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Self Care > Week 4: GI products > Flashcards

Week 4: GI products Flashcards

1
Q

What is the main symptom of GERD?

A

Heartburn

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2
Q

What is heartburn?

A

Burning sensation in the stomach

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3
Q

What medications can cause heart burn?

A
  1. Potassium
  2. Iron
  3. NSAIDs
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4
Q

When would we exclude self treatment for heart burn?

A
  1. Frequent heartburn for more than 3 months
  2. While taking H2RA or PPI
  3. 2 weeks or while taking H2RA or PPI
  4. Difficulty or pain on swallowing
  5. Vomiting up blood/black tarry stool
  6. Weight loss
  7. Nausea, vomiting, or diarrhea
  8. Children
  9. Chest pain with sweating
  10. 45 YO adults with indigestion
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5
Q

What are the treatment goals for heart burn?

A
  1. Complete relief of symptoms
  2. Reduce recurrence of symptoms
  3. Prevent/manage unwanted effects of medication
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6
Q

Non pharm treatments of heartburn?

A
  1. Weight loss
  2. Non smoking
  3. Time
  4. Elevated sleeping
  5. Journal diet
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7
Q

What are the pharm treatments for heart burn?

A
  1. Antacids
  2. H2RAs
  3. H2RA + antacid
  4. PPI
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8
Q

What are antacids?

A
  1. Neutralizes gastric acid
  2. Liquid form has a faster onset
  3. Reevaluate if needing more than twice a week
  4. Most eliminated renal
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9
Q

What should be avoided when taking antacids?

A

Amphetamines

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10
Q

What should be avoided when taking sodium bicarbonate?

A
  1. Quinidine
  2. Salicylates (decreases salicylate response)
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11
Q

What are histamine receptor antagonists?

A
  1. Decrease gastric secretion by blocking histamine receptors of parietal cells
  2. Well tolerated
  3. As needed drug and prevention
  4. Effective in relieving fasting and nocturnal symptoms
  5. Eliminated by a combination of renal (most important) and hepatic metabolism
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12
Q

What are the side effects of H2RAs?

A

Headache, diarrhea, constipation, dizziness, drowsiness

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13
Q

What should you do when taking Antacids, H2RAs, or PPIs?

A

Don’t take concurrently with antineoplastics, TKIs/
separate from antacids by several hours

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14
Q

What should you avoid when taking H2RAs and PPIs?

A

Avoid taking with Concurrent Itraconazole, ketoconazole, atazanavir, iron sulfate, calcium carbonate therapy

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15
Q

What is important to know about cimetidine?

A

Avoid use of cimetidine in patients taking medications metabolized by CYP enzymes

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16
Q

What happens if you take citalopram with cimetidine or PPIs?

A

Citalopram dose should not exceed 20 mg per day if not used concomitantly

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17
Q

What is a PPI?

A
  1. Inhibit hydrogen potassium ATPase, irreversibly blocking the final step in gastric acid secretion
  2. Increased bioavailability when daily dosing but reduced after a meal
  3. Relief takes 1-4 days
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18
Q

What are adverse effects of PPIs?

A

Headache, abdominal pain, diarrhea, constipation, or flatulence

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19
Q

What should we do about taking PPIs with Warfarin, theophylline, tacrolimus, mycophenolate, or mofetil?

A

Avoid concurrent use of check prescriber

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20
Q

What should we do when taking PPIs with digoxin?

A

Check with prescriber before use

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21
Q

What should we do when taking PPIs with methotrexate?

A

Avoid concurrent use of high dose methotrexate

Significant toxicity is unlikely with lower weekly doses

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22
Q

What are the preventative measures of taking omeprazole and esomeprazole with clopidogrel?

A

Avoid concurrent use, clinically significant interaction is unlikely

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23
Q

What is the preventative measure of taking omeprazole and esomeprazole with cilostazol or diazepam?

A

Avoid concurrent use

Lansoprazole may be a safer alternative

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24
Q

What are the disadvantages of bismuth subsalicylate?

A
  1. Not recommended for children and be avoided in patient with salicylate sensitivity or bleeding risks
  2. Risk of Reyes syndrome in children
  3. black stool and tongue
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25
Q

What heat burn product is compatible with pregnancy?

A

H2RAs

Calcium and magnesium antacids

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26
Q

What heat burn product is compatible with lactation?

A

Cimetidine and Famotidine

Aluminum-, calcium-, or magnesium-containing antacids

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27
Q

What heat burn product is recommended for pediatrics with GI problems?

A

Lifestyle modifications

Antacids

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28
Q

58 y/o male with known heartburn controlled with lifestyle modifications. Friends invited him out to local chili cook-off, and he seeks advice on preventing symptoms.
What do you recommend and why?

A

PRN H2RA (as needed and preventative treatment)

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29
Q

46 y/o mother of 2 with a new job complains of moderate heartburn symptoms 3-4 times per week. What do you recommend and why?

A
  1. Daily PPI
  2. PRN H2RA
  3. Lifestyle mod
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30
Q

54 y/o male presents complaining of severe heartburn, pounding in his chest. He appears pale, weak, diaphoretic, short of breath. Recommendation?

A

Refer

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31
Q

What is constipation?

A

Occurrence of fewer than 3 bowel movements per week accompanied by straining and difficult passage of hard, dry stools

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32
Q

What is primary constipation?

A

Slower than normal GI transit time or a defecatory disorder

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33
Q

What is secondary constipation?

A

Systemic, neurologic, and psychological disorders and/or structural abnormalities

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34
Q

What might contribute to constipation?

A

Inadequate dietary fiber and fluid intake

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35
Q

What are drugs that induce constipation?

A
  1. Analgesics
  2. Anatacids
  3. Opiates
  4. NSAIDs
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36
Q

What are the treatment goals for constipation?

A
  1. Relieve and reestablish
  2. Establish dietary and exercise habits
  3. Safe and effective use of laxatives
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37
Q

What are the exclusions for self-treatment for constipation?

A
  1. Abdominal pain and significant distension
  2. Fever
  3. Nausea/vomiting
  4. Unexplained flatulence
  5. Chronic conditions
  6. Daily laxative use
  7. Age
  8. Abnormal stool
  9. Persistant greater than 2 weeks or over 3 months
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38
Q

What are the non pharm treatments for constipation?

A
  1. Gradual increase in fiber, 25g/day for women and 38g for men
  2. Increase fluid intake 8-8 ounce glasses/day with added fibers
  3. Physical activity
  4. Bowel training: attempting after waking and 30 minutes after meals
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39
Q

What are bulk-forming agents?

A
  1. Contains methylcellulose, polycarbophil, and psyllium
  2. Onset of 12-24 hrs but delayed to 72 hrs
  3. Absorb fluid from intestine, swell to form soft, bulky stool
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40
Q

What are the adverse effects of bulking forming agents?

A
  1. Abdominal cramping and flatulence
  2. Avoid in patients with difficulty swallowing, or esophageal structures, intestinal ulcerations, stenosis
  3. Avoid in patients who are fluid restricted
  4. Councel patients to take in adequate fluids
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41
Q

What are the hyperosmotic agents?

A
  1. PEG 3350
  2. Glycerin
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42
Q

What do hyperosmotics do?

A
  1. Draw water into the colon or rectum through osmosis to stimulate a bowel movement
  2. Onset 12-72hr, can take up to 96hr
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43
Q

What are the adverse effects of hyperosmotics?

A

Bloating, abdominal discomfort, cramping, and flatulence

No DDI

44
Q

What is the dosage form for glycerin?

A
  1. Suppository
  2. BM within 15-30 minutes
  3. Approved in all age groups
45
Q

What are types of stimulants?

A
  1. Sena
  2. Bisacodyl
  3. Castor oil-safe alternatives (no recommended)
46
Q

What are the functions of stimulants?

A
  1. Increases intestinal motility, increases secretion of water and electrolytes in the intestine
  2. Onset 6-10 hrs for oral, 15-60mins for suppositories
47
Q

What are the Adverse effects of stimulants?

A

Severe cramping, electrolyte, and fluid deficiencies, hypokalemia

48
Q

What is the dosage form of stimulants?

A

Enteric coated

Should not be broken, crushed, chewed, or given with agents that increase gastric pH

49
Q

OTC antacids?

A

Tums
Gaviscon
Mylanta

50
Q

OTC H2RA?

A

Pepcid
Cimetidine
Zantac

51
Q

OTC PPI?

A

Prilosec
Nexium
Zegerid

52
Q

OTC bulking forming agents?

A

Wal-mucil

53
Q

OTC hyper osmotic agents?

A

MiraLax

54
Q

OTC stimulants?

A

Dulcolax

55
Q

What are emollients (stool softeners)?

A
  1. Act in the small and large intestine to increase the wetting efficiency of intestinal fluid
  2. Facilitates mixture of aqueous and fatty substances to soften the fecal mass
  3. Commonly used in combination with stimulants
56
Q

OTC emollients?

A

Colace

57
Q

Example of emollient active ingredient?

A

Docusate

Onset: 12-72hr delay 3-5 days
Well tolerated, limited adverse effects

58
Q

Example of lubricants?

A

Mineral oil

59
Q

What are lubricants?

A
  1. softens fecal content by coating stool and preventing colonic absorption of fecal water
  2. Onset 6-8hr as liquid, rectal 5-15 minutes
60
Q

What are the counseling points for lubricants?

A
  1. Should not be taken before lying down
  2. Should not be used in children <6, pregnant, bedridden or geriatrics, individuals with difficulty swallowing
  3. Due to risks associated with use of mineral oil, it is a last resort
61
Q

What is a saline laxatives?

A
  1. Magnesium sulfate or sodium phosphate
  2. Draw water into the small and large intestine by osmosis
  3. Increase intraluminal pressure and promote GI motility
  4. Oral (30-min - 3hr) or rectal (2-15min)
62
Q

What are the adverse effects of saline laxatives?

A

Abdominal cramping, nausea, vomiting, dehydration

63
Q

What are the adverse effects of saline laxatives?

A

Abdominal cramping. nausea, vomiting, dehydration

64
Q

What are the risks of using saline laxatives?

A
  1. Higher DDI and drug disease
  2. Caution in renal impairment, newborns, older adults
65
Q

What should you avoid using with docusate salts?

A

Mineral oil
Avoid concurrent use

66
Q

What should you avoid using with magnesium citrate?

A

Fluroquinolone and tetracycline antibiotics

Avoid oral magnesium citrate within 1–3 hours of ingestion of oral tetracyclines or fluoroquinolones

67
Q

What should you avoid using with bisacodyl?

A

Avoid Milk products or drugs that raise gastric pH within 1 hr before or after ingestion

68
Q

Rank the GI treatment in terms of speed (fastest to slowest)

A
  1. Enemas
  2. Suppositories
  3. Lubricants
  4. Salines
  5. Stimulants
  6. Osmotics
  7. Stool softeners
  8. Bulk
69
Q

Rank the GI treatment in terms of comfort (most to least)

A
  1. Stool softeners
  2. Bulk
  3. Osmotic
  4. Stimulants
  5. Salines
  6. Lubricants
  7. Suppositories
  8. Enemas
70
Q

What products for constipation are recommended for pediatrics?

A
  1. Lifestyle changes and diet
  2. 2-6 years: oral decussate, magnesium OH, senna
  3. 6-12: oral–methylcellulose, psyllium powder, docusate, mineral oil , bisacodyl, senna, mag citrate, mag hydroxide, mag sulfate
    rectal – glycerin suppositories, mineral oil, sodium phosphate, and bisacodyl
71
Q

What products for constipation are recommended for geriatrics?

A

Bulk-forming laxatives or PEG 3350

Life style mod

Stool softener

72
Q

What products for constipation are recommended for pregnancy?

A
  1. Supplements
  2. Lifestyle and diet
  3. Bulk-forming
  4. short term use of senna or bisacodyl is considered low risk
  5. Avoid castor oil, mineral oil, and saline laxatives
73
Q

What products for constipation are recommended for lactation?

A
  1. Senna, bisacodyl, PEG 3350, and docusate are considered compatible
  2. Avoid castor oil and mineral oil
74
Q

24 y/o male recently left military service and entered 4-year college. Complains of straining to pass small, hard stools only a few times a week compared to his usual bowel habits.

A

Gradually increasing fiber
Bulk-forming laxative
Stool softener
Stimulant laxative
Osmotic laxative

75
Q

36 y/o male, opiate user (chronic pain), has not had a bowel movement in 6-7 days. Complains of severe abdominal pain and distension, bowel sounds absent. What do you recommend and why?

A

Refer

76
Q

What is diarrhea?

A

abnormal increase in stool frequency, liquidity, weight or volume

77
Q

What is abnormal diarrhea?

A

3 BM per day

78
Q

What are the risk factors of diarrhea?

A
  1. Attendance or employment at day cares
  2. Food handlers or caregivers
  3. Congregate living conditions
  4. Consumption of unsafe foods
  5. Diverticulitis, immunocompromised
79
Q

What is viral gastroenteritis?

A
  1. Norovirus in adults
  2. Transmitted by contaminated water or food, people, surfaces
  3. Rotavirus in infants and children (seasonally and 2 oral vaccines)
80
Q

What is bacterial gastroenteritis?

A
  1. Food borne transmission
  2. Campylobacter, E.coli, Salmonella
  3. Extremely watery diarrhea or bloody diarrhea depending on the pathogen
81
Q

What is protozoal diarrhea?

A
  1. Not rx treatments are not available, refer
82
Q

What is foodborne gastroenteritis?

A
  1. Noravirus
  2. Linked to poor sanitation and manufacturing practices in food facilities
83
Q

What is traveller’s diarrhea?

A
  1. Acquired mainly by ingestion of contaminated food or water
  2. Fruit, veggies, raw meat, seafood, water, ice cubes
84
Q

What is food induced diarrhea?

A

Provoked by food intolerance

85
Q

What are the meds that may cause diarrhea?

A
  1. Cimetidine
  2. Magnesium containing antacids
  3. NSAIDs
  4. Osmotic laxatives
  5. PPIs
  6. St. Johns wort
  7. Stimulant laxatives (senna, bisacodyl)
86
Q

What are the exclusions for diarrhea?

A
  1. Children
  2. Persistent fever and vomiting
  3. Blood and pus and mucus in stool
  4. High output
  5. Severe dehydration and abdominal pain/distress
  6. Chronic med
87
Q

What are exclusions for diarrhea self treatment for pregnancy?

A

Chronic or persistent
Suboptimal response to oral rehydration solution already administered

88
Q

What are the treatment goals of diarrhea?

A
  1. Prevent or correct fluid and electrolyte loss
  2. Controls symptoms
  3. Identify and treat the cause
  4. Prevent acute morbidity and mortality
  5. Focus should be on fluid and electrolyte replacement by oral rehydration solutions
89
Q

What are fluid and electrolyte management for diarrhea?

A
  1. Rehydration using ORS
90
Q

What are the 2 phases of rehydration?

A

Rehydration: over 3-4 hrs quickly replaces water and electrolyes to restore normalcy
Maintenance: maintain normal body composition until adequate dietary intake is reestablished

91
Q

What is dietary management for diarrhea?

A

Early referring in combination with ORS improves outcomes

92
Q

What are the preventative measures for diarrhea?

A

Hand washing, cleaning contaminated surfaces

93
Q

What is the function loperamide?

A
  1. Synthetic opioid agonist that lacks central nervous system effects
  2. Slows intestinal motility and allows absorption of electrolytes and water
  3. Helps reduce daily fecal volume, increased viscosity and bulk volume, and reduced fluid and electrolyte loss
  4. Labeled for use in children 6 years and older
94
Q

What are Adverse effects of loperamide?

A
  1. Dizziness and constipation
  2. Few DDI
  3. Not for invasive bacterial diarrhea
95
Q

OTC loperamide

A

Imodium

96
Q

What is bismuth subsalicylate?

A
  1. Reduce frequency of unformed stools, increase stool consistency, release abdominal cramping, decrease nausea and vomiting
  2. Caution in patients taking aspirin
  3. Approved for acute diarrhea in children 12 years and older
97
Q

What is the bismuth subsalicylate adverse effect?

A
  1. Children recovering from chicken pox, risk of Reyes
  2. Black staining of stool
  3. Antibiotic DDI
98
Q

OTC bismuth subsalicylate?

A

Pepto bismol

99
Q

Diarrhea recommendation for pediatrics?

A
  1. Antidiarrheal medications are not recommended
  2. Pre-mixed solutions are preferred
  3. If symptoms persist, recommend PCP
100
Q

Diarrhea recommendation for geriatrics?

A

Diarrhea is more likely to be severe or possibly fatal in these patients, should be recommended to PCP

101
Q

Diarrhea recommendation for pregnancy?

A

Recommend to PCP
BSS is contraindicated during pregnancy

102
Q

Diarrhea recommendation for lactation?

A

BSS should be avoided

103
Q

38 y/o female recently diagnosed with T2DM and started on metformin. Now reports 2-3 loose stools per day and mild cramping abdominal pain.

A

Refer

104
Q

Pham medications for constipation?

A
  1. bulk
  2. Hyperosmotic
  3. Stimulants
  4. Emollients
  5. Lubricants
  6. Saline laxatives
105
Q

Pharm meds for diarrhea?

A
  1. Loperamide
  2. BSS

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