Module 8 GI

Question 1

Most cases of diverticulitis are symptomatic or asymptomatic?

Answer 1

Asymptomatic

Question 2

Where do most diverticulitis occur?

Answer 2

SIgmoid and descending colon

Question 3

How does intraluminal pressure affect diverticulitis?

Answer 3

More cases occur in the colon where intraluminal pressure are the highest

Question 4

Name the symptoms involved in a colonic diverticulum perforation

Answer 4

Pain to Left Lower Quadrant
Left Lower Quadrant Mass
Fever
Leukocytosis
Constipation or loose stools
N/V
Stool occult blood

Question 5

What is the pharmacological treatment for mild diverticulitis cases?

Answer 5

Augmentin 875/125mg BID or metronidazole 500mg TID
plus
Ciprofloxacin 500mg BID or Bactrim 160/800 BID
x7-10 days or until afebrile for 3-5 days

Question 6

What is the pharmacological treatment for severe cases of diverticulitis?

Answer 6

IV antibiotics for 5-7 days, then oral:

second gen cephalosporin, piperacillin-taxobactam, or ticaricillin clavulanate

Question 7

This is a chronic, recurrent disease with diffuse mucosal inflammation involving only the colon (can involve the rectum).

Answer 7

Ulcerative colitis

Question 8

This is a chronic, recurrent disease involving patchy transmural inflammation and any part of the GI tract.

Answer 8

Crohn’s Disease

Question 9

What are the 4 pharmacologic agents used in treating ulcerative colitis and Crohn’s Disease?

Answer 9

5-Aminosalicylic acid derivatives, corticosteroids, immunomodulating agents, and biologic agents

Question 10

What are the side effects of 5-Aminosalicylic acids?

Answer 10

nausea, rash, diarrhea, pancreatitis, acute interstitial nephritis

Question 11

Why are 5-Aminosalicylic acids used in the treatment of ulcerative colitis and Crohn’s Disease?

Answer 11

anti-inflammatory effects targeting the intestinal tract

Question 12

What are the 2 most commonly used (and doses) 5-Aminosalicylic acids?

Answer 12

Asacol 2.4-4.8g/d or Pentasa 4g/d

Question 13

What are the 3 most common antibiotics used in treating Crohn’s disease?

Answer 13

Metronidazole 10mg/kg/day
Ciprofloxacin 500mg BID
Rifaximin 400mg TID
for 6-12 weeks

Question 14

Which corticosteroids are used for mild-moderate cases of inflammatory bowel disease? for severe cases?

Answer 14

Mild to moderate: Budesonide (Entocort) 9mg/day for 8-16 weeks
Severe cases: Prednisone or methylprednisolone for 8-16 weeks, 5-10 weeks for UC

Question 15

What are the adverse effects of short term use of corticosteroids?

Answer 15

Mood changes, insomnia, wt gain, edema, dyspepsia, elevated glucose, acne, moon facies

Question 16

What are the adverse effects of long term use of corticosteroids?

Answer 16

osteoporosis, myopathy, cataracts, susceptibility to infections

Question 17

What are the preferred immunomodulating drugs used in treatment of inflammatory bowel disease?

Answer 17

mercaptopurine or axathioprine more often than methotrexate

Question 18

Why would immunomodulating drugs be used for inflammatory bowel disease?

Answer 18

for those that do not respond to corticosteroids or those that need repeated courses

Question 19

Name the most common H2RA’s.

Answer 19

cimetidin (Tagamet)
ranitidine (Zantac)
famotidine (Pepcid)
nizatidine (Axid)

Question 20

Name the most common PPIs.

Answer 20

omeprazole (Prilosec)
esomeprazole (Nexium)
lansoprazole (Prevacid)
pantoprazole (Protonix)

Question 21

Name the types of laxatives.

Answer 21

stimulants
osmotics
bulk-producing
lubricants
surfactants
hyperosmolar

Question 22

What is the first line therapy for treatment of PUD with H. pylori?

Answer 22

PPI plus clarithromycin 500mg BID plus amoxicillin 1g BID

Question 23

How does one treat GERD?

Answer 23

step 1: antacids and lifestyle modifications
step 2: lifestyle modifications and H2RA
step 3: lifestyle modifications and PPI
then step down as symptoms are controlled

Question 24

How does one treat PUD?

Answer 24

step 1: lifestyle modifications and antacids
step 2: H. pylori testing and PPI
step 3: treatment for H. pylori and PPI
refer to gastroenterologist for any alarm symptoms or bleeding

Question 25

What medication is sometimes used as part of the multidrug regimen in treating H. pylori?

Answer 25

bismuth subsalicylate

Question 26

What is sucralfate and when is it used?

Answer 26

a cytoprotective agent, it is a basic aluminum salt that binds to necrotic ulcer tissue to cover and protect the site. also stimulate endogenous prostaglandin synthesis. Used in PUD, but not as a healing agent.

Question 27

Which cytoprotective agent is pregnancy category X?

Answer 27

Misoprostol

Question 28

Name the most common phenothiazines and what are they used for?

Answer 28

Antiemetics: prochlorperazine (Compazine)

promethazine (Phenergan)

Question 29

Which antihistamines are used for nausea?

Answer 29

dimenhydrinate (Dramamine)
diphenhydramine (Benadryl)
hydroxyzine (Vistaril)
meclizine (Antivert)

Question 30

Which medications block the CTZ (chemoreceptor trigger zone)?

Answer 30

phenothiazines

Question 31

Which medications are used to treat nausea and vomiting due to gastroenteritis?

Answer 31

5-HT3 receptor antagonists and phenothiazines

Question 32

Which medications are best used for motion sickness?

Answer 32

antihistamines

Question 33

Which medications decrease gastric acid secretion by only 35-50%?

Answer 33

H2RAs

Question 34

Which H2RA is contraindicated in liver disease?

Answer 34

ranitidine (Zantac)

Question 35

Which PPI is pregnancy category C?

Answer 35

omeprazole (Prilosec)

Question 36

What are the drug interaction concerns with PPIs?

Answer 36

CYP450
ketoconazole
digoxin
warfarin
black box warning with clopidogrel