UTA Nurs 5334 Advance Pharm
Module 8 Questions and Answers A+
Graded (2025)
Peptic .ulcer .disease .(PUD) .- .CORRECT .ANSWER-refers .to .a .group .of .upper
.gastrointestinal .(GI) .disorders .characterized .by .varying .degrees .of .erosion .of
.the .esophagus, .stomach, .and .small .intestine. .Severe .ulcers .can .be .complicated
.by .hemorrhage .and .perforation. .
.can .develop .in .any .region .exposed .to .acid .and .pepsin, .ulceration .is .most
.common .in .the .lesser .curvature .of .the .stomach .and .the .duodenum.
Most .cases .of .PUD .are .caused .by .- .CORRECT .ANSWER-Helicobacter .pylori .and
.eradication .of .this .bacterium .not .only .promotes .healing .but .also .greatly .reduces
.the .chance .of .recurrence. .
.develop .when .there .is .an .imbalance .between .mucosal .defensive .factors .and
.aggressive .factors. .
The .major .defensive .factors .are .mucus .and .bicarbonate. .The .major .aggressive
.factors .are .H. .pylori, .nonsteroidal .antiinflammatory .drugs.
Mucus .Defense .factor .- .CORRECT .ANSWER-is .secreted .continuously .by .cells .of
.the .GI . mucosa, .forming .a .barrier .that .protects .underlying .cells .from .attack .by
.acid .and .pepsin
Bicarbonate .defense .factor .- .CORRECT .ANSWER-is .secreted .by .epithelial .cells
.of .the .stomach .and .duodenum. .It .serves .to .neutralize .any .hydrogen .ions .that
.penetrate .the .mucus. .
.produced .by .the .pancreas .is .secreted .into .the .lumen .of .the .duodenum, .where .it
.neutralizes .acid .delivered .from .the .stomach
Adequate .blood .flow .(GI) .- .CORRECT .ANSWER-to .cells .of .the .GI .mucosa .is
.essential .for .maintaining .mucosal .integrity.
Prostaglandins .Defense .mechanism .- .CORRECT .ANSWER-stimulate .secretion .of
.mucus .and .bicarbonate, .and .they .promote .vasodilation, .which .helps .maintain
.submucosal .blood .flow. .
They .provide .additional .protection .by .suppressing .secretion .of .gastric .acid.
,H. .pylori .- .CORRECT .ANSWER-is .a .gram-negative .bacillus .that .can .colonize .the
.stomach .and .duodenum. .By .residing .in .the .space .between .epithelial .cells .and
.the .mucus .barrier .that .protects .these .cells, .the .bacterium .manages .to .escape
.destruction .by .acid .and .pepsin. .
can .remain .in .the .GI .tract .for .decades.
NSAIDs .affect .on .GI .- .CORRECT .ANSWER-are .the .underlying .cause .of .many
.gastric .ulcers .and .some .duodenal .ulcers.
.inhibit .the .biosynthesis .of .prostaglandins. .By .doing .so .they .can .decrease
.submucosal .blood .flow, .suppress .secretion .of .mucus .and .bicarbonate, .and
.promote .secretion .of .gastric .acid. .
.also .irritate .the .gastric .mucosa .directly.
Gastric .acid .affect .on .GI .- .CORRECT .ANSWER-is .an .absolute .requirement .for
.peptic .ulcer .generation: .in .the .absence .of .acid, .no .ulcer .will .form. .
.causes .ulcers .directly .by .injuring .cells .of .the .GI . mucosa .and .indirectly .by
.activating .pepsin, .a .proteolytic .enzyme.
.hypersecretion .by .itself .is .insufficient .to .cause .ulcers
Zollinger-Ellison .syndrome .- .CORRECT .ANSWER-is .the .primary .disorder .in
.which .hypersecretion .of .acid .alone .causes .ulcers. .The .syndrome .is .caused .by .a
.tumor .that .secretes .gastrin, .a .hormone .that .stimulates .gastric .acid .production.
.The .amount .of .acid .produced .is .so .large .that .it .overwhelms . mucosal .defenses.
.Pepsin .is .a .proteolytic .enzyme .present .in . gastric .juice. .Like .gastric .acid, .pepsin
.can .injure .unprotected .cells .of .the .gastric .and .duodenal .mucosa
PUD .goals .of .drug .therapy .- .CORRECT .ANSWER-(1) .alleviate .symptoms, .(2)
.promote .healing, .(3) .prevent .complications .(hemorrhage, .perforation, .and
.obstruction), .and .(4) .prevent .recurrence. . Except .for .antibiotics, .the .drugs
.employed .do .not .alter .the .disease .process. .they .simply .create .conditions
.conducive .to .healing. .Because .nonantibiotic .therapies .do .not .cure .ulcers, .the
.relapse .rate .after .their .discontinuation .is .high. .the .relapse .rate .after .antibiotic
.therapy .is .low.
Drug .classes .used .to .treat .PUD .- .CORRECT .ANSWER-antibiotics, .antisecretory
.agents .(PPIs .and .H2 .receptor .antagonists); .mucosal .protectants, .antisecretory
.agents .that .enhance .mucosal .defenses .and .antacids
Drugs .act .in .three .basic .ways .to .promote .ulcer .healing. .- .CORRECT .ANSWER-
they .can .(1) .eradicate .H. .pylori .(antibiotics), .(2) .reduce .gastric .acidity
.(antisecretory .agents, .misoprostol, .and .antacids), .and .(3) .enhance .mucosal
.defenses .(sucralfate .and .misoprostol).
risk .factors .for .ulcer .development .- .CORRECT .ANSWER-older .than .60 .years,
.history .of .ulcers, .high-dose .NSAID .therapy
prophylactic .PUD .drug .therapy .- .CORRECT .ANSWER-PPIs .(e.g., .omeprazole) .are
.preferred. .Misoprostol .is .also .effective .but .can .cause .diarrhea. . Antacids,
.sucralfate, .and .H2 .receptor .blockers .are .not .recommended.
, NSAID-induced .ulcers .- .CORRECT .ANSWER-can .be .treated .with .any .ulcer
.medication. .However, .H2 .receptor .blockers .and .PPIs .are .preferred. .If .possible,
.the .offending .NSAID .should .be .discontinued .to .accelerate .healing. .If .the .NSAID
.cannot .be .discontinued, .a .PPI .is .the .best .choice .to .promote .healing.
evaluation .ulcer .healing .- .CORRECT .ANSWER-by .monitoring .for .relief .of .pain
.and .by .radiologic .or .endoscopic .examination .of .the .ulcer .site. .Eradication .of .H.
.pylori .can .be .determined .with .several .methods, .including .breath .tests, .serologic
.tests, .stool .tests, .and .microscopic .observation .of .a .stained .biopsy .sample
implementation .of .nondrug .measures .for .PUD .- .CORRECT .ANSWER-Diet .plays .a
.minor . role .in .ulcer . management. .The .traditional ."ulcer .diet," .consisting .of .bland
.foods .together .with .milk .or .cream .does .not .accelerate .healing. .Furthermore,
.there .is .no .convincing .evidence .that .caffeine-containing .beverages .(coffee, .tea,
.and .colas) .promote .ulcer .formation .or .interfere .with .recovery. . A .change .in
.eating .pattern .may .be .beneficial: .consumption .of .five .or .six .small .meals .a .day,
.rather .than .three .larger .ones, .can . reduce . fluctuations .in .intragastric .pH .and .may
.facilitate .recovery. .
Smoking .is .associated .with .an .increased .incidence .of .ulcers .and .delays
.recovery. .Patients .should .stop .smoking.
antibiotics .for .PUD .- .CORRECT .ANSWER-clarithromycin, .amoxicillin, .bismuth,
.metronidazole, .and .tetracycline.
None .is .effective .alone. .Furthermore, .if .these .drugs .are .used .alone, .there .is
.increased .risk .for .developing .resistance.
Amoxicillin .on .H .pylori .- .CORRECT .ANSWER-H. .pylori .is .highly .sensitive .. .The
.rate .of .resistance .is .low: .only .about .3%.
Bismuth .subsalicylate .and .bismuth .subcitrate .on .H .pylori .- .CORRECT .ANSWER-
act .topically .to .disrupt .the .cell .wall .of .H. .pylori, .thereby .causing .lysis .and .death.
.
. may .also .inhibit .urease .activity .and .prevent .H. .pylori .from .adhering .to .the
.gastric .surface. .
.can .cause .a .harmless .black .coloration .to .the .tongue .and .stool. .Long-term
.therapy .may .carry .a .risk .for .neurologic .injury
Tetracycline .on .H .pylori .- .CORRECT .ANSWER-an .inhibitor .of .bacterial .protein
.synthesis, .is .highly .active .against .H. .pylori. .Resistance .is .rare .(<1%).
Metronidazole .(Flagyl) .and .Tinidazole .on .H .pylori .- .CORRECT .ANSWER-is .very
.effective .against .sensitive .strains .of .H. .pylori. .Unfortunately, .more .than .40% .of
.strains .are .now .resistant.
minimize .emergence .of .resistance .of .PUD .treatment .- .CORRECT .ANSWER-the
.guidelines .recommend .using .at .least .two .antibiotics, .and .preferably .three. .
An .antisecretory .agent .which .includes .PPI .or .histamine-2 .receptor .antagonist
.(H2RA)—should .be .included .as .well. .
Module 8 Questions and Answers A+
Graded (2025)
Peptic .ulcer .disease .(PUD) .- .CORRECT .ANSWER-refers .to .a .group .of .upper
.gastrointestinal .(GI) .disorders .characterized .by .varying .degrees .of .erosion .of
.the .esophagus, .stomach, .and .small .intestine. .Severe .ulcers .can .be .complicated
.by .hemorrhage .and .perforation. .
.can .develop .in .any .region .exposed .to .acid .and .pepsin, .ulceration .is .most
.common .in .the .lesser .curvature .of .the .stomach .and .the .duodenum.
Most .cases .of .PUD .are .caused .by .- .CORRECT .ANSWER-Helicobacter .pylori .and
.eradication .of .this .bacterium .not .only .promotes .healing .but .also .greatly .reduces
.the .chance .of .recurrence. .
.develop .when .there .is .an .imbalance .between .mucosal .defensive .factors .and
.aggressive .factors. .
The .major .defensive .factors .are .mucus .and .bicarbonate. .The .major .aggressive
.factors .are .H. .pylori, .nonsteroidal .antiinflammatory .drugs.
Mucus .Defense .factor .- .CORRECT .ANSWER-is .secreted .continuously .by .cells .of
.the .GI . mucosa, .forming .a .barrier .that .protects .underlying .cells .from .attack .by
.acid .and .pepsin
Bicarbonate .defense .factor .- .CORRECT .ANSWER-is .secreted .by .epithelial .cells
.of .the .stomach .and .duodenum. .It .serves .to .neutralize .any .hydrogen .ions .that
.penetrate .the .mucus. .
.produced .by .the .pancreas .is .secreted .into .the .lumen .of .the .duodenum, .where .it
.neutralizes .acid .delivered .from .the .stomach
Adequate .blood .flow .(GI) .- .CORRECT .ANSWER-to .cells .of .the .GI .mucosa .is
.essential .for .maintaining .mucosal .integrity.
Prostaglandins .Defense .mechanism .- .CORRECT .ANSWER-stimulate .secretion .of
.mucus .and .bicarbonate, .and .they .promote .vasodilation, .which .helps .maintain
.submucosal .blood .flow. .
They .provide .additional .protection .by .suppressing .secretion .of .gastric .acid.
,H. .pylori .- .CORRECT .ANSWER-is .a .gram-negative .bacillus .that .can .colonize .the
.stomach .and .duodenum. .By .residing .in .the .space .between .epithelial .cells .and
.the .mucus .barrier .that .protects .these .cells, .the .bacterium .manages .to .escape
.destruction .by .acid .and .pepsin. .
can .remain .in .the .GI .tract .for .decades.
NSAIDs .affect .on .GI .- .CORRECT .ANSWER-are .the .underlying .cause .of .many
.gastric .ulcers .and .some .duodenal .ulcers.
.inhibit .the .biosynthesis .of .prostaglandins. .By .doing .so .they .can .decrease
.submucosal .blood .flow, .suppress .secretion .of .mucus .and .bicarbonate, .and
.promote .secretion .of .gastric .acid. .
.also .irritate .the .gastric .mucosa .directly.
Gastric .acid .affect .on .GI .- .CORRECT .ANSWER-is .an .absolute .requirement .for
.peptic .ulcer .generation: .in .the .absence .of .acid, .no .ulcer .will .form. .
.causes .ulcers .directly .by .injuring .cells .of .the .GI . mucosa .and .indirectly .by
.activating .pepsin, .a .proteolytic .enzyme.
.hypersecretion .by .itself .is .insufficient .to .cause .ulcers
Zollinger-Ellison .syndrome .- .CORRECT .ANSWER-is .the .primary .disorder .in
.which .hypersecretion .of .acid .alone .causes .ulcers. .The .syndrome .is .caused .by .a
.tumor .that .secretes .gastrin, .a .hormone .that .stimulates .gastric .acid .production.
.The .amount .of .acid .produced .is .so .large .that .it .overwhelms . mucosal .defenses.
.Pepsin .is .a .proteolytic .enzyme .present .in . gastric .juice. .Like .gastric .acid, .pepsin
.can .injure .unprotected .cells .of .the .gastric .and .duodenal .mucosa
PUD .goals .of .drug .therapy .- .CORRECT .ANSWER-(1) .alleviate .symptoms, .(2)
.promote .healing, .(3) .prevent .complications .(hemorrhage, .perforation, .and
.obstruction), .and .(4) .prevent .recurrence. . Except .for .antibiotics, .the .drugs
.employed .do .not .alter .the .disease .process. .they .simply .create .conditions
.conducive .to .healing. .Because .nonantibiotic .therapies .do .not .cure .ulcers, .the
.relapse .rate .after .their .discontinuation .is .high. .the .relapse .rate .after .antibiotic
.therapy .is .low.
Drug .classes .used .to .treat .PUD .- .CORRECT .ANSWER-antibiotics, .antisecretory
.agents .(PPIs .and .H2 .receptor .antagonists); .mucosal .protectants, .antisecretory
.agents .that .enhance .mucosal .defenses .and .antacids
Drugs .act .in .three .basic .ways .to .promote .ulcer .healing. .- .CORRECT .ANSWER-
they .can .(1) .eradicate .H. .pylori .(antibiotics), .(2) .reduce .gastric .acidity
.(antisecretory .agents, .misoprostol, .and .antacids), .and .(3) .enhance .mucosal
.defenses .(sucralfate .and .misoprostol).
risk .factors .for .ulcer .development .- .CORRECT .ANSWER-older .than .60 .years,
.history .of .ulcers, .high-dose .NSAID .therapy
prophylactic .PUD .drug .therapy .- .CORRECT .ANSWER-PPIs .(e.g., .omeprazole) .are
.preferred. .Misoprostol .is .also .effective .but .can .cause .diarrhea. . Antacids,
.sucralfate, .and .H2 .receptor .blockers .are .not .recommended.
, NSAID-induced .ulcers .- .CORRECT .ANSWER-can .be .treated .with .any .ulcer
.medication. .However, .H2 .receptor .blockers .and .PPIs .are .preferred. .If .possible,
.the .offending .NSAID .should .be .discontinued .to .accelerate .healing. .If .the .NSAID
.cannot .be .discontinued, .a .PPI .is .the .best .choice .to .promote .healing.
evaluation .ulcer .healing .- .CORRECT .ANSWER-by .monitoring .for .relief .of .pain
.and .by .radiologic .or .endoscopic .examination .of .the .ulcer .site. .Eradication .of .H.
.pylori .can .be .determined .with .several .methods, .including .breath .tests, .serologic
.tests, .stool .tests, .and .microscopic .observation .of .a .stained .biopsy .sample
implementation .of .nondrug .measures .for .PUD .- .CORRECT .ANSWER-Diet .plays .a
.minor . role .in .ulcer . management. .The .traditional ."ulcer .diet," .consisting .of .bland
.foods .together .with .milk .or .cream .does .not .accelerate .healing. .Furthermore,
.there .is .no .convincing .evidence .that .caffeine-containing .beverages .(coffee, .tea,
.and .colas) .promote .ulcer .formation .or .interfere .with .recovery. . A .change .in
.eating .pattern .may .be .beneficial: .consumption .of .five .or .six .small .meals .a .day,
.rather .than .three .larger .ones, .can . reduce . fluctuations .in .intragastric .pH .and .may
.facilitate .recovery. .
Smoking .is .associated .with .an .increased .incidence .of .ulcers .and .delays
.recovery. .Patients .should .stop .smoking.
antibiotics .for .PUD .- .CORRECT .ANSWER-clarithromycin, .amoxicillin, .bismuth,
.metronidazole, .and .tetracycline.
None .is .effective .alone. .Furthermore, .if .these .drugs .are .used .alone, .there .is
.increased .risk .for .developing .resistance.
Amoxicillin .on .H .pylori .- .CORRECT .ANSWER-H. .pylori .is .highly .sensitive .. .The
.rate .of .resistance .is .low: .only .about .3%.
Bismuth .subsalicylate .and .bismuth .subcitrate .on .H .pylori .- .CORRECT .ANSWER-
act .topically .to .disrupt .the .cell .wall .of .H. .pylori, .thereby .causing .lysis .and .death.
.
. may .also .inhibit .urease .activity .and .prevent .H. .pylori .from .adhering .to .the
.gastric .surface. .
.can .cause .a .harmless .black .coloration .to .the .tongue .and .stool. .Long-term
.therapy .may .carry .a .risk .for .neurologic .injury
Tetracycline .on .H .pylori .- .CORRECT .ANSWER-an .inhibitor .of .bacterial .protein
.synthesis, .is .highly .active .against .H. .pylori. .Resistance .is .rare .(<1%).
Metronidazole .(Flagyl) .and .Tinidazole .on .H .pylori .- .CORRECT .ANSWER-is .very
.effective .against .sensitive .strains .of .H. .pylori. .Unfortunately, .more .than .40% .of
.strains .are .now .resistant.
minimize .emergence .of .resistance .of .PUD .treatment .- .CORRECT .ANSWER-the
.guidelines .recommend .using .at .least .two .antibiotics, .and .preferably .three. .
An .antisecretory .agent .which .includes .PPI .or .histamine-2 .receptor .antagonist
.(H2RA)—should .be .included .as .well. .
