Pharm Flashcards
Hep B Tx
First line: pegylated interferon alpha, entecavir, tenofovir disoproxil fumarate (TDF)*
C. diff colitis Tx
metronidazole (PO, IV)
vancomycin (PO only! IV doesn’t penetrate gut)*
Hep C Tx
protease inhibitor (eg sofosbuvir/simeprevir)
H. pylori Tx
1st line: Triple therapy regimen (10-14 days)
Clarithromycin: 500mg PO BID
Amoxicillin: 1g PO BID
Metronidazole: 500mg PO BID
PPI PO BID (eg esomeprazole, lansoprazole)
Gastroparesis Tx**
Metoclopramide (Reglan) – acts on dopamine receptors in stomach/intestines/brain
**watch for tardive dyskinesias
Giardia Tx
Metronidazole
Tx Cryptosporidiosis
Nitazoxanide
Pancreatitis Tx
DO NOT SEND PTS HOME (acute) Maintain pt NPO IV fluids* (helps) Pain control – Meperidine standard but shifting now to Dilaudid (concern that morphine and its derivatives can cause spasm at sphincter of Oddi and increased biliary pressure, can make ab pain/Sx worst) Anti-emetic – IV zofran, phenergan Parenteral antacid (H2 blocker or PPI)
1st line Tx of hypertriglyceridemia
Fibrates
Spontaneous Bacterial Peritonitis tx**
Cefotaxime x 5 days
Medications that can cause chronic liver dz and cirrhosis**
Amiodarone
Methotrexate
Hepatotoxic meds
NSAIDs, isoniazid, valproic acid, erythromycin, amoxicillin-clavulanate, ketoconazole, chlorpromazine, ezetimibe
Limit acetaminophen <2g/day
Crohn’s Dz Tx
mild to mod: salicylate (5 ASA), maintenance mesalamine
mod to sev: systemic corticosteroids (prednisone or Budesonide), consider immunosup maintenance (azathioprine)
Humira, Infliximab, methotrexate, tacrolimus f refractory
no immunosuppressants if infectious colitis on DDx
Examples of 5-ASA (5-aminosalicylates)
Rowasa, Pentasa, Asacol
1st step Tx in IBD
Entocort
Budesonide, used in IBD
Steroid whose systemic effects are reduced due to first pass in the liver.
glucagon in acute dysphagia
glucagon 1 mg IV to relax lower esophagus first - let blous pass on its own
Eosinophilic esophagitis tx
First line – inhaled corticosteroid (spray during breath hold then swallow) x 8 wks
Candida esophagitis – most common adverse reaction
Esophageal Motility Disorders Tx
CCB or TCA (EG IMIPRAMINE)
GERD Tx
H2 receptor antagonist: pepcid
then PPI instead
Over-the-counter Anti-emetics
sodium citrate/dextrose/fructose (Nauzene)
phosphoric acid (Emitrol)
bismuth subsalicylate (Pepto-Bismol)
Ginger (available in candies, drinks, and teas)
Tx acute vomitting
Anticholinergics – hyoscyamine (Levsin), dicyclomine (Bentyl), transdermal scopolamine (Transderm Scop)
H1 antihistaminics – promethazine (Phenergan), Diphenhydramine (Benadryl), doxylamine (Unisom), meclizine (Bonine, Antivert), dimenhydrinate (Dramamine)
Dopamine receptor antagonists – metoclopramide (Reglan), domperidone, prochlorperazine (Compazine), chlorpromazine (Thorazine), haloperidol (Haldol)
5HT3-Antagonists – ondansetron (Zofran), granisetron (Kytril), dolasetron (Anzemet)
Adjuvant antiemetics – corticosteroids, benzodiazepines, cannabinoids, trimethobenzamide (Tigan), aprepitant (Emend)
Dopamine receptor antagonist SE
Extrapyramidal effects (dyskinesia, dystonia) eg metoclopramide (Reglan), prochlorperazine (Compazine), chlorpromazine (Thorazine), haloperidol (Haldol)
Functional chronic nausea and vomiting (after ruling out everything else) Tx
reassurance, low-dose Tricyclic antidepressants (Amitriptyline, Nortriptyline)
Antidiarrheals
Loperimide (Imodium) Diphenoxylate atropine (Lomotil)
Laxatives
Metamucil, colace, dulcolax, senekot, polyethylene glycol
Elavil
Amitriptyline (TCA)
IBS Symptomatic Tx
Imipramine (Tofranil), Amitriptyline (Elavil)
provide a visceral analgesic effect by increasing pain threshold in the gut. It prolongs oral-cecal transit time, reduces abdominal pain, mucorrhea, and stool frequency
IBS specific Tx
Alosetron (Lotronex)- very limited for diarrhea
Lubiprostone (Amitiza)- constipation dominant
Linaclotide (Linzess)- Constipation dominant
