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N/V GERD UC/CD Antibiotics > UC/CD and GERD notes > Flashcards

UC/CD and GERD notes Flashcards

1
Q

Mg Hydroxide
Calcium carbonate
sodium bicarb

A

Antacids (GERD)

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2
Q

when to administer antacids compared to other meds as well as eating?

A

take 1-2 hours before OR 4-6 hours after meds

take RIGHT AFTER eating

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3
Q

antacid MOA

A

weak base that reacts with gastric acid to form water and salt, diminishing acidity

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4
Q

Cimetidine
Famotidine
Nizatidine
Ranitidine

A

H2 Blockers

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5
Q

Which type of GERD drug’s MOA is inhibiting the histamine 2 receptors in gastric parietal cells?

A

H2 blockers

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6
Q

onset of H2 blockers

A

30 min (lasts 12 hours)

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7
Q

AE H2 blockers?

A

fatigue, dizziness, constipation, diarrhea, confusion

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8
Q

Which H2 blocker acts as a nonsteroidal antiandrogen, increasing the risk for gynecomastia and galactorrhea

A

Cimetidine

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9
Q

Cimetidine inhibits which substrate?

A

CYP450s

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10
Q

True or false: all H2 blockers reduce efficicay of drugs that require acidity for absorption

A

TRUE

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11
Q

This class MOA blocks gastric acid by inhibiting gastric H pumps

A

PPIs

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12
Q

When do you take PPIs?

A

30-60 min before breakfast/largest meal of day

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13
Q

PPIs have a short 1/2 life, but what is their duration of action?

A

18 hours

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14
Q

Is it ok to D/C PPIs abruptly?

A

no- can cause rebound acid…taper.

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15
Q

Long term AE of PPIs

A

C.diff, Vit B12 deficiency, decreased bone density, increased risk of fractures (GIVE CALCIUM CITRATE)

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16
Q

Which PPI is the strongest CYP2C19 inhibitor?

A

omeprazole

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17
Q

What is the MOA of Misoprostol?

A

prostaglandin analog - inhibits secretion of acid and stimulates secretion of mucus/bicarb

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18
Q

What is misoprostol used for?

A

reducing risk of NSAID-induced gastric ulcers (prefer PPIs if possible)

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19
Q

What is inconvenient about misoprostol?

A

dosed 4x daily, LARGE tablets

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20
Q

is misoprostol ok for pregnancy?

A

NO

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21
Q

Can you use other GERD meds with misoprostol?

A

NO - cannot use PPIs, H2 blockers, antacids - they wont work

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22
Q

Which gerd med MOA includes inhibiting activity of pepsin, increasing secretion of mucus?

A

Bismuth Subsalicylate

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23
Q

How to approach Rx therapy for GERD?

A

H2 first –> switch to PPI if H2 don’t work.

24
Q

How to approach Rx for NSAID-induced PUD

A

D/C NSAID!

if you can’t d/c nsaid, Rx PPI + nonselective NSAID

25
Q

How to Rx for H.pylori PUD

A

PPI + 2 abx (Clarithromycin and amoxicillin)

if you need quadruple therapy, add BISMUTH

26
Q

Approaching long-term acid-suppression?

A

PPI and H2 are OTC options…H2 preferred and safer longterm (also more likely to be covered by insurance

27
Q

Difference between IBD and CD?

A

inflammation is transmural in CD and limited to mucosa in UC

CD - mouth to anus
UC - limited to colon and rectum

28
Q

what is a huge inflammatory contributor to inflammation in CD/UC?

A

TNF-alpha

29
Q

Which meds to AVOID in those with IBD to reduce the risk of toxic megacolon?

A

anti-peristaltic GI meds (Loperamide, diphenoxylate)

causes acute colinic dilation = toxic megacolon!

30
Q

What are the IBD medication classes (3)?

A

Aminosalicylates
Corticosteroids
Immunosuppressants

31
Q

Mesalamine
Sulfasalazine
Olsalazine
Balsalazide

A

Aminosalicylates (IBD)

32
Q

what parts of the intestines toes PO 5-ASA reach?

A

ileum, colon

enema reaches colon/rectum
(suppository reaches rectum)

33
Q

sulfasalazine AE?

A

due to sulfapyridine component: headache, n/v, bone marrow suppression, reduced sperm count, pulmonitis

34
Q

do not give sulfasalazine to which patients?

A

SULFA ALLERGY

PREGNANCY!

35
Q

if you must give sulfasalazine to pregnant patient, what do you also administer?

A

folic acid

36
Q

Immunosuppressants MOA in IBD?

A

targets immune response to cytokines involved in IBD

37
Q 
azathioprine
6-merc
methotrexate
cyclosporine
biologics
A

immunosuppressants

38
Q

Which immunosuppressant do you use for maintenance IBD and reducing need for LONG TERM STEROID USE?

A

azathioprine

6-mercap

39
Q

which immunosuppressant is a folate antagonist?

A

methotrexate - used for remission of CD

40
Q

can you give methotrexate to pregnant patient?

A

NO

41
Q

Why is cyclosporine given in patients with IBD?

A

to prevent organ rejection in transplants, but for IBD it’s for fulminant/refractory symptoms in active disease

42
Q

What are biologics MOA?

A

reducing TNF-alpha, sub! or IV only

43
Q

what is the concern with using biologics?

A

Risk of reactivating TB

44
Q

which 2 antibiotics are commonly used in CD?

A

metronidazole and ciprofloxacin

45
Q

Treatment for active Mild-Mod UC

A

oral or topical aminosalicylate

OR

oral budesonide

46
Q

maintaining remission in mild/mod UC

A

topical mesalamine (or topical steroid if unresponsive)

47
Q

treating moderate-severe active UC

A

oral aminosalicylates +/- corticosteroids

can always step up to immunomod

48
Q

severe-fulminant active UC

A

Hospitalize!
IV mesalamine and steroids
CYCLOSPORINE in 7-10 days of unresponsiveness

49
Q

What is the LAST option in remission of UC if all other meds have failed?

A

Vedolizumab

50
Q

are steroids (oral and topical) effective at maintaining remission?

A

NO - use 5-ASA or immunomods

51
Q

treating mild-mod CD

A

oral budesonide

52
Q

why budesonide for a mild/mod CD flare?

A

it is not absorbed systemically, and localizes to the rectosigmoid region

53
Q

treating mod-severe CD

A

oral corticosteroids (if unresponsive to sulfasalazine/mesalamine)

can also try infliximab + azathioprine

54
Q

treating fulminant CD

A

HOSPITALIZE

IV steroids, biologics

55
Q

is it ok to use topical/systemic steroids for maintaining remission of CD?

A

NO - use immunosuppressants or biologics

N/V GERD UC/CD Antibiotics (2 decks)

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