Pharmacology Exam I Overview
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Questions and Answers

Which of the following statements accurately describes the role of clavulanic acid?

  • It is used to treat anaerobic infections.
  • It enhances the effectiveness of non-beta-lactam antibiotics.
  • It protects the beta-lactam ring. (correct)
  • It is a bacteriostatic agent.
  • What is a potential side effect of using fluoroquinolones?

  • Nephrotoxicity.
  • Nausea and vomiting.
  • Prolonged QT interval. (correct)
  • Hypersensitivity rash.
  • In the context of antimicrobial therapy, what does 'bactericidal' mean?

  • It destroys bacteria. (correct)
  • It prevents bacteria from forming spores.
  • It reduces the virulence of bacteria.
  • It inhibits the growth of bacteria.
  • What is the primary concern when administering first doses of beta-lactam antibiotics?

    <p>Hypersensitivity reactions. (B)</p> Signup and view all the answers

    Which route of potassium chloride administration requires dilution and a controlled rate?

    <p>Intravenous. (B)</p> Signup and view all the answers

    Before a surgical procedure, how long should cefazolin be administered to meet QSEN guidelines?

    <p>60 minutes. (A)</p> Signup and view all the answers

    What adverse effect should be monitored when administering macrolides?

    <p>Prolonged QT interval. (B)</p> Signup and view all the answers

    Which medication would be contraindicated in patients with severe renal impairment or untreated Addisons?

    <p>Potassium-sparing diuretics. (B)</p> Signup and view all the answers

    What is a primary mechanism of action for Ozempic in treating diabetes?

    <p>Slows gastrointestinal emptying (C)</p> Signup and view all the answers

    Which of the following is a contraindication for lipase inhibitors?

    <p>Malabsorption (D)</p> Signup and view all the answers

    What is a common adverse effect of prostaglandins in gastric treatment?

    <p>Diarrhea (B)</p> Signup and view all the answers

    What is a critical consideration when administering H2 receptor antagonists like Cimetidine?

    <p>They are enzyme inhibitors that may increase drug serum levels. (A)</p> Signup and view all the answers

    Which class of laxatives is considered the strongest and most abused?

    <p>Stimulant cathartics (D)</p> Signup and view all the answers

    What precaution should be taken when using Ondansetron, a 5-HT3 serotonin receptor antagonist?

    <p>Exceeding 16mg may increase the risk of QT prolongation. (D)</p> Signup and view all the answers

    What effect does a hypertonic solution have on cells?

    <p>Cells shrink due to fluid being drawn out. (B)</p> Signup and view all the answers

    When should antacids be administered in relation to meals?

    <p>1 hour before or after meals (D)</p> Signup and view all the answers

    What is the primary action of calcium channel blockers in the context of cardiovascular health?

    <p>Promote vasodilation of arteries. (A)</p> Signup and view all the answers

    What adverse effect is specifically associated with dipine calcium channel blockers?

    <p>Peripheral edema. (A)</p> Signup and view all the answers

    What is a common side effect of vincristine that is indicated by the phrase 'gets on nerves'?

    <p>Peripheral neuropathy (C)</p> Signup and view all the answers

    Which medication is associated with the management of anemia as indicated by the use of erythropoietin?

    <p>Procrit (B)</p> Signup and view all the answers

    Which class of medications is used to lower preload and afterload in heart failure?

    <p>ACE inhibitors and ARBs. (B)</p> Signup and view all the answers

    What is the antidote for heparin, an anticoagulant?

    <p>Protamine sulfate. (B)</p> Signup and view all the answers

    What type of vaccine is indicated as being more stable due to its components being weakened?

    <p>Attenuated vaccine (C)</p> Signup and view all the answers

    Which medication is contraindicated for children due to the risk of Reye's syndrome?

    <p>Aspirin (A)</p> Signup and view all the answers

    Which treatment is recommended for hand-foot syndrome associated with chemotherapy?

    <p>Tylenol (D)</p> Signup and view all the answers

    Which condition is a contraindication for anticoagulant administration?

    <p>Recent surgery. (B)</p> Signup and view all the answers

    What is the primary treatment for acute gout pain?

    <p>NSAIDs (C)</p> Signup and view all the answers

    What is the main purpose of cytokine inhibitors in therapy?

    <p>To promote tissue repair (A)</p> Signup and view all the answers

    What is a notable side effect of phenytoin?

    <p>Gingival hyperplasia (C)</p> Signup and view all the answers

    What is the mechanism of action for aspirin as an antiplatelet medication?

    <p>Irreversibly binds to thromboxane A2 and inhibits its production. (A)</p> Signup and view all the answers

    Which medication is specifically contraindicated for organ transplant recipients or those with serious cardiopulmonary diseases?

    <p>Neumega (B)</p> Signup and view all the answers

    Which of the following statements is true regarding warfarin?

    <p>It requires monitoring of PT/INR levels. (C)</p> Signup and view all the answers

    Which of the following medications is specifically used for migraine relief by constricting blood vessels?

    <p>Triptans (C)</p> Signup and view all the answers

    Which medication should not be combined with triptans due to the risk of vasoconstriction?

    <p>Ergot preparations (C)</p> Signup and view all the answers

    What is a common adverse effect of potassium-sparing diuretics?

    <p>Hyperkalemia. (B)</p> Signup and view all the answers

    What is the precaution regarding Levothyroxine in the management of hypothyroidism?

    <p>It should be taken alone 30-60 minutes before breakfast (B)</p> Signup and view all the answers

    What is the primary goal of using Aricept in Alzheimer's treatment?

    <p>Slow disease progression (B)</p> Signup and view all the answers

    Which statement accurately describes monoclonal and polyclonal antibodies?

    <p>Monoclonal antibodies are derived from a single cell line (D)</p> Signup and view all the answers

    What is a possible consequence of acetaminophen overdose in individuals with liver impairment?

    <p>Liver necrosis (B)</p> Signup and view all the answers

    What is the preferred initial treatment for permanent relief of Parkinson's Disease symptoms?

    <p>Levodopa (B)</p> Signup and view all the answers

    What is a key characteristic of Terbutaline in its use during pregnancy?

    <p>Category C medication for pre-term labor (C)</p> Signup and view all the answers

    Which adverse effect is associated with anticholinergics when used for bronchoconstriction?

    <p>Anticholinergic effects (D)</p> Signup and view all the answers

    What is the primary use of corticosteroids in the management of asthma?

    <p>For chronic management on a daily basis (C)</p> Signup and view all the answers

    Which statement is true regarding leukotriene modifiers?

    <p>Prevent leukotrienes from binding and can be combined with other drugs (A)</p> Signup and view all the answers

    Which drug is associated with the risk of pulmonary toxicity?

    <p>Bleomycin (C)</p> Signup and view all the answers

    What is crucial to remember when using immunosuppressant monoclonal antibodies?

    <p>Have a significant risk for anaphylaxis and malignancies (C)</p> Signup and view all the answers

    What type of medication is characterized by a narrow therapeutic range of 5-15 mcg/mL?

    <p>Xanthines (C)</p> Signup and view all the answers

    Which side effect is specifically associated with Adriamycin?

    <p>Cardiac toxicity and red discoloration of secretions (D)</p> Signup and view all the answers

    Flashcards

    Bacteriostatic vs. Bactericidal

    Bacteriostatic drugs inhibit bacterial growth, while bactericidal drugs kill bacteria.

    Anti-Microbial Superinfection

    Superinfection occurs when antimicrobial drugs kill beneficial bacteria, allowing harmful bacteria to thrive.

    Beta-Lactam Antibiotics Action

    Beta-lactam antibiotics work by interfering with the bacterial cell wall synthesis.

    Hypersensitivity Risk (Antibiotics)

    Some antibiotics can trigger allergic reactions in susceptible individuals.

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    Hypokalemia Treatment

    Treat low potassium with potassium chloride (KCl), diluted and given slowly intravenously.

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    Hyperkalemia Treatment

    For high potassium, use calcium gluconate, insulin, glucose, limit potassium intake, address acidosis.

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    Enteral Nutrition

    Enteral nutrition provided through a tube directly into the gastrointestinal tract (preferred over IV).

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    Antiemetic Classification

    Antiemetics are drugs used to control or prevent nausea and vomiting.

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    Lipase Inhibitors

    Medications that block fat absorption by 30%, but are contraindicated in malabsorption and require vitamin supplementation.

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    Ozempic

    A medication that slows gastrointestinal emptying and increases satiety, with a Boxed Warning for thyroid cancer and pancreatitis.

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    Peptic Ulcer Disease (PUD) Protection

    PUD protection mechanisms include mucus, bicarbonate, blood flow, and prostaglandins that protect the stomach lining from acid.

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    Antacids

    Provide localized neutralization of stomach acid, but different types can cause constipation (Al) or diarrhea (Mg).

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    PPIs (Proton Pump Inhibitors)

    First-line drugs for acid reduction which irreversibly bind to acid enzymes preventing acid pumping, but may affect vitamin B12 absorption.

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    IV Fluids: Isotonic

    IV fluids with equal concentration as blood, used for hydration, fluid replacement, and treating dehydration or sepsis. Examples include 0.9% Normal Saline and Lactated Ringers.

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    IV Fluids: Hypertonic

    IV fluids with more solutes than blood, used to treat hyponatremia (low sodium levels).

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    IV Fluids: Hypotonic

    IV fluids with fewer solutes causing blood cell swelling, use cautiously because it can cause cellular swelling. Examples include 0.45% Normal Saline

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    Calcium Channel Blockers (CCBs)

    Drugs that affect vascular smooth muscle, mainly arterioles and heart, to lower blood pressure and increase coronary blood flow. They also reduce heart rate, atrioventricular (AV) conduction, and contractility.

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    Angina/High Blood Pressure (HTN) treatment

    Calcium channel blockers (e.g., dihydropyridines) are often used to treat angina and high blood pressure due to their effects on blood vessels and heart.

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    Anticoagulants

    Drugs that prevent or treat blood clots by preventing the formation of fibrin from fibrinogen.

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    Heparin

    An anticoagulant, often given intravenously (IV) or subcutaneously (sub-Q), that's used to rapidly prevent clotting. Its effectiveness is monitored by aPTT.

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    Warfarin

    An anticoagulant that works by preventing the synthesis of clotting factors, monitored by prothrombin time (PT) and INR.

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    Antiplatelets

    Medication preventing platelets from clumping together, thus preventing clot formation, often used to prevent heart attack & stroke.

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    Heart Failure Treatment (ACE & ARBs)

    ACE inhibitors and ARBs help dilate blood vessels, reducing preload and afterload, and also suppresses aldosterone, further lowering pressure.

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    Osmotic Diuretics

    Diuretics that increase osmotic pressure, drawing water into the vascular system, reducing sodium and water retention. Administered intravenously.

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    Glycoprotein IIb/IIIa Receptor Antagonist

    A powerful medication that prevents platelets from clumping together, acting like a super aspirin. It's given intravenously after a heart attack or stent placement.

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    Thrombolytic Agents

    These medications break down fibrin, the protein that forms blood clots. They're used to treat heart attacks, blood clots in the lungs (pulmonary embolism), and stroke.

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    Terbutaline

    A medication given subcutaneously (under the skin) to help prevent premature labor. It's categorized as Pregnancy Category C, meaning there's some risk to the fetus.

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    Anticholinergics (Trop)

    These medications block the action of acetylcholine, a neurotransmitter that causes bronchoconstriction (narrowing of airways). Often used with beta-2 agonists in treating asthma.

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    Xanthines

    A second-line treatment for asthma, used if other medications don't work well. They have effects similar to caffeine, but with a narrow therapeutic range.

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    Corticosteroids

    They suppress inflammation and are essential for managing persistent asthma. Used in both acute and chronic settings.

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    Inhaled Glucocorticoids (Asthma)

    The first-line treatment for asthma, taken DAILY, not as needed. They help prevent inflammation in airways.

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    Leukotriene Modifiers

    These medications prevent leukotrienes, inflammatory chemicals, from binding to their receptors. They're effective for asthma when combined with other medications.

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    Vincristine

    A chemotherapy drug that can cause peripheral neuropathy, often described as a tingling or numbness sensation in the hands and feet.

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    Alemtuzumab

    An immunosuppressant medication used to treat multiple sclerosis. It works by reducing the number of immune cells that attack the myelin sheath surrounding nerve fibers.

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    Tamoxifen

    An anti-estrogen medication used to treat breast cancer. It works by blocking the effects of estrogen on breast cancer cells.

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    Aromatase Inhibitors

    Medications used to treat breast cancer by blocking the enzyme aromatase, which converts androgens to estrogen.

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    Anti-androgens/LH-releasing Hormones

    Medications used to treat prostate cancer by blocking the production or action of male hormones (androgens) that promote prostate cancer growth.

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    Colony Stimulating Factors

    Medications that stimulate the production of neutrophils, a type of white blood cell, in patients with severe neutropenia.

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    Interferons

    Proteins that have antiviral and anti-cancer properties. They can be used to treat hepatitis B and C, some cancers, and multiple sclerosis.

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    Levothyroxine

    A synthetic thyroid hormone used to treat hypothyroidism. It replaces the hormone that is not being produced by the thyroid gland.

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    Aspirin in Children

    Aspirin is contraindicated in children due to the risk of Reye's syndrome, a serious condition that can cause liver and brain damage.

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    Salicylate Toxicity

    Salicylate toxicity is a serious complication that can occur with high doses of aspirin. It can lead to acidosis, central nervous system depression, and tinnitus.

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    Celebrex Action

    Celebrex, a COX-2 inhibitor, is used to reduce inflammation and pain. It has a lower risk of gastrointestinal side effects compared to other NSAIDs.

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    Tylenol Usage

    Tylenol is a nonsteroidal anti-inflammatory drug that primarily reduces fever and pain. It does not reduce inflammation. It's contraindicated in severe liver impairment.

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    Gout Treatment

    Gout is a condition caused by high uric acid levels. The first-line treatment is NSAIDs. IV or oral options are available if NSAIDS are ineffective.

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    Triptans for Migraines

    Triptans are selective serotonin receptor agonists that are effective in aborting migraines. They are contraindicated in patients with angina, heart attack, or hypertension.

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    Ergot Preparations for Migraines

    Ergot preparations relieve migraines by constricting blood vessels. They are contraindicated in patients with coronary artery disease or hypertension. Do not use triptans within 24 hours of ergot use.

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    Phenytoin for Seizures

    Phenytoin is an anti-epileptic drug that is used to control seizures. It can be administered intravenously, but it must be diluted and given slowly due to its irritant properties.

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    Study Notes

    EXAM-I Overview

    • Local effects at site; Systemic through blood to target tissue
    • Pure Food and Drug Act: No adulterants. Food, Drug, and Cosmetic Act: Testing required to prove safety. Durham-Humphrey Amendment: OTC vs. prescription drugs (refills need prescriptions). Kefauver-Harris Amendment: Prove drugs' effectiveness (testing older drugs necessary). Comprehensive Drug Abuse Prevention and Control Act: DEA/locked-up, inventory, & disposal; nurses involved.
    • SCH-I: Non-medical use; SCH-II: High abuse; no refills; SCH-III: Abuse; SCH-IV: Some abuse; SCH-V: Controlled substances; record keeping needed. NIH Revitalization Act: Inclusion of women/minorities required in drug trials. FDA Modernization Act: Experimental drug access.
    • Drug Development Phases:
      • Phase I: Healthy volunteers; toxicity testing.
      • Phase II: Disease subjects; comparison.
      • Phase III: Double blind studies.
      • Phase IV: Marketed drugs.
    • Beers Criteria: Outcomes in older adults.
    • Absorption: Administering drugs to enter the bloodstream; Enteral (GI tract); Parenteral (other routes). Bioavailability: Portion reaching circulation (PO < 100%).
    • Distribution: Systemic distribution to target cells; BBB (blood-brain barrier); Protein Binding (Bound drugs, inactive).
    • Metabolism: Liver (CYP-P450 enzymes); Enzyme Induction & Inhibition. Excretion: Elimination (kidney).
    • Toxicity: Therapeutic range; Minimum Effective Concentration (MEC); Steady state (4-5 half-lives). Pharmacodynamics: Drug effects on body systems; Agonist/Antagonist; Up/Down regulation; Additive/Synergistic actions. Pharmacogenomic Variations: Age, sex, ethnicity, genetics affect drug response & metabolism.
    • Pregnancy Categories: A (no risk), B (no risk in animals), C (risk in animals), D (risk in babies), X (unacceptable risk),
    • Drug Orders: Date, time, drug, dose, route, frequency, and signature needed.

    Anti-Microbial Drugs

    • Colonization: Doesn't cause injury; Superinfection: Depletion of normal flora. Community-Acquired (<48 hours post-admission); Hospital-acquired (>46 hours).
    • Bacteriostatic: Inhibits growth; C&S (culture & sensitivity): Before first dose. Beta-Lactam: Cell wall inhibitor; need "ring." Clavulanate protects.
    • "Cillin": Bactericidal (ruptures cell wall); Hypersensitivity; BBW: Don't administer IV PCN G; monitor for 30 minutes after first dose; QSEN: Don't double dose.
    • "Cef"/"ceph": Bactericidal (broad spectrum); QSEN: 60 minutes before surgery; superinfection risk.
    • "Micin"/"mycin": Bactericidal (ribosomal); serious systemic infections; prolonged QT interval; hypersensitivity; oto/nephrotoxicity; 2-3 liters of water/day; peak/trough monitoring.
    • "Floxacin": Bactericidal (DNA); 1st line anthrax; adverse effects: photosensitivity, tendinitis/tendon rupture, peripheral neuropathy, CNS/CV effects, prolonged QT interval; BBW: Myasthenia gravis exacerbation.
    • "Cycline": Bacteriostatic (protein synthesis); Lyme disease/animal bites/STIs; H. Pilori; Photosensitivity; take with water; no hypersensitivity/renal failure/pregnancy/<8-year-old use.
    • "Sulfa": Bacteriostatic (folic acid); UTI, burns, bronchitis; Late pregnancy use caution; Photosensitivity, kernicterus babies, blood dyscrasias, Stevens-Johnson Syndrome.
    • "Thromycin": Cidal/static (protein synthesis); strep/URI/STIs; put on babies' eyes; caution in liver disease; Adverse: Temporary hearing loss.
    • Vancomycin: Cida (cell wall gram-positive); serious infections (MRSA); Red man syndrome; Slow IV administration (1-2 hours).

    Tuberculosis Treatment (TB)

    • Latent TB: 3 options for 3-9 months; Active TB: 10 options for 6-9 months.
    • Isoniazid (INH): Cell wall inhibition; common; used in combination for active TB; Adverse: Peripheral neuropathy, hepatotoxicity. Avoid alcohol (ETOH); many drug interactions.
    • Rifamycins (RNA): Enzyme inducer; used in combination for active TB; Adverse: Orange/red urine, hepatotoxicity.

    Other Anti-infective Drugs

    • Antivirals: Harm host cells; DNA replication issues. HIV/AIDS: Combination therapy is essential; "Zidovudine (AZT)" for childbirth; Review PEP & PrEP. Antifungals: IV with a pump and in-line filter; use with antipyretics/antiemetics/antihistamines; BBW: Fatal infection.
    • Antiparasitics: less info provided.

    GI Drugs

    • A, D, E, K vitamins are fat-soluble; Folic Acid/Vit B12 crucial during pregnancy; Vitamin K prevents bleeding; all toxic at high levels.
    • Iron supplements: 10-20% absorbed; excreted in stool; black, tarry stool; use in anemia/motherhood; may stain teeth; take on empty stomach, 2-4 hours before/after meals; BBW: Anaphylaxis (iron dextran); Z-track method for IM injection.
    • Hyperkalemia: "CRIK"; Calcium gluconate protects heart; Remove K; Insulin+glucose; Restrict K; Monitor acidosis, peaked T-waves.
    • Hypokalemia: KCL; Contraindications: Severe renal impairment, hyperkalemia, untreated Addison's, potassium-sparing diuretics. Check K levels; Administer IV diluted & slowly (10 mEq/hr).
    • Magnesium: MG = BM; antidote is calcium gluconate.

    Other Drugs and Treatments

    • Nutritional products: Enteral preferred; complications include aspiration. CVC/PICC lines.
    • Anorexiants: Phentermine; increases SNS activity; contraindicated if SNS is already elevated; habit/tolerance forming.
    • Lipase inhibitors: Block 30% of fat; contraindicated in malabsorption; vitamin supplementation needed.
    • Ozempic: Slows GI emptying & increases satiety; BBW: Thyroid cancer/pancreatitis.
    • PUD: My Belly's Basic Protection (mucus, Bicarbonate, Blood flow, Prostaglandins).
    • Antacids: Localized action; neutralize HCL; shake before use; Aluminum (constipation); Magnesium (diarrhea); 1 hour before/after meals.
    • H2RA: Cimetidine; blocks H2 receptors; decreased acid; QSEN: enzyme inhibitor>increased drug serum levels.
    • PPIs: "Prazole"; 1st-line; bind to acid enzyme (prevents pumping); may affect B12 absorption; QSEN: pharmacogenomic effects.
    • Prostaglandin: Inhibits gastric acid secretion; Adverse: Diarrhea in 10-40% of patients; BBW: Birth defects.
    • Bismuth Subsalicylate (Pepto-Bismol): Avoid in aspirin allergy.
    • Antiemetics: Phenothiazine ("azine"): Blocks CTZ; Adverse: EPS (Extrapyramidal symptoms, anticholinergic effects, sedation, orthostatic hypotension); BBW: Increased death risk in dementia.
    • Antihistamines: DO NOT give hydroxyzine IV; administer deep IM.

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