1. lifestyle 2. PRNs (antacids or H2RA) 3. scheduled rx (H2RA or PPI 4. surgery

- antacid + H2RA - PPI + pm H2RA

1. lifestyle 2. antacids w/o aspirin 3. H2RAs 4. PPIs only if severe

1. thicken foods 2. PPIs and H2RAs for 8 weeks for DIAGNOSED GERD

1. PPI BID 2. Bismuth 525mg QID 3. Metro250-500mg QID 4. Tetra 500mgQID -10-14 days -helidac and pylera packs

1. PPI BID 2. Clar 250-500mg BID 3. Amox 1g BID 4. Metro250-500mg BID -10-14 days -PPI and amox whole time or first half

1. PPI BID 2. Levofloxacin 500mg qd 3. Amox 1g -10-14 days

1. Levo 250mg qd 2. high dose PPI qd 3. Nitro 500mg BID 4. Doxycycline 100mg qd -7-10 days

Exam 6 drugs Flashcards by Brooke Thornburg

GERD tx

lifestyle
PRNs (antacids or H2RA)
scheduled rx (H2RA or PPI
surgery

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Antacids

-Tums 2-4 tab
-MoM 5-15mL
-Maalox 10-20mL

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H2RAs

-inhibition off H2 in parietal cells
-AVOID in risk of delirium
-HA, dizzy, fatigue, C orD, confusion, agitation, B12 deficiency
-famotidine
-cimetidine

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Famotidine

-H2RA
-10-20mg BID max 40
-2nd line GERD

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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

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PPI side effects

-HA
-nausea
diarrhea
-abpain
-pneumonia
-hypoMg
-bone probs
-B12
-CKD

-inc effect of methotrexate, phenytoin, warfarin

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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

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Combo GERD tx

antacid + H2RA
PPI + pm H2RA

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GERD tx in preg

lifestyle
antacids w/o aspirin
H2RAs
PPIs only if severe

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Ped tx of GERD

thicken foods
PPIs and H2RAs for 8 weeks for DIAGNOSED GERD

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H. pylori PUD tx (IS THERE AN ORDER)

-Bismuth
-Clarithromycin
-Levofloxacin
-Rifabutin
-Vonoprazan

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Bismuth quad therapy

PPI BID
Bismuth 525mg QID
Metro250-500mg QID
Tetra 500mgQID

-10-14 days

-helidac and pylera packs

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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

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Levofloxacin triple

PPI BID
Levofloxacin 500mg qd
Amox 1g

-10-14 days

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Levofloxacin quad

Levo 250mg qd
high dose PPI qd
Nitro 500mg BID
Doxycycline 100mg qd

-7-10 days

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Rifabutin and vonoprazan

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Prevention of NSAID PUD

-PPI w NSAID (40mg)
-H2RA w NSAID
-Misoprostol w NSAID
-COX-2 inhibitor (celecoxib) nalproxen?

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Misoprostol

-E1 prostaglandin analog
-200mcg wf
-inc secretion
-dec secretion?
-diarrhea, ab pain , NV

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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

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NSAID PUD tx if pt can stop NSAID

-PPI
-H2RA
-sucralfate 1q QID before meals and at bedtime

-8weeks

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Tx of traveller’s diarrhea

mild: NO antibx, loperamide or BSS
-mod: loperamide +/- antibx
-severe: antibiotic

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Antimotility drugs

-tx diarrhea
-opioid mu AGONISTS
-short term use
-diphenoxylate/atropine

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Diphenoxylate/atropine

-antimotility
-opioid agonist
-tx diarrhea
-IBS-D

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Loperamide

-4mg start, 2 after each loose stool max 16mg/day
-diarrhea txx
-high dose death and heart probs

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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

1. psyllium and PEG lax 2. Hyoscyamine and dicylomine anti-spas 3. SSRis 4. Lubiproston and linaclotide 5. 5-HT4 agonist Tegaserod 6mg BID before meals

IBS-D tx

1. diet 2. add loperamide or dicyloamine -replace w eluxadoline if still pain -consider rifaximin 3. add serotonin-3 ANTAgonist 4. 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

1. glycerin suppository -adjust diet -prune juice -AVOID mineral oil, lax, enemas, honey

Management of constipation in kids

1. educate 2. disimpaction 3. maintenance therapy 4. behavior

Disimpaction options

1. PEG 1-1.5g/kg/day 3-6 days 2, enema

Maintenance tx peds

1. 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