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NURS8024 Pharm Exam 1 Study Guide Questions 100% Well Answered Solutions.

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  • Course
  • NURS 8024
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  • NURS 8024

Gastric acid secretion by parietal cells of the gastric mucosa are stimulated by - Answer *acetycholine, histamine, gastrin Receptor-mediated binding of acetylcholine, histamine, or gastrin results in - Answer *the activation of protein kinases, which in turn stimulates the H+/K+-adenosin...

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  • September 17, 2024
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  • NURS 8024
  • NURS 8024
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NURS8024 Pharm Exam 1 Study Guide
Questions 100% Well Answered
Solutions.
Gastric acid secretion by parietal cells of the gastric mucosa are stimulated by - Answer *acetycholine,
histamine, gastrin



Receptor-mediated binding of acetylcholine, histamine, or gastrin results in - Answer *the activation of
protein kinases, which in

turn stimulates the H+/K+-adenosine triphosphatase (ATPase) proton pump



Gastrin and acetylcholine stimulate release of - Answer histamine



receptor binding of prostaglandin E2 and

somatostatin diminish - Answer gastric acid production



Antacids - Answer weak bases that react with gastric acid to

form water and a salt → diminishing gastric acidity



Reduce pepsin activity - pepsin inactive at a pH >4



Wide variety* in chemical composition, acid-neutralizing capacity, sodium content, palatability, and price



Acid neutralizing ability* of an antacid depends on its capacity to neutralize gastric HCl and on whether
the stomach is full or empty

• food delays stomach emptying, allowing more time for the antacid to react

,Therapeutic uses of antacids - Answer • Symptomatic relief of peptic ulcer disease (PUD) and
gastroesophageal reflux (GERD)

• May promote healing of duodenal ulcers, but not

robust evidence for efficacy in Tx of acute gastric

ulcers

• Calcium carbonate preparations

• also used as calcium supplements for the treatment of osteoporosis



Commonly used antacid drugs - Answer Classes

• Calcium salts: calcium carbonate: Tums/Rolaids

• Sodium bicarbonate: Alka-Seltzer

• Aluminum salts - Aluminum hydroxide: Amphojel; Aluminum carbonate: Basaljel

• Magnesium salts/ magnesium oxide: Milk of Magnesia

• Combination products

• Aluminum hydroxide and magnesium hydroxide (Maalox, Mylanta)

• Alginic acid, magnesium trisilicate, calcium stearate

(Gaviscon)



Adverse effects of antacids - Answer • Aluminum hydroxide tends to be constipating

• Magnesium hydroxide tends to cause diarrhea

• Binding of phosphate by aluminum-containing antacids → hypophosphatemia

• Sodium bicarbonate → belching and flatulence, potential for systemic alkalosis

• Sodium content of antacids → can be important in pts w/ HTN or CHF

• Excessive intake of calcium carbonate along w/ calcium foods → hypercalcemia



Mucosal Protective Agents - Answer Cytoprotective compounds

Sucralfate

Bismuth Compounds

,Cytoprotective Compounds - Answer enhance mucosal protection

mechanisms → preventing mucosal injury, ↓ inflammation, promotes healing of existing ulcers



Sucralfate - Answer complex of aluminum hydroxide and sulfated sucrose

• Small, poorly soluble molecule

• Polymerizes in stomach acid → binds to injured tissue, forms physical barrier coating over ulcer bed-
impairs diffusion of HCl and prevents degradation of mucus by pepsin and acid

• Accelerates healing of peptic ulcers and ↓ recurrence rate

• Stimulates prostaglandin release, mucus and bicarbonate output

• *BIG drawback.... Must be taken qid• used in long-term maintenance therapy to prevent recurrence

• Requires an acidic pH for activation -should not be administered with H2 antagonists or antacids

• Little of the drug is absorbed systemically, very well tolerated

• Can interfere w/ absorption of other drugs by binding to them

• Does not prevent NSAID-induced ulcers



Bismuth Compounds - Answer • Coats ulcers → protective layer against acid and pepsin

• May stimulate prostaglandin, mucus, and bicarbonate secretion

• Antimicrobial effect- binds enterotoxins

• reduces stool frequency & liquidity in acute infectious diarrhea

• Causes black stools- harmless

• Avoid in renal insufficiency



In geriatric patients avoid use of - Answer - antacids that contain magnesium in patients with renal
failure

- sodium-containing antacids because of fluid

retention



Antacids in Pediatrics - Answer Safety not established in children

, Antacids during pregnancy and lactation - Answer No FDA category established, although antacids

generally are considered safe for use in pregnancy



Antisecretory agents - Answer Histamine-2 receptor antagonists

Proton pump inhibitors



Examples of Histamine-2 receptor antagonists - Answer ranitidine, *cimetidine, famotidine, nizatidine



Examples of Proton pump inhibitors - Answer • omeprazole, esomeprazole

• Lansoprazole, pantoprazole

• rabeprazole



H2 Receptor antagonists - Answer • MOA

• Acts selectively on H2 receptors in the stomach, blood vessels, and other sites (no effect on H1
receptors)

• Competitively blocks binding of histamine to H2 receptors

• less effective than PPIs against stimulated secretion

• Four drugs: cimetidine*. ranitidine, famotidine, and nizatidine

• Can inhibit > 90% basal, food-stimulated and nocturnal secretion of gastric acid after a single dose

• Main clinical use is to inhibit gastric acid secretion

• particularly effective against nocturnal acid secretion



H2 Receptor antagonist ADEs - Answer • H2 antagonists very safe

• ADE < 3% of patients - diarrhea, h/a, fatigue, myalgias, constipation

• Drugs such as ketoconazole, which depend on an acidic medium for gastric absorption, may not be
efficiently absorbed if taken w/ H2 blocker

• Not used for NSAID-induced ulcers

• Better healing and prevention with PPIs

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