GI

Question 1

drugs for GERD

Answer 1

PPI, H2antags, Antacids (avoid with levo)

Question 2

PPIs: drugs, mechanism, adverse rxns

Answer 2

• 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

Question 3

H2 antags: drugs, adverse rxns

Answer 3

• zantac, pepcid
• avoid caffeine, may need renal adjustment
• cytopenias, gynecomastia, hypersensitivities, LFT abnl
• use prn

Question 4

Aminosalcylates. Which has less side effects? What are the side effects?

Answer 4

for IBD: Sulfasalazine and mesalamine (less side effects, ok for sulfa allergy)…N/V diarrhea

Question 5

Corticosteriods. side effects

Answer 5

for IBD: budesonide (PO)- not long term, hyperglycemia, osteoporosis, HTN

Question 6

Immunosuppressants

Answer 6

azathioprine, mercaptopurie, cyclosporine, methotrexate

Question 7

Azathioprine

Answer 7

-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%

Question 8

Cyclosporine

Answer 8

-immunosuppressant for IBD

short-term, IV infusion, nephrotoxicity and neurotoxicity

Question 9

Methotrexate

Answer 9

-immunosuppressant for IBD

IM or SQ once a week in crohns

Question 10

Biologics

Answer 10

-infliximab, adalimumab, certolizumab, natalizumab

Question 11

Constipation IBS

Answer 11

• fiber, psyllium, tegaserod only for women

Question 12

Diarrhea IBS

Answer 12

-avoid irritants, anti-diarrheal meds,

anticholinergics, tricyclic antidepressants: paroxetine (SSRI) but not for pain and constipation

Question 13

Pancreatitis

Answer 13

• 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)

Question 14

Intestinal motility disorders

Answer 14

• 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.

Question 15

Lubiprostone

Answer 15

Constipation IBS

• Cl channel activator
• nausea, headache—>not for pts with obstruction, severe diarrhea, pregnant women

Question 16

Linaclotide

Answer 16

• Cl channel activator for constipation IBS

- diarrhea, no kids under 6yrs

Question 17

infliximab

Answer 17

• biologic for IBD
• IgG1 that binds TNF and inhibits inflammatory effect in gut (no use if TB) …side effects: rash, nausea, headaches, cough, infections

Question 18

adalimumab

Answer 18

• 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

Question 19

• certolizumab

- Natalizumab

Answer 19

• biologics for IBD
• certolizumab- try to avoid in HF
• Natalizumab- last choice d/t brain inflammation

Question 20

anti-diarrhea meds

Answer 20

for diarrhea IBS

Loperamide OTC and Lomotil controlled

Question 21

anti-cholinergics

Answer 21

for diarrheal IBS

-Bentyl and Levsin reduce peristalsis (don’t use in glaucoma), Alosetron restricted use program, for women

Question 22

tricyclic antidepressants:

Answer 22

for diarrhea IBS

paroxetine (SSRI) but not for pain and constipation