GI Flashcards
drugs for GERD
PPI, H2antags, Antacids (avoid with levo)
PPIs: drugs, mechanism, adverse rxns
- nexium, prilosec, prevacid
- irreversibly binds to H/K ATPase, take before eating
- headache, diarrhea, abd pain, osteoporosis (chronic)
- take chronically- takes 2-3 days to kick in
H2 antags: drugs, adverse rxns
- zantac, pepcid
- avoid caffeine, may need renal adjustment
- cytopenias, gynecomastia, hypersensitivities, LFT abnl
- use prn
Aminosalcylates. Which has less side effects? What are the side effects?
for IBD: Sulfasalazine and mesalamine (less side effects, ok for sulfa allergy)…N/V diarrhea
Corticosteriods. side effects
for IBD: budesonide (PO)- not long term, hyperglycemia, osteoporosis, HTN
Immunosuppressants
azathioprine, mercaptopurie, cyclosporine, methotrexate
Azathioprine
-immunosuppressant for IBD
severe side effects (same as mercaptopurie)
-toxicity if TMPT deficient so reduce dose
-interacts with allopurinol (gout) so reduce dose to 25%
Cyclosporine
-immunosuppressant for IBD
short-term, IV infusion, nephrotoxicity and neurotoxicity
Methotrexate
-immunosuppressant for IBD
IM or SQ once a week in crohns
Biologics
-infliximab, adalimumab, certolizumab, natalizumab
Constipation IBS
- fiber, psyllium, tegaserod only for women
Diarrhea IBS
-avoid irritants, anti-diarrheal meds,
anticholinergics, tricyclic antidepressants: paroxetine (SSRI) but not for pain and constipation
Pancreatitis
- Fluid and nutritional support—> pain and nausea treat with IV analgesics and anti-emetics
- Octreotide: mimics natural somatostatin (not for acute)…side effects hyperglycemia, nausea, and pain, flatulence
- Enzymes: exogenous enzymes
- Antidepressants: SSRI and tricyclic antidepressants (desipramine)
Intestinal motility disorders
- Cholinergics: decrease parasympathetics, involved in pseudo-obstruction
- Neostigmine: inhibits destruction of Ach
- Bethanecol: synthetic muscarinic stimulant (not IV or IM)
- Prokinetics: reglan- blocks dopamine receptors, side effects extrapyramidal sxs, dose dependent.
- Erythromycin- prokinetic for gastroparesis, diabetics.
Lubiprostone
Constipation IBS
- Cl channel activator
- nausea, headache—>not for pts with obstruction, severe diarrhea, pregnant women
Linaclotide
- Cl channel activator for constipation IBS
- diarrhea, no kids under 6yrs
infliximab
- biologic for IBD
- IgG1 that binds TNF and inhibits inflammatory effect in gut (no use if TB) …side effects: rash, nausea, headaches, cough, infections
adalimumab
- biologic for IBD
- IgG1 ab to TNF same as infliximab but no murine so reduces ab against it, use tylenol for headache and antihistamine for rash
- certolizumab
- Natalizumab
- biologics for IBD
- certolizumab- try to avoid in HF
- Natalizumab- last choice d/t brain inflammation
anti-diarrhea meds
for diarrhea IBS
Loperamide OTC and Lomotil controlled
anti-cholinergics
for diarrheal IBS
-Bentyl and Levsin reduce peristalsis (don’t use in glaucoma), Alosetron restricted use program, for women
tricyclic antidepressants:
for diarrhea IBS
paroxetine (SSRI) but not for pain and constipation
