Gastrointestinal Disorders: GERD Overview
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Questions and Answers

What is a key element necessary for effective learning in relation to note-taking?

  • Use of digital note-taking tools
  • Listening without distraction
  • Providing all information beforehand
  • Direct involvement in organizing information (correct)

    • Which class of medications is likely to have the longest duration of action for treating heartburn?

  • Prokinetics
  • Antacids
  • Proton pump inhibitors (correct)
  • H2-receptor antagonists

    • Which factor does NOT typically exacerbate heartburn and dyspepsia?

  • High-fat meals
  • Peppermint
  • Citrus fruits
  • Hydration (correct)

    • What is one of the adverse effects commonly associated with OTC medications for dyspepsia?

    <p>Constipation</p> Signup and view all the answers

    In assessing the severity of GI complaints, which method is typically emphasized?

    <p>Patient's self-report of symptoms</p> Signup and view all the answers

    Which is important to consider when recommending drug treatment for heartburn?

    <p>Duration of symptoms</p> Signup and view all the answers

    What aspect of OTC medications for heartburn should be critically assessed?

    <p>Advantages and disadvantages</p> Signup and view all the answers

    Which is NOT a common treatment approach for heartburn and dyspepsia?

    <p>Physical therapy</p> Signup and view all the answers

    When considering the mechanism of action for antihistamines in heartburn treatment, what should be evaluated?

    <p>Acid production reduction</p> Signup and view all the answers

    Which dietary component is often linked to increased heartburn symptoms?

    <p>Spicy foods</p> Signup and view all the answers

    Which substance is known to commonly trigger heartburn due to its composition?

    <p>Peppermint</p> Signup and view all the answers

    What is the recommended action if a patient’s heartburn symptoms persist or worsen?

    <p>Consult a gastroenterologist</p> Signup and view all the answers

    Which of the following foods is NOT mentioned as a risk factor for heartburn?

    <p>Plain bread</p> Signup and view all the answers

    What does the acronym SCHOLAR-MAC in relation to patient assessment stand for?

    <p>Symptoms, Characteristics, History, Onset, Location, Aggravating factors, Remitting factors, Medications, Allergies, Conditions</p> Signup and view all the answers

    Which behavior modification is generally effective in managing heartburn?

    <p>Eating smaller, more frequent meals</p> Signup and view all the answers

    Which of the following beverages is likely to exacerbate heartburn symptoms?

    <p>Sparkling water</p> Signup and view all the answers

    What type of condition is gastroesophageal reflux disease (GERD) commonly associated with?

    <p>Back flow of stomach contents into the esophagus</p> Signup and view all the answers

    Which lifestyle factor is considered a risk for developing heartburn?

    <p>Smoking</p> Signup and view all the answers

    What essential strategy is recommended for effective learning in addressing heartburn issues?

    <p>Identifying and solving problems prior to instruction</p> Signup and view all the answers

    Which food is frequently associated with increasing the risk of heartburn?

    <p>Chocolate</p> Signup and view all the answers

    Which of the following medications is classified as an alpha-2 adrenergic agonist?

    <p>brimonidine</p> Signup and view all the answers

    What is a common adverse effect associated with the use of beta-1 selective blockers?

    <p>bradycardia</p> Signup and view all the answers

    Which drug is indicated for both hypertension and heart failure?

    <p>ramipril</p> Signup and view all the answers

    Which class of medication does Atrovent HFA belong to?

    <p>anticholinergic</p> Signup and view all the answers

    Which of the following drugs is associated with hyperkalemia as an adverse effect?

    <p>spironolactone</p> Signup and view all the answers

    What is a common indication for the medication montelukast?

    <p>asthma</p> Signup and view all the answers

    Which adverse effect is commonly associated with the use of corticosteroids?

    <p>weight gain</p> Signup and view all the answers

    What drug interaction is a potential concern with the use of anticoagulants like rivaroxaban?

    <p>increased bleeding risk with NSAIDs</p> Signup and view all the answers

    Which of the following medications is indicated for muscle spasms?

    <p>tizanidine</p> Signup and view all the answers

    Which adverse effect may occur with the use of inhaled corticosteroids like fluticasone?

    <p>oral candidiasis</p> Signup and view all the answers

    Which class of medication is commonly associated with causing sedation as a side effect?

    <p>Benzodiazepines</p> Signup and view all the answers

    What is the primary indication for the use of lamotrigine?

    <p>Seizures</p> Signup and view all the answers

    Which adverse effect is commonly associated with the use of SSRIs like escitalopram?

    <p>Sexual dysfunction</p> Signup and view all the answers

    What is a potential cardiovascular side effect of lithium use?

    <p>Arrhythmias</p> Signup and view all the answers

    What type of drug is typically used as a first-line treatment for hypertension?

    <p>ACE inhibitors</p> Signup and view all the answers

    Which of the following medications is classified as a beta-3 agonist?

    <p>Mirabegron</p> Signup and view all the answers

    Which of the following is a common adverse effect of anticonvulsants like carbamazepine?

    <p>Dizziness</p> Signup and view all the answers

    What is a common adverse effect of opioid analgesics?

    <p>Constipation</p> Signup and view all the answers

    Which of the following drugs is an anticholinergic medication indicated for overactive bladder?

    <p>Oxybutynin</p> Signup and view all the answers

    Which of the following medications can cause hyperkalemia as a side effect?

    <p>Lisinopril</p> Signup and view all the answers

    How should the concentration of electrolytes in oral solutions be expressed?

    <p>Both milliequivalents and metric weight</p> Signup and view all the answers

    What is the correct way to express the concentration of topical solutions?

    <p>As a percentage concentration</p> Signup and view all the answers

    When preparing an oral solution, how should the concentration be stated for an ingredient of 50 mg in 5 mL?

    <p>50 mg/5 mL</p> Signup and view all the answers

    What is a note to consider when using Alcohol, USP as an excipient in solution preparations?

    <p>Its concentration must be expressed in volume/volume percent</p> Signup and view all the answers

    Which method is recommended for dispensing solutions intended for non-oral administration?

    <p>In an appropriately sized amber bottle</p> Signup and view all the answers

    For a formulation containing Phenobarbital 40 mg/5 mL, which auxiliary labeling might be necessary?

    <p>Store under refrigeration</p> Signup and view all the answers

    In which scenario should oral solutions not be stored under refrigeration?

    <p>When they contain unstable drug(s) at low temperatures</p> Signup and view all the answers

    What term should be used to express the concentration of oral solutions administered?

    <p>Metric weight or volume per volume</p> Signup and view all the answers

    What is the final concentration of phenobarbital after adding 15 mL of liquid to an initial dose of 1.5% phenobarbital?

    <p>0.75%</p> Signup and view all the answers

    What would be the glycerin concentration after diluting a 15% glycerin solution in the same manner?

    <p>7.5%</p> Signup and view all the answers

    Which factor most significantly affects the solubility of phenobarbital when mixed with orange juice?

    <p>The acidity of orange juice</p> Signup and view all the answers

    What is the concentration of alcohol, USP after dilution if the initial concentration is 40%?

    <p>20%</p> Signup and view all the answers

    What is the reason for advising against diluting phenobarbital with water or juice?

    <p>It reduces the solubility of phenobarbital.</p> Signup and view all the answers

    At what alcohol concentration would 0.75% phenobarbital with 7.5% glycerin remain soluble?

    <p>~31%</p> Signup and view all the answers

    What is the equilibrium expression for the weak acid phenobarbital?

    <p>HP ⇄ H+ + P-</p> Signup and view all the answers

    Which component in orange juice could negatively impact the solubility of phenobarbital?

    <p>Vitamin C</p> Signup and view all the answers

    What is the primary reason for selecting a specific vehicle when preparing a solution dosage form?

    <p>To ensure proper drug solubility and stability</p> Signup and view all the answers

    Which of the following statements about drug solubility is true?

    <p>Solubility should be confirmed before preparation of a solution</p> Signup and view all the answers

    What characterizes an appropriate solvent for given drug substances?

    <p>Solvents must match the polarity of the solute to enhance solubility</p> Signup and view all the answers

    Which of the following is NOT a common solvent for oral solutions?

    <p>Acetone</p> Signup and view all the answers

    When preparing a co-solvent system for a controlled substance solution, which is the most relevant consideration?

    <p>Compatibility of the co-solvency with intended use</p> Signup and view all the answers

    What is the primary characteristic of an electrolyte solution?

    <p>It consists of dissolved ions in a solvent</p> Signup and view all the answers

    Which type of solution must remain sterile during preparation and packaging?

    <p>Injectable solutions</p> Signup and view all the answers

    Which of the following vehicles is a common choice for preparing topical solution dosage forms?

    <p>Acetone</p> Signup and view all the answers

    Study Notes

    Gastrointestinal Disorders

    • Heartburn is the most common symptom of gastroesophageal reflux disease (GERD), also known as acid reflux.
    • GERD occurs when acid or other stomach contents back up into the esophagus.
    • GERD can be controlled through behavior modification and over-the-counter medication.
    • If symptoms persist or worsen, a gastroenterologist should be consulted for additional tests and to rule out more serious conditions.

    Learning Objectives

    • Classify the severity of a patient's GI complaints.
    • Describe diet, pharmacologic agents, and other issues that can exacerbate heartburn & dyspepsia.
    • Compare and contrast the mechanism of action, indications, onset, and duration of action, and adverse effects of OTC medications used to treat heartburn & dyspepsia.
    • Assess the advantages and disadvantages of OTC medications used to treat heartburn & dyspepsia.
    • Recommend an appropriate drug treatment selection for a patient with heartburn & dyspepsia.
    • Formulate appropriate counseling information to be provided to a patient on a given treatment regimen for heartburn & dyspepsia.

    SCHOLAR-MAC

    • SCHOLAR-MAC is a mnemonic device used to help gather information about a patient's symptoms.
    • The abbreviation stands for:
      • Symptoms
      • Characteristics
      • History
      • Onset
      • Location
      • Aggravating Factors
      • Remitting Factors
      • Medications
      • Allergies
      • Conditions

    Causes of Heartburn

    • Risk Factors: Food & beverages

      • Fried or fatty foods
      • Chocolate
      • Peppermint
      • Alcohol
      • Coffee (decaf too)
      • Carbonated beverages
      • Garlic, onions, peppers
      • Vinegar
      • Tomato sauce
      • Citrus fruits or juices

    • Risk Factors: Lifestyle

      • Overeating
      • Smoking
      • Eating late at night
      • Bending over or lying down after eating
      • Wearing tight clothing
      • Pregnancy
      • Obesity
      • Stress
      • Certain medications (e.g., aspirin, ibuprofen, some antibiotics)

    Key Learning Strategy

    • Make it Stick!
      • Trying to solve a problem before being taught the solution leads to better learning, even when errors are made in the attempt.

    Brand and Generic Medications with Indications, Adverse Effects, and Classes

    • Aldactone (spironolactone): aldosterone antagonist indicated for heart failure and hypertension; potential adverse effects include eye irritation, gynecomastia, drowsiness, dry mouth, and hyperkalemia.
    • Alphagan P (brimonidine ophthalmic): alpha-2 adrenergic agonist indicated for glaucoma; potential adverse effects include eye irritation.
    • Catapres (clonidine): alpha-2 adrenergic agonist indicated for hypertension; potential adverse effects include drowsiness, dry mouth, and hyperkalemia.
    • Lotensin (benazepril): angiotensin converting enzyme inhibitor (ACEI) indicated for hypertension and heart failure; potential adverse effects include dry cough and hyperkalemia.
    • Vasotec (enalapril): angiotensin converting enzyme inhibitor (ACEI) indicated for hypertension and heart failure; potential adverse effects include dry cough and hyperkalemia.
    • Zestril (lisinopril): angiotensin converting enzyme inhibitor (ACEI) indicated for hypertension and heart failure; potential adverse effects include dry cough and hyperkalemia.
    • Altace (ramipril): angiotensin converting enzyme inhibitor (ACEI) indicated for hypertension and heart failure; potential adverse effects include dry mouth and hyperkalemia.
    • Atrovent HFA (ipratropium inhaled): anticholinergic indicated for COPD; potential adverse effects include dry mouth and bitter taste.
    • Spiriva Respimat (tiotropium inhaled): anticholinergic indicated for COPD and asthma; potential adverse effects include drowsiness and bitter taste.
    • Tessalon Perles (benzonatate): antitussive indicated for cough; potential adverse effects include bradycardia and hallucination.
    • Inderal (propranolol): beta-1 and beta-2 nonselective blocker indicated for migraine prophylaxis and essential tremor; potential adverse effects include eye irritation, fatigue, and eye sensitivity to light.
    • Betimol (timolol ophthalmic): beta-1 and beta-2 nonselective blocker indicated for glaucoma; potential adverse effects include bradycardia and fatigue.
    • Coreg (carvedilol): beta-1 and beta-2 nonselective blocker/alpha-1 blocker indicated for heart failure and hypertension; potential adverse effects include bradycardia and fatigue.
    • Normodyne (labetalol): beta-1 and beta-2 nonselective blocker/alpha-1 blocker indicated for hypertension and heart failure; potential adverse effects include bradycardia and fatigue.
    • Tenormin (atenolol): beta-1 selective blocker indicated for hypertension and angina; potential adverse effects include bradycardia and fatigue.
    • Toprol XL (metoprolol succinate): beta-1 selective blocker indicated for hypertension and angina; potential adverse effects include bradycardia and fatigue.
    • Lopressor (metoprolol tartrate): beta-1 selective blocker indicated for hypertension and angina; potential adverse effects include bradycardia and fatigue.
    • Calan (verapamil): nondihydropyridine calcium channel blocker (CCB) indicated for hypertension, atrial fibrillation, and angina; potential adverse effects include hypotension, diarrhea, and hyperkalemia.
    • Lumigan (bimatoprost ophthalmic): prostaglandin analog indicated for glaucoma; potential adverse effects include pruritus and eosinophilia.
    • Xalatan (latanoprost ophthalmic): prostaglandin analog indicated for glaucoma; potential adverse effects include diarrhea.
    • Travatan Z (travoprost ophthalmic): prostaglandin analog indicated for glaucoma; potential adverse effects include diarrhea.
    • Dexilant (dexlansoprazole): proton pump inhibitor (PPI) indicated for GERD and GI ulcers; potential adverse effects include diarrhea.
    • Protonix (pantoprazole): proton pump inhibitor (PPI) indicated for GERD and GI ulcers; potential adverse effects include diarrhea.
    • Pristiq (desvenlafaxine): antidepressant; serotonin norepinephrine reuptake inhibitor (SNRI) indicated for depression; potential adverse effects include UV light sensitivity and nausea.
    • Viibryd (vilazodone): antidepressant; selective serotonin reuptake inhibitor (SSRI) indicated for depression; potential adverse effects include nausea.
    • Proventil HFA (albuterol inhaled): short-acting beta-2 agonist indicated for asthma and COPD; potential adverse effects include thrombocytopenia and peripheral edema.
    • Xopenex (levalbuterol inhaled): short-acting beta-2 agonist indicated for asthma and COPD; potential adverse effects include nausea.
    • Robaxin (methocarbamol): skeletal muscle relaxant indicated for muscle spasms; potential adverse effects include weight gain.
    • Lioresal (baclofen): skeletal muscle relaxant indicated for muscle spasms; potential adverse effects include hypersensitivity to sulfa agents.
    • Soma (carisoprodol): skeletal muscle relaxant indicated for muscle spasms; potential adverse effects include hypersensitivity to sulfa agents.
    • Flexeril (cyclobenzaprine): skeletal muscle relaxant indicated for muscle spasms; potential adverse effects include xerostomia.
    • Microzide (hydrochlorothiazide): thiazide diuretic indicated for hypertension and edema; potential adverse effects include nausea.
    • Thalitone (chlorthalidone): thiazide-like diuretic indicated for hypertension and edema; potential adverse effects include nausea.

    Antibiotic, Antifungal, and Antiviral Medications

    • Zithromax (azithromycin): antibiotic; macrolide indicated for bacterial infections; potential adverse effects include diarrhea and nausea.
    • Omnicef (cefdinir ): antibiotic; cephalosporin (3rd gen.) indicated for bacterial infections; potential adverse effects include diarrhea and nausea.
    • Teflaro (ceftaroline IV): antibiotic; cephalosporin (5th gen.) indicated for bacterial infections; potential adverse effects include diarrhea and a positive direct Coomb's test.
    • Keflex (cephalexin): antibiotic; cephalosporin (1st gen.) indicated for bacterial infections; potential adverse effects include nausea and vomiting.
    • Lanoxin (digoxin): antiarrhythmic indicated for atrial fibrillation and anti-MRSA; potential adverse effects include atrial tachycardia and dizziness.
    • Vibramycin (doxycycline): antibiotic; tetracycline indicated for bacterial infections and heart failure; potential adverse effects include photosensitivity and dermatologic effects.
    • Plaquenil (hydroxychloroquine): antimalaria; aminoquinoline indicated for systemic lupus erythematosus (SLE) and malaria; potential adverse effects include CNS effects.
    • Novolog (insulin aspart): antidiabetic; insulin, rapid-acting indicated for diabetes; potential adverse effects include hypoglycemia and weight gain.
    • Levemir (insulin detemir): antidiabetic; insulin, long-acting indicated for diabetes; potential adverse effects include hypoglycemia.
    • Lantus (insulin glargine): antidiabetic; insulin, long-acting indicated for diabetes; potential adverse effects include hypoglycemia and weight gain.
    • Humalog (insulin lispro ): antidiabetic; insulin, rapid-acting indicated for diabetes; potential adverse effects include hypoglycemia and headache.
    • Levaquin (levofloxacin): antibiotic; fluoroquinolone indicated for bacterial infections; potential adverse effects include diarrhea.
    • Merrem (meropenem IV): antibiotic; carbapenem indicated for bacterial infections; potential adverse effects include hypersensitivity and UV light sensitivity.
    • Minocin (minocycline): antibiotic; tetracycline derivative indicated for bacterial infections and acne; potential adverse effects include dizziness and headache.
    • Macrodantin (nitrofurantoin): antibiotic indicated for bacterial infections (UTI); potential adverse effects include diarrhea and fatigue.
    • Zofran (ondansetron): antiemetic; selective 5-HT3 receptor antagonist indicated for prevention of N/V; potential adverse effects include brown urine.
    • Tamiflu (oseltamivir): influenza neuraminidase inhibitor indicated for prevention/treatment of flu; potential adverse effects include nausea and fatigue.
    • PenVK (penicillin V potassium): antibiotic; penicillin indicated for bacterial infections; potential adverse effects include diarrhea and vomiting.
    • Zosyn (piperacillin & tazobactam IV): antibiotic; penicillin-based indicated for bacterial infections; potential adverse effects include diarrhea and nausea.
    • Phenergan (promethazine): phenothiazine; histamine-1 antagonist indicated for nausea; potential adverse effects include bradycardia and headache.
    • Januvia (sitagliptin): antidiabetic; dipeptidyl peptidase-4 inhibitor (DPP-4) indicated for diabetes; potential adverse effects include hypoglycemia and CNS effects.
    • Janumet (sitagliptin & metformin): dipeptidyl peptidase 4 (DPP-4) & biguanide indicated for diabetes; potential adverse effects include diarrhea and headache.
    • Imitrex (sumatriptan): serotonin 5HT 1B/1D receptor agonist indicated for acute migraine and cluster headache; potential adverse effects include tingling sensation and chest tightness.
    • Valtrex (valacyclovir): viral DNA polymerase inhibitor indicated for herpes simplex and herpes zoster; potential adverse effects include headache and nausea.
    • Vancocin (vancomycin): antibiotic; glycopeptide indicated for bacterial infection; potential adverse effects include hypotension and red man syndrome.

    Anticonvulsants, Antiemetics, and Antipsychotics

    • Neurontin (gabapentin): anticonvulsant indicated for postherpetic neuralgia and adjunct for seizures; potential adverse effects include dizziness and drowsiness.
    • Lyrica (pregabalin): anticonvulsant indicated for fibromyalgia and neuropathic pain; potential adverse effects include dizziness and peripheral edema.
    • Topomax (topiramate): anticonvulsant indicated for epilepsy and migraine; potential adverse effects include dizziness and drowsiness.
    • Reglan (metoclopramide): antiemetic; gastrointestinal prokinetic agent indicated for diabetic gastroparesis and prevention post-op & chemo n/v; potential adverse effects include drowsiness and dystonia.
    • Tegretol (carbamazepine): antiepileptic indicated for seizures and neuralgia; potential adverse effects include nausea and low WBC count.
    • Trileptal (oxcarbazepine): antiepileptic indicated for epilepsy and neuralgia; potential adverse effects include nausea and low WBC count.
    • Zestoretic (lisinopril & hydrochlorothiazide): antihypertensive; angiotensin converting enzyme inhibitor (ACEi) & thiazide diuretic indicated for hypertension; potential adverse effects include dizziness and hypotension.
    • Trexall (methotrexate): antineoplastic; antirheumatic indicated for cancer and rheumatoid arthritis; potential adverse effects include thrombocytopenia and diarrhea.
    • Requip (ropinirole): antiparkinson; dopamine agonist indicated for Parkinson's disease and restless leg syndrome; potential adverse effects include hypotension and syncope.
    • Mirapex (pramipexole): anti-parkinson; dopamine agonist indicated for Parkinson's disease and restless leg syndrome; potential adverse effects include orthostatic hypotension and drowsiness.
    • Plavix (clopidogrel): antiplatelet; thienopyridine indicated for acute coronary syndrome; potential adverse effects include bleeding.
    • Vyvanse (lisdexamfetamine): CNS stimulant indicated for ADHD and binge eating disorder; potential adverse effects include hypertension and palpitations.
    • Medrol (methylprednisolone): corticosteroid indicated for allergic conditions and skin conditions; potential adverse effects include cardiovascular symptoms and CNS effects.
    • Trulicity (dulaglutide): glucagon-like peptide-1 receptor agonist (GLP-1) indicated for Type 2 diabetes; potential adverse effects include hypoglycemia and diarrhea.
    • Victoza (liraglutide): glucagon-like peptide-1 receptor agonist (GLP-1) indicated for Type 2 diabetes; potential adverse effects include hypoglycemia and diarrhea.
    • Vytorin (ezetimibe & simvastatin): HMG-CoA reductase inhibitor indicated for hyperlipidemia; potential adverse effects include myalgia, nausea, and diarrhea.
    • Namenda (memantine): N-Methyl-D-Aspartate (NMDA) receptor antagonist indicated for Alzheimer's dementia; potential adverse effects include dizziness and headache.
    • MS Contin (morphine LA): opioid analgesic indicated for pain; potential adverse effects include sedation and constipation.
    • Percocet (oxycodone & acetaminophen): opioid analgesic indicated for pain; potential adverse effects include sedation and constipation.
    • OxyContin (oxycodone LA): opioid analgesic indicated for pain; potential adverse effects include sedation and constipation.
    • Ultram (tramadol): opioid analgesic & selective norepinephrine reuptake inhibitor (SNRI) indicated for pain; potential adverse effects include sedation and constipation.
    • Strattera (atomoxetine): selective norepinephrine reuptake inhibitor (SNRI) indicated for ADHD; potential adverse effects include nausea.
    • Jardiance (empagliflozin): sodium-glucose cotransporter 2 (SGLT2) inhibitor indicated for Type 2 diabetes; potential adverse effects include nausea and fatigue.
    • Synthroid (levothyroxine): thyroid indicated for hypothyroidism; potential adverse effects include UTI and dyslipidemia.
    • Zyloprim (allopurinol): xanthine oxidase inhibitor indicated for gout; potential adverse effects include angina and cardiac arrhythmia.
    • Lithobid (lithium): antimanic indicated for bipolar disorder; potential adverse effects include arrhythmia and ataxia.
    • Haldol (haloperidol): antipsychotic; butyrophenone indicated for schizophrenia and bipolar disorder; potential adverse effects include extrapyramidal reaction, arrhythmias, dizziness, xerostomia, akathisia, insomnia, and sedation.
    • Ditropan (oxybutynin): antispasmodic indicated for overactive bladder; potential adverse effects include dizziness and xerostomia.
    • Abilify (aripiprazole): atypical antipsychotic indicated for schizophrenia and bipolar disorder; potential adverse effects include akathisia, insomnia, weight gain, sedation, and xerostomia.
    • Seroquel (quetiapine): atypical antipsychotic indicated for schizophrenia and bipolar disorder; potential adverse effects include sedation, xerostomia, weight gain, and dizziness.
    • Risperdal (risperidone): atypical antipsychotic indicated for schizophrenia and bipolar disorder; potential adverse effects include sedation, dizziness, weight gain, decreased BMD, thrush, nausea, and insomnia.
    • Xanax (alprazolam): benzodiazepine indicated for anxiety and panic disorder; potential adverse effects include drowsiness, ataxia, sedation, and lethargy.
    • Klonopin (clonazepam): benzodiazepine indicated for anxiety and seizure disorder; potential adverse effects include drowsiness, ataxia, sedation, and lethargy.
    • Valium (diazepam): benzodiazepine indicated for anxiety; potential adverse effects include hypotension, sedation, and drowsiness.
    • Restoril (temazepam): benzodiazepine indicated for insomnia; potential adverse effects include hypotension, sedation, and drowsiness.
    • Ativan (lorazepam): benzodiazepine indicated for anxiety and status epilepticus; potential adverse effects include hypertension, urinary retention, tachycardia, insomnia, and oral candidiasis (thrush).
    • Myrbetriq (mirabegron): beta-3 agonist indicated for overactive bladder (OAB); potential adverse effects include tachycardia, insomnia, and oral candidiasis (thrush).
    • Wellbutrin (bupropion): dopamine/norepinephrine-reuptake inhibitor indicated for depression and smoking cessation aid; potential adverse effects include decreased BMD, thrush, nausea, insomnia, and cardiac problems.
    • Advair (fluticasone & salmeterol): inhaled corticosteroid & long acting beta-2 agonist indicated for asthma and COPD; potential adverse effects include headache and flushing.
    • Symbicort (budesonide & formoterol): inhaled corticosteroid & long-acting beta-2 agonist indicated for asthma and COPD; potential adverse effects include nausea, insomnia, or sedation, and ejaculatory disorders.
    • Chantix (varenicline): nicotine receptor partial agonist indicated for smoking cessation; potential adverse effects include tachycardia, palpitations, and GI problems.
    • Voltaren (diclofenac): non-steroidal anti-inflammatory drug (NSAID); acetic acid indicated for inflammation and pain; potential adverse effects include tachycardia, palpitations, and GI problems.
    • Cialis (tadalafil): phosphosdiesterase-5 inhibitor indicated for erectile dysfunction and benign prostatic hyperplasia; potential adverse effects include headache, flushing, and nausea.
    • Lexapro (escitalopram): selective serotonin reuptake inhibitor (SSRI) indicated for depression and anxiety; potential adverse effects include insomnia, or sedation, and ejaculatory disorders.
    • Zoloft (sertraline): selective serotonin reuptake inhibitor (SSRI) indicated for depression and anxiety; potential adverse effects include insomnia, or sedation, and ejaculatory disorders.
    • Combivent (Respimat) (albuterol & ipratropium): short-acting beta-2 agonist & anticholinergic indicated for COPD and asthma; potential adverse effects include cardiac arrhythmia and ataxia.
    • DuoNeb (solution) (albuterol & ipratropium): short-acting beta-2 agonist & anticholinergic indicated for COPD and asthma; potential adverse effects include cardiac arrhythmia and ataxia.
    • Elavil (amitriptyline): tricyclic antidepressant indicated for depression; potential adverse effects include angina and orthostatic hypotension.
    • Apresoline (hydralazine): vasodilator indicated for hypertension; potential adverse effects include hypotension and dizziness.
    • Isordil (isosorbide dinitrate): vasodilator indicated for angina; potential adverse effects include hypotension and dizziness.
    • Aricept (donepezil): acetylcholinesterase inhibitor indicated for Alzheimer's dementia; potential adverse effects include gastrointestinal (NVD), insomnia, dizziness, and rash.
    • Lamictal (lamotrigine): anticonvulsant indicated for seizures; potential adverse effects include increased diastolic BP, drowsiness, and thrombocytopenia.
    • Keppra (levetiracetam): anticonvulsant indicated for seizures; potential adverse effects include nausea, tremor, sedation, and nystagmus.
    • Depakote, Depakene (valproic acid and derivatives): anticonvulsant; antimanic indicated for epilepsy and bipolar disorder (mania); potential adverse effects include fatigue, hypotension, hot flashes, and fatigue.
    • Dilantin (phenytoin): antiepileptic; hydantoin indicated for epilepsy; potential adverse effects include bleeding, hypotension, headache, abdominal pain, and increased BP.
    • Hyzaar (losartan & hydrochlorothiazide): antihypertensive; angiotensin II receptor blocker (ARB); thiazide diuretic indicated for hypertension and edema; potential adverse effects include tachycardia, insomnia, and decreased serum calcium.
    • Arimidex (anastrozole): antineoplastic; aromatase inhibitor indicated for breast cancer; potential adverse effects include abdominal pain/regurgitation, anorexia, insomnia, and increased BP.
    • Integrilin (IV) (eptifibatide): antiplatelet; glycoprotein IIb/Illa Inhibitor indicated for acute coronary syndrome; potential adverse effects include immunosuppression, increased blood sugar, edema, venous thromboembolism, and malaise.
    • Aggrenox (aspirin & dipyridamole): antiplatelet; salicylate & phosphodiesterase inhibitor indicated for stroke prevention; potential adverse effects include nausea, vomiting, hypertension, peripheral edema, headache, xerostomia, and confusion.
    • Adipex-P (phentermine): appetite suppressant indicated for obesity; potential adverse effects include sedation, dizziness, and constipation.
    • Fosamax (alendronate): bisphosphonate indicated for osteoporosis and Paget's disease; potential adverse effects include sedation and constipation.
    • Focalin XR (dexmethylphenidate): CNS stimulant indicated for ADHD and narcolepsy; potential adverse effects include sedation and constipation.
    • Adderall XR (dextroamphetamine & amphetamine): CNS Stimulant indicated for ADHD; potential adverse effects include hyper or hypokalemia, hyperuricemia, hypotension, and local irritation.
    • Deltasone (prednisone): corticosteroid indicated for inflammation and pain; potential adverse effects include skin atrophy.
    • Estrace (estradiol): estrogen derivative indicated for breast cancer and osteoporosis prevention; potential adverse effects include flu-like injection reactions, upper respiratory tract infections.
    • Imuran (azathioprine): immunosuppressant indicated for prevent kidney transplant rejection; potential adverse effects include dizziness, drowsiness, nausea, low WBC count, and hypotension.
    • Cellcept (mycophenolate): immunosuppressant indicated for prophylaxis of organ rejection and rheumatoid arthritis; potential adverse effects include hypotension, syncope, orthostatic hypotension, drowsiness, bleeding, and hypertension.
    • Lunesta (eszopiclone): nonbenzodiazepine hypnotic indicated for insomnia; potential adverse effects include headache, abdominal pain, increased BP, tachycardia, and insomnia.
    • Ambien (zolpidem): nonbenzodiazepine hypnotic indicated for insomnia; potential adverse effects include sedation, constipation, and constipation.
    • Lortab (acetaminophen & hydrocodone): opioid analgesic indicated for pain; potential adverse effects include sedation, constipation, and constipation.
    • Duragesic (fentanyl): opioid analgesic indicated for pain; potential adverse effects include sedation, constipation, and constipation.
    • Dilaudid (hydromorphone): opioid analgesic indicated for pain; potential adverse effects include sedation, constipation, and constipation.
    • Dyazide (triamterene & hydrochlorothiazide): potassium-sparing diuretic & thiazide diuretic indicated for hypertension and edema; potential adverse effects include hyper or hypokalemia, hyperuricemia, hypotension, and local irritation.
    • Kenalog (triamcinolone): topical corticosteroid indicated for pruritis and inflammation; potential adverse effects include skin atrophy.
    • Humira (adalimumab): tumor necrosis factor (TNF) alpha blocker indicated for Crohn's disease and ulcerative colitis; potential adverse effects include flu-like injection reactions, upper respiratory tract infections, and rash.### Common Diseases and Conditions
    • GERD
    • Gastric ulcer
    • Depression
    • Anxiety
    • Asthma
    • COPD
    • Muscle spasm
    • Spasticity
    • Hypertension
    • Edema
    • Bradycardia
    • Increased pigmentation of the iris and eyelashes, as well as eyelash growth
    • Diarrhea
    • Nausea
    • Headache
    • Tachycardia
    • Drowsiness
    • Hypokalemia

    Common Adverse Effects (AEs)

    • Constipation
    • Blurred vision or stinging
    • Sexual dysfunction
    • Nervousness
    • Dizziness
    • Transient increased urination

    Medications

    • Generic Name:
      • Nebivolol (Bystolic)
      • Beclomethasone (inhaled) (Qvar inhaler)
      • Budesonide (inhaled) (Pulmicort Flexhaler)
      • Fluticasone (nasal) (Flonase)
      • Fluticasone (inhaled) (Flovent HFA)
      • Amlodipine (Norvasc)
      • Nifedipine (Procardia)
      • Fenofibrate (Tricor)
      • Meclizine (Antivert)
      • Atorvastatin (Lipitor)
      • Pravastatin (Pravachol)
      • Rosuvastatin (Crestor)
      • Simvastatin (Zocor)
      • Ezetimibe (Zetia)
      • Montelukast (Singulair)
      • Furosemide (Lasix)
      • Diltiazem (Cardizem)
      • Finasteride (Proscar)
      • Tamsulosin (Flomax)
      • Doxazosin (Cardura)
      • Tizanidine (Zanaflex)
      • Guanfacine (Intuniv)
      • Celecoxib (Celebrex)
      • Meloxicam (Mobic)
      • Buspirone (BuSpar)
      • Solifenacin (Vesicare)
      • Dicyclomine (Bentyl)
      • Enoxaparin (Lovenox)
      • Rivaroxaban (Eliquis)
      • Apixaban (Xarelto)
      • Mirtazapine (Remeron)
      • Citalopram (Celexa)
      • Fluoxetine (Prozac)
      • Paroxetine (Paxil)
      • Trazodone (Desyrel)
      • Duloxetine (Cymbalta)
      • Venlafaxine (Effexor XR)
      • Nortriptyline (Pamelor)
      • Irbesartan (Avapro)
      • Losartan (Cozaar)
      • Olmesartan (Benicar)
      • Valsartan (Diovan)

    Medication Classes

    • Beta-1 selective blockers
    • Corticosteroids
    • Dihydropyridine calcium channel blockers (CCB)
    • Fibric acid derivatives (fibrate)
    • Histamine H-1 antagonists
    • HMG-CoA reductase inhibitors
    • Intestinal cholesterol absorption inhibitors
    • Leukotriene receptor antagonists
    • Loop diuretics
    • Nondihydropyridine calcium channel blockers (CCB)
    • 5-alpha reductase inhibitor
    • Alpha-1 adrenergic antagonist
    • Alpha-2 adrenergic agonists
    • Analgesics
    • Antianxiety agents
    • Anticholinergics
    • Anticoagulants
    • Antidepressants
    • Antihypertensives
    • Angiotensin II receptor blockers (ARB)

    Common Drug Indications

    • Beta-1 selective blockers: hypertension
    • Corticosteroids: asthma, allergic rhinitis
    • Dihydropyridine CCBs: hypertension
    • Fibric acid derivatives: hypertriglyceridemia
    • Histamine H-1 antagonists: vertigo
    • HMG-CoA reductase inhibitors: hyperlipidemia
    • Intestinal cholesterol absorption inhibitors: hyperlipidemia
    • Leukotriene receptor antagonists: asthma
    • Loop diuretics: edema
    • Nondihydropyridine CCBs: hypertension
    • 5-alpha reductase inhibitor: benign prostatic hyperplasia (BPH)
    • Alpha-1 adrenergic antagonists: BPH
    • Alpha-2 adrenergic agonists: spasticity, hypertension
    • Analgesics: pain
    • Antianxiety agents: anxiety
    • Anticholinergics: overactive bladder, irritable bowel syndrome
    • Anticoagulants: venous thromboembolism, prevent/treat blood clots
    • Antidepressants: depression, anxiety
    • Antihypertensives: hypertension
    • Angiotensin II receptor blockers: hypertension, diabetic nephropathy, heart failure

    Common Adverse Effects

    • Beta-1 selective blockers: bradycardia, throat irritation
    • Corticosteroids: oral candidiasis (thrush), throat irritation, unpleasant taste, nosebleeds, reflex tachycardia
    • Dihydropyridine CCBs: angina, peripheral edema, reflex tachycardia, increased LFTs
    • Fibric acid derivatives: dyspepsia, dry mouth
    • Histamine H-1 antagonists: drowsiness, headache
    • Statins: myalgia, headache, diarrhea
    • Intestinal cholesterol absorption inhibitors: headache, dizziness
    • Leukotriene receptor antagonists: headache, dizziness
    • Loop diuretics: hypokalemia, increased urination
    • Nondihydropyridine CCBs: bradycardia
    • 5-alpha reductase inhibitor: decrease libido, ejaculation failure
    • Alpha-1 adrenergic antagonists: orthostatic hypotension, dizziness
    • Alpha-2 adrenergic agonists: hypotension, xerostomia, drowsiness
    • Analgesics: peripheral edema, hypertension
    • Antianxiety agents: dizziness, nausea
    • Anticholinergics: xerostomia, sedation
    • Anticoagulants: bleeding, thrombocytopenia
    • Antidepressants: sedation, increased appetite, insomnia or sedation, ejaculatory disorders, serotonin syndrome
    • Antihypertensives: orthostatic hypotension, malaise

    Solution Dosage Forms

    • A solution is one or more chemical substances dissolved in a suitable solvent or mix of solvents.
    • Oral solutions are sweetened and/or flavored to improve palatability and mask drug taste.
    • Injectable and ophthalmic solutions must be sterile.
    • The vehicle (solvent) should be selected based on the route of administration and drug solubility.
    • "Like dissolves like" - polar solvents dissolve polar solutes and vice versa.
    • Water is the most common solvent, but others include alcohol, USP, glycerin, propylene glycol, oils, acetone, isopropanol, polyethylene glycol, collodion, polymers.

    Labeling of Solution Preparations

    • If a preparation is for oral administration, the instruction should use "Give/Take…orally…"
    • If a preparation is for topical administration, the instruction should use "Apply… (indicate area)"
    • If a preparation is for a specific use (e.g., shampoo or soak) use an appropriate verb like "Use..."
    • If a preparation is administered nasally or otically, use "Place/Instill... (indicate route)"
    • For oral solutions, express the active ingredient concentration as a metric weight or volume per volume to be administered (e.g., 50 mg/5 mL)
    • For electrolyte solutions, include both milliequivalent and metric weight (e.g., 8 mEq (50 mg)/5 mL)
    • For topical, nasal, or otic solutions, express as a percentage concentration (e.g., 10%)
    • If Alcohol, USP is used as an excipient, its %(v/v) concentration within the final product must be expressed on the prescription label.

    Auxiliary Labeling

    • If a solution is not dispensed in a tight container with a safety closure, an appropriate label is required.
    • Oral solutions, even if preserved, should be refrigerated, unless contraindicated.
    • Possible contraindications for refrigeration include solutions near saturation point, high viscosity, or medications unstable at low temperatures.
    • If the prescription is for non-oral administration, it should contain a label indicating the appropriate route of elimination (e.g., "For external use only" or "Not for oral use").
    • Solutions should be dispensed in an appropriately sized amber bottle or other packaging device suitable for the application (e.g., unit dose oral syringes, nasal or topical sprays).

    Phenobarbital Example (Case #1)

    • Phenobarbital 40 mg/5 mL solution is prepared with glycerin (13.5 mL) and made up to 3 fl.oz.
    • The phenobarbital concentration is 1.5% (w/v).
    • Glycerin concentration is 15% (v/v).
    • To ensure solubility, the formulation will likely contain co-solvents (e.g., Alcohol, USP) which are not explicitly stated in the text.
    • Dilution of the solution with water or juice is not advised.
    • Phenobarbital is a weak acid and therefore sensitive to pH changes.
    • Diluting with juice may make phenobarbital less soluble and alter the equilibrium of the drug.
    • If the patient is concerned about taste, the product can be reformulated with flavors and/or sweeteners.

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    Description

    This quiz focuses on gastrointestinal disorders, particularly gastroesophageal reflux disease (GERD). It covers symptoms, management strategies, and the pharmacology of over-the-counter treatments for heartburn and dyspepsia. Students will also learn to assess and recommend appropriate medications based on patient needs.

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