AGNP BOARD EXAM QUESTIONS Prescription Gastroenterology (85 Questions)
A 45-year-old woman has been taking oral omeprazole (Prilosec) 40 mg twi... [Show More] ce daily for the treatment of gastroesophageal reflux. To discontinue the medication the nurse practitioner would:
advise the patient to stop the medication.
reduce the dose by 50% every other day.
reduce the dose by 50% weekly. Correct
reduce dose by 50% every month.
For patients on a moderate to high dose of a PPI (e.g., omeprazole (Prilosec) 40 mg daily or twice daily), reduce the dose by 50% every week until the patient is on the lowest dose of the medication. For patients on twice daily dosing, the initial reduction can be accomplished by decreasing the dosing to once in the morning before breakfast. Once the patient has completed a week at the lowest dose, the medication can be discontinued.
Patients receiving long-term proton pump inhibitors (PPIs) are at increased risk for fractures and:
lower extremity edema.
myocardial infarction. Correct
Analysis of patients taking PPIs for long periods of time showed an increased risk of myocardial infarctions. This is thought to be related to reduced nitric oxide in the blood vessel walls. The FDA suggests that providers consider periodically obtaining magnesium levels in patients while they are on a PPI. Increased risk of myocardial infarction has not been associated with histamine receptor blockers.
Ondansetron (Zofran) dosage should be adjusted in patients:
with renal insufficiency.
who are pregnant.
who are > 65 years old.
with hepatic impairment. Correct
Ondansetron (Zofran) is a 5-HT3 receptor antagonist used for the treatment of nausea and vomiting. Dose limitations are recommended for patients with severe hepatic impairment (Child-Pugh class C); use with caution in mild-moderate hepatic impairment; clearance is decreased and half-life increased in hepatic impairment. No dosage adjustment is recommended with renal insufficiency, pregnancy or in advanced age.
The antiemetic that does NOT have potential to cause QT prolongation is:
promethazine (Phenergan). Correct
Antihistamines such as promethazine and diphenhydramine do not cause QT prolongation. Dopamine and serotonin antagonists are both associated with QT prolongation. Chlorpromazine (Thorazine) and prochlorperazine (Compazine) are dopamine antagonists. Ondansetron (Zofran) is a serotonin antagonist. If a patient has suspected QT interval prolongation or is taking other medications with which the QT interval prolongation could be additive, a 12-lead EKG is recommended before treatment is initiated. [Show Less]