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Pharm III Final > GI > Flashcards

GI Flashcards

1
Q

GI drug selection therapy is based on…

A

Identifying disease treatment in context of the patient’s medical history and organ function

Noting drug allergies

Reconciling meds (Rx and OTC)

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2
Q

Name that class:

Bismuth Subsalicylate (Pepto-Bismol)

A

Cytoprotective

Anti-diarrheal

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3
Q

Name that class:

Ondansetron (Zofran)

A

Antiemetic

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4
Q

Name that class:

Ranitidine (Zantac)

A

H2 blocker

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5
Q

Name that class:

Calcium carbonate (Tums)

A

Antacid

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6
Q

Name that class:

Magnesium hydroxide

A

Laxative

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7
Q

Name that class:

Famotidine

A

H2 blocker

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8
Q

Name that class:

Promethazine (Phenergan)

A

Antiemetic

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9
Q

Name that class:

Esomeprazole (Nexium)

A

PPI

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10
Q

Name that class:

Pantoprazole (Protonix)

A

PPI

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11
Q

Name that class:

Lansoprazole (Prevacid)

A

PPI

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12
Q

Name that class:

Prochlorperazine (Compazine)

A

Antiemetic

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13
Q

Name that class:

Diphenoxylate/atropine (Lomotil)

A

Antidiarrheal

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14
Q

Name that class:

Omeprazole (Prilosec)

A

PPI

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15
Q

Name that class:

Magnesium hydroxide/Aluminum hydroxide (Maslow)

A

Antacid

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16
Q

Name that class:

Metoclopramide (Reglan)

A

Prokinetic

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17
Q

Name that class:

Adalimumab (Humira)

A

Anti-inflammatory

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18
Q

Name that class:

Lubiprostone (Amitiza)

A

Anti-constipation

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19
Q

Name that class:

Linaclotide (Linzess)

A

Anti-constipation

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20
Q

Name that class:

Dicyclomine (Bentyl)

A

Antispasmodic

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21
Q

Name that class:

Misoprostol (Cytotec)

A

Cytoprotective

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22
Q

Name that class:

Infliximab (Remicade)

A

Anti-inflammatory

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23
Q

Name that class:

Polyethylene glycol (Miralax)

A

Laxative

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24
Q

Name that class:

Loperamide (Imodium)

A

Anti-diarrheal

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25
Q

Name that class:

Senna (Senokot)

A

Laxative

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26
Q

Name that class:

Lab tulles

A

Laxative

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27
Q

What are the alarm features for GERD?

A 
Dysphagia
Hematemesis
Melena
Anemia
Unintentional weight loss
Personal Hx of cancer
Inadequate response to therapy
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28
Q

What should your plan be for a patient with GERD in the absence of alarm features?

A

Discuss dietary, lifestyle, behavior mods

Consider pharmacological therapy (Antacid vs H2 blocker vs PPI)
• Ranitidine (Zantac) first line

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29
Q

What are the benefits of using H2 blockers for GERD?

A

Quick onset, appropriate for ON-DEMAND RELIEF

Most effective for decreasing NOCTURNAL acid formation

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30
Q

What are some causes of esophagitis other than reflux?

A

Infectious (ie Candida)

Eosinophilic

Pill-induced

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31
Q

What medications can lead to pill-induced esophagitis

A

BISPHOSPHONATES

Iron supplements

NSAIDs/Aspirin

Potassium

Tetracycline

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32
Q

Which medication is most appropriate for the treatment of reflux esophagitis?

A

Omeprazole (Prilosec) or any other PPI

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33
Q

How long do PPIs take to work?

A

Relief of symptoms generally takes 2-5 days

Best given in the morning, 30 min before breakfast

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34
Q

What is the rebound effect with PPIs?

A

Acid hypersecretion with abrupt d/c

Consider taper therapy

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35
Q

What are the possible risks associated with chronic PPI therapy?

A

Nutrient malabsorption (Ca, Mg, B12, Fe)

Osteoporosis related fractures (consider bone density scans)

C. difficile/other enteric infections

Kidney disease

Use lowest effective dose for shortest duration possible

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36
Q

Which antacid:

SE = diarrhea

A

Magnesium

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37
Q

Which antacid:

Hypermagnesemia risk (caution in patients with renal insufficiency)

A

Magnesium

38
Q

Which antacid:

SE = constipation

A

Aluminum hydroxide

39
Q

Which antacid:

Hypercalcemia risk

A

Calcium carbonate (tums)

40
Q

Which antacid:

Risk of sodium/fluid retention (caution in patients with edema, cirrhosis, HF, renal impairment)

A

Sodium Bicarbonate

41
Q

What non-invasive tests can help diagnose H. pylori infection?

A

Urea breath test

Stool antigen

42
Q

What is the first-line therapy for a patient with H. pylori?

A

Quadruple therapy - PPI, Bismuth, Metronidazole, Tetracycline

43
Q

Why is eradication testing necessary for patients treated for H. pylori?

A

Risk of PUD, Fe deficiency anemia, and gastric malignancy

44
Q

Which meds should be d/c prior to H. pylori testing and in what timeframe?

A

PPI 1-2 weeks prior to testing

Bismuth/antibiotics 4 weeks prior to testing

45
Q

“Burning, gnawing” epigastric pain aggravated by meals (sx 30 min after meal)

Partial relief with Zantac

No vomiting, hematemesis, melena, weight loss

Takes ibuprofen 600 mg TID for past year

A

Probable PUD secondary to chronic NSAID use

46
Q

What are some common causes of PUD?

A

H. pylori
ZES
Physiologic stress
NSAID use

47
Q

What is the most appropriate diagnostic test for PUD?

A

EGD

48
Q

What complications do you worry about with PUD and how would you recognize them?

A

Hemorrhage (hematemesis, melena, heme (+) stool)

Penetration/perforation (peritoneal signs, free air under diaphragm)

Obstruction (succussion splash)

49
Q

In addition to NSAIDs, concomitant use of what meds can complicate PUD?

A

Anticoagulants
Aspirin
Steroids

50
Q

As a general rule, active duodenal ulcers should be treated for ______ and gastric ulcers for _______

A

Duodenal - 4 weeks

Gastric - 8 weeks

51
Q

In the setting of NSAID induced PUD we would advise the patient to d/c NSAID. If patient needs to keep using them, what would you recommend?

A

Maintenance PPI therapy

52
Q

What cytoprotective medication can be used to prevent NSAID-induced ulcers in non-pregnant patients?

A

Misoprostol (Cytotec)

We don’t use in pregnancy b/c it’s an abortifacient

53
Q

If a patient has T2DM and complains of early satiety, post-prandial nausea, and intermittent vomiting, especially after large fatty meals, what should you suspect?

A

Diabetic Gastroparesis

Be sure to r/o PUD or gastric cancer too though

54
Q

What dietary recommendations should you make to a patient with diabetic gastroparesis?

A

Reinforce small frequent low fat, low residue meals

55
Q

What is the best long-term treatment option for gastroparesis?

A

Improved glucose control

But if you want to give them a med, you can give them Metoclopramide (Reglan)

56
Q

How should Metoclopramide (Reglan) be used for patients with gastroparesis?

A

Advise lowest effective dose for shortest duration possible due to risk of extrapyramidcal symptoms and tardive dyskinesia

Contraindications: obstruction, perforation, GI hemorrhage

Educate pt about possible abdominal cramping and diarrhea

57
Q

What are the cautions for Ondansetron (Zofran)

A

Caution with cardiac arrhythmias and QT interval prolongation

Risk of serotonin syndrome (caution in combo with other serotonergic drugs)

58
Q

What are the precautions for Promethazine (Phenergan) and Prochlorperazine (Compazine)

A

Sedating

Drug-induced parkinsonism

59
Q

Generalized abdominal pain, alternating diarrhea/constipation

Sx worse with food and stress

What you think?

A

Irritable Bowel Syndrome

60
Q

What is a good initial medication to suggest to a patient with IBS?

A

Antispasmodic meds (ie Dicyclomine - Bentyl)

Has anticholinergic properties, use with caution in elderly patients

61
Q

When would you consider Amitriptyline for a patient with IBS?

A

Psychosocial component and relief of abdominal pain

62
Q

When would you consider Eluxadoline (Viberzi) for patients with IBS?

A

If they have IBS-D

63
Q

What recommendations should be made for patients with chronic constipation?

A

Reconcile meds, identify hypomotility agents
Ensure adequate fiber and fluid intake
Encourage exercise
Consider pharmacological therapy

64
Q

What medications can exacerbate constipation?

A 
Anti-psychotics
Aluminum hydroxide
Dicyclomine (Bentyl)
Antidepressants
Opioids
65
Q

Which meds are bulk-forming laxatives?

A

Psyllium (Metamucil)
Methylcellulose (citrucel)
Polycarbophil (FiberCon)
Benefited

66
Q

SE for bulk-forming laxatives

A

Flatulence, bloating

Need to take with FLUID

67
Q

SE of stool softeners (ie Docusate)

A

GI cramping

68
Q

Which meds are osmotic laxatives?

A

Polyethylene glycol (Miralax)
Milk of magnesia
Mag citrate
Lactulose

69
Q

SE of osmotic laxatives

A

GI discomfort
Bloating
Caution with Mg-containing laxatives and hypermagnesemia in patients with renal insufficiency

70
Q

Which meds are stimulant laxatives

A

Bisacodyl (Dulcolax)

Senna (Senokot)

71
Q

SE of stimulant laxatives

A

GI cramping

Rare electrolyte disturbances

Melanosis coli

72
Q

Which laxatives are available by Rx only

A

Lubiprostone (Amitiza)
Linaclotide (Linzess)
Plecanatide (Trulance)

73
Q

Contraindications for use of laxatives

A 
Acute abdomen
Intestinal obstruction
Perforation
Toxic megacolon
Unexplained abdominal pain
74
Q

Overuse of laxatives can lead to…

A

Laxative dependency

Fluid/electrolyte imbalance

Alterations in bowel function

75
Q

When would you consider the use of Methylnaltrexone (Relistor)?

A

Opioid-induced constipation with advanced illness (palliative care) or in chronic noncancer pain

76
Q

What meds are known to cause/aggravate diarrhea?

A 
Mg
Reglan
Augmentin
Metformin
Colchicine
77
Q

If a patient was recently on Clindamycin for a dental infection and is now presenting with diarrhea, how would you approach care?

A

Consider C. difficile infection

Order C. diff stool test, treat empirically with oral vancomycin or metronidazole

78
Q

What are the precautions/contraindications for anti-diarrheal use?

A 
Bloody or suspected infectious diarrhea
High fever/toxicity
Pseudomembranous colitis
Acute ulcerative colitis
Use caution in patients with hx of drug abuse
79
Q

What are some possible adverse reactions from anti-diarrheal use?

A

Ileus

Toxic megacolon

80
Q

What is the most common adverse effect of pesto-bismol?

A

May cause temporary harmless black tongue, mouth, stool

81
Q

Why should you avoid using pepto-bishop in children?

A

Contains salicylate - risk of Reye Syndrome (like aspirin)

82
Q

CT with contrast shows your patient has diverticulitis. What is the most appropriate treatment?

A

Flatly + Cipro

Follow up with colonoscopy 6-8 weeks after resolution of Sx to exclude concomitant colon cancer or IBD

83
Q

How do you diagnose IBD?

A

Colonoscopy

84
Q

Which med is most appropriate in managing a patient with newly diagnosed IBD-UC?

A

Mesalamine (Lialda)

85
Q

In the event a patient with IBD develops an acute flare, which class of meds may be helpful to reduce remission but are not appropriate for maintenance therapy?

A

Corticosteroids

Reasonable to provide short burst in tapering doses

86
Q

What are the side effects/risks of chronic steroid therapy?

A 
Increased appetite and weight gain
Increased risk of infection
Low bone density/osteoporosis
Worsening diabetes
PUD
Cataracts
Adrenal insufficiency

Always have an exit strategy when prescribing them

87
Q

When are abx appropriate for IBD patients

A

Perinatal Crohn Disease (Cipro and Flagyl)

88
Q

Side effect of Cipro?

A

Tendon rupture

89
Q

Side effect of Flagyl

A

Disulfiram-like reaction with EtOH

90
Q

Immunomodulators and biologists require frequent monitoring of which labs?

A

CBC
LFTs

Be cautious with infections, hepatotoxicity, and malignancies

Pharm III Final (8 decks)

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