N/V/D/C, pancreatitis, IBS Flashcards
nausea DOC for general medical use
phenothiazines (promethazine, prochlorperazine) or serotonin antagonists (ondansetron, granisetron ,palonosetron)
nausea DOC for chemo
serotonin antagonists (ondansetron, graniestron, palonosetron)
NK1 antagonist (aprepitant, fosaprepitant, netupitant/palonosetron, rolapitant)
dexamethasone
olanzapine
nausea DOC postop
serotonin antagonist (ondansetron, granisetron, palonosetron)
scopolamine
dexamethasone
nausea DOC motion sickness
antihistamine
scopolamine
nausea DOC pregnancy
emeterol (phosphorylated carbohydrate solution)
pyridoxine w/ or w/o doxylamine
ginger
nausea DOC gastroparesis
metoclopramide
phenothiazines
promethazine, prochloperazine
both antidopaminergic = EPS risk
promethazine also antihistamine, anicholinergic
do not give either SC
palonosetron duration of action
long, 1-5 days. only 1 dose required
haloperidol & Droperidol requirement for n/v
EKG at baseline and 2-4 hours post
qtc risk
neurokinin 1 antagonists
aprepitant, fosaprepitant, netupitant/palonosetron, rolapitant
emend may reduce efficacy of warfarin/birth control
Rolapitant has long half life of 7 days
can you cut scopolamine patch
no
dronabinol, nabilone
delta-9 tetrahydrocannabinol targeting endogenous cannabinoid receptors
use for chemo induced n/v
Local complications of pancreatitis
late phase of pancreatitis (>1 week)
necrosis, hemorrhage, pseudocyst, abscess, infection
drug-induced pancreatitis
Amiodarone
Azathioprine/mercaptopurine
cannabis
diuretics
estrogen
exenatide
mesalamine/sulfasalazine
pentamidine
sitagliptin
tetracycline
bactrim
valproic acid
other notable causes of pancreatitis
trigs >1000
toxin - scorpion venom
long-term alcohol abuse
gallstones
lipase in pancreatitis
> 3x ULN - most sensitive test for diagnosis
Acute pancreatitis treatment
-NS or LR 250-500ml/hr
-IV narcotics, avoiding meperidine
-IV zofran, prochlorperazine, promethazine
avoid TPN and antibiotics (unless necrosis)
Reversible once cause addressed
Chronic pancreatitis management
-abstinence from alcohol
-narcotics + nonnarcotics
-pancreatic enzyme replacement
-oral zofran, prochlorperazine, promethazine
-antioxidant
Pancreatic enzyme replacement
Recommended if pt has weight loss, malnutrition, diarrhea, steatorrhea, osteoporosis/penia
Dose based on lipase, starting with 40-50,000 unit per meal, half dose for snacks or 500-1000 unit/kg/meal
May need to add PPI if max response not seen (must have PPI with Viokace)
Pancreatic enzyme derivation
porcine pancreas - avoid in pork allergy
drug-induced diarrhea
acarbose/miglitol
ABX
antineoplastics
colchicine
digoxin
over replacement of levothyroxine
metoclopramide
NSAIDs
misoprostol
orlistat
sorbitol
avoid bismuth subsalicylate in these pts
salicylate allergy
<12 y/o
pregnant or nursing
caution anticoagulants
ART-associated diarrhea in HIV tx
crofelemer (mytesi)
loperamide BBW
TdP
cardiac arrest
death
all in higher-than-recommended doses
drug-induced constipation
aluminum containing meds (antacid, sucralfate)
antihistamine
benzo
BAS
CCB
calcium
diuretics
iron supplement
opioid
phenothiazine
scopolamine, benztropine
TCAs
onset of mag citrate, mag hydroxide, sodium phosphate
15 min - 3 hours
glycerin suppository onset
1 hour
lactulose onset
1-2 days; may also cause gas, bloating
polyethylene glycol onset
1-3 days
bisacodyl onset
6-12 hours
suppository - 1 hour
senna onset
6-12 hours
fiber onset
12-72 hours
safe in pregnancy
linaclotide (linzess) & plecanatide (trulance)
IBS-C and CIC
guanylate cyclase C agonist (increases fluid secretion and transit time)
may cause severe dehydration
m
CI in <2y/o (linzess) and <6y/o (trulance). avoid both in 6-17
methylnaltrexone onset
4 hours
opioid induced constipation treatment options
methylnaltrexone (relistor)
naldemedine (symproic)
naloxegol (movantik)
prucalopride
serotonin agonist specific for GI serotonin receptors
warning for suicide
docusate onset
1-6 days
lubiprostone (amitiza)
indication: CIC, OIC, IBS-C in women >18 y/o
Need negative pregnancy test before initiation
take with food
tenapanor (ibsrela)
agent for IBS -C
CI <6 y/o and not recommended <18 d/t severe dehydration
antispasmodics for IBS
dicyclomine
hyoscyamine
peppermint oil (may worsen GERD)
TCA for IBS
slow motility in IBS-D, can be used in IBS-C but may worsen constipation
amitriptyline, nortriptyline, imipramine
laxatives for IBS-C
psyllium = best evidence
avoid stimulants, can worsen abdominal pain
IBS-C treatments with global effects
linaclotide (linzess), lubiprostone (amitiza), plecanatide (trulance)
= may decrease abdominal pain, bloating, flatulence
IBS-D treatments
eluxadoline (viberzi) (CIV)
Alosetron (lotronex) - REMS
Rifaximin
