UC/CD and GERD notes Flashcards
Mg Hydroxide
Calcium carbonate
sodium bicarb
Antacids (GERD)
when to administer antacids compared to other meds as well as eating?
take 1-2 hours before OR 4-6 hours after meds
take RIGHT AFTER eating
antacid MOA
weak base that reacts with gastric acid to form water and salt, diminishing acidity
Cimetidine
Famotidine
Nizatidine
Ranitidine
H2 Blockers
Which type of GERD drug’s MOA is inhibiting the histamine 2 receptors in gastric parietal cells?
H2 blockers
onset of H2 blockers
30 min (lasts 12 hours)
AE H2 blockers?
fatigue, dizziness, constipation, diarrhea, confusion
Which H2 blocker acts as a nonsteroidal antiandrogen, increasing the risk for gynecomastia and galactorrhea
Cimetidine
Cimetidine inhibits which substrate?
CYP450s
True or false: all H2 blockers reduce efficicay of drugs that require acidity for absorption
TRUE
This class MOA blocks gastric acid by inhibiting gastric H pumps
PPIs
When do you take PPIs?
30-60 min before breakfast/largest meal of day
PPIs have a short 1/2 life, but what is their duration of action?
18 hours
Is it ok to D/C PPIs abruptly?
no- can cause rebound acid…taper.
Long term AE of PPIs
C.diff, Vit B12 deficiency, decreased bone density, increased risk of fractures (GIVE CALCIUM CITRATE)
Which PPI is the strongest CYP2C19 inhibitor?
omeprazole
What is the MOA of Misoprostol?
prostaglandin analog - inhibits secretion of acid and stimulates secretion of mucus/bicarb
What is misoprostol used for?
reducing risk of NSAID-induced gastric ulcers (prefer PPIs if possible)
What is inconvenient about misoprostol?
dosed 4x daily, LARGE tablets
is misoprostol ok for pregnancy?
NO
Can you use other GERD meds with misoprostol?
NO - cannot use PPIs, H2 blockers, antacids - they wont work
Which gerd med MOA includes inhibiting activity of pepsin, increasing secretion of mucus?
Bismuth Subsalicylate
How to approach Rx therapy for GERD?
H2 first –> switch to PPI if H2 don’t work.
How to approach Rx for NSAID-induced PUD
D/C NSAID!
if you can’t d/c nsaid, Rx PPI + nonselective NSAID
How to Rx for H.pylori PUD
PPI + 2 abx (Clarithromycin and amoxicillin)
if you need quadruple therapy, add BISMUTH
Approaching long-term acid-suppression?
PPI and H2 are OTC options…H2 preferred and safer longterm (also more likely to be covered by insurance
Difference between IBD and CD?
inflammation is transmural in CD and limited to mucosa in UC
CD - mouth to anus
UC - limited to colon and rectum
what is a huge inflammatory contributor to inflammation in CD/UC?
TNF-alpha
Which meds to AVOID in those with IBD to reduce the risk of toxic megacolon?
anti-peristaltic GI meds (Loperamide, diphenoxylate)
causes acute colinic dilation = toxic megacolon!
What are the IBD medication classes (3)?
Aminosalicylates
Corticosteroids
Immunosuppressants
Mesalamine
Sulfasalazine
Olsalazine
Balsalazide
Aminosalicylates (IBD)
what parts of the intestines toes PO 5-ASA reach?
ileum, colon
enema reaches colon/rectum
(suppository reaches rectum)
sulfasalazine AE?
due to sulfapyridine component: headache, n/v, bone marrow suppression, reduced sperm count, pulmonitis
do not give sulfasalazine to which patients?
SULFA ALLERGY
PREGNANCY!
if you must give sulfasalazine to pregnant patient, what do you also administer?
folic acid
Immunosuppressants MOA in IBD?
targets immune response to cytokines involved in IBD
azathioprine 6-merc methotrexate cyclosporine biologics
immunosuppressants
Which immunosuppressant do you use for maintenance IBD and reducing need for LONG TERM STEROID USE?
azathioprine
6-mercap
which immunosuppressant is a folate antagonist?
methotrexate - used for remission of CD
can you give methotrexate to pregnant patient?
NO
Why is cyclosporine given in patients with IBD?
to prevent organ rejection in transplants, but for IBD it’s for fulminant/refractory symptoms in active disease
What are biologics MOA?
reducing TNF-alpha, sub! or IV only
what is the concern with using biologics?
Risk of reactivating TB
which 2 antibiotics are commonly used in CD?
metronidazole and ciprofloxacin
Treatment for active Mild-Mod UC
oral or topical aminosalicylate
OR
oral budesonide
maintaining remission in mild/mod UC
topical mesalamine (or topical steroid if unresponsive)
treating moderate-severe active UC
oral aminosalicylates +/- corticosteroids
can always step up to immunomod
severe-fulminant active UC
Hospitalize!
IV mesalamine and steroids
CYCLOSPORINE in 7-10 days of unresponsiveness
What is the LAST option in remission of UC if all other meds have failed?
Vedolizumab
are steroids (oral and topical) effective at maintaining remission?
NO - use 5-ASA or immunomods
treating mild-mod CD
oral budesonide
why budesonide for a mild/mod CD flare?
it is not absorbed systemically, and localizes to the rectosigmoid region
treating mod-severe CD
oral corticosteroids (if unresponsive to sulfasalazine/mesalamine)
can also try infliximab + azathioprine
treating fulminant CD
HOSPITALIZE
IV steroids, biologics
is it ok to use topical/systemic steroids for maintaining remission of CD?
NO - use immunosuppressants or biologics
