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D116 Advanced Pharmacology GI IBS, UC and Crohn s Answers 2023.
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D116 Advanced Pharmacology: GI - IBS,UC and Crohn's Answers 2023
A patient in the clinic reports frequent episodes of bloating, abdominal pain, and loose
stools to the primary care nurse practitioner (NP). An important question the NP should
ask about the abdominal pain is:
a. the relation of the pain to stools.
b. what time of day the pain occurs.
c. whether the pain is sharp or diffuse.
d. the age of the patient when the pain began. - Ans ANS: A
The new Rome II guidelines maintain that irritable bowel syndrome (IBS) of any subtype
is characterized by a strong relationship between abdominal pain and defecation
because of visceral hypersensitivity to gut-related events. The other characteristics of
pain may be assessed to help guide management of IBS, but the first is necessary for a
correct diagnosis.
A patient has been diagnosed with IBS and tells the primary care NP that symptoms of
diarrhea and cramping are worsening. The patient asks about possible drug therapy to
treat the symptoms. The NP should prescribe:
a. mesalamine (Asacol).
b. dicyclomine (Bentyl).
c. simethicone (Phazyme).
d. metoclopramide (Reglan). - Ans ANS: B
Dicyclomine has indirect and direct effects on the smooth muscle of the gastrointestinal
(GI) tract. Both actions help to relieve smooth muscle spasm. Mesalamine is used to
treat ulcerative colitis. Simethicone acts locally to treat symptoms of trapped air and
gas. Metoclopramide is used to increase motility
A woman with IBS has been taking antispasmodic medications and reports some relief,
but she tells the primary care NP that the disease is interfering with her ability to work
because of increased pain. The NP should consider prescribing:
a. alosetron (Lotronex).
b. misoprostol (Cytotec).
c. simethicone (Phazyme).
d. tricyclic antidepressants (TCAs). - Ans ANS: D
, TCAs and selective serotonin reuptake inhibitors (SSRIs) have been shown to reduce
symptoms and are useful for long-term treatment. Alosetron is ordered by a GI
specialist if symptoms are resistant to all other interventions and has been shown to be
effective in women with diarrhea-predominant IBS. Misoprostol is used to treat NSAID-
induced ulcers. Simethicone acts locally to treat symptoms of trapped air and gas.
A patient who has IBS experiences diarrhea, bloating, and pain but does not want to
take medication. The primary care NP should recommend:
a. 25 g of fiber each day.
b. avoiding gluten and lactose in the diet.
c. increasing water intake to eight to ten glasses per day.
d. beginning aerobic exercise, such as running, every day. - Ans ANS: A
A diet with adequate fiber is the cornerstone of treatment, and 25 g per day is
recommended. Unless the patient has a documented gluten or lactose malabsorption,
avoiding these substances is not recommended. Water intake should be six to eight
glasses per day. Regular walking is usually the best exercise.
A patient who has IBS has been taking dicyclomine and reports decreased pain and
diarrhea but is now having occasional constipation. The primary care NP should
recommend:
a. beginning treatment with an SSRI.
b. beginning therapy with a TCA.
c. over-the-counter (OTC) laxatives as needed when constipated.
d. increasing the amounts of raw fruits and vegetables in the diet. - Ans ANS: C
Patients who experience constipation may use OTC laxatives as needed.
Antidepressants, such as SSRIs or TCAs, are used long-term to help with pain. Raw
fruits and vegetables can increase the likelihood of bloating.
A patient takes an antispasmodic and an occasional antidiarrheal medication to treat
IBS. The patient comes to the clinic and reports having dry mouth, difficulty urinating,
and more frequent constipation. The primary care NP notes a heart rate of 92 beats per
minute. The NP should:
a. prescribe a TCA.
b. discontinue the antidiarrheal medication.
c. encourage the patient to increase water intake.
d. lower the dose of the antispasmodic medication. - Ans ANS: D
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