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Pharmacology > Unit 6 GI disorders > Flashcards

Unit 6 GI disorders Flashcards

1
Q

What are phenothiazines? What are major side effects?

A

prochlorperazine and promethazine. drowsiness, extrapyramidal affects, anticholinergic effects

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2
Q

What do phenothiazines interact with?

A

anticoagulants, alpha blockers, anticonvulsants

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3
Q

What are antihistamine-anticholinergics? What are major side effects?

A

hydroxyzine, meclizine, dimenhydrinate. Drowsiness, anticholinergic symptoms.

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4
Q

When are antihistamine-anticholinergics contraindicated?

A

in nursing mothers, asthma, glaucoma, gi or gu disorders

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5
Q

What is most frequently used benzodiazepine for N/V? when is it contraindicated?

A

lorazepam. Contraindicated in renal or hepatic failure.

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6
Q

What are serotonin antagonists? What are adverse reactions?

A

Zofran. AEs include headache, abd pain, increased AST/ALT, ecg changes

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7
Q

What is the cutoff for renal function when giving metoclopramide?

A

if CrCl <40, cut dose in half.

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8
Q

What is first second third line for non-chemo related N/V?

A

phenothiazine, antihistamine/anticholinergic, 3rd, reevaluate

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9
Q

Define mild, mod, severe heartburn?

A

mild-/= to 3x wkly, no symptoms suggesting complicated disease. Severe-Mod GERD that fails appropriate therapy.

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10
Q

How do you diagnose PUD?

A

epigastric pain, dyspepsia in 2/3 of duodenal and 1/3 gastric patients

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11
Q

What are goals of treating PUD?

A

relieve ulcer pain, dyspepsia. Heal existing ulcers, eradicate H pylori

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12
Q

What are considerations in using clarithromycin to treat PUD?

A

It is acid stable. Should not be used to treat subsequent PUD issues due to issues with resistance.

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13
Q

What are considerations in using metronidazole in PUD?

A

it is NOT pH dependent. Resistance is low.

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14
Q

What are considerations in using amoxil in PUD?

A

Must have neutral pH so give with omeprazole

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15
Q

What are H2RAs? How long does healing take?

A

famotidine, ranitidine, cimetadine. 70-95% healing in 4-6 wks

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16
Q

What are side effects of H2RAs?

A

thrombocytopenia, neutropenia, bradycardia, arrhythmia

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17
Q

What do H2RAs interact with?

A

warfarin , phenytoin

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18
Q

When should PPIs be used in treatment of GERD? PUD?

A

once daily, 30-60min before first meal in GERD and 1-2x daily in PUD

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19
Q

What is first line tx in GERD? Second line?

A

H2RAs and/or PPIs. 2nd, referral to GI

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20
Q

what meds commonly cause constipation?

A

antacids, anticholiergics, antihistamines, calcium clonidine, diuretics, Iron, Statins, Narcotics, TCAs, CCBs

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21
Q

what are hyperosmotic laxatives?

A

lactulose, miralax

22
Q

What is safest in treating constipation in infants?

A

glycerin

23
Q

what is laxative of choice in patients who should avoid straining?

A

surfactant laxatives-colace, docusate

24
Q

What is 1st, 2nd, 3rd line tx for constipation?

A

1-bulk forming laxative(if contraindicated, docusate) 2-mag citrate, 3-stimulant laxative

25
Q

How is acute, persistant and chronic diarrhea differentiated?

A

acute-<30, chronic 30 or longer

26
Q

what are antimotility agents in treating diarrhea?

A

loperamide, diphenoxylate

27
Q

What are special considerations of antimotility agents?

A

may make infectious diarrhea worse. Caution in hepatic failure, not for <4 y/o. CAUTION in bloody stools and leukocytes

28
Q

How does bismuth work

A

it is antisecretory, antimicrobal, absorbant

29
Q

What is 1st, 2nd, 3rd line for diarrhea?

A

loperamide, adsorbet or antisecretory, dyphenoxylate

30
Q

What is hallmark signs of IBS?

A

pain w/ change in consistency of stool that is relived by defacation

31
Q

What are 4 criteria for IBS?

A

abd distention, relief w/ BM, more frequent stools w/ onset of pain, looser stools w/ onset

32
Q

What is first line in treating IBS w/ Constipation? IBS w/ Diarrhea?

A

IBS-C: Osmotic laxatives. IBS-D loperimide

33
Q

In IBD, what does tissue biopsy often show?

A

TNF, IL-1, leukotrienes

34
Q

What is the hallmark sign of IBD?

A

bloody diarrhea, wt loss, fever

35
Q

What is GI mucosa in Crohns?

A

discontinuous narowed thick edematous patches w/ presence of ulcerations, lesions, fissures, granulomas

36
Q

what findings on GI Mucosa occur exclusively in Crohns?

A

granulomas and fistulas

37
Q

What is GI mucosa in ulcerative colitis?

A

continuous superficial uniform inflammation and ulceration

38
Q

Are extraintestinal complications of skiun, joint and liver problems more common in Crohns or UC?

A

Crohns

39
Q

How long should it take a patient to recover from a IBD exacerbation?

A

2-4 wks

40
Q

What is the gold standard of mild-mod IBD? How do they work?

A

aminosalisylates-sulfasalazine. They decrease inflammation by inhibiting prostaglandin synthesis

41
Q

What are side effects of sulfasalazine? What supplement do these pt’s often need?

A

steven-johnson syndrome, N/V, hepatitis. They need folic acid

42
Q

When are corticosteroids used in IBD?

A

Intermittently for acute IBD exacerbation

43
Q

How is prednisone tapered?

A

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

44
Q

what are long-term effects of corticosteroid use?

A

decreased bone density, buffalo hump, ulcers

45
Q

How are immunosuppressives used in IBD?

A

Used as adjunctive with aminoglycosides to induce and maintain remission

46
Q

When is IV cyclosporine used in IBD?

A

In severe acute exacerbation in ulcerative colitis when pt is refractory to corticosteroids

47
Q

When is methotrexate used in IBD?

A

it is effective only in crohns, not ulcerative colitis.

48
Q

What should patients be tested before prior to using biological agents such as remicaide and Humira?

A

TB

49
Q

What is tx for mild, mod, severe crohns?

A

mild: oral aminosalicylates alone or w/ abx. Mod: aminosalicylates and corticosteroids. severe: iv corticosteroids and biologicals

50
Q

What is common treatment of mild ulcerative colitis?

A

aminosalicylates-oral and rectal

Pharmacology (11 decks)

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