Exam 6 drugs Flashcards
GERD tx
- lifestyle
- PRNs (antacids or H2RA)
- scheduled rx (H2RA or PPI
- surgery
Antacids
-Tums 2-4 tab
-MoM 5-15mL
-Maalox 10-20mL
H2RAs
-inhibition off H2 in parietal cells
-AVOID in risk of delirium
-HA, dizzy, fatigue, C orD, confusion, agitation, B12 deficiency
-famotidine
-cimetidine
Famotidine
-H2RA
-10-20mg BID max 40
-2nd line GERD
PPIs
-IRREVERSIBLE H/K atpase inhibition
-omeprazole 20mg
-panto 20-40mg hr beforemeal
-esomep 20mg
-lansop 15mg
-Dexlan rx only 30-60
-Rabe 10-20mg before meal
-14 days then retry in 4 months
-3rd line for GERD
-use in h pylori PUD
PPI side effects
-HA
-nausea
diarrhea
-abpain
-pneumonia
-hypoMg
-bone probs
-B12
-CKD
-inc effect of methotrexate, phenytoin, warfarin
Sucralfate
-protectant
-nonacid reflux gerd
-NSAID PUD
-1g QID
-constipation, metallic taste, toxic in renal failure
-admin on empty tummy 4 hours away from other meds
Combo GERD tx
- antacid + H2RA
- PPI + pm H2RA
GERD tx in preg
- lifestyle
- antacids w/o aspirin
- H2RAs
- PPIs only if severe
Ped tx of GERD
- thicken foods
- PPIs and H2RAs for 8 weeks for DIAGNOSED GERD
H. pylori PUD tx (IS THERE AN ORDER)
-Bismuth
-Clarithromycin
-Levofloxacin
-Rifabutin
-Vonoprazan
Bismuth quad therapy
- PPI BID
- Bismuth 525mg QID
- Metro250-500mg QID
- Tetra 500mgQID
-10-14 days
-helidac and pylera packs
Clarithromycin Quad
- PPI BID
- Clar 250-500mg BID
- Amox 1g BID
- Metro250-500mg BID
-10-14 days
-PPI and amox whole time or first half
Levofloxacin triple
- PPI BID
- Levofloxacin 500mg qd
- Amox 1g
-10-14 days
Levofloxacin quad
- Levo 250mg qd
- high dose PPI qd
- Nitro 500mg BID
- Doxycycline 100mg qd
-7-10 days
Rifabutin and vonoprazan
??
Prevention of NSAID PUD
-PPI w NSAID (40mg)
-H2RA w NSAID
-Misoprostol w NSAID
-COX-2 inhibitor (celecoxib) nalproxen?
Misoprostol
-E1 prostaglandin analog
-200mcg wf
-inc secretion
-dec secretion?
-diarrhea, ab pain , NV
Celecoxib
-low dose 200mg in NSAID PUD prevention for pt at high CV risk (or use nalproxen)
-combine w PPI
-low gas low CV risk can still take NSAIDs
NSAID PUD tx if pt can stop NSAID
-PPI
-H2RA
-sucralfate 1q QID before meals and at bedtime
-8weeks
Tx of traveller’s diarrhea
mild: NO antibx, loperamide or BSS
-mod: loperamide +/- antibx
-severe: antibiotic
Antimotility drugs
-tx diarrhea
-opioid mu AGONISTS
-short term use
-diphenoxylate/atropine
Diphenoxylate/atropine
-antimotility
-opioid agonist
-tx diarrhea
-IBS-D
Loperamide
-4mg start, 2 after each loose stool max 16mg/day
-diarrhea txx
-high dose death and heart probs
Bulk lax
-psyllium (metamucil)
-mix w 8oz water
-not if bedridden
Acute Constipation drugs
-bulk (psyllium)
-docusate 100mg BID/qd (surfactant)
-mineral oil (lube) (only prevention)
-saline (mom, mg citrate, enema)
-hyperosmotic agents
-stimulant lax (senna, bisacodyl)
-lubiprostone, linaclotide, plecanatide, lactitol
-
acute constipation relief timeline
-1 hr: enema, bisacodyl or glycerin suppository
-3-6hr: Mg citrate, PEG
-24hr: bisacodyl or senna tablets (stimulant)
48hr: MoM, PEG, hyperosmotic
docusate
-surfactant for constipation tx
mineral oil
-lube for constipation
-only preventss
saline lax
-MoM
-Mg citrate
-enema
-draws fluid into colon
-AVOID in renal pts
Hyperosmotic agents
-tx constipation
-sorbitol or lactulose 30-60mL/qd
-PEG 17g in h2o
-glycerin suppositories (quick onset)
-1-3 day onset
Bisacodyl suppositories
-stimulant lax
-10mg prn
-quick onset
Lubiprostone
-24mcg w water
-lax
Linaclotide
-145mcg qd 30 min before first meal
Plecanatide
-3mg qd
-inc chloride and bicarbonate secretions
-diarrhea
-constipation tx
lactitol
-20g qg
-do NOT admin w other meds
Tx of constipation in spinal injury
-routine use of bowel stimulants
tx of constipation in preg
-diet
-fiber
-docusate
Tx of constipation in diabetics
-prokinetic agents
-(metoclopromide and prucalopride)
Tx of constipation in pts on opioids
-stimulants
-then add docusate, lactulose, or PEG prn
-AVOID bulk lax
-opioid antagonists
Opioid antagonists for constipation in pt on opioids
-Mathylnaltrexone
-Naloxegol
GI prep
-hyperosmotics
-saline lax
-clear liquids
IBS-C tx
1.inc fiber + fluid
2. add bulk lax (psyllium) or PEG 17g
3. anti-spas/anticholinergic for pain (hyocyamine, dicyclomine 20mg-40mg QID)
4. consider lubiprostone or linaclotide
5. antidepressants
6. serotonin-4 agonist last line
Agents for IBS-C
- psyllium and PEG lax
- Hyoscyamine and dicylomine anti-spas
- SSRis
- Lubiproston and linaclotide
- 5-HT4 agonist Tegaserod 6mg BID before meals
IBS-D tx
- diet
- add loperamide or dicyloamine
-replace w eluxadoline if still pain
-consider rifaximin - add serotonin-3 ANTAgonist
- antidepressants
Eluxadoline
-100mg BID 75 if no gallbladder
-use in IBS-D if ab pain
5-HT3 ANTAgonist for IBS-D
-Alosetron 0.5mg BID
Additional agents for IBS-D
-rifaximin
-peppermint oil
-probiotics
antidepresants for IBS-D
-nortryptilline
-amitryiptyline 25mg
-trimipramine 25mg
-desipramine 25mg
Tx for NV
-antihistamines/anticholinergics
-phenothiazines
-serotonin antagonists
-NK-1 ANTAgonists
-Butyrophenones
-Metoclopramide
-corticosteroids
-cannabinoids
antihistamines/antic for NV
-meclizine
-dimehydramine
-scopolamine
Phenothiazines
-prochloraperazine
-promethazine
-chlorpromazine
-dopamine inhibitors
serotonin antagonists for NV
-ondansetron
-franisetron
-palonosetron
-dolasetron
NK-1 antagonist drugs for NV
-aprepitant
-fosprepitant
-rolapitant
Butyrophenones for NV
-haloperidol and droperidol
Metoclopramide for NV
-dopamine inhibition
-eps at high dose give w benadryl
corticosteroids for NV
-dexamethasone
Tx of motion sickness
-Scopolamine patch
-Dimenhydrinate 50mg
-Meclizine 25mg
Tx of NV secondary to gasrtro or pain
-ondansetron 4-8mg q8-12h PRN
PONV tx moderate
-only 1 agent if propofol is used
PONV tx highest risk
-2 agents
-5HT3 + metoclopramide + aprepitant
smisulpride
-5-10mg IV over 1-2 minutes
Tx of constipation in infants
- glycerin suppository
-adjust diet
-prune juice
-AVOID mineral oil, lax, enemas, honey
Management of constipation in kids
- educate
- disimpaction
- maintenance therapy
- behavior
Disimpaction options
- PEG 1-1.5g/kg/day 3-6 days
2, enema
Maintenance tx peds
- PEG 1g/kg/day
-Lactulose 1-3mL/kg/day
-Docusate 5mg/kg/day
-stim lax last line
Rescue maintenance peds
-bisacodyl
-senna
-stim lax
add clavulanate to amoxicillin
decrease diarrhea
Fluid requirements
-100 mL/kg for first 10kg
-50mL/kg for next set of 10
-if over 20 kg, 20mL/kg over 20 +1500mL
Drug therapy diarrhea peds
-only for supportive care
-do not use in infectious diarrhea
-Loperamide and cholestyramine
Cholestyramine
-Cl and 4’ ammonium
-will bind other meds