From this list, select the four defensive factors that protect the GI tract.
Mucous
Bicarbonate
Blood flow
Prostaglandins
Enzymes
Fats
Pepsin
Select the two main mechanisms by which chronic use of NSAIDs can cause ulcers.
inhibit prostaglandin synthesis
Directly irritate GI mucosa
Increase mucosal blood flow
Decrease gastric acid secretion
Increase mucous secretion
Which of the following is best described as a proteolytic enzyme in gastric juice that injures unprotected cells of the GI mucosa?
Pepsinogen
Prostaglandin
Which cells are responsible for pumping acid into the lumen of the stomach?
Mucosal
Parietal
Gastric
You are caring for a patient who has peptic ulcer disease. The patient tells you, "My brother has reflux disease and he stopped drinking coffee and alcohol. He got so much better. Should I stop drinking coffee and alcohol too?" What is the best response?
"Yes, it would be a good idea for you to stop drinking coffee and alcohol. There are other dietary modifications that you can make. Would you like me to give you pamphlet about that?"
"Dietary modifications are more helpful for people with reflux disease. In people with peptic ulcer disease, changes to your diet may help relieve some of your symptoms but it won't actually affect the healing of your ulcers."
"Dietary modifications are really important. If you eliminate certain foods from your diet, it will allow your body to heal."
"Changes to your diet make no real difference. You can keep drinking alcohol and coffee, if you want."
Which of the following drugs work to decrease acid secretion?
proton pump inhibitors
histamine-2 receptor antagonists
misoprostol
antacids
What is the main contraindication of taking misoprostol to prevent NSAID-induced PUD and duodenal ulcers?
Pregnancy
Hypertension
Taking clopidogrel (antiplatelet agent)
Taking antibiotics
Why are patients advised against taking clopidogrel (antiplatelet agent) and a PPI concurrently?
PPIs reduce the efficacy of clopidogrel
PPIs result in a toxic build up of clopidogrel
Clopidogrel inactivates PPIs
PPIs increase the availability of clopidogrel
PPIs are more potent than histamine-2 receptor antagonists because they irreversibly inhibit H+K+ATPase.
Which patient population should be advised against using magnesium hydroxide (milk of magnesia) for symptomatic relief of PUD/GERD?
Patients with renal failure
Patients with congestive heart failure
Patients with hypertension
Patients who are pregnant
All of the following are classes of laxatives EXCEPT:
bulk-forming
stimulant
osmotic
surfactants
Which of the following laxatives (miscellaneous class) is given as a large amount of solution (usually 4 litres) to cleanse the bowel prior to diagnostic or surgical procedures?
Mineral oil
Lactulose
Polyethylene glycol-electrolyte mix
Pico-Salax
You are caring for a patient who reports that they have chronic constipation. They tell you that unless they take Milk of Magnesia, they become constipated. What is the best response?
"You can continue to take Milk of Magnesia. It is a gentle laxative and will help you to have regular bowel movements."
"Milk of Magnesia is an older product. Would you like me to recommend something that might be more helpful?"
"If this is a serious problem that is really bothering you, I suggest you take it up with your family doctor."
"It is common for patients to become dependent on laxatives, which can have some adverse effects, including dehydration, electrolyte imbalances, and colitis. Would it be OK if we talked more about some alternatives?"
A mother of a 4-year-old child tells you that her child is recovering from a viral infection. She says that her child is continuing to have some diarrhea and asks you what she should do. What is the best response?
"You can give your child some PeptoBismol, which is an over-the-counter product and will help your child to have less watery stools."
"You should not give your child PeptoBismol. You can offer your child an oral rehydration solution and I can give you a simple recipe. If your child has diarrhea for more than 24 hours or has symptoms of dehydration, you can bring him/her to the hospital or your pediatrician."
"Your child needs to be taken to the ER right away."
