NR 565 Pharmacology Week 7 questions and answers with accurate solutions 2026(PASSED)

Definition: Acid reflux/heartburn

A burning sensation in the chest + recurrent regurgitation of acidic stomach contents into the mouth or throat; can affect teeth and esophagus

Acid reflux/heartburn symptoms

Burning sensation in chest, sour taste, stomach/chest pain, sore throat/hoarseness, wheezing/coughing, eroded teeth enamel

When is GERD defined

If heartburn/acid reflux symptoms interfere with daily life or occur more than 2x/week

Defensive factors to protect against ulcers: Mucus

Secreted by GI mucosa cells, forms protective barrier against acid and pepsin

Defensive factors to protect against ulcers: Bicarbonate

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

Essential for maintaining mucosal integrity

Defensive factors to protect against ulcers: Prostaglandins

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

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

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

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

Takes 2-3 days to reach max effect; acid activated; irreversibly block H+ and amount of HCL produced

Side effects: PPIs

Headache, nausea, diarrhea

Long-term use: renal complications, bone fractures, dementia, decreased absorption of ca+, mg+, + B12

Contraindications: PPIs

Hypocalcemia; increased risk of CAP with short-term use

*Pts. taking NSAIDs can take PPIs for ulcer prophylaxis

Medications: PPIs

OTC: esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec)

RX: dexlansoprazole (dexilant), pantoprazole (protonix), rabeprazole (aciphex)

Therapeutic action: Histamine-2 Receptor Antagonists (H2RA)

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

Headache, nausea

Containdications: H2RA

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

Cimetidine (Tagamet), famotidine (Pepcid), nizatidine (axid), ranitidine (Zantac)

Therapeutic action: Cytoprotective agents

Used to treat/prevent ulcer formation

Medications: Cytoprotective agents

Sucralfate (carafate): pregnancy category B

Misoprostol (cytotec): pregnancy category X

PPIs can lead to

Pneumonia, fractures, rebound acid hyper secretion, hypomagnesemia, diarrhea

*Interacts with clopidogrel (plavix) d/t CYP2C19 inhibition

H2RAs can lead to

Anti-androgenic effects, CNS effects, pneumonia

Antacids can lead to

Constipation, diarrhea, sodium excess

Drug reactions: Antacids

Interferes with absorption of other drugs (i.e. sucralfate); separate administration by 1 hour

Prescribing considerations: H2RAs

Baseline h. pylori, monitor gastric pH (5 or >), use caution with decreased liver or kidney function, report lethargy, somnolence, restlessness, confusion, or hallucinations

Prescribing considerations: PPIs

Baseline h. pylori and mg+, monitor mg+ level periodically, generally safe, encourage ca+ and vitamin D intake to decrease risk of fractures/osteoporosis

Symptoms of hypomagnesemia from PPIs

Palpitations, muscle cramps, tremors

Peptic Ulcer Disease (PUD)

The formation of ulcers in the lining of the stomach and duodenum; stomach = gastric, duodenum = duodenal

Characteristics of Gastric ulcers

Age 50-70, equal in gender, increased cancer risk, normal or decreased parietal cell mass + acid production, increased gastrin, normal pepsinogen, associated gastritis common, h. pylori present in 60-80%, pain in upper abdomen, antacids cause relief, food causes pain; clinical course is chronic ulcers

Characteristics of Duodenal ulcers

Age 20-50, more common in men, cancer risk not changed, increased parietal cell mass + acid production, normal gastrin, increased pepsinogen, gastritis not commonly present, h. pylori in 95-100%, pain in upper abdomen, pain from antacids, food causes relief, nocturnal pain common, clinical course is exacerbation + remission pattern

PUD therapy: Step 1

Lifestyle modifications, OTC antacids or H2RAs

PUD therapy: Step 2

H. pylori testing, PPIs

PUD therapy: Step 3

H. pylori treatment, PPI + abx

PUD therapy: Step 4

Triple therapy: PPI + clarithromycin or metronidazole + amoxicillin

Quadruple therapy: PPI + metronidazole, tetracycline, + bismuth sabsalicylate (2nd-line tx for those that fail 1st-line tx)

Levofloxacin-based triple therapy: PPI + levofloxacin + amoxicillin (usually 2nd-line/rescue therapy)

PUD treatment follow-up

Continue PPIs for 8-12 weeks to promote healing, high-risk patients may require chronic acid suppression therapy; if symptoms don't resolve after exhaustive treatment, refer to gastroenterology

Definition: Constipation

Unsatisfactory defecation with infrequent stool amounts, difficulty passing stool, or both

Definition: Primary + Secondary constipation

Primary: can be treated pharmacologically

Secondary: focused on addressing underlying condition

Constipation in children

Delay or avoidance of bowel movements, decreased water absorption = formation of hard stools, less commonly from health/nutrition issues (fear, doesn't want to stop playing, angst of public bathrooms, stress with potty training)

Bulk laxatives

Polycarbophil, psyllium, methylcellulose

Osmotic (Saline) laxatives

PEG, magnesium hydroxide/sulfate/citrate, sodium phosphate, lactulose

Stimulant laxatives

Senna, bisacodyl, castor oil

Surfactant laxatives

docusate sodium/calcium

Other laxatives

Lubiprostone, plecanatide, PEG-electrolyte solution

Contraindications: Lubricant laxatives

Older adults d/t risk of lipoid pneumonia from aspiration; use caution in pregnancy

Contraindications: Stimulant laxatives

Severe CVD, anal. fissures, abdominal pain/obstruction, N/V with fever

Contraindications: Osmotic (saline) laxatives

Renal dysfunction, CVD/HF, dehydration, DM-can increase BS, older adults

Laxative abuse

Associated with belief that more BMs are needed; used to aid weight loss, can lead to health issues/chronic constipation, refer to behavioral health

Laxative abuse complications

Decreased defecation reflexes, electorally imbalance, dehydration, colitis

Antiemetics: Serotonin agonists

Block serotonin receptors on vagal afferents + in chemoreceptor trigger zone; used in radiation, chemo, and post-op

Antiemetic medications: Serotonin agonists

Ondansetron, granisetron, dolasetron, palonosetron

Antiemetics: Glucocorticoids

MOA is unknown; used in chemo

Antiemetic medications: Glucocoricoids

dexamethasone, methylprednisolone

Antiemetics: Substance P/Neurokinin-1 Antagonists

Blocks receptors for substance P/Neurokinin-1 in the brain; used in chemo

Antiemetic medications: Substance P/Neuroknin-1 Antagonists

Aprepitant, netupittant, palonsetron, fosaprepitant, rolapitant

Antiemetics: Phenothiazines

Blocks dopamine receptors in the chemoreceptor triggers zone; used in chemo, post-op, general

Antiemetic medications: Phenothiazines

Chlorpromazine, perphenazine, prochlorperazine, promethazine

Antiemetics: Butyrophenones

Blocks dopamine receptors in the chemoreceptor trigger zone; used in chemo, post-op, general

Antiemetic medications: Butyrophenones

Haloperidol, Doperidol

Antiemetics: Others

Metoclopraimde; blocks dopamine receptors in the chemoreceptor trigger zone; increased GI motility; used in chemo, post-op, general

Antiemetics: Cannabinoids

MOA unknown; may activate cannabinoid receptors in the vomiting center; used in chemo

Antiemetic medications: Cannabinoids

Dronabinol, Nabilone

Antiemetics: Antihistamines

Block H-1/muscarinic receptors from inner ear to vomiting center; used in motion sickness

Antiemetic medications: Antihistamines

Cyclizine, dimenhydrinate (dramamine), diphenhydramine, hydroxyzine, meclizine

Antiemetics: Anticholinergics

Scopolamine; blocks H-1/muscarinic receptors from inner ear to committing center; used in motion sickness

Diarrhea

The passage of loose, watery stool; can also have abdominal cramping + frequent bowel movements

Acute: Several days

Chronic: longer than 2 weeks; may indicate infection or IBD

Causes of diarrhea

Virus, bacteria, or parasite (i.e. rotavirus)

Antidiarrheals: Opioids

Effective for non-infectious diarrhea; low levels that don't create dependence; high, excessive doses can create morphine-like effects

Antidiarrheal medications: Opioids

Diphenoxylate (lomotil), loperamide (Imodium)

Traveler's diarrhea

Usually caused by E. coli; resolves spontaneously

Traveler's diarrhea treatment

Cipro 500mg BID for non-pregnant adults

Pepto bismol

Antidiarrheals: Bismuth subsalicylate

GI upset, diarrhea, heartburn, indegestion

Bismuth subsalicylate properties

Antibacterial, antisecretory

Contraindications: Bismuth subsalicylate

Children/teens recovering from chicken pox/flu-like illness due to increased risk of Reye's syndrome; individuals with aspirin hypersensitivity

Side effects: Bismuth subsalicylate

Gray/back stools, black tongue

IBS diagnostic criteria

Presence of abdominal pain or discomfort that cannot be explained by structural or chemical abnormalities for at least 12 weeks in the previous year and contain 2 of the following:

-Pain related to defection

-Onset of pain associated with change in stool freq.

-Onset of pain associated with chant in stool consist.

4 Major forms of IBS

IBS-D: abdominal pain with diarrhea

IBS-C: abdominal pain with constipation

IBS-M: abdominal pain with alternating D/C

IBS-U: abdominal pain with D/C that doesn't fit well into another category

IBS symptom triggers

Stress, depression, diet (caffeine, alcohol, fried food, gas-generating vegetables, sorbitol), overproduction of gastric acid, excessive bacterial colonization of the small intestine

Non-specific IBS medications: Antispasmodics

Hyoscyamine, dicyclomine

IBS specific drugs: Alosetron

IBS-D in women; selective blockade of 5-HT receptors

IBS specific drugs: Eluxadoline, Lubiprostone

IBD-D, IBS-C. in women; mu- and kappa- opioid receptor antagonist; selective activation of cL channels in the intestine

IBS specific drugs: Linactolide

IBS-C; Guaylate cyclase agonist; increased intestinal fluid secretion + motility

Definition: IBS

Common GI disorder involving motility + sensitivity problems of the large intestine

Symptoms: IBS

Gas + bloating, abdominal pain, irregular bowel patterns, diarrhea or constipation, mucus around or within stools, heartburn, nausea

Goal of treatment: IBS

Symptom management, lifestyle choices + medications directed towards symptoms

Definition: IBD

Chronic disease with no cure that affects both the small + large intestine; includes ulcerative colitis and chrohn's disease

Symptoms: IBD

Frequent, urgent need to have a bowel movement, abdominal pain + cramping, diarrhea or bloody diarrhea, N/V, unexplained weight loss, malnutrition

Goal of treatment: IBD

Induce remission by decreasing inflammation that causes the symptoms