Pharm Blessings for my favs (you) Flashcards
well.
this is about to be shitty
but it doesn’t have to be T-PAINful….
But first, quick shoutout to sasha for being a BALLER and posting notes from all the cases
xoxoxoxoxoxoxo
What are 3 drug options for a person having an acute attack of diarrhea?
- Fiber
- Kaolin-pectin [kaopectolin]
- Loperinide [imodium]
What is the non-pharm diet treament for acute diarrhea?
BRAT diet
bananas, rice, applesauce, toast
what’s worse for diarrhea: high sugar content or low sugar content?
high
loperinide [imodium] is an opioid.
does it have analgesic effects?
nope
no numb nuggets for you
do opioids increase or decrease bowel motility?
decrease
you can use fiber [metamucil] for constipation or diarrhea.
how do you prescribe it differently?
for diarrhea: lots of fiber w/ little water
for constipation: lots of fiber w/ lots of water
your patient has chronic diarrhea secondary to a gastrectomy. what is the DOC?
octreotide [sandostatin] depo injection
in this post-gastrectomy pt with diarrhea, why can’t we give him kaolin-pectin [kaopectolin]?
this is absorbed in the stomach
which you took out
what should you supplement ocreotide [sandostatin] with
B12 and folate
your patient has ulcerative colitis. what drug is this patient likely going to be on to manage it?
5-ASA/mesalamine [asacol]
ok so she’s on this 5-ASA/mesalamine [asacol] for her ulcerative colitis. but now she’s got macrocytic anemia.
what’s going on?
5ASA/mesalamine [asacol] has decreased her B12/folate so supplement!
which drug for chron’s disease is steroid-sparing?
azathioprine [imuran]
what are the side effects of azathioprine [imuran]?
pancreatitis (pain, steatorrhea)
hepatitis (jaundice, itching, pain)
marrow toxicity (easy bruising, bleeding)
what are you at an increased risk for when you mix azathioprine [imuran] with sulfasalazine [azulfadine]?
myelosuppression
how long does it take for azathioprine [imuran] to take full effect?
3-6 months
an old man is constipated…. shocker.
what are you going to give him?
miralax
what’s the ratio of miralax:water for constipation?
one tbsp : 240ml
after taking miralax, within how many days should you have a BM?
1 to 3
what makes people with constipation lazy?
they just don’t give a shit
OBVIOUSLY what do you r/o in a patient with constipation?
obstruction or impaction
what is the DOC for esophageal varices?
octreotide [sandostatin]
Tommy went on a tangent about how octreotide [sandostatin] treats esophageal varices…
so why does that work?
it constricts the stomach vessels which then decreases hepatic/portal blood flow which then decreases the pressure in the esophagus
in a nutshell
regardless of what the drug table says, what is used all the time for people who are nauseous and vomming?
odansetron [zofran]
what is the typical regimen for HCV?
PEG interferon + ribavirin [virazole] + sofosbuvir [sovaldi]
what is the alternative regimen for HCV that costs like 40,000 dolla dolla bill ya’lls?
Ledapisvir + Sofosbuvir [Harvoni]
which HCV regimen has less s/e?
harvoni
pick the correct word in parentheses:
a) ribavirin [virazole] is for (eradication, suppression) of HCV
b) lamivudine [epivir] is for (eradication, suppression) of HBV
a) eradication
b) suppression
what is the DOC for hepatic encephalopathy?
and why?
lactulose [enulose]
induces BM to get rid of wastes
what is the secondary agent for hepatic encephalopathy if lactulose [enulose] doesn’t work?
rifaximin [xifaxan]
*side note: white is weirdly obsessed with this drug because it’s new so i would take a look at it*
chemically, what does lactulose [enulose] do?
prevents the conversion from ammonia to ammonium
chemically, what does rifaximin [xifaxan] do?
alternates the bacteria flora to have the safe effect as lactulose [enulin]
what are the MC s/e of lactulose [enulin]?
gas and diarrhea
what is the DOC for steatorrhea secondary to chronic pancreatitis?
pancrelipase [viokace]
what could make someone’s pancrelipase [viokace] be less effective?
increased stomach acids
the drug might get partially broken down by the time it gets to the duodenum
what other disease is steatorhhea seen in?
cystic fibrosis
oh my good god this is only case 9
oh baby i got what you need
what is a pancreatic analgesic that is to be taken after surgery?
Meperidine [demerol]
can elderly take Meperidine [demerol]?
nope - confusion, seizures
when do we make the most acid?
when should we take an H2 blocker?
7pm
take at 6pm
what is the DOC for GERD with nocturnal sx?
ranitidine [zantac]
how long does it take PPIs to have max effect?
3-5 days
how long are PPIs FDA approved to take for?
12 weeks
(but like literally everyone I know that’s on them takes them forever)
what can happen if you take PPIs for 1-2 years?
inc risk for:
CVD
hip fracture
gastric atrophy
decreased B12 absorption
pneumonia
cdiff
what is the ONLY PPI you can go on while on clopidogrel?
pantoprazole [protonix]
what enzyme metabolizes both PPIs and clopidogrel?
QRN83X3
lol just kidding that’s nonsense it’s CYP
i’m literally fresh outta good jokes
usually they just ooze right out of me like mucopurulent discharge oozes out of a pilonidal cyst
like diarrhea oozes out of a butthole
like vomit oozes out of you after reading that
how do you tell a patient to take pantoprazole [protonix]?
one hour prior to breakfast and other drugs
which drug is used as a surfactant to treat ulcers?
sulcrafate [carafate]
which drug is used to treat NSAID ulcers?
misoprostol [cytotec]
what is the DOC for diverticulitis?
cipro and metronidazole
(AKA flagyl for your vagyl)
(but now it’s metronid for your divertic)
for 10-14 days
what are the 2 MC side effects of cipro?
diarrhea oozes from your butthole
tendon rupture
what’s the DOC for cdiff?
and then what if that doesn’t work?
and then what’s your 3rd line?
metronidazole [flagyl]
IV vanco
rifaximin [xifaxan]
(see! white never talks about 3rd line agents. he loves rifaximin)
So Primaxin is what gave flash card #54 cdiff. What is primaxin used for?
anti-pseudomonas
what’s the triple drug regimen for H pylori duodenal ulcers?
- omeprazole 2x daily
- amox or metronidazole [flagyl]
- clarithromycin
what’s the quad drug regimen for H pylori ulcers?
- omeprazole 2x daily
- tetracycline
- metronidazole
- bismuth
when should you take omeprazole?
on empty stomach one hour before breakfast
DOC for IBS-D?
loperimide [imodium]
DOCs for IBS-C?
senokot [senna]
fiber
why are men like laxatives?
they irritate the shit out of you
how are women like anti-diarrheals?
they help make things get hard
WOAH THIS JOKE IS RATED NC-17
what if IBS cramping doesn’t go away?
put on antispasmodic
your patient has a history of gout and NSAID GI bleeds.
what could you give for ppx of GI bleeds?
PPI like omeprazole
this is just a weird case but
same dude. same hx of gout. STILL had a GI bleed on a PPI. He still wants to continue the NSAID, so what do you do?
change to cox-2 inhibitor for NSAID (like celcoxib)
increase PPI dosage
give misoprostol [cytotec] to protect
give sucralfate [carafate] to protect
which drug is a synthetic prostaglandin?
a) sucralfate [carafate]
b) misoprostol [cytotec]
misoprostol [cytotec]
what are your two drug options for motion sickness?
meclizine
scopolamine
which motion sickness drug is a patch?
scopolamine
how early do you have to apply the scopolamine patch, and how often do you change it?
apply 4 hours before
change every 72h
what is the biggest s/e of meclizine?
sedation
what might the elderly experience as a s/e to either meclizine or scopolamine?
urinary retention
what are the s/e of anticholinergic drugs like scopolamine?
no pee
no see
no spit
no shit
which anti-emetic drug do you give pre-op and post-op?
ondansetron [zofran]
which 3 drugs together are 90% effective for n/v from chemo/rad?
ondansetron [zofran]
aprepitant [emend]
dexamethasone [maxidex]
which post-chemo drug is dissolved under the tongue?
ondansetron [zofram]
which post-chemo drug is short-term use?
aprepitant [emend]
UGH IS THIS OVER YET
what 2 drugs do you give as PRE-chemo treatment, one hour before?
dexamethasone [maxidex]
aprepitent [emend]
what are the indications for meclizine [antivert]?
vertigo
motion sickness prev + tx
what are the indications for ondansetron [zofran]?
postop n/v
(but like Tdubs said.. it’s used all the time)
what’s the MOA of meclizine [antivert]?
anticholinergic
antihistamine
H1 agonist
works at vestibular-cerebellar pathways
what’s the MOA of ondansetron [zofran]?
serotonin antagonist
what’s the MOA of dexamethasone [maxidex]?
corticosteroid
but works on serotonin receptors too
which drug decreases the effectiveness of progestin?
aprepitant [emend]
what is a great medicine, but should not be prescribed for diarrhea?
laughter
what is the DOC for diabetic gastroparesis?
metoproclomide [reglan]
what type of drug is metoproclomide [reglan]?
prokinetic agent
how long are prokinetic agents FDA approved for?
why is this an issue with gastroparesis?
12 weeks
an issue because gastroparesis never really goes away
what does metoproclimide [reglan] have a black box warning for?
extrapyrimidal sx like tardive dyskinesia
did i make this card already?
when do we tell a pt to take a PPI?
30-60 minutes before breakfast
yes i think i made this card already
if you were wondering @ which card you start to get forgetful the answer is card 89
what are alarming sx with PUD or GERD?
coffee ground emesis
dysphagia
black tarry stool
(get endoscopy)
what happens if you don’t titrate down a PPI?
rebound acid effect
what is the treatment for chronic HCV genotype 2?
Sofosbuvir + Ribavarin for 12 weeks
you’re putting a male on ribavarin [virazole]. What do you have to tell him if he has a partner?
that this drug is some alien shit and it turns his sperm into hitmen ninjas that can abort another woman’s baby just because he’s on the drug
like whaaaaaat
how many hepatitis cases did we have?
“3.”
“know them.”
-blessington
what 2 drugs can you rx for IBS-C that is non-responsive to OTC shizzz?
lubiprostone [amitiza] or linclotide [linzess]
for what age group of women can you not rx lubiprostone [amitiza]?
less than 18y
what drug class is lubiprostone [amitiza]?
laxative
calcium channel activator
what is the name of the colonoscopy prep and what do you need to know about it?
it’s called GoLytely
it’s an osmotic electrolyte laxative
GI practices use different variations of this
watch dehydration with this!
OMG YOU DID IT
I DID IT
I DIDN’T THINK I WAS GOING TO MAKE IT
good luck and happy pooping!
