UC/CD/IBS/ Insomnia / Pregnancy / Testosterone/ Derm Flashcards by Alexandria Arnett

What is the difference between UC and CD?

UC - inflammatory disease of large intestine “left-sided or distal disease”
- BLOOD in stool

CD - Extends deeper and often in ileum and cecum - NO BLOOD in stool - “skip lesions”

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How manage mild-moderate UC ?

Alternative?

Salicylates - mesalamine, balasalazide, azulfidine

If you can’t use salicylates use Systemic corticosteroids - budesonide

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Mesalamine

Brand names

Lialda DR
Apriso CR
Asacol HD DR
Delzicol DR
Pentasa CR
Canasa suppository
Rowasa rectal suspension

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Sulfasalazine

Brand
Indication

Azulfidine

Mild-mod UC

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Management of mod-severe UC

Oral corticosteroids

Rectal corticosteroids if distal

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Budesonide

Brand / indications

Entocort - CD

Uceris - CD

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Balasalazide

Brand
MOA
Indications
Contraindication

Colazal, Giazo

Cleaved in colon to produce mesalamine

Salicylate allergy

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How to manage refractory UC?

TNF blockers - inflixamab, adalimumab

JAK inhibitor - Tofactinib (Xeljanz)

Vedolizumab (entyvio)

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What are the 4 steps of managing mild-moderate CD?

Salicylate
Anaerobic agent (metronidazole or ciprofloxacin)
Treat as mod-severe
Maintenance therapy

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What are the 4 steps of managing moderate-severe CD?

Systemic corticosteroid
Immunosuppressnts -azathioprine or 6-MP
Infliximab (remicade), adalimumab (humira) , certolizumab (Cimzia)
Other immunomodulators (methotrexate) or vedolizumab (entyvio)

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What antibiotics are used in CD and doses?

Metronidazole 10-20mg/kg/day
Ciprofloxacin 1g/day

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What is the difference between IBD and IBS?

IBD is an inflammatory disease

IBS is a disorder of the lower intestinal tract and can involve severe diarrhea or constipation

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Eluxadoline

Brand
Control class
MOA
Indication
Contraindication

Viberzi

Opioid receptor agonist

IBS diarrhea

Hepatic impairment, pancreatitis

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Loperamide

Brand
MOA
Indication
Max

Immodium

Acts on opioid receptors

Diarrhea

OTC - 8mg/day
RX - 16mg/day

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Alosteron

Brand
MOA
Indication
Caution
Contraindication

Lotronex

Selective 5HT3R antagonist

IBS-diarrhea in WOMEN who failed other therapies

Severe constipation

Fluvoxamine

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Lubiprostone

Brand
MOA
Indication

Amitza

Chloride channel activator

IBS- constipation in WOMEN >18y.o
Opioid induced constipation
Chronic constipation

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Linaclotide

Brand
MOA
Indication
Counseling
Contraindication
Caution

Linzess

Guanyate cyclase-C agonist

IBS- constipation
Chronic idiopathic constipation
Functional constipation

Take on empty stomach before 1st meal

<2y.o

Caps are sensitive to moisture

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Plecantide

Brand
MOA
Indication
BBW

Trulance

Guanyate cyclase-C agonist

IBS- consipation
CIC

<6y.o

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Tenapanor

Brand
MOA
Dose
BBW

Ibsrela

Sodium/hydrogen exchanger 3 inhibitor

50mg PO BID

<6y.o

What are 5 medications that are short acting and used for sleep onset insomnia?

Zaleplon (sonata)
Zolpidem
Triazolam
Lorazepam
Ramelteon

What are 4 medications that are longer-acting and used for sleep maintenance insomnia?

Zolpidem ER
Eszopiclone
Temazepam
Estazolam

What 2 medications help treat awakening in the middle of the night insomnia ?

Zaleplon

Sublingual zolpidem (intermesso)

Which medication helps with insomnia and depression?

What type of insomnia is it used for?

Doxepin (adapin, sinequan, silenor)

For those who have trouble staying asleep

Zolpidem

Brand name/ROA

Ambien tab
Ambien CR tab
Zolpimis - Oral spray on tongue
Edluar - Sublingual tablet
Intermesso - Sublingual

Intermezzo counseling

If they wake up in the middle of the night , they can use this sublingual tablet as long as they have 4 more hours remaining of sleep

What are 2 melatonin based medications for insomnia? brand + dose

1. Ramelteon (rozerem) - 8mg PO 2. Tasimelteon (hetlioz) - 20mg PO

Suvorexant Brand Control Class MOA Indication Dose

Belsomra C4 Orexin receptor ANTAGonist Insomnia - sleep onset and maintenance 10mg PO - up to 20mg daily

lembirexant brand control class Indication

DayVigo C4 Insomnia

Dardorexant brand Indication

Quviviq Insomnia

What are the 5 pregnancy categories ?

A - Well controlled human studies show no risk B - Animal studies show no risk C - animal studies show risk D - Definite fetal abnormalites in human studies but may have benefit X - Contraindicated in pregnancy

What are some recs for N/V in 1st trimester?

Vitamin B6 IM/PO Diclegix Bonjesta OTc benadryl 5HT3 inhibitors

Recs for pain in pregnancy?

Tylenol is DOC

Recs for constipation in pregnancy?

Increase fluid and fiber MIlk of magensium Senna and bisacodyl are category C

Recs for rhinitis in pregnancy?

Saline nasal spray is DOC Antihistamines

What DEA class is testoterone?

Indications of testosterone?

Breast cancer in females Delayed puberty in males Hypogonadism in males

Testosterone IM Where to give BBW

Gluteal muscle Pulmonary oil microembolism

Testosterone nasal gel Brand Counseling

Natesto Prime pump 10 times Blow nose prior Refrain from blowing nose for 1 hour after administration

Testosterone patch Brand Dose Application sides

Androderm Daily patch Back, abdomen, upper arms, thigh

Testosterone gel Brand names and application site

Androgel 1% and 1.62% - shoulder, upper arm, abdomen Aziron solution Testim - axilla Vogelxo - shoulder/upper arm Foresta - front/inner thigh They are all FLAMMABLE

What are the 4 steps for acne management?

1. Benzoyl peroxide 2. Topical antibiotic + benzyl peroxide * Benzamycin (erythromycin) *Benzaclin (clindamycin) 3. Oral antibiotic 4. Isotretinoin

Isotretinoin Brand Indication Requirements Dose / age / counseling ADE

Absorica, amnesteen, claravis, myorisan, zenatane Severe recalcitrant nodular cystic acne 2 forms of contraception start 1 month before and 2 negative pregnancy tests every month REMS - wholesaler, pharmacy, prescriber, patient 7 day window before pick up 10,20,30,40 mg caps PO QD >12 y.o with food Dry skin, sun sensitivity, depressed, hepatotoxicity, bone marrow suppressionW

What are 4 creams for acne + brand name ?

Tretinoin (altreno, atralin, refissa, renova) Tazarotene (avage, fabio, tazorac) Triafarotene (aklief) Tretinoin/benzyl peroxide (twyneo)

Atopic dermatitis Characteristics Treatment options

Eczema , skin dryness, crusting, pruirtis 1. Topical corticosteroids 2. Topical calcineurin inhibitors 3. PDE4 inhibitors 4. IL4R alpha antagonist

2 calcineurin inhibitors for atopic dermatitis + brand name

Pimecrolimus (elidel) 1% cream Tacrolimus (protopic ) 0.03 and 1% ointment

PDE4 inhibitor and IL4R alpha antagonist options for atopic dermatitis

PDE4I - Crisaborole (Eucrisa) 2% ointment Dupilumab (Dupixent) SUBQ

Psoriasis Characteristic DOC

Autoimmune condition that causes overproduction of skin cells Methotrexate