IBD - GI

Question 1

metoclopramide MOA

Answer 1

dopamine antagonists enhances upper GI tract response to ACH to enhance motility - increases colon motility - shortens transit time

Question 2

metoclopramide uses

Answer 2

gastroparesis, persistent GERD, N/V - can be useful for diabetes - short term use only given risk of TD <12wks

Question 3

metoclopramide side effects

Answer 3

drowsiness, dystonia, HA

Question 4

metoclopramide caution with

Answer 4

BLACK BOX WARNING: can cause tardative dyskinesia (irreversible)
Cl: GI hemorrhage, mechanical obstruction, perforation

Question 5

domperidone MOA

Answer 5

peripheral dopamine antagonists increases esophageal peristalsis, gastric motility and gastric emptying decreases small bowel transit time

Question 6

domperidone uses

Answer 6

gastroparesis/motility disorder, N/V

Question 7

domperidone side effects

Answer 7

HA, migraines, xerostomia

Question 8

domperidone caution with

Answer 8

BLACK BOX WARNING: increased risk of cardiac arrhythmias or sudden cardiac death
caution with other QT prolonging agents
Cl for patients with prolactinomas

Question 9

erythromycin MOA

Answer 9

macrolide antibiotics - motilin agonists - increases gastric contractions

Question 10

erythromycin uses

Answer 10

gastroparesis - use for max 4 wks duration d/t tachyphylaxis

Question 11

erythromycin side effects

Answer 11

cardiovascular arrhythmias, QT prolongation, superinfection (c diff)

Question 12

erythromycin caution with

Answer 12

major inhibitor of CYP3A4
myasthenia gravis - may exacerbate or cause symptoms

Question 13

neostigmine MOA

Answer 13

acetylcholinesterase inhibitor

Question 14

neostigmine use

Answer 14

acute colonic pseudo - obstruction - myasthenia gravis - post op bladder distention/urinary frequency

Question 15

neostigmine side effects

Answer 15

cardiac arrhythmias - especially bradycardia
dizziness, drowsiness, diarrhea

Question 16

neostigmine caution

Answer 16

cardiovascular disease

Question 17

aminosalicylates MOA

Answer 17

work topically on affected/inflamed areas of mucous - anti-inflammatory and immunosuppressive activity

Question 18

prodrug of aminosalicylates

Answer 18

sulfasalazine

Question 19

sulfasalazine side effects

Answer 19

nausea, HA, rash, arthralgia, bone marrow suppression
oligospermia in men (infertility) - reversible

Question 20

sulfasalazine caution with

Answer 20

impairs folate absorption - supplement with daily folate

Question 21

mesalamine side effects

Answer 21

nausea, HA, diarrhea, abd pain
nephrotoxicity/intestinal nephritis (rare)

Question 22

mesalamine drug interactions

Answer 22

antacids, H2RAs, PPIs can diminish efficacy

Question 23

mesalamine caution with

Answer 23

severe renal or hepatic impairment

Question 24

immunosuppressants MOA

Answer 24

immunosuppressant

Question 25

immunosuppressants use

Answer 25

induce or maintain remission in both UC and crohns - good for pts who cannot maintain remission when steroids are taped down - can reduce steroid dose

Question 26

azathoprine side effects

Answer 26

N/V, bone marrow suppression

Question 27

azathoprine drug interactions

Answer 27

avoid with allopurinol - leukopenia

Question 28

azathoprine caution with

Answer 28

BLACK BOX WARNING: chronic immunosuppression increases the risk of malignancy

Question 29

methotrexate MOA

Answer 29

immunosuppressant, anti-inflammatory for IBD, acts as a folate antagonists, inhibiting DNA synthesis repair and cellular replication

Question 30

methotrexate side effects

Answer 30

diarrhea, N/V, alopecia, bone marrow suppression, muscositis severe possibly fatal skin reactions - SJS/TEN

Question 31

methotrexate interactions

Answer 31

BLACK BOX WARNING: unexpectedly severe bone marrow suppression and aplastic anemia reported in some patients with concomitant use of MTX

Question 32

methotrexate caution with

Answer 32

BLACK BOX WARNING: possibly of serious toxic/fatal side effects - closely monitor for bone marrow, liver, lung, skin, and kidney toxicities including: hepatotoxicity (monitor LFTs), PPI, lung disease, malignant lymphomas teratogen - cl in pregnancy give folic acid to reduce effects of side effects

Question 33

umabs administration

Answer 33

induction dose (wks 0, 2, 6) - maintenance dose every 8 wks labs every 2 wks for 2 mo drug level every 3-4 mo repeat colonoscopy at 6 mo must get PPD prior to initiating therapy and while on treatment

Question 34

umabs side effects

Answer 34

injection site reactions infusion reaction acute and delayed 2 wks - skin rash, joint pain, myalgia, fever can premedicate with benadryl to avoid this HA, abd pain, liver toxicity, HF, infections, URIs rare: t cell lymphoma

Question 35

umabs drug interactions

Answer 35

risk of infection is worse with concomitant immunosuppression no live vaccines while on therapy

Question 36

umabs caution with

Answer 36

BLACK BOX WARNING: serious infections d/t immunosuppression heart disease liver disease

Question 37

glucocorticoids MOA

Answer 37

inhibits production of inflammatory cytokines and inhibits migration of inflammatory migration of inflammatory cells to affected area

Question 38

glucocorticoids uses

Answer 38

moderate - severe crohns and UC - helpful in early treatment and during flares

Question 39

rectal glucocorticoids

Answer 39

hydrocortisone

Question 40

glucocorticoids side effects

Answer 40

hyperglycemia adrenal suppression peptic ulcers immunosuppression anxiety/jittery sodium/fluid retention

Question 41

glucocorticoids caution with

Answer 41

HF, HTN, diabetes (hyperglycemia), cataracts, glaucoma (increased pressure) liver disease - may have decreased conversion of prednisone - prednisolone