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ADVANCED PHARMACOLOGY NSG 533
CASE STUDY 2025| BRAND NEW ACTUAL
EXAM WITH 100% VERIFIED QUESTIONS
AND CORRECT SOLUTIONS| GUARANTEED
VALUE PACK| ACE YOUR GRADES.
Infectious diarrhea:
C diff - - correct answer - The initial step in the treatment of
Clostridium difficile infection (CDI) is cessation of the inciting
antibiotic as soon as possible
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Therapy for non-severe difficile infection (CDI) consists of oral
metronidazole >> oral vancomycinLimitations of metronidazole
include dose-dependent peripheral neuropathy and side effects of
nausea and metallic taste.Use of oral vancomycin is appropriate
for initial therapy of non-severe disease in patients who are
pregnant, breastfeeding, or intolerant/allergic to
metronidazoleRifaximin— Small case series have suggested that
sequential therapy with vancomycin followed by Rifaximin may be
effective for the treatment of recurrent CDI
Traveler's diarrhea - the classic travelers' diarrhea due to
enterotoxigenic Escherichia coli (ETEC) generally produces
malaise, anorexia, and abdominal cramps followed by the sudden
onset of watery diarrhea. The illness is generally self-limited with
symptoms lasting for approximately one to five days. - correct
answer - Antibiotics are warranted to treat diarrhea in those who
develop severe diarrhea, characterized by more than four
unformed stools daily, fever, or blood, pus, or mucus in the stool.
In addition, some travelers desire antibiotic treatment for milder
disease if the illness is a large burden on a business trip or
vacation.For mild to moderate disease, anti-motility drugs(eg.
loperamide) may be used as monotherapyFor sever disease, anti-
motility drugs(eg. loperamide) may be used cautiously as
adjunctive therapyuse in combination with simethicone may
provide faster relief of symptoms
For adults, several different antibiotic options are effective for
travelers' diarrhea. In general, fluoroquinolones (eg ciprofloxacin)
are the first choice for their efficacy and tolerability. However, for
travelers to Asia, azithromycin is preferable because of increasing
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resistance to fluoroquinolones among enteric pathogens in that
region. Azithromycin is also the preferred agent for pregnant
women and children. We only use Rifaximin if a fluoroquinolone
or azithromycin is not available or appropriate because its efficacy
for invasive disease is unknown
Nausea / Vomiting
When choosing an agent - correct answer - Focus on individual
patient, evaluate risk factors, and rule out other causes.
Agent related variables (efficacy, ADR's, cost)
Please review mechanisms, ADRs and
Promethazine -Block DA2 receptors in the CTZ + have
antihistaminic and anticholinergic effects.ADR's: EPS, sedation,
hypotension
Place in therapy: "general purpose antiemetics". not very effective
in severe n/v (i.e. chemotherapy induced n/v (CINV)Example
Lorazepam -Benzodiazepines bind to GABA-A receptors. GABA
is the major inhibitory NT in the CNS
benzodiazepines are sedatives, not antiemetic agents
Sedative and anti-anxiety effects → reduce anticipatory N/V
associated with chemotherapy ADRs - CNS - sedation,
hallucinations, euphoria; CV - hypotension
CINV - Evaluate emetogenic potential of regimen
Mono therapy for chemotherapy with low and moderate
emetogenic risk
, Page | 4
Aggressive (combination of agents with different mechanisms)
antiemetics for highly emetogenic regimens and delayed CINV
Examples
Dexamethasone + metoclopramide + diphenhydramine +
lorazepam Ondansetron + dexamethasone Ondansetron +
metoclopramide Metoclopramide + dexamethasone Ondansetron
+ dexamethasone + prochlorperazine
Ondansetron + dexamethasone + aprepitant
EP is a 38-year-old female patient that comes in for diabetes
education and management. She was diagnosed 12 years ago
and states lately she is not able to control her diet although she
continues a 1600 calorie diet with appropriate daily carbohydrate
intake (per dietitian prescription) and walks 40 minutes every day
of the week. She states compliance with all medications. She
denies any history of hypoglycemia despite being able to identify
signs and symptoms and describe appropriate treatment
strategies.
PMH: T2DM, HTN, obesity, depression, s/p thyroidectomy due to
thyroid cancer
FmHx: Noncontributory
SHx: (−) Smoking, alcohol use, past marijuana use while in high
school
Medications: Metformin 850 mg tid, glipizide 20 mg bid, lisinopril
20 mg daily, sertraline 100 mg daily, multivitamin daily
Vitals: BP 128/82 mg Hg; P 72 beats/min; BMI 31 m/kg2
ADVANCED PHARMACOLOGY NSG 533
CASE STUDY 2025| BRAND NEW ACTUAL
EXAM WITH 100% VERIFIED QUESTIONS
AND CORRECT SOLUTIONS| GUARANTEED
VALUE PACK| ACE YOUR GRADES.
Infectious diarrhea:
C diff - - correct answer - The initial step in the treatment of
Clostridium difficile infection (CDI) is cessation of the inciting
antibiotic as soon as possible
, Page | 2
Therapy for non-severe difficile infection (CDI) consists of oral
metronidazole >> oral vancomycinLimitations of metronidazole
include dose-dependent peripheral neuropathy and side effects of
nausea and metallic taste.Use of oral vancomycin is appropriate
for initial therapy of non-severe disease in patients who are
pregnant, breastfeeding, or intolerant/allergic to
metronidazoleRifaximin— Small case series have suggested that
sequential therapy with vancomycin followed by Rifaximin may be
effective for the treatment of recurrent CDI
Traveler's diarrhea - the classic travelers' diarrhea due to
enterotoxigenic Escherichia coli (ETEC) generally produces
malaise, anorexia, and abdominal cramps followed by the sudden
onset of watery diarrhea. The illness is generally self-limited with
symptoms lasting for approximately one to five days. - correct
answer - Antibiotics are warranted to treat diarrhea in those who
develop severe diarrhea, characterized by more than four
unformed stools daily, fever, or blood, pus, or mucus in the stool.
In addition, some travelers desire antibiotic treatment for milder
disease if the illness is a large burden on a business trip or
vacation.For mild to moderate disease, anti-motility drugs(eg.
loperamide) may be used as monotherapyFor sever disease, anti-
motility drugs(eg. loperamide) may be used cautiously as
adjunctive therapyuse in combination with simethicone may
provide faster relief of symptoms
For adults, several different antibiotic options are effective for
travelers' diarrhea. In general, fluoroquinolones (eg ciprofloxacin)
are the first choice for their efficacy and tolerability. However, for
travelers to Asia, azithromycin is preferable because of increasing
, Page | 3
resistance to fluoroquinolones among enteric pathogens in that
region. Azithromycin is also the preferred agent for pregnant
women and children. We only use Rifaximin if a fluoroquinolone
or azithromycin is not available or appropriate because its efficacy
for invasive disease is unknown
Nausea / Vomiting
When choosing an agent - correct answer - Focus on individual
patient, evaluate risk factors, and rule out other causes.
Agent related variables (efficacy, ADR's, cost)
Please review mechanisms, ADRs and
Promethazine -Block DA2 receptors in the CTZ + have
antihistaminic and anticholinergic effects.ADR's: EPS, sedation,
hypotension
Place in therapy: "general purpose antiemetics". not very effective
in severe n/v (i.e. chemotherapy induced n/v (CINV)Example
Lorazepam -Benzodiazepines bind to GABA-A receptors. GABA
is the major inhibitory NT in the CNS
benzodiazepines are sedatives, not antiemetic agents
Sedative and anti-anxiety effects → reduce anticipatory N/V
associated with chemotherapy ADRs - CNS - sedation,
hallucinations, euphoria; CV - hypotension
CINV - Evaluate emetogenic potential of regimen
Mono therapy for chemotherapy with low and moderate
emetogenic risk
, Page | 4
Aggressive (combination of agents with different mechanisms)
antiemetics for highly emetogenic regimens and delayed CINV
Examples
Dexamethasone + metoclopramide + diphenhydramine +
lorazepam Ondansetron + dexamethasone Ondansetron +
metoclopramide Metoclopramide + dexamethasone Ondansetron
+ dexamethasone + prochlorperazine
Ondansetron + dexamethasone + aprepitant
EP is a 38-year-old female patient that comes in for diabetes
education and management. She was diagnosed 12 years ago
and states lately she is not able to control her diet although she
continues a 1600 calorie diet with appropriate daily carbohydrate
intake (per dietitian prescription) and walks 40 minutes every day
of the week. She states compliance with all medications. She
denies any history of hypoglycemia despite being able to identify
signs and symptoms and describe appropriate treatment
strategies.
PMH: T2DM, HTN, obesity, depression, s/p thyroidectomy due to
thyroid cancer
FmHx: Noncontributory
SHx: (−) Smoking, alcohol use, past marijuana use while in high
school
Medications: Metformin 850 mg tid, glipizide 20 mg bid, lisinopril
20 mg daily, sertraline 100 mg daily, multivitamin daily
Vitals: BP 128/82 mg Hg; P 72 beats/min; BMI 31 m/kg2
