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Questions and Answers
What is the primary mechanism of action for short-acting beta agonists (SABAs)?
What is the primary mechanism of action for short-acting beta agonists (SABAs)?
Which side effect is commonly associated with the use of beta 2 receptor agonists?
Which side effect is commonly associated with the use of beta 2 receptor agonists?
What distinguishes long-acting beta agonists (LABAs) from short-acting beta agonists (SABAs)?
What distinguishes long-acting beta agonists (LABAs) from short-acting beta agonists (SABAs)?
Which type of laxative is primarily used to soften impacted stool?
Which type of laxative is primarily used to soften impacted stool?
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Inhaled anticholinergics primarily work by antagonizing which neurotransmitter?
Inhaled anticholinergics primarily work by antagonizing which neurotransmitter?
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What is a common side effect associated with the use of diuretics?
What is a common side effect associated with the use of diuretics?
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Which type of laxative uses water to increase intraluminal pressure in the intestines?
Which type of laxative uses water to increase intraluminal pressure in the intestines?
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Which drug would be contraindicated for patients with severe liver disease?
Which drug would be contraindicated for patients with severe liver disease?
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What is a potential side effect of long-term use of thiazide diuretics?
What is a potential side effect of long-term use of thiazide diuretics?
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What is a common side effect of methylxanthines, such as Theophylline?
What is a common side effect of methylxanthines, such as Theophylline?
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Which class of laxative is contraindicated for use in pregnancy?
Which class of laxative is contraindicated for use in pregnancy?
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Which of the following is a characteristic of second-generation antihistamines?
Which of the following is a characteristic of second-generation antihistamines?
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Which of the following is an adverse effect specifically associated with aldosterone antagonists?
Which of the following is an adverse effect specifically associated with aldosterone antagonists?
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What is the unique characteristic of inhaled corticosteroids when compared to systemic corticosteroids?
What is the unique characteristic of inhaled corticosteroids when compared to systemic corticosteroids?
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What clinical condition is associated with the use of opioid receptor antagonists?
What clinical condition is associated with the use of opioid receptor antagonists?
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Which type of drug is primarily used as an expectorant?
Which type of drug is primarily used as an expectorant?
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What is the mechanism by which loop diuretics exert their effect?
What is the mechanism by which loop diuretics exert their effect?
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What potential risk is associated with long-term use of inhaled corticosteroids in children?
What potential risk is associated with long-term use of inhaled corticosteroids in children?
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Which is true regarding the pharmacokinetics of oral decongestants?
Which is true regarding the pharmacokinetics of oral decongestants?
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What is a common adverse effect of osmotic laxatives?
What is a common adverse effect of osmotic laxatives?
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What class of medications do leukotriene modifiers belong to?
What class of medications do leukotriene modifiers belong to?
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Which of the following laxatives acts by increasing chloride secretion in the intestinal epithelium?
Which of the following laxatives acts by increasing chloride secretion in the intestinal epithelium?
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Which of the following antitussives is chemically related to tetracaine?
Which of the following antitussives is chemically related to tetracaine?
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Which type of diuretic is indicated for use in patients with heart failure?
Which type of diuretic is indicated for use in patients with heart failure?
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What is the main purpose of antitussives?
What is the main purpose of antitussives?
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What is an essential precaution when using magnesium-containing laxatives?
What is an essential precaution when using magnesium-containing laxatives?
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What is the primary action of absorbent drugs used as antidiarrheals?
What is the primary action of absorbent drugs used as antidiarrheals?
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What should be avoided in children, especially those with Down syndrome?
What should be avoided in children, especially those with Down syndrome?
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Which of the following is contraindicated in patients with Parkinson disease?
Which of the following is contraindicated in patients with Parkinson disease?
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Which drug is used to treat nausea and vomiting due to chemotherapy when other agents have failed?
Which drug is used to treat nausea and vomiting due to chemotherapy when other agents have failed?
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Which of the following side effects is associated with cannabinoids like dronabinol?
Which of the following side effects is associated with cannabinoids like dronabinol?
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What is the primary action of 5-HT3 receptor antagonists in preventing chemotherapy-induced nausea and vomiting?
What is the primary action of 5-HT3 receptor antagonists in preventing chemotherapy-induced nausea and vomiting?
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Which adverse effect is common and should be carefully monitored in pediatric patients using phenothiazines?
Which adverse effect is common and should be carefully monitored in pediatric patients using phenothiazines?
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Which condition is a contraindication for using anticholinergics like scopolamine?
Which condition is a contraindication for using anticholinergics like scopolamine?
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What are the actions of antihistamines in treating motion sickness?
What are the actions of antihistamines in treating motion sickness?
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What is an important precaution for using loperamide in chronic diarrhea treatment?
What is an important precaution for using loperamide in chronic diarrhea treatment?
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Which of the following is a known adverse effect of 5-HT3 receptor antagonists?
Which of the following is a known adverse effect of 5-HT3 receptor antagonists?
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Which of the following is a key characteristic of Eluxadoline?
Which of the following is a key characteristic of Eluxadoline?
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What is an important consideration when using aprepitant as a substance P/neurokinin 1 receptor antagonist?
What is an important consideration when using aprepitant as a substance P/neurokinin 1 receptor antagonist?
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Which drug class is used as adjunctive therapy for preventing chemotherapy-induced nausea?
Which drug class is used as adjunctive therapy for preventing chemotherapy-induced nausea?
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What effect do Histamine-2 receptor antagonists (H2RAs) have on gastric acid production?
What effect do Histamine-2 receptor antagonists (H2RAs) have on gastric acid production?
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What is one of the primary goals of GERD therapy?
What is one of the primary goals of GERD therapy?
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Which of the following is an example of nonpharmacologic therapy for GERD?
Which of the following is an example of nonpharmacologic therapy for GERD?
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Which drug is most potent at lowering gastric acid secretion among H2RAs?
Which drug is most potent at lowering gastric acid secretion among H2RAs?
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What is a potential cardiovascular adverse effect of H2RAs?
What is a potential cardiovascular adverse effect of H2RAs?
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What is the primary action of proton pump inhibitors (PPIs) in GERD treatment?
What is the primary action of proton pump inhibitors (PPIs) in GERD treatment?
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Which of the following is NOT a common CNS adverse effect associated with H2RAs?
Which of the following is NOT a common CNS adverse effect associated with H2RAs?
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What is a potential adverse effect of long-term use of proton pump inhibitors?
What is a potential adverse effect of long-term use of proton pump inhibitors?
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What long-term effect should be monitored in patients taking H2RAs?
What long-term effect should be monitored in patients taking H2RAs?
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Which type of medication is typically not first-line treatment for GERD?
Which type of medication is typically not first-line treatment for GERD?
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Which drug is primarily used for its prokinetic properties but does not heal esophageal lesions?
Which drug is primarily used for its prokinetic properties but does not heal esophageal lesions?
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What should be avoided during nonpharmacologic therapy for GERD?
What should be avoided during nonpharmacologic therapy for GERD?
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What is a key benefit of using antacids in GERD treatment?
What is a key benefit of using antacids in GERD treatment?
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Which of the following could lead to serious adverse effects when used as an antacid?
Which of the following could lead to serious adverse effects when used as an antacid?
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What is the primary goal of therapy for peptic ulcer disease (PUD)?
What is the primary goal of therapy for peptic ulcer disease (PUD)?
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Which symptom should prompt a patient to contact their healthcare provider while on GERD treatment?
Which symptom should prompt a patient to contact their healthcare provider while on GERD treatment?
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In which condition should calcium-based antacids be avoided?
In which condition should calcium-based antacids be avoided?
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Which statement regarding the use of H2RAs in pregnancy is correct?
Which statement regarding the use of H2RAs in pregnancy is correct?
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Which drug is used in therapy for improving lower esophageal sphincter (LES) tone?
Which drug is used in therapy for improving lower esophageal sphincter (LES) tone?
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What is a major concern associated with prokinetic agents in GERD treatment?
What is a major concern associated with prokinetic agents in GERD treatment?
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What should be monitored for patients on proton pump inhibitors who are older?
What should be monitored for patients on proton pump inhibitors who are older?
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What is the recommended action if a patient experiences new symptoms while on GERD treatment?
What is the recommended action if a patient experiences new symptoms while on GERD treatment?
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Which drug class is preferred for most patients with frequent GERD symptoms?
Which drug class is preferred for most patients with frequent GERD symptoms?
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What could be a clinical use of antacids aside from treating GERD?
What could be a clinical use of antacids aside from treating GERD?
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Which of the following is primarily affected by H2RAs in the gastric environment?
Which of the following is primarily affected by H2RAs in the gastric environment?
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What is a common adverse effect associated with cimetidine use?
What is a common adverse effect associated with cimetidine use?
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Which long-term side effect should be monitored in patients taking H2RAs?
Which long-term side effect should be monitored in patients taking H2RAs?
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Which drug among the following is used primarily for its prokinetic properties?
Which drug among the following is used primarily for its prokinetic properties?
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Which action of H2RAs is NOT intended?
Which action of H2RAs is NOT intended?
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Which condition makes the use of H2RAs particularly concerning due to CNS effects?
Which condition makes the use of H2RAs particularly concerning due to CNS effects?
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What should be considered when prescribing H2RAs to pregnant women?
What should be considered when prescribing H2RAs to pregnant women?
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What medication class is known to be more effective than H2RAs for gastric acid suppression?
What medication class is known to be more effective than H2RAs for gastric acid suppression?
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What is one of the main goals in the treatment of peptic ulcer disease (PUD)?
What is one of the main goals in the treatment of peptic ulcer disease (PUD)?
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Which adverse effect might arise due to the use of nizatidine?
Which adverse effect might arise due to the use of nizatidine?
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What condition is important to avoid when prescribing diphenoxylate and difenoxin?
What condition is important to avoid when prescribing diphenoxylate and difenoxin?
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Which medication is indicated for females with diarrhea-predominant IBS not responsive to other therapies?
Which medication is indicated for females with diarrhea-predominant IBS not responsive to other therapies?
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What is a common adverse effect associated with the use of phenothiazines?
What is a common adverse effect associated with the use of phenothiazines?
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What action do 5-HT3 receptor antagonists perform to prevent nausea?
What action do 5-HT3 receptor antagonists perform to prevent nausea?
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In which patient population should antihistamines be used cautiously due to the risk of agitation?
In which patient population should antihistamines be used cautiously due to the risk of agitation?
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Which drug is contraindicated in patients with a history of hypersensitivity and should be avoided in pregnancy?
Which drug is contraindicated in patients with a history of hypersensitivity and should be avoided in pregnancy?
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What is a known cardiovascular side effect of 5-HT3 receptor antagonists?
What is a known cardiovascular side effect of 5-HT3 receptor antagonists?
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What type of drug is an effective adjunct therapy in preventing chemotherapy-induced nausea when combined with 5-HT3 antagonists?
What type of drug is an effective adjunct therapy in preventing chemotherapy-induced nausea when combined with 5-HT3 antagonists?
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What effect does scopolamine have in the prevention of nausea and vomiting?
What effect does scopolamine have in the prevention of nausea and vomiting?
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Which of the following best describes the primary action of beta 2 receptor agonists?
Which of the following best describes the primary action of beta 2 receptor agonists?
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What is the pharmacokinetic route of excretion for beta 2 receptor agonists?
What is the pharmacokinetic route of excretion for beta 2 receptor agonists?
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Which population should be monitored closely for urinary retention when using anticholinergics?
Which population should be monitored closely for urinary retention when using anticholinergics?
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Which side effect is commonly associated with inhaled anticholinergics?
Which side effect is commonly associated with inhaled anticholinergics?
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What is a significant risk when using cannabinoids for nausea in patients with a history of seizures?
What is a significant risk when using cannabinoids for nausea in patients with a history of seizures?
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Which class of medications directly inhibits the formation of leukotrienes?
Which class of medications directly inhibits the formation of leukotrienes?
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What symptom might increase in patients using loperamide for chronic diarrhea treatment?
What symptom might increase in patients using loperamide for chronic diarrhea treatment?
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Which medication should not be used in patients with a history of biliary disorders?
Which medication should not be used in patients with a history of biliary disorders?
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What is a significant precaution when using inhaled corticosteroids?
What is a significant precaution when using inhaled corticosteroids?
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Which of the following is a common side effect of theophylline?
Which of the following is a common side effect of theophylline?
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Why should caution be given when prescribing phenothiazines to pediatric patients?
Why should caution be given when prescribing phenothiazines to pediatric patients?
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What distinguishes second-generation antihistamines from first-generation antihistamines?
What distinguishes second-generation antihistamines from first-generation antihistamines?
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Which of the following is a side effect of leukotriene receptor agonists?
Which of the following is a side effect of leukotriene receptor agonists?
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Which option describes a delivery system for inhaled corticosteroids?
Which option describes a delivery system for inhaled corticosteroids?
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What is the mechanism of action for decongestants?
What is the mechanism of action for decongestants?
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Which of the following is contraindicated when using antihistamines?
Which of the following is contraindicated when using antihistamines?
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Which of the following drugs contains phenylalanine and is contraindicated in certain individuals?
Which of the following drugs contains phenylalanine and is contraindicated in certain individuals?
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Which of the following is a side effect commonly associated with diuretics?
Which of the following is a side effect commonly associated with diuretics?
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Which type of diuretic is known for causing electrolyte imbalances, specifically hypokalemia?
Which type of diuretic is known for causing electrolyte imbalances, specifically hypokalemia?
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What mechanism do bulk-producing laxatives primarily employ to treat constipation?
What mechanism do bulk-producing laxatives primarily employ to treat constipation?
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Which type of laxative should be avoided in patients with renal dysfunction?
Which type of laxative should be avoided in patients with renal dysfunction?
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What is a common precaution when using stimulant laxatives?
What is a common precaution when using stimulant laxatives?
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Which class of medications is primarily indicated for short-term relief from diarrhea?
Which class of medications is primarily indicated for short-term relief from diarrhea?
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What is a known adverse effect of opioid receptor antagonists?
What is a known adverse effect of opioid receptor antagonists?
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Which side effect is commonly linked to aldosterone antagonists?
Which side effect is commonly linked to aldosterone antagonists?
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Which type of diuretic exerts its effect by inhibiting sodium reabsorption in the distal renal tubule?
Which type of diuretic exerts its effect by inhibiting sodium reabsorption in the distal renal tubule?
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Which laxative type is contraindicated in cases of bowel obstruction?
Which laxative type is contraindicated in cases of bowel obstruction?
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What potential adverse effect should be monitored in patients taking lactulose?
What potential adverse effect should be monitored in patients taking lactulose?
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Which symptom is a common adverse effect of laxatives in general?
Which symptom is a common adverse effect of laxatives in general?
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Which class of drugs would be most appropriate for managing constipation induced by opioids?
Which class of drugs would be most appropriate for managing constipation induced by opioids?
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Which laxative is specifically contraindicated in pregnancy due to potential nutrient absorption issues?
Which laxative is specifically contraindicated in pregnancy due to potential nutrient absorption issues?
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What is the primary goal of GERD therapy?
What is the primary goal of GERD therapy?
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Which lifestyle modification is recommended for managing GERD symptoms?
Which lifestyle modification is recommended for managing GERD symptoms?
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What class of medication is considered first-line therapy for frequent GERD symptoms?
What class of medication is considered first-line therapy for frequent GERD symptoms?
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Which adverse effect is commonly associated with aluminum-based antacids?
Which adverse effect is commonly associated with aluminum-based antacids?
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Which of the following is NOT an action of proton pump inhibitors?
Which of the following is NOT an action of proton pump inhibitors?
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What is a recommended precaution when using proton pump inhibitors?
What is a recommended precaution when using proton pump inhibitors?
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Which of the following indicates a serious potential adverse effect of prokinetic agents?
Which of the following indicates a serious potential adverse effect of prokinetic agents?
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What is a key feature of histamine-2 receptor antagonists (H2RAs)?
What is a key feature of histamine-2 receptor antagonists (H2RAs)?
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Which of the following is a potential risk associated with long-term use of proton pump inhibitors?
Which of the following is a potential risk associated with long-term use of proton pump inhibitors?
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What should NOT be done when using antacids for treatment?
What should NOT be done when using antacids for treatment?
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What is a common clinical use for antacids?
What is a common clinical use for antacids?
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Which of the following is a sign of possible adverse effects from long-term use of proton pump inhibitors?
Which of the following is a sign of possible adverse effects from long-term use of proton pump inhibitors?
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Which nonpharmacologic therapy should be prioritized for GERD management?
Which nonpharmacologic therapy should be prioritized for GERD management?
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What is the result of reduced gastric acid levels due to proton pump inhibitors?
What is the result of reduced gastric acid levels due to proton pump inhibitors?
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Study Notes
Beta 2 Receptor Agonists
- Bind to β2 smooth muscle cells in the airway, causing bronchodilation via cyclic AMP pathway
- Inhibit release of hypersensitivity mediators (especially from mast cells)
- All have some β1 receptor activity which causes many side effects
- Absorbed from the bronchi
- Metabolized in the liver
- Excreted in the urine
- Multiple forms and delivery systems
- Side effects include tachycardia and tremors
- Precautions are needed in patients with arrhythmias, cardiovascular disease, or hyperthyroidism
Short Acting Beta Agonists (SABA)
- Duration: 4-6 hours
- Examples: Albuterol (Proair, Ventolin, Proventil), Levalbuterol (Xopenex), Pirbuterol (Maxair), Tirbutaline (Brethine)
Long Acting Beta Agonists (LABA)
- Duration: 12 hours
- Examples: Salmeterol (Serevent), Formoterol (Foradil), Arformoterol (Brovana)
Ultra Long Acting Beta Agonists (ULABA)
- Duration: 24 hours
- Examples: Indacaterol (Arcapta Neohaler), Olodaterol (Striverdi Respimat), Vilanterol (Breo Ellipta)
Inhaled Anticholinergics
- Block muscarinic cholinergic receptors, antagonizing acetylcholine
- Decrease cyclic GMP, decreasing smooth muscle contractility of the lungs.
- Poorly absorbed from lungs and GI tract
- 90% is excreted in feces
- 10% metabolized by hydrolysis
- Side effects include dry mouth, cough, headache
- Precautions include avoiding use in patients with urinary retention, BPH, or closed-angle glaucoma
Inhaled Muscarinic Antagonists
- Short Acting Muscarinic Antagonists (SAMA) – 4-6 hours: e.g., Ipratropium bromide (Atrovent), Ipratropium bromide/albuterol (Combivent)
- Long Acting Muscarinic Antagonists (LAMA): e.g., Tiotroprium bromide (Spiriva Handihaler and Respimat), Aclidinium bromide (Tudorza Pressair), Umeclidinium bromide (Incurise Ellipta), Revefenacin (Yupelri)
Methylxanthines
- Examples: Theophylline
- Inhibits phosphodiesterase, increasing cAMP → bronchial smooth muscle and pulmonary vessel relaxation
- Well absorbed orally
- Metabolized in the liver
- Excretion in the urine
- Side effects: headache, irritability, gastric irritation, N/V
- Monitoring of serum drug levels is required to prevent toxicity.
Inhaled Corticosteroids
- Inhibit IgE and mast cell migration into bronchial mucosa.
- Inhibit late-phase allergic reactions.
- Rapidly absorbed from lungs and GI tract.
- Metabolism in the liver, excretion in the urine.
- Side effects: xerostomia, hoarseness, mouth irritation, dysgeusia, oral candidiasis.
- Precaution: HPA suppression, not for status asthmaticus, and high-dose ICS in children may limit growth
Highest to Lowest Potency Inhaled Corticosteroids
- Examples: Fluticasone furoate DPI (Arnuity Ellipta), Mometasone furoate DPI (Asmanex Twisthaler), Fluticasone propionate DPI (ArmonAir Digihaler and generic diskus formulation), Beclomethasone dipropionate (QVAR RediHaler), Ciclesonide MDI (Alvesco Inhalation Aerosol), Budesonide DPI (Pulmicort Flexhaler)
Leukotriene Modifiers
- Leukotrienes are inflammatory mediators produced by mast cells and eosinophils.
- Examples: Montelukast (Singulair) and Zileuton (Zyflo)
- Inhibit leukotriene receptor action, reducing bronchospasm and airway hyperresponsiveness, and vascular leakage.
Antihistamines
- Block the action of histamine by binding to H1 receptors.
- Examples: Diphenhydramine (Benadryl, Chlorpheniramine (Chlor-Trimeton), Hydroxyzine (Atarax), Cetirizine (Zyrtec), Levocetirizine (Xyzal), Loratadine (Claritan), Desloratadine (Clarinex), Fexofenadine (Allegra)
- Well absorbed orally, metabolized in the liver, excreted in the urine
- Side effects: sedation, dry mouth, blurred vision, tremors, and others.
- Precautions: avoid use in young children, patients with BPH, narrow-angle glaucoma, and newborns and premature infants (convulsions).
Olopatadine (Patanase)
- Nasal corticosteroids with action and pharmacokinetic similar to ICS.
- Side effects: nasal irritation, itching, sneezing, dryness, epistaxis.
- Oral and topical forms available.
Decongestants
- Examples: Pseudoephedrine, Phenylephrine
- Stimulate alpha-adrenergic receptors in the nasal mucosa.
- Well absorbed in the GI tract, wide distribution.
- Excreted partially through the liver/partially in urine as active metabolite.
- Precautions: Avoid use in children less than 4 years of age (oral) or 6 years of age (topical).
Antitussives (Cough Suppressants)
- Examples: Codeine, Dextromethorphan, Benzonate
- Act on receptors in the cough center of the medulla.
- Absorbed well from GI tract.
- Side effects: drowsiness, dizziness, nausea.
- Codeine and Dextromethorphan can cause dependence.
- Not to be used with respiratory illnesses or those allergic to "caine" chemicals.
Expectorants
- Example: Guaifenesin
- Reduces sputum viscosity and stimulates goblet cells.
- Indirectly activates GI vagal afferents, increasing mucus hydration for enhanced mucociliary clearance.
- Side effects include GI upset, nausea, and diarrhea.
- Generally safe but precautions may apply, especially to those with asthma, COPD or heart failure or ACE inhibitors.
Diuretics
- First-line therapy for hypertension and heart failure.
- Increase sodium and water excretion → reduce blood volume and peripheral resistance.
- Classes: carbonic anhydrase inhibitors, osmotic diuretics, aldosterone antagonists/potassium-sparing, loop diuretics, and thiazides.
- Side effects: electrolyte imbalances (hypokalemia, hypercalcemia, hyponatremia, hypomagnesemia), high sodium intake exacerbates potassium loss, elevated uric acid, glucose intolerance, and others.
Laxatives
- Stimulants: cascara, senna, bisacodyl, castor oil
- Osmotics: magnesium hydroxide, magnesium citrate, sodium phosphate, polyethylene glycol (PEG) 3350
- Lubricants: mineral oil
- Bulk-producing: psyllium, methylcellulose, polycarbophil
- Surfactants: docusate medications
- Hyperosmolar: glycerin, lactulose
- Chloride channel activators: lubiprostone
- Opioid receptor antagonists: methylnaltrexone
Antidiarrheals
- Absorbent drugs: kaolin and pectin, bismuth subsalicylate.
- Opiates: diphenoxylate with atropine, difenoxin with atropine, loperamide.
Anticholinergics
- Example: Scopolamine
- Bind to histamine-1 and central cholinergic receptors → reduce secretions and GI motility.
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Description
Explore the mechanism, classifications, and side effects of Beta 2 receptor agonists. This quiz covers short-acting, long-acting, and ultra-long-acting beta agonists, highlighting their usage and precautions. Test your knowledge on key examples and their pharmacokinetics.
