GI/GU Case Review Jaynstein (Final) Flashcards
which antibiotics have a high risk of causing c-diff?
flouroquinolones, augmentin, cephalosporins, clindamycin
which antibiotics have a moderate risk of causing c-diff?
macrolides, amoxicillin, tetracycline
which antibiotics have a low risk of causing c-diff?
aminoglycosides, metronidazole, vancomycin, bactrim, doxy
SxS of E.coli
Incubation period: 1 to 3 days
Diarrhea (often bloody), severe stomach cramps, vomiting, sometimes fever
Causes/risks/exposures linked to E.coli
Fecally contaminated food or water- undercooked ground beef, drinking of unpasteurized juices and milk, working with cattle
ABX tx options for E.coli?
Cipro, azithromycin, bactrim
SxS of vibrio?
Incubation period: 24 hrs to 3 days
Watery diarrhea, N/V, fever and chills, abd cramping
Causes/risks/exposures linked to vibrio?
eating raw or undercooked shellfish/oysters
ABX tx options for vibrio?
not recommended, lots of fluids
3rd generation cephalosporins plus either doxy or cipro
SxS of Shigella?
Incubation period: 1 to 3 days
Diarrhea (sometimes bloody), fever, stomach pain
Causes/risks/exposures linked to Shigella?
Fecal contaimination of food and water
ABX tx options for Shigella?
Cipro or azithromycin
Causes/risks/exposures linked to Salmonella?
Eggs, poultry, meat, unpasteurized milk or juice, fresh produce
ABX tx options for Salmonella?
Not recommended unless severe illness
Cipro for severe illiness
Lots of fluids
SxS of Campylobacter?
Sxs usually start 2 to 5 days after ingestion and last about one week
Diarrhea (often bloody), fever, and stomach cramps
Causes/risks/exposures linked to Campylobacter?
Eating raw or undercooked poultry or eating something that touched it, untreated water
ABX tx options for Campylobacter?
Antibiotics not recommended
Lots of fluids
If antibiotic needed cipro is drug of choice
Sxs of Giardia?
Diarrhea, gas, foul-smelling, greasy poop that can float, stomach cramps or pain, upset stomach or nausea, dehydration
Causes/risks/exposures linked to Giardia?
Kids in childcare settings, travelers to areas with poor sanitation
ABX tx options for Giardia?
tinidazole and metronidazole
Causes/risks/exposures linked to c-diff?
Recent antibiotics, being 65 or older, recent stay at hospital or nursing home, immunocompromised, previous c diff infection
ABX tx options for C. Diff
Vanco po or fidaxomicin (is preferred but is very expensive)
Which medications can cause GERD?
CCBs and nitrates
MOA of antacids?
increases pH of gastric refluxate by neutralizing gastric acid
Which antacids should you avoid in CKD?
antacids containing Mg and aluminum
MOA of sucralfate?
a mucosal coating agent that forms a protective barrier btwn esophageal tissue and gastric refluxate; do not use as mono-therapy, avoid in CKD
MOA of H2 receptor antagonists?
acid-suppressive agents that inhibit the action of histamine at the H2 receptor of the parietal cell, decreasing basal acid secretion
Which H2RT is most effective?
trick question, they are all equally effective ! and available OTC
Name some H2RTs.
famotidine, ranitidine, climetidine
MOA of proton-pump inhibitors (PPIs)?
irreversibly bind to the H+/K+ ATPase pump of the parietal cell, thereby inhibiting the final steps of acid secretions
what are some adverse effects of PPIs
linked to increased risk of c-diff, increased fracture risk, vitamin B12 deficiency, CKD, and worsens PNA prognosis
What are some drugs that interact with PPIs?
Plavix, diazepam, phenytoin
Which PPI is category C in pregnancy?
omeprazole
Name some medications that contribute to renal impairment.
metformin, cetirizine (Zyrtec), Vit C and D, HCTZ, NSAIDs
When is naproxen contraindicated in those with DKD (diabetic related kidney disease)?
Should be used with caution in patients w/ decreased kidney function (<60 mL/min) and is CONTRAINDICATED when <30 mL/min
*also contraindicated in those on diuretics and ACEI or ARBs
When is metformin contraindicated in those with DKD?
dose reduction is recommended at GFR <45 mL/min and discontinuation is recommended at GFR <30 mL/min
*also in patients w/ hepatic impairment and cardiac failure
MOA of biguanides AKA he pormetformin?
inhibits the production and release of glucose from the liver and enhances insulin sensitivity
Biguanides (metformin) is expected to decrease A1C by what percent?
1-2%
MOA of sulfonylureas (eg, glyburide, glimepiride, glipizide)?
promote pancreatic beta-cell secretion of insulin; efficacy is reduced in later stages of DM
Sulfonylureas are expected to decrease A1C by what percent?
1-2%
Side effects of sulfonylureas?
hypoglycemia and weight gain
Which sulfonylureas are contraindicated in renal failure?
glyburide is contraindicated and glimepiride should be used w/ caution
Which sulfonylurea is preferred in renal disease ?
glipizide, but it NEEDS renal dosing
MOA of alpha-glucosidase inhibitors (acarbose, miglitol)?
delayed GI break-down and absorption of carbohydrates
Alpha-glucosidase inhibitors expected to decrease A1C by what percent?
only 0.5-0.8%
What creatine level is needed to prescribe Alpha-glucosidase inhibitors?
less than 2.0
MOA of TZDs (rosiglitazone (Avandia), pioglitazone) ?
reduce insulin resistance by decreasing hepatic glucose release and promoting skeletal muscle glucose absorption
Side effects of TZDs?
associated with weight gain, fluid retention, and increased fracture risk in women
TZDs are expected to decrease A1C by what percent?
Average A1C decline is 0.5–1.4%
Contraindications to TZDs?
TZDs are contraindicated in hepatic dysfunction and cardiac failure
MOA of DPP-4 inhibitors (alogliptin, linagliptin, sitagliptin (Januvia), and saxagliptin) ?
increased incretin (GLP-1 and GIP) levels, inhibiting glucagon secretion, decreasing blood glucose, increasing insulin secretion, and decreasing gastric emptying.
DPP-4 inhibitors are expected to decrease A1C by what percent?
A1C reduction averages 0.5–1%
Are DPP-4 inhibitors contraindicated in ESRD?
No, but they need to be appropriately dosed, except for Linagliptin
MOA of Incretin mimetic/glucagon-like peptide-1 (GLP-1) agonist (albiglutide, exenatide (byetta), liraglutide (victoza)) ?
These agents stimulate GLP-1 receptors enhancing glucose-dependent insulin secretion by the pancreatic β-cell, suppressing inappropriately elevated glucagon secretion and slowing gastric emptying
Do GLP-1 agonists cause weight gain?
NO, they curb appetite and delay gastric emptying leading to weight loss
Contraindications of GLP-1 agonists?
Cannot be prescribed with a DPP-4 inhibitor
OR
in patients with CrCl <30
MOA of Sodium-glucose transport protein (SGLT2) inhibitors canagliflozin (Invokana), dapagliflozin, and empagliflozin (Jardiance) ?
reduce tubular glucose reabsorption (pee out glucose), therefore reducing blood glucose levels and the need for insulin release
SGLT2 inhibitors are useful in which patients?
Consider in obese and HTN patients – associated with weight loss (2-8# in 18 weeks) and antihypertensive (up to 7mmHg systolically) properties
Side effects of SGLT2 inhibitors?
euglycemic DKA, increased UTIs, pancreatitis
Contraindications of SGLT2 inhibitors?
GFR <45mL/min
Which class of DM med has the greatest AIC reduction and allows the tightest glucose control?
Injectable insulin
Which class of DM med is the best option for patients with severe renal dysfunction?
Injectable insulin
MOA of ACE inhibitors ?
inhibit conversion of angiotensin I to angiotensin II, reducing vasoconstriction and aldosterone secretion.
Thiazide diuretics are recommended in patients in which stages of CKD?
stages 1-3.
Loop diuretics are recommended in patients in which stages of CKD?
stages 4-5
Name some classes of medications that are not the drug of choice for treating HTN in CKD.
potassium-sparing diuretics and B blockers
Can CCBs be used in treating HTN in CKD?
Yes, if the patient fails to tolerate treatment with ACE or ARB or requires intensification of therapy
Bile acid sequestrants/binding resins (colestipol, cholestyramine, and colesevelam) reduce LDL levels by?
15-20%
Fibrates (bezafibrate, gemfibrozil, and fenofibrate) are effective in reducing TGs, LDL or HDL?
TGs
Can you combine Fibrates/statin treatment in patients with CKD?
NO. This is contraindicated due to the significant increased risk of rhabdo
