The GI - ATI PHARM

A health care professional should question the use of metoclopramide (Reglan) for a patient who is taking which of the following drugs? A.) Digoxin (Lanoxin) B.) Warfarin (Coumadin) C.) Fluvoxamine (Luvox) D.) Allopurinol (Zyloprim)

A.) Digoxin (Lanoxin)--Metoclopramide, a prokinetic drug, can interfere with the absorption of many drugs, including digoxin, diazepam (Valium), tetracycline, and lithium (Lithobid). The patient should not take this drug.

A health care professional is assessing a client who has administered ondansetron (Zofran) IV 1 hr ago. Which of the following findings is an adverse effect of this drug? A.) Dizziness B.) Rash C.) Tardive dyskinesia D.) Abdominal cramping

A.) Dizziness--Dizziness and lightheadedness are the most common adverse effects of ondansetron.

A health care professional should question the use of diphenoxylate/atropine (Lomotil) for a patient who has which of the following disorders? A.) Inflammatory bowel disease B.) Thrombophlebitis C.) Agranulocytosis D.) Immunization with a live virus

A.) Inflammatory bowel disease--Diphenoxylate is an opioid, which can cause the severe complication of toxic megacolon in patients who have inflammatory bowel disease. This disorder is a contraindication for the use of the drug.

A health care professional is about to administer ondansetron (Zofran) to a patient who is receiving chemotherapy. Which of the following actions should the health care professional take? (Select all that apply) A.) Infuse the drug 30 min prior to chemotherapy B.) Administer the drug when the patient reports nausea C.) Infuse the drug slowly over 15 min D.) Administer the drug immediately following chemotherapy E.) Repeat the dose 4 hr after chemotherapy

A.) Infuse the drug 30 min prior to chemotherapy--The health care professional should administer IV ondansetron, a serotonin antagonist, 30 min prior to chemotherapy to prevent chemotherapy-induced nausea and vomiting. When treating radiation-induced nausea and vomiting, it is appropriate to give the drug orally 1 to 2 hr prior to radiation therapy and then every 8 hr. C.) Infuse the drug slowly over 15 min-- The health care professional should infuse ondansetron slowly over 15 min to prevent chemotherapy-induced nausea. E.) Repeat the dose 4 hr after chemotherapy--For maximum effectiveness, the health care professional should administer ondansetron 4 hr and then 8 hr after chemotherapy. When treating anesthesia-induced nausea and vomiting, it is appropriate to give the drug 1 hr before anesthesia induction.

A health care professional is caring for an older adult patient who is about to begin taking cimetidine (Tagamet) to treat duodenal ulcer. The health care professional should tell the patient to report which of the following adverse reactions? A.) Lethargy B.) Cellulitis C.) Dry mouth D.) Myalgia

A.) Lethargy--Cimetidine, a histamine2 receptor antagonist, can cause CNS effects, such as lethargy, depression, confusion, and seizures, especially in older adults. The health care professional should tell the patient to report these effects. If they persist, ranitidine (Zantac) might be a better alternative for the patient.

A health care professional should conclude that alosetron (Lotronex) therapy is effective when a patient who is taking it reports which of the following? A.) One formed stool per day B.) Urination without burning C.) No nausea or vomiting D.) Less GI reflux

A.) One formed stool per day--Alosetron, a serotonin 5-HT3 receptor antagonist, treats the diarrhea and pain of severe irritable bowel syndrome. One formed stool per day indicates symptom relief.

A primary care provider should use caution when prescribing bisacodyl (Dulcolax) for a patient who has: A.) anorexia nervosa B.) myelosupression C.) hypomagnesemia D.) diabetes mellitus

A.) anorexia nervosa--Bisacodyl, a stimulant laxative, requires caution with patients who have an eating disorder because of the risk of laxative abuse. Health care professionals should monitor intake and output carefully and discourage long-term use.

A primary care provider who is considering the various pharmacologic options for a patient who has peptic ulcer disease should understand that which of the following drugs require monitoring of the patient's phosphorus levels? A.) Omeprazole (Prilosec) B.) Aluminum hydroxide (Amphojel) C.) Sucralfate (Carafate) D.) Ranitidine (Zantac)

B.) Aluminum hydroxide (Amphojel)--Antacids that contain aluminum, such as aluminum hydroxide, can cause hypophosphatemia because of aluminum's ability to bind with phosphate and decrease its absorption. The drug requires monitoring of phosphorus levels.

A health care professional should question the use of dimenhydrinate for a patient who has which of the following disorders? A.) Hyperthyroidism B.) Angle-close glaucoma C.) Hypertension D.) Diabetes mellitus

B.) Angle-close glaucoma--Dimenhydrinate, an antihistamine, is inappropriate for patients who have angle-closure glaucoma because it has anticholinergic properties. Anticholinergic drugs can increase intraocular pressure, making angle-closure glaucoma a contraindication for the use of the drug.

A health care professional is caring for a patient who is about to begin taking azathioprine (Imuran) to treat inflammatory bowel disease. The health care professional should tell the patient to report which of the following adverse effects? (Select all that apply.) A.) Impotence B.) Bruising C.) Jaundice D.) Sore throat E.) Nausea

B.) Bruising--Azathioprine can cause thrombocytopenia. The health care professional should monitor platelet count, and tell the patient to report easy or unexplained bruising or bleeding. C.) Jaundice--Azathioprine can cause hepatitis. The health care professional should monitor liver function tests, and tell the patient to report abdominal pain or jaundice. D.) Sore throat--Azathioprine can cause agranulocytosis. The health care professional should tell the patient to report sore throat or fatigue. E.) Nausea--Azathioprine can cause nausea, vomiting, and anorexia. The health care professional should tell the patient to take azathioprine with food to minimize GI effects.

When talking with a patient about taking lubiprostone (Amitiza), the health care professional should tell the patient not to take the drug if he has which of the following? A.) Nausea B.) Diarrhea C.) Urinary retention D.) Sore throat

B.) Diarrhea--Lubiprostone, a chloride channel activator, increases peristalsis and activates the chloride channels in the intestinal wall, which then increases the secretion of sodium and water. These actions treat constipation and can make diarrhea much worse.

A health care professional is reviewing the medical record of a patient who is to begin taking ranitidine (Zantac). Which of the following medications interacts with ranitidine? A.) Phenobarbital sodium (Luminal) B.) Ketoconazole C.) Lisinopril (Prinivil) D.) Hydrochlorothiazide (HydroDIURIL)

B.) Ketoconazole--Ranitidine reduces the absorption of ketoconazole.

When administering sulfasalazine (Azulfidine) to a patient, the health care professional should check which of the following to help identify an adverse effect on the drug? (Select all that apply) A.) Level of consciousness B.) Skin integrity C.) Temperature D.) Urine output E.) CBC

B.) Skin integrity--Sulfasalazine can cause a skin rash, so the health care professional should check the patient's skin for rashes. The drug can also cause nausea. If the patient reports nausea, the health care professional should suggest taking the drug with food or water. C.) Temperature--Sulfasalazine can cause a fever, so the health care professional should check the patient's temperature and treat fever with an antipyretic. E.) CBC--Sulfasalazine can cause hematologic disorders, such as agranulocytosis and hemolytic and macrocytic anemia. The health care professional should check the patient's CBC periodically during therapy, and tell her to report sore throat or fatigue.

When talking with a patient about taking omeprazole (Prilosec) to treat a duodenal ulcer, the health care professional should include which of the following instructions? A.) Taking the drug w/ food B.) Swallow the capsules whole C.) Dissolve the tablets in water D.) Take the drug at bedtime

B.) Swallow the capsules whole--Omeprazole, a proton pump inhibitor, is unstable in stomach acid. The health care professional should tell the patient to swallow the capsules or tablets whole and not chew the delayed-release tablets.

A primary care provider should use caution when prescribing sulfasalazine (Azulfidine) for a patient who has: A.) pancreatitis B.) aspirin sensitivity C.) bronchitis D.) GERD

B.) aspirin sensitivity--Any sensitivity to salicylates, sulfonamides, or trimethoprim (Primsol) is a contraindication for the use of sulfasalazine, a 5-aminosalicylate. This is because intestinal bacteria metabolize the drug into 5-aminosalicylic acid, a salicylate. Aspirin is also a salicylate.

A health care professional should question the use of misoprostol (Cytotec) for a patient who has which of the following? A.) A seizure disorder B.) Rheumatoid arthritis C.) A positive pregnancy test D.) Heart failure

C.) A positive pregnancy test--Misoprostol, a prostaglandin E analog, is a pregnancy risk category X drug. It can cause uterine contractions and induce abortion; therefore, primary care providers must confirm that patients are not pregnant before prescribing the drug. Patients taking it must use contraception.

A health care professional is caring for a patient who is about to begin taking alosetron (Lotronex) to treat irritable bowel syndrome. The health care professional should tell the patient to report which of the following adverse effects? A.) Headache B.) Drowsiness C.) Abdominal pain D.) Sore throat

C.) Abdominal pain--Alosetron, a serotonin 5-HT3 receptor antagonist, can cause ischemic colitis. The health care professional should tell the patient to report abdominal pain, bloody diarrhea, or rectal bleeding, and to stop taking the drug if these symptoms occur.

When talking with a patient about taking loperamide (Imodium), the health are professional should include which of the following instructions? A.) Dissolve the powder thoroughly in 8 oz of water B.) Have diphenhydramine available C.) Avoid activities that require alertness D.) Take 30 min before activities that trigger nausea

C.) Avoid activities that require alertness--Loperamide, an opioid agonist, can cause sedation and dizziness. The health care professional should caution the patient about not taking it before activities that require alertness.

When talking with a patient about taking metoclopramide (Reglan) to treat GERD, the health care professional should include which of the following instructions? A.) Take the drug once a day in the morning B.) Stop taking the drug if drowsiness develops C.) Chew gum or suck on hard candy D.) Take acetaminophen (Tylenol) for headaches

C.) Chew gum or suck on hard candy--Metoclopramide, a prokinetic, can cause anticholinergic effects, including dry mouth. Chewing gum, sucking on hard candy, and sipping water can help minimize this effect.

A health care professional is caring for a patient who is about to begin using dimenhydrinate to prevent motion sickness. Which of the following instructions should the health care professional include when talking with the patient about taking the drug? (select all that apply.) A.) Sit upright for 30 min after taking the drug B.) Avoid antacids when taking the drug C.) Take the drug 30 to 60 min before activities that trigger nausea D.) Avoid activities that require alertness E.) Increase fluid and fiber intake

C.) Take the drug 30 to 60 min before activities that trigger nausea--The health care professional should tell the patient to take dimenhydrinate 30 to 60 min before activities that cause nausea and again before meals and at bedtime. D.) Avoid activities that require alertness--Dimenhydrinate can cause sedation. The health care professional should suggest avoiding activities that require alertness. E.) Increase fluid and fiber intake--Dimenhydrinate can cause anticholinergic effects, such as dry mouth and constipation. The health care professional should tell the patient to increase activity level and fluid and fiber intake.

When talking with a patient about taking psyllium (Metamucil) to treat constipation, the health care professional should include which of the following instructions? (Select all that apply). A.) Expect results in 6 to 12 hr B.) Urinate every 4 hr C.) Take the drug with at least 8 oz of fluid D.) Avoid activities that require alertness E.) Increase fluid and fiber intake

C.) Take the drug with at least 8 oz of fluid--To prevent esophageal obstruction, patients should take psyllium with at least 8 oz of fluid, and, after mixing the powdered form, drink it immediately. E.) Increase fluid and fiber intake--The health care professional should tell the patient to increase activity and fluid and fiber intake, and to keep track of bowel function.

Which of the following drugs has protocols that require patients to meet specific risk-management criteria and sign a treatment agreement before the health care professional can administer the drug? A.) Lubiprostone (Amitiza) B.) Azathioprine (Imuran) C.) Sulfasalazine (Azulfidine) D.) Alosetron (Lotronex)

D.) Alosetron (Lotronex)--Patients who take alosetron, a serotonin 5-HT3 receptor antagonist, can develop severe constipation that can lead to impaction, bowel obstruction, perforation, and potentially fatal ischemic colitis. Because of these risks, health care professionals must inform patients of the benefits and risks of the drug therapy, and patients must sign a treatment agreement.

A health care professional is caring for a patient who is about ot begin taking ranitidine (Zantac) to treat GERD. The health care professional should tell the patients to take certain precautions when taking which of the following over-the-counter drugs? A.) Ginkgo biloba B.) Antidiarrheals C.) St. John's wort D.) Antacids

D.) Antacids--Antacids can decrease the absorption of ranitidine, a histamine2-receptor antagonist. The health care professional should tell the patient to allow at least 1 hr between taking ranitidine and taking an antacid.

A health care professional is caring for a patient who has recently had a myocardial infarction and is about to begin taking docusate sodium (Colace). The health care professional should explain that docusate sodium will have which of the following therapeutic effects? A.) Reduces inflammation B.) Reduces gastric acid C.) Prevents diarrhea D.) Prevents straining

D.) Prevents straining--Docusate sodium, a stool softener, prevents straining during defecation and prevents the elevation in blood pressure that can result from straining. It also helps relieve constipation and reduce the painful elimination of hard stools.

A health care professional is caring for a patient who takes phenytoin (Dilantin) for a seizure disorder and is about to begin sucralfate (Carafate) therapy to treat a duodenal ulcer. The health care professional should tell the patient to take the drugs at least 2 hr apart because: A.) phenytoin increases the metabolism of sucralfate B.) phenytoin reduces the effectiveness of sucralfate C.) sucralfate increases the risk of phenytoin toxicity D.) sucralfate interferes with the absorption of phenytoin

D.) sucralfate interferes with the absorption of phenytoin--Sucralfate decreases the absorption of phenytoin. The health care professional should tell the patient to allow at least 2 hr between taking the two drugs and should monitor the patient's phenytoin levels.