A patient with type 1 diabetes reports taking propranolol for hypertension. What
concern does this information present for the provider?
- Correct Answer – A patient with Type 1 DM is insulin dependent for glucose
control and at high risk for hypoglycemic episodes. Propranolol causes prolonged
hypoglycemic episodes. Needs to switch to ACE or ARB.
A provider teaches a patient who has been diagnosed with hypothyroidism about
a new prescription for levothyroxine. Which statement by the patient indicates a
need for further teaching?
a. “I should not take heartburn medication without consulting my provider first.”
b. “I should report insomnia, tremors, and an increased heart rate to my provider.”
c. “If I take a multivitamin with iron, I should take it 4 hours after the
levothyroxine.”
d. “If I take calcium supplements, I may need to decrease my dose of
levothyroxine.” - Correct Answer – D. Calcium may reduce levothyroxine absorption. Further
education is needed if the patient feels she can take half of a prescribed
medication.
MC has undiagnosed multiple gastric ulcers. Shortly after consuming a large meal
and alcohol he experiences significant GI distress. He takes an OTC heartburn
remedy. Within a minute or two he develops what he will later describe as
“belching, nausea and a bad bloated feeling”. Several of the ulcers began to bleed
and he becomes profoundly hypotensive from the blood loss and is taken to the
ED. Endoscopy confirms multiple bleeds; the endoscopist remarks that it appears
as if the lesions had been literally stretched apart causing additional tissue
damage. What did the patient most likely take (i.e. what was the OTC remedy)? - Correct Answer – I would accept Alka-Selzer. I contains NaHCO3 (as well as ASA).
In the presence of HCL it Liberates CO2, that can cause gastric distention, belching
and nausea. The reaction is fairly swift allowing little time for dissipation. Tums, its
primary ingredient calcium carbonate which when taken cause a reaction with the
stomach acid such as production of carbon dioxide gas which can cause bloating
and the stomach to stretch to tear the ulcers open.
On your way to this examination, you experience the vulnerable feeling that an
attack of acute diarrhea is imminent! If you stop at a drug store, which antidiarrheal drugs could you buy without a prescription even though it is chemically
related to the strong opioid analgesic meperidine (but acts only on the peripheral
opioid receptor)? - Correct Answer – Loperamide
JA has multiple medical problems and is taking several drugs including
theophylline, warfarin and phenytoin. His conditions were well controlled, but
recently he started to experience some GI distress for which of his “well
intentioned friends” gave him some medication. He presents to you with toxic
effects of all his other medications and plasma levels of those medications
elevated. What was most likely the medication he took? - Correct Answer – Cimetidine
What lifestyle modifications should be recommended? - Correct Answer – -losing weight if overweight
-elevating head of bed while asleep
-eating smaller meals
-avoid foods/meds that exacerbate gerd
-stop smoking
-stop drinking alcohol
What medications / foods can contribute to GERD? - Correct Answer – -Medications: anticholinergics, barbituates, dopamine,
estrogen, opioids, progesterone, theophylline, nitrates
-Foods: cirus fruits/juices, coffee, tomatoes, spicy food, carbonated drinks
Fried/fatty foods, garlic, onions, chocolate
What is the most effective PPI or H2RA within each of these classes? - Correct Answer – -PPI- bismuth quadruple therapy combined with proton pump
inhibitors
-H2RA- Famotidine 80mg
Other products such as antacids are also available. What are some of these and
what is their place in therapy? - Correct Answer – -Reflux symptoms <2 times a week (infrequent)
-Effective for immediate relief
-Magnesium/Aluminum Hydroxide (Maalox)- can cause constipation
-Alginic Acid
Why would antibiotics be used for PUD caused by H Pylori? What is a typical
regimen and duration of therapy? What patient specific factors should be
considered and how should treatment be monitored? - Correct Answer – Considerations before regimen choice: