GI PACKET 1 TX Flashcards
TREATMENT of FUNCTIONAL DYSPEPSIA
- Tell the pt the condition is not serious but may be CHRONIC
- Eliminate ____ and _______
- ½ pts get relief from PLACEBO (__ blockers are only marginally better)
- Low doses of ________ may moderate visceral afferent sensitivity
o Desipramine (Norpramin) or Nortriptyline (Pamelor)
- Cognitive behavior therapy or other psychotherapies
H PYLORI POSITIVE PATIENTS
o Abx therapy cures 90% of pts with peptic ulcers & may improve S/S of functional dyspepsia
o Triple therapy: _____ + ______ + _______(or quadruple therapy with PPI)
caffeine, ETOH
H2
antidepressants
amoxicillin, clarithromycin, lansoprazole
NAUSEA & VOMITING
- Acute vomiting = most cases are mild, self-limited = NO SPECIFIC TREATMENT
o Try clear liquids and crackers - Severe, acute vomiting –> may need ________ (if showing symptoms of dehydration OR _______with metabolic alkalosis)
- To maintain hydration –> IV 0.45% _____ with 20 meq/L __________ (standard IV bag)
- Use nasogastric suction tube for gastric decompression (for comfort)
- ANTI-EMETICS
1. Serotonin 5-HT3 receptor antagonists ¬– ___________(ZOFRAN)
o Approved for preventing chemotherapy and radiation induced N/V
o Often used for other indications like pre-surgery, pregnancy, etc.
o Side effects = very “clean” meds, FEW side effects or interactions
2. ________ – PREDNISONE, DEXAMETHASONE
o Used for chemo/radiation induced N/V (often used in combo with ____)
o MOA is unknown
o Side effects = ___, don’t use long-term
3. ___________antagonists – APREPITANT (CINVANTI)
o Newer meds; injectable forms
o Used in cancer patients, often in combo with Zofran or corticosteroids
4. _____ antagonists – PROCHLORPERAZINE (COMPRO), PROMETHAZINE (PHENERGAN)
o Side effects = extrapyramidal symptoms (________, tics) and ________
5. Antihistamines and Anticholinergics
o Prevention of vomiting arising from stimulation of the labyrinth (ex. motion sickness, vertigo, migraines)
o Side effects = ________
o Side effects of anticholinergics in elderly
6. _______
hospitilization
hypokalemia
saline, potassium chloride
odansetron corticosteroids zofran LOTS neurokinin receptor dopamine muscle twitches, depression drowsiness cannibinoids
HICCUPS TREATMENT - Usually \_\_\_\_\_ and self-limiting - Acute benign hiccups: tongue traction, lift uvula with spoon, stimulate \_\_\_\_\_\_\_\_ with a catheter, eat 1 tsp dry \_\_\_\_\_\_, hold breath, rebreathe into bag, carotid massage - Persistent hiccups: o TREAT PREDISPOSING CAUSE o Drugs: \_\_\_\_\_\_\_\_ (Thorazine)
benign
nasopharynx
granulated sugar
chlorpromazine
CONSTIPATION
TREATMENT
- DIET = ____ & ______
o May cause temporary distension and flatulence
o Fiber benefits most patients
o Will NOT benefit patients with severe colonic inertia or outlet disorders
- FIBER SUPPLEMENTS
o ____ Powder: 1-4 tbsps twice daily mixed with fluids or sprinkled over foods; provides 20-40 g/d of fiber –> may be gas producing
o Drug Supplements –>less gas producing
_____ (Metamucil, Perdiem)
_______ (Citrucel)
Polycarbophil (FiberCon)
Guargum (Benefiber)
- MEDICATIONS
1. OSMOTIC LAXATIVES
o Used to soften stools
o May be given alone or with fiber supplements
o Can safely use ______
o Titrate until they produce soft to semiliquid stools
TYPES:
NONABSORABLE SUGARS – _______ OR LACTULOSE
May cause increased bloating, cramps, flatulence
POLYETHYLENE GLYCOL – MIRALAX OR GoLYTELY, CoLYTE, NuLYTE
Usually used for colonic lavage before colonoscopy
Can also use daily at 200-1000 mL
MAGNESIUM SALTS – MAGNESIUM HYDROXIDE OR MAGNESIUM SULFATE
Should NOT be given to _____ patients – patients with chronic renal insufficiency
2. STOOL SURFACTANT AGENTS –____________ (COLACE) not a laxative, often given with stimulant
o Softens stools
o Can give orally or rectally
3. STIMULANT LAXATIVES – _______, CASTOR OIL, ______ (OTC laxative), CASCARA (nature’s remedy, causes cramps)
o Stimulate fluid secretion and contraction of the colon
o Resulting in a bowel movement within ___ hours after oral administration OR 15-60 minutes after rectal administration
o May cause severe cramps and diarrhea
o DO NOT use chronically –> may cause loss of ___ function of colon
- In severe constipation–> use ____ first before giving laxative
o Types: saline enemas, soapsuds enema (for impaction), tap-water enemas (irritating), oil retention enemas (for hard or impacted stool)
- TREATMENT FOR FECAL IMPACTION:
o Severe impaction of stool in rectal vault can stop any further fecal flow
o Can cause partial or complete large bowel obstruction
o PREDISPOSING FACTORS: medications (opioids), patients with psychiatric problems, prolonged bed rest and debility, neurogenic disease of the colon, spinal cord disease
o S/S
Decreased appetite
N/V, Abdominal pain, abdominal distension
Diarrhea from liquid leaking around impaction
Firm feces palpable on digital rectal exam
FLUID, FIBER bran psyllium methylcellulose long-term SORBITOL
RENAL
DOCUSATE SODIUM
BISACODYL
SENNA
6-12 hours
neuro
ENEMA
ACUTE DIARRHEA
TREATMENT
- DIET
o REST THE BOWEL –> AVOID high-__ foods, fats, milk products, caffeine, ETOH
o FREQUENT FEEDINGS OF –> ____ drinks, tea, “___” carbonated drinks, and soft, easily digested foods (soup, crackers, bananas, applesauce, rice, toast)
- REHYDRATION
o Pedialyte or ______
o Severe dehydration –< IV fluids (lactated ringer injection)
- ANTIDIARRHEAL AGENTS
o _____ agents –> decrease stool number and liquidity and control fecal urgency
o NOT to be used with ____ diarrhea, high ____, or systemic toxicity (can induce toxic megacolon, which is an extremely dilated colon with high risk for perforation) *DO NOT GIVE TO PATIENTS WITH ____ *
o If a candidate, use:
1. ______ (Imodium)
It is an opiate receptor agonist
Signals opioid receptors in the body to keep working
2. Bismuth Subsalicylate (Pepto-Bismol)
Reduces symptoms in ________
Reduces vomiting with viral enteritis
- ANTIBIOTICS – EMPIRIC TREATMENT ARE THE ____________
o Ciprofloxacin (Cipro), Ofloxacin (Floxin), Norfloxacin (Noroxin) – ALL FOR 5-7 DAYS
o Rifaximin = empiric treatment of noninflammatory traveler’s diarrhea
o Do NOT use macrolides and penicillins due to widespread resistance
- SPECIFIC ANTIMICROBIAL TREATMENT
o Antibiotics are NOT recommended for nontyphoid Salmonella, Campylobacter, STEC, Aeromonas, or Yersinia – except in severe disease
o Continued antibiotic treatment is recommended for shigellosis, cholera, extraintestinal salmonellosis, listeriosis, and C. diff
fiber fruit flat Gatorade Opioid bloody, fever C DIFF Loperamide traveler's diarrhea FLUOROQUINOLONES
chronic diarrhea
TREATMENT
- MEDICATION OPTIONS (AS LONG AS NOT BLOODY/SUSPECTING C DIFF)
o _______
o Diphenoxylate with atropine (Lomotil)
o Codeine and deodorized tincture of opium
o ________ (Catapres)
o Cholestyramine (Questran) – for diarrhea secondary to intestinal resection or ileal disease
loperamide
clonidine
ESOPHAGITIS
TREATMENT:
- Candida esophagitis: antifungal –> ______ 400 mg qd PO x 2-3 wks
- CMV esophagitis: if HIV+ HAART (HIV tx) + GANCICLOVIR
- Herpes simplex: immunocompromised pts –> oral ______ 400 mg 5x/day x 2-3 wks
FLUCONAZOLE
ACYCLOVIR
EOSINOPHILIC ESOPHAGITIS
- TREATMENT:
o 1st line: trial of ___ BID x 2 mo up to 50% have dramatic improvement of s/s
o Refer to allergist
PPI
ESOPHAGEAL/PEPTIC STRICTURES TREATMENT: - Effective tx is by DILATION with flexible \_\_\_\_(under fluoroscopic guidance), catheters, or balloons o Needs one or many sessions - Long term \_\_ can decrease recurrence
bougies
ppi
WEBS/RINGS
TREATMENT: ____ (balloon) dilator follower by a ___ to prevent recurrence
bougie, ppi
GERD
TREATMENT OF GERD:
- LIFESTYLE MODIFICATIONS: for all symptomatic GERD pts
o ____when appropriate
o Avoid alcohol, caffeine, chocolate, large meals
o Stop smoking
o Avoid ___ juice and tomato-based foods
o ____ head of the bed
o Wait __ hours after a meal before reclining
- MILD S/S: infrequent symptoms
o lifestyle modifications & antacid
_____ provide symptomatic, immediate relief of heart burn
most antacids are OTC (i.e. TUMS)
DO NOT USE ANTACIDS with _______ IN RENAL FAILURE
o ______: anti-gas that reduces reflux feeling in upright position
o _____ if symptoms persist (all available OTC) – have a delay in onset (30 min or more) but longer duration of action (up to 8 hrs)
“idine” (TAGAMET, ZANTAC, AXID, PEPCID)
o combo agents = Ca and Mg antacid + Pepcid (H2 blocker)
- MODERATE S/S: symptoms several times per week or daily (uncomplicated GERD)
o PPI – “-prazole” (PRILOSEC, ACIPHEX, PEVACID, NEXIUM, PROTONIX) try for 4-8 weeks then assess
if response is good –> continue for 8-12 weeks then d/c
if relapse –> continuous therapy, intermittent 2-4 wk courses, or “on demand” therapy until s/s go away
SIDE EFFECTS OF LONG TERM USE OF PPI’S: ↑ infections (____), iron & B12 deficiency, ↓ Mg, pneumonia, hip fractures due to impaired Ca++ absorption
- SEVERE SYMPTOMS & EROSIVE DISEASE:
o If they fail to respond to PPI –> ______(may not have GERD)
o DDX: eosinophilic esophagitis, achalasia, ZE syndrome, etc.)
- REFRACTORY GERD consider:
o Gastrinoma with gastric hypersecretion (Zollinger-Ellison syndrome)
o Pill-induced esophagitis
o Resistance to PPIs
o Medical noncompliance
*** if pH monitoring shows normal amt of reflux–> try low dose ________
- ABLATION: endoscopic ablation for patients with progressive disease (Baretts, poorly controlled s/s, extraesophageal manifestiations)
- New devices (LINX) can treated GERD: minimally invasive magnetic artificial sphincter
o Flexible, elastic string of titanium beads placed laparoscopically below diaphragm at GE jxn (good alternative to fundoplication surgery)
o fixes the LES to expand for during swallowing and close after swallowing
weight loss citrus elevate 3 antacids magnesium Gaviscon H2 blockers C DIFF endoscopy tricyclic antidepressant
ESOPHAGEAL CANCER
TREATMENT: depends if cancer is deemed curable (r_____, _____ and possibly chemo)
- if the cancer is deemed uncurable due to extensive localized spread or multiple mets, therapy goals = tx of ____
o can include palliative xray therapy or chemotherapy
radiation, resection
symptoms
ACHALASIA
TREATMENT:
- _______ into LES —> temporary relief (given to pts who can’t tolerate invasive procedures)
- ______dilation of LES (to open up the narrowing)
- _____: to remove/dilate the non-functional area
endoscopic botox inj
surgical
myotomy
ZENKER’S DIVERTICULUM
TREATMENT for symptomatic pts = _____ (myotomy)
surgery
MALLORY WEISS TEARS
TREATMENT: most patients spontaneously stop bleeding w/o tx
- In refractory pts —>_____or endoscopic hemostatic therapies (______, banding, clipping)
EPI injections
coagulation
