NSG 533 Advanced Pharm Exam 1
Comprehensive Questions
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Answers Graded A+
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GERD physiology - Answer: Lower esophageal sphincter dysfunction
(LES)- transient relaxtions, low tone
Hiatal hernia=promotes reflux
,Delayed gastric emptying/increased intra ab pressure: obesity,
pregnancy
Injury is from acid+pepsin exposure to esophageal mucosa-severity
relates to exposure time +clearance
What worsens GERD - Answer: ETOH, smoking, obesity, late meals,
large/fatty meals
caffeine, chocolate/peppermint may reduce LES tone- Peppermint may
worsen reflux by relaxing LES
MEDS that worsen: anticholinergics, CCB, nitrates, theophylline,
progesterone
symptoms of GERD - Answer: typical: heartburn, regurgitation
atypical: chronic cough, hoarseness, asthma like symptoms
ALARM: dysphagia, odynophagia, wt loss, GI bleed anemia
alarm= endoscopy, not OTC trial
,when to test vs tx GERD - Answer: uncomplicated GERD-> empiric PPI
trial 8 wk
Alarm or refractory GERD--> EGD
Persistent symptoms despite PPI--> pH monitioring, manometry
PPI risks - Answer: Increased risk of fractures (postmenopausal
women) pneumonia, C diff, hypomagnesemia, B12 and iron
malabsorption, atrophic gastritis, kidney disease
Non-pharm interventions for all GI conditions - Answer: Diet+trigger:
greasy/spicy foods, ETOH, caffeine; lactose/FODMAPS is IBS type
symptoms
hydration
tobacco cessation
wt mgmt
meds reveiw: remove/replace offending meds when possible- NSAIDs,
iron, opiods, anticholinergics.
, When to refer/escalate: alarm symptoms (GI bleed, wt loss, progressive
dysphagia, severe dehydration, persistent vomiting, severe ab pain
GERD pharmacology - Answer: Antacids-PRN fastest relief
neutralize acid: short duration
counseling: separate from other meds (chelation/absorption issues)
TUMS (calcium carbonate): highest acid neutralizing, rapid
Risks: hypercalcemia, constipation (Al), kidney stones (Ca), diarrhea
(Mg)
H2 receptor antagonist (H2RAs)
good for mild/intermittent symptoms, nocturnal symptoms
less potent that PPIs for healing/maintenance of erosive disease
PEPCID (famotidine): most potent, +Nocturnal, fewer interactions than
cimetidine (CYP), longer duration of action, min CNS effects
PPIs
MOST effective acid suppression + best for esophagitis healing and
maintenance
Take before meals (30-60 min before breakfast)
PANTOPRAZOLE (safest): preferred when on clopidogrel, fewer
interactions
OMEPRAZOLE/ESOMEPRAZOLE: most potent, part of H.pylori regimen--
decreases clopidogrel activation
Comprehensive Questions
(Frequently Tested) with Verified
Answers Graded A+
Professional Academic Assistance Services
Services Offered
• Proctored Exam Assistance
• Online Class Management (Full Course Support)
• Exam Preparation & Study Materials
• Assignments and Coursework Support
• Essay and Research Paper Writing
• Discussion Posts & Responses
• Editing and Proofreading
• Confidential Academic Consultation
Helping Students Achieve Academic Excellence
GERD physiology - Answer: Lower esophageal sphincter dysfunction
(LES)- transient relaxtions, low tone
Hiatal hernia=promotes reflux
,Delayed gastric emptying/increased intra ab pressure: obesity,
pregnancy
Injury is from acid+pepsin exposure to esophageal mucosa-severity
relates to exposure time +clearance
What worsens GERD - Answer: ETOH, smoking, obesity, late meals,
large/fatty meals
caffeine, chocolate/peppermint may reduce LES tone- Peppermint may
worsen reflux by relaxing LES
MEDS that worsen: anticholinergics, CCB, nitrates, theophylline,
progesterone
symptoms of GERD - Answer: typical: heartburn, regurgitation
atypical: chronic cough, hoarseness, asthma like symptoms
ALARM: dysphagia, odynophagia, wt loss, GI bleed anemia
alarm= endoscopy, not OTC trial
,when to test vs tx GERD - Answer: uncomplicated GERD-> empiric PPI
trial 8 wk
Alarm or refractory GERD--> EGD
Persistent symptoms despite PPI--> pH monitioring, manometry
PPI risks - Answer: Increased risk of fractures (postmenopausal
women) pneumonia, C diff, hypomagnesemia, B12 and iron
malabsorption, atrophic gastritis, kidney disease
Non-pharm interventions for all GI conditions - Answer: Diet+trigger:
greasy/spicy foods, ETOH, caffeine; lactose/FODMAPS is IBS type
symptoms
hydration
tobacco cessation
wt mgmt
meds reveiw: remove/replace offending meds when possible- NSAIDs,
iron, opiods, anticholinergics.
, When to refer/escalate: alarm symptoms (GI bleed, wt loss, progressive
dysphagia, severe dehydration, persistent vomiting, severe ab pain
GERD pharmacology - Answer: Antacids-PRN fastest relief
neutralize acid: short duration
counseling: separate from other meds (chelation/absorption issues)
TUMS (calcium carbonate): highest acid neutralizing, rapid
Risks: hypercalcemia, constipation (Al), kidney stones (Ca), diarrhea
(Mg)
H2 receptor antagonist (H2RAs)
good for mild/intermittent symptoms, nocturnal symptoms
less potent that PPIs for healing/maintenance of erosive disease
PEPCID (famotidine): most potent, +Nocturnal, fewer interactions than
cimetidine (CYP), longer duration of action, min CNS effects
PPIs
MOST effective acid suppression + best for esophagitis healing and
maintenance
Take before meals (30-60 min before breakfast)
PANTOPRAZOLE (safest): preferred when on clopidogrel, fewer
interactions
OMEPRAZOLE/ESOMEPRAZOLE: most potent, part of H.pylori regimen--
decreases clopidogrel activation
