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Pharmacology > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Highly emitogenic drugs

A

carboplatin, cisplatin, carmustine, cyclophosphomide, dactinomycin, doxorubicin

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2
Q

Receptors in the medulla triggering vomiting

A

cholinergic, histaminic, dopaminergic, opioid, serotonergic, benzodiazepine

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3
Q

Sensory input is received from ____ _____ ____.

A

chemoreceptor trigger zone (CTZ)

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4
Q

Clinical presentation of nausea and vomiting

A

simple
complex
psychogenic

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5
Q

What is simple N&V?

A

infrequent and usually self-limiting

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6
Q

What is complex N&V?

A

symptoms not relieved by simple, mono therapy

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7
Q

What is psychogenic N&V?

A

deep emotional cause

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8
Q

When is antiemetic therapy indicated?

A

electrolyte imbalances or dehydration
anorexia or weight loss
refuse potentially curative therapy

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9
Q

What is the treatment for simple N&V?

A

nothing-symptomatic relief, spontaneous resolution

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10
Q

When is lack of relief most debilitating in simple N&V?

A

in patients receiving mitogenic chemotherapy

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11
Q

Pharmacotherapy consideration of N&V

A

most conditions require mono therapy, if symptoms continue or get worse, consider combination therapy

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12
Q

What is the treatment of simple N&V?

A

usually minimal and usually effective in small, infrequent doses

  1. numerous OTC agents
  2. Prescription antiemetics
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13
Q

What is treatment of complex N&V?

A

more aggressive compared to simple,
often with 2 or more drugs in small-moderate doses
Achieve control via 2 mechanisms

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14
Q

What are the OTC antacids available? (3)

A

magnesium hydroxide
aluminum hydroxide
calcium carbonate

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15
Q

How do antacids work?

A

neutralization of gastric acidity

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16
Q

When are antacids used?

A

heartburn and GERD

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17
Q

What are the AE of antacids?

A

MG: osmotic diarrhea

Ca/AI: constipation

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18
Q

When are Histamine 2 Antagonists used? (H2RAs)

A

simple N&V of heartburn

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19
Q

How do H2RAs work?

A

they competitively inhibit histamine at H2 receptors

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20
Q

What does low toxicity and short half life allow of H2RAs?

A

daily or BID dosing

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21
Q

What are common OTC histamine 2 antagonists? (4)

A

cimetidine (Tagamet HB)
Famotidine (Pepcid AC)
Nizatidine (Axid AR)
Rantidine (Zantac)

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22
Q

Why is cimetidine (Tagamet) used less out of the OTC Histamine 2 antagonists?

A

potential drug interactions

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23
Q

How do anticholinergics work?

A

interrupt visceral afferents

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24
Q

What are anticholinergics useful for?

A

simple N&V

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25
Q

What are the AE of Anticholinergics? (5)

A 
drowsiness
confusion
blurred eyes
dry mouth
urinary retention
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26
Q

What are the common anticholinergics? (5)

A 
Diphenhydramine (Benadryl)
hydroxyzine (ataraxic, vistaril)
meclizine (antivert)
Promethazine (phenergan)
Trimethobenamide (Tigan)
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27
Q

Accidental intra-aterial injection of Promethazine (phenergan) has caused what?

A

intravenous thrombosis
nerve damage
paralysis
tissue necrosis and gangrene

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28
Q

What is the limit concentrations of promethazine (phenergan)?

A

25mg/mL max

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29
Q

How is promethazine given?

A

IVPB NOT IVP

large bore needle to large veins. Inject into farthest port of running IV

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30
Q

What are the most widely prescribed antiemetics?

A

Phenothiazines

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31
Q

How do phenothiazines work?

A

block dopamine receptors in the CTZ

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32
Q

What are SE of phenothiazines?

A 
extrapyramidal reactions
hypersensitivity
liver dysfunction
marrow aplasia
excessive sedation
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33
Q

What are the common phenothiazines? (2)

A

prochlorperazine (compazine)

chlorpromazine (thorazine)

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34
Q

What are Butyrophenones?

A

competitive D2 antagonists

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35
Q

What are the 2 agents of Butyrophenones?

A

haloperidol (haldol)

droperidol (Inapsine)

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36
Q

When are butyrophenones used?

A

moderately emitogenic chemotherapy

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37
Q

What are the adverse reactions of Butyrophenones?

A 
sedation and dystonias (usually occur late in therapy and typically respond to IV diphenhydramine)
QT prolongation (esp haldol)
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38
Q

What are the effective corticosteroids for N&V? (2)

A

methylprednisolone (solu-medrol, IV)

Dexamethasone (Decadron, IV)

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39
Q

Corticosteroids are NOT indicated for SNV. why?

A

due to secondary risks

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40
Q

How was metoclopramide (reglan)work?

A

dopaminergic blockade

accelerates GI transit (pro kinetic)

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41
Q

What are the AE of metoclopramide?

A

fairly well tolerated at high IV doses- but extrapyramidal effects

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42
Q

How do you treat extrapyramidal effects of metoclopramide (reglan)?

A

treat with IV diphenhydramine

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43
Q

What is metoclopramide frequently combined with?

A

benzodiazepines
corticosteroids
antimuscarinics
H1RAS

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44
Q

When are selective serotonin antagonists useful?

A

in CINV with highly emitogenic agents

*increasingly important in recent years)

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45
Q

What are available agents of Selective serotonin antagonists? (4)

A

ondansetron (zofran) generic
granisetron (kytrol, sancuso)
dolansetron (Anzemet)
Palonsetron (Aloxi)

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46
Q

When are combination regimens used?

A

reserved for patients with CNV & CINV

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47
Q

What is the goal of combination regimens?

A

use agents with different MOAs to limit toxicities

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48
Q

What steroid is best studied?

A

dexamethasone

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49
Q

When is dexamethasone beneficial?

A

helpful in patients with delayed NV & in combination with metoclopramide and lorazepam

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50
Q

What is unique to cytotoxic chemo?

A

Anticipatory VN (ANV)

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51
Q

Who experiences ANV?

A

up to 25% of chemo patients especially with high emitogenic

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52
Q

What med works best for ANV?

A

benzodiazepines (Ativan & valium)

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53
Q

What are common causes of post op N;V?

A

surgery of the abdomen, eye, ear, nose & throat

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54
Q

What is the female to male ratio in post op N&V?

A

3:1

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55
Q

What is the ratio of children to adults for post op N&V?

A

2:1

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56
Q

What are risk factors for post op N&V?

What medication has a high risk for post op N&V?

A

obesity
increased age
h/o motion sickness
prior post op N&V

inhaled anesthetics cyclopropane &
N2O are especially emitogenic

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57
Q

What meds are very effective for post op NV?

A

serotonin antagonists

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58
Q

What percentage of pregnant women experience N&V?

A

50%

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59
Q

What dictates what antiemetic will be used in pregnancy?

A

teratogenicity

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60
Q

What are the current recommendations of antiemetics and pregnancy?

A

Peridoxine (vitamin B6)

Antihistamines (antivert, bendryl, doxylamine)

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61
Q

What are recommended antiemetics and children? (3)

A

corticosteroids
diphenhydramine
serotonin receptor antagonists

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62
Q

What can few GERD cases progress to?

A

erosive esophagitis

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63
Q

What do serious symptoms of GERD require?

A

serious symptoms may require intensive acid-suppressive therapy & long term maintenance therapy

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64
Q

What are the 2 factors involved in GERD?

A

defensive factors

aggressive factors

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65
Q

What is the omeprazole test?

A

omeprazole 40-60mg daily x 7 days

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66
Q

What are the phases of GERD treatment?

A

Phase I: lifestyle changes

Phase II: OTC & prescription intervention

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67
Q

Which antacids are the most effective?

A

chewable tabs

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68
Q

What SE can be caused by combination products for GERD therapy?

A

diarrhea constipation
demineralization
drug-drug interactions

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69
Q

What is the standard dose for nonerrosive GERD?

A

twice daily

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70
Q

What is the dose for nonresponders and erosive disease for GERD?

A

high dose &/or QID

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71
Q

What is the duration of therapy for GERD?

A

longer than or PUD
PUD: 4-6 weeks
GERD: 8 weeks or more (12-16)

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72
Q

What are the SE of cimetidine(Tagamet)

A

several drug-drug interactions including warfarin

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73
Q

How do PPIs work?

A

inhibit gastric H+/K+ ATP pump that result in potent acid suppression

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74
Q

PPIs only inhibit what?

A

actively secreting pumps

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75
Q

How should PPIs be taken?

A

dose 15-30 mins before breakfast (and before meals or snack and 12h later if BID

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76
Q

What is the S-isomer of omeprazole and “proven superior”?

A

esomeprazole

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77
Q

What are the AE of PPIs?

A

diminished therapeutic effect of clopidogrel (pantoprazole effects less)
osteoporosis- bone fractures (Ca needs acid for absorption)
Hypomagnesemia

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78
Q

What supplements should be taken with PPIs think: osteoporosis?

A

Ca and VIt D supplements

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79
Q

How long should PPIs be used?

A

lowest effective doses for the SHORTEST duration

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80
Q

PPIs are well tolerated with -____ side effects

A

few

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81
Q

What is a pro kinetic agent?

A

metoclopramide (reglan)

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82
Q

Why do pro kinetics have limited use in GERD?

A

profiles of bethanecol & metoclopramide limit their use in GERD

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83
Q

What is the main mucosal protectant?

A

sucralfate (carafate)

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84
Q

How do mucosal Protectants work?

A

binds to exposed mucosal ulcers (protein changes) and prevents acid contact to promote healing

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85
Q

When are mucosal protectants used?

A

only for mildest forms of GERD

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86
Q

What is the dose of sucralfate (carafate)?

A

1 gram QID

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87
Q

What drug is the effective for mild maintenance therapy of GERD?

A

H2RAs

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88
Q

What is usually the drug of choice for maintenance therapy of GERD?

A

PPIs

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89
Q

What is significant about GERD in the elderly?

A

many elders have decreased mucosal defenses

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90
Q

Why are PPIs the drug of choice for GERD in the elderly?

A

superior efficacy

once daily dosing

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91
Q

What are the 3 common forms of PUD?

A

H pylori- associated
NSAID- induced
stress ulcers

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92
Q

What are the terms associated with PUD?

A

dyspepsia-uninvestigated dyspeptic symptoms

Non ulcer dyspepsia-dyspeptic symptoms & negative endoscopy

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93
Q

What percentage of Americans will develop PUD?

A

10%

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94
Q

What might be the reason why PUD mortality has decreased overall but has INCREASED in the elderly?

A

Increased NSAID use?

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95
Q

Most peptic ulcers are caused by: (4)

A

acid
pepsin
H pylori
NSAID

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96
Q

What is the cytoprotection of mucosa?

A

mucosal integrity is maintained by endogenous prostaglandins
(COX-1)

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97
Q

Mucosal defense and healing is a balance of what?

A

agressive and defensive factors

98
Q

Most its with PUD have H pylori, but _____ of H. pylori infections develop PUD

A

15%

99
Q

How does H pylori affect PUD?

A

infection leads to hypersecretiojn of gastric acid

100
Q

What percentage of regular NSAID users develop duodenal ulcers?

A

15-30%

101
Q

How do NSAIDs damage the mucosa?

A

direct or topical irritation

systemic inhibition of endogenous GI mucosal PG synthesis

102
Q

What are the complications of PUD?

A

upper GL bleed (mortality is 6-10%)
Peforation
Obstruction

103
Q

What is the COX-1 selectivity for aspirin?

A

166

104
Q

What is the COX-1 sensitivity for ibuprofen?

A

15

105
Q

What is the COX-1 sensitivity for naproxen?

A

0.6

106
Q

What is the COX-1 sensitivity for etodolac?

A

0.1

107
Q

What is the COX-1 sensitivity for selective COX 2 inhibitor?

A

0.0025

108
Q

What are the general recommendations of PUD? (3)

A
  1. eliminate or reduce psychological stress, ciggs and NSAIDs
  2. minimize and eliminate alcohol
    eradicate HP (use diff abs if second course is required)
109
Q

What is the main treatment recommendation for PUD with H2RA or PPI?

A

high-risk patients with ulcer complications
patients who fail HP eradication
Pts with h pylori negative ulcers

110
Q

When should a PPI or PPI + misoprostol be given?

A

The NSAID cannot be discontinues and the ulcer is large. patient is at risk of developing serious ulcer related complications

111
Q

What is the efficacy of H pylori treatment with 3 drug regimens?

A

> 90%

112
Q

What are the preferred regimens for treatment of H pylori?

A

Clarithromycin 500mg BID
Amoxicillin 1g BID
PPI BID
ALL for 14 days

can switch amox with metronidazole 500mg BID x 14 days

113
Q

When was the prepackaged regimen for H pylori Helidac discontinues?

A

Dcd by manufacturer 4/25/14

114
Q

What are the 2 prepackaged H pylori regimens?

A

Prevpac (1 pack is 14 days)

Pylera

115
Q

What are the conventional treatments of active peptic DUODENAL ulcers?

A

PPIs x 4 weeks
H2RAs x 4 weeks
Sucralfate x 6 weeks
OTC antacids x 8 weeks

116
Q

How is the conventional treatment of gastric ulcers different compared to duodenal ulcers?

A

same meds but higher doses with a longer duration. Gastric ulcers are usually larger than duodenal

117
Q

What is the cause of most refractory ulcers?

A

H pylori positive

118
Q

How do you treat refractory ulcers?

A

doubling the dose heals most refractory ulcers

119
Q

When is prostaglandin-misoprostol used?

A

in patients that are unable to stop NSAID use

120
Q

What kind of prostaglandin is misoprostol?

A

exogenous

121
Q

What is the mechanism of misoprostol?

A

replaces endogenous PGs lost by NSAID- mediated COX- 1 inhibition

122
Q

What are the AE of misoprostol?

A

GI

N&V 100% lasts < 3 days

123
Q

What is a common AE of misoprostol in 10% of pts?

A

myelosuppression

124
Q

What category is misoprostol for pregnancy?

A

category X

125
Q

What is the unlabeled use of a PPI for prevention of rebleeding in PU bleed? And the dosage?

A

pantoprazole (protonix)
80mg IVP x1
then 8mg/hr CIV x 72 hours

126
Q

Why is 40mg of pantoprazole not given for PPI prevention of rebelled in PU bleed?

A

40mg infusion daily does NOT raise gastric pH sufficiently to enhance coagulation in active GIB

127
Q

What is the general approach to pharmacotherapy in GI?

A

question about diet and concurrent medications

128
Q

How can fiber affect diet?

A

Fiber without fluids will WORSEN constipation

129
Q

What are the medications for constipation in order of increasing effectiveness? (7)

A

emollient laxatives (stool softeners)
lubricants
bulk forming laxatives (fiber)
saccharides (lactulose and sorbitol)
Stimulants (Dipenylmethane/Antheaquinon Derivatives)
Saline Cathartics (Mg, SO4, PO4, Citrate)
Polyethylene Glycol- Electrolyte lavage solution

130
Q

How do emollients, stool softeners, work?

A

they absorb water by increasing surface tension, acts as surfactants

131
Q

What is an example of an emollient?

A

docusate

132
Q

What is an example of a combined medication including an emollient?

A

pericolace (docusate & senna)

133
Q

What is the only lubricant in routine use for constipation?

A

Mineral oil

134
Q

What are common side effects of lubricants? (2)

A

may be aspirated (chemical pneumonitis)

decreases absorption of fat soluble vitamins

135
Q

What do bulk forming laxatives require to be affected?

A

sufficient fluid intake

136
Q

How long is the onset of bulk forming laxatives?

A

12 hours- 3 days

137
Q

What are the benefits of bulk forming laxatives compared to other meds for constipation?

A

minimal side effects

safe for pregnant females**

138
Q

Lactulose is a synthetic ______.

A

disaccharide

139
Q

How does lactulose work?

A

It’s metabolized by colonic bacteria to low MW acids resulting in osmotic effect in the colon

140
Q

Sorbitol is a ______ with osmotic action.

A

monosaccharide

141
Q

How do stimulants work for treating constipation?

A

function by stimulating peristalsis

142
Q

What are examples of stimulants? (2)

A

Senna

bisacodyl

143
Q

When are stimulants not recommended for constipation? (2)

A

pregnancy

for regular daily use

144
Q

How do saline cathartics medications work for constipation?

A

increase intestinal water by osmotic pressure, water moves into hypertonic GI tract, swelling stretched GI wall and increases peristalsis

145
Q

How soon will higher doses of saline cathartics work?

A

2-6 hours (more cramping compared to lower dosage)

146
Q

What are PO examples of saline cathartics?

A

milk of magnesia

magnesium citrate

147
Q

What medication is commonly used prior to diagnostic examination?

A

saline cathartics

148
Q

What medication is used to cleanse bowel for procedures (colonoscopy)

A

polyethylene glycol (PEG) electrolyte lavage solutions

149
Q

How much polyethylene glycol (PEG) electrolyte lavage solutions needs to be ingested?

A

4L

150
Q

When can polyethylene glycol (PEG) electrolyte lavage solutions be discontinued?

A

when stools turn clear

151
Q

Why is important to wait until you get home to start polyethylene glycol (PEG) electrolyte lavage solutions?

A

rapid onset of action!

152
Q

What are examples of polyethylene glycol (PEG) electrolyte lavage solutions?(2)

A

GoLytely

Miralax

153
Q

What is important to remember when starting opioids?

A

anticipate and prophylax for OIC (opiate induced constipation)

154
Q

Does tolerance develop to OIC?

A

NO

155
Q

What are the Peripherally acting mu-opiod receptor antagonists (PAMORAs) prescribed for OIC?

A 
Methylnaltrexone bromide (Relistor)
Naloxegol (Movantik)
156
Q

What is the MOA of methylnaltrexone bromide (Relistor)?

A

inhibition of peripheral GI mu receptors

157
Q

What kind of derivative is methylnaltrexone bromide (Relistor) and how does it work?

A

quaternary naltrexone derivative, limits CNS access

158
Q

How are are the PO and SC doses of methylnaltrexone bromide (Relistor)?

A

PO: $1600/month
SC: $3300/month

159
Q

What is a SE of methylnaltrexone bromide (Relistor)?

A

may precipitate symptoms of opioid withdrawal

160
Q

Does methylnaltrexone bromide (Relistor) affect opioid analgesic affects?

A

NO- limited CNS access

161
Q

What is the MOA of Naloxegol (Movantik)?

A

inhibition of peripheral GI mu receptors

162
Q

Why does Naloxegol (Movantik) have limited CNS access?

A

its naloxone conjugated with PEG polymer

163
Q

What is the pregnancy category of Naloxegol (Movantik)??

A

Category :C

164
Q

What are the side effects of Naloxegol (Movantik)?

A

may precipitate symptoms of opioid withdrawal

may reduce analgesia with disruptions to blood brain barrier

165
Q

What is important to determine with diarrhea that is a symptom of a disease?

A

infectious vs non-infectious

166
Q

What usually causes acute diarrhea?

A

viral gastroenteritis

167
Q

What are the 2 things about BM in acute diarrhea?

A

BMs are frequent and never bloody

168
Q

What is important to maintain with clinical presentation of diarrhea?

A

medication history to identity drug induced diarrhea

169
Q

What are common drugs classes that cause diarrhea? (3)

A

Laxatives
Mg-containing antacids
Antibiotics (mostly broad spectrum)

170
Q

What are the 4 mechanisms that cause diarrhea?

A

osmotic diarrhea
secretory diarrhea
altered transit
infection (exudative)

171
Q

What is an example of antibiotic-associated diarrhea?

A

clostridium difficle

172
Q

How can you differentiate from osmotic diarrhea and secretory?

A

fasting will control osmotic diarrhea, if secretory diarrhea will persist with fasting

173
Q

how can water and electrolytes be replaced?

A

if not severe, enteral is preferred since less costly

174
Q

What are pharmacologic therapies for diarrhea?

A

opiates and opiate derivatives
adsorbants
anti secretory agents

175
Q

Why are opiates little used for diarrhea treatment?

A

due to decrease respiratory rate and decreased peristalsis

some opiates were developed specifically for this indication

176
Q

What are examples of opiate/opiate derivatives for diarrhea?

A

loperamide (Imodium)

Diohenoxylate/atropine (lomotil)

177
Q

What is the MOA of adsorbents for diarrhea?

A

coat the GI tract walls-absorbing toxins

178
Q

What are examples of adsorbents? (2)

A 
bismuth salts (pepto bismol)
Kaolin &amp; pectin (kaopectate)
179
Q

What is a SE of all adsorbents?

A

may inhibit other drug absorption

180
Q

What are common anti secretory agent medications?

A 
bismuth subsalicylate (pepto bismol)
Octreotide (sandostatin)
181
Q

Other than diarrhea when else will octreotide be used?

A

carcinoid tumors $$$$$$$

182
Q

Traveler’s diarrhea is commonly caused by what?

A

e-coli

183
Q

How is travelers diarrhea treated?

A

fluoroquinolone antibiotics

cipro 500mg BID x3 days

184
Q

What causes C. dif diarrhea?

A

the MINOR anaerobic gut flora dominates gut flora after broad spectrum antibiotics

185
Q

What are the treatments for c diff diarrhea? (3)

A

metronidazole
vancomycin (if failed metronidazole)
rifaximin (xifaxin)

186
Q

What are the 2 principal types of IBD?

A

ulcerative colitis

crohns disease

187
Q

What IBD is associated with “crypt abscesses” and “pseudo polyps”?

A

ulcerative colitis

188
Q

What IBD involved the colon and rectum?

A

ulcerative colitis

189
Q

What IBD involves the mouth to anus

A

crohns disease

190
Q

What IBD involves transmural inflammation (deep ulcers), “cobblestone appearance”, and often skip lesions

A

Crohn’s disease

191
Q

Why is ‘infectious’ an etiology for IBD?

A

up to 1/3 of CD patients have altered anaerobic bowel flora

192
Q

Which IBD has a greater genetic component?

A

Crohn’s

first degree relatives have a 10X increased incidence

193
Q

What suggests that IBD has an immunological etiology?

A

responsiveness to immunosuppressive drugs (CS’s azathioprine)

194
Q

What are common extra intestinal manifestations of IBD?

A

arthritis/arthralgias

hepatobiliary (increased LFTs)

195
Q

What are the common clinical signs and symptoms for IBD for mild?

A

Mild: <4 stools/day with or without blood, ESR normal

196
Q

What are the common clinical signs and symptoms for IBD for moderate?

A

Moderate: > 4 stools/day, minimal systemic effects

197
Q

What are the common clinical signs and symptoms for IBD for severe?

A

Severe: >6 stools/ day with blood, systemic OR ESR>30

198
Q

What are the non pharmacological IBD treatments? (3)

A

nutritional support
medical management
surgery

199
Q

When to consider nutritional support for IBD treatment?

A

“short gut” secondary to multiple small bowel resections (Crohns patients)

200
Q

What type of IBD is surgery curative?

A

ulcerative colitis

201
Q

What are the IBD pharmacology treatments? (5)

A 
anti-inflammatory agents
corticosteroids
antibiotics
immunosupressants/immune modulators
Pain control
202
Q

How can corticosteroids by given? and what determines route?

A

PO, IV or PR

severity dependent

203
Q

What is the corticosteroid dose for moderate to severe IBD?

A

prednisone 40-60mg daily PO

204
Q

What is the generic cost of prednisone per month?

A
205
Q

Which corticosteroid has minimal systemic absorption and can cost $600/month?

A

budesonide

206
Q

what are the immunosuppressant agents used for IBD? (4)

A

Azathioprine (AZA)
6-mercaptopurine (6MP)
cyclosporine (CSA)
Methotrexate (MTX)

207
Q

What immusuppressant agents are used for steroid refractory UC & CD?

A

Azathioprine (AZA)

6-mercaptopurine (6MP)

208
Q

What immunosuppressant is used for acute, severe ulcerative colitis?

A

cyclosporine (CSA) by CIV

4mg/kg/d

209
Q

What type of biologics are used for IBD? and examples (2)

A

anti TNF

Infliximab, Remicade

210
Q

What are the biologics class prototypes now available?

A

“biosimilars”

211
Q

What are the Biologics- chimeric monoclinal antibodies?

A

75% human; 25% mouse

212
Q

What is important to do prior to starting biologics (Anti TNF)?

A

numerous deaths from TB therefore all patients need PPD test BEFORE therapy

213
Q

How much are Anti-TNF agents (biologics) monthly?

A

$3-10K/monthly

214
Q

What biologics are restricted to patients who fail steroids, immunosuppressants, or anti TNF agents?

A

anti-integrin antibodies ($6-12K/monthly)

215
Q

What antibiotic is mainly used for active crohns disease for perineal lesions or fistulas?

A

metronidazole (flagyl)

216
Q

What is the usual adult dose of metronidazole for IBD therapy?

A

500mg po TID

217
Q

What other 2 antibiotics besides metronidazole are used for IBD?

A

ciprofloxacin (500mg Q12)

clarithromycin

218
Q

What is a selected complication of IBD especially in ulcerative colitis?

A

toxic megacolon- may be life threatening

219
Q

What medication is used for mild IBD?

A

Sulfasalazine PO 3-6g/daily every 6 hours

220
Q

What medication used for moderate IBD?

A

Sulfasalazine PO 3-6g/daily every 6 hours

Prednisone PO 40-60mg/daily

221
Q

What mediation is used for severe IBD?

A

IV steroids

Hydrocortisone (solucortef) 100mg IVP every 6-8 hours OR methylprednisolone (solumedrol) 20-40mg IVP every 6 hours

222
Q

What GI disorder is characterized by symptom constellation?

A

Irritable bowel syndrome (IBS)

223
Q

What are common complaints of IBS?

A

pain & bloating

224
Q

What are the proposed features of IBS? (3)

A

altered bowel motility
visceral hypersensitivity
psychosocial factors

225
Q

What is the currently primary means of IBS identification?

A

symptoms

dominant symptoms remain constant in 75%

226
Q

What are the alarm symptoms of IBS that may suggest organic disease? (7)

A 
weight loss
rectal bleeding
anemia
steatorrhea
fever
family h/o colon ca
initial onset after 50
227
Q

What are the 3 subgroup classifications of IBS?

A 
diarrhea-predominant (IBS-D)
constipation predominant (IBS-C)
Mixed pattern (IBS-M)
228
Q

What are the IBS treatments for pain? (3)

A

Anticholinergic (antispasmodica) agents
Triclyclics
SSRIs

229
Q

What are examples of Anticholinergic (antispasmodica) agents?

A 
hycosamine
Atropine combo (lomotil)
230
Q

What are the examples of tricyclics used for IBS pain?

A

amitriptyline (elavil)

Desipramine (Norpramin)

231
Q

What are the examples of SSRIs used for IBS pain?

A

Paroxetine (Paxil)
Citalopram (lexapro)
Fluoxetine (Prozac)

232
Q

What medications are used in diarrhea predominant IBS?

A

loperamide
diphenoxylate
Cholestyramine (questran)

233
Q

What medication was originally withdrawn of GlaxoSmithKline in 2000 to due 70 cases is ischemic colitis but reproved by FDA in 2002 with restrictions?

A

Alosetron (Lotronex)

234
Q

When is Alosetron (Lotronex) indicated?

A

for females with IBS-D & no response to other antidiarrheal agents greater than 6 months

235
Q

What medication is an opioid mu receptor agonist and mu receptor antagonist (mixed) due decrease GI motility and water secretion?

A

Eluxadoline (Viberzi)

236
Q

What classification is Eluxadoline (Viberzi)? and why?

A

scheduled IV

may cause euphoria and drunkedness

237
Q

What are the treatment options for IBS-C

A

osmotic laxative
lactulose
lubiprosone (Amitiza)
Linaclotide (Linzess)

238
Q

What type of medication is approved for idiopathic constipation that is a PGE-1 derivative, activates chloride channels, and produced Cl rich fluid secretion?

A

lubiprosone (Amitiza)

239
Q

What are the SE of lubiprosone (Amitiza)?

A 
diarrhea (13%)
headache (13%)
abdominal distention (7%)
abdominal pain (7%)
flatulence (6%)
240
Q

What medicine approved for IBS-C is a guanylate cyclase C agonist that increases fluid secretion and increases GI motility?

A

Linaclotide (Linzess)

241
Q

What are the AE of Linaclotide (Linzess)?

A 
diarrhea (20%)
abdominal pain (7%)

Pharmacology (17 decks)

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