GI

Question 1

Drugs that can worsen GERD symptoms

Answer 1

ASA/NSAIDs
Bisphosphonates
Dabigatran
Estrogen products
Fish oil products
Iron supplements
Nicotine replacement therapy
Steroids
Tetracyclines

Question 2

Initial treatment for GERD

Answer 2

Lifestyle modification
PPI once daily x8 weeks

Question 3

Examples of antacids

Answer 3

Calcium carbonate
Magnesium hydroxide
Bicarb/ASA/citric acid (alka-seltzer)

Question 4

Key points for antacids

Answer 4

Al and Mg can accumulate with renal dysfunction
Ca and Al = constipation
Mg = loose stools
Ca based antacids preferred in pregnancy

Question 5

Examples of histamine-2 receptor antagonists

Answer 5

Famotidine
Ranitidine
Cimetidine

Question 6

Key points for H2RAs

Answer 6

Warnings for confusion (elderly, renal impairment, etc.), B12 deficiency w/ long use
Cimetidine = gynecomastia, impotence, many DDIs
Onset ~60 min
Can be used in pregnancy

Question 7

Examples of proton pump inhibitors

Answer 7

Esomeprazole
Omeprazole
Lansoprazole
Pantoprazole
Dexlansoprazole

Question 8

Key points for PPIs

Answer 8

Take 30-60 min before breakfast
Warnings for C. diff, low Mg, vit B12 def, osteoporosis
Cannot take clopidogrel with (es)omeprazole
Only pantoprazole and esomeprazole available as IV
Should only be used for 8 weeks in elderly pts unless demonstrated need or chronic NSAID use

Question 9

What drug class is metoclopramide?

Answer 9

Dopamine antagonist

Question 10

Key points for metoclopramide

Answer 10

Can cause tardive dyskinesia, EPS, parkinson-like symptoms, drowsiness
Avoid in pts with parkinson’s disease
Decrease dose by 50% if CrCl <60 mL/min

Question 11

Drugs that require an acidic gut (affected by antacids/PPIs/H2RAs

Answer 11

Antiretrovirals (rilpivirine, atazanavir)
Antivirals (ledipasvir, velpatasvir)
Azoles
Cefpodoxime, cefuroxime
Iron products
Mesalamine
Risendronate DR
TKIs (dasatanib, erlotinib, pazopanib)

Question 12

Drugs that antacids bind with (chelate)

Answer 12

Antiretrovirals (bictegravir, dolutegravir, elvitegravir, raltegravir)
Bisphosphonates
Isoniazid
Levothyroxine
Mycophenolate
FQ
Sotalol
Steroids (esp. budesonide)
Tetracyclines

Question 13

Cimetidine inhibits which enzymes?

Answer 13

CYP2C19, CYP3A4, and CYP1A2

Question 14

What enzyme do PPIs inhibit?

Answer 14

CYP2C19

Question 15

3 most common causes of PUD

Answer 15

H. pylori
NSAID use
Stress ulcers

Question 16

Duodenal ulcers are associated with pain when _______

Answer 16

Not eating (2-3 hours after eating)
(Eating lessens the pain)

Question 17

Gastric ulcers are associated with pain when _________

Answer 17

Eating

Question 18

Which drugs must be held for 2 weeks prior to H. pylori testing?

Answer 18

PPIs
Bismuth
Abx

Question 19

1st line H. pylori treatment when >15% resistance rates to macrolides

Answer 19

Bismuth subsalicylate 300 mg QID +
Metronidazole 250-500 mg QID +
Tetracycline 500 mg QID +
PPI BID

Duration 10-14 days

Question 20

1st line H. pylori treatment when <15% resistance rates to macrolides

Answer 20

Amoxicillin 1g BID +
Clarithromycin 500 mg BID +
PPI BID

Duration 14 days

Question 21

Cytoprotective drugs that can be used to help prevent NSAID-related ulcers

Answer 21

Misoprostol
Sucralfate

Question 22

Drugs that can cause constipation

Answer 22

Al and Ca antacids
Antidiarrheals
Clonidine
Colesevelam
Anticholinergics
Iron
Non-DHP CCBs
Opioids
Sucralfate (contains Al)

Question 23

Examples of PAMORAs

Answer 23

Alvimopam (Entereg)
Methylnaltrexone (Relistor)
Naloxegol (Movantik)

Question 24

Key points for PAMORAs

Answer 24

Must be on opioids >7 days to use
Potential risk of MI w/ long term use

Question 25

Drugs that cause diarrhea

Answer 25

Acetylcholinesterase inhibitors (donepezil) Mg antacids Antibiotics Antidiabetics Antineoplastics Colchicine Laxatives Misoprostol Mycophenolate Metoclopramide Protease inhibitors Quinidine Roflumilast

Question 26

OTC, what is the max time loperamide can be used for?

Answer 26

48 hours

Question 27

Max doses for loperamide (OTC and Rx)

Answer 27

OTC = 8 mg/day Rx = 16 mg/day

Question 28

Clinical features of UC vs CD

Answer 28

UC - Bloody diarrhea - Fistulas/strictures uncommon - Located in colon - Superficial - Continuous pattern - Smoking is protective CD - Non-bloody diarrhea - Fistulas/strictures common - Located anywhere in GI tract - Transmural - Non-continuous pattern - Smoking is RF

Question 29

What foods should pts with UC or CD avoid?

Answer 29

Fats and dairy Caffeine Alcohol

Question 30

What drugs are used to treat acute CD/UC flares?

Answer 30

Steroids Tapered off over 8-12 once remission is achieved

Question 31

Treatment options for UC

Answer 31

5-ASA Anti-TNF agents Ustekinumab (Stelara) Tofacitinib (Xeljanz) Vedolizumab (Entyvio) IV cyclosporine

Question 32

Treatment options for CD

Answer 32

Steroids (budesonide for 3 mo) +/- thiopurine/methotrexate Anti-TNF +/- thiopurine Ustekinumab (Stelara)

Question 33

Examples of anti-TNF agents used for UC/CD

Answer 33

Adalimumab (Humira) Infliximab (Remicade) Certolizumab (Cimzia) - CD Golimumab (Simponi) - UC

Question 34

What enzyme is budesonide a substrate of?

Answer 34

CYP3A4

Question 35

What is the primary form of 5-ASA in the US?

Answer 35

Mesalamine

Question 36

Examples of 5-ASAs

Answer 36

Mesalamine Sulfasalazine Balsalazide Olsalazine

Question 37

Key points for 5-ASAs

Answer 37

Mesalamine suppositories (1-3 hrs) and enemas (overnight) must be retained CI w/ allergies to salicylates (+sulfa w/ sulfasalazine) More SE w/ sulfasalazine Balsalazide capsule beads can stain teeth/tongue ER forms can leave ghost tablet

Question 38

Formulations + names of mesalamine

Answer 38

ER capsules = Pentasa ER tablets = Asacol Enema = Rowasa Suppository = Canasa

Question 39

Examples of thiopurines

Answer 39

Azathioprine Mercaptopurine

Question 40

Key points for thiopurines

Answer 40

Causes immunosuppression Should perform TPMT gene testing - deficiency = increased risk of myelosupression Azathioprine is prodrug of mercaptopurine

Question 41

What is the frequency of methotrexate when used for CD?

Answer 41

IM/subq once weekly

Question 42

Examples of integrin receptor antagonists

Answer 42

Natalizumab (Tysabril) Vedolizumab (Entyvio)

Question 43

Key points for integrin receptor antagonists

Answer 43

For induction and remission of IBD Natalizumab: risk of progressive multifocal leukoencephalopathy (PML), REMS program, d/c if no response by 12 weeks, for CD only Vedolizumab: for UC and CD, d/c if no response by 14 weeks

Question 44

DOC for motion sickness

Answer 44

Scopolamine -- Anticholinergic Benadryl, dimenhydrinate (Dramamine), meclizine (Bonine) -- Antihistamines

Question 45

Which antiemetics are not effective for motion sickness

Answer 45

Metoclopramide 5HT-3 antagonists

Question 46

When should a scopolamine patch be applied?

Answer 46

4 hours before needed or night before surgery Lasts for 3 days