UC/CD/IBS/ Insomnia / Pregnancy / Testosterone/ Derm Flashcards
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”
How manage mild-moderate UC ?
Alternative?
Salicylates - mesalamine, balasalazide, azulfidine
If you can’t use salicylates use Systemic corticosteroids - budesonide
Mesalamine
Brand names
Lialda DR
Apriso CR
Asacol HD DR
Delzicol DR
Pentasa CR
Canasa suppository
Rowasa rectal suspension
Sulfasalazine
Brand
Indication
Azulfidine
Mild-mod UC
Management of mod-severe UC
Oral corticosteroids
Rectal corticosteroids if distal
Budesonide
Brand / indications
Entocort - CD
Uceris - CD
Balasalazide
Brand
MOA
Indications
Contraindication
Colazal, Giazo
Cleaved in colon to produce mesalamine
UC
Salicylate allergy
How to manage refractory UC?
TNF blockers - inflixamab, adalimumab
JAK inhibitor - Tofactinib (Xeljanz)
Vedolizumab (entyvio)
What are the 4 steps of managing mild-moderate CD?
- Salicylate
- Anaerobic agent (metronidazole or ciprofloxacin)
- Treat as mod-severe
- Maintenance therapy
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)
What antibiotics are used in CD and doses?
- Metronidazole 10-20mg/kg/day
- Ciprofloxacin 1g/day
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
Eluxadoline
Brand
Control class
MOA
Indication
Contraindication
Viberzi
C4
Opioid receptor agonist
IBS diarrhea
Hepatic impairment, pancreatitis
Loperamide
Brand
MOA
Indication
Max
Immodium
Acts on opioid receptors
Diarrhea
OTC - 8mg/day
RX - 16mg/day
Alosteron
Brand
MOA
Indication
Caution
Contraindication
Lotronex
Selective 5HT3R antagonist
IBS-diarrhea in WOMEN who failed other therapies
Severe constipation
Fluvoxamine
Lubiprostone
Brand
MOA
Indication
Amitza
Chloride channel activator
IBS- constipation in WOMEN >18y.o
Opioid induced constipation
Chronic constipation
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
Plecantide
Brand
MOA
Indication
BBW
Trulance
Guanyate cyclase-C agonist
IBS- consipation
CIC
<6y.o
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
- Ramelteon (rozerem) - 8mg PO
- 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?
C3
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?
- Benzoyl peroxide
- Topical antibiotic + benzyl peroxide
* Benzamycin (erythromycin)
*Benzaclin (clindamycin) - Oral antibiotic
- 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
- Topical corticosteroids
- Topical calcineurin inhibitors
- PDE4 inhibitors
- 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
