Module 8 GI Flashcards
Most cases of diverticulitis are symptomatic or asymptomatic?
Asymptomatic
Where do most diverticulitis occur?
SIgmoid and descending colon
How does intraluminal pressure affect diverticulitis?
More cases occur in the colon where intraluminal pressure are the highest
Name the symptoms involved in a colonic diverticulum perforation
Pain to Left Lower Quadrant Left Lower Quadrant Mass Fever Leukocytosis Constipation or loose stools N/V Stool occult blood
What is the pharmacological treatment for mild diverticulitis cases?
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
What is the pharmacological treatment for severe cases of diverticulitis?
IV antibiotics for 5-7 days, then oral:
second gen cephalosporin, piperacillin-taxobactam, or ticaricillin clavulanate
This is a chronic, recurrent disease with diffuse mucosal inflammation involving only the colon (can involve the rectum).
Ulcerative colitis
This is a chronic, recurrent disease involving patchy transmural inflammation and any part of the GI tract.
Crohn’s Disease
What are the 4 pharmacologic agents used in treating ulcerative colitis and Crohn’s Disease?
5-Aminosalicylic acid derivatives, corticosteroids, immunomodulating agents, and biologic agents
What are the side effects of 5-Aminosalicylic acids?
nausea, rash, diarrhea, pancreatitis, acute interstitial nephritis
Why are 5-Aminosalicylic acids used in the treatment of ulcerative colitis and Crohn’s Disease?
anti-inflammatory effects targeting the intestinal tract
What are the 2 most commonly used (and doses) 5-Aminosalicylic acids?
Asacol 2.4-4.8g/d or Pentasa 4g/d
What are the 3 most common antibiotics used in treating Crohn’s disease?
Metronidazole 10mg/kg/day
Ciprofloxacin 500mg BID
Rifaximin 400mg TID
for 6-12 weeks
Which corticosteroids are used for mild-moderate cases of inflammatory bowel disease? for severe cases?
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
What are the adverse effects of short term use of corticosteroids?
Mood changes, insomnia, wt gain, edema, dyspepsia, elevated glucose, acne, moon facies
What are the adverse effects of long term use of corticosteroids?
osteoporosis, myopathy, cataracts, susceptibility to infections
What are the preferred immunomodulating drugs used in treatment of inflammatory bowel disease?
mercaptopurine or axathioprine more often than methotrexate
Why would immunomodulating drugs be used for inflammatory bowel disease?
for those that do not respond to corticosteroids or those that need repeated courses
Name the most common H2RA’s.
cimetidin (Tagamet)
ranitidine (Zantac)
famotidine (Pepcid)
nizatidine (Axid)
Name the most common PPIs.
omeprazole (Prilosec)
esomeprazole (Nexium)
lansoprazole (Prevacid)
pantoprazole (Protonix)
Name the types of laxatives.
stimulants osmotics bulk-producing lubricants surfactants hyperosmolar
What is the first line therapy for treatment of PUD with H. pylori?
PPI plus clarithromycin 500mg BID plus amoxicillin 1g BID
How does one treat GERD?
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
How does one treat PUD?
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
What medication is sometimes used as part of the multidrug regimen in treating H. pylori?
bismuth subsalicylate
What is sucralfate and when is it used?
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.
Which cytoprotective agent is pregnancy category X?
Misoprostol
Name the most common phenothiazines and what are they used for?
Antiemetics: prochlorperazine (Compazine)
promethazine (Phenergan)
Which antihistamines are used for nausea?
dimenhydrinate (Dramamine)
diphenhydramine (Benadryl)
hydroxyzine (Vistaril)
meclizine (Antivert)
Which medications block the CTZ (chemoreceptor trigger zone)?
phenothiazines
Which medications are used to treat nausea and vomiting due to gastroenteritis?
5-HT3 receptor antagonists and phenothiazines
Which medications are best used for motion sickness?
antihistamines
Which medications decrease gastric acid secretion by only 35-50%?
H2RAs
Which H2RA is contraindicated in liver disease?
ranitidine (Zantac)
Which PPI is pregnancy category C?
omeprazole (Prilosec)
What are the drug interaction concerns with PPIs?
CYP450 ketoconazole digoxin warfarin black box warning with clopidogrel
