NURS 8024 Pharm Exam 1 UPDATED ACTUAL QUESTIONS AND CORRECT ANSWERS

NURS 8024 Pharm Exam 1 UPDATED
ACTUAL QUESTIONS AND CORRECT
ANSWERS
Gastric acid secretion by parietal cells of the gastric mucosa are stimulated by - CORRECT
ANSWER *acetycholine, histamine, gastrin



Receptor-mediated binding of acetylcholine, histamine, or gastrin results in - CORRECT
ANSWER *the activation of protein kinases, which in

turn stimulates the H+/K+-adenosine triphosphatase (ATPase) proton pump



Gastrin and acetylcholine stimulate release of - CORRECT ANSWER histamine



receptor binding of prostaglandin E2 and

somatostatin diminish - CORRECT ANSWER gastric acid production



Antacids - CORRECT ANSWER weak bases that react with gastric acid to

form water and a salt → diminishing gastric acidity



Reduce pepsin activity - pepsin inactive at a pH >4



Wide variety* in chemical composition, acid-neutralizing capacity, sodium content, palatability, and
price



Acid neutralizing ability* of an antacid depends on its capacity to neutralize gastric HCl and on
whether the stomach is full or empty

• food delays stomach emptying, allowing more time for the antacid to react



Therapeutic uses of antacids - CORRECT ANSWER • Symptomatic relief of peptic ulcer
disease (PUD) and gastroesophageal reflux (GERD)

• May promote healing of duodenal ulcers, but not

,robust evidence for efficacy in Tx of acute gastric

ulcers

• Calcium carbonate preparations

• also used as calcium supplements for the treatment of osteoporosis



Commonly used antacid drugs - CORRECT ANSWER Classes

• Calcium salts: calcium carbonate: Tums/Rolaids

• Sodium bicarbonate: Alka-Seltzer

• Aluminum salts - Aluminum hydroxide: Amphojel; Aluminum carbonate: Basaljel

• Magnesium salts/ magnesium oxide: Milk of Magnesia

• Combination products

• Aluminum hydroxide and magnesium hydroxide (Maalox, Mylanta)

• Alginic acid, magnesium trisilicate, calcium stearate

(Gaviscon)



Adverse effects of antacids - CORRECT ANSWER • Aluminum hydroxide tends to be
constipating

• Magnesium hydroxide tends to cause diarrhea

• Binding of phosphate by aluminum-containing antacids → hypophosphatemia

• Sodium bicarbonate → belching and flatulence, potential for systemic alkalosis

• Sodium content of antacids → can be important in pts w/ HTN or CHF

• Excessive intake of calcium carbonate along w/ calcium foods → hypercalcemia



Mucosal Protective Agents - CORRECT ANSWER Cytoprotective compounds

Sucralfate

Bismuth Compounds



Cytoprotective Compounds - CORRECT ANSWER enhance mucosal protection

mechanisms → preventing mucosal injury, ↓ inflammation, promotes healing of existing ulcers



Sucralfate - CORRECT ANSWER complex of aluminum hydroxide and sulfated sucrose

,• Small, poorly soluble molecule

• Polymerizes in stomach acid → binds to injured tissue, forms physical barrier coating over ulcer
bed- impairs diffusion of HCl and prevents degradation of mucus by pepsin and acid

• Accelerates healing of peptic ulcers and ↓ recurrence rate

• Stimulates prostaglandin release, mucus and bicarbonate output

• *BIG drawback.... Must be taken qid• used in long-term maintenance therapy to prevent recurrence

• Requires an acidic pH for activation -should not be administered with H2 antagonists or antacids

• Little of the drug is absorbed systemically, very well tolerated

• Can interfere w/ absorption of other drugs by binding to them

• Does not prevent NSAID-induced ulcers



Bismuth Compounds - CORRECT ANSWER • Coats ulcers → protective layer against acid and
pepsin

• May stimulate prostaglandin, mucus, and bicarbonate secretion

• Antimicrobial effect- binds enterotoxins

• reduces stool frequency & liquidity in acute infectious diarrhea

• Causes black stools- harmless

• Avoid in renal insufficiency



In geriatric patients avoid use of - CORRECT ANSWER - antacids that contain magnesium in
patients with renal failure

- sodium-containing antacids because of fluid

retention



Antacids in Pediatrics - CORRECT ANSWER Safety not established in children



Antacids during pregnancy and lactation - CORRECT ANSWER No FDA category established,
although antacids

generally are considered safe for use in pregnancy



Antisecretory agents - CORRECT ANSWER Histamine-2 receptor antagonists

Proton pump inhibitors

, Examples of Histamine-2 receptor antagonists - CORRECT ANSWER ranitidine, *cimetidine,
famotidine, nizatidine



Examples of Proton pump inhibitors - CORRECT ANSWER • omeprazole, esomeprazole

• Lansoprazole, pantoprazole

• rabeprazole



H2 Receptor antagonists - CORRECT ANSWER • MOA

• Acts selectively on H2 receptors in the stomach, blood vessels, and other sites (no effect on H1
receptors)

• Competitively blocks binding of histamine to H2 receptors

• less effective than PPIs against stimulated secretion

• Four drugs: cimetidine*. ranitidine, famotidine, and nizatidine

• Can inhibit > 90% basal, food-stimulated and nocturnal secretion of gastric acid after a single dose

• Main clinical use is to inhibit gastric acid secretion

• particularly effective against nocturnal acid secretion



H2 Receptor antagonist ADEs - CORRECT ANSWER • H2 antagonists very safe

• ADE < 3% of patients - diarrhea, h/a, fatigue, myalgias, constipation

• Drugs such as ketoconazole, which depend on an acidic medium for gastric absorption, may not be
efficiently absorbed if taken w/ H2 blocker

• Not used for NSAID-induced ulcers

• Better healing and prevention with PPIs



Cimetidine - CORRECT ANSWER • Inhibits cytochrome P450 and can slow metabolism -
potentiating the action of other drugs

• warfarin, diazepam, phenytoin, quinidine,

carbamazepine, theophylline, and imipramine

• Cimetidine can have endocrine effects, acts as a

nonsteroidal antiandrogen. (effects include gynecomastia, galactorrhea, and reduced sperm count)