NURS8024: MODULE 3 EXAM
QUESTIONS AND ANSWERS
Describe antacids. - Correct Answers -weak bases that react with gastric acid to form
water and salt, diminishing gastric acidity
acid-neutralizing ability depends on the capacity to neutralize gastric HCl and on
whether the stomach is full or empty
Therapeutic use of antacids. - Correct Answers -symptomatic relief of PUD (duodenal
more than gastric) and GERD
Ca-carbonate versions may be used off-label as Ca supplements for osteoporosis
goals of Tx: reduce or eliminate symptoms, decrease frequency and duration of GERD,
and promote healing of injured mucosa and prevent complications
List some commonly used antacid drug classes. - Correct Answers -calcium salts: ca-
carbonate (Tums)
sodium bicarbonate (Alka-Seltzer)
aluminum salts: al-hydroxide (Amphojel), al-carbonate (Basajel)
magnesium salts/oxide (Milk of Magnesia)
combination products: al-hydroxide + mg-hydroxide (Maalox, Mylanta), alginic acid +
mg-trisilicate + ca-stearate (Gaviscon)
List some adverse effects of antacids. - Correct Answers -al-hydroxide: constipation
mg-hydroxide: diarrhea
aluminum containing antacids: binding of phosphate (hypophosphatemia)
sodium bicarb: belching, flatulence, systemic alkalosis
antacids with sodium: problematic in HTN and CHF
excessive intake of ca-carbonate w/ ca-foods: hypercalcemia
,can cause drug interactions with cartain drugs (e.g. ABX)
List some patient variables to consider for antacids. - Correct Answers -Geriatrics: avoid
mg-antacids with renal failure, avoid na-antacids d/t fluid retention
Peds: safety not established
Preg/Lact: no FDA category established, generally safe
Describe mucosal protective agents. - Correct Answers -cytoprotective compounds that
enhance mucosal protection mechanisms, prevent mucosal injury, decrease
inflammation, and promotes healing of existing ulcers
Sucralfate - Correct Answers -mucosal protective agent
complex of al-hydroxide and sulfated sucrose
becomes gel in the stomach, binds to injured tissue, and forms a physical barrier over
the ulcer bed
accelerates healing of peptic ulcers and decreases recurrence (with LT use)
is difficult to maintain pt adherence: interferes with absorption of other substances and
must be taken QID
requires an acidic pH for activation (do not use with H2/PPI)
Describe bismuth compounds. - Correct Answers -mucosal protective agents, MOA
unclear
bismuth subcitrate potassium - combination Rx with metronidazole and tetracycline for
H. pylori
bismuth subsalicylate (OTC) - coats ulcers & protects against pepsin and acid,
antimicrobial effect binds enterotoxins, decreases stool frequency & liquidity in AID,
causes black stools (harmless), avoid in renal insufficiency
Describe antisecretory agents. - Correct Answers -Histamine 2-Antagonists & Proton
Pump Inhibitors
H2RA - ranitidine, cimetidine, famotidine, nizatidine
THINK: histamINE = drugs end in -dINE
PPI - omeprazole, esomeprazole, lansoprazole, pantoprazole, rabeprazole
, THINK: prOton pump inhibitors = end in -zOle
List indications for H2RAs. - Correct Answers -duodenal ulcer treatment and
maintenance
gastric ulcer treatment
GERD
pathologic hypersecretory conditions
List indications for PPIs. - Correct Answers -gastric and duodenal ulcers
GERD
pathologic hypersecretory conditions
H. pylori
Describe H2RAs. - Correct Answers -MOA: acts selectively on H2Rs in stomach, blood
vessels, and other sites; blocks binding of histamine (less effective than PPIs for
stimulated secretion)
Clinical Use: inhibit gastric acid secretion, better for basal secretion (at night and when
fasting)
Dosing: early evening is optimal time
ADEs: very safe; <3% of pts will have diarrhea, HA, fatigue, myalgias, and constipation
do NOT use for NSAID-induced ulcers or active ulcers (use PPIs instead)
Interactions: may interfere with drugs that require acidic medium for absorption (e.g.
ketoconazole, iron)
Describe some precautions to consider when using cimetidine. - Correct Answers -
inhibits CYP450 system and can slow metabolism of other drugs (warfarin, diazepam,
phenytoin, quinidine, carbamazepine, theophylline and imipramine)
can have endocrine effects - antiandrogen (gynecomastia, galactorrhea, reduced sperm
count)
Describe PPIs: - Correct Answers -MOA: inhibits the H+/K+-ATPase proton pump,
suppresses secretion of hydrogen ions into the gastric lumen and thus gastric acid
secretion
QUESTIONS AND ANSWERS
Describe antacids. - Correct Answers -weak bases that react with gastric acid to form
water and salt, diminishing gastric acidity
acid-neutralizing ability depends on the capacity to neutralize gastric HCl and on
whether the stomach is full or empty
Therapeutic use of antacids. - Correct Answers -symptomatic relief of PUD (duodenal
more than gastric) and GERD
Ca-carbonate versions may be used off-label as Ca supplements for osteoporosis
goals of Tx: reduce or eliminate symptoms, decrease frequency and duration of GERD,
and promote healing of injured mucosa and prevent complications
List some commonly used antacid drug classes. - Correct Answers -calcium salts: ca-
carbonate (Tums)
sodium bicarbonate (Alka-Seltzer)
aluminum salts: al-hydroxide (Amphojel), al-carbonate (Basajel)
magnesium salts/oxide (Milk of Magnesia)
combination products: al-hydroxide + mg-hydroxide (Maalox, Mylanta), alginic acid +
mg-trisilicate + ca-stearate (Gaviscon)
List some adverse effects of antacids. - Correct Answers -al-hydroxide: constipation
mg-hydroxide: diarrhea
aluminum containing antacids: binding of phosphate (hypophosphatemia)
sodium bicarb: belching, flatulence, systemic alkalosis
antacids with sodium: problematic in HTN and CHF
excessive intake of ca-carbonate w/ ca-foods: hypercalcemia
,can cause drug interactions with cartain drugs (e.g. ABX)
List some patient variables to consider for antacids. - Correct Answers -Geriatrics: avoid
mg-antacids with renal failure, avoid na-antacids d/t fluid retention
Peds: safety not established
Preg/Lact: no FDA category established, generally safe
Describe mucosal protective agents. - Correct Answers -cytoprotective compounds that
enhance mucosal protection mechanisms, prevent mucosal injury, decrease
inflammation, and promotes healing of existing ulcers
Sucralfate - Correct Answers -mucosal protective agent
complex of al-hydroxide and sulfated sucrose
becomes gel in the stomach, binds to injured tissue, and forms a physical barrier over
the ulcer bed
accelerates healing of peptic ulcers and decreases recurrence (with LT use)
is difficult to maintain pt adherence: interferes with absorption of other substances and
must be taken QID
requires an acidic pH for activation (do not use with H2/PPI)
Describe bismuth compounds. - Correct Answers -mucosal protective agents, MOA
unclear
bismuth subcitrate potassium - combination Rx with metronidazole and tetracycline for
H. pylori
bismuth subsalicylate (OTC) - coats ulcers & protects against pepsin and acid,
antimicrobial effect binds enterotoxins, decreases stool frequency & liquidity in AID,
causes black stools (harmless), avoid in renal insufficiency
Describe antisecretory agents. - Correct Answers -Histamine 2-Antagonists & Proton
Pump Inhibitors
H2RA - ranitidine, cimetidine, famotidine, nizatidine
THINK: histamINE = drugs end in -dINE
PPI - omeprazole, esomeprazole, lansoprazole, pantoprazole, rabeprazole
, THINK: prOton pump inhibitors = end in -zOle
List indications for H2RAs. - Correct Answers -duodenal ulcer treatment and
maintenance
gastric ulcer treatment
GERD
pathologic hypersecretory conditions
List indications for PPIs. - Correct Answers -gastric and duodenal ulcers
GERD
pathologic hypersecretory conditions
H. pylori
Describe H2RAs. - Correct Answers -MOA: acts selectively on H2Rs in stomach, blood
vessels, and other sites; blocks binding of histamine (less effective than PPIs for
stimulated secretion)
Clinical Use: inhibit gastric acid secretion, better for basal secretion (at night and when
fasting)
Dosing: early evening is optimal time
ADEs: very safe; <3% of pts will have diarrhea, HA, fatigue, myalgias, and constipation
do NOT use for NSAID-induced ulcers or active ulcers (use PPIs instead)
Interactions: may interfere with drugs that require acidic medium for absorption (e.g.
ketoconazole, iron)
Describe some precautions to consider when using cimetidine. - Correct Answers -
inhibits CYP450 system and can slow metabolism of other drugs (warfarin, diazepam,
phenytoin, quinidine, carbamazepine, theophylline and imipramine)
can have endocrine effects - antiandrogen (gynecomastia, galactorrhea, reduced sperm
count)
Describe PPIs: - Correct Answers -MOA: inhibits the H+/K+-ATPase proton pump,
suppresses secretion of hydrogen ions into the gastric lumen and thus gastric acid
secretion
