GI & Infectious Diseases

Question 1

Antacids adverse reactions

Answer 1

constipation (aluminum-containing products), diarrhea (magnesium-containing products), gastric pH disruption

Question 2

H2 Receptor blockers (H2RA)

Answer 2

Prevent histamine activated release of gastric acid under normal conditions, during stimulation by food and can be protective of GI mucosa from NSAID induced damage. Adverse reactions are headache/dizziness but well tolerated

Question 3

Proton Pump Inhibitors (PPI)

Answer 3

Very effective, reduce gastric acid 80-95%

Question 4

PPIs adverse effects

Answer 4

-prazoles!!

Short term: well tolerated/headache

Long term: Community Acquired Pneumonia, C. diff, Hypocalcemia, Hypomagnesemia, Hip and Vertebral fractures (with >1 yr use & high doses)

Question 5

Metoclopramide (Reglan)

Answer 5

Pro-motility agent and beneficial for diabetic gastroparesis. Adverse reactions include drowsiness/fatigue, extrapyramidal symptoms (tardive dyskinesia)

Question 6

Sucralfate

Answer 6

Forms protective gel in stomach and sticks to ulcers and shields them from stomach acid. Adverse effects are constipation

Question 7

Anti-emetics (Ondansetron and prochlorperazine)

Answer 7

Causes: motion sickness, recovery from surgery, other meds (chemo/radiation). Selected based on reason for nausea

Question 8

Penicillins

Answer 8

Impairs contruction of bacteria cell wall, first line therapy for ear infections, strep. Adverse effects is rash, GI upset, and allergic reactions

Question 9

Cephalosporins

Answer 9

Similar to penicillins in that they impair cell wall formation. Useful for UTIs, intra-abdominal infections, skin infections. Sides effects include allergic reactions (small chance of cross reactivity with penicillins, GI upset

Question 10

Carbapenems

Answer 10

Broad spectrum, treats multi drug resistant organisms, ADE include allergic reactions

Question 11

Beta-lactamase inhibitors

Answer 11

Addition of beta-lactamase inhibitor broadens spectrum of antibiotic activity. ADE include diarrhea, allergic reactions

Question 12

Vancomycin

Answer 12

Inhibitions of cell wall synthesis, can be nephrotoxic, broad specturm

Question 13

Aminoglycosides

Answer 13

Effective against gram negatives

inhibit bacterial protein synthesis, side effects include ototoxicity and nephrotoxicity

Question 14

Macrolides

Answer 14

Covers both gram + and gram -

Azithromycin = used for pneumonia and COPD, side effects are gi upset

Question 15

Tetracyclines

Answer 15

Gram + and gram - coverage

Doxycycline - useful in tock borne diseases, skin infections

ADE is GI upset, calcium binding in teeth, sensitivity to UV rays

Question 16

Linezolid

Answer 16

Effective against gram positives including MRSA, can cause serotonin syndrome when used with other agents. Side effects inculde thrombocytopenia and serotonin syndrome risk

Question 17

Clindamycin

Answer 17

Covers both gram + and some gram -, second line agents for SSTI. Side effects are GI distress and C. diff infection

Question 18

Fluoroquinolones (ciprofloxacin, levofloxacin)

Answer 18

good for respiratory tract, UTIs, osteomyelitis. Side effects include tendonitis

Question 19

Sulfamethoxazole (trimethoprim (bactrim))

Answer 19

SSTI and UTI. Side effects are hepatotoxicity, nephrotoxicity and rash

Question 20

Metronidazole

Answer 20

coverage for anaerobic bacteria, good for intraabdominal infections in combon with other abx. Side effects are GI distress and confusion

Question 21

Fluroquinolones & Tendinitis/Tendon Rupture

Answer 21

Levofloxacin and ciprofloxacin,

Stop taking at first sign of tendon pain, swelling or inflammation and contact provider promptly to change antibiotic.

High risk patients are:
Age >60yr
Concomitant corticosteroid use
Kidney failure
Previous tendon disorder
Solid organ transplant
Strenuous physical activity
Long FQ duration and higher doses
Diabetes

Question 22

Daptomycin

Answer 22

Used for skin and other infections, activity against MRSA, side effects include myopathy

Question 23

Nitrofuranatoin

Answer 23

used for UTIs. Side effects are neurotoxicity and hepatotoxicity but both are rare.

Question 24

Antibiotic Stewardship

Answer 24

Appropriate spectrum empiric prescribing
Appropriate durations
Completing antibiotic courses
Judicious initiation
Timely de-escalation

Question 25

Anti-herpes: Acyclovir and Valacyclovir

Answer 25

Used to treat HSV-1, HSV-2, and varicella-zoster, Can be used as suppressive (preventive) therapy in certain patients. Side effects include GI upset, headaches, dizziness, and crystalluria with IV administration

Question 26

Anti-herpes: Docosanol (Abreva)

Answer 26

Topical drug used to treat herpes lesions around the mouth. Needs to be applied early in course. Side effects include local skin irriation and headache

Question 27

Ganciclovir and Valganciclovir

Answer 27

Treats CMV infections, ADE is bone marrow suppression, severe neutropenia (requiring discontinuation)

Question 28

Foscarnet

Answer 28

Treats CMV retinitis. ADE is nephrotoxicity

Question 29

Cidofovir

Answer 29

Treats CMV retinitis. ADE is nephrotoxicity, neutropenia

Question 30

Anti-influenza: Oseltamivir (tamiflu)

Answer 30

effective against influenza A and B, best if used within 48 hours of symptom onset, used for treatment or prophylaxis in high-risk patients. Side effects include CNS effects (hallucinations) and nausea, vomiting.

Question 31

Systematic (IV) antifungal medications

Answer 31

Azoles, echinocandins, Amphotericin B (highest spectrum of activity, adverse effects are infusion reactions like joint/muscle pain, muscle weakness, and nephrotoxic. Not well tolerated at all)

Question 32

What 2 drugs can cause extrapyramidal symptoms?

Answer 32

Metoclopramide
Prochlorperazine

Question 33

What 2 medications are only indicative of C. diff?

Answer 33

Oral vancomycin
Fidaxomicin