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NAPLEX Study Time > GI > Flashcards

GI Flashcards

1
Q

Drugs that can worsen GERD symptoms

A

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

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2
Q

Initial treatment for GERD

A

Lifestyle modification
PPI once daily x8 weeks

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3
Q

Examples of antacids

A

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

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4
Q

Key points for antacids

A

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

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5
Q

Examples of histamine-2 receptor antagonists

A

Famotidine
Ranitidine
Cimetidine

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6
Q

Key points for H2RAs

A

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

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7
Q

Examples of proton pump inhibitors

A

Esomeprazole
Omeprazole
Lansoprazole
Pantoprazole
Dexlansoprazole

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8
Q

Key points for PPIs

A

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

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9
Q

What drug class is metoclopramide?

A

Dopamine antagonist

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10
Q

Key points for metoclopramide

A

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

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11
Q

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

A

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

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12
Q

Drugs that antacids bind with (chelate)

A

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

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13
Q

Cimetidine inhibits which enzymes?

A

CYP2C19, CYP3A4, and CYP1A2

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14
Q

What enzyme do PPIs inhibit?

A

CYP2C19

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15
Q

3 most common causes of PUD

A

H. pylori
NSAID use
Stress ulcers

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16
Q

Duodenal ulcers are associated with pain when _______

A

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

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17
Q

Gastric ulcers are associated with pain when _________

A

Eating

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18
Q

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

A

PPIs
Bismuth
Abx

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19
Q

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

A

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

Duration 10-14 days

20
Q

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

A

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

Duration 14 days

21
Q

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

A

Misoprostol
Sucralfate

22
Q

Drugs that can cause constipation

A

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

23
Q

Examples of PAMORAs

A

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

24
Q

Key points for PAMORAs

A

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

25
Q

Drugs that cause diarrhea

A

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

26
Q

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

A

48 hours

27
Q

Max doses for loperamide (OTC and Rx)

A

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

28
Q

Clinical features of UC vs CD

A

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

29
Q

What foods should pts with UC or CD avoid?

A

Fats and dairy
Caffeine
Alcohol

30
Q

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

A

Steroids
Tapered off over 8-12 once remission is achieved

31
Q

Treatment options for UC

A

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

32
Q

Treatment options for CD

A

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

33
Q

Examples of anti-TNF agents used for UC/CD

A

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

34
Q

What enzyme is budesonide a substrate of?

A

CYP3A4

35
Q

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

A

Mesalamine

36
Q

Examples of 5-ASAs

A

Mesalamine
Sulfasalazine
Balsalazide
Olsalazine

37
Q

Key points for 5-ASAs

A

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

38
Q

Formulations + names of mesalamine

A

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

39
Q

Examples of thiopurines

A

Azathioprine
Mercaptopurine

40
Q

Key points for thiopurines

A

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

41
Q

What is the frequency of methotrexate when used for CD?

A

IM/subq once weekly

42
Q

Examples of integrin receptor antagonists

A

Natalizumab (Tysabril)
Vedolizumab (Entyvio)

43
Q

Key points for integrin receptor antagonists

A

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

44
Q

DOC for motion sickness

A

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

45
Q

Which antiemetics are not effective for motion sickness

A

Metoclopramide
5HT-3 antagonists

46
Q

When should a scopolamine patch be applied?

A

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

NAPLEX Study Time (8 decks)

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