Deck 31: Medications for Irritable Bowel Syndrome and Other Gastrointestinal Problems

Question 1

A woman has severe IBS and takes hyoscyamine sulfate (Levsin),simethicone (Phazyme),and a TCA.She reports having continued severe diarrhea.The primary care NP should:

A) order diphenoxylate (Lomotil).
B) prescribe alosetron after ruling out pregnancy.
C) refer her to a gastroenterologist for endoscopy.
D) increase the fiber in her diet to 30 g per day.

Answer 1

refer her to a gastroenterologist for endoscopy.

Question 2

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).

Answer 2

tricyclic antidepressants (TCAs).

Question 3

A patient who has diabetic gastroparesis sees a gastroenterology specialist who orders metoclopramide (Reglan).Within 24 hours,the patient describes having extrapyramidal symptoms (EPS)to the primary care NP.The NP will contact the gastroenterologist and should expect to prescribe:

A) benztropine (Cogentin).
B) cimetidine.
C) an SSRI antidepressant.
D) a TCA.

Answer 3

benztropine (Cogentin).

Question 4

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.

Question 5

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.

Question 6

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).

Question 7

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.

Question 8

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.