GI Flashcards
1
Q
Indications for __________:
dyspepsia (heartburn), mild GERD and PUD
A
Antacids (Aluminum, Calcium, Sodium, and Magnesium- based)
2
Q
MOA of __________:
*neutralize hydrochloric acid in the stomach, thereby increasing gastric pH > 4
*weak bases that react w/ HCl to form water and salt
*lasts 20-40 mins on empty stomach and 2-3 hrs on full stomach
A
Antacids (Aluminum, Calcium, Sodium, and Magnesium- based)
3
Q
Safety Considerations/SE of ____________:
Warfarin (Coumadin)- may reduce absorption
Constipation
A
Aluminum-Based Antacids
4
Q
Contraindications of __________:
Patients w/ renal insufficiency (high aluminum levels deposit in bone → osteomalacia)
A
Aluminum-Based Antacids
5
Q
Special Note about _________:
Be sure to separate from other medications by 2 hours
A
Antacids
6
Q
Example of Aluminum-Based Antacid
A
Aluminum Hydroxide- Amphogel
7
Q
Contraindications of __________:
Patients w/ renal calculi
A
Calcium-Based Antacids
8
Q
SE/Interactions of ________:
Constipation
A
Calcium-Based Antacids
9
Q
Special Note about _________:
Used in calcium deficiency (w/ vit D)
A
Calcium-Based Antacids
10
Q
Examples of Calcium-Based Antacids
A
Calcium Carbonate-Tums®, Rolaids®
11
Q
Contraindications of __________:
Patients with cardiovascular disease (HTN)
Avoid in Pregnancy
A
Sodium-Based Antacids
12
Q
SE/Interactions of ________:
May contribute to hypertension
A
Sodium-Based Antacids
13
Q
Avoid ________ in patients with severe abdominal pain of unknown origin.
A
Antacids
14
Q
SE of ________:
Diarrhea
A
Magnesium-Based Antacids
15
Q
Contraindications of __________:
Patients w/ renal insufficiency (unable to excrete Mg → hypermagnesemia)
A
Magnesium-Based Antacids
16
Q
All ________ increase or decrease absorption/SE of other drugs and increase absorption/SE of enteric coated drugs.
A
Antacids
17
Q
Special Note about _________:
Used in Mg deficiency
A
Magnesium-Based Antacids
18
Q
Example of Sodium-Based Antacids
A
Sodium Bicarbonate(Alka Seltzer®)
19
Q
Example of Magnesium-Based Antacids
A
Magnesium Hydroxide(Milk of Magnesia®)
20
Q
Do not take ______ with Iron or PNV
A
Antacids
21
Q
H2RA (Histamine Receptor Agonists) Examples
A
cimetidine (Tagamet)
ranitidine (Zantac)
famotidine (Pepcid)
22
Q
Indications for __________:
Heartburn
Prevents gastric/duodenal ulcers after one has healed
GERD after PPI therapy
A
H2RA (Histamine Receptor Agonists)
23
Q
MOA of _________:
Inhibit acid secretion by gastric parietal cells by blocking H2 receptors
-Certain drugs in this class may affect gastric emptying and lower esophageal sphincter pressure also
A
H2RA (Histamine Receptor Agonists)
24
Q
Safety Consideration for __________:
metabolized by CYP450 enzyme system in liver → increased concentration of other drugs metabolized by CYP450
Caution in patients w/ renal impairment (CNS adverse reactions)
Caution in older adults
A
H2RA (Histamine Receptor Agonists)
25
Contraindications of __________:
| Patients w/ liver disease (can cause hepatitis)
Ranitidine (Zantac)
26
```
SE of _________:
Drowsiness
Dizziness
GI upset
Hematologic changes
```
H2RA (Histamine Receptor Agonists)
27
SE of _________:
Gynecomastia
Impotence in men
Cimetidine (Tagamet)
28
Of the H2RA (Histamine Receptor Agonists), __________ has most drug interactions and adverse effects and __________ has the fewest.
Cimetidine (Tagamet)- most
| Famotidine (Pepcid)- fewest
29
H2RA (Histamine Receptor Agonists) are Pregnancy Category ___
B
30
H2RA (Histamine Receptor Agonists) that are safe in children
Ranitidine (Zantac)
| Famotidine (Pepcid)
31
Special Note about _______:
| Look out for GI bleeds!
H2RA (Histamine Receptor Agonists)
32
Indications for __________:
gastric conditions characterized by hyperacidity like erosive gastritis, GERD, Zollinger-Ellison syndrome
***part of a multidrug regimen for PUD caused by H. pylori
Proton Pump Inhibitors (PPI)
33
MOA of ________:
| Suppress gastric acid secretion (antisecretory) by inhibiting Hydrogen/Potassium pump
Proton Pump Inhibitors (PPI)
34
```
SE of __________:
Achlorhydria (absence of hydrochloric acid in the stomach)
Dizziness
Drowsiness
GI upset
```
Proton Pump Inhibitors (PPI)
35
Safety Consideration for __________:
Metabolized by CYP450 → interaction w/ other drugs metabolized by CYP450
Decreased absorption of meds that need acidic environment to be absorbed
Caution in patients w/ hepatic dysfunction (metabolized in liver)
Caution in the elderly (excreted by kidneys)
Caution with use of clopidogrel (Plavix)
Long-term use:
Nutritional deficiencies (iron, vit B12, and Ca need acid to be absorbed)
Osteoporosis
Increased risk for infection including C diff and pneumonia (impaired defense against microbes)
Gastric cancer risk (hyperplasia of cells)
Proton Pump Inhibitors (PPI)
36
Contraindications of __________:
| Clopidogrel (Plavix) → decreased effectiveness of clopidogrel → increased clot formation because both drugs use CYP2C19
omeprazole and esomeprazole (PPIs)
37
PPIs except omeprazole are Pregnancy Category ___
B
38
Omeprazole is Pregnancy Category ___
C
39
Special Notes about __________:
No adverse effects in breastfed infants
FDA approved in 1+ yo patients
Increased monitoring of INR for patients on warfarin
Be on the lookout for signs of GI bleed!!
Proton Pump Inhibitors (PPI)
40
Indication for __________:
| prevention of peptic ulcers (chronic NSAID use)
Prostaglandin Analogs
| Misoprostol (Cytotec)
41
MOA of _________:
| inhibits gastric section and encourages mucus production by binding to prostaglandin E receptors
Prostaglandin Analogs
| Misoprostol (Cytotec)
42
Safety Considerations/SE of __________:
Caution in patients w/ renal impairment which doubles the half-life
GI upset
Increased diarrhea risk w/ magnesium based antacids
Prostaglandin Analogs
| Misoprostol (Cytotec)
43
Contraindications of _________:
Pregnancy (uterine contractions)
Pregnancy Category X
Prostaglandin Analogs
| Misoprostol (Cytotec)
44
Examples of Stimulant Laxatives
Senna
Bisacodyl
Castor Oil
Cascara sagrada
45
MOA of ____________:
Stimulates myenteric plexus and acts on intestinal mucosa
Stimulate release of prostaglandins and increase in cAMP → secretion of electrolytes → stimulation of peristalsis
Stimulant Laxatives
46
Contraindications of ___________:
| Castor oil in pregnancy (contractions)
Stimulant Laxatives
47
Safety Considerations of _________:
Caution for patients w/ severe CVD (bisacodyl)
Caution for patients w/ ETOH intolerance (cascara has ETOH in it)
Stimulant Laxatives
48
these drugs are good for constipation caused by reduced mobility, constipating drugs, and IBS because they work quickly and should be used for short-term only
Stimulant Laxatives
49
__________ is a Pregnancy Category C because it can cause diarrhea in infant if breastfeeding
Cascara sagrada
50
Bisacodyl is Pregnancy Category ____
B
51
Examples of Osmotic Laxatives
magnesium hydroxide
magnesium citrate
polyethylene glycol
52
MOA of _________:
| draws water into intestines to increase pressure (hypertonic salt-based solutions)
Osmotic Laxatives
53
Contraindications of ALL ___________:
| Patient w/ nausea/vomiting, undiagnosed abdominal pain, or suspected bowel obstruction
Laxatives
54
Contraindications of ___________:
Patients with:
Renal insufficiency (unable to excrete magnesium)
Hypermagnesemia
Hypercalcemia
Heart block
Children < 4 yo (can cause electrolyte disturbance)
Osmotic Laxatives
55
```
SE of ALL _________:
Cramping
Flatulence
Bloating
Perianal irritation
```
Laxatives
56
Examples of Bulk-Producing Laxatives
psyllium
| methylcellulose
57
MOA of _______:
Similar to increasing fiber in diet because drug is made of polysaccharides and cellulose
**When combined w/ water they expand and increase peristalsis
Bulk-Producing Laxatives
58
Safety Considerations of _________:
| Caution in patients w/ narrow esophageal or intestinal lumen
Bulk-Producing Laxatives
59
Special Notes about _________:
Good for long-term use w/ simple chronic constipation. Work slower but fewer adverse effects
Safe in pregnancy
Bulk-Producing Laxatives
60
Example of Lubricant Laxative
mineral oil
61
MOA of ________:
Prevents colonic absorption of fecal water which softens stool and lubricates the intestine to allow stool to flow more easily
Lubricant Laxatives
62
Safety Considerations of _________:
Decreases absorption of fat soluble vitamins (ADEK)
Potential for aspiration in children <4 yo if given orally
Caution with:
Elderly
Patients w/ dysphagia → lipid pneumonia
Pregnancy (due to decrease in fat soluble vitamins)
Newborns (causes issues)
Lubricant Laxatives
63
Special Notes about _________:
| Good for fecal impactions
Lubricant Laxatives
64
Examples of Surfactants Laxatives
docusate sodium
docusate calcium
docusate potassium
65
MOA of ________:
| facilitate mixture of fat and water in the stool causing an emollient effect
Surfactants Laxatives
66
Type of laxative that can be used in infants through older adults and is safe in pregnancy
Surfactants Laxatives
67
Type of laxative that is good for dry, hard stools, when straining should be avoided, and when passing stool is painful
Surfactants Laxatives
68
Examples of Hyperosmolar Laxatives
glycerin
| lactulose
69
MOA of _________:
| glycerin irritates the intestines and draws water into the intestine bringing more liquid into the stool
Hyperosmolar Laxatives
70
Safety Considerations of _________:
caution in patients with:
Volume depletion
DM (lactulose can cause hyperglycemia)
Hyperosmolar Laxatives
71
Type of laxative that is good for fecal impaction for patients w/ neurogenic bowel and chronic constipation in older adults
Hyperosmolar Laxatives
72
Hyperosmolar Laxatives:
glycerin pregnancy category __
lactulose pregnancy category __
C
| B
73
Example of Absorbent Preparation Antidiarrheal
```
bismuth subsalicylate (Pepto Bismol)
kaolin pectin
```
74
MOA of ___________:
| antisecretory with some antimicrobial effects
Absorbent Preparation Antidiarrheal
75
Contraindications of ____________:
Salicylate in children
Patients w/ aspirin hypersensitivity
```
Absorbent Preparation Antidiarrheal
bismuth subsalicylate (Pepto Bismol)
```
76
Safety Considerations of _________:
| Increased risk for toxicity w/ aspirin use
```
Absorbent Preparation Antidiarrheal
bismuth subsalicylate (Pepto Bismol)
```
77
Absorbent Preparation Antidiarrheals are all Pregnancy Category ___ except kaolin pectin which is a ___.
C...B
78
Example of Opiate Antidiarrheal
loperamide (Imodium)
79
MOA of _________:
| binds to opiate receptors in intestinal wall → decreased motility
Opiate Antidiarrheal
80
SE of all ___________:
| Rebound constipation
Antidiarrheals
81
Safety Considerations of ALL _________:
| Caution in older adults due to risk of impaction
Antidiarrheals
82
Safety Considerations of _________:
Increased transit time can lead to toxic megacolon (discontinue if abdominal distention occurs)
May prolong diarrhea caused by infectious agents
Risk for CNS depression w/ other CNS depression drugs
Opiate Antidiarrheals
83
All Opiate Antidiarrheals are Pregnancy Category ___ except loperamide which is a ___
C...B
84
Anticholinergic Antidiarrheals are indicated for _________ and _________.
diarrhea and IBD
85
MOA of ___________:
| antispasmodic and decrease water content in bowels
Anticholinergic Antidiarrheals
86
Safety Considerations of _________:
| Risk for anticholinergic SEs w/ other anticholinergics
Anticholinergic Antidiarrheals
87
Anticholinergic Antidiarrheals are Pregnancy Category ___
C
88
Examples of Antihistamine Antiemetics
dimenhydrinate (Dramamine)
| hydroxyzine (Vistaril)
89
MOA of _________:
block H1 receptors → decreased salivation
bind to cholinergic receptors → decreased n/v
Antihistamine Antiemetics
90
```
Safety Considerations of _________:
Similar to anticholinergics..Caution in patients with:
Narrow angle glaucoma
Seizure disorders
Hyperthyroidism
CVD
Prostatic hypertrophy
```
Antihistamine Antiemetics
91
```
SE of ___________ and ____________:
drowsiness
dry mouth
blurred vision
urinary retention
constipation
dry eyes
```
Antihistamine Antiemetics
| Phenothiazines Antiemetics
92
Contraindications of ____________:
| Patients w/ severe liver disease (metabolized by liver)
Antihistamine Antiemetics
93
these drugs are helpful in nausea r/t motion sickness d/t their ability to depress vestibulocerebellar pathway
Antihistamine Antiemetics
94
```
Special Notes about _________:
have anticholinergic properties
may need to reduce dose in older adults
paradoxical excitation in kids
better for long-term use d/t less severe adverse effects
```
Antihistamine Antiemetics
95
Example of Phenothiazines Antiemetics
promethazine (Phenergan)
96
Antihistamine Antiemetics are all Pregnancy category ___ except hydroxyzine (Vistaril) which is category __
B...C
97
MOA of _________:
| block dopamine receptors in chemoreceptor trigger zone (CTZ), cholinergic receptors and H1 receptors
Phenothiazines Antiemetics
| promethazine (Phenergan)
98
```
Safety Considerations of _________:
Can cause sedation and extrapyramidal SE
Can cause silent pneumonia due to suppression of cough reflex and vomit aspiration
Caution in patients with:
Acute/ Chronic respiratory disorders
Children <5 yr (extrapyramidal SE/respiratory depression)
Hypotension w/ Antihypertensives
Lithium increases extrapyramidal SE risk
```
Phenothiazines Antiemetics
| promethazine (Phenergan)
99
```
Contraindications of ____________:
Patients with:
Parkinson’s
Narrow-angle glaucoma
Bone marrow depression
Severe cardiovascular disease
Severe hepatic disease
Children <2 yr (respiratory depression)
```
Phenothiazines Antiemetics
| promethazine (Phenergan)
100
Phenothiazines Antiemetics are Pregnancy Category ___
C
101
Pediatric Cautions for ___________:
| children more prone to extrapyramidal symptoms so use lowest effective dose
```
Phenothiazines Antiemetics (promethazine (Phenergan)
Prokinetic (metoclopramide (Reglan)
```
102
__________ can change urine color to pink or reddish brown
Phenothiazines Antiemetics
| promethazine (Phenergan)
103
Special Notes about _________:
| can cause bone marrow depression in long-term use so monitor CBC and consider short-term use only
Phenothiazines Antiemetics
| promethazine (Phenergan)
104
Example of Cannabinoid Antiemetic
cannabinoid dronabinol (Marinol)
105
Indication for __________:
| chemotherapy-induced n/v
```
Cannabinoid Antiemetic
cannabinoid dronabinol (Marinol)
```
106
MOA of _________:
| appetite stimulant
```
Cannabinoid Antiemetic
cannabinoid dronabinol (Marinol)
```
107
Caution for __________:
| may lower seizure threshold in those w/ seizure disorders
```
Cannabinoid Antiemetic
cannabinoid dronabinol (Marinol)
```
108
Safety Considerations of _________:
| Increased CNS depression w/ other meds causing DNS depression
Antihistamine Antiemetics
Phenothiazines Antiemetics
Cannabinoid Antiemetics
109
```
SE of ______:
euphoria
dizziness
depression
paranoid thoughts
tachycardia
hypotension
```
```
Cannabinoid Antiemetic
cannabinoid dronabinol (Marinol)
```
110
Special Notes about __________:
high potential for abuse
Pregnancy category C
```
Cannabinoid Antiemetic
cannabinoid dronabinol (Marinol)
```
111
Example of 5-HT3 receptor antagonists Antiemetic
ondansetron (Zofran)
112
MOA of _________:
| blocks serotonin peripherally and centrally
5-HT3 receptor antagonists Antiemetic
| ondansetron (Zofran)
113
Caution for __________:
May mask progressive ileus
Caution in patients with PKU (contains aspartame)
5-HT3 receptor antagonists Antiemetic
| ondansetron (Zofran)
114
```
SE of ______:
headache
constipation
fatigue
dizziness
***QT PROLONGATION
```
5-HT3 receptor antagonists Antiemetic
| ondansetron (Zofran)
115
5-HT3 receptor antagonists Antiemetic
| ondansetron (Zofran) is Pregnancy Category ___
B
116
Example of Anticholinergics Antiemetic
scopolamine (Transderm Scop)
117
inhibits muscarinic receptors in parasympathetic nervous system
blocks cholinergic transmission from reticular center to vomiting center
decrease saliva and GI motility
Anticholinergics Antiemetic
| scopolamine (Transderm Scop)
118
```
Cautions for _________:
Elderly due to CNS effects
Patients with:
Open-angle glaucoma
GI or bladder neck obstruction
```
Anticholinergics Antiemetic
| scopolamine (Transderm Scop)
119
Contraindications of ____________:
| Patients with narrow-angle glaucoma
Anticholinergics Antiemetic
| scopolamine (Transderm Scop)
120
SE of ______:
dry mouth
drowsiness
blurred vision
Anticholinergics Antiemetic
| scopolamine (Transderm Scop)
121
Special Notes about ________ and __________:
Pregnancy category C
Not approved in Peds
```
Anticholinergics Antiemetic (scopolamine (Transderm Scop)
NK1 receptor antagonists Antiemetic (aprepitant (Emend)
```
122
Example of NK1 receptor antagonists Antiemetic
aprepitant (Emend)
123
Indications for ___________:
| chemotherapy-induced n/v and post-op
NK1 receptor antagonists Antiemetic
| aprepitant (Emend)
124
MOA of _________:
crosses blood brain barrier and binds to NK1 receptors which increases the antiemetic activity of 5-HT3 receptor antagonists
NK1 receptor antagonists Antiemetic
| aprepitant (Emend)
125
Caution for __________:
Increases concentrations of birth control and other chemotherapy meds because...
it inhibits CYP3A4 → elevated concentrations of meds that are metabolized by CYP3A4
NK1 receptor antagonists Antiemetic
| aprepitant (Emend)
126
SE of ______:
fatigue
dizziness
elevated AST/ALT and BUN
NK1 receptor antagonists Antiemetic
| aprepitant (Emend)
127
Example of Prokinetic
metoclopramide (Reglan)
128
Indication for ________:
| when GI motility is a problem: gastroparesis, GERD, n/v associated w/ chemotherapy
Prokinetic (metoclopramide (Reglan)
129
MOA of _________:
stimulate upper GI motility by sensitizing tissues to ACh which causes increased gastric contractions and relaxed pyloric sphincter
dopamine receptor antagonist in CNS which produces antiemetic effects (similar to phenothiazines)
Prokinetic (metoclopramide (Reglan)
130
Safety Considerations for __________:
Can cause EPS and sedation
Decrease dose in those w/ decreased renal function
Anticholinergics reverse the effects of metoclopramide and vice versa
Risk for tardive dyskinesia w/ long-term use- don’t use > 12 wks if possible
Caution in patients with:
Hx of depression (dopamine activity)
Renal impairment
Prokinetic (metoclopramide (Reglan)
131
```
Contraindications for ___________:
MAOIs- hypertensive crisis
Disorders where GI stimulation would be dangerous:
GI hemorrhage
Obstruction
Perforation
```
Prokinetic (metoclopramide (Reglan)
132
SE of ______:
dizziness
diarrhea
hypoglycemia in diabetics
Prokinetic (metoclopramide (Reglan)
133
_________ is helpful in n/v due to delayed gastric emptying (gastroparesis)
Prokinetic (metoclopramide (Reglan)
134
Prokinetic (metoclopramide (Reglan) is Pregnancy Category ___
B
135
__________ is excreted in breast milk but present in lower doses than an infant would be prescribed
Prokinetic (metoclopramide (Reglan)
136
__________ improve abdominal pain, global assessment scores, and overall symptom scores. (Statistically Significant Benefit)
Antidepressants (SSRIs TCAs "Tricyclic Antidepressants)
137
_______ may be beneficial in determining an association between certain foods and IBS symptoms in individual
food diary
138
________ reduce IBS symptoms and decrease pain and flatulence
Probiotics
139
__________ treatments effectively improve IBS symptoms and include cognitive behavior therapy, psychotherapy, and relaxation with stress management strategies
Psychological
140
_________ decrease stool frequency and increase stool consistency. (For IBS)
Antidiarrheals
141
_________ improve stool frequency but do not lessen abdominal pain. (for IBS constipation)
Laxatives
142
Gram negative bacteria that causes chronic inflammation that weakens and damages the stomach lining and can lead to ulcers and increased risk of gastric cancer...major cause of PUD
H.Pylori
143
Treatment often takes 3-4 drugs due to resistance. Multi-med regimen can lead to decreased compliance increasing resistance even more. QUADRUPLE therapy is now required unless the practicitioner is aware of clarithromycin resistance rates <15%.
H.Pylori
144
Duration of therapy for all regimens is PO medications for 14 days
There are 2 first line therapy options listed, both using a 4 drug or quadruple regimen
***Know resistance patterns in your area to determine treatment.
H.Pylori Treatment
145
Some H. Pylori regimens include __________ which is contraindicated in pregnancy.
tetracycline
146
type of diarrhea most frequently caused by a viral infection and most episodes are self-limiting
Acute Diarrhea
147
Stool Thickeners include:
Loperamide (imodium)
Kaopectate
Bulk-forming laxatives
148
_______ is protective to the bowel for mild diarrhea but doesn't slow peristalsis
Bismuth subsalicylate (pepto bismol)
149
__________ is a “salicylate” (as is aspirin) and may lead to gastric irritation...contraindicated under same conditions as aspirin
Bismuth subsalicylate (pepto bismol)
150
occurs from exposure to non-familiar enteric bacterial (usually e.coli). Self-limiting condition usually lasting 2-3 days
Travelers’ diarrhea
151
_______ diarrhea lasts longer than 7 days
Parasitic
152
Treatment for _________:
Usually 1-5 days of :
Nonpregnant:
Azithromycin+quinolone abx (Cipro)+Rifaximin
Pregnant: Azithromycin only
Faster relief is obtained when both an antibiotic and a medication that slows intestinal transit time (imodium) are given together
Travelers’ diarrhea
153
Treatment for __________:
Tetracycline or Sulfamethoxazole 800+
Trimethoprim 160 (Septra or Bactrim)+
Fluoroquinolone (Ciprofloxacin, Cipro)
Dysenteric disease and Cholera
154
diarrhea secondary to exposure to salmonella, shigella, campylobacter or giardia
Dysenteric disease and Cholera
155
Causesof _________:
Giardia
e. Histolytic
Salmonella
156
Treatment of _________:
| Metronidazole (flagyl)
Salmonella
157
Treatment of _______ in _________:
First line: Loperamide (imodium) (category B): likely safe in breastfeeding due to minimal oral absorption and very small amounts in breast milk.
Diphenoxylate (lomotil) (category C): caution is advised during breastfeeding due to limited studies.
Diarrhea in Pregnancy
158
Avoid ___________ in pregnancy because it's effect is uncertain and due to the salicylate component, it should be avoided in pregnancy and lactation.
Bismuth subsalicylate (pepto bismol, kaopectate)
159
_______ diagnosis is based on clinical history, physical examination, and absence of alarm symptoms suggesting other pathology
IBS
160
alarm symptoms of IBS
weight loss
rectal bleeding
anemia
mass
family history of colon or ovarian cancer
age > 60 years old with change in bowel habits
161
```
These ppear to improve symptoms of ______:
Exercise
Antibiotics
Antispasmodics
***Peppermint oil
***Probiotics
```
IBS
162
Due to chelation, conditions such as osteoporosis may be increased when a patient takes ________ long term
antacids
163
__________ is effective in reducing abdominal pain, distention, flatulence and bowel movements in patients with IBS
Peppermint oil
164
Adverse effect of peppermint oil
Heartburn
165
Peppermint oil is safe to take up to ____ weeks
8
166
MOA of ___________:
Antispasmodic effect on intestinal smooth muscles, reduction of gastric motility, and an anti-inflammatory and antimicrobial effect in the small intestine
Peppermint oil
167
form of probiotic likely effective in treating IBS
Bifidobacteria
168
typically colonize in the colon and disappears from the feces within 2 weeks of stopping it - so continued use is necessary
Products stored for long periods of time or stored improperly (stored in refrigerator) may contain few life and active organisms and can lessen effectiveness
Bifidobacteria
169
Taking this for 4-8 weeks (improvement usually seen in 1 week) reduces abdominal pain, bloating, and bowel movement difficulty and relieves constipation
Bifidobacteria
170
when used in a probiotic combinations: supplements containing ________ and _________ along with helicobacter therapy increases the rate of eradication of H. pylori and reduces the incidence of side effects of helicobacter therapy alone
lactobacillus and bifidobacteria
171
_____________ can also help with rotaviral diarrhea and traveler’s diarrhea, and can lead to increase remission of ulcerative colitis
Combination probiotics
172
Adverse Effects of ________:
Bloating
Flatulence
Bifidobacteria
173
Cautions for __________:
| severely immunosuppressed patient
Bifidobacteria
174
used to treat and prevent all sorts of GI distress
Can prevent infectious types of diarrhea such as rotaviral diarrhea in children and traveler’s diarrhea, can prevent antibiotic associated diarrhea.
Can be added to triple therapy for improving H. Pylori eradication rates
Lactobacillus
175
_______ is safe for children, during pregnancy and lactation.
Lactobacillus
176
Separate _______ by at least 2 hours with other medications
Lactobacillus
177
FODMAPS
Fermentable Oligo-, Di-, Mono-saccharides And Polyols
178
Foods high in ________ can lead to bloating, abdominal pain, and gas
FODMAPs (Fermentable Oligo-, Di-, Mono-saccharides And Polyols)
179
Foods low in __________ have shown to be very effective in treating patients with IBS
FODMAPs (Fermentable Oligo-, Di-, Mono-saccharides And Polyols)
180
To follow this diet, patients eliminate all _________ food for about 3-8 weeks. Some patients notice relief in 1 week, others it can take 8 weeks. It should not last forever. Slowly, these food can be reintroduced to determine threshold.
high FODMAP
181
wheat, rye, legumes, and various fruits and vegetables, such as garlic and onions
Oligosaccharides
182
milk, yogurt and soft cheese. Lactose is the main carb
Disaccharides
183
varius fruit including figs, mangos, and sweeteners such as honey and agave nectar. Fructose is the main carb
Monosaccharides
184
certain fruits and vegetables including blackberries and lychee, as well as some low-calorie sweeteners like those in sugar free gum
Polyols
185
Use: treating constipation
Adverse effects: transient flatulence, abdominal distention
Consume with enough water or it can cause esophageal and bowel obstruction
Black psyllium
186
Uses: soften stools for constipation (can be as effective as senna and colace, but not as effective as prunes)
Functional constipation: great option for kids.
Taking a combination product containing this, acacia fiber, and fructose for 8 weeks can improve symptoms of constipation by 78%
Blonde psyllium
187
Reduce nausea, vomiting, and the use of rescue antiemetic in adults and children postoperatively.
Pregnancy: sea bands
Acupressure
188
Step 1: lifestyle and diet changes
Step 2: treatments that do not use medications
Ginger: 1g per day (1 day =24 hours)
Helps reduce the nausea (not necessarily the vomiting)
Acupressure
Step 3: medications (OTC and prescription)
Steps in N/V Treatment in Pregnancy
189
First line drug for pregnancy N/V that help the body through metabolization of fat and protein
B6 (pyridoxine)
190
Needed for healthy skin, hair, eyes, and liver
Help body make neurotransmitters (this may be part of the reason they work in n/v because of the transmitters)
Help nervous system function properly
Involved in brain development in pregnancy and infancy and immune function
Can be used as a single agent alone, or in combination with doxylamine (antihistamine) - some providers will tell them how to make their own or they prescribe diclectin
B6 (pyridoxine)
191
first line drug for pregnancy N/V that is higher cost than making your own with B6 and doxylamine, but nice delayed release
Delayed release tablet of B6 (pyridoxine) and doxylamine
Diclectin
192
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Other drugs for ________:
Dimenhydrinate
Prochlorperazine (antipsychotic)
Promethazine
Metoclopramide
Ondansetron
Last resort treatment: Methylprednisolone
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Pregnancy N/V
193
BBW:
MANY drug to drug interactions including Warfarin, calcium channel blocker, and metronidazale
CP450 inhibitor—this should not be a first line med for anyone taking other medications
cimetidine (Tagemet)
194
BBW:
| Pregnancy--Teratogenic
omeprazole (Prilosec)
195
BBW:
crosses the placental barrier and may cause extrapyramidal signs and methemoglobinemia in neonates with maternal administration during delivery
In patients with a history of tardive dyskinesia (TD) or a dystonic reaction to metoclopramide
• When stimulation of gastrointestinal motility might be dangerous (e.g., in the presence of gastrointestinal hemorrhage, mechanical obstruction, or perforation).
• In patients with pheochromocytoma or other catecholamine-releasing paragangliomas- may cause a hypertensive/pheochromocytoma crisis, probably due to release of catecholamines from the tumor
• In patients with epilepsy, may increase the frequency and severity of seizures
• In patients with hypersensitivity- Reactions have included laryngeal and glossal angioedema and bronchospasm
***chronic use may cause tardive dyskonesia; avoid treatment for over 12 weeks
metoclopramide (Reglan)
196
BBW:
May cause tardive dyskinesia
No use in children under 2 or people with Parkinson’s disease
May cause severe respiratory depression, especially in children
promethazine (Phenergan)
197
Tagamet ________ the effect of __________ because it inhibits the enzyme that breaks it down, causing it to stay in the system longer. This leads to ________.
increases
Warfarin
Bleeding
198
If a drug is a CYP450 inhibitor, it will ___________ the Area Under the Curve because it will stop the other drug(s) from being metabolized and being excreted.
increases
