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PHM 604 > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Causes of N/V

A

general
disorders of balance
N/V pregnancy
PONV

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2
Q

Apfel risk score

A

Female
Non smoker
History of motion sickness / previous PONV
expected use of postoperative opioids

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3
Q

Treatment of general N/V

A

metoclopramide
phenothiazine
5-HT3 antag

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4
Q

Treatment of balance N/V

A

antihistamines

OTC

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5
Q

Treatment of NVP

A

doxylamine + BG
5HT
metoclopramide
prochlorperazine

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6
Q

PONV

Apfel Score = 4

A

Scopolamine patch before
IV dexamethasone during
5HT3 at the end

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7
Q

PONV

Apfel Score = 2-3

A

5HT3 at the end

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8
Q

PONV

Apfel Score = 1

A

No therapy

rescue 5HT3

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9
Q

Antihistamines N/V

A 
Dimenhydrinnate
Diphehydramine
Mecclizine
Doxylamine
Scopolamine
Hydroxyzine
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10
Q

Phenothiazines N/V

A

Promethazine
Prochlorperazine
Chlorpromazine

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11
Q

5HT3 Antagonists N/V

A

Ondansetron
Dolasetron
Granisetron
Palonosetron

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12
Q

Corticosteroids N/V

A

Dexamethasone

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13
Q

Antihistamines N/V used for

A

Balance
NVP
PONV as rescue

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14
Q

Phenothiazines N/V used for

A

General
PONV as rescue
NVP (low)

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15
Q

5HT3 Antagonists N/V used for

A

General
PONV
NVP (low - above pheno)

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16
Q

Prokinetics N/V

A

Metoclopramide

Erythromycin

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17
Q

Prokinetics N/V used for

A

General (gastroparesis)
PONV as rescue
NVP (low)

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18
Q

Corticosteroids N/V used for

A

PONV

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19
Q

AEs of antihistamines N/V

A

drowsy, sedation, paradoxical

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20
Q

AEs of phenothiazines N/V

A 
tissue damage (deep IM, no IV)
QT prolong 
extrapyramidal
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21
Q

AEs of 5HT3 N/V

A

constipation, HA, QT prolongation

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22
Q

AEs of metoclopramide N/V

A

extrapyramidal, dystonia, QT prolongation, diarrhea

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23
Q

AEs of erythromycin N/V

A

N/V, diarrhea, QT prolongation

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24
Q

AEs of corticosteroids N/V

A

agitation, insomnia, inc. appetite, hyperglycemia, hypertension

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25
Q

N/V therapies that cause QT prolongation

A

Phenothiazines
5HT-3 Antagonists
Prokinetics

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26
Q

N/V therapies that should be avoided to be given IV

A

Phenothiazines (specifically promethazine, chlorpromazine)

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27
Q

Diarrhea treatment options

A

Loperamide
Bismuth
Diphenoxylate + atropine
Octreotide

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28
Q

MOA of loperamide

A

u and gamma receptor agonists
delay transit time
inc. water absorption

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29
Q

Why is diphenoxylate given with atropine

A

it is an opioid derivative

decreases abuse because people cannot take large amount of atropine

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30
Q

Indications for diphenoxylate

A

Diarrhea and IBD - UC

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31
Q

Octreotide given for

A

intestinal carcinoid tumors and chemo induced diarrhea

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32
Q

Constipation treatment options

A 
PEG 
Lactulose 
Lubiprostone 
Linaditide 
Plecanatide 
Methylnaltrexone 
Naloxegol 
Naldemedine
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33
Q

Opioid receptor antagonists used for

A

Constplation

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34
Q

Opioid receptor antagonists are…

A

Methylnaltrexone
Naloxegol
Naldemedine

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35
Q

We give lactulose for which patients?

A

constipation who have cirrhosis or hepatic encephalopathy

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36
Q

Which therapy is for constipation and IBS-C

A

Lubiprostone (Amitiza)
Linaditide (Linzess)
Plecanatide (Trulance)

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37
Q

Rome 4 Criteria

A

For IBS
Recurrent abdominal pain (1 day/ week x 3 months)

At least 2 of:
Associated with deification
Change in frequency
Change in form

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38
Q

Most common IBS patients

A

women <50 years old

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39
Q

IBS-C treatment options

A

Lubiprostone (Amitiza)

Secretagogues:
Linaclatide (Linzess)
Plecanatide (Trulance)

Tegaserod (Zelnorm)

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40
Q

1st line IBS-C treatment

A

Lupiprostone
Linaclatide (Linzess)
Plecanatide (Trulance)

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41
Q

Who can receive Tegaserod (Zelnorm)

A

Women < 65 without cardiac history and max 1 cardiac risk factor

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42
Q

What are the cardiac risk factors for Tegaserod (Zelnorm)?

A 
HTN
smoking
BMI>30
DM
HDL
Age > 55
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43
Q

AEs of Tegaserod

A

Increased cardiac events

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44
Q

AEs of secretagogues

A

diarrhea (more common in Linaclotide aka Linzess)

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45
Q

Patient is on Tegaserod for 4 weeks with no effect. What should we do?

A

d/c because of cardiac risk

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46
Q

IBS-D Treatment options

A

Rifaximin (Xifaxan)
Eluxadoline (Viberzi)
Alosetron

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47
Q

1st line IBS-D treatment

A

Rifaximin (Xifaxan)

Eluxadoline (Viberzi)

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48
Q

2nd line IBS-D treatment

A

Alosetron - for women who have failed other therapies

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49
Q

Rifaximin is best for

A

IBS-D with SIBO (small intestine bacterial overgrowth)

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50
Q

Rifaximin treatment length

A

14 days

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51
Q

AEs of Eluxadoline (Viberrzi)

A

sphincter of oddi dysfunction

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52
Q

C/I of Eluxadoline (Viberrzi)

A

pancreatitis, no gallbladdeer, alcoholism, 3 drinks a day

because of sphincter of oddi dysfunction

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53
Q

AEs of Alosetron

A

severe constipation and ischemic colitis

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54
Q

Patient was on Rifaximin for 14 days. It did not help what should we give them?

A

Eluxadoline (1st line)

Alosetron (2nd line)

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55
Q

Patient was on Alosetron and saw no benefit in 4 weeks. What should we do?

A

d/c because of risk of severe constipation and ischemic colitis

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56
Q

IBS any subtype treatments

A

TCA antidepressants
Soluble fiber
Counseling

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57
Q

TCA for IBS

A

Amitriptyline

Nortriptyline

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58
Q

Which TCA for IBS has more AEs?

A

Amitriptyline

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59
Q

Soluble fiber for IBS

A

Psyllium

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60
Q

AEs for TCAs

A

sedation, dry mouth, anti cholinergic

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61
Q

GERD definition

A

heartburn last for longer than 3 months or refractory to stoping OTC medications

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62
Q

Dyspepsia is

A

bad digestion, discomfort, fullness, gnawing

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63
Q

How to diagnosis GERD

A

Symptoms + Endoscopy

especially to rule out Barrett’s

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64
Q

Treatment for GERD

A

PPI for 8 weeks

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65
Q

Chronic GERD Treatment

A

PPIs for patients with complications or for patients that get sxs back when stopping (try to titrate them down)

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66
Q

AEs of PPIs

A 
infection risk 
kidney injury
thrombocytopenia
CNS
osteoporosis + fracture risk
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67
Q

Patient experienced heartburn after dinner. What should we recommend?

A

OTC
PPI
H2RA
antacids (immediate relief)

68
Q

Gastritis and duodenitis go down to which layer?

A

Lamina propria

69
Q

Gastric, Peptic, and duodenal ulcers goes down to which layer?

A

Submucosa

70
Q

Food helps which type of ulcer?

A

Duodenal

71
Q

Food worsens which type of ulcer?

A

Peptic/Gastric

72
Q

Peptic ulcer disease causes

A

H pylori
NSAIDs
Critical illness
alcoholism

73
Q

Diagnosis of H. pylori PUD

A

Endoscopy
Tissue sample

Blood test
Urea blood tests
Fecal antigen tests

74
Q

H. pylori PUD treatment options

A

Bismuth Quadruple Therapy
Levofloxacin Based Triple Therapy
Triple Therapy

75
Q

Components of Bismuth Quadruple Therapy

A

PPI BID
Bismuth QID
Tetracycline QID
Metronidazole QD or TID

76
Q

Components of Levofloxacin Based Triple Therapy

A

PPI BID
Levofloxacin QD
Amoxicillin BID

77
Q

Components of Triple Therapy

A

PPI BID
Clarithromycin BID
Amoxicillin BID
(or metro for allergy)

78
Q

All H. pylori PUD therapy includes

A

PPI BID and ABX

79
Q

Treatment duration for H pylori PUD

A

10 - 14 days

80
Q

How to confirm eradication of H. pylori PUD after treatment?

A

Wait 4 weeks and then test by urea blood test or fecal antigen test

81
Q

Risk factors for NSAID induced PUD

A 
Age > 65
Patients with hx of ulcer
Steroids + NSAID
Non selective NSAID
NSAIDs + anticoag
NSAIDs + anti platelet
82
Q

When should patients be on prophylaxis for NSAIDs induced ulcers?

A

Taking NSAIDs chronically and have 1 risk factor

83
Q

How to diagnosis NSAID induced PUD?

A

Dyspepsia
Taking an NSAID
Endoscopy

84
Q

NSAID induced PUD treatment

A

PPI QD for 4 weeks

85
Q

Treatment if a patient is chronically taking NSAIDs and has PUD

A

PPI for 8 weeks to chronically

86
Q

Prevention of NSAID induced PUD by

A

Switch to APAP
Add PPI preventively
Add misoprostol
Use selective

87
Q

SRMB stands for

A

Stress related mucosal bleeding

88
Q

Major risk factors for SRMB

A

Respiratory failure - vent 48 hours
Coagulopathy
INR > 1.5 or platelets < 50

89
Q

Minor risk factors for SRMB

A

Sepsis
hypotension / need pressers
Hx of GI bleed
Use of high dose steroids (>250mg hydro)

90
Q

Who gets stress ulcer prophylaxis?

A

Someone with 1 major or 2 minor risk factors

91
Q

Stress Ulcer Prophylaxis treatment

A

H2RAs –> Ranitidine

92
Q

Can we use PPI’s in SRMB?

A

Yes but not first choice because of infection risk

Should go with H2RA first

93
Q

Zollinger Ellison Syndrome Treatment

A

PPI q8-12 hrs

94
Q

Upper GI Bleed Treatment

A 
IV bolus isotonic 
Packed red blood cells 
Oxygen 
Reverse anticoagulation 
Endoscopy burn 
Acid suppression
95
Q

When to give PRBC and how much to give?

A

1 unit to increase Hg by 1 point

Goal Hg of 7

96
Q

Acid suppression dose in UGIB

A

80 mg pantoprazole IV bolus
8mg/hr x 72 hours infusion
(or IV BID PPI)

97
Q

Patient is on ASA and plavix for new stent and has UGIB. What do we do?

A

Make sure Hg stable

resume ASA in 1-3 days (7 max)

98
Q

Patient is on ASA for primary prevention and has UGIB. What do we do?

A

d/c ASA

99
Q

IBD patho

A 
defective muscosa
leaky junctions 
inappropriate antigen recognition
few T regulators 
expansion of lamina propria
100
Q

Signs of IBD

A

diarrhea, blood in stool, abdominal pain, weight loss

101
Q

Diagnosis of IBD

A 
Age 15-30 with symptoms 
inc. ESR
inc. CRP
inc. calprotectin in stool 
Colonoscopy 
CT scans MRI
102
Q

Ulcerative colitis is in

A

rectum and colon

103
Q

Crohn’s is in

A

mouth to annus

104
Q

Ulcerative colitis is superficial or deep?

A

Superficial

105
Q

Crohn’s is superficial or deep?

A

Deep

106
Q

Which IBD disease has continuous inflammation?

A

UC

107
Q

Which IBD disease has patchy, cobble stone inflammation?

A

CD

108
Q

Perianal involvement is seen in

A

CD

109
Q

Toxic megacolon
Colon cancer
Colectomy

Are associated with

A

UC

110
Q

Malnutrition
Vitamin deficiency
Strictures

Are associated with

A

CD

111
Q

Which IBD treatment can be cured?

A

UC

112
Q

Proctitis means

A

UC in rectum

113
Q

Left Sided / Distal means

A

UC in rectum + sigmoid + descending

114
Q

Extensive means

A

UC past splenic flexure

115
Q

Suppositories and enemas can reach extensive UC

True or False

A

False

Thats why we need to give oral medications

116
Q

Categories of treatments for IBD

A 
5-ASA
Immunmodulators
ABX
Corticosteroids 
Biologics
117
Q

5-ASA derivatives drugs

A

5-ASA (Mesalmine)
Sulfasalazine
Olsalazine
Balsalazide

118
Q

Immunomodulator drugs

A 
AZA
6-MP
MTX 
Cyclosporine 
Tacrolimus
119
Q

ABX drugs for IBD

A

Metro

Cipro

120
Q

Corticosteroids for IBD

A

Prednisone
Methylpred
Hydro
Budensonide

121
Q

Biologics categories

A

Anti TNF
Selective adhesion molecule inhibitor
IL-12, IL-23 inhibitor
JAK inhibitor

122
Q

Anti TNF biologic drugs

A

Infliximab
Adalimumab
Certolizumab
Golimumab

123
Q

Selective adhesion molecule inhibitor biologic drugs

A

Natalizumab

Vedolizumab

124
Q

IL-12, IL-23 inhibitor drugs

A

Ustekinumab

125
Q

JAK inhibitor drugs

A

Tafacitinib

Upadacitinib

126
Q

Biologics for UC only

A

Glimumab (TNF)
Tafacitnnib (JAK)
Upadacitinib (JAK)

127
Q

Biologics for CD only

A

Certolizumab

Natalizumab

128
Q

Biologics for both CD and UC

A

Infliximab
Adalimumab
Vedolizumab
Ustekinumab

129
Q

Biologics given IV

A

Infliximab (TNF)
Natalizumab (IL)
Vedolizumab (IL)
Ustekinumab ( maintenance SC )

130
Q

Biologics given SC

A

Adalimumab (TNF)
Certolizumab (TNF)
Golimumab (TNF)
Ustekinumab (for maintenance)

131
Q

Biologics given PO

A

Tafacitinib (JAK)

Upadacitinib (JAK)

132
Q

5 ASA MOA

A

act topically to dec. inflammation

133
Q

Balsalazide has less AEs than Sulfasalazine because

A

does not have sulfa part

134
Q

Sulfasalazine AEs

A

GI, rash, photo, blood dyscrasias

135
Q

5-ASA with least daily dosing

A

Olsalazine

136
Q

Canasa is a ___ for ___

A

5-ASA suppository

rectal

137
Q

Rowasa is a ____ for ___

A

5-ASA enema

rectal + distal

138
Q

Asacol/Lialda/Delzicol is a ___ for ____

A

5-ASA PO

terminal ileum

139
Q

Pentasa is a ___ for ___

A

5-ASA PO

Jejunum

140
Q

AZA takes ___ for full effect

A

4 months

141
Q

Monitoring for AZA/MTX/6MP

A

CBC q3months
LFTs and pancreatic enzyme
Lymphomas

142
Q

Most potent corticosteroid for IBD

A

Budesonide because does not go systemic

143
Q

Entocort is ___ for ___ to treat ____

A

Budesonide
ileum
active CD

144
Q

Uceris is ___ for ___ to treat ____

A

Budesonide
colon
active UC

145
Q

AEs for biologics

A

Infusion for IV
Injection for SC
Infections
Malignancy

146
Q

BBW for TNF

A

Infections

Malignancy

147
Q

BBW for JAK

A

Infections
Malignancy
Increased risk of cancer, cardio events, thrombosis, death

148
Q

BBW for Natalizumab

A

Progressive Multifocal Leukoencephalopathy

reactivatio of human JC polymavirus

149
Q

ABX used for ___ in ___

A

fissures or fistulas in crohn’s

150
Q

Active therapy for Mild-moderate Crohn’s

A

PO Budesonide (Entocort) for 8 weeks

NO 5-ASA unless colonic (Sulfa)

151
Q

Active therapy for moderate - severe Crohn’s

A

PO Prednisone +/- AZA/MTX/6MP

Biologic + AZA

152
Q

Active therapy for severe - fulminant Crohn’s

A

Surgery
IV Steroids
IV Infliximab

153
Q

Maintenance Therapy Crohn’s

A

6-MP/AZA/MTX

Budesonide ish (4 months max)

Biologics

5-ASA only if colonic

154
Q

Mild UC defined

A 
< 4 stools 
some blood
Hg normal 
ESR normal 
CRP high 
FP high
155
Q

Moderate - Severe UC defined

A 
> 6 stools 
frequent blood
Hg < 75%
ESR high 
CRP high
FP high
156
Q

Fulminant UC defined

A 
> 10 stools 
continuous blood
Hg < 8
ESR high 
CRP high 
FP high
157
Q

Active Distal UC treatment

A

Topical 5-ASA (supp. or enema)

Oral 5-ASA

Both if you can

158
Q

Maintenance Distal UC treatment

A

Topical 5-ASA

Oral 5-ASA

159
Q

Active Extensive UC treament

A

Oral 5-ASA +/- Budesonide (Uceris) for 8 weeks

160
Q

Maintenance Extensive UC treatment

A

Oral 5-ASA

161
Q

Moderate - Severe Active UC treatment

A

Budesonide (Uceris)

Prednisone

Infliximab +/- AZA/6MP

162
Q

Moderate - Severe Maintenance UC treatment

A

was on steroids –> 6MP/AZA

was on biologic –> continue + 6MP/AZA

163
Q

Fulminant Active UC treatment

A

IV steroids
IV infliximab IV cyclosporine
surgery (curative)

164
Q

Fulminant Maintenance UC treatment

A

was on steroids –> 6MP/AZA
was on biologic –> continue + 6MP/AZA
was on cyclo –> 6MP/AZA or vedolizumab

165
Q

Methotrexate is used for UC

True or false

A

False

PHM 604 (3 decks)

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