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GI Disorders (exam 3) Flashcards

1
Q

signs and symptoms of dyspepsia

A

upper abdominal discomfort
bloating or gassiness
nausea
feeling full too quick after eating
epigastric pain and burning

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2
Q

heartburn signs and symptoms

A

pain or burning feeling in the upper abdomen
bitter taste in mouth
happens 1-2 hours after eating

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3
Q

clinical presentation of heartburn

A

lying down worsens
occurs 1 hour after eating
bitter taste in mouth
water brash
alarming symptoms

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4
Q

clinical presentation of dyspepsia

A

postprandial fullness
early satiation
epigastric pain/burning
weight loss, anemia, blood loss, dysphagia

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5
Q

dietary risk factors for heartburn and dyspepsia

A

fatty or spicy food
chocolate
alcohol
carbonated/caffeinated beverages

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6
Q

medications that are risk factors for heartburn and dyspepsia

A

bisphosphonates
aspirin
NSAIDs
Iron
CCBs
estrogens/progestins

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7
Q

lifestyle risk factors for heartburn and dyspepsia

A

exercise
smoking
obesity
stress
pregnancy

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8
Q

exclusions for self treatment of heartburn and dyspepsia

A

frequent symptoms (over 3 months/2 weeks on treatment)
severe heartburn/dyspepsia
nocturnal heartburn
difficulty or pain swallowing
adults over 45 with new onset dyspepsia
vomiting blood/black stools
chronic hoarseness, wheezing, coughing
chronic NVD
pregnancy/nursing
children under 12

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9
Q

how to treat mild and infrequent symptoms

A

antacids or H2RAs

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10
Q

how to treat moderate and infrequent symptoms

A

H2RAs

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11
Q

frequent heartburn over 2 days/week

A

PPIs

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12
Q

nonpharmacologic treatment for heartburn and dyspepsia

A

avoid triggers
avoid large meals
weight loss
stop/reduce smoking
don’t lie down for 3 hours after eating

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13
Q

antacids indication

A

mild infrequent heartburn

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14
Q

antacid products

A

sodium bicarbonate
calcium carbonate (tums)
aluminum salts
magnesium salts

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15
Q

drug interactions with antacids

A

decreases absorption of tetracyclines, quinolones, ketoconazole, itraconazole, iron, atazanavir
decreased efficacy of enteric coatings
increases urinary pH

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16
Q

because antacids interact with absorption of tetracyclines and quinolones, what is an important counseling point?

A

Separate dosing by 2-4 hours

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17
Q

patients should use caution with combination

A

antacid-aspirin containing products

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18
Q

greatest risk groups for antacids

A

over 60
history of stomach ulcers/bleeding problems
uses anticoagulant, systemic steroid, NSAIDs
drink 3 or more alcohol a day

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19
Q

H2RAs indication

A

mild-moderate infrequent episodic heartburn

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20
Q

ADRs of H2RAs

A

headache
N/D
dizziness
drowsiness

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21
Q

H2RAs inhibit _________ enzymes which is involved with drugs such as

A

CYP450

theophylline, warfarin, amiodarone, phenytoin, clopidogrel, TCAs

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22
Q

Pepcid AC dosing

A

1 tablet PO QD

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23
Q

Pepcid complete

A

famotidine 10mg
calcium carbonate
magnesium hydroxide

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24
Q

Pepcid AC Max strength

A

famotidine 20mg

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25
Tagamet HB
cimetidine 200mg
26
Zantac
Ranitidine
27
PPIs onset of action when is full effect felt?
2 hours 1-4 days
28
Dosing of PPIs
1 t po qd 30 mins before breakfast
29
examples of OTC PPIs
omeprazole 20mg lansoprazole 15mg esomeprazole 20mg
30
ADRs of PPIs
abdominal pain headache diarrhea dizziness
31
risk with long term use of PPIs
dementia and CKD C dificile infection hypomagnesemia bone fracture CAP
32
PPIs (esomeprazole and omeprazole) interact with ________________ which may decrease antiplatelet effects
clopidogrel
33
bismuth subsalicylate (pepto bismol) indications
heartburn upset stomach indigestion nausea diarrhea
34
ADRs of pepto bismol
darkening of tongue and stool bismuth toxicity salicylate toxicity
35
warnings on pepto bismol
do not use in children, especially infected with a virus not recommended in pregnancy
36
drug interactions with pepto bismol
warfarin aspirin oral hypoglycemics
37
what can children 2-12 years use for heartburn/dyspepsia
calcium carbonate antacids for mild transient infrequent heartburn
38
what can children over 12 years use for heartburn/dyspepsia
H2RAs
39
PPIs can be used for people over
18
40
clinical presentation of intestinal gas
excessive belching bloating abdominal distention flatulence abdominal discomfort and cramping
41
exclusions for treatment of intestinal gas
symptoms for several days or several times per month severe, debilitating symptoms sudden change in location of abdominal pain increased severity/frequency of symptoms onset over 40 years old symptoms with significant abdominal discomfort or sudden change in bowel function
42
if what other symptoms are present, can we not treat intestinal gas?
severe, persistent diarrhea/constipation GI bleeding fatigue unintended weight loss frequent nocturnal symptoms
43
non pharmacological therapy for intestinal gas
modification of diet and eating habits avoidance of gas producing foods avoid mild/dairy if lactose intolerant
44
Simethicone brand names
Mylanta gas Gas X
45
ADRs of simethicone
NONE!
46
simethicone MOA
reduces surface tension of gas bubbles breaks them or makes it one big bubble
47
alpha-galactosidase brand name
beano
48
alpha-galactosidase is used
prophylactically with foods known to cause gas
49
do not use beano when
galactosemia mold allergy
50
lactose replacement (Lactaid) ADR
none!
51
when is lactaid supposed to be taking?
each time dairy products are consumed
52
nonprescription antiemetic can be used for
motion sickness pregnancy mild infectious diseases
53
exclusions for self treatment of NV in adults
food poisoning (over 24 hrs) severe abdominal pain fever and/or diarrhea bloody vomit dark urine chronic diseases drug induced jaundice severe symptoms in pregnancy/nursing head injury severe headache, stiff neck, photophobia NV caused by chemo/radiation diabetes with gastroperesis/high blood glucose/urine ketones and signs of dehydration, DKA or HHS
54
exclusions of self treatment for NV in children
stiff neck under 6 months, weight under 17.6 lb, vomited clear foods 3 times, watery diarrhea refusal to drink fluids lack of urination in 8-12 hrs lethargy vomiting with each feeding vomit is red/black/green suspected poisoning vomiting with diarrhea, distended abdomen or fever signs of severe dehydration caregiver unable to manage NV at home
55
first line non pharmacological therapy for N/V
oral rehydration solutions (ORS) - pedialyte
56
why is pedialyte preferred over sports drinks?
sports drinks have high sugar content
57
pharmacological therapy for N/V from motion sickness
antihistamines
58
take antihistamines ______________ before travel to prevent motion sickness
30-60 minutes
59
ADRs of antihistamines
drowsiness anticholinergic effects
60
use antihistamines in caution with
other CNS depressants (alcohol, sedatives)
61
examples of OTC antihistamines
dimenhydrinate (dramamine) diphenhydramine (Benadryl) meclizine (antivert) doxylamine (sleep aid)
62
pharmacological therapy for N/V associated with food/beverages
antacids H2RAs bismuth subsalicylate phosphorylated carbohydrate solution (PCS)
63
phosphorylated carbohydrate solution
emetrol mixture of levulose, dextrose and phosphoric acid
64
emetrol produces an __________ effect which inhibits _____________________
osmotic gastric emptying and GI motility
65
use emetrol with caution in patients with
diabetes
66
ADRs of emetrol
stomach pain diarrhea
67
exclusions to self treatment of diarrhea
under 6 months severe abdominal pain severe dehydration persistent vomiting risk for complications: diabetes, CKD, etc persistent fever (over 102.2F) blood, mucus, pus in stool substantial volume of diarrhea suboptimal response to dehydration pregnancy chronic or persistent diarrhea (over 14 days)
68
nonpharmacologica treatment for diarrhea
pedialyte dietary management preventative measures
69
pharmacological therapy for diarrhea
loperamide pepto bismol
70
dosing for loperamide
4 mg after first loose stool, then 2 mg for each subsequent stool MDD: 8mg (rx =16)
71
how long can a patient self treat with loperamide for?
maximum 48 hours
72
ADRs of loperamide
headache drowsiness abdominal pain
73
primary constipation
slower than normal GI transit time defecatory disorder
74
secondary constipation
systemic, neurologic, and psychological disorders structural abnormalities inadequate fiber and fluid intake medications
75
exclusions of self treatment of constipation
marked abdominal pain or significant distention/cramping fever paraplegia colostomy use marked change in character of stool blood in stool, dark tarry stool history of IBD age under 2 marked/unexplained flatulence NV daily laxative use unexplained changes in bowel habits symptoms persisting for over 2 weeks anorexia
76
first line treatment of constipation
dietary and lifestyle modification
77
non pharmacological treatment of constipation
increasing intake of high fiber foods gradually increase fluid intake regular exercise bowel training
78
pharmacological therapy of constipation
bulk forming laxatives hyper osmotic laxatives saline laxatives stimulant laxatives stool softeners
79
first line pharmacological therapy for constipation
bulk forming agents
80
bulk forming laxatives are short term therapy for
people with low fiber diets new mothers in postpartum older adults patients with colostomies, IBS, diverticular disease
81
bulk forming laxatives onset
works in 12-24 hours effect may take up to 72 hours
82
ADRs of bulk forming laxatives
abdominal cramping flatulence
83
take bulk forming laxatives with
plenty of fluids
84
when to avoid bulk forming laxatives
patients with swallowing difficulties patients on fluid restricted diets
85
separate dosing of bulk laxatives and oral medications by ____________ to prevent DDIs
2 hours
86
examples of bulk forming laxatives
methylcellulose (citrucel powder) calcium polycarbophil (fiber con) psyllium (Metamucil)
87
hyper osmotic laxatives MOA
draw water into colon or rectum through osmosis to stimulate bowel movement
88
examples of hyper osmotic laxatives
PEG3350 (miralax) glycerin suppositories
89
PEG3350 can be used in ____________ which glycerin suppositories can be used in _____________
patients over 17 all patients
90
glycerin suppositories produces a bowel movement within
15-30 minutes
91
saline laxatives MOA
increase intraluminal pressure and promote GI motility by osmotic effect
92
saline laxatives examples
magnesium citrate magnesium hydroxide (MOM) magnesium sulfate sodium phosphate
93
indication for saline laxatives
constipation colonoscopy
94
stimulant laxatives MOA
increase intestinal motility increase secretion of water and electrolytes in intestine
95
examples of stimulant laxatives
Senna bisacodyl
96
stimulant laxatives time to onset
6-10 hours after oral administration 15-60 minutes after rectal administration
97
emollients MOA
anionic surfactants --> soften fecal mass
98
example of emollients
docusate
99
emollients indication
prevent straining and painful defecation used in combination with stimulant for opioid induced constipation
100
lubricants MOA
coats stool and prevents colonic absorption of water
101
example of lubricants
mineral oil
102
warning with mineral oil
lipid pneumonia resulting from aspiration into the lungs
103
recommendations when taking mineral oil
don't take before lying down avoid in patients at risk for aspiration
104
do not use mineral oil in patients
under 6 years pregnant immobile older adults with difficulty swallowing
105
what is preferred for constipation in the elderly? what to avoid?
bulk forming laxatives saline laxatives and mineral oil
106
what is preferred in constipation for pregnancy? what to avoid?
dietary measures first, then bulk forming laxatives or docusate mineral oil, castor oil and saline laxatives
107
clinical presentation of pinworm
asymptomatic pruritis in perianal area at night (most common)
108
exclusions to self treatment of pinworm
liver disease under 2 years/ weight under 25 lbs vague symptoms and negative visual inspection need for repeat dosing pregnancy/nursing helminthic infections other than pinworm hypersensitivity to pyrantel pamoate
109
non pharmacological therapy for pinworm
keep everything clean: body, house, clothes, etc short nails shower every day
110
pharmacological therapy for pinworm
pyrantel pamoate
111
pyrantel pamoate MOA
stimulates the release of Ach and inhibits cholinesterase and paralyzes the adult worms in GI tract paralyzed worms released in stool
112
pyrantel pamoate dosing
11mg/kg as a single, oral dose
113
can you repeat pyrantel pamoate?
yes! in 2 weeks if symptoms don't resolve BUT! need consultation with PCP

Community Pharmacy (12 decks)

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