AGNP Board Exam – Gastroenterology
Prescription
1. Question:
A 45-year-old woman has been taking oral omeprazole (Prilosec) 40 mg twice
daily for the treatment of gastroesophageal reflux. To discontinue the
medication the nurse practitioner would:
advise the patient to stop the medication.
reduce the dose by 50% every other day.
reduce the dose by 50% weekly. Correct
reduce dose by 50% every month.
Explanation:
For patients on a moderate to high dose of a PPI (e.g., omeprazole (Prilosec)
40 mg daily or twice daily), reduce the dose by 50% every week until the
patient is on the lowest dose of the medication. For patients on twice daily
dosing, the initial reduction can be accomplished by decreasing the dosing to
once in the morning before breakfast. Once the patient has completed a
week at the lowest dose, the medication can be discontinued.
2. Question:
Patients receiving long-term proton pump inhibitors (PPIs) are at increased
risk for fractures and:
lower extremity edema.
extraesophageal symptoms.
myocardial infarction. Correct
muscle spasms.
Explanation:
Analysis of patients taking PPIs for long periods of time showed an increased
risk of myocardial infarctions. This is thought to be related to reduced nitric
oxide in the blood vessel walls. The FDA suggests that providers consider
periodically obtaining magnesium levels in patients while they are on a PPI.
Increased risk of myocardial infarction has not been associated with
histamine receptor blockers.
3. Question:
Ondansetron (Zofran) dosage should be adjusted in patients:
with renal insufficiency.
who are pregnant.
who are > 65 years old.
, with hepatic impairment. Correct
Explanation:
Ondansetron (Zofran) is a 5-HT3 receptor antagonist used for the treatment
of nausea and vomiting. Dose limitations are recommended for patients with
severe hepatic impairment (Child-Pugh class C); use with caution in mild-
moderate hepatic impairment; clearance is decreased and half-life increased
in hepatic impairment. No dosage adjustment is recommended with renal
insufficiency, pregnancy or in advanced age.
4. Question:
The antiemetic that does NOT have potential to cause QT prolongation is:
promethazine (Phenergan). Correct
chlorpromazine (Thorazine).
ondansetron (Zofran).
prochlorperazine (Compazine).
Explanation:
Antihistamines such as promethazine and diphenhydramine do not cause QT
prolongation. Dopamine and serotonin antagonists are both associated with
QT prolongation. Chlorpromazine (Thorazine) and prochlorperazine
(Compazine) are dopamine antagonists. Ondansetron (Zofran) is a serotonin
antagonist. If a patient has suspected QT interval prolongation or is taking
other medications with which the QT interval prolongation could be additive,
a 12-lead EKG is recommended before treatment is initiated.
5. Question:
Promethazine (Phenergan), a 1st generation antihistamine, is
contraindicated in the presence of:
motion sickness.
sedation.
asthma. Correct
seasonal allergic rhinitis.
,Explanation:
Promethazine (Phenergan) is contraindicated in patients with
hypersensitivity reaction to promethazine, other phenothiazines, or any
component of the formulation; coma; lower respiratory tract symptoms,
including asthma; children younger than 2 years of age; intra-arterial or
subcutaneous administration.
6. Question:
Oral metoclopramide is contraindicated in the patient diagnosed with:
migraines.
epilepsy. Correct
diabetes.
renal impairment.
Explanation:
Metoclopramide (Reglan) is contraindicated in situations when
gastrointestinal (GI) motility may be dangerous, including mechanical GI
obstruction, perforation, or hemorrhage; pheochromocytoma; history of
seizure disorder (e.g., epilepsy); and concomitant use with other agents
likely to increase extrapyramidal reactions. Caution is advised in patients
with renal impairment; dosage adjustment may be needed.
7. Question:
Hyperosmotic agents and saline laxatives should be avoided or used with
caution in patients who have:
chronic constipation.
liver disease.
heart failure. Correct
hypothyroidism.
Explanation:
Hyperosmotic agents and saline laxatives may seriously alter fluid and
electrolyte balance. This increases the risk for dehydration and electrolyte
, disturbances, especially hypokalemia. Therefore, the risks versus the
benefits should be considered prior to use in patients with heart failure.
8. Question:
Corticosteroids, used in the treatment of ulcerative colitis, usually do NOT:
increase the rate of infection.
reduce the effectiveness of vaccines.
increase the effectiveness of antibiotics. Correct
increase the risk of developing osteoporosis.
Explanation:
Corticosteroids usually do NOT increase the effectiveness of antibiotics; they
reduce their effectiveness. Because they suppress the immune system, they
increase the rate of infection, reduce the effectiveness of vaccines and
increase the risk of osteoporosis and fractures due to loss of calcium with
corticosteroids.
9. Question:
The plasma elimination half-life of esomeprazole (Nexium) is:
1-1.5 hours. Correct
2-3 hours.
3.5-5 hours.
6-8 hours.
Explanation:
The plasma elimination half-life of esomeprazole (Nexium) is approximately 1
to 1.5 hours. Less than 1% of the parent drug is excreted in the urine.
Approximately 80% of an oral dose of esomeprazole is excreted as inactive
metabolites in the urine, and the remainder is found as inactive metabolites
in the feces.
10. Question:
Proton pump inhibitors (PPIs), such as pantoprazole (Protonix), block
gastrointestinal acid secretion by:
Prescription
1. Question:
A 45-year-old woman has been taking oral omeprazole (Prilosec) 40 mg twice
daily for the treatment of gastroesophageal reflux. To discontinue the
medication the nurse practitioner would:
advise the patient to stop the medication.
reduce the dose by 50% every other day.
reduce the dose by 50% weekly. Correct
reduce dose by 50% every month.
Explanation:
For patients on a moderate to high dose of a PPI (e.g., omeprazole (Prilosec)
40 mg daily or twice daily), reduce the dose by 50% every week until the
patient is on the lowest dose of the medication. For patients on twice daily
dosing, the initial reduction can be accomplished by decreasing the dosing to
once in the morning before breakfast. Once the patient has completed a
week at the lowest dose, the medication can be discontinued.
2. Question:
Patients receiving long-term proton pump inhibitors (PPIs) are at increased
risk for fractures and:
lower extremity edema.
extraesophageal symptoms.
myocardial infarction. Correct
muscle spasms.
Explanation:
Analysis of patients taking PPIs for long periods of time showed an increased
risk of myocardial infarctions. This is thought to be related to reduced nitric
oxide in the blood vessel walls. The FDA suggests that providers consider
periodically obtaining magnesium levels in patients while they are on a PPI.
Increased risk of myocardial infarction has not been associated with
histamine receptor blockers.
3. Question:
Ondansetron (Zofran) dosage should be adjusted in patients:
with renal insufficiency.
who are pregnant.
who are > 65 years old.
, with hepatic impairment. Correct
Explanation:
Ondansetron (Zofran) is a 5-HT3 receptor antagonist used for the treatment
of nausea and vomiting. Dose limitations are recommended for patients with
severe hepatic impairment (Child-Pugh class C); use with caution in mild-
moderate hepatic impairment; clearance is decreased and half-life increased
in hepatic impairment. No dosage adjustment is recommended with renal
insufficiency, pregnancy or in advanced age.
4. Question:
The antiemetic that does NOT have potential to cause QT prolongation is:
promethazine (Phenergan). Correct
chlorpromazine (Thorazine).
ondansetron (Zofran).
prochlorperazine (Compazine).
Explanation:
Antihistamines such as promethazine and diphenhydramine do not cause QT
prolongation. Dopamine and serotonin antagonists are both associated with
QT prolongation. Chlorpromazine (Thorazine) and prochlorperazine
(Compazine) are dopamine antagonists. Ondansetron (Zofran) is a serotonin
antagonist. If a patient has suspected QT interval prolongation or is taking
other medications with which the QT interval prolongation could be additive,
a 12-lead EKG is recommended before treatment is initiated.
5. Question:
Promethazine (Phenergan), a 1st generation antihistamine, is
contraindicated in the presence of:
motion sickness.
sedation.
asthma. Correct
seasonal allergic rhinitis.
,Explanation:
Promethazine (Phenergan) is contraindicated in patients with
hypersensitivity reaction to promethazine, other phenothiazines, or any
component of the formulation; coma; lower respiratory tract symptoms,
including asthma; children younger than 2 years of age; intra-arterial or
subcutaneous administration.
6. Question:
Oral metoclopramide is contraindicated in the patient diagnosed with:
migraines.
epilepsy. Correct
diabetes.
renal impairment.
Explanation:
Metoclopramide (Reglan) is contraindicated in situations when
gastrointestinal (GI) motility may be dangerous, including mechanical GI
obstruction, perforation, or hemorrhage; pheochromocytoma; history of
seizure disorder (e.g., epilepsy); and concomitant use with other agents
likely to increase extrapyramidal reactions. Caution is advised in patients
with renal impairment; dosage adjustment may be needed.
7. Question:
Hyperosmotic agents and saline laxatives should be avoided or used with
caution in patients who have:
chronic constipation.
liver disease.
heart failure. Correct
hypothyroidism.
Explanation:
Hyperosmotic agents and saline laxatives may seriously alter fluid and
electrolyte balance. This increases the risk for dehydration and electrolyte
, disturbances, especially hypokalemia. Therefore, the risks versus the
benefits should be considered prior to use in patients with heart failure.
8. Question:
Corticosteroids, used in the treatment of ulcerative colitis, usually do NOT:
increase the rate of infection.
reduce the effectiveness of vaccines.
increase the effectiveness of antibiotics. Correct
increase the risk of developing osteoporosis.
Explanation:
Corticosteroids usually do NOT increase the effectiveness of antibiotics; they
reduce their effectiveness. Because they suppress the immune system, they
increase the rate of infection, reduce the effectiveness of vaccines and
increase the risk of osteoporosis and fractures due to loss of calcium with
corticosteroids.
9. Question:
The plasma elimination half-life of esomeprazole (Nexium) is:
1-1.5 hours. Correct
2-3 hours.
3.5-5 hours.
6-8 hours.
Explanation:
The plasma elimination half-life of esomeprazole (Nexium) is approximately 1
to 1.5 hours. Less than 1% of the parent drug is excreted in the urine.
Approximately 80% of an oral dose of esomeprazole is excreted as inactive
metabolites in the urine, and the remainder is found as inactive metabolites
in the feces.
10. Question:
Proton pump inhibitors (PPIs), such as pantoprazole (Protonix), block
gastrointestinal acid secretion by:
