Colorectal Dz #4 Flashcards
C. diff testing for making the dx: (2)
*only diarrhea samples should be tested!!
1- Enzyme immunoassay (EIA): may be insensitive; multiple samples improves
2- PCR for C. diff: more sensitive, but more expensive
Drugs less likely to cause C.difficile: (5)
- IV aminoglycosides
- Sulfonamides
- Macrolides
- Vancomycin
- Tetracycline
Drugs that cause C.diff: (4)
- 3rd generation cephalosporin- Ceftriaxone (rocephin)
- fluoroquinalones
- ampicillin
- clindamycin
Progressive SXS to watch out for with colitis: (4)
- Dehydration: may lead to AKI
- Electrolyte derangements: MC hypokalemia
- Abdominal pain: can give narcotics
- Sepsis i.e. HoTN, increasing abdominal pain, rigidity, etc.
When is C. diff classified as severe? (3)
C. diff is generally considered severe if the following criteria are met:
1- Leukocytosis > 15k
2-Serum creatinine > 1.5x pts baseline
3-Shock, HoTN
When might ischemic colitis occur? (3)
- Trauma
- Surgery
- Syncope (secondary to HoTN)
Places most vulnerable to ischemic colitis: (2)
splenic flexure and rectosigmoid junction
Common etiologies of LGIB include: (5)
1- diverticular bleeding 2- angiodysplasia/AVM 3- benign anorectal dz 4- IBD 5- neoplasias
Diverticulitis mild SXS outpt pharm tx: (3)
1- cipro and flagyl
2- augmentin
3- avelox
Diverticulitis mod-severe SXS inpt pharm tx: (4)
1- meropenum
2- imipenem
3- augmentin
4- zosyn
If pt must take an NSAID with PUD, these precautions should be made: (3)
1- NSAID to lowest dose
2- concomitant PPI or misoprostolol (cytotec)
3- administer with meals
cytotoxic agents w/ high emetic risk: (3)
high: (90%)
cisplatin
carmustine
cyclophosphamide (>1500)
cytotoxic agents w/ moderate emetic risk: (2)
moderate: (30-90%)
carboplatin
cyclophosphamide (<1500)
cytotoxic agents w/ low emetic risk: (2)
low: (10-30%)
etoposide
5-FU
emetic preventative measures should be used in these 2 situations:
chemo-induced emesis
indications for surgery with toxic megacolon: (5)
1- free perforation 2- massive hemorrhage (6-8 units) 3- progression of colonic dilation 4- increasing toxicity (HoTN) 5- persistent dilation on maximal medication tx after 24-72 hrs
this drug is only available to women <55 y.o. with either IBS or chronic idiopathic constipation tx:
Tegaserod (Zelnorm)
Common SE of bowel stimulants: (3)
- PRO loss
- salt overload
- hypokalemia
this drug is indicated for post-op ileus constipation tx:
alvimopan (entereg)
this drug is indicated for BOTH cancer and non cancer opioid use and can be injected SQ:
methylnaltrexone (relistor)
this drug is indicated for ONLY non-cancer opioid use and can be taken PO:
naloxegol (movantik)
this is a key finding in making the dx of fecal impaction:
copious amounts of stool in the rectum
what are the locations where fecal impactions can occur: (3)
1- rectal vault (DRE dx)
2- proximal rectum (DRE nondx)
3- sigmoid colon (DRE nondx)
TX for fecal impaction:
- multiple enemas (soapsuds, mineral oil)
- manual disimpaction
Risk factors for c.diff development: (7)
1- MC secondary to ampicillin, Ceftriaxone, fluoroquinolones, or clindamycin use
2- ppi use
3- enteral feeding
4- receiving multiple abx or prolonged abx (>10d)
5- elderly, debilitated, or immunocompromised
6- GI dz
7- surgery