Unit 6 GI disorders Flashcards
What are phenothiazines? What are major side effects?
prochlorperazine and promethazine. drowsiness, extrapyramidal affects, anticholinergic effects
What do phenothiazines interact with?
anticoagulants, alpha blockers, anticonvulsants
What are antihistamine-anticholinergics? What are major side effects?
hydroxyzine, meclizine, dimenhydrinate. Drowsiness, anticholinergic symptoms.
When are antihistamine-anticholinergics contraindicated?
in nursing mothers, asthma, glaucoma, gi or gu disorders
What is most frequently used benzodiazepine for N/V? when is it contraindicated?
lorazepam. Contraindicated in renal or hepatic failure.
What are serotonin antagonists? What are adverse reactions?
Zofran. AEs include headache, abd pain, increased AST/ALT, ecg changes
What is the cutoff for renal function when giving metoclopramide?
if CrCl <40, cut dose in half.
What is first second third line for non-chemo related N/V?
phenothiazine, antihistamine/anticholinergic, 3rd, reevaluate
Define mild, mod, severe heartburn?
mild-/= to 3x wkly, no symptoms suggesting complicated disease. Severe-Mod GERD that fails appropriate therapy.
How do you diagnose PUD?
epigastric pain, dyspepsia in 2/3 of duodenal and 1/3 gastric patients
What are goals of treating PUD?
relieve ulcer pain, dyspepsia. Heal existing ulcers, eradicate H pylori
What are considerations in using clarithromycin to treat PUD?
It is acid stable. Should not be used to treat subsequent PUD issues due to issues with resistance.
What are considerations in using metronidazole in PUD?
it is NOT pH dependent. Resistance is low.
What are considerations in using amoxil in PUD?
Must have neutral pH so give with omeprazole
What are H2RAs? How long does healing take?
famotidine, ranitidine, cimetadine. 70-95% healing in 4-6 wks
What are side effects of H2RAs?
thrombocytopenia, neutropenia, bradycardia, arrhythmia
What do H2RAs interact with?
warfarin , phenytoin
When should PPIs be used in treatment of GERD? PUD?
once daily, 30-60min before first meal in GERD and 1-2x daily in PUD
What is first line tx in GERD? Second line?
H2RAs and/or PPIs. 2nd, referral to GI
what meds commonly cause constipation?
antacids, anticholiergics, antihistamines, calcium clonidine, diuretics, Iron, Statins, Narcotics, TCAs, CCBs
what are hyperosmotic laxatives?
lactulose, miralax
What is safest in treating constipation in infants?
glycerin
what is laxative of choice in patients who should avoid straining?
surfactant laxatives-colace, docusate
What is 1st, 2nd, 3rd line tx for constipation?
1-bulk forming laxative(if contraindicated, docusate) 2-mag citrate, 3-stimulant laxative
How is acute, persistant and chronic diarrhea differentiated?
acute-<30, chronic 30 or longer
what are antimotility agents in treating diarrhea?
loperamide, diphenoxylate
What are special considerations of antimotility agents?
may make infectious diarrhea worse. Caution in hepatic failure, not for <4 y/o. CAUTION in bloody stools and leukocytes
How does bismuth work
it is antisecretory, antimicrobal, absorbant
What is 1st, 2nd, 3rd line for diarrhea?
loperamide, adsorbet or antisecretory, dyphenoxylate
What is hallmark signs of IBS?
pain w/ change in consistency of stool that is relived by defacation
What are 4 criteria for IBS?
abd distention, relief w/ BM, more frequent stools w/ onset of pain, looser stools w/ onset
What is first line in treating IBS w/ Constipation? IBS w/ Diarrhea?
IBS-C: Osmotic laxatives. IBS-D loperimide
In IBD, what does tissue biopsy often show?
TNF, IL-1, leukotrienes
What is the hallmark sign of IBD?
bloody diarrhea, wt loss, fever
What is GI mucosa in Crohns?
discontinuous narowed thick edematous patches w/ presence of ulcerations, lesions, fissures, granulomas
what findings on GI Mucosa occur exclusively in Crohns?
granulomas and fistulas
What is GI mucosa in ulcerative colitis?
continuous superficial uniform inflammation and ulceration
Are extraintestinal complications of skiun, joint and liver problems more common in Crohns or UC?
Crohns
How long should it take a patient to recover from a IBD exacerbation?
2-4 wks
What is the gold standard of mild-mod IBD? How do they work?
aminosalisylates-sulfasalazine. They decrease inflammation by inhibiting prostaglandin synthesis
What are side effects of sulfasalazine? What supplement do these pt’s often need?
steven-johnson syndrome, N/V, hepatitis. They need folic acid
When are corticosteroids used in IBD?
Intermittently for acute IBD exacerbation
How is prednisone tapered?
Pt is on 40-60mg/d dose and show improvement in 7-10 days, slowly taper by 5-10mg/wk until 20mg daily, then decrease by 2.5mg/wk
what are long-term effects of corticosteroid use?
decreased bone density, buffalo hump, ulcers
How are immunosuppressives used in IBD?
Used as adjunctive with aminoglycosides to induce and maintain remission
When is IV cyclosporine used in IBD?
In severe acute exacerbation in ulcerative colitis when pt is refractory to corticosteroids
When is methotrexate used in IBD?
it is effective only in crohns, not ulcerative colitis.
What should patients be tested before prior to using biological agents such as remicaide and Humira?
TB
What is tx for mild, mod, severe crohns?
mild: oral aminosalicylates alone or w/ abx. Mod: aminosalicylates and corticosteroids. severe: iv corticosteroids and biologicals
What is common treatment of mild ulcerative colitis?
aminosalicylates-oral and rectal
