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PC707 Module 3 Questions Correct Answers 2025Version, Exams of Pharmacology

Chapman UniversityPharmacology

What are the main pharmacologic categories of drugs we used to manage gastric acid secretion and the effects: - ✔✔ -antacids -H2 receptor antagonists -proton pump inhibitors (PPIs) -prostoglandin analogs -mucosal protectant sulcrafate (Carafate)

Typology: Exams

2024/2025

Available from 07/14/2025

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PC707 Module 3 Questions | Correct
Answers |2025Version
Anti-Ulcer drugs help by: - ✔✔
-altering gastric pH by decreasing acid secretion
-protecting the stomach wall lining by increasing mucosal protection
-eradicating harmful bacteria Ex: H. Pylori
What are the main pharmacologic categories of drugs we used to manage gastric acid secretion and the
effects: - ✔✔
-antacids
-H2 receptor antagonists
-proton pump inhibitors (PPIs)
-prostoglandin analogs
-mucosal protectant sulcrafate (Carafate)
What is the first OTC medication tried by patients with dyspepsia? - ✔✔-Antacids
-->these are typically not effective for persistant GERD and PUD
What are antacids? How do they work? - ✔✔-organic salts
-neutralize the hydrochloric acid in the stomach
-raises the gastric pH above 4.0
What are the main side effects of antacids? - ✔✔-diarrhea
-constipation
What are the different categories of antacids? - ✔✔-calcium carbonate
-sodium bicarbonate
-aluminum based
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Partial preview of the text

Download PC707 Module 3 Questions Correct Answers 2025Version and more Exams Pharmacology in PDF only on Docsity!

PC707 Module 3 Questions | Correct

Answers | 2025 Version

Anti-Ulcer drugs help by: - ✔✔

  • altering gastric pH by decreasing acid secretion
  • protecting the stomach wall lining by increasing mucosal protection
  • eradicating harmful bacteria Ex: H. Pylori What are the main pharmacologic categories of drugs we used to manage gastric acid secretion and the effects: - ✔✔
  • antacids
  • H 2 receptor antagonists
  • proton pump inhibitors (PPIs)
  • prostoglandin analogs
  • mucosal protectant sulcrafate (Carafate) What is the first OTC medication tried by patients with dyspepsia? - ✔✔-Antacids -->these are typically not effective for persistant GERD and PUD What are antacids? How do they work? - ✔✔-organic salts
  • neutralize the hydrochloric acid in the stomach
  • raises the gastric pH above 4. What are the main side effects of antacids? - ✔✔-diarrhea
  • constipation What are the different categories of antacids? - ✔✔-calcium carbonate
  • sodium bicarbonate
  • aluminum based
  • magnesium based
  • aluminum hydroxide What is important teaching for patients taking antacids? - ✔✔-decreasing the stomach pH can cause the decrease absorption of drugs that rely on acidic conditions
  • if taking enteric coated medications--reducing stomach acid can cause the medication to dissolve and absorb in the stomach instead of the intestine always separate antacids from other medications by 2 hours Calcium carbonate antacids: - ✔✔-Tums
  • can cause CONSTIPATION
  • require adequate fluid intake to dissolve
  • can be used in patients needing to take an antacid who also could benefit from extra calcium intake. - potential for milk "alkali" syndrome, metabolic alkalosis Sodium Bicarbonate antacids: - ✔✔-Alka Seltzer
  • contains aspirin (ASA)
  • potential to WORSEN GI distress. - increased risk for water retention and fluid overload
  • potential to cause hypertension
  • Contraindicated in pregnancy, children, patient with CVD* Aluminum based antacids: - ✔✔-Amphogel
  • can cause CONSTIPATION
  • requires adequate fluid intake to dissolve
  • Contraindicated in patients with renal insufficiency* Magnesium based antacids: - ✔✔-Milk of magnesia
  • suspension mixture is more effective
  • can cause DIARRHEA
  • Contraindicated in renal insufficiency*

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 H 2 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
  • H 2 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*
  • contraindicated in pregnancy (category X) UNLESS for cervical ripening--can cause uterine contractions*
  • not recommended in lactation--limited information What is mucosal protectant sulcrafate (Carafate)? - ✔✔-does not neutralize or decrease acid
  • promotes ulcer healing by coating the ulcers with a gel like substance that creates a barrier against pepsin & acids
  • very few drug-drug interactions or adverse effects—however, can decrease absorption of certain drugs in particular warfarin, theophylline, digoxin, phenytoin* What is important to remember if a patient is going to stop taking a PPI? - ✔✔-they must wean off of it slowly
  • if they abruptly stop--it could cause rebound hyperacidity* What is Peptic Ulcer Disease (PUD)? - ✔✔-erosion of the GI mucosa
  • typically caused by H. Pylori (gram - bacillus)*
  • multi-drug regimens are needed to treat due to high resistance (lack of compliance due to cost & multi- drug plan)*
  • goals are symptom relief, gastric & duodenal mucosa healing, and prevention of complications and reoccurrence H. Pylori increases the risk for: - ✔✔-gastric cancer—due to chronic inflammation What is the step-wise approach to managing GERD? - ✔✔-lifestyle changes-->antacids-->H2 blockers--

PPIs for 8 weeks then reassess to possibly wean-->if erosive esophagitis/Barrets continue on PPI and reassess every 6 - 12 months with potential referral-->if no response to PPI refer to GI specialist

  • important to remember--symptom severity dictates where you start in the treatment* Quadruple therapy is the new recommendation in the treatment for H. Pylori except in the rare case that: - ✔✔-local clarithromycin resistance rates are less than 20 %
  • resistance rates are very important to consider when prescribing antibiotics*

Are PPIs safe in pregnancy and lactation? - ✔✔-limited data available but data is reassuring and indicates no teratogenicity

  • animal studies of Prilosec* have showed teratogenic effects but was not found in subsequent studies
  • only use if other choices do not work
  • potentially reassess for reasons H 2 blockers and antacids didn't work and reconsider lifestyle
  • mixed safety in lactation--best to avoid if possible What are some lifestyle changes that can help with constipation? - ✔✔-increased fiber intake
  • fluids
  • regular exercise
  • set consistent bowel habits What is the first line treatment for constipation if lifestyle changes do not work? (Non-pregnant patient)
  • ✔✔-hyperosmotic laxatives--safer profile What are the different classes of laxatives? - ✔✔-osmotic
  • bulk-forming
  • surfactant
  • stimulant
  • "lubricant"--glycerin suppositories
  • "others"--lactulose & mineral oil Contraindications for use of any class of laxatives: - ✔✔-undiagnosed abdominal pain, nausea, vomiting, or suspected bowel obstruction
  • symptoms could indicate appendicitis, regional enteritis, diverticulitis, ulcerative colitis, or bowel obstruction* Why is bowel obstruction a contraindication for using laxatives? - ✔✔-increasing peristalsis could cause bowel perforation* What are the different types of osmotic laxatives? What are the common side effects? - ✔✔-sodium & magnesium salts
  • potential to cause esophageal obstruction or bowel obstruction*
  • avoid in patients with narrow esophageal lumen* What are surfactant laxatives? - ✔✔-"stool softeners"
  • ducousate sodium (Colace)
  • decreases surface tension to allow water to move into stool
  • alters the stool consistency
  • works in 1 - 3 days
  • daily use may cause bowel dependence What is mineral oil used for? - ✔✔-used as a surfactant laxative
  • works in 1 - 3 days
  • it can cause decreased absorption of fat soluble vitamins causing vitamin deficiencies (A, D, E, K) What are stimulant laxatives? - ✔✔- Increases peristalsis by intestinal nerve stimulation
  • Increased water & electrolytes in the intestinal lumen
  • acts as an "irritant"
  • only use as last resort
  • use with caution--overuse can cause bowel dependence
  • works in 6 - 12 hours
  • Ex: bisacodyl (Dulcolax) & senna (Senokot or Ex-lax) & Castor oil What do some people abuse stimulant laxatives for? - ✔✔-eating disorders What is the first line for constipation in pregnancy--after lifestyle & diet changes? - ✔✔-bulk-forming laxatives
  • these have very low systemic absorption What is important to remember when choosing a laxative in pregnancy? - ✔✔-some laxatives can stimulate peristalsis and may cause uterine contractions
  • stimulant laxatives are contraindicated in pregnancy
  • Ex: castor oil--category X What is important to monitor when giving laxatives to the elderly? - ✔✔-monitor for dehydration Which laxatives are deemed the safest in pregnancy and lactation? - ✔✔-bulk-forming laxatives (Metamucil or Citrucel)
  • glycerin suppositories What alternative laxatives could be used in pregnancy & lactation? - ✔✔Pregnancy:
  • ducosate sodium (Colace) is category C in pregnancy Lactation:
  • Colace & Senokot is safe in breastfeeding Rectal enemas in pregnancy? - ✔✔-strictly contraindicated during pregnancy--may cause pre-term labor Functional constipation? - ✔✔-infrequent or painful defecation, fecal incontinence, and abdominal pain
  • no underlying organic cause
  • common in children What are some red flags in children who come in with "constipation"? - ✔✔-constipation starting < 1 month old
  • passage of meconium > 48 hours old
  • family history of Hertzsprung Disease (HD)
  • blood in stool
  • failure to thrive
  • fever
  • bilious vomiting
  • severe abdominal distention

What treatment options are available for travelers diarrhea? - ✔✔-if bacterial--first line is now a macrolide (azthromycin)*

  • if salmonella, giardia, E. histolyic--Flagyl could be used (no alcohol with use)* Should you treat every person with travelers diarrhea? - ✔✔-there is faster relief with antibiotics & anti motility drugs
  • however, do not treat unless it's severe
  • it may cause acute retention of the offending pathogen Would you give a patient an antibiotic to "prevent" travelers diarrhea before they travel? - ✔✔-NO
  • this leads to antibiotic resistance What is the first line anti-motility drug in pregnancy & lactation? - ✔✔-loperamide (Imodium)-category B--minimal oral absorption and minimal in breast milk AVOID Pepto-Bismol in pregnancy & lactation due to salicylate content What are some potential herbals that could be used for constipation? - ✔✔-black psyllium
  • blond psyllium
  • prunes Black psyllium: - ✔✔-can be used for constipation
  • adverse effects are transient flatulence & abdominal distention
  • make sure to consume enough water to avoid esophageal & bowel obstructions* Blond psyllium: - ✔✔-can be used for constipation
  • as effective as Senokot & Colace
  • not as effective as prunes* Prunes: - ✔✔-can be used for mild or moderate constipation
  • safe, palatable, and more effective than psyllium

What is irritable bowel syndrome (IBS)? - ✔✔-functional

  • no specific organic pathology
  • abdominal pain, altered bowel habits, and abdominal distention
  • can be predominately constipation, diarrhea, or alternating
  • said to have "excessive" bacteria
  • goals are symptom relief* What treatments are available for IBS? - ✔✔-exercise
  • broad spectrum antibiotics (rifaximin-Xifaxan)--to help "reduce" the number of bacteria colonizing--to decrease symptoms
  • antispasmodics (dicyclomine-Bentyl)
  • peppermint oil
  • probiotics (bifidobacteria)
  • diet changes (low FODMAP)
  • antidepressant (SSRIs & try-cyclic)--decreases abdominal pain unrelated to decreasing depression*
  • anti-diarrheals (loperamide-Imodium) Why is a FODMAP used in treatment of IBS? - ✔✔-"fermentable, oligosaccharides, disaccharides, monosaccharides, and polyols"
  • foods high in these often cause bloating, abdominal pain, gas
  • eliminate all foods high in these for 3 - 8 weeks then slowly reintroduce them into diet to determine which are tolerable and which aren't What are the effectiveness of probiotics? - ✔✔-the effectiveness is species, dose, and disease specific
  • can help stabilize the "normal gut flora"
  • they can help decrease flatulence and abdominal pain Contraindicated in those who are immunocompromised What are the two most commonly used probiotics? - ✔✔-Bifidobacteria or Lactobacillus
  • 5 - HT3 antagonists
  • NK1 antagonists
  • anticholinergics
  • accupressure
  • ginger How is N/V induced in the body? - ✔✔*Direct acting stimuli activate the vomiting center directly--signals from cerebral cortex (anticipation, fear, worry), signals from sensory organs (taste, smell, etc.), signals from vestibular inner ear *Indirect acting stimuli activate the chemoreceptor trigger zone which then activates the vomiting center--stomach and small intestine (vagal response), emetogenic drugs (opiods, etc.) *once the vomiting center is activated--coordinated response to the stomach, diaphragm and abdominal muscles to expel gastric contents How can peppermint oil be used in treatment of IBS? - ✔✔-causes antispasmodic effect on intestinal muscles, anti-inflammatory, antimicrobial, and reduces gastric motility
  • can decrease abdominal pain, distention, flatulence
  • can only take up to 8 weeks safely*
  • adverse effect--heartburn* Which anti-emetic medications must be used cautiously in patients with glaucoma, seizure disorder, and CVD? - ✔✔-antihistamines & anticholinergics these are contraindicated in patients with severe liver disease What are the common side effects of antihistamines & anticholinergics? - ✔✔-drowsiness
  • dry mouth
  • blurred vision
  • urinary retention
  • flushed

anticholinergic effects Antihistamines may produce what opposite effect in children? - ✔✔-hyperactivity What is the Black box warning for Promethazine? - ✔✔-respiratory depression can be SEVERE

  • deaths have occurred
  • contraindicated in children < 2 years old*
  • use with extreme caution in children > 2 years old Anti-histamines: - ✔✔-Ex: diphenhydramine (Benadryl)
  • helps reduce nausea and vomiting
  • blocks histamine receptors & can also block dopamine 2 receptors
  • main adverse effect is drowsiness
  • usually used for motion sickness and morning sickness
  • causes anticholinergic effects Phenothiazines: - ✔✔-Ex: promethazine (Phenergan)
  • helps reduce nausea and vomiting
  • blocks dopamine 2 receptors in the chemoreceptor trigger zone which blocks cholinergic, alpha 1 , and histamine receptors
  • sedating
  • may cause extrapyramidal symptoms like tardive dyskinesia*
  • can suppress cough
  • contraindicated in children less than 2 years old and people with parkinsons* Anticholinergics: - ✔✔-Ex: transdermal scoplamine patch
  • help reduce nausea and vomiting, especially due to motion sickness
  • competitively inhibits muscarinic receptors in the parasympathetic nervous system
  • should be avoided in the elderly whenever possible*
  • crosses the BBB*
  • CYP 450 inhibitor & inducer--drug interactions are complex
  • usually for chemo-induced nausea
  • antidepressant, antianxyolytic, and antiemetic What is the step-wise approach when treating N/V in pregnancy? - ✔✔-lifestyle and diet changes first (small frequent meals, avoiding odors, foods, supplements that trigger nausea)
  • then try non pharmacological methods such as ginger or acupressure
  • then try OTC or prescription medications What is important pre-conception education to help prevent or reduce N/V in pregnancy? - ✔✔-taking prenatal vitamins one month before conception can greatly reduce N/V in pregnancy What is the recommendation for ginger use in pregnancy in the treatment of nausea? - ✔✔- 1 g/day spaced out over 24 hours (level B evidence)
  • works more effectively for nausea rather than vomiting What are Sea-bands? - ✔✔-passive acupressure bands applied to the wrist
  • particular pressure on the P 6 pressure point (three cm on the inner side of the wrist between the two tendons)
  • can prevent and/or relieve nausea and vomiting How does B 6 help reduce N/V? - ✔✔-helps the metabolism of fats & proteins
  • helps the body make certain neurotransmitters that may play a role What is in Diclectin or Diclegis? Is it safe in pregnancy? - ✔✔-combination of B 6 (pyroxidine) & Doxylamine (antihistamine)
  • B6 alone or this combination together is safe and effective and considered a 1 st line pharmacologic treatment for N/V in pregnancy (level A evidence) What is methylpredinisolone & dexamethasone? Are they safe in pregnancy? - ✔✔-steroids
  • sometimes used in the treatment of N/V
  • should only be used a last resort (level B evidence)
  • DO not use until at least 10 weeks gestation--could cause congenital defects What are oral ulcers? - ✔✔-aphthous ulcers
  • "canker sores"
  • open sores in the buccal mucosa related to mediators of inflammation
  • can be triggered by trauma, stress, vitamin/mineral deficiencies What is stomatitis? - ✔✔-open sores in the buccal mucosa related to inflammation from viruses
  • can be triggered by trauma, stress, vitamin/mineral deficiencies What is the goal for treatment of canker sores and stomatitis? What OTC medications could be used? - ✔✔-correct the potential underlying problem (vitamin deficiency etc)
  • pain control
  • peroxide half strength after meals for cleaning
  • orajel or orabase--contains benzocaine--avoid in children < 2 or those with an allergy* What are some prescription medications to treat "few ulcers" such as canker sores? - ✔✔-aphthasol (Amlexanox) *discontinued in the US
  • topical steroid (triamcinolone dental paste)* What are some prescription mediations to treat "multiple ulcers in the case of stomatitis? - ✔✔-steroid solution (dexamethasone elixir) used as a mouth rinse
  • magic mouthwash--mixture of lidocaine, maalox, and diphenhydramine--swish and swallow 5 mL no more than every 4 hours (most common)* What are DMARDS? - ✔✔-immunosuppressive drugs that target specific components of the inflammatory process (TNF cells, T cells, B cells, etc.)
  • most patients who use these drugs show improvement but some have a paradoxical effect that aggravates or worsens*