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Therapeutics > Exam 6 drugs > Flashcards

Exam 6 drugs Flashcards

1
Q

GERD tx

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

Antacids

A

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

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3
Q

H2RAs

A

-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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4
Q

Famotidine

A

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

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5
Q

PPIs

A

-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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6
Q

PPI side effects

A

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

-inc effect of methotrexate, phenytoin, warfarin

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7
Q

Sucralfate

A

-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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8
Q

Combo GERD tx

A
  • antacid + H2RA
  • PPI + pm H2RA
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9
Q

GERD tx in preg

A
  1. lifestyle
  2. antacids w/o aspirin
  3. H2RAs
  4. PPIs only if severe
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10
Q

Ped tx of GERD

A
  1. thicken foods
  2. PPIs and H2RAs for 8 weeks for DIAGNOSED GERD
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11
Q

H. pylori PUD tx (IS THERE AN ORDER)

A

-Bismuth
-Clarithromycin
-Levofloxacin
-Rifabutin
-Vonoprazan

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12
Q

Bismuth quad therapy

A
  1. PPI BID
  2. Bismuth 525mg QID
  3. Metro250-500mg QID
  4. Tetra 500mgQID

-10-14 days

-helidac and pylera packs

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13
Q

Clarithromycin Quad

A
  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

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14
Q

Levofloxacin triple

A
  1. PPI BID
  2. Levofloxacin 500mg qd
  3. Amox 1g

-10-14 days

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15
Q

Levofloxacin quad

A
  1. Levo 250mg qd
  2. high dose PPI qd
  3. Nitro 500mg BID
  4. Doxycycline 100mg qd

-7-10 days

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16
Q

Rifabutin and vonoprazan

A

??

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17
Q

Prevention of NSAID PUD

A

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

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18
Q

Misoprostol

A

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

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19
Q

Celecoxib

A

-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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20
Q

NSAID PUD tx if pt can stop NSAID

A

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

-8weeks

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21
Q

Tx of traveller’s diarrhea

A

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

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22
Q

Antimotility drugs

A

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

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23
Q

Diphenoxylate/atropine

A

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

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24
Q

Loperamide

A

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

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25
Q

Bulk lax

A

-psyllium (metamucil)
-mix w 8oz water
-not if bedridden

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26
Q

Acute Constipation drugs

A

-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
-

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27
Q

acute constipation relief timeline

A

-1 hr: enema, bisacodyl or glycerin suppository
-3-6hr: Mg citrate, PEG
-24hr: bisacodyl or senna tablets (stimulant)
48hr: MoM, PEG, hyperosmotic

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28
Q

docusate

A

-surfactant for constipation tx

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29
Q

mineral oil

A

-lube for constipation
-only preventss

30
Q

saline lax

A

-MoM
-Mg citrate
-enema

-draws fluid into colon
-AVOID in renal pts

31
Q

Hyperosmotic agents

A

-tx constipation
-sorbitol or lactulose 30-60mL/qd
-PEG 17g in h2o
-glycerin suppositories (quick onset)
-1-3 day onset

32
Q

Bisacodyl suppositories

A

-stimulant lax
-10mg prn
-quick onset

33
Q

Lubiprostone

A

-24mcg w water
-lax

34
Q

Linaclotide

A

-145mcg qd 30 min before first meal

35
Q

Plecanatide

A

-3mg qd
-inc chloride and bicarbonate secretions
-diarrhea
-constipation tx

36
Q

lactitol

A

-20g qg
-do NOT admin w other meds

37
Q

Tx of constipation in spinal injury

A

-routine use of bowel stimulants

38
Q

tx of constipation in preg

A

-diet
-fiber
-docusate

39
Q

Tx of constipation in diabetics

A

-prokinetic agents
-(metoclopromide and prucalopride)

40
Q

Tx of constipation in pts on opioids

A

-stimulants
-then add docusate, lactulose, or PEG prn
-AVOID bulk lax
-opioid antagonists

41
Q

Opioid antagonists for constipation in pt on opioids

A

-Mathylnaltrexone
-Naloxegol

42
Q

GI prep

A

-hyperosmotics
-saline lax
-clear liquids

43
Q

IBS-C tx

A

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

44
Q

Agents for IBS-C

A
  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
45
Q

IBS-D tx

A
  1. diet
  2. add loperamide or dicyloamine
    -replace w eluxadoline if still pain
    -consider rifaximin
  3. add serotonin-3 ANTAgonist
  4. antidepressants
46
Q

Eluxadoline

A

-100mg BID 75 if no gallbladder
-use in IBS-D if ab pain

47
Q

5-HT3 ANTAgonist for IBS-D

A

-Alosetron 0.5mg BID

48
Q

Additional agents for IBS-D

A

-rifaximin
-peppermint oil
-probiotics

49
Q

antidepresants for IBS-D

A

-nortryptilline
-amitryiptyline 25mg
-trimipramine 25mg
-desipramine 25mg

50
Q

Tx for NV

A

-antihistamines/anticholinergics
-phenothiazines
-serotonin antagonists
-NK-1 ANTAgonists
-Butyrophenones
-Metoclopramide
-corticosteroids
-cannabinoids

51
Q

antihistamines/antic for NV

A

-meclizine
-dimehydramine
-scopolamine

52
Q

Phenothiazines

A

-prochloraperazine
-promethazine
-chlorpromazine

-dopamine inhibitors

53
Q

serotonin antagonists for NV

A

-ondansetron
-franisetron
-palonosetron
-dolasetron

54
Q

NK-1 antagonist drugs for NV

A

-aprepitant
-fosprepitant
-rolapitant

55
Q

Butyrophenones for NV

A

-haloperidol and droperidol

56
Q

Metoclopramide for NV

A

-dopamine inhibition
-eps at high dose give w benadryl

57
Q

corticosteroids for NV

A

-dexamethasone

58
Q

Tx of motion sickness

A

-Scopolamine patch
-Dimenhydrinate 50mg
-Meclizine 25mg

59
Q

Tx of NV secondary to gasrtro or pain

A

-ondansetron 4-8mg q8-12h PRN

60
Q

PONV tx moderate

A

-only 1 agent if propofol is used

61
Q

PONV tx highest risk

A

-2 agents
-5HT3 + metoclopramide + aprepitant

62
Q

smisulpride

A

-5-10mg IV over 1-2 minutes

63
Q

Tx of constipation in infants

A
  1. glycerin suppository
    -adjust diet
    -prune juice
    -AVOID mineral oil, lax, enemas, honey
64
Q

Management of constipation in kids

A
  1. educate
  2. disimpaction
  3. maintenance therapy
  4. behavior
65
Q

Disimpaction options

A
  1. PEG 1-1.5g/kg/day 3-6 days
    2, enema
66
Q

Maintenance tx peds

A
  1. PEG 1g/kg/day
    -Lactulose 1-3mL/kg/day
    -Docusate 5mg/kg/day
    -stim lax last line
67
Q

Rescue maintenance peds

A

-bisacodyl
-senna

-stim lax

68
Q

add clavulanate to amoxicillin

A

decrease diarrhea

69
Q

Fluid requirements

A

-100 mL/kg for first 10kg
-50mL/kg for next set of 10
-if over 20 kg, 20mL/kg over 20 +1500mL

70
Q

Drug therapy diarrhea peds

A

-only for supportive care
-do not use in infectious diarrhea
-Loperamide and cholestyramine

71
Q

Cholestyramine

A

-Cl and 4’ ammonium
-will bind other meds

Therapeutics (78 decks)

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