PC 707 UPDATED COMPREHSNIVE 2026
QUESTIONS AND ANSWERS SURE A+
✔✔What can cause heartburn in pregnancy? - ✔✔-hormonal fluctuations
-anatomic changes
✔✔Are antacids safe in pregnancy? - ✔✔-Yes, due to poor absorption
-EXCEPT sodium bicarbonate (AlkaSeltzer) due to aspirin content, risk for fetal and
maternal metabolic alkalosis, and fluid retention and overload*
✔✔What are the typical order of interventions for pregnancy heartburn? - ✔✔-lifestyle
changes then try antacids
-Milk of magnesia is first line* --category B
-Tums--category C
-make sure to consider if she has diarrhea or constipation
-if antacids fail to work--H2 receptor antagonists are next
-Zantac is the most studied and deemed the safest H2 blocker in pregnancy*—however,
Zantac currently is being investigated to have a carcinogen—Pepcid is a great
alternative
✔✔What are H2 receptor antagonists? How is it different from H1 receptor antagonists?
- ✔✔-H2 receptors are primarily in the parietal cells of the stomach and when stimulated
increase the secretion of gastric acid
-H2 blockers help to competitively block the binding to these receptors--therefore
decreasing acid secretion*
-this is different from H1 blockers--which primarily blocks the histamine that is involved
in allergic reactions
✔✔What are the different types of H2 receptor antagonists? - ✔✔-cimetidine (Tagamet)
-famotidine (Pepcid)
-ranitidine (Zantac)
-nizatidine (Axid)
,✔✔Why should cimetidine (Tagamet) be avoided whenever possible? - ✔✔-it is a potent
CYP enzyme inhibitor causing deceased metabolism of many drugs--increasing drug
levels*
-many drug to drug interactions: warfarin, phenytoin, propanolol, nifidepine,
chlondiapoxide, diazepam, lidocaine, tricyclic antidepressants, theophylline,
metronidazole*
✔✔Why is famotidine (Pepcid) a good go to drug for H2 antagonist? - ✔✔-least CYP
inhibitor effect
-fewer drug to drug interactions
✔✔Why is it important to document a thorough assessment of different drugs the
patient has tried to relieve dyspepsia? - ✔✔-many insurance companies require a step-
wise approach to prescribing before approving
-antacids-->H2 blockers-->PPIs
✔✔What are the only lifestyle changes that could reduce the symptoms of GERD? -
✔✔-elevation of HOB
-weight loss
-avoiding meals 2-3 hours before bed
✔✔Plans for treating GERD begins with determining the severity of symptoms. True or
false? - ✔✔-true
-if a patient comes in with moderate-severe GERD OR erosive disease and they most
likely have already tried antacids and/or H2 blockers--next step is PPIs*
-if a patient comes in with mild GERD they may or may not have tried antacids, if so--try
H2 blockers*
✔✔It's very important to educate patients to take antacids & vitamins/iron supplements:
- ✔✔-at least 2 hours apart
-taking them together can cause little to no absorption of the vitamins/supplements and
may cause deficiencies
✔✔Pepto-Bismol (bismuth subsalicylate) take aways: - ✔✔-not known to be effective for
dyspepsia
-may change the color of stool to black
-Contraindicated in pregnancy, lactation, and children <12 due to aspirin content*
-antimicrobial, antisecretory, mild anti-inflammatory
-May cause black tongue
-could be used as adjunctive in tx of H. Pylori
✔✔What is metoclorpramide (Reglan)? - ✔✔-dopamine antagonist
-promotes gastric emptying (prokinetic)
, -tones the lower esophageal sphincter
-occasionally is used in pregnancy
-risk for tardive dyskinesia*
✔✔BLACK BOX WARNING: Reglan - ✔✔-chronic use is associated with tardive
dyskinesia
-can be irreversible
-should be avoided in all but rare cases where the benefits outweigh the risks
✔✔Reglan using during lactation? - ✔✔-may help increase maternal prolactin release
and used as a galactagogue to increase milk production significantly when effective--
can work in 1-2 days!
-AAP recommends avoiding use due to potential antidopaminergic effects on the infant
-however, dose given & amounts actually in breastmilk is much less than standard dose
given to an infant requiring the medication
-must weigh risks versus benefits
✔✔What is GERD? - ✔✔-dysfunction of the anti-reflux mechanism of the lower
esophageal sphincter
-goals are lifestyle changes & symptom relief
✔✔What is the fastest treatment for a patient with acute gastric distress? - ✔✔-antacids
-H2 antagonists & PPIs take more time to decrease the acid
✔✔What is a GI cocktail? What must you ALWAYS rule out before giving it? - ✔✔-used
for severe GI distress
-contains Maalox/Mylanta, Lidocaine, Donnatal
-Cardiac events must be ruled out--this cocktail could mask cardiac symptoms*
✔✔What are proton pump inhibitors (PPIs)? - ✔✔-anti-secretory
-stops the active production & pumping of acid out of the parietal cells by inhibiting
enzymes that produces gastric acid
-the strongest but takes the longest to work.
-Ex: omeprazole (Prilosec)*
✔✔What are the risks of taking PPIs? - ✔✔-decreased acid secretion can cause
decreased protein digestion--potentially causing B12, calcium, and magnesium
deficiencies* -risk for c.diff & pneumonia
-long term use may increase risk of fractures* (more with chronic use, higher doses,
multiple doses/day)
-potential for precancerous lesions--leading to gastric malignancy*
✔✔How do PPIs potentially set the stage for gastric malignancy? - ✔✔-long term use of
PPIs can cause hyperplasia of the stomach lining
-this is a precursor "precancerous lesion"
QUESTIONS AND ANSWERS SURE A+
✔✔What can cause heartburn in pregnancy? - ✔✔-hormonal fluctuations
-anatomic changes
✔✔Are antacids safe in pregnancy? - ✔✔-Yes, due to poor absorption
-EXCEPT sodium bicarbonate (AlkaSeltzer) due to aspirin content, risk for fetal and
maternal metabolic alkalosis, and fluid retention and overload*
✔✔What are the typical order of interventions for pregnancy heartburn? - ✔✔-lifestyle
changes then try antacids
-Milk of magnesia is first line* --category B
-Tums--category C
-make sure to consider if she has diarrhea or constipation
-if antacids fail to work--H2 receptor antagonists are next
-Zantac is the most studied and deemed the safest H2 blocker in pregnancy*—however,
Zantac currently is being investigated to have a carcinogen—Pepcid is a great
alternative
✔✔What are H2 receptor antagonists? How is it different from H1 receptor antagonists?
- ✔✔-H2 receptors are primarily in the parietal cells of the stomach and when stimulated
increase the secretion of gastric acid
-H2 blockers help to competitively block the binding to these receptors--therefore
decreasing acid secretion*
-this is different from H1 blockers--which primarily blocks the histamine that is involved
in allergic reactions
✔✔What are the different types of H2 receptor antagonists? - ✔✔-cimetidine (Tagamet)
-famotidine (Pepcid)
-ranitidine (Zantac)
-nizatidine (Axid)
,✔✔Why should cimetidine (Tagamet) be avoided whenever possible? - ✔✔-it is a potent
CYP enzyme inhibitor causing deceased metabolism of many drugs--increasing drug
levels*
-many drug to drug interactions: warfarin, phenytoin, propanolol, nifidepine,
chlondiapoxide, diazepam, lidocaine, tricyclic antidepressants, theophylline,
metronidazole*
✔✔Why is famotidine (Pepcid) a good go to drug for H2 antagonist? - ✔✔-least CYP
inhibitor effect
-fewer drug to drug interactions
✔✔Why is it important to document a thorough assessment of different drugs the
patient has tried to relieve dyspepsia? - ✔✔-many insurance companies require a step-
wise approach to prescribing before approving
-antacids-->H2 blockers-->PPIs
✔✔What are the only lifestyle changes that could reduce the symptoms of GERD? -
✔✔-elevation of HOB
-weight loss
-avoiding meals 2-3 hours before bed
✔✔Plans for treating GERD begins with determining the severity of symptoms. True or
false? - ✔✔-true
-if a patient comes in with moderate-severe GERD OR erosive disease and they most
likely have already tried antacids and/or H2 blockers--next step is PPIs*
-if a patient comes in with mild GERD they may or may not have tried antacids, if so--try
H2 blockers*
✔✔It's very important to educate patients to take antacids & vitamins/iron supplements:
- ✔✔-at least 2 hours apart
-taking them together can cause little to no absorption of the vitamins/supplements and
may cause deficiencies
✔✔Pepto-Bismol (bismuth subsalicylate) take aways: - ✔✔-not known to be effective for
dyspepsia
-may change the color of stool to black
-Contraindicated in pregnancy, lactation, and children <12 due to aspirin content*
-antimicrobial, antisecretory, mild anti-inflammatory
-May cause black tongue
-could be used as adjunctive in tx of H. Pylori
✔✔What is metoclorpramide (Reglan)? - ✔✔-dopamine antagonist
-promotes gastric emptying (prokinetic)
, -tones the lower esophageal sphincter
-occasionally is used in pregnancy
-risk for tardive dyskinesia*
✔✔BLACK BOX WARNING: Reglan - ✔✔-chronic use is associated with tardive
dyskinesia
-can be irreversible
-should be avoided in all but rare cases where the benefits outweigh the risks
✔✔Reglan using during lactation? - ✔✔-may help increase maternal prolactin release
and used as a galactagogue to increase milk production significantly when effective--
can work in 1-2 days!
-AAP recommends avoiding use due to potential antidopaminergic effects on the infant
-however, dose given & amounts actually in breastmilk is much less than standard dose
given to an infant requiring the medication
-must weigh risks versus benefits
✔✔What is GERD? - ✔✔-dysfunction of the anti-reflux mechanism of the lower
esophageal sphincter
-goals are lifestyle changes & symptom relief
✔✔What is the fastest treatment for a patient with acute gastric distress? - ✔✔-antacids
-H2 antagonists & PPIs take more time to decrease the acid
✔✔What is a GI cocktail? What must you ALWAYS rule out before giving it? - ✔✔-used
for severe GI distress
-contains Maalox/Mylanta, Lidocaine, Donnatal
-Cardiac events must be ruled out--this cocktail could mask cardiac symptoms*
✔✔What are proton pump inhibitors (PPIs)? - ✔✔-anti-secretory
-stops the active production & pumping of acid out of the parietal cells by inhibiting
enzymes that produces gastric acid
-the strongest but takes the longest to work.
-Ex: omeprazole (Prilosec)*
✔✔What are the risks of taking PPIs? - ✔✔-decreased acid secretion can cause
decreased protein digestion--potentially causing B12, calcium, and magnesium
deficiencies* -risk for c.diff & pneumonia
-long term use may increase risk of fractures* (more with chronic use, higher doses,
multiple doses/day)
-potential for precancerous lesions--leading to gastric malignancy*
✔✔How do PPIs potentially set the stage for gastric malignancy? - ✔✔-long term use of
PPIs can cause hyperplasia of the stomach lining
-this is a precursor "precancerous lesion"
