Pancreatitis Exam 3

Question 1

exocrine functions of the pancreas

Answer 1

secretion of digestive enzymes

Question 2

endocrine functions of the pancreas

Answer 2

secretion of hormones

Question 3

exocrine secretions

Answer 3

• Centroacinar ductular cells secrete bicarbonate and other electrolytes to neutralize gastric acid when pancreatic juice enters the duodenum
• Amylase
• Lipase
• Trypsinogen
• Ribonuclease and deoxyribonuclease
• Trypsin inhibitor

Question 4

Amylase

Answer 4

Digestion of starches and glycogen through hydrolysis

Question 5

Lipase

Answer 5

Breaks down triglycerides, cholesterol and other fats

Question 6

Trypsinogen

Answer 6

Digests proteins into oligopeptides and free amino acids

Question 7

Ribonuclease and deoxyribonuclease

Answer 7

Break down nucleic acids

Question 8

Trypsin inhibitor

Answer 8

Reduces activity of trypsin

Question 9

medications associated with acute pancreatitis

Answer 9

• Azathioprine
• Didanosine
• Enalapril
• Mercaptopurine
• Mesalamine
• Valproic acid/salts

Question 10

What is the goal for treating pancreatitis?

Answer 10

relieve abdominal pain, nausea and vomiting, replace fluid and electrolytes, and prevent complications

Question 11

Nonpharmacologic for treating pancreatitis

Answer 11

• Biliary sphincterotomy and ERCP: remove biliary tract stones in severe biliary pancreatitis or cholangitis
• Surgery: Pseudocysts, Abscesses, Hemorrhagic or necrotic tissue
• NPO initially to allow pancreas to rest (if given food, will lead to pancreas secreting enzymes then will lead to inflammation, pain, N/V)
• Enteral nutrition or TPN if oral med held for > 1 week

Question 12

Pharmacologic for treating pancreatitis: first thing to do within 24 hours

Answer 12

• fluid resuscitation reduces morbidity and mortality
• Bolus of 15-20 mL/kg followed by ~250mL/hr maintenance
• Monitor: hematocrit, BUN and serum creatinine to assess for successful hydration; watch for fluid overload

Question 13

Pharmacologic for treating pancreatitis: abdominal pain control

Answer 13

Parenteral opioids preferred (e.g. IV morphine or hydromorphone)

Question 14

Pharmacologic for treating pancreatitis: N/V

Answer 14

• Intravenous antiemetics due to inability to tolerate oral medications such as ondansetron or prochlorperazine, topical promethazine also a choice
• Antisecretory agents (PPI or H2 antagonist) to prevent stress related ulcers in severe pancreatitis

Question 15

Pharmacologic for treating infected necrotizing pancreatitis

Answer 15

• Target gram negatives and anaerobes or percutaneous drainage
• Impipenem 500 mg q8 hr
• Fluoroquinolone + metronidazole (PCN allergy)
• Third generation cephalosporin + metronidazole

Question 16

Creon dosage forms

Answer 16

Enteric-coated minimicrospheres

Question 17

Pancreaze dosage forms

Answer 17

Enteric-coated minitablets / microtablets

Question 18

Pertzye dosage forms

Answer 18

Enteric-coated microspheres with bicarbonate buffer

Question 19

Ultresa dosage forms

Answer 19

Enteric-coated minitablets / microtablets

Question 20

Viokace dosage forms

Answer 20

• Tablets

- Not enteric coated, so must give with a proton pump inhibitor

Question 21

Zenpep dosage forms

Answer 21

Enteric-coated beads

Question 22

counseling points for pancrelipase products

Answer 22

• Must be taken with a meal/snack or shortly thereafter
• Do not crush or chew
• Retention in mouth may cause mucosal irritation
• Contents of delayed release capsules may be sprinkled on applesauce