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Therapeutics II > Block 1: Pancreatitis > Flashcards

Block 1: Pancreatitis Flashcards

1
Q

What is acute pancreatitis?

A
  1. Severe upper abdominal pain
  2. Elevation of pancreatic enzymes in blood
  3. Most common GI disorder causing hospitalization in the US
  4. Self-limiting
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2
Q

What is chronic pancreatitis?

A
  1. Long-standing inflammation -> loss in pancreatic exocrine and endocrine functions
  2. Chronic abdominal pain, malabsoprtion, steatorrhea
  3. Progressive disease
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3
Q

What are the RF of acute pancreatitis?

A
  1. Gallstone dx (structural)
  2. Alcohol consumption (toxic)
  3. Hypertriglyceremia (metabolic)
  4. CF (Genetic)
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4
Q

Which of the following patients would most likely be diagnosed with pancreatitis?
A. 28-year-old male with acute onset of hematemesis
B. 19-year-old pregnant female with mild nausea on awakening
C. 48-year-old alcoholic with tremor, diaphoresis, tachycardia, and delirium
D. 37-year-old obese female with a history of cholecystitis and worsening abdominal pain and nausea

A

D. 37-year-old obese female with a history of cholecystitis and worsening abdominal pain and nausea

Sx of pancreatitis

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5
Q

Describe the presentations of acute pancreatitis?

A
  1. Abdominal pain
  2. Nausea and vomiting
  3. Epigastric tenderness, guarding, distened abdominal
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6
Q

What are the lab markers we are looking for in acute?

A

Amylase and lipase

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7
Q

How do you diagnose acute pancreatitis?

A

2 of the following 3:
1. Upper abdominal pain
2. Serum lipase or amylase concentration at least 3x greater than upper limit of normal
3. Characterisitcs findings on imaging studies

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8
Q

What is acute tx?

A
  1. IV fluid (LR)
  2. Pain management
  3. Nutrition (GI rest and enteral foods as tolerated)
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9
Q

Your patient was admitted yesterday with severe pain and nausea/vomiting associated with an episode of acute pancreatitis and a blood pressure of 94/63 mmHg. Which of the following is the most appropriate recommendation to maintain this patient’s fluid balance?

A. Furosemide 40mg BID
B. Oral liquids as tolerated
C. 1000mL NS IV bolus
D. Lactated Ringer’s 30ml/kg IV bolus

A

D. Lactated Ringer’s 30ml/kg IV bolus

LR restores electrolytes and fluid balance.

NS can also be used.

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10
Q

What can you use for acute pain management?

A

Mild/moderate: NSAIDs or Tylenol
Severe: Opioids (short course, may require IV, then step down to PO, then to non-opioid therapy

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11
Q

Your patient was admitted yesterday with severe pain and nausea/vomiting associate with an episode of acute pancreatitis. Which of the following analgesics would be most appropriate for this patient?

A. Hydromorphone IV
B. Acetaminophen PR
C. Oxycodone PO
D. Ibuprofen PO

A

A. Hydromorphone IV due to severe pain and has vomiting

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11
Q

When are antibiotics used in the management of patients with pancreatitis?

A. Only in acute severe pancreatitis
B. Only in infected necrotizing pancreatitis
C. Only in recurrent/chronic pancreatitis
D. In all cases of pancreatitis (always)

A

B. Only in infected necrotizing pancreatitis

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12
Q

What are non-pharms for pancreatitis?

A
  1. Smoking cessation
  2. Alcohol absention
  3. Small meals (low fat)
  4. Enertal feeding tubes for patients with extreme weight loss
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13
Q

What is the biggest risk factor for chronic pancreatitis?

A

Consumption of ≥150g/d of alcohol for ≥15yr (10 standard drinks)

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14
Q

What is chronic pancreatitis?

A

Long-standing pancreatic inflammation resulting in irreversible destruction of pancreatic tissue from fibrin deposition -> loss of exocrine and endocrine functions

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15
Q

What are the sx of chronic pancreatitis?

A
  1. Abdominal pain
  2. Steatorrhea
  3. Pancreatic DM
  4. Diarrhea (3-4 dookies/day)
  5. Weight loss for malabsorption or acute/chronic pain
  6. Osteoporosis Vit D malabsorption
16
Q

What are ex of abdominal pain from chronic?

A
  1. Epigastric radiates to back
  2. Deep and pentrating
  3. W/ meals and at night
  4. N/V
17
Q

What is steatorrhea?

A
  1. Foul smelling stools with obvious oil drops
  2. Fat-soluable vitamin def
18
Q

What is pain management for chronic panc?

A
  1. Step up therapy: APAP, NSAIDs, weak opoids, combo weak opiods+adjuvant, increased potency opioids + adjuvant
  2. Scheduled doses (not prn)
  3. Use PO therapy
19
Q

What are opioid options for chronic pain?

A
  1. Tramadol
  2. Codeine
20
Q

What are the adjuvent agents?

A

Pregablin

21
Q

What are pancreatic enzymes for?

A
  1. Treat malabsorption to assist pain
  2. Combo with acid suppressant increase effect
  3. Reduce dietary fat intake
  4. Enteric coated
22
Q

What is the counseling point for pancreatitc enzymes?

A

Dose with each and every meal or snack

23
Q

How do you dose PERT?

A

Lipase 500 units/kg/meal
Lipase 250 units/kg/snack

24
Q

What is the tx of malabsoprtion and steatorrhea?

A

PERT (30,000-50,000) during or after meals

Increase does to max of 90,000 USP of lipase/meal

Enteric coated

25
Q

Uses of acid suppression while with PERT?

A

Improve efficacy

Non-enteric or enteric

Therapeutics II (30 decks)

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