GI-Diarrhea, IBS, IBD, Nausea

Question 1

What are dietary treatments for diarrhea?

Answer 1

Stop solids x24h avoid diary. 2. Osmotic diarrhea- FAST 3. Bacterial diarrhea in Kids- FEED them. 4. Replace water and electrolytes

Question 2

When should you avoid diarrheal agents?

Answer 2

Bloody, high fever, systemic toxicity, worsening

Question 3

What antidiarrheal opioid agonists that delay intraluminal transit, INC gut capacity, prolong contact and absorption- more water absorbed,dry?

Answer 3

Diphenoxylate, Difenoxin, Loperamid (Imodium) ADE- FATAL ARRHYTHMIAS OD. DI- CNS depressants

Question 4

What agent bind bile the help form feces?

Answer 4

Cholestyramine, Colestipol-DEC TG DI- Binds other drugs avoid w/in 2hrs

Question 5

What can be taken as antisecretory for Travelers diarrhea (take 2 QID b4 meals?

Answer 5

Bismuth subsalicylate-Pepto- ADE- tinnitus, INC GOUT, DI- anticoagulant, tetracycline

Question 6

How does Octreotide work?

Answer 6

Inhibits more than somatostatin which affects glucagon, GH, insulin 2. Slow GI motility 3. Inhibit gallbladder-dec. bile 4. Inhibits TSH secretin, gastrin,serotonin 5. T/1/2- 1.5 HRS 6. INC TRANSIT time to stay in longer 7. USE GIB

Question 7

What anti- diarrhea is AVOIDed for travelers”?

Answer 7

Octreotide- USE acromegaly, tumors, vasoactive tumors. NON FDA- GIB, GI- fistula, Diarrhea-ca,, AIDs, idiopathic, dumping syndrome

Question 8

Why is Octreotide last resort?

Answer 8

1. CV 2. CNS 3. Derm 4. Endocrine-sugars 5. GI stones

Question 9

What is natural agent is used to replace colonic microflora?

Answer 9

Lactobacillus

Question 10

What is 1st line for IBS?

Answer 10

1. Education 2. AVOID triggers-gum

Question 11

What is 1st RX if diet fails for IBS?

Answer 11

Constipation- psyllium, AVOID stimulants lax Diarrhea- AVOID art. sweeteners, Loperamid, Cholestyramine last resort. Pain- SSRI. NO TCA if constipation

Question 12

What RX affects serotonin antagonist, delaying transit, INC water and electrolyte absorption for IBS diarrhea?

Answer 12

Alestron: ADE- SEVERE ischemic colitis, constipation

Question 13

Which agent for IBS with diarrhea is contraindicated in Alcoholics, Pancreatitis?

Answer 13

Eluxadoline

Question 14

What agents are used for n/v that dec vestibular input?

Answer 14

Scopolamine: ADE dry mouth, avoid ETOH. WASH hands d.t risk of temp blinders. USE- travel on cruise if NEEDED

Question 15

What agents are sedatives, antihistamine, antiemetic by depressing conduction of labyrinth of inner ear via interruption of visceral afferent pathways?

Answer 15

Antihistamine-Diphenhydramine, Anticholinergics- dimenhydrinate, meclizine-less drowsy. AVOID- Narrow angle glaucoma, BPH, Asthma, ETOH

Question 16

What antiemetic is AVOIDed in pt with seizures?

Answer 16

Phenothiazine- prochlorperazine, promethean. ADE- abused via block dopamine thus INC EPS, DDI- SSRI, opioids,

Question 17

What are ADEs and use of steroids in chemo for n/v?

Answer 17

Enhance 5ht3 antagonist for delayed N/preventions- ADE-GAD, euphoria, GI, HA, INC sugars, osteoporosis

Question 18

Which drug is antiemetic 5ht3 antagonist that is safe and used chemo post n/v?

Answer 18

Ondansetron-Zofran- 4hr t/2 life. ADE- reduce dose for liver, QT prolongation, INC HR. Other drugs may reduce

Question 19

What is MOA for neurokinin?

Answer 19

crosses BBB occupies NK1 receptors, NO serotonin,dopamine or steroid receptors- aprepitant. ADE- GI, CYP effects

Question 20

What are benefits of Cannabinoids?

Answer 20

Used with phenothiazine my reduce ADEs. 1. Euphoria 2. Appetite stimulant 3. NO tolerance to antiemetic 4. THC psychoactive substance inhibits vomit via medulla oblongata

Question 21

What do benzo. lorazepam diazepam treat in chemo?

Answer 21

1. N/V after 1st treatment anticipatory 2. Moderate severe N/V 3. <50y 4. Motion sickness 5. warm and hot post chemo 6. weakness

Question 22

WHat are MOA sulfasalazine and ADE?

Answer 22

USE- IBD inhibit macrophages production, anti-inflam ADEs- GI, Heme, infertility, Derm, pulmonary infiltrates, lupus like, reynauld’s. INC METHOTREXATE toxicity- bone marrow suppression

Question 23

What are RX for IBD?

Answer 23

Sulfasalazine, Methotrexate

Question 24

What is the Steroid with least ADEs?

Answer 24

Budesonide

Question 25

What agent is anti tumor necrosis factor TNF that has these ADE for IBD: infusion rxn fever, HA, urticaria, cardiopulmonary, hypotension, PPD test*,heme, liver, CNS, T Cell Lymphoma

Answer 25

Infliximab

Question 26

Many drugs are related to Acute pancreatitis, what can be given for supplementation?

Answer 26

Lipase- use chronic abdominal pain, malabsorption, steatorrhea

Question 27

How do you treat hepatic encephalopathy?

Answer 27

1. Goals- maintain fluid and hemo support 2. Limit protein 3. Lactulose

Question 28

What is MOA of lactulose?

Answer 28

Laxative the bacteria ferment dec coloni ph to approx 5, this effect eliminates ammonia as well as protein subtrastre and inhibits ammonia production

Question 29

What can be used for esophageal varices As a result from ascites and liver cirrhosis?

Answer 29

Propanolol-Unopposed alpha mediated vasoconstriction and decrease in portal pressure