NR 565 / NR565 Advanced Pharmacology Final Exam Review | Already Rated A | Latest, 2021/2022| Chamberlain College

NR 565 / NR565 Advanced Pharmacology Final Exam Review | Already Rated A | Latest, 2021/2022| Chamberlain College

NR 565 / NR565 Advanced
Pharmacology Final Exam Review |
Already Rated A | Latest, 2021/2022|
Chamberlain College

1. gastroesophageal reflux disease (GERD)

• common disorder characterized by heartburn and acid regurgitation.

1. Major groups of GERD

• erosive esophagitis and
• non-erosive reflux disease (NERD).

1. Drug of choice for GERD

• Proton Pump Inhibitors;

1. Cimetidine use for GERD

• drug of choice for relieving symptoms.; does little to hasten healing.

1. Proton Pump Inhibitor MOA

• irreversibly blocking hydrogen and the amount of HCl produced by the stomach

1. Proton Pump Inhibitor Prototype Drug

• Omeprazole

1. PPI AE

• Pneumonia,
• FX,
• Rebound Acid Hypersecretion,
• Hypomagnesemia

1. PPI Monitoring

• Magnesium (Hypomagnesimia)

1. PPI Drug Interaction

• Clopidogrel (Plavix)

1. Antidiarrheal drugs fall into two major groups

• (1) specific antidiarrheal drugs: Treat the underlying causative agent
• (2) nonspecific antidiarrheal drugs: Treat the symptom but do not treat the agent

1. Opioids (antidiarrheals)

• most effective antidiarrheal agents;
• activating opioid receptors in the GI tract,
• these drugs decrease intestinal motility and thus slow down intestinal transit,
  which allows more time for absorption of fluid and electrolytes.

1. diphenoxylate (Lomotil, others) and loperamide (Imodium, others)

• most frequently employed opioids for diarrhea

1. Diphenoxylate (Lomotil)

• Opioid Antidiarrheal; Formulated w/ atropine to discourage abuse

1. Diphenoxylate (Lomotil) MOA
2. Loperamide (Imodium)

• Opioid Antidiarrheal; Meperidine analog

1. Loperamide (Imodium) MOA

• treat diarrhea and reduce the volume of discharge from ileostomies.
• Benefits derive from suppressing bowel motility and from suppressing fluid
  secretion into the intestinal lumen.

1. Bismuth subsalicylate (Pepto-Bismol)

• -popular over-the-counter medication that can be used for upset stomach,
  diarrhea, heartburn, and general indigestion.
• -antibacterial and antisecretory properties; used to treat traveler’s diarrhea

1. Bismuth subsalicylate (Pepto-Bismol) Contraindication

• contraindicated in children or teenagers during or after recovery from chickenpox
  or flu-like illness due to the risk of Reye’s syndrome and in individuals with
  aspirin hypersensitivity.

1. Bismuth subsalicylate (Pepto-Bismol) AE

• gray/black stools and
• black tongue from the bismuth.

1. Traveler’s diarrhea

• Escherichia coli

1. Traveler’s Diarrhea Treatment

• -Ciprofloxacin for adults.
• -Azithromycin (Zithromax) is preferred for children and for pregnant women).
• -Rifaximin (Xifaxan) may also be used provided the patient is not pregnant or
  febrile and that stools are not bloody.

1. Metoclopramide MOA

• A prokinetic agent:
  (1) suppresses emesis (by blocking receptors for dopamine and serotonin in
  the CTZ)
  (2) it increases upper GI motility (by enhancing the actions of
  acetylcholine).

1. Prokinetic Agent

• Metoclopramide; Drugs that increase the tone and motility of the GI tract.
  Indications include gastroesophageal reflux disease (GERD), CINV, and diabetic
  gastroparesis.

1. Metoclopramide (Reglan) PO Dose Use

• 1) diabetic gastroparesis
• 2) suppression of gastroesophageal reflux.

1. Metoclopramide (Reglan) IV Dose Use

• 1) suppression of postoperative nausea and vomiting,
• 2) suppression of CINV,
• 3) facilitation of small bowel intubation
• 4) facilitation of radiologic examination of the GI tract.

1. Metoclopramide (Reglan) AE

• High-dose therapy: sedation and diarrhea are common
• Long-term high-dose therapy: irreversible tardive dyskinesia, characterized by
  repetitive, involuntary movements of the arms, legs, and facial muscles.

1. Metoclopramide contraindication

• Contraindication in patients with GI obstruction, perforation, or hemorrhage.

1. Misoprostol (Cytotec)

• an analog of prostaglandin E1. In the United States, the drug’s only approved GI
  indication is prevention of gastric ulcers caused by long-term therapy with
  NSAIDs.

1. Misoprostol (Cytotec) Contraindication

• contraindicated during pregnancy due to risk for partial or complete expulsion of
  the developing fetus.

1. Peptic Ulcer Disease Step 2 Therapy

• H. pylori testing & Treatment with PPIs

1. H. pylori

• gram-negative bacillus that can colonize the stomach and duodenum; most
  common cause of gastric and duodenal ulcers

1. H. Pylori Treatment

• PPI plus antibiotics

1. H. pylori triple therapy

• Amoxicillin,
• Clarithromycin or
• Metronidazole, PPI (omeprazole)

1. H. pylori quadruple therapy

• PPI,
• bismuth,
• metronidazole,
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