NR 565 Final Exam (Advanced Pharmacology)
Questions WITH CORRECT VERIFIED
ANSWERS GRADED A+ || 100%
GUARANTEED PASS NEWEST VERSION
Metoclopramide (Reglan) ADR - Answer tardive dyskinesia, depression,
dizziness, diarrhea, hypoglycemia (diabetics)
Metoclopramide (Reglan) drug interactions - Answer increase CNS depression
with other CNS depressant drugs,
increased risk for EPs with other drugs that cause EPs, anticholinergics reverse
action of Reglan
Proton Pump Inhibitors (PPIs) MOA - Answer antisecretory; inhibit
H+/K+/ATpase enzyme system secretory surface or parietal cell; suppress gastric
acid secretion up to 72 hours
Proton Pump Inhibitors (PPIs) indications - Answer hyperacidity, duodenal &
gastric ulcers, erosive gastritis, Zollinger-Ellison syndrome, part of regimen for
PUD, GERD
Proton Pump Inhibitors (PPIs) - Answer omeprazole (Prilosec), esomeprazole
(Nexium), pantoprazole (Protonix), lansoprazole (Prevacid), dexlansoprazole
(Dexilant), rabeprazole (Aciphex)
,PPI Precautions/Contraindications - Answer caution in: hepatic dysfunction, &
elderly
contraindicated:
protonix & rabeprazole in children <12
PPI ADRs - Answer nutrient deficiencies: decreased iron, B12, & Ca+ (long-
term use, increases risk for osteoporosis and fractures, increased risk for c-diff,
samonella, and campy,
increases risk for PNA (short-term), ? causes gastric cancer
PPI drug interactions - Answer CYP 450 enzymes, decreased effects of certain
antivirals, decreases absorption of ketoconazole, ampicillin, digoxin, and iron salts,
monitor INR with coumadin and PPIs
PPI black box warning - Answer Plavix and omeprazole: decreases the active
metabolite of Plavix by 46%= decreased effectiveness
PPI monitoring - Answer patients on PPI for ulcer= test for H. pylori, stop PPI
therapy x 2 weeks for H. pylori breath test or stool test.
GERD management - Answer 1. Non-pharm measures
- Elevate head of bed
- Avoid alcohol, caffeine, spices, peppermint, etc
- Stop smoking
- Weight reduction if obese
2. Antacids PRN
3. H2 blockers ("-tidines") in high doses at night or divided BID dosing
,4. PPIs ("-zoles") if H2 blockers are ineffective
5. GI/surgical consult PRN
PPI therapy for mod to severe GERD - Answer PPI daily x 8 weeks, 30-60
mins before breakfast; tailored to symptom relief; if no relief after 3 months=refer
to GI specialist;
PPI step up or step down approach - Answer if no symptom relief in 8 weeks,
increase PPI to BID for 4-8 weeks; if symptom free for 4 weeks step down to daily
PPI & reassess in 6-12 months; no symptom relief in 8 weeks=refer
PUD stepped-approach algorithm - Answer Step 1: lifestyle
modification/antacids
Step 2: H. pylori testing/PPI
Step 3 (uncomplicated): tx for H.pylori
Step 4 (uncomplicated): PPI continues for 8-12 weeks until healed
Step 5 (uncomplicated, low risk): no on-going therapy
Step 5 (uncomplicated, high risk): PPI or H2RA (smokers, >60, CPOD, CAD, hx
of bleeding, ulcers or NSAIDs)
Step 3 (complicated, bleeding): refer to GI for endoscopy
Step 4 (complicated): tx for H. pylori
Step 5 (complicated): repeat endoscopy in 12 weeks to determine healing
1st line triple therapy for H. Pylori - Answer 1.) PPI BID
2.) clarithromycin 500 mg BID or metronidazole 500 mg BID
3.) amoxicillin 1G BID
x 10-14 days
, 2nd line therapy for H. Pylori with PCN allergy - Answer 1.) PPI BID
2.) clarithromycin 500 mg BID
3.) metronidazole 500 mg BID
x 7-14 days
2nd line therapy or rescue therapy for H. Pylori - Answer 1.) PPI BID
2.) levofloxacin 250-500 mg BID
3.) amoxicillin 1G BID
x 10-14 days
IBS with constipation treatment - Answer lupiprastone (Amitiza)
Traveler's Diarrhea Treatment - Answer bismuth subsalicylate (pepto-bismol) 2
tablets or 2 oz before each meal and at HS;
High risk destinations for traveler's diarrhea - Answer Central & South
American, Africa, Middle East, Mexico, Asia,
Intermediate risk destinations for traveler's diarrhea - Answer eastern Europe,
South Africa, and Caribbean Islands
the most common cause of Traveler's diarrhea - Answer E. coli
other causes of traveler's diarrhea - Answer 2) campy
Questions WITH CORRECT VERIFIED
ANSWERS GRADED A+ || 100%
GUARANTEED PASS NEWEST VERSION
Metoclopramide (Reglan) ADR - Answer tardive dyskinesia, depression,
dizziness, diarrhea, hypoglycemia (diabetics)
Metoclopramide (Reglan) drug interactions - Answer increase CNS depression
with other CNS depressant drugs,
increased risk for EPs with other drugs that cause EPs, anticholinergics reverse
action of Reglan
Proton Pump Inhibitors (PPIs) MOA - Answer antisecretory; inhibit
H+/K+/ATpase enzyme system secretory surface or parietal cell; suppress gastric
acid secretion up to 72 hours
Proton Pump Inhibitors (PPIs) indications - Answer hyperacidity, duodenal &
gastric ulcers, erosive gastritis, Zollinger-Ellison syndrome, part of regimen for
PUD, GERD
Proton Pump Inhibitors (PPIs) - Answer omeprazole (Prilosec), esomeprazole
(Nexium), pantoprazole (Protonix), lansoprazole (Prevacid), dexlansoprazole
(Dexilant), rabeprazole (Aciphex)
,PPI Precautions/Contraindications - Answer caution in: hepatic dysfunction, &
elderly
contraindicated:
protonix & rabeprazole in children <12
PPI ADRs - Answer nutrient deficiencies: decreased iron, B12, & Ca+ (long-
term use, increases risk for osteoporosis and fractures, increased risk for c-diff,
samonella, and campy,
increases risk for PNA (short-term), ? causes gastric cancer
PPI drug interactions - Answer CYP 450 enzymes, decreased effects of certain
antivirals, decreases absorption of ketoconazole, ampicillin, digoxin, and iron salts,
monitor INR with coumadin and PPIs
PPI black box warning - Answer Plavix and omeprazole: decreases the active
metabolite of Plavix by 46%= decreased effectiveness
PPI monitoring - Answer patients on PPI for ulcer= test for H. pylori, stop PPI
therapy x 2 weeks for H. pylori breath test or stool test.
GERD management - Answer 1. Non-pharm measures
- Elevate head of bed
- Avoid alcohol, caffeine, spices, peppermint, etc
- Stop smoking
- Weight reduction if obese
2. Antacids PRN
3. H2 blockers ("-tidines") in high doses at night or divided BID dosing
,4. PPIs ("-zoles") if H2 blockers are ineffective
5. GI/surgical consult PRN
PPI therapy for mod to severe GERD - Answer PPI daily x 8 weeks, 30-60
mins before breakfast; tailored to symptom relief; if no relief after 3 months=refer
to GI specialist;
PPI step up or step down approach - Answer if no symptom relief in 8 weeks,
increase PPI to BID for 4-8 weeks; if symptom free for 4 weeks step down to daily
PPI & reassess in 6-12 months; no symptom relief in 8 weeks=refer
PUD stepped-approach algorithm - Answer Step 1: lifestyle
modification/antacids
Step 2: H. pylori testing/PPI
Step 3 (uncomplicated): tx for H.pylori
Step 4 (uncomplicated): PPI continues for 8-12 weeks until healed
Step 5 (uncomplicated, low risk): no on-going therapy
Step 5 (uncomplicated, high risk): PPI or H2RA (smokers, >60, CPOD, CAD, hx
of bleeding, ulcers or NSAIDs)
Step 3 (complicated, bleeding): refer to GI for endoscopy
Step 4 (complicated): tx for H. pylori
Step 5 (complicated): repeat endoscopy in 12 weeks to determine healing
1st line triple therapy for H. Pylori - Answer 1.) PPI BID
2.) clarithromycin 500 mg BID or metronidazole 500 mg BID
3.) amoxicillin 1G BID
x 10-14 days
, 2nd line therapy for H. Pylori with PCN allergy - Answer 1.) PPI BID
2.) clarithromycin 500 mg BID
3.) metronidazole 500 mg BID
x 7-14 days
2nd line therapy or rescue therapy for H. Pylori - Answer 1.) PPI BID
2.) levofloxacin 250-500 mg BID
3.) amoxicillin 1G BID
x 10-14 days
IBS with constipation treatment - Answer lupiprastone (Amitiza)
Traveler's Diarrhea Treatment - Answer bismuth subsalicylate (pepto-bismol) 2
tablets or 2 oz before each meal and at HS;
High risk destinations for traveler's diarrhea - Answer Central & South
American, Africa, Middle East, Mexico, Asia,
Intermediate risk destinations for traveler's diarrhea - Answer eastern Europe,
South Africa, and Caribbean Islands
the most common cause of Traveler's diarrhea - Answer E. coli
other causes of traveler's diarrhea - Answer 2) campy
