2-4 tabs or 10-20 mL afters meals and HS 76. Tums - ANSWER calcium carbonate (antacid) 500 mg, 2-4 tabs prn 77. Patient directed therapy for GERD with nonprescription H2RA - ANSWER up to twice a day cimetidine famotidine nizatidine 78. cimetidine - ANSWER tagament 200 mg 2x/day 79. famotidine - ANSWER pepcid AC 10-20 mg 2x/day 80. nizatidine - ANSWER axid AR 75 mg 2x/day 81. patient directed therapy for GERD with nonprescription PPI - ANSWER taken once daily esomeprazole lansoprazole omperazole omperazole/sodium bicarb 82. esomperazole - ANSWER nexium 24 hr 20 mg 1x/day 83. lansoprazole - ANSWER prevacid 24 hr 25 mg 1x/day 84. Omperazole - ANSWER prilosec OTC 20 mg 1x/day 85. omeprazole/sodium bicarb - ANSWER zegerid OTC 20 mg/1100 mg 1x/day 86. how long after pt directed therapy for gerd not working should pt see provider? - ANSWER 2 weeks 87. typical s/s GERD < 2x/week tx w: - ANSWER antacids/H2RA prn 88. typical s/s GERD > 2x/week tx w: - ANSWER daily PPI 2-8 weels no relief: PPI 2x/day for 8-12 weeks w/ relief: antacids/H2RA prn 89. Atypical s/s GERD w evidence of reflux tx: - ANSWER daily PPI 2-8 weeks no relief: PPI 2x/day for 8-12 weeks no further s/s: taper to lowest effective PPI dose further s/s: endoscopy and further eval w relief: antacids/H2RA prn 90. Pharm therapy goals for GERD - ANSWER increase pH of gastric contents neutralize acid decrease acid production 91. antacids are ____ to H2RAs - ANSWER inferior 92. H2RAs decrease acid secretion less than - ANSWER PPIs 93. Provider directed therapy for GERD - ANSWER trial daily PPI for 8 weeks not controlled by trial: retrial w PPI 2x/day 94. Provider directed therapy for erosive esophagitis - ANSWER tx w at least 8 week PPI 2x/day if continued > 8 weeks: use lowest effective PPI dose and schedule 95. Maintenance GERD therapy - ANSWER adding H2RA therapy may be effective on demand PPI dosing 96. Pts who wish to stop long term PPI - ANSWER slowly titrate off gastric hypersecretion with sudden withdrawal use H2RAs for breakthrough s/s 97. GERD and pregnancy - ANSWER use mild-mod antacids to tx avoid antacids with mag trisilicate avoid compounds with sodium bicarb if severe freq heartburn: start PPI 98. 3 most common causes of PUD - ANSWER H. pylori, NSAIDs, SRMD 99. H. pylori - ANSWER commonly causes DU when selecting 1st line tx consider if PCN allergy, previous exposure to macrolide abx 100. Macrolide abx - ANSWER -omycin's 101. Strongest H. Pylori 1st line tx recommendations - ANSWER Bismuth Quad Therapy for 10-14 days & Concomitant Therapy for 10-14 days 102. Bismuth Quad Therapy for 10-14 Days - ANSWER Bismuth 300 mg QID Metronidazole 250-500 mg QID Tetracycline 500 mg QID PPI BID 103. Concomitant Therapy for 10-14 days - ANSWER clarithromycin 500 mg BID amoxicillin 1 g BID nitroimidazole 500 mg BID PPI BID 104. weaker 1st line H. Pylori tx if no previous macrolide exposure - ANSWER clarithromycin triple therapy for 14 days 105. Clarithromycin triple therapy for 14 days - ANSWER Clarithromycin 500 mg BID Amoxicillin 1g BID OR metronidazole 500 mg TID PPI BID 106. Initial tx was Bismuth Quad Therapy w no PCN allergy failed, secondary tx - ANSWER levofloxacin triple therapy if no previous quinolone exposure concomitant therapy rifabutin triple therapy high dose dual therapy 107. Initial tx was Clarithromycin Triple Therapy w no PCN allergy failed, secondary tx: - ANSWER Bismuth Quad Therapy 108. Levofloxacin triple therapy 109. rifabutin triple therapy 110. high dose dual therapy 111. IF PCN ALLERGY: bismuth quad therapy 112. Retest for H. Pylori after: - ANSWER at least 4 weeks off regimen and 1-2 weeks after DC of PPI 113. Preferred tx of NSAID ulcers - ANSWER PPIs preferred to sucralfate and H2RAs 114. 4 weeks of PPI use 115. Meds for NSAID ulcer tx - ANSWER Misoprostol 116. Duexis 117. Prevacid NapraPAC 118. Vimovo 119. Celecoxib 120. Sucralfate 121. Misoprostol - ANSWER synthetic prostaglandin 122. 200 mcg 4x/day 123. inhibits acid secretion 124. promotes mucosal defense 125. superior to H2RAs 126. SEs: abd pain, gas, diarrhea 127. Misoprostol contraindicated in - ANSWER pregnancy 128. Arthotec - ANSWER combination product for NSAID induced GU 129. diclofenac 50 or 75 mg 130. misoprostol 200 mcg 131. Duexis - ANSWER H2RA 132. used for pt w RA and OA with GUs 133. ibuprofen 800 mg 134. famotidine 26.6 mg 135. 3x/day 136. Prevacid NapraPAC - ANSWER lansoprazole & naproxen 137. Vimovo - ANSWER naproxen + esomeprazole 138. Celecoxib - ANSWER NSAID w cox 2 selective inhibitor 139. Sucralfate - ANSWER protects stomach lining against gastric acid, pepsin, bile salts 140. SEs: constipation, N, metallic taste, aluminum tox in RF pts 141. effective tx for NSAID GU when NSAID stopped 142. Prevention of SRMD - ANSWER PPIs and H2RAs 143. Long term maintenance of ulcer healing - ANSWER sucralfate 1g 4x/day or 1-2g 2x/day 144. low dose PPIs/H2RAs only indicated for pts w severe complications secondary to PUD 145. GI Bleed tx - ANSWER IV PPI for 72 hrs followed by oral PPI 146. Anticholinergics for nausea - ANSWER scopolamine TD 147. apply 2-4 hrs prior to motion sickness event 148. lasts up to 72 hrs 149. Anticholinergic effects: sedation, visual disturbances, dry mouth, dizziness 150. Antihistamines for nausea - ANSWER diphenhydramine, dimenhydrinate, doxylamine, meclizine, cetirizine, fexofenadine 151. prevent/tx N/V from motion sickness, vertigo, HA 152. SEs: drowsiness, blurred vision, urinary retention 153. Dopamine antagonist groups - ANSWER phenothiazines, butyrophenones, prokinetic agents 154. block stimulation of D2 receptors in CTZ 155. Phenothiazines - ANSWER promethazine, prochlorperazine, chlorpromazine 156. act via central dopaminergic mechanism in CTZ 157. SEs: sedation, orthostatic hypotension, EPS 158. Do not give IV promethazine unless diluted d/t - ANSWER potential tissue necrosis and limb amputation 159. EPS - ANSWER extrapyramidal symptoms 160. dystonia, tardive dyskinesia, akathisia 161. Butyrophenones - ANSWER Droperidol, haloperidol 162. centrally acting antidopaminergic agents 163. used for PONV, CINV 164. Droperidol - ANSWER PONV, CIMV 165. SEs: sedation, agitation, restlessness, QT interval prolongation 166. 12 lead prior to admin 167. Haloperidol - ANSWER PONV, CIMV 168. antiemetic effects in LOW DOSES: 05-2 mg 169. Metoclopramide and Domperidone - ANSWER D2 receptor antagonists, used as prokinetic GI motility stimulants and antiemetics 170. useful in PONV, CINV, GERD, gastroparesis 171. crosses BBB 172. Corticosteroids - ANSWER Dexamethasone and methylprednisolone 173. used alone or with other antiemetics 174. for PONV, CIMV, radiation induced N/V 175. short term use SEs: GI upset, anxiety, insomnia, hyperglycemia 176. Cannabinoids - ANSWER dronabinol & nabilone 177. used to prevent/tx refractory/delayed CINV 178. MOA unk 179. SEs: sedaiton, euphoria, hypotension, ataxia, visual difficulties 180. Benzos - ANSWER Lorazepam 181. used to prevent/tx CINV 182. used as adjunct to antiemetic therapy 183. SEs: sedation, amnesia