WBR0728: Difference between revisions

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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor= {{YD}} (Reviewed by  {{YD}})
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Pharmacology
|MainCategory=Pharmacology
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|MainCategory=Pharmacology
|MainCategory=Pharmacology
|SubCategory=Gastrointestinal
|SubCategory=Gastrointestinal
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|MainCategory=Pharmacology
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|MainCategory=Pharmacology
|MainCategory=Pharmacology
|SubCategory=Gastrointestinal
|SubCategory=Gastrointestinal
|Prompt=A 48 year old male patient presents to the physician's office complaining of heartburn. Following appropriate work-up, he is diagnosed with gastro-esophageal reflux disease (GERD). The patient informs the physician that he has recently been using over-the-counter aluminum hydroxide, which has been effectively relieving his symptoms. Chronic use of aluminum hydroxide is associated with which of the following conditions?
|Prompt=A 48-year-old man presents to the physician's office complaining of heartburn. Following appropriate work-up, he is diagnosed with gastro-esophageal reflux disease (GERD). The patient informs the physician that he has recently been using over-the-counter aluminum hydroxide, which has been effectively relieving his symptoms. Chronic use of aluminum hydroxide is associated with which of the following conditions?
|Explanation=Aluminum-based antacids, such as aluminum hydroxide, are indicated for GERD. Although they are over-the-counter medications, they are not free of side effects. In comparison to other antacids, aluminum-based antacids are known to commonly cause constipation, which might predispose to hemorrhoids. As such, physicians must be cautious in allowing patients with hemorrhoids to use aluminum-based antacids because of their potential exacerbation.  
|Explanation=Antacids, such as aluminum hydroxide, contain cations that buffer gastric pH. Following the introduction of PPi and H2 receptor antagonists, the role of antacids in GERD has significantly decreased. Nonetheless, they are still used among patients since they are easily accessible over-the-counter drugs. In contrast to magnesium-based antacids which are associated with diarrhea, aluminum-based antacids are associated with constipation, which might predispose patients to hemorrhoids. As such, physicians must be cautious in to educate patients with hemorrhoids about the use of aluminum-based antacids.


Educational Objective: Aluminum hydroxide is associated with constipation, which might predispose to hemorrhoids.
The following table highlights the adverse effects of antacids:


[[Image:WBRantacidtable.jpg|600px]]
|AnswerA=Diarrhea
|AnswerA=Diarrhea
|AnswerAExp=Magnesium-based antacids are associated with diarrhea.
|AnswerAExp=Magnesium-based antacids are associated with diarrhea.
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|AnswerCExp=Aluminum-based antacids are associated with constipation, which might predispose to hemorrhoids.
|AnswerCExp=Aluminum-based antacids are associated with constipation, which might predispose to hemorrhoids.
|AnswerD=Hyperkalemia
|AnswerD=Hyperkalemia
|AnswerDExp=Generally, antacids are associated with hypokalemia, not hyperkalemia.
|AnswerDExp=Generally, all antacids are associated with metabolic alkalosis and hypokalemia, not hyperkalemia.
|AnswerE=Cardiac arrest
|AnswerE=Cardiac arrest
|AnswerEExp=Although very rare, magnesium-based antacids are associated with cardiac arrest.
|AnswerEExp=Although very rare, magnesium-based antacids are associated with cardiac arrest.
|EducationalObjectives=Aluminum hydroxide is associated with constipation, which might predispose to hemorrhoids.
|References=First Aid 2014 page 371
|RightAnswer=C
|RightAnswer=C
|WBRKeyword=antacid, magnesium, aluminum, hydroxide, hemorrhoids, constipation, side, effect, GERD, gastroesophageal, reflux, disease, heartburn
|WBRKeyword=Antacid, Antacids, Adverse, Reaction, Adverse drug reaction, Side, Effect, Side effect, Magnesium, Aluminum hydroxide, Aluminum, Hydroxide, Hemorrhoids, Gastroesophageal reflux disease, Constipation, GERD, Gastroesophageal, Reflux, Heartburn
|Approved=No
|Approved=Yes
}}
}}

Latest revision as of 01:30, 28 October 2020
Author [[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Yazan Daaboul, M.D.)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pharmacology
Sub Category SubCategory::Gastrointestinal
Prompt [[Prompt::A 48-year-old man presents to the physician's office complaining of heartburn. Following appropriate work-up, he is diagnosed with gastro-esophageal reflux disease (GERD). The patient informs the physician that he has recently been using over-the-counter aluminum hydroxide, which has been effectively relieving his symptoms. Chronic use of aluminum hydroxide is associated with which of the following conditions?]]
Answer A AnswerA::Diarrhea
Answer A Explanation AnswerAExp::Magnesium-based antacids are associated with diarrhea.
Answer B AnswerB::Hyporeflexia
Answer B Explanation AnswerBExp::Magnesium-based antacids are associated with hyporeflexia.
Answer C AnswerC::Hemorrhoids
Answer C Explanation AnswerCExp::Aluminum-based antacids are associated with constipation, which might predispose to hemorrhoids.
Answer D AnswerD::Hyperkalemia
Answer D Explanation AnswerDExp::Generally, all antacids are associated with metabolic alkalosis and hypokalemia, not hyperkalemia.
Answer E AnswerE::Cardiac arrest
Answer E Explanation AnswerEExp::Although very rare, magnesium-based antacids are associated with cardiac arrest.
Right Answer RightAnswer::C
Explanation [[Explanation::Antacids, such as aluminum hydroxide, contain cations that buffer gastric pH. Following the introduction of PPi and H2 receptor antagonists, the role of antacids in GERD has significantly decreased. Nonetheless, they are still used among patients since they are easily accessible over-the-counter drugs. In contrast to magnesium-based antacids which are associated with diarrhea, aluminum-based antacids are associated with constipation, which might predispose patients to hemorrhoids. As such, physicians must be cautious in to educate patients with hemorrhoids about the use of aluminum-based antacids.

The following table highlights the adverse effects of antacids:


Educational Objective: Aluminum hydroxide is associated with constipation, which might predispose to hemorrhoids.
References: First Aid 2014 page 371]]

Approved Approved::Yes
Keyword WBRKeyword::Antacid, WBRKeyword::Antacids, WBRKeyword::Adverse, WBRKeyword::Reaction, WBRKeyword::Adverse drug reaction, WBRKeyword::Side, WBRKeyword::Effect, WBRKeyword::Side effect, WBRKeyword::Magnesium, WBRKeyword::Aluminum hydroxide, WBRKeyword::Aluminum, WBRKeyword::Hydroxide, WBRKeyword::Hemorrhoids, WBRKeyword::Gastroesophageal reflux disease, WBRKeyword::Constipation, WBRKeyword::GERD, WBRKeyword::Gastroesophageal, WBRKeyword::Reflux, WBRKeyword::Heartburn
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