NV,D,C,IBS,GERD/PUD Flashcards
antihistamine options for NV
dimenhydrinate
diphenhydramine
meclizine
doxylamine
scopolamine
hydroxyzine
generic for Bonine
meclizine
generic for Unisom
doxylamine
generic for dramamine
dimenhydrinate
phenothiazines used for NV
promethazine
prochlorperazine
generic name for phenergan
promethazine
genetic name for compazine
prochlorperazine
side effects of phenothiazines
hypotension, QTcP, EPS
BBW for phenergan (promethazine)
tissue damage – DO NOT GIVE IV
main 5-HT3 antagonist used for NV
ondansetron (zofran)
side effects of zofran
constipation, headache, QTcP
prokinetics used for NV
metoclopramide
erythromycin
generic for reglan
metoclopramide
side effects of Reglan
EPS, QTcP, diarrhea
side effects of erythromycin
NV, diarrhea, QTcP
corticosteroid used for NV
dexamethasone
1st and 2nd line for general NV
- 5HT3 > metoclopramide
- phenothiazine
first line for disorders of balance
antihistamines
1st and 2nd line for NV of pregnancy
- antihistamines + B6
(doxylamine/Unisom + B6)
Diclegis or Bonjesta if OTC do not work - 5-HT3 > metoclopramide
1st and 2nd line for gastroparesis
- metoclopramide
- erythromycin
Apfel Criteria for post-op NV (4)
female
nonsmoker
hx of motion sickness or PONV
planned used of post-op opioids
what treatment is used for PONV if score 4 (high risk)
scopolamine patch 2 hours before anesthesia
IV dexamethasone after anesthesia
5HT3 at end of surgery
treatment for moderate risk PONV (score 2-3)
5HT3 at end of surgery
treatment for low risk PONV (score 0-1)
no planned therapy
rescue therapy for PONV
5HT3 antagonist or drug from another class
general approach of treatment for acute constipation
osmotic, sitmulant
general approach of treatment for chronic constipation
- bulk forming
- osmotic/stimulant
therapies used for chronic idiopathic constipation
lubiprostone
linaclotide
plecanatide
generic for amitiza
lubiprostone
generic for linzess
linaclotide
generic for trulance
plecanatide
side effects of lubiprostone
diarrhea and nausea
side effects of linzess
diarrhea
side effect of plecanatide
lower diarrhea rate
1st and 2nd line OTC options for opioid induced constipation
- osmotics- miralax, lactulose
- stimulants- bisacodyl, senna
RX options for opioid induced constipation
methylnaltrexone
naloxegol
naldemidine
lubiprostone
generic for Relistor
methylnaltrexone
generic for Movantik
naloxegol
generic for Symproic
naldemidine
what class of drugs is relistor, movantik, and symproic
M receptor peripheral antagonists
treatment options for diarrhea (3)
loperamide
diphenoxylate + atropine
octeotride
generic for Lomitol
diphenoxylate + atropine
why is atropine in Lomitol?
limits abuse, drug is a control
self care diarrhea options
pepto bismol, pedialyte, imodium
chronic pain at least 1 day a week in the last 3 months associated with defecation, change in stool frequency, and change in stool consistency
IBS diagnosis criteria
treatment options for IBS-C (5)
lubiprostone
linaclotide
procanatide
tenapanor
Tegaserod
generic for Ibsrela
tenapanor
side effect of IBS-C treatment
diarrhea
treatment for IBS-D (3)
rifaximin
eluxadoline
alosetron
generic for xifaxan
rifaximin
generic for Viberzi
eluxadoline
generic for lotronex
alosetron
when is xifaxan considered? what is the course of therapy?
SIBO present
14 day course repeated twice PRN
what is the REMS for alosetron
severe constipation and ischemic colitis
discontinue in 4 weeks if no benefit occurs
what is the adverse event associated with viberzi
sphincter of oddi spasm/dysfunction
contraindications to viberzi
pancreatitis, alcoholism of 3 or more drinks/day, do not have a gallbladder
due to sphincter of oddi effect
options for any subtype of IBS
antidepressants (TCAs, SSRIs)
soluble fiber
Dicyclomine
heartburn > 3months or refractory to OTC therapy
GERD
empiric treatment started with > 3months of refractory GERD
lifestyle mod + 8 weeks PPI QD
what to do after initial GERD treatment if symptoms
resume?
improve?
do not improve?
resume- find lowest dose
improve- d/c therapy
do not improve- continue PPI, consider +/- H2RA PRN, go to BID PPI
when is long term PPI treatment required for GERD
Barrett’s esophagus
strictures
severe erosive esophagitis
potential outcomes from long term PPI use
C diff, gastroenteritis, SIBO, pneumonia, CKD + AKI, bone fracture, dementia, MI
stomach acid eating away at the GI lining
PUD
2 major causes of PUD
H. pylori
NSAIDs
diagnosis for NSAID PUD
EGD when symptoms + history
diagnosis for H pylori PUD
Invasive- EGD, tissue sample + culture
Noninvasive- Ab blood test, UBT
treatment of H. pylori PUD
14 day therapy with antibiotics + PPI
triple therapy regimen for H pylori PUD
PPI BID
clarithromycin 500 mg BID
amoxicillin 1 g BID
bismuth quad therapy regimen for H pylori PUD
PPI BID
bismuth salicylate/subcitrate
tetracycline 500 mg QID
metronidazole 250 mg QID
when is PUD prophylaxis required with NSAID use
DAPT (ASA + P2Y12)
multiple risk factors present
treatment of NSAID PUD
PPI QD x 4-8 weeks if d/c NSAID
chronic PPI if cannot d/c NSAID
acid suppression regimen for UGIB
IV PPI x 3 days: 80 mg panto/eso bolus then 40 mg IV BID
discharge on BID PO x 2 weeks then switch to QD
generic for zegerid
omeprazole
generic for prevacid
lansoprazole
generic for aciphex
rabeprazole
generic for protonix
pantoprazole
generic for nexium
esomeprazole
generic for dexilant
dexlansoprazole
generic for tagamet
cimetidine
generic for pepcid
famotidine
genetic for axid
nizatidine
generic for zantac
ranitidine