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NR 565 PHARMACOLOGY WEEK #7 EXAM QUESTIONS AND ANSWERS
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NR 565 PHARMACOLOGY WEEK #7 EXAM QUESTIONS AND ANSWERS
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NR 565 PHARMACOLOGY WEEK #7EXAM QUESTIONS AND ANSWERS
Definition: Acid reflux/heartburn - Answer-A burning sensation in the chest + recurrent
regurgitation of acidic stomach contents into the mouth or throat; can affect teeth and
oesophagus
Acid reflux/heartburn symptoms - Answer-Burning sensation in chest, sour taste,
stomach/chest pain, sore throat/hoarseness, wheezing/coughing, eroded teeth enamel
When is GERD defined - Answer-If heartburn/acid reflux symptoms interfere with daily
life or occur more than 2x/week
Defensive factors to protect against ulcers: Mucus - Answer-Secreted by GI mucosa
cells, forms protective barrier against acid and pepsin
Defensive factors to protect against ulcers: Bicarbonate - Answer-Secreted by epithelial
cells of stomach/duodenum; most is trapped by mucus layer to neutralize H ions;
produced + secreted by pancreas into duodenum
Defensive factors to protect against ulcers: Blood flow - Answer-Essential for
maintaining mucosal integrity
Defensive factors to protect against ulcers: Prostaglandins - Answer-Stimulate secretion
of bicarb and mucus; promotes vasodilation, helps to maintain blood flow, surpasses
secretion of gastric acid
Factors that increase the risk of ulcer development - Answer-H. pylori: can colonize the
stomach + duodenum
NSAIDs: underlying cause of many ulcers
HCL: Absolute requirement for ulcer development
Pepsin: enzyme in HCL that can injure unprotected mucosal cells
Smoking: delays healing, increases risk of recurrence
Therapeutic effect: Proton Pump Inhibitors - Answer-Most effective for inhibiting acid
secretion; bind to gastric PPs, blocking acid production; decreased acid = decreased
reflux and GERD symptoms
Role of gastric parietal cells - Answer-Produce + release acid/hydrogen when activated
by histamine, gastrin, + acetylcholine; gastric PP moves acid into stomach and k+ into
parietal cells; HCL is formed when H+ binds to cl-
Other info: PPIs - Answer-Takes 2-3 days to reach max effect; acid activated;
irreversibly block H+ and amount of HCL produced
, Side effects: PPIs - Answer-Headache, nausea, diarrhea
Long-term use: renal complications, bone fractures, dementia, decreased absorption of
ca+, mg+, + B12
Contraindications: PPIs - Answer-Hypocalcemia; increased risk of CAP with short-term
use
*Pts. taking NSAIDs can take PPIs for ulcer prophylaxis
Medications: PPIs - Answer-OTC: esomeprazole (Nexium), lansoprazole (Prevacid),
omeprazole (Prilosec)
RX: dexlansoprazole (dexilant), pantoprazole (protonix), rabeprazole (aciphex)
Therapeutic action: Histamine-2 Receptor Antagonists (H2RA) - Answer-Decreases
acid secretion by blocking histamine 2-receptors in gastric parietal cells; provides relief
from GERD symptoms; can be used as prophylaxis; more effective than antacids, less
than PPIs; Intermittent or fixed dosing
Side Effects: H2RAs - Answer-Headache, nausea
Containdications: H2RA - Answer-Cimetidine: weak inhibitor of CYP450 (warfarin,
phenytoin, theophylline, lidocaine, antacids)
Famotidine: safe in geriatrics; use caution with renal impairment
Nizatidine: may cause asymptomatic v-tach; increase risk of hepatoellular injury
Ranitidine + Cimetidine: Increased risk of mental status changes in older adults
Medications: H2RAs - Answer-Cimetidine (Tagamet), famotidine (Pepcid), nizatidine
(axid), ranitidine (Zantac)
Therapeutic action: Cytoprotective agents - Answer-Used to treat/prevent ulcer
formation
Medications: Cytoprotective agents - Answer-Sucralfate (carafate): pregnancy category
B
Misoprostol (cytotec): pregnancy category X
PPIs can lead to - Answer-Pneumonia, fractures, rebound acid hyper secretion,
hypomagnesemia, diarrhea
*Interacts with clopidogrel (plavix) d/t CYP2C19 inhibition
H2RAs can lead to - Answer-Anti-androgenic effects, CNS effects, pneumonia
Antacids can lead to - Answer-Constipation, diarrhea, sodium excess
Drug reactions: Antacids - Answer-Interferes with absorption of other drugs (i.e.
sucralfate); separate administration by 1 hour
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