NSG533 ACTUAL EXAM SCRIPT 2026
COMPLETE QUESTIONS AND ACCURATE
ANSWERS REVIEW SHEET
◉ NSAID induced ulcers
Prevention:.
Answer: Misoprostol or PPI. H2RAs not recommended for
prophylaxis.COX-2 inhibitors are associated with a significantly
lower incidence of gastric and duodenal ulcers when compared to
traditional NSAIDs. However, this beneficial effect is negated when
the patient is taking concomitant low-dose aspirin. The usefulness of
these agents has also been reduced by their association with
myocardial infarction and other thrombotic CV eventsCOX-2
inhibitors and NSAIDs to be discussed in more detail later in the
semester
Candidate for prophylaxis
◉ Candidate for prophylaxis.
Answer: History of prior gastrointestinal event
Age over 60 (5x greater risk)
High NSAID dosage
Concurrent use of corticosteroids (4x greater risk)
,Concurrent use of anticoagulants, antiplatelets or low dose ASA (12x
greater risk)
Treatment: Discontinue NSAID If possibleEradicate H Pylori if
(+)H2RAs or PPIsPPIs heal NSAID-related ulcers more effectively as
compared with H2RAs and are therefore the antisecretory drug of
choice for treating NSAID-related ulcers, especially when NSAIDs are
continuedPatients with NSAID-associated ulcers should be treated
with a PPI for a minimum of eight weeksSucralfate is an option for
healing only if NSAID will be stopped
◉ Constipation.
Answer: Approach to treatment should begin with determination of
cause(including medications a patient may be on table 21-
1)OpiatesAnticholinergics (eg. tricyclic antidepressant
(amitryptiline), diphenhydramine, benztropine, etc.)NDHP-CCB (eg
verapamil)Oral iron preparationsCalcium or aluminum
antacidsNSAIDsClonidineDiuretics
◉ Constipation treatment.
Answer: Non-pharmacological interventions first (diet (fiber),
exercise, fluids)Probiotics - limited data Best Pract Res Clin
Gastroenterol. 2011;25:119-126
PharmacologicalBulk forming agents (eg. methylcellulose
(Citrucel*))Administer 240 mL of water with each dose to prevent
esophageal / GI obstruction and worsening symptomPhysical
binding of other substances including medicationsSafe in
pregnancyEmollients (softeners) (eg. docusate (Colace*)Facilitate
, mixing of aqueous and fatty materials in the intestinal tractUsed for
prevention, NOT treatment. Commonly prescribed with medications
that may cause constipation (chronic opiate use, iron
supplementation)Safe in pregnancyLubricant laxative (mineral oil /
castor oil)Coats stool to allow easy passage / Prevents colonic water
absorptionSystemic absorption - can generate immune
responseAspiration - may lead to lipoid pneumoniaDecreases
absorption of fat-soluble vitamins a DO NOT use in
pregnancyHyperosmotics (eg. polyethylene glycol
(Miralax*))Osmotic effects to retain fluid in GI tractSafe in
pregnancySaline laxatives - Composed of relatively poorly absorbed
ions (Mg+ - sulfate, - phosphate, - citrate)(eg. MOM*)Osmotic effects
to retain fluid in GI tractMay be used occasionally to treat
constipation in otherwise healthy adultADRs: fluid and electrolyte
disturbances: Mg (renal dysfunction) or Na (CHF)
accumulationStimulant laxatives (Senna, Bisacodyl) (eg Sennokot*,
Dulcolox*)Only recommended for intermittent use - daily use
strongly discouragedNew agents available for specific use ONLY (eg.
IBS-C, OIC)NOT discussed in this course
◉ Summary of constipation recommendations.
Answer: Slow Transit ConstipationHyperosmotic laxativesSenna,
Bisacodyl and other stimulants are second line
Those who need to avoid straining (eg hemorrhoids, hernia,
MI)Stool softeners or PEG
ChildrenDiet, fluid exerciseAvoid under 6 years without
evaluationGlycerin suppository, docusate
COMPLETE QUESTIONS AND ACCURATE
ANSWERS REVIEW SHEET
◉ NSAID induced ulcers
Prevention:.
Answer: Misoprostol or PPI. H2RAs not recommended for
prophylaxis.COX-2 inhibitors are associated with a significantly
lower incidence of gastric and duodenal ulcers when compared to
traditional NSAIDs. However, this beneficial effect is negated when
the patient is taking concomitant low-dose aspirin. The usefulness of
these agents has also been reduced by their association with
myocardial infarction and other thrombotic CV eventsCOX-2
inhibitors and NSAIDs to be discussed in more detail later in the
semester
Candidate for prophylaxis
◉ Candidate for prophylaxis.
Answer: History of prior gastrointestinal event
Age over 60 (5x greater risk)
High NSAID dosage
Concurrent use of corticosteroids (4x greater risk)
,Concurrent use of anticoagulants, antiplatelets or low dose ASA (12x
greater risk)
Treatment: Discontinue NSAID If possibleEradicate H Pylori if
(+)H2RAs or PPIsPPIs heal NSAID-related ulcers more effectively as
compared with H2RAs and are therefore the antisecretory drug of
choice for treating NSAID-related ulcers, especially when NSAIDs are
continuedPatients with NSAID-associated ulcers should be treated
with a PPI for a minimum of eight weeksSucralfate is an option for
healing only if NSAID will be stopped
◉ Constipation.
Answer: Approach to treatment should begin with determination of
cause(including medications a patient may be on table 21-
1)OpiatesAnticholinergics (eg. tricyclic antidepressant
(amitryptiline), diphenhydramine, benztropine, etc.)NDHP-CCB (eg
verapamil)Oral iron preparationsCalcium or aluminum
antacidsNSAIDsClonidineDiuretics
◉ Constipation treatment.
Answer: Non-pharmacological interventions first (diet (fiber),
exercise, fluids)Probiotics - limited data Best Pract Res Clin
Gastroenterol. 2011;25:119-126
PharmacologicalBulk forming agents (eg. methylcellulose
(Citrucel*))Administer 240 mL of water with each dose to prevent
esophageal / GI obstruction and worsening symptomPhysical
binding of other substances including medicationsSafe in
pregnancyEmollients (softeners) (eg. docusate (Colace*)Facilitate
, mixing of aqueous and fatty materials in the intestinal tractUsed for
prevention, NOT treatment. Commonly prescribed with medications
that may cause constipation (chronic opiate use, iron
supplementation)Safe in pregnancyLubricant laxative (mineral oil /
castor oil)Coats stool to allow easy passage / Prevents colonic water
absorptionSystemic absorption - can generate immune
responseAspiration - may lead to lipoid pneumoniaDecreases
absorption of fat-soluble vitamins a DO NOT use in
pregnancyHyperosmotics (eg. polyethylene glycol
(Miralax*))Osmotic effects to retain fluid in GI tractSafe in
pregnancySaline laxatives - Composed of relatively poorly absorbed
ions (Mg+ - sulfate, - phosphate, - citrate)(eg. MOM*)Osmotic effects
to retain fluid in GI tractMay be used occasionally to treat
constipation in otherwise healthy adultADRs: fluid and electrolyte
disturbances: Mg (renal dysfunction) or Na (CHF)
accumulationStimulant laxatives (Senna, Bisacodyl) (eg Sennokot*,
Dulcolox*)Only recommended for intermittent use - daily use
strongly discouragedNew agents available for specific use ONLY (eg.
IBS-C, OIC)NOT discussed in this course
◉ Summary of constipation recommendations.
Answer: Slow Transit ConstipationHyperosmotic laxativesSenna,
Bisacodyl and other stimulants are second line
Those who need to avoid straining (eg hemorrhoids, hernia,
MI)Stool softeners or PEG
ChildrenDiet, fluid exerciseAvoid under 6 years without
evaluationGlycerin suppository, docusate
