Pharm Blessings for my favs (you) Flashcards by Paige LaPointe

well.

this is about to be shitty

but it doesn’t have to be T-PAINful….

https://www.youtube.com/watch?v=SyVcyT-fOao

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But first, quick shoutout to sasha for being a BALLER and posting notes from all the cases

xoxoxoxoxoxoxo

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What are 3 drug options for a person having an acute attack of diarrhea?

Fiber
Kaolin-pectin [kaopectolin]
Loperinide [imodium]

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What is the non-pharm diet treament for acute diarrhea?

BRAT diet

bananas, rice, applesauce, toast

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what’s worse for diarrhea: high sugar content or low sugar content?

high

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loperinide [imodium] is an opioid.

does it have analgesic effects?

nope

no numb nuggets for you

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do opioids increase or decrease bowel motility?

decrease

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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

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your patient has chronic diarrhea secondary to a gastrectomy. what is the DOC?

octreotide [sandostatin] depo injection

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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

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what should you supplement ocreotide [sandostatin] with

B12 and folate

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your patient has ulcerative colitis. what drug is this patient likely going to be on to manage it?

5-ASA/mesalamine [asacol]

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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!

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which drug for chron’s disease is steroid-sparing?

azathioprine [imuran]

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what are the side effects of azathioprine [imuran]?

pancreatitis (pain, steatorrhea)

hepatitis (jaundice, itching, pain)

marrow toxicity (easy bruising, bleeding)

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what are you at an increased risk for when you mix azathioprine [imuran] with sulfasalazine [azulfadine]?

myelosuppression

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how long does it take for azathioprine [imuran] to take full effect?

3-6 months

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an old man is constipated…. shocker.

what are you going to give him?

miralax

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what’s the ratio of miralax:water for constipation?

one tbsp : 240ml

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after taking miralax, within how many days should you have a BM?

1 to 3

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what makes people with constipation lazy?

they just don’t give a shit

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OBVIOUSLY what do you r/o in a patient with constipation?

obstruction or impaction

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what is the DOC for esophageal varices?

octreotide [sandostatin]

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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

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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 [https://www.youtube.com/watch?v=EPFGUHDIHwQ](https://www.youtube.com/watch?v=EPFGUHDIHwQ)

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?

1. omeprazole 2x daily 2. amox or metronidazole [flagyl] 3. clarithromycin

what's the quad drug regimen for H pylori ulcers?

1. omeprazole 2x daily 2. tetracycline 3. metronidazole 4. 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!