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Notes > GI Disorders > Flashcards

GI Disorders Flashcards

1
Q

foods that lower LES

A

alcohol
caffeine
chocolate
citrus
garlic/onion
peppermint
nicotine

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2
Q

drugs that lower LES

A

alpha adrenergic agonists
calcium channel blockers
anticholinergics
theophylline
benzos
opiates

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3
Q

H2RA drug interactions

A

cimetidine worst

warfarin, theophylline, decreased absorption of antifungals

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4
Q

best PPI w/clopidogrel

A

pantoprazole

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5
Q

PPI drug interactions

A

methotrexate - increases toxicity
antifungals have decreased absorption due to lower pH

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6
Q

highest risk NSAIDs for GI bleed

A

ketorolac
indomethacin
piroxicam

highest risk in first 3 months

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7
Q

What can cause a false negative in H. pylori?

A

PPI
Antibiotics

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8
Q

when do you treat w/H pylori and why?

A

always
carcinogen

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9
Q

different types of H pylori tests?

A

serologic (blood) - can’t differentiate b/w new or old or eradication
urea breath test - can diagnose and test eradication
stool antigen - not quite as sensitive or specific
invasive tests - expensive, time consuming and difficult

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10
Q

1st line for H pylori?

A

PPI + 2 antibiotics

pantoprazole (double dose or standard) + clarithromycin 500mg BID + amoxicillin 1000mg BID + Flagyl 500mg TID

for 14 days

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11
Q

quadruple therapy for H pylori

A

Bismuth subsalicylate + Flagyl + TCN/Doxy + PPI

pantoprazole (double/standard) + bismuth subsalicylate 300mg QID/bismuth subcitrate 120-300mg QID + Flagyl 250-500mg TID-QID + TCN 500mg QID

for 10 - 14 days

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12
Q

sequential dosing for H Pylori

A

PPI (standard/double) + amoxicillin 1000mg BID x 5 - 7 days
PPI BID + Clarithromycin 500mg BID + Flagyl/tinidazole 500mg BID x 5 - 7 days

complex and not a favorite

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13
Q

High risk CV and High risk Bleed risk - what NSAID to use?

A

avoid NSAIDs and COX2 Inhibitors

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14
Q

High risk CV and Low/Mod Bleed risk - what NSAID to use?

A

naproxen and PPI

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15
Q

Low risk CV and low risk GI bleed - what NSAID to use?

A

NSAIDs ok

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16
Q

Low risk CV and mod risk GI Bleed - what NSAID to use?

A

NSAID and PPI

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17
Q

Low risk CV and high risk GI bleed - what NSAID to use?

A

COX 2 Inhibitor and PPI

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18
Q

why use erythromycin in endoscopy with GI bleed?

A

erythromycin 250mg IV 30 to 60 minutes prior will push blood distally and improve diagnostic yield

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19
Q

Protonix Therapy with GI bleed

A

Protonix 80mg IVP then 8mg/hr for up to 72 hours after surgery
BID PPI for 2 weeks after endoscopy

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20
Q

Indications for stress-ulcer prophylaxis inpatient

A

1 of following:
ventilator >48 hrs, platelets <100, INR >1.5, burns, head/spinal injury, hx of bleeds, trauma, transplant, low pH, surgery >4hr, acute lung injury

2 of the following:
sepsis, ICU stay >7 days, occult bleeding, >250mg hydrocortisone, hepatic failure, renal insufficiency, hypotension, anticoagulation

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21
Q

markers of inflammation

A

IL-1
IL-6
TNF

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22
Q

ulcerative colitis
(location, perfs, cancer risk, polyps, megacolon)

A

rectum and colon
no perfs
increased cancer risk
polyps and toxic megacolon

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23
Q

Crohn’s disease
(location, perfs, cancer risk, polyps, megacolon)

A

from mouth to anus - usually ileum
deep ulcers, fistulas, perfs
malabsorption but no cancer or polyps

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24
Q

Ulcerative Colitis Mild Stages

A

<4 poops a day
Normal ESR
topical treatment

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25
Q

Ulcerative Colitis Moderate Stages

A

> 4 poops a day
could have fever, anemia, tachycardia
treat with topicals and PO sulfasalazine then budesonide/steroids

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26
Q

Ulcerative Colitis Severe Stage

A

> 6 poops a day w/ blood
fever, HR >90, ESR>30, Hgb <75% of normal, tender abdomen, bowel edema

treat with PO Budesonide, then steroids, then TNF-a

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27
Q

Ulcerative Colitis Fulminant

A

> 10 stools a day with blood
have to have blood to be fulminant, dilated colon
treat w/methylprednisolone 40-60mg daily, if fails then do infliximab or cyclosporine

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28
Q

Crohn’s disease mild/moderate Stages

A

no systemic symptoms
can do mesalamine/sulfasalazine
minimally effective
budesonide 9mg/day
flagyl 10-20mg/kg/day
ciprofloxacin 1g/day + Flagyl

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29
Q

Crohn’s disease Mod/Severe Stages

A

sxs anemia, N/V, >10% weight loss
Prednisone 40-60mg/day or Budesonide 9mg/day if terminal ileum, TNF-a + Thiopurines

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30
Q

Crohn’s disease Severe Stages

A

no response to steroids
can have high temps, abdominal pain, vomiting, possible obstruction, abscess
treat w/ IV steroids, parenteral nutrition after 5 - 7 days, possibly cyclosporine IV

31
Q

Budesonide PO is good for what GI location?

A

8 week cycles best, not long term
for ileum and ascending colon
have rectal foam for descending colon

32
Q

antispasmodics for colonic disease

A

dicyclomine
propantheline
hyoscyamine

33
Q

cholestyramine for colonic disease

A

sequesters bile acid to decrease diarrhea after ileal resection

34
Q

aminosalicylates

A

sulfasalazine - activated in the colon, ADR hemolytic anemia, hepatotoxicity, bone marrow suppression, pancreatitis, decreases sperm production

remove sulfa - mesalamine, olsalazine, balsalazide - could cause nephrotoxicity

35
Q

location of action for aminosalicylates in colonic disease

A

colon only, activated there

36
Q

corticosteroids for colonic disease

A

budesonide is 15x more potent than prednisone
takes 2 weeks to transfer from prednisone to budesonide

37
Q

Mercaptopurine
azathioprine

A

TPMT metabolizes azathioprine to mercaptopurine
pancreatitis, bone marrow suppression, N/V/D, rash, hepatotoxicity, T-Cell lymphoma esp if male and adds TNF-a

38
Q

methotrexate

A

bone marrow suppression, N/V/D, pulmonary toxicity, hepatotoxicity

39
Q

tofacitinib

A

oral JAK inhibitor for moderate to severe UC
10mg PO BID
if no relief after 16 weeks then discontinue
D/C - renal impairment, mod hepatic failure, 3A4/2C19 inhibitor, stop if ANC < 0.5, interrupt if Hgb <8 or drops >2, infection
ADR - URTI, increase CPK, rash, HA, diarrhea, herpes zoster, TB, neutropenia, low Hgb, lymphocytopenia, malignancies, GI perf
can cause DVT, PE, and thrombosis with RA if >50 yo and CVD if higher than recommended doses given

40
Q

biologics for UC/Crohn’s

A

infliximab - combine w/azathiopurine for induction, increases HF, antibodies, bone marrow suppression, cancer risk, and CNS effects
adalimumab** - 2nd line, less antibodies
certolizumab** - most effective agent if CRP > 10
golimumab** - only once others have failed or steroid dependent
natalizumab - must test for antibodies, increased cancer risk a lot, no combo therapy
vedolizumab - similar to natalizumab but less cancer risk
ustekinumab - IL-12 and IL-23 last line essentially

41
Q

octreotide dosing for varices

A

octreotide 50mcg IVP then 50mcg/hr for 3 to 5 days

42
Q

vasopressin for variceal bleeding

A

0.2 - 0.4units/min + nitroglycerin 40-400mcg/min x 3 - 5 days
must use combination therapy

43
Q

beta blockers for varicese

A

non-selective
propranolol, carvedilol, nadolol
goal resting HR is 55-60 or 25% reduction from baseline

44
Q

medication that increased risk of death in variceal bleeding

A

isosorbide will decrease HR but increased risk of death in primary prophylaxis

45
Q

bacteria in spontaneous bacterial peritonitis

A

E coli, Klebsiella, Strep pneumo, Rarely MSSA

46
Q

albumin dosing in spontaneous bacterial peritonitis

A

albumin 1.5g/kg on admission
albumin 1g/kg on day 3 reduced mortality and renal failure

47
Q

prophylaxis for bacterial peritonitis

A

ciprofloxacin or Bactrim DS 5 days a week

48
Q

hepatorenal failure and peritoneal issues

A

vasoconstrictors for BP (levophed) or midodrine
and octreotide

49
Q

hepatitis A exposure

A

Immune globulin 0.1ml/kg IM within 2 weeks of exposure
chronic liver disease gets a vaccine and the IG

50
Q

Hep B Treatment

A

Treat if ALT >2x ULN and DNA load is >20k
Pegylated interferon (Pegasys) 180mcg SC weekly x yr - initially increases ALT

51
Q

Pegasys

A

pegylated interferon given 180mcg SC qweekly x 48 weeks Hep B
is a cytokine w/antiviral, antri-proliferative, and anti-immune activity
can cause bone marrow suppression, leukopenia, thrombocytopenia, CNS effects, seizures, psychosis, flu, thryoid issues, alopecia, CVA

52
Q

Hep B Reverse Transcriptase Inhibitors

A

Entecavir 1mg daily
Tenofovir

can also do lamivudine or telbivudine but not as good, has resistance, BBW for lactic acidosis, hepatomegaly, osteoporosis

53
Q

Hepatitis C Drugs

A

Zepatier (elbasvir/grazoprevir) PO daily 12 weeks
Mavyret (glecaprevir/pibrentasvir) PO daily 8-16 weeks
Interferon/Peg-interferon
Ribavirin PO BID x 12 wks
Sofosbuvir daily x 12 weeks, has combo w/velpatasvir +/- voxilaprevir but still needs ribavirin

54
Q

Heb B Vaccines

A

Heplisav “saves” a dose (2)
Engerix (give 4th dose if HD)
Twinrix is only for adults who are unvaccinated

55
Q

drug interactions with antiretrovirals

A

PPI’s decrease [x]
anticonvulsants, rifampin, St Johns Wort
amodiodarone
statin [x] is increased

56
Q

drugs that can cause pancreatitis

A

amiodarone
azathioprine
cannabis
diuretics
estrogen
exenatide
mesalamine
sulfasalazine
sitagliptin
TCN
Bactrim
Depakote

57
Q

pain killer to avoid with pancreatitis

A

demerol

58
Q

pancreatic enzyme replacement dose

A

40k units/meal and 1/2 for snacks
500-1000u/kg/meal

59
Q

DOC for HIV ART diarrhea

A

crofelemer, octreotide

60
Q

DOC for short bowel syndrome diarrhea

A

teduglutide (GLP2)

61
Q

constipation meds that increase fluid secretion and help transit time

A

linaclotide 290 for IBS
linaclotide 145 for idiopathic
plecanatide 3mg daily

62
Q

opioid induced constipation drugs

A

methylnaltrexone
naldemedine
naloxegol

63
Q

drugs for idiopathic constipation

A

linaclotide 145
prucalopride (suicide ADR)
lubiprostone 24mcg BID w/meals

64
Q

drugs for IBS

A

linaclotide 290mcg
lubiprostone 8mcg
tenapanor

65
Q

lubiprostone

A

take w/meals
24mcg BID for idiopathic constipation
8mcg BID for IBS
need neg pregnancy test before use

66
Q

IBS anticholinergic contraindications

A

GI obstructions
myasthenia gravis
glaucoma

67
Q

drugs for IBS-diarrhea

A

SSRIs and TCAs
eluxadoline
alosetron
rifaximin

68
Q

tegaserod

A

for IBS constipation in women <65 and low cardiovascular risks

may cause ischemic bowel but works - use 2nd line behind lubiprostone and linaclotide

69
Q

phenothiazine drugs and ADRs

A

promethazine, prochlorperazine

EPS, injection site reactions, anticholinergic, anti-dopamine

70
Q

serotonin antagonist drugs and ADR

A

ondansetron, dolasetron, granisetron, palonosetron

QTc prolongation
correct mag and k

71
Q

haloperidol/droperidol side effects for N/V

A

Extrapyramidal side effects
QTc prolongation

72
Q

NK1 antagonists

A

fosaprepitant, neupitant/aloxi, rolapitant

emend is only inj. others tabs

reduces birth control pill and warfarin

rolapitant has 7 days 1/2 life

CYP 3A4 interactions

73
Q

Diclegis / Bonjesta

A

doxylamine and pyridoxine 10/10mg for pregnancy if all others fail
Category A

74
Q
A

Notes (12 decks)

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