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RRCCPA Pharmacotherapeutics > GI/GU Case Review Jaynstein (Final) > Flashcards

GI/GU Case Review Jaynstein (Final) Flashcards

1
Q

which antibiotics have a high risk of causing c-diff?

A

flouroquinolones, augmentin, cephalosporins, clindamycin

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2
Q

which antibiotics have a moderate risk of causing c-diff?

A

macrolides, amoxicillin, tetracycline

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3
Q

which antibiotics have a low risk of causing c-diff?

A

aminoglycosides, metronidazole, vancomycin, bactrim, doxy

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4
Q

SxS of E.coli

A

Incubation period: 1 to 3 days

Diarrhea (often bloody), severe stomach cramps, vomiting, sometimes fever

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5
Q

Causes/risks/exposures linked to E.coli

A

Fecally contaminated food or water- undercooked ground beef, drinking of unpasteurized juices and milk, working with cattle

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6
Q

ABX tx options for E.coli?

A

Cipro, azithromycin, bactrim

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7
Q

SxS of vibrio?

A

Incubation period: 24 hrs to 3 days

Watery diarrhea, N/V, fever and chills, abd cramping

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8
Q

Causes/risks/exposures linked to vibrio?

A

eating raw or undercooked shellfish/oysters

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9
Q

ABX tx options for vibrio?

A

not recommended, lots of fluids

3rd generation cephalosporins plus either doxy or cipro

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10
Q

SxS of Shigella?

A

Incubation period: 1 to 3 days

Diarrhea (sometimes bloody), fever, stomach pain

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11
Q

Causes/risks/exposures linked to Shigella?

A

Fecal contaimination of food and water

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12
Q

ABX tx options for Shigella?

A

Cipro or azithromycin

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13
Q

Causes/risks/exposures linked to Salmonella?

A

Eggs, poultry, meat, unpasteurized milk or juice, fresh produce

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14
Q

ABX tx options for Salmonella?

A

Not recommended unless severe illness

Cipro for severe illiness

Lots of fluids

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15
Q

SxS of Campylobacter?

A

Sxs usually start 2 to 5 days after ingestion and last about one week

Diarrhea (often bloody), fever, and stomach cramps

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16
Q

Causes/risks/exposures linked to Campylobacter?

A

Eating raw or undercooked poultry or eating something that touched it, untreated water

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17
Q

ABX tx options for Campylobacter?

A

Antibiotics not recommended

Lots of fluids

If antibiotic needed cipro is drug of choice

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18
Q

Sxs of Giardia?

A

Diarrhea, gas, foul-smelling, greasy poop that can float, stomach cramps or pain, upset stomach or nausea, dehydration

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19
Q

Causes/risks/exposures linked to Giardia?

A

Kids in childcare settings, travelers to areas with poor sanitation

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20
Q

ABX tx options for Giardia?

A

tinidazole and metronidazole

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21
Q

Causes/risks/exposures linked to c-diff?

A

Recent antibiotics, being 65 or older, recent stay at hospital or nursing home, immunocompromised, previous c diff infection

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22
Q

ABX tx options for C. Diff

A

Vanco po or fidaxomicin (is preferred but is very expensive)

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23
Q

Which medications can cause GERD?

A

CCBs and nitrates

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24
Q

MOA of antacids?

A

increases pH of gastric refluxate by neutralizing gastric acid

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25
Q

Which antacids should you avoid in CKD?

A

antacids containing Mg and aluminum

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26
Q

MOA of sucralfate?

A

a mucosal coating agent that forms a protective barrier btwn esophageal tissue and gastric refluxate; do not use as mono-therapy, avoid in CKD

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27
Q

MOA of H2 receptor antagonists?

A

acid-suppressive agents that inhibit the action of histamine at the H2 receptor of the parietal cell, decreasing basal acid secretion

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28
Q

Which H2RT is most effective?

A

trick question, they are all equally effective ! and available OTC

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29
Q

Name some H2RTs.

A

famotidine, ranitidine, climetidine

30
Q

MOA of proton-pump inhibitors (PPIs)?

A

irreversibly bind to the H+/K+ ATPase pump of the parietal cell, thereby inhibiting the final steps of acid secretions

31
Q

what are some adverse effects of PPIs

A

linked to increased risk of c-diff, increased fracture risk, vitamin B12 deficiency, CKD, and worsens PNA prognosis

32
Q

What are some drugs that interact with PPIs?

A

Plavix, diazepam, phenytoin

33
Q

Which PPI is category C in pregnancy?

A

omeprazole

34
Q

Name some medications that contribute to renal impairment.

A

metformin, cetirizine (Zyrtec), Vit C and D, HCTZ, NSAIDs

35
Q

When is naproxen contraindicated in those with DKD (diabetic related kidney disease)?

A

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

36
Q

When is metformin contraindicated in those with DKD?

A

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

37
Q

MOA of biguanides AKA he pormetformin?

A

inhibits the production and release of glucose from the liver and enhances insulin sensitivity

38
Q

Biguanides (metformin) is expected to decrease A1C by what percent?

A

1-2%

39
Q

MOA of sulfonylureas (eg, glyburide, glimepiride, glipizide)?

A

promote pancreatic beta-cell secretion of insulin; efficacy is reduced in later stages of DM

40
Q

Sulfonylureas are expected to decrease A1C by what percent?

A

1-2%

41
Q

Side effects of sulfonylureas?

A

hypoglycemia and weight gain

42
Q

Which sulfonylureas are contraindicated in renal failure?

A

glyburide is contraindicated and glimepiride should be used w/ caution

43
Q

Which sulfonylurea is preferred in renal disease ?

A

glipizide, but it NEEDS renal dosing

44
Q

MOA of alpha-glucosidase inhibitors (acarbose, miglitol)?

A

delayed GI break-down and absorption of carbohydrates

45
Q

Alpha-glucosidase inhibitors expected to decrease A1C by what percent?

A

only 0.5-0.8%

46
Q

What creatine level is needed to prescribe Alpha-glucosidase inhibitors?

A

less than 2.0

47
Q

MOA of TZDs (rosiglitazone (Avandia), pioglitazone) ?

A

reduce insulin resistance by decreasing hepatic glucose release and promoting skeletal muscle glucose absorption

48
Q

Side effects of TZDs?

A

associated with weight gain, fluid retention, and increased fracture risk in women

49
Q

TZDs are expected to decrease A1C by what percent?

A

Average A1C decline is 0.5–1.4%

50
Q

Contraindications to TZDs?

A

TZDs are contraindicated in hepatic dysfunction and cardiac failure

51
Q

MOA of DPP-4 inhibitors (alogliptin, linagliptin, sitagliptin (Januvia), and saxagliptin) ?

A

increased incretin (GLP-1 and GIP) levels, inhibiting glucagon secretion, decreasing blood glucose, increasing insulin secretion, and decreasing gastric emptying.

52
Q

DPP-4 inhibitors are expected to decrease A1C by what percent?

A

A1C reduction averages 0.5–1%

53
Q

Are DPP-4 inhibitors contraindicated in ESRD?

A

No, but they need to be appropriately dosed, except for Linagliptin

54
Q

MOA of Incretin mimetic/glucagon-like peptide-1 (GLP-1) agonist (albiglutide, exenatide (byetta), liraglutide (victoza)) ?

A

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

55
Q

Do GLP-1 agonists cause weight gain?

A

NO, they curb appetite and delay gastric emptying leading to weight loss

56
Q

Contraindications of GLP-1 agonists?

A

Cannot be prescribed with a DPP-4 inhibitor
OR
in patients with CrCl <30

57
Q

MOA of Sodium-glucose transport protein (SGLT2) inhibitors canagliflozin (Invokana), dapagliflozin, and empagliflozin (Jardiance) ?

A

reduce tubular glucose reabsorption (pee out glucose), therefore reducing blood glucose levels and the need for insulin release

58
Q

SGLT2 inhibitors are useful in which patients?

A

Consider in obese and HTN patients – associated with weight loss (2-8# in 18 weeks) and antihypertensive (up to 7mmHg systolically) properties

59
Q

Side effects of SGLT2 inhibitors?

A

euglycemic DKA, increased UTIs, pancreatitis

60
Q

Contraindications of SGLT2 inhibitors?

A

GFR <45mL/min

61
Q

Which class of DM med has the greatest AIC reduction and allows the tightest glucose control?

A

Injectable insulin

62
Q

Which class of DM med is the best option for patients with severe renal dysfunction?

A

Injectable insulin

63
Q

MOA of ACE inhibitors ?

A

inhibit conversion of angiotensin I to angiotensin II, reducing vasoconstriction and aldosterone secretion.

64
Q

Thiazide diuretics are recommended in patients in which stages of CKD?

A

stages 1-3.

65
Q

Loop diuretics are recommended in patients in which stages of CKD?

A

stages 4-5

66
Q

Name some classes of medications that are not the drug of choice for treating HTN in CKD.

A

potassium-sparing diuretics and B blockers

67
Q

Can CCBs be used in treating HTN in CKD?

A

Yes, if the patient fails to tolerate treatment with ACE or ARB or requires intensification of therapy

68
Q

Bile acid sequestrants/binding resins (colestipol, cholestyramine, and colesevelam) reduce LDL levels by?

A

15-20%

69
Q

Fibrates (bezafibrate, gemfibrozil, and fenofibrate) are effective in reducing TGs, LDL or HDL?

A

TGs

70
Q

Can you combine Fibrates/statin treatment in patients with CKD?

A

NO. This is contraindicated due to the significant increased risk of rhabdo

RRCCPA Pharmacotherapeutics (11 decks)

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