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IPT: GI/Resp > Block 1 > Flashcards

Block 1 Flashcards

1
Q

According to the Rome IV criteria, what must constipation entail?

A

2+ of the following:

Straining at least 25% of defecations
Fewer than 3 bowel movements/week
Hard stools at least 25% of defecations

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2
Q

Which Rx for constipation activates Cl- channels?

A

Lubiprostone

Binds to EP4 receptors which increases fluid secretion via the lumen

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3
Q

Tofacitinib MOA and AE?

A

Inhibits JAK enzymes for UC only

Dont take w/ TNF-alpha inhibitors or thiopurines

AE= malignancy and TB (both BBW)

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4
Q

Whats something to keep in mind when prescribing aprepitant for someone on chemos?

A

Inhibits CYP3A4, therefore decrease dose of decadron by 50%

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5
Q

What diagnostic tests are required for CD?

A

3 kinds: endoscopy, radiographic, and pathologic

Endoscopy: use video camera endoscopy

Radiographic: CT scan, then MRI

Pathologic: Biopsy

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6
Q

If patient has NSAID-induced ulcers and you are NOT able to d/c NSAID, whats next?

A

Continue NSAID at lowest effective dose for shortest duration then add PPI (preferred) or misoprostol for 8-12 weeks, then treat H.pylori if that exists

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7
Q

Which H2RA is associated with thrombocytopenia?

A

All of them, but its reversible

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8
Q

What are the types of Tx failure on TNF-alpha inhibitors?

A

Mechanistic failure: good trough, no AB; choose another agent

Non-immune mediated PK failure: low trough, no AB; increase dose or shorten interval, or add immunomodulator

Immune mediated PK failure: low trough, AB development; choose another agent

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9
Q

What are the main receptors found on the superficial epithelial cells?

A

EP3

M1

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10
Q

Ciprofloxacin MOA?

A

Inhibits DNA gyrase

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11
Q

What are the dopamine receptor antagonists (DRAs)?

A

Prochlorperazine, chlorpromazine, and metoclopramide

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12
Q

How should you treat medium emetic risk in CINV?

A

Day 1 before chemo:
5-HT3RAs + Decadron

Days 2 + 3:
5-HT3RAs + Decadron

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13
Q

What are the risk factors of post-operative patients who may experience N/V due to anethesia?

A

Age <50, less not greater than :O

Female

Nonsmoker

History of PONV or motion sickness

Hydration status

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14
Q

What did clinical trials find about Natalizumab?

A

DOES cause PML (REMS program required)

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15
Q

Just know theres a psychological etiology behind IBD. Stress correlates w/ IBD flares

A

K

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16
Q

What are the neurokinin-1 receptor antagonists (NK1RA)?

A

Aprepitant and fosaprepitant

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17
Q

Which Rx actions may be decreased due to bismuth subsalicylate?

A

ACE and sulfinpyrazone

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18
Q

Which Rx actions and AE may be increased due to bismuth subsalicylate?

A

Insulin, methotrexate, and valproic acid

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19
Q

What Rx are the 5-HT3 receptor antagonists?

A

-setrons

Ondansetron for example

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20
Q

If patient has NSAID-induced ulcers and you are able to d/c NSAID, whats next?

A

Initiate PPI (or H2RA, sucralfate, misoprostol) for 4 weeks, then treat H.pylori if that exists

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21
Q

When is cyclosporine and tacrolimus indicated for IBD?

A

Not recommended only consider in severe ulcerative colitis

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22
Q

DDI with H2RAs?

A

-azoles and -vir (protease inhibitors)

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23
Q

What are some AE of DRAs?

A

Sedation, extrapyramidal side effects like hypotension and cardiac effects

Metoclopramide BBB - tardive dyskinesia with high doses or long term use

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24
Q

Mercaptopurine MOA and Target

A

MOA: Inhibits DNA (Purine) synthesis

Target: HGPRT

**Prodrug = Azathioprine

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25
Q

What anatomical feature is the main defense against reflux?

A

LES

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26
Q

Methotrexate MOA and Target

A

MOA: Inhibits DNA synthesis, inhibits dihydrofolate reductase; Inhibits conversion of folic acid to tetrahydrofolic acid

Target: DHFR

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27
Q

Misoprostol is a synthetic __________ that activates __________ receptors

A

Synthetic prostaglandin E1 (PGE1) and activates prostaglandin E3 receptors

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28
Q

What are some Rx that will reduce LES pressure?

A

ABCDENT rule

Anticholinergics

Barbituates

Caffeine, CCBs

Dopamine

Estrogen, progesterone

Nicotine, Nitrates

Tetracycline, Theophylline

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29
Q

Which Rx is a cannabinoid and has antiemetic effects?

A

Dronabinol

Lipid soluble so that the onset is within one hour

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30
Q

Metronidazole MOA?

A

Targets bacterial protein/DNA

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31
Q

What are the anti-TNFa Rx for IBD?

A

Certolizumab, Infliximab, Adalimumab

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32
Q

Methotrexate AE?

A

Hepatic fibrosis/cirrhosis, bone marrow suppression, teratogenicity for men and women

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33
Q

What kind of antibody is Infliximab?

A

Chimeric IgG1 monoclonal

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34
Q

What is the first-line Tx for N/V in pregnancy?

A

Doxylamine + Pyridoxine

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35
Q

Who should NOT take bismuth subsalicylate?

A

Bleeding issues, black/bloody stool, or Von Willebrand disease, taking salicylate Rx, or warfarin

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36
Q

UC vs CD

Rectal bleed

A

Both, however its more severe in UC

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37
Q

In regards to efficacy, what do studies say about antacids?

A

Controversial on superiority of antacids vs. placebo

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38
Q

Bismuth subsalicylate is used to treat (constipation/diarrhea)

A

Diarrhea

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39
Q

Antacid DDI?

A

Antibiotics

Quinidine

Iron sulfate

Sulfonylureas

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40
Q

CD Severity

CDAI scoring?

A

150-220 = mild/moderate

221-450 = moderate/severe

> 450 = severe/fulminant

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41
Q

PPIs vs H2RAs, what kind of ulcers can PPIs prevent that H2RAs cant?

A

PPIs can prevent both duodenal and gastric

H2RAs can only prevent duodenal

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42
Q

What are the goals of inducing and maintaining symptomatic control of IBD?

A

Induce remission within 3 months

Maintain remission >3months

Reduce steroid burden

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43
Q

What is the preventative therapy for NSAID-induced ulcers?

A

PPI, double dose of H2RAs, or misoprostol

Replace NSAID with COX-2 inhibition (celecoxib)

Treat H.pylori infection

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44
Q

How often should you test for JC virus for Natalizumab and Vedolizumab?

A

Every 6 months

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45
Q

What are the alarm Sx of PUD?

A

Bloody stool, dark stool, or bloody vomit

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46
Q

Ustekinumab MOA and AE?

A

anti-p40; TNF-alpha inhibition for CROHNS only

AE= PLS (not PML) and carcinoma

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47
Q

Glucocorticoid-unresponsive patients…

A

do not improve even w/ prolonged high dose steroids

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48
Q

Which 5-HT3RA is a prodrug?

A

Dolasetron which is converted to hydrodolastron

Metabolized via CYP2D6 and CYP3A4

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49
Q

What are some secondary preventative measures for NSAID induced ulcers?

A

Tx with PPI for 4-8 weeks (can use Misoprostol as well)

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50
Q

How does azathioprine become mercaptopurine?

A

Non-enzymatically remove nitroimidazole group

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51
Q

What is the only Abx that can help with diarrhea?

A

Rifaxamin

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52
Q

For PPIs to be activated in the body, what are the first and last steps?

A

1st - add 2 Hydrogens

Last - binds sulfur group from PPI to proton pump

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53
Q

Before initiation of TNF-alpha inhibitors, what should you do?

A

Assess for latent or active TB, any latent infections, viral hepatitis, risk of infection

Give any live vaccines prior to new Rx

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54
Q

Aminoglycosides affect what region of the brain?

A

Cerebellum via H1 and M receptors that influences the emetic center (medulla)

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55
Q

What are the trough thresholds for therapeutic Rx monitoring for TNF-alpha inhibitors?

A

Certolizumab ≥20

Infliximab ≥5

Adalimumab ≥7.5

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56
Q

Which 5-H3RAs has an increased chance of QTc prolongation?

A

Ondansetron if IV dose >16mg/day

Palonosetron has less effect

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57
Q

Which PPI should be administered before bedtime only?

A

Omeprazole-sodium bicarb

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58
Q

Sulfasalazine AE?

A

N/V/D

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59
Q

Difference between budesonide CIR and MMX?

A

CIR site = distal ileum and ascending colon

MMX site = throughout the colon

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60
Q

When are NK1RA utilized?

A

In conjunction w/ 5-HT3RAs and decadron in emetogenic chemos

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61
Q

When you swallow food, how does the LES respond?

A

It relaxes and opens up to allow food to pass

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62
Q

What are the emollients for constipation?

A

Docusate

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63
Q

What is the infectious etiology behind IBD?

A

Dysbiosis; more bacteria that promotes inflammation located in GI

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64
Q

What are some direct irritant Rx of GERD?

A

Alendronate, ASA, Iron, NSAIDs, KCl, Quinidine

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65
Q

What Rx can cause constipation?

A

Opiates

Antihistamines

Antacids

Diuretics

TCAs

Iron

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66
Q

Which IV chemos put you in the medium risk (30-90%) emetic zone? Oral chemos?

A

Busulfran, Idarubicin, and Oxaliplatin

Crizotinib

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67
Q

Which 5-HT3RAs are eliminated by urine only?

A

Ondansetron and Palonosetron

The others are via urine and feces

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68
Q

Which PPIs are a concern with DDI?

A

Omeprazole and esomeprazole vs phenytoin, diazepam, and warfarin (it inhibits CYP2C19, therefore decreases its elimination of those Rx)

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69
Q

How should you treat high emetic risk in CINV?

A

Day 1 before chemo:
NK-1 + 5-HT3RAs + Decadron + Olanzapine

Days 2-4:
NK-1 + Decadron + Olanzapine

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70
Q

If PPIs do not work, what is the last step possible? What are some issues with it?

A

Antireflux surgery; effective for only 5-20 yrs

Gas bloat syndrome, dysphagia, splenic trauma, vagal denervation

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71
Q

What are the receptors found in the solitary tract nucleas?

A

5-HT3

D2

M (not just M1 found in chemoreceptors)

CB1

H1

NK1

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72
Q

Antacid AE?

A

Aluminum - Constipation

Magnesium - Diarrhea

Caution in those with renal dysfunction as it can accumulate

Chalky taste

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73
Q

Which combination products for triple/quadruple therapy do have PPIs included?

A

Prevpac + Omeclamox-Pak

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74
Q

CD Severity

Wt loss?

A

Mild/moderate <10%

The rest are >10%

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75
Q

What are the alarm Sx of constipation?

A

Hematochezia/melana

Colon cancer history (family)

Wt. loss

Anemia

Anorexia

Refractory constipation

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76
Q

What Rx can cause motion sickness that disrupts the inner ear?

A

Aminoglycosides

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77
Q

Which laxatives require your BG to be checked on a regular basis?

A

Lactulose and sorbitol

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78
Q

UC vs CD

Cobblestone appearance

A

CD

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79
Q

What are the main receptors found on the parietal cells?

A

M3

CCK2

H2

EP3

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80
Q

How do emollients for constipation work?

A

Lowers the surface tension of stool by facilitating the mixing of aqueous and fatty materials

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81
Q

What classes of drugs can you use for abdominal pain in IBS?

A

Antispasmodics like dicyclomine and hyoscyamine (intermittent pain) or antidepressants like TCAs or SSRIs (chronic pain)

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82
Q

What heterocycle does cimetidine have that mimics histamine?

A

Imidazole (plays a role in inhibition CYP450)

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83
Q

What are the osmolar agents for constipation?

A

Lactulose, sorbitol, magnesium salts, glycerin, PEG

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84
Q

What are the alarm Sx of GERD?

A

Any swallowing issues (pain, difficulty, choking)

Bleed

Wt loss

NON-reflux chest pain

Vomit

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85
Q

How do bulk-forming agents for constipation work?

A

Absorb fluids in the intestines, should be taken with water

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86
Q

What are some lifestyle modifications that can be made to alleviate GERD symptoms?

A

Less food that causes decreased LES tone

Protein rich diet

Smaller meals

Elevate head of bed

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87
Q

What are the main groups found in an H2RA?

A

Basic heterocycle - imparts H2 selectivity

Flexible chain - extends polar groups

Polar neutral group - antagonistic property

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88
Q

What are the various ways LES pressure is reduced?

A
  1. Spontaneously (majority); unrelated to swallowing or peristalsis
  2. Transient increase in ab. pressure (stress reflux, pregnancy, obesity
  3. Atonic
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89
Q

What should you use to treat someone in the medium and high risk categories in PONV?

A

5-HTRAs and decadron - most evidence

Droperidol with some evidence, watch for AE

Rescue therapy with phenothiazine or metoclopramide

**do not repeat drug given for prophylaxis within 6 hrs

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90
Q

Octreotide MOA?

A

Blocks release of serotonin and other GI peptides

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91
Q

Triple therapy to treat H. pylori includes what?

A

PPI BID + clarithromycin 500mg BID + amoxicillin 1000mg BID (or Flagyl 500mg BID if allergic to amoxicillin) for 14 days

92
Q

Glucocorticoid-responsive patients…

A

improve clinically within 1-2 weeks and remain in remission as steroids are tapered and then d/c

93
Q

When IBD flares up (induction) how many weeks of therapy should you be on? Maintenance?

A

4-8wks, max of 16wks

Taper Rx to lowest effective dose

94
Q

Quadruple therapy to treat H. pylori includes what?

A

PPI + bismuth salicylate + Flagyl + tetracycline

Use if intolerant to first-line therapy (triple) or if they have used macrolides before (clarithroMYCIN)

95
Q

Prescription strength H2RA are typically __x the OTC dose

A

2x

96
Q

How deep is the damage (layers) of ulcerative colitis vs chrons?

A

UC - mucosa and submucosa

Chrons - all the way down to serosa

97
Q

What stimulates ECL cells?

A

Gastrin from G cells (onto CCK2 receptors)

or

ACh from ENS neurons (onto M1 receptors)

98
Q

What are the bulk forming agents for constipation?

A

Psyllium, fiber

99
Q

What did clinical trials find about Vedolizumab?

A

NOT found to cause PML (or less risk, no REMS required)

100
Q

CD Severity

Systemic toxicity, Sign/symptoms, Tx failure

A

Mild/moderate has no toxicity and no Tx failure exists; tolerates PO. The rest have toxicity and Tx failures.

Moderate/severe: intermittent N/V

Severe/Fulminant: abscess, persistent N/V, obstruction

101
Q

If you have hepatic disease, which PPI is substantially cleared less?

A

Lansoprazole and esomeprazole

102
Q

PPI AE?

A

Headache, diarrhea

B12 deficiency (decreases absorption)

Low magnesium

Bone fractures

C. diff colitis + gastroenteritis

Pneumonia

103
Q

Of the TNF-alpha inhibitors, which one is IV only?

A

Infliximab, the others are SQ

104
Q

What are the stimulant laxatives for constipation?

A

Bisacodyl

105
Q

Which IV chemos put you in the high risk (>90%) emetic zone? Oral chemos?

A

Cyclophosphamide and Cisplatin

Crizotinib

106
Q

Which Rx is the most effective for prophylaxis and Tx of motion sickness?

A

Scopolamine (anticholinergic agent)

107
Q

Which Rx for N/V has a concern for possible cyclic vomitting?

A

Dronabinol

108
Q

What are the alarm Sx of diarrhea?

A

Hematochezia/melana

Colon cancer history (family)

Wt. loss

Anemia

Dehydration

IBD history (family)

109
Q

What are some pearls associated w/ H1RAs?

A

Problematic in elderly

Risk of complications w/ BPH, narrow angle glaucoma, asthma

110
Q

How many times a week should one suffer with GERD to utilize antacids?

A

<2 times a week

111
Q

What are the main mechanisms of diarrhea?

A

Secretory (decreased Na absorption and increased chlorine secretion)

Osmotic (increased luminal osmolarity)

Exudative (involves mucus, large volumes,…)

Altered transit (reduction of contact time in intestine)

112
Q

What is the purpose of LES of the esophagus?

A

Separates gastric and esophageal lumens

113
Q

Which NSAIDs have the highest risk of induced ulcers?

A

Nonselectives, but the most are indomethacin, piroxicam, and ketorolac

114
Q

Which TNF-alpha inhibitors has the highest % of antibody development?

A

Infliximab

115
Q

What kind of antibody is Vedolizumab?

A

Humanized IgG1 antibody

116
Q

Misoprostol and GERD, what is the MOA?

A

Binds to EP3 on both parietal cells and superficial epithelial cells and blocks progression

117
Q

When should you d/c Natalizumab and Vedolizumab if there is no effect?

A

12 wks for Natalizumab

14wks for Vedolizumab

118
Q

What are the main physiological components that can cause GERD?

A
  1. LES pressure
  2. Esophageal Clearance
  3. Gastric emptying
  4. Anatomic disturbances
  5. Reflux composition
119
Q

What is the sequential therapy to treat H. pylori?

A

PPI + Amoxicillin x 5 days

PPI + Clarithromycin + Tinidazole (or Flagyl) x 5 days

120
Q

What extent of UC should you give oral therapy?

A

Pancolitis

121
Q

When is mercaptopurine indicated for IBD?

A

Reduce steroid dose or maintain remission

122
Q

Loperamide MOA?

A

Mu-receptor agonist; decreases cAMP

Anti-secretory activity against cholera and some E.coli toxins

123
Q

Why is Mercaptopurine toxic?

A

Has many metabolic pathways

xanthine oxidase to 6-thiouric acid

TPMT to 6-MMP

HGPRT to 6-TG

124
Q

What is the main functional group found on mesalamine?

A

Amine (-NH2) group at 5’

125
Q

Important info about sulfasalazine

A

Prodrug of mesalamine

Cleaves at the double bond N=N via colonic bacteria

Once cleaved, it becomes 5-aminosalicylic acid and sulfapyridine

126
Q

Which Rx is useful as a anxiolytic for N/V?

A

Lorazepam

127
Q

Which portion of the esophagus is the LES?

A

Smooth muscle of the lowest 2-4cm of esophagus

128
Q

What are some GERD risk factors?

A
  1. Certain hormones (cholecystokinin, progesterone in pregnancy)
  2. High fat foods, chocolate, spicy stuff
  3. Smoking, caffeine, alcohol
  4. FH
  5. Obesity
  6. Respiratory diseases
129
Q

PPIs are metablized by what CYP protein?

A

Benzimidazole and Pyridine group - CYP2C19

Sulfinylmethyl - CYP3A4

130
Q

Octreotide is used to treat (constipation/diarrhea)

A

Diarrhea

131
Q

When is alginic acid utilized for GERD?

A

Take at the same time as antacids to create a protective barrier

132
Q

What are the key structures found in PPIs?

A

Benzimidazole

Sulfinylmethyl (important one)

Pyridine

133
Q

UC Severity

Stool numbers?

A

Remission - formed stools

Mild - <4

Moderate/Severe - >6

Fulminant - >10

134
Q

Which components of the triple/quadruple therapy regimen can cause disulfiram-like rxns with alcohol?

A

Flagyl, also causes dyspepsia and metallic taste

135
Q

Antimotility agents such as loperamide, tincture of opium, diphenoxylate, difenoxin, and paregoric should not be used when?

A

In pseudomembranous colitis, acute ulcerative colitis, C. diff or other toxin producing infections

136
Q

What are the main complications of GERD?

A
  1. Esophagitis
  2. Esophageal strictures (narrowing of esophagus)
  3. Barrett’s esophagus (replacement of epithelial lining)
  4. Cancer of esophagus
137
Q

According to the Rome IV criteria, what must IBS entail?

A

Ab pain at least 1 day/week in the last 3 months associated with defecation and changes in frequency of stool

138
Q

Besides bulk-forming agents, what other class requires lots of water?

A

Emollients

139
Q

Pearls of loperamide?

A

High doses can cause euphoria and cardiovascular issues

140
Q

What should you know about radiation induced N/V?

A

High risk - total body irradiation. Tx with 5-HTRAs and decadron before and after

Moderate - upper body, ab. Pretty much the same with high risk

Low - brain, head, pelvic. Use 5-HTRAs only

141
Q

Which PPI can be administered w/o food?

A

Dexlansoprazole

142
Q

Which ones are pro-drugs?

H2RAs or PPIs?

A

PPIs

PPIs require gastric acid to be converted to active sulfenamide in the acidic canaliculi of parietal cells

Sulfenamide binds covalently to cysteine residues of proton pumps and irreversibly inhibits it.

143
Q

What is composed in sucralfate?

A

Sucrose sulfate-aluminum complex

144
Q

What is the typical dosing schedule for PPI on GERD?

A

8 week therapy, once a day (may go up to twice daily)

145
Q

UC vs CD

Carcinoma

A

UC

146
Q

ECL cells produce what?

A

Histamine

147
Q

What are the risk levels associated with PONV?

A

Very low - no risk factors - watch and wait

Medium - 1/2 risk factors - 1/2 interventions

High - 3/4 risk factors - >2 interventions

148
Q

How is bismuth subsalicylate elimnated?

A

Bismuth (not really absorbed) - stool

Salicylate - urine

149
Q

Which H2RA is associated with gynecomastia?

A

Cimetidine

150
Q

UC Severity

Hemoglobin count

A

Normal for remission and mild

Moderate/Severe - 75% of normal

Fulminant - transfusion required

151
Q

Glucocorticoid-dependent patients…

A

respond to glucocorticoids, but experience relapse of Sx as dose is tapered

152
Q

What is the immunologic etiology behind IBD?

A

Paneth stop producing defensins

Goblet cells produce less mucus

153
Q

What are the diagnostic tools used in PUD?

A

Gold standard is a histology to confirm H. pylori, but urea breath test is the most convenient and specific

154
Q

UC Severity

CRP levels

A

Normal for remission

Elevated for everything else

155
Q

How do NSAIDs cause ulcers?

A

Inhibits prostaglandin synthesis, which decreases production of bicarb and mucus

156
Q

UC Severity

Endoscopy (Mayo subscore)

A

Remission: 0-1

Mild: 1

Moderate/Severe: 2-3

Fulminant: 3

157
Q

Which receptors influence the cAMP-dependent pathway in the parietal cells?

A

H2 and EP3, H2 positively influences it and EP3 negatively influences it. Both act on proton pump

158
Q

Why is celecoxib okay to be used in patients who are somewhat prone to NSAID-induced ulcers?

A

Inhibits COX-2 only. COX-2 doesnt pertain to GI mucosal integrity

Nabumetone follows the same category

159
Q

Blood borne emetics influence what regions?

A

Chemo receptor trigger zone (BBB) and Stomach/Small intestines (only 5-HT3)

160
Q

When is the best time to administer antacids?

A

1-3 hrs after meals to increase duration AND prevent Rx interactions

161
Q

Lubiprostone is used to treat (constipation/diarrhea)

A

Constipation

162
Q

Loperamide is used to treat (constipation/diarrhea)

A

Diarrhea

163
Q

Contraindications to Natalizumab and Vedolizumab?

A

Immunosuppressants and TNF-alpha inhibitors

164
Q

Mesalamine MOA?

A

Decrease inflammation

Targets leukotriene, free radials

165
Q

Cyclosporine MOA?

A

Inactivates calcineurin via cyclophilin; reversibly inhibits T lymphocytes and helper cells, blocks IL-2

166
Q

Mesalamine AE?

A

Diarrhea w/wo blood, bloating, flatulence, Interstitial nephritis

167
Q

Which receptors influence the calcium-dependent pathway in the parietal cells?

A

M3 and CCK2 both positively influence it, which acts on the proton pump to produce gastric acid

168
Q

What can you do if initial PPI isnt working?

A

Refer

Increase dose or BID dosing

Switch PPI name

169
Q

UC vs CD

Strictures, fistulas, granulomas

A

CD

170
Q

What is the Tx for N/V in pregnancy that is persistent?

A

Ondansetron, metoclopramide, or promethazine

171
Q

What role does the benzimidazole and pyridine group on PPIs have?

A

Electron donating groups found on their R parts can increase activity

172
Q

What are some concerns with uses of H2RAs long term?

A

Tachyphylaxis

173
Q

What kind of antibody is Adalimumab?

A

Humanized IgG1 antibody

174
Q

What is the Tx for N/V in pregnancy that is refractory?

A

Methylprednisolone

175
Q

What can cause a build up of gastric volume (slow gastric emptying)?

A
  1. Smoking
  2. High fat meals
  3. Certain medications
176
Q

What kind of antibody is Certolizumab?

A

Not an antibody, its a humanized Fab against TNF alpha

177
Q

H.pylori should be treated only if they have…

A

Gastric/duodenal ulcers

MALT lymphoma

Resection of gastric cancer

178
Q

How should you treat moderate-severe UC?

A

Budesonide MMX 9mg/day, wait and see for 1-2wks

If on remission, taper budesonide

If not, add TNF-alpha except certolizumab. SWITCH to vedolizumab or tofacitinib if that doesnt work

179
Q

Which H1RA has both anticholinergic and antihistamine effects?

A

Cyclizine

180
Q

What is esophageal clearance and how is it altered?

A

Increased esophageal contact time w/ acid

Swallowing increases saliva and rate of clearance which is decreased with age

181
Q

What do the receptors in the superficial epithelial cells produce?

A

Mucus and bicarb (both positively influenced)

182
Q

How do stimulant laxatives for constipation work?

A

Cause the intestines to contract

***caution with use on bisacodyl for more than 10 days. it’ll cause loss of muscle tone on the colon

183
Q

What are the immunosuppressants for IBD?

A

Mercaptopurine, Methotrexate, Cyclosporine

184
Q

What kind of testing is required for thiopurines prior to initiation?

A

For Mercaptopurine, TPMT must be done

Normal = empiric weight-based dosing

Intermediate activity = 50% reduction in dose

Low = 0-10% of normal dose or do not use

185
Q

What Rx cause diarrhea?

A

Alpha-glucosidase inhibitors (acarbose)

Biguanides (metformin)

Colchicine

HAART

TKIs

ABx

Digoxin

Orlistat

186
Q

UC Severity

ESR levels

A

<30 for remission and mild

> 30 for moderate/severe + fulminant

187
Q

Antacid MOA?

A

Maintain gastric pH >4 (decreases pepsin production) AND neutralizes gastric fluid (increases LES pressure)

188
Q

What are the chemoreceptor trigger zones of the area postrema that influences the emetic center?

A

5-HT3

D2

M1

CB1

189
Q

What are the butyrophenones? When are they useful?

A

Haloperidol and droperidol; used as breakthrough therapy for chemo-induced N/V

EKG must be used for droperidol

190
Q

Which Rx for constipation is a peptide guanylate cyclase-C agonist?

A

Linaclotide (Linzess)

Increases cGMP which stimulates secretion of chloride and bicarb

Eliminated via stool

191
Q

If on the twice daily regimen, when should PPI be administered?

A

Before breakfast + 30-60min before evening meal

192
Q

Gagging reflex via the pharynx affects what?

A

Solitary tract nucleus

193
Q

Which Rx for IBD take months to work? (3-6 months)

A

Mercaptopurine + Methotrexate

194
Q

How should you treat mild UC?

A

Mesalamne or 5-ASA

195
Q

When should you expect improvements in Tx for IBD?

A

2-4 wks, max improvement in 12-16 wks

196
Q

Which antimotility agents are mixed with atropine to avoid abuse?

A

Diphenoxylate and difenoxin

197
Q

How should you treat severe UC?

A

Test for C.diff

Give TPN

Give IV methylprednisolone 60mg/day or hydrocortisone 100mg IV 3-4x day

If no response in 3-5 days, give IV cyclosporine to IV infliximab

If failed again, colectomy

198
Q

Natalizumab MOA?

A

Binds to alpha4-integrins on WBC

***Vedolizumab is another Rx in this class (binds to alpha4beta7)

199
Q

For moderate-severe CD maintenance/induction, what should you order?

A
  1. Prednisone max of 60mg/day. Wait and see for 1-2wks and taper it
  2. Add thiopurine or methotrexate
    * *doesnt increase chance of remission, just more likely to maintain steroid-induced remission
  3. Add anti-TNF alpha except certolizumab
  4. If step 3 doesnt work, REPLACE it with a monoclonal antibody
200
Q

How do osmotic laxatives for constipation work?

A

Osmotically draw water into the lumen

***caution in older adults and those w/ heart/kidney failure. can cause dehydration

201
Q

What are the polymorphisms involved in IBD?

A

System autophagy (regulates IL-1B)

OCTN1 (linked w/ CD in caucasians)

NOD2 (pathogen recognition)

202
Q

For mild-moderate CD maintenance/induction, what should you order and not order?

A

Order:

Budesonide CIR for disease in ileum and/or colon
**max 4 months, loses efficacy after that

DO NOT order:

  • Mesalamine nor sulfasalazine
  • Abx
  • Glucocorticoids

For induction: just manage what you can, symptom relief via loperamide

203
Q

What are the H1RAs?

A

Cyclizine, hydroxyzine, promethazine, benadryl, doxylamine, meclizine, dimenhydrinate

204
Q

What is the most common AE of 5-HT3RAs?

A

Headache (1) and Constipation (2)

205
Q

Which Rx for N/V is contraindicated in those w/ parenteral BZD?

A

Olanzapine

206
Q

Who should be placed on prescription therapy for GERD?

A

Those who dont respond to lifestyle modifications or other therapies after 2 WEEKS

Those with alarm symptoms

207
Q

Which Rx for treatment of GERD/PUD is associated with blackening of stool?

A

Bismuth subsalicylate (harmless btw)

Black tongue as well. Dont use in peeps with kidney issues

208
Q

What are the risk factors involved in CINV?

A

Young age

Female

Low alcohol consumption

Smoker

Chemo drugs

209
Q

What is an alternative regimen for the triple therapy?

A

PPI + Levofloxacin + Amoxicillin for 14 days

210
Q

Which components of the triple/quadruple therapy regimen can cause photosensitivity?

A

Tetracycline

211
Q

In GERD, what is the material that is directly irritating to the patient?

A

Bile acids

pH <2 - esophagitis

pH <4 - severe GERD

212
Q

Which Rx for constipation is a mu-opioid antagonist?

A

Methylnaltrexone (Relistor); for opioid induced constipation

213
Q

Sulfasalazine vs Mesalamine, which one is excreted via stool?

A

Mesalamine

214
Q

Which 5-HT3RA has the longest t1/2?

A

Palonosetron

~40hrs

215
Q

UC vs CD

Systemic symptoms

A

CD

216
Q

Which H1RA has both antimuscarinic and antihistamine effects?

A

Benadryl

217
Q

For severe-fulminant CD maintenance/induction, what should you order?

A
  1. IV methylprednisolone 40-60mg/day for 7 days
    * *if in remission, change to PO and slowly taper
  2. If no response to steroid, start anti-TNF alpha
218
Q

When should PPI be administered?

A

30-60 min before breakfast or biggest meal of the day

219
Q

What are the risk factors of PUD?

A

H. pylori and NSAIDs

Smoking, SRMD (stress-related mucosal damage), Zollinger-Ellison syndrome (too much gastric acid secretion), infections

220
Q

Which laxative is approved for children ≥2 yrs old??

A

Glycerin

221
Q

Which Rx for N/V is typically advised not to use as IV anymore due to serious tissue injury?

A

Promethazine

222
Q

When is sucralfate utilized in GERD?

A

Limited role in non-pregnant patients

223
Q

Which H2RA has many drug-drug interaction concerns?

A

Cimetidine (vs warfarin, phenytoin, theophylline, and lidocaine). It increases their concentration

224
Q

Morphine content in tincture of opium?

A

10mg/ml, 25x more potent than paregoric (CAMPHORATED tincutre of opium, 0.4mg/ml)

225
Q

Linaclotide is used to treat (constipation/diarrhea)

A

Constipation

226
Q

Which agent for constipation are surfactant agents?

A

Docusate

IPT: GI/Resp (4 decks)

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