1
Q
________ stimulate the production of mucus and can be inhibited by NSAIDs
A
Prostaglandins
2
Q
Side effects of NaHCO3?
A
systemic alkalosis, fluid retention
3
Q
Which are in Alka-Seltzer?
NaHCO3
CaCO3
Al(OH)3
Mg(OH)2
A
ASA + NAHCO3
4
Q
What are side effects of CaCO3?
A
hypercalcemia, nephrolithiasis, milk-alkali syndrome
5
Q
Which medications contain CaCO3?
Rolaids
Tums
Alka-Seltzer
Maalox
A
Rolaids- CaCO3 + Mg(OH)2
Tums- CaCO3
6
Q
What are side effects of Al(OH)3?
A
constipation, hypophosphatemia
7
Q
Which medications contain Al(OH)3?
AlternaGel
Rolaids
Tums
Alka-Seltzer
Maalox/Mylanta
Gaviscon
A
AlternaGel- Al(OH)3
Maalox/Mylanta- Al(OH)3 + Mg(OH)2
Gaviscon- Al(OH)3 + Mg(OH)2
8
Q
What is a side effect of Mg(OH)2?
A
Diarrhea
9
Q
Which medications contain Mg(OH)2?
AlternaGel
Rolaids
Tums
Alka-Seltzer
Maalox/Mylanta
Gaviscon
A
Rolaids- CaCO3 + Mg(OH)2
Maalox, Mylanta- Al(OH)3 + Mg(OH)2
Gaviscon- Al(OH)3 + Mg(CO)3
10
Q
Where is histamine secreted in the stomach?
A
Secreted from ECL and attaches to parietal cell
11
Q
Which are H2RAs?
Diphenhydramine
Benzimidazoles
Cimetidine
Vanoprazan
Famotidine
A
Diphenhydramine (Benadryl)
Cimetidine (Tagamet)
Famotidine (Pepcid)
12
Q
Which are PPIs?
Diphenhydramine
Benzimidazoles
Cimetidine
Vanoprazan
Famotidine
A
Benzimidazoles- Omeprazole (Prilosec) and Esomeprazole (Nexium)
Vanoprazan
13
Q
T/F: H2RAs are prodrugs
A
F: PPIs
14
Q
H2RAs or PPIs?: can result in Vit B12 deficiency
A
PPI
15
Q
H2RAs or PPIs?: irreversible inhibition
A
PPI
16
Q
Which are mucosal protectants?
Pepto-Bismol
Sucralfate (Carafate)
Vanoprazan
Misoprostol (Cytotec)
Bisacodyl (Dulcolax)
A
Sucralfate (Carafate)
Misoprostol (Cytotec)
17
Q
Which is contraindicated when avoiding aluminum?
Sucralfate (Carafate)
Tums
Alka-Seltzer
Maalox
A
Sucralfate and Maalox
18
Q
What is the first-line treatment method for H. Pylori and Peptic Ulcers?
A
Pepto-Bismol (Bismuth subsalicylate)
19
Q
Which laxatives are bulk and osmotic?
Castor Oil
MiraLax
Metamucil
Bisacodyl
GloLytely
A
Metamucil, Miralax, golytely
20
Q
What is the D2 dopamine receptor antagonist that blockades results to increase ACh release and anti-emetic effects?
Tegaserod (Zelnorm)
Linaclotide (Linzess)
Prucalopride (Motegrity)
Metoclopramide (Reglan)
A
Metoclopramide (Reglan)
21
Q
What is metoclopramide (Reglan)?
PPI
Prokinetic
H2RA
Mucosal Protectant
A
Prokinetic
22
Q
Which are opioid receptor antagonist used for GI disorders?
Prucalopride (Motegrity)
Lubiprostone (Amatiza)
Tegaserod (Zelnorm)
Metoclopramide (Reglan)
Linaclotide (Linzess)
A
Prucalopride (Motegrity)
Tegaserod (Zelnorm)
23
Q
Which are chloride channel activators used for GI disorders?
Prucalopride (Motegrity)
Lubiprostone (Amatiza)
Tegaserod (Zelnorm)
Metoclopramide (Reglan)
Linaclotide (Linzess)
A
Lubiprostone (Amatiza)
Linaclotide (Linzess)
24
Q
Symptoms or complications resulting from refluxed stomach contents into the esophagus or beyond into the oral cavity (including the larynx) or lung
A
GERD
25
What happens to LES pressure in GERD?
Lowers LES pressure
26
Which foods decrease LES pressure in GERD?
Fatty meals, Chocolate, Coffee, Tea, Garlic, Onions, Chili Peppers, Alcohol
27
What are direct irritants to esophageal mucosa?
Spicy foods, orange and tomato juice, coffee, tobacco
28
What common meds decrease LES pressure?
Caffeine, Nicotine, Estrogen, Progesterone
29
What common meds are a direct irritant to esophageal mucosa?
Aspirin (ASA), NSAIDs, Iron
30
Which diagnostic test is preferred for assessing mucosal injury and complications?
Upper endoscopy
Reflux (pH) test
Manometry
Barium Radiography
Upper endoscopy
31
Which diagnostic test useful for patients not responding to acid suppression after normal endoscopy?
Upper endoscopy
Reflux (pH) test
Manometry
Barium Radiography
Reflux (pH) test
32
Which diagnostic test useful for a patient who failed 2 trials of PPI with normal endoscopy findings?
Upper endoscopy
Reflux (pH) test
Manometry
Barium Radiography
Manometry
33
Which diagnostic test is not useful since it lacks sensitivity and specificity?
Upper endoscopy
Reflux (pH) test
Manometry
Barium Radiography
Barium Radiography
34
How many days of OTC without relief must occur before a PPI can be introduced?
14 days
35
What are the side effects of calcium?
Constipation; milk-alkali syndrome
36
What are the side effects of Aluminum?
Constipation; confusion, nephrotoxicity
37
What are the side effects of magnesium?
Diarrhea; Accumulation
38
When should medications be taken if taking antacids?
2 hrs before or 4-6hrs after antacids
39
What is tums?
Calcium carbonate
Magnesium hydroxide
Al + Mg
Al + Mg + Simethicone
Ca + Mg
Ca + Simethicone
calcium carbonate
40
what is milk of magnesia?
Calcium carbonate
Magnesium hydroxide
Al + Mg
Al + Mg + Simethicone
Ca + Mg
Ca + Simethicone
Magnesium hydroxide
41
What is Maalox/Gaviscon?
Calcium carbonate
Magnesium hydroxide
Al + Mg
Al + Mg + Simethicone
Ca + Mg
Ca + Simethicone
Al + Mg
42
What is Mylanta?
Calcium carbonate
Magnesium hydroxide
Al + Mg
Al + Mg + Simethicone
Ca + Mg
Ca + Simethicone
Al + Mg + Simethicone
43
What is Rolaids?
Calcium carbonate
Magnesium hydroxide
Al + Mg
Al + Mg + Simethicone
Ca + Mg
Ca + Simethicone
Ca + Mg
44
What is Alka-Seltzer?
Calcium carbonate
Magnesium hydroxide
Al + Mg
Al + Mg + Simethicone
Ca + Mg
Ca + Simethicone
Ca + Simethicone
45
Which has reversible/irreversible inhibitions?
PPIs vs H2RAs?
H2RAs: Reversible
PPIs: Irreversible
46
What is the first, second and third line therapy for a pregnant woman experiencing GERD?
1st- Lifestyle Mod
1st (Med)- antacids
2nd- H2RAs
3rd- PPI (EXCEPT Omeprazole)
47
What GI meds should be avoided when lactating?
PPIs and H2RAs
48
Where would pain be present in H.Pylori clinical presentation?
Duodenum>Stomach
49
Where would pain be present in NSAID clinical presentation?
Stomach>Duodenum
50
Where would pain be present in stresses clinical presentation?
Stomach>Duodenum
51
______ pain relieves while eating food, while ______ pain worsens while eating food
Duodenum pain relieves while eating food, while stomach pain worsens while eating food
52
What are the three main afflicters of peptic ulcer disease (PUD) ?
Bugs (H. Pylori), Drugs (NSAIDs), and Stress (Recovery)
53
What is the treatment method for H. Pylori?
PPI + 2-3 antibiotics
54
What is in quadruple therapy?
PPI BID, Bismuth Subsalicylate, Metronidazole, and Tetracycline
55
What are the two types of convenience packaging for H. Pylori quadruple therapy?
Helidac- 14 blister cards
Pylera- 3-in-1 capsule
56
Which treatment option contains triple, sequential and LOAD therapy?
Clarithromycin
Levofloxacin
Rifabutin
Levofloxacin
57
Which H. Pylori therapy does not contain amoxicillin?
Triple
Sequential
Quadruple (LOAD)
Hybrid
Bismuth Quadruple (LOAD)
58
Which H. Pylori therapy is salvage therapy?
Triple
Sequential
Quadruple (LOAD)
Hybrid
Triple in Rifabutin
Quadruple LOAD in Levofloxacin
59
Which regimen is best for macrolide exposure?
Triple
Sequential
Quadruple (LOAD)
Hybrid
Levofloxacin Triple or Sequential
60
What is the prophylaxis regimen used for NSAID induced PUD?
PPIs, H2RAs, Sucralfate while on NSAIDs
61
What is the treatment regimen for NSAID induced PUD?
PPIs, H2RAs, Sucralfate
8 wks if on NSAIDs stopped, 12 wks if continued
62
If NSAID therapy must be continued with potential PUD, which is recommended?
Naproxen
63
What locations are common for contagious diarrhea?
Daycares and Long-term care facilites
64
Norovirus causes what symptoms?
Diarrhea and vomiting
65
What are the four pathophysiological pathways of diarrhea?
Secretory, Osmotic, Exudative and Altered Intestinal transit
66
Which diarrheal pathway is characterized by a change in active ion transport either from a decrease in sodium absorption or increase in chloride secretion into the lumen?
Secretory
Osmotic
Exudative
Altered Intestinal Transit
Secretory
67
In secretory diarrhea, what ion transport change occurs? Is this altered by fasting?
Decrease sodium absorption and increase in chloride secretion into the lumen
Not altered by fasting
68
Which diarrheal pathway is a subset of secretory and is secondary to inflammatory disease of the bowel (IBD)?
Secretory
Osmotic
Exudative
Altered Intestinal Transit
Exudative
69
Which diarrheal pathway is caused when poorly absorbed substances are retained in intestinal fluids resulting in an influx of water and electrolytes into the lume?
Secretory
Osmotic
Exudative
Altered Intestinal Transit
Osmotic
70
What influx into the lumen in osmotic diarrhea? Is it altered by fasting state?
influx of water and electrolytes
Improves with fasting state
71
What questions should be asked is choosing the treatment method for diarrhea?
Is the drug
Indicated, Effective, Safe, Adherance/Convenient?
72
What diet is recommended in the treatment of diarrhea?
BRAT diet
73
In pharmacological treatment goals of diarrhea, we want to (increase/decrease) fluid accumulation in lumen, (increase/decrease) propulsive contractions, and (increase/decrease) mixing contractions
decrease fluid accumulation in lumen, decrease propulsive contractions, and increase mixing contractions
74
What can be taken to prevent travelers diarrhea?
Calcium carbonate
Antibiotics
Bismuth subsalicylate
Loperamide
Bismuth subsalicylate
75
What is the mild, moderate, and severe treatment options for travelers diarrhea?
Mild: Loperamide or BSS may be considered (antibiotics not recommended)
Mod: Antibiotic may be used, loperamide may be considered as monotherapy or adjunct
Severe: Antibiotics should be used (single dose preferred), Loperamide may be adjunct
76
Which diarrheal drug activates the mu opioid receptors on the smooth muscle of the bowel to reduce peristalsis?
antimotility drugs
77
What antimotility agent is used in the treatment of diarrhea that is OTC? Rx?
OTC: Loperamide (Imodium)
Rx: Combo Atropine
78
What is a serious risk associated with loperamide?
cardiac- QT prolongation
79
Which are absorbents?
Loperamide (Imodium)
Psyllium (Metamucil)
Bismuth subsalicylate (Pepto Bismol)
Polycarbophil (FiberCon)
Psyllium (Metamucil)
Polycarbophil (FiberCon)
80
Which are anti-motility?
Loperamide (Imodium)
Psyllium (Metamucil)
Bismuth subsalicylate (Pepto Bismol)
Polycarbophil (FiberCon)
Loperamide (Imodium)
81
Which are anti-secretory?
Loperamide (Imodium)
Psyllium (Metamucil)
Bismuth subsalicylate (Pepto Bismol)
Polycarbophil (FiberCon)
Bismuth subsalicylate (Pepto Bismol)
82
How often does constipation occur for it to be acute?
< 3 bowel movements per week
83
How often does constipation occur for it to be chronic?
symptoms lasting over 6 weeks
84
Agents with strong anti_______ properties care a common cause of constipation
anticholinergic
85
How should fiber be added to a diet of someone who is constipated?
Add high-fiber to diet slowly, increasing fiber over 7-10 days
86
Prunes and kiwifruit is used for (diarrhea/constipation/nausea/vomiting)
constipation
87
T/F: Docusate softens stools better than bulk laxatives
F: Bulk laxatives soften stools better than docusate
88
What surfactant decreases fecal surface tension (stool softener) to prevent constipation?
Docusate (DOSS)
89
What should be avoided in renal patients?
Milk of magnesia
Mineral oil
Docusate (DOSS)
Polyethylene Glycol (Miralax)
Metamucil
Stimulant Lax
Milk of magnesia
90
Which is excellent for chronic constipation?
Milk of Magnesia
Mineral Oil
Docusate (DOSS)
Polyethylene Glycol (Miralax)
Metamucil
Polyethylene Glycol (Miralax)
91
Which is the DOC for opioid induced constipation?
Milk of magnesia
Mineral oil
Docusate (DOSS)
Polyethylene Glycol (Miralax)
Metamucil
Stimulant Lax
Stimulant Lax- Senna and Bisacodyl
92
Which therapeutic option will give relief ASAP-1hr?
Citrate of Magnesia
Bisacodyl
Enema
Senna Tab
Glycerin Suppository
PEG
Milk of Magnesia
Enema, Bisacodyl or Glycerin suppository
93
Which therapeutic option will give relief within 3-6hrs?
Citrate of Magnesia
Bisacodyl
Enema
Senna Tab
Glycerin Suppository
PEG
Milk of Magnesia
Citrate of Magnesia and larger doses of PEG (Miralax)
94
Which therapeutic option will give relief within 24hrs?
Citrate of Magnesia
Bisacodyl
Enema
Senna Tab
Glycerin Suppository
PEG
Milk of Magnesia
Bisacodyl or senna tablets
95
Which therapeutic option will give relief within 48hrs?
Citrate of Magnesia
Biascodyl
Enema
Senna Tab
Glycerin Suppository
PEG
Milk of Magnesia
Milk of Magnesia and PEG (Miralax)
96
When should follow-up occur in acute constipation? Chronic?
Acute: 1-2 days
Chronic: 1-2 weeks
97
What is the first step (non-pharm) for nausea and vomiting?
Put gut to rest: clear liquid diet, IV hydration
98
What are the three important drug therapy options for treating nausea and vomiting?
Antihistamines/Anticholinergics
Serotonin Antagonists
Corticosteroids
99
Which is better tolerated in nausea and vomiting?
Antihistamines/Anticholinergics
Serotonin Antagonists
Corticosteroids
Corticosteroids
100
What two Antihistamines/Anticholinergics are mainly used in motion sickness?
Dimenhydrinate (Dramamine) and Meclizine (Bonine)
101
What medication is used for N/V Secondary to gastroenteritis pain?
Dimenhydrinate (Dramamine)
Ondansetron
Promethazine
Meclizine
Ondansetron
Promethazine
102
Which medication is used for post-op NV?
Aprepitant (Emend)
Lorazepam
Olanzapine
103
Why are the serotonin antagonist (-trons) more efficable in nausea and vomiting?
They have central and peripheral effects
104
What is the most common diagnoses GI disorder?
IBS
105
What diet is best for IBS?
Low FODMAP diet
106
What is the non-pharmacologic management recommended with IBS?
Physical activity and cognitive behavioral therapy
107
What is the step-wise treatment of IBS-C?
1. Increase fiber and fluid intact (avoiding foods making sympt worse)
2. Add bulk-forming lax
3. Consider anti-spasmodic or anticholinergic
4. Lubiprostone
... Serotonin (SSRIs)
108
What are non-pharm treatment options for IBS-D?
Manage stress and diet (lactose-free and caffeine-free)
109
What is the step-wise process for IBS-D treatment?
1. Dietary mods
2. Loperamide or anti-spasmodic
3. Serotonin-3 antagonist (Tricyclic antidepressants)
