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NAPLEX Review UWorld > GI Disease > Flashcards

GI Disease Flashcards

1
Q

Which of the following describes the mechanism of action of infliximab?

A. Monoclonal antibody that binds to integrin

B. Monoclonal antibody against interleukin-1

C. Monoclonal antibodythat binds to TNF

D. Monoclonal antibody that depletes CD20 B cells

E. Monoclonal antibody that inhibits T cell activation

A

Monoclonal antibodythat binds to TNF

Remicade

Infliximab is an anti-TNF monoclonal antibody approved for several autoimmune conditions, including inflammatory bowel disease.

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2
Q

Crohn’s Disease Tx

Options

A

Steroids (± thiopurine or MTX)

Anti-TNF ± thiopurine

Ustekinumab (Stelara)

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3
Q

Crohn’s Disease Tx

Mild disease of the ileum and/or right colon

A

Oral budesonide (Entocort EC, Uceris) for ≤ 3 months; after this course, discontinue treatment or change to thiopurine or methotrexate

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4
Q

Crohn’s Disease Tx

Moderate-severe disease

A

Anti-TNF agents
* Adalimumab (Humira)
* Infliximab (Remicade)
* Certolizumab (Cimzia)

Thiopurine (azathioprine, mercaptopurine)

Methotrexate

IL receptor antagonist
* Ustekinumab (Stelara)

Agents can be used as monotherapy or in combination

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5
Q

Crohn’s Disease Tx

Refractory to mod-severe treatments and/or steroid dependent

A

Integrin receptor antagonists:

Vedolizumab (Entyvio)

Natalizumab (Tysabri)

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6
Q

Integrin Receptor Antagonist

Risk, Form, & SE

A

Risk of Progressive Multifocal Encephalopathy (PML)

IV only

Don’t give w/ live vaccines

Hypersensitivity rxn can occur

Stop Tx after 12 + weeks of not working

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7
Q

Ulcerative Colitis Tx

Options

A

5-ASA (oral and/or rectal) ± steroids (oral or rectal)

Anti-TNF agents

Ustekinumab (Stelara)

Tofacitinib (Xeljanz)

Vedolizumab (Entyvio)

IV cyclosporine

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8
Q

Ulcerative Colitis Tx

Mild disease

A

Mesalamine (5-ASA) rectal and/or oral preferred

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9
Q

Ulcerative Colitis Tx

Moderate-severe disease

A

Anti-TNF agents
* Adalimumab (Humira)
* Infliximab (Remicade)
* Golimumab (Simponi)

Thiopurine (azathioprine, mercaptopurine)

Cyclosporine

IL receptor antagonist
* Ustekinumab (Stelara)

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10
Q

Ulcerative Colitis Tx

Refractory to mod-severe treatments and/or steroid dependent

A

Integrin receptor antagonists
* Vedolizumab (Entyvio)

Janus kinase inhibitor
* Tofacitinib (Xeljanz)

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11
Q

A pharmacist will counsel a patient on the correct use of Transderm Scop. Which of the following are correct counseling statements? (Select ALL that apply.)

A. Peel off the clear backing from the patch and apply it to a clean, dry, hairless area of the skin behind the ear.

B. Press firmly for at least 30 seconds to make sure the patch sticks well, especially around the edges.

C. Apply the patch 1 hour before the activity expected to cause motion sickness.

D. If motion sickness continues after 3 hours, apply a second patch behind the other ear.

E. Carefully wash hands after application and do not touch eyes if there is any medication on fingers.

A

Peel off the clear backing from the patch and apply it to a clean, dry, hairless area of the skin behind the ear.

Press firmly for at least 30 seconds to make sure the patch sticks well, especially around the edges.

Carefully wash hands after application and do not touch eyes if there is any medication on fingers.

An important counseling point for Transderm Scop is that it should be applied at least 4 hours before the activity expected to cause motion sickness.

As with most patches, it should not be cut.

Remove the old patch when it is time to place the next patch.

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12
Q

Scopolamine (Transderm Scop)

Things to remember

A

Alternate Ears

Can cause painful/mydriasis (dialation of pupils) if it gets in eyes

Last 3 days

Remove prior to MRI

Apply at least 4 hours before needed or the night before surgery

Press firmly for 30 secs

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13
Q

Proctitis refers to inflammation of the following:

A. Small intestine

B. Gall bladder

C. Liver

D. Rectum

E. Esophagus

A

Rectum

Proctitis is inflammation of the rectum.

It can be caused by IBD, sexually transmitted diseases or radiation of certain cancers.

Patients often complain of feeling like they need to have a bowel movement constantly.

Treatment is directed at the underlying cause.

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14
Q

Ulcerative Colitis

A

Mucosal inflammation confined to rectum & colon

Superficial Ulcerations

Continuous pattern

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15
Q

Crohn’s Disease

A

Transmural inflammation in any part of the GI tract

Thickened & edematous bowel wall → narrowed, ulcerated & fibrotic w/ fistulas

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16
Q

UC & Crohn’s

Diagnosis

A

Rule out other conditions

Laboratory blood tests for inflammation

Stool testing

Imaging tests: CT or MRI

Visualization with tissue biopsy
* Colonoscopy: entire colon
* Sigmoidoscopy: end part of the intestine, closest to the rectum (only for U.C.)
* Endoscopy: upper Gl, through mouth (only for upper Gl symptoms, Crohn’s Disease)

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17
Q

UC & Crohn’s: Lifestyle Measures And Supportive Care

Diet

A

Small frequent meals

Avoid trigger foods and substances

Prevent nutritional deficiencies

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18
Q

UC & Crohn’s: Lifestyle Measures And Supportive Care

Symptom Control

A

Antidiarrheals (loperimide [Imodium])

Antispasmodics (dicyclomine [Bentyl])

Nicotine - for UC

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19
Q

UC & Crohn’s: Lifestyle Measures And Supportive Care

Natural Products

A

Probiotics

Fish oils

Peppermint, herbal teas

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20
Q

Aminosalicylates is mainly used for?

A

UC

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21
Q

Sulfasalazine breaks down into?

A

Sulfapyridine - Toxcicity

5-ASA (mesalamine) - Efficacy

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22
Q

Mesalamine Brands

A

Pentasa (ER cap)

Asacol (ER tab)

Rowasa (Enema)

Canasa (Supp)

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23
Q

What med for UC leaves a ghost tablet?

A

mesalamine (Asacol)

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24
Q

Rectal Meds are usually given when?

A

QD HS

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25
Q

What is the physical (mechanical) cause of gastroesophageal reflux disease?

A. The histamine receptors over-secreteacid.

B. The parietal cells over-secrete acid.

C. Food gets stuck in the esophagus.

D. Lower esophageal sphincter tone is reduced.

E. The gastric muscle contracts suddenly.

A

Lower esophageal sphincter tone is reduced.

Gastroesophageal reflux disease (GERD) occurs when the stomach contents leak backward, through the lower esophageal sphincter (LES), into the esophagus.

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26
Q

Key drugs that can worsen GERD

A

ASA/NSAIDs

Bisphosphonates

Dabigatran

Estrogen products

Fish oil products

Iron supplements

Nicotine replacement therapy

Steroids

Tetracyclines

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27
Q

A pregnant female is asking the pharmacist for a recommendation for heartburn symptoms. The symptoms began during the third month of the pregnancy (she is currently 14 weeks pregnant). She states that whenever she eats anything, she has heartburn. She takes a daily prenatal vitamin. She gets adequate calcium from the vitamin and a cheese stick she eats with lunch. Choose the most appropriate recommendation.

A. Tagamet

B. Protonix

C. Tums

D. Misoprostol

E. Metoclopramide

A

Tums

Calcium antacids are considered first-line in pregnancy.

Cimetidine (Tagamet)

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28
Q

Antacids are ___ & ___ acting

A

Fast & shorting acting

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29
Q

Antacids Concerns

Al & Mg

A

Accumulation w/ severe renal dysfunction

Not Rec CrCl < 30

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30
Q

Antacids Concerns

Alka Seltzer Original

A

Contains Na & ASA

> 500 mg Na per tab → edema in pts w/ HF or cirrhosis

Risk of bleeding w/ ASA

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31
Q

Antacids

Tums

A

Calcium carbonate

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32
Q

Antacids

Mylanta Supreme

A

Calcium carbonate + Mg

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33
Q

Antacids

Maalox Advanced Maximum Strength

A

Calcium carbonate + simethicone (anti-gas)

34
Q

Antacids

Milk of Magnesia (MOM)

A

Magnesium hydroxide

35
Q

Antacids

Maalox, Mylanta Max

A

Magnesium hydroxide + Aluminum

Maalox & Mylanta Classic: + simethicone

36
Q

Antacids

Alka-Seltzer

A

Sodium bicarbonate + ASA + citric acid

37
Q

Antacids

SE

A

Unpleasant taste

38
Q

Antacids SE

Calcium

A

Constipation

Bloating

Belching

39
Q

Antacids SE

Aluminum

A

Constipation

Hypophosphatemia

40
Q

Antacids SE

Magnesium

A

Loose stools

Use w/ Al may counter-balance

41
Q

A patient asks the pharmacist if there is anything over-the-counter that she could take for car sickness. Which of the following would be appropriate? (Select ALL that apply.)

A. Diphenhydramine

B. Meclizine

C. Promethazine

D. Dimenhydrinate

E. Loratadine

A

Diphenhydramine

Meclizine

Dimenhydrinate

Diphenhydramine (Benadryl), dimenhydrinate (Dramamine) and meclizine (Bonine) are antihistamines with anticholinergic side effects, making them useful for preventing motion sickness.

Non-sedating, second-generation antihistamines (e.g., loratadine) are not helpful for motion sickness.

Promethazine (Phenergan) is available by prescription only.

42
Q

How long before the activity expected to cause motion sickness should OTC motion sickness meds be taken?

A

30-60 mins

43
Q

Transderm Scop vs OTC motion sickness

A

Does not work better but Transderm Scop last longer

44
Q

Thiopurines

Drugs

A

Azathioprine (Azasan, Imuran)

Mercaptopurine (Purixan)

45
Q

Thiopurines Effects

A

Not safe in pregnancy

Myelosuppression

Steroid Sparing (helps w/ excessive need for steroids)

46
Q

Which of the following are short-term adverse effects of prednisone?

A. Cataracts and poor wound healing

B. Osteoporosis and immunosuppression

C. Fat deposits in the face and adrenal suppression

D. Cushing’s syndrome and growth retardation

E. Insomnia and mood changes

A

Insomnia and mood changes

A patient started on steroids short-term may experience elevated blood pressure, changes in mood, insomnia and elevated blood glucose, among other adverse effects.

The remaining choices are long-term adverse effects of corticosteroids.

47
Q

IBD

Steroids

A

Use for Short Duration

Route - IV/PO/PR

Adverse Effects
* Short term
* Long term

48
Q

IBD: Steroids

Adverse Effects: Short term

A

↑ appetite

Wt gain

Fluid Retention

Emotional instability

Insomnia

49
Q

IBD: Steroids

Adverse Effects: Long term

A

Cushingoid Effects

Immunosuppression

Impaired wound healing

50
Q

IBD

Which med do you not crush?

A

Entocort EC - for CD

Uceris - for UC

51
Q

IBD: Steroids

Drug Intxn

A

Avoid w/ antacids

CYP3A4 inhibitors

52
Q

A patient beginning treatment with Amitizashould be counseled on which common side effect?

A. Constipation

B. Hyponatremia

C. Hypertension

D. Somnolence

E. Nausea

A

Nausea

Amitiza (lubiprostone)

53
Q

lubiprostone

Brand, Most common SE, Indication

A

Amitiza

Nausea

For Constipation

Take w/ food & water to ↓ nausea

54
Q

Constipation

A

Osmotic Laxatives

Bulk-Forming Laxatives

Emollient/Stool Softener

Stimulant Laxatives

Calcium-Channel Activator

55
Q

Bulk-Forming Laxatives

Examples

A

Psyllium (Metamucil)

Calcium polycarbophil (FiberCon)

Methylcellulose (Citrucel)

Wheat dextrin (Benefiber)

56
Q

Osmotics

A

Mg Hydroxide (Milk of Magnesia [MOM])

Polyethylene glycol 3350 (Miralax)

Glycerin

Lactulose (RX)

Sodium phosphates (Fleet Enema)

57
Q

Stimulants

A

Senna (Ex-Lax, Senokot)

Biscodyl (Dulcolax)

58
Q

Emollients

A

Docusate sodium (Colace)

59
Q

Senna + docusate

A

Senna S, Senokot S

60
Q

Lubricants

A

Mineral Oil

61
Q

Chloride Channel Activator

A

Lubiprostone (Amitiza)

62
Q

Guanylate Cyclase C Agonists

A

linaclotide (Linzess)

Plecanatide (Trulance)

63
Q

Peripharally-Acting Mu-Opioid Receptor Antagonists (PAMORAs)

A

Alvimopan (Entereg)

Methylnatrexone (Relistor)

Naloxegol (Movantik)

naldemedine (Symproic)

64
Q

Non-Drug Tx for Constipation

A
65
Q

Drugs that cause constipation

A

Antacids (aluminum- and calcium- containing)

Antidiarrheals

Clonidine

Colesevelam

Drugs with anticholinergic effects:
* Antihistamines (e.g., diphenhydramine)
* Antispasmodics (e.g., baclofen)
* Phenothiazines (e.g., prochlorperazine)
* TCAs (e.g., amitriptyline)
* Incontinence drugs (e.g., oxybutynin)

Iron

Non-DHP calcium channel blockers (especially verapamil)

Opioids

Sucralfate (contains an aluminum complex)

66
Q

PPI MOA

A

Irreversibly bind to the gastric H/K-ATPase pump

67
Q

PPI Drugs

A

Esomeprazole (Nexium)

Lansoprazole (Prevacid)

Omeprazole (Prilosec)

Dexlansoprazole (Dexilant)

Pantoprazole (Protonix)

Rabeprazole (Aciphex)

68
Q

Omeprazole + sodium bicarbonate

A

Zegerid

69
Q

When to take PPI

A

Generally 30-60 minutes before meals

70
Q

Which PPI can be taken w/out regard to meal?

A

Dexlansoprazole (Dexilant)

Pantoprazole (Protonix) - tablets

Rabeprazole (Aciphex) - tablets

71
Q

Which PPI comes IV?

A

exomeprazole (Nexium)

pantoprazole (Protonix)

72
Q

PPI SE

Chronic Use

A

C.difficile associated diarrhea

Osteoporosis-related fractures (≥ 1 yr)

Hypomagnesemia

Vit B12 deficiency (use ≥ 2 yrs)

Long term use can ↑ risk of infection

73
Q

Esomeprazole + naproxen

A

Vimovo

74
Q

What drug does omeprazole & esomeprazole diminish the therapeutic effect of?

A

Clopidogrel

They inhibit CYP2C19

rabeprazole or pantoprazole have less risk

75
Q

Non-Steroidal Anti-iniflammatory Drug-induced Ulcers

Cytoprotective Drugs

A

Misoprostol (Cytotec)

Sucralfate (Carafate)

Misoprostol + diclofenac (Arthrotec)

76
Q

Cytoprotective Drugs

Misoprostol

Non-Steroidal Anti-iniflammatory Drug-induced Ulcers

A

Prostaglandin E1 analog

Boxed Warning: Abortifacient

SE: Diarrhea, abdominal pain

Arthrotec: NSAID ↑ risk of serious GI events (bleeding & ulceration & CV disease (eg, MI, stroke)

77
Q

Cytoprotective Drugs

Sucralfate

Non-Steroidal Anti-iniflammatory Drug-induced Ulcers

A

Sucrose-sulfate-aluminumb complex, interacts w/ albumin & fibrinogen to form a physical barrier over an open ulcer

Take before meals

SE: Constipation

Notes: binding interactions - separate from other drugs

Arthrotec: NSAID ↑ risk of serious GI events (bleeding & ulceration & CV disease (eg, MI, stroke)

78
Q

Which PPI does not come in a capsule form?

A

Pantoprazole

79
Q

Which of the following statements concerning NSAIDs is correct? (Select ALL that apply.)

A. All NSAIDs can cause gastric ulcers when used chronically.

B. COX-2 selective NSAIDs have an increased riskof gastrointestinal side effects.

C. All NSAIDs should be used cautiouslyin patients with a history of cardiovascular or renal disease.

D. COX-2 selective NSAIDs have an increased risk of causing cardiovascular events.

E. Patients with high risk for GI bleeding should preferably use sucralfate concurrently with an NSAID.

A

All NSAIDs can cause gastric ulcers when used chronically.

All NSAIDs should be used cautiouslyin patients with a history of cardiovascular or renal disease.

COX-2 selective NSAIDs have an increased risk of causing cardiovascular events.

All NSAIDs should be used with caution in patients with existing cardiovascular or renal disease.

The COX-2 selective drugs have less GI risk but increased cardiovascular risk.

All NSAIDs increase the risk for gastric ulcers.

80
Q

Which medication/s can be prescribed for irritable bowel syndrome with constipation in a 35-year-old female if OTC treatment options have failed? (Select ALL that apply.)

A. Linzess

B. Methylnaltrexone

C. Amitiza

D. Eluxadoline

E. Bentyl

A

Linzess

Amitiza

Linaclotide (Linzess)and lubiprostone (Amitiza) are approved for the treatment of various types of constipation, including IBS-C.

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