Week 5: GI products Part 2 Flashcards
What is aerophagia?
Accumulation of intestinal gas
What can cause intestinal gas?
- Eating quickly or gulping
- Carbonated beverages
- Anxiety
- Gum chewing
- Smoking
What is lactase?
The enzyme that normally breaks down lactose in the intestinal lumen so that it can be absorbed
What do people with lactase deficiency experience?
Malabsorbed lactase remains in intestinal lumen, colonic bacteria causes fermentation
What are drugs that may cause gas?
- Affect intestinal flora
- Affect metabolism of glucose
- Affect GI motily
- Products that contain or release gas
What are the treatment goals for gas?
- Reduce the frequency. intensity, and duration of intestinal gas
- Reduce the affect it has on person’s lifestyle
What are the exclusions of gas?
- Persistnat
- Severe debilitating symptoms
- Change in abdominal pain
- Abdominal discomfort
- Presence of accompanying symptoms such as diarrhea or constipation
What are non pharm treatments for gas?
- Diet
- SLow eating
- Excersise
- Vitamins
What is simethicone?
- Relieves gas
2 Reduce surface tension of gas bubbles - Not absorbed from the GI
- Safe for pediatrics
- Cause hypersensitivity or intestinal perforations and obstruction
What is α-Galactosidase/
- Hydrolyzes oligosaccharides into their broken-down parts before they can be metabolized by colonic bacteria
- prophylactic treatment before high fiber foods or foods containing oligosaccharides
- Not for patients with galactosemia
- From mold
What is lactase replacement?
- For lactose intolerance, break down lactose
- Aids in digestion of dairy products
What are pharm treatments for gas?
- Simethicone
- α-Galactosidase
- Lactase replacement
- Probiotics
Pediatric treatment for gas?
Simethicone - dosing based on age
Liquid formulations available
Lactation treatment for gas
Simethicaone
45 y/o male with known lactose intolerance forgot to take his Lactaid before a trip to Pizza Hut with work friends. Now seeks relief from abdominal pain, bloating, distension.
What do you recommend and why?
Lactaid
What is anorectal disorder?
Involve the perianal canal, anal canal, and/or lower rectum
What are common anorectal disorders?
- Hemorrhoids (most common)
- Pruritus
- Anal fissure (refer)
- Anorectal carcinoma (refer)
What are exclusions of anorectal disorders?
- Diagnosed GI diseases
- History of colon cancer
- Mild and severe symptoms
What are the treatment goals for anorectal disorders?
- Maintain soft stools to prevent straining during BM
- Alleviate and maintain remission of anorectal symptoms
- Prevent complications
What are the non pharm anorectal disorders?
- Dietary modifications
- Proper bowel habits and hygoiene
- Surgery
What is the function of local anesthetics?
- Provides temporary relief of itching, irritation, burning, discomfort, soreness, and pain
- Provides relief by reversibly blocking transmission of nerve impulses
- Lidocaine, benzocaine, dibucaine, tetracaine
Pramoxine hydrochloride, dyclonine hydrochloride
Benzyl alcohol
What are the forms of local anestetics?
- Aerosol foams
- Ointments
- Creams
- Jellies
What are the risks of using local anesthetics?
- Allergic reaction
- Not for open sores, can cause systemic effect
What are vasoconstrictors for anorectal disorders?
- Topical ephedrine, phenylephrine, and epinephrine
- α-adrenergic effects to constrict arterioles which helps decrease swelling of hemorrhoidal tissue
- Provide relief from itching, discomfort, and irritation
- Ephedrine and phenylephrine safe for external and intrarectal use
- Epinephrine approved only for external use
What are the adverse effects of vasoconstrictors?
- Ephedrine and epinephrine can cause systemic effects if absorbed (↑ cardiac rate, bronchodilation)
- Contact dermatitis
- Patients with comorbid conditions should be recommended to PCP before recommending treatment with vasoconstrictor
- DM, HTN, on depression medications, thyroid disease, heart disease.
What are protectants?
- Provide physical protective barriers
- Systemic absorption is minimal, adverse reactions uncommon
- Includes: Absorbents, demulcents, emollients
What are astringents?
- Promote coagulation
- Decrease cell volume, easy drying
- For thin protective layer over damaged area
What the adverse effects of witch hazel?
Alcohol irritation
What are keratolytics?
- Foster loosening of surface cells and tunrover
- Relives itching and inflammation
- Can be found in combination with other products but due adverse effects would recommend other, safer products
OTC keratolytics?
ALcloxa and resorcinol
What are corticoids?
Hydrocortisone: vasoconstrictor and antipruiritc
What are Analgesics, Anesthetics, and Antipruritics?
Provides temporary relief of burning, pain, or itching by producing a cool, warm, or tingling sensation
External use only
What are example Analgesics, Anesthetics, and Antipruritics?
- Menthol
- Camphor
- Juni[per tar
What is menthol?
Use sparingly due to risk of laryngospasm, dyspnea, cyanosis
What is camphor?
Can be absorbed through mucous membranes and stimulate the CNS which can cause convulsions or death.
What is juniper tar?
Use sparingly, if ingested orally can cause organ failure and cardiac abnormalities
What is preganancy/lactation treatment for anorectal?
- External products
- Lifestyle
What is pediatrics treatment for anorectal?
Referral under 12
What is geriatric treatment for anorectal?
- Adult treatment
- Consider comorbid conditions and if they have history or family history of colon cancer
34 y/o male complaining of bleeding in the anal area for the past 5 days. He is experiencing burning, pain, and blood on the toilet paper with each wiping. He has had these symptoms before but they are currently worse. He has tried using hydrocortisone cream without much relief. Hx of colon cancer in the family
Refer
What is the pharm treatment for anorectal?
- Local anesthetics
- Vasoconstrictor
- Protectnats
- Astringents
- Keratolytics
- Corticosteroids
- Analgesics, Anesthetics, and Antipruritics
What are pinworms?
- only worm infection that has OTC approved treatment
- Most commonly seen in children ages 5-14 years
- Prone to reinfection
- Nocturnal pruritus
What is the route of transmission for pinworms?
Ingestion of infective eggs by direct anus-mouth transfer by fingers and fomites
How do you confirm a pinworm infection?
- Nighttime perianal or perineal itching in a child
- Visual inspection of the perianal or perineal area for the adult worm
- A cellophane tape or an adhesive paddle test.
Exclusion of pin worm therapy OTC?
- Liver disease
- Preganancy
- Lactation
- Under 2
- Vague symptoms and negative visual inspection
- Helminthic infections other than pinworms
- Hypersensitivity to pyrantel pamoate
- Need for repeat dosing
What are the treatment goals for pin worms?
- Relieve symptoms
- Eradicate pinworms from the patient and the household to prevent reinfection
- Prevent transmission to other persone
Nonpharm treatment of pin worms?
- Education
- Eggs destroyed in sunlight
- Wash sheets
- Shower
- Change underwear
- Clean and vacuum
What is pyrantel pamoate?
- Paralyzes adult worms, causing them to loosen their hold on intestinal wall and allows them to be excreted
- Single oral dose based on patient’s body weight
3.Another can be given in two weeks if symptoms have not resolved but patient should first be referred to PCP
Adverse effects of pyrantel pamoate?
Nausea, vomiting, diarrhea, cramps
with preexisting liver dysfunction, severe malnutrition, or anemia should not use pyrantel pamoate without first consulting PCP
Mother of 5 y/o child describes how her child is constantly itching his bottom, especially at night while he sleeps, and she is looking for a good itch cream for “those sensitive areas.”
What do you recommend and why?
Pyrantel pamoate
What is the pharm treatment for pinworms?
Pyrantel pamoate
What is nausea?
Person’s subjective feeling of needing to vomit
What is retching?
involuntary rhythmic diaphragmatic and abdominal contractions
What is vomiting?
rapid, forceful expulsion of GI tract contents
What is the signs of dehydration?
- Dry mouth
- Decreased skin turbot
- Dark urine
What are the exclusions of nausea and vomiting?
- Fever and/or diarrhea
- Severe upper quad pain
- Yellow skin or eye color
- Heard injury
- Glaucoma, BPH, bronchitis, asthma, emphysema
What are the treatment goals of nausea and vomiting?
- Provide symptomatic relief
- Identify and correct underlying cause
- Prevent and correct complications
- Prevent future occurances
What are non pharm treatments of nausea and vomioting?
Oral rehydration
What are oral rehydration solutions?
1.Use premade solutions or can use 6 teaspoons of sugar and ½ teaspoon of salt in a liter of water
2. Weight based
3. 5 ml q15 mins for small children and 15 ml q15 mins for older children and adults
What treats motion sickness?
Antihistamine: Meclizine, pihenhydramine, doxylamine
What are adverse effects of motion sickness med?
dry mouth, confusion, dizziness, tremors, and constipation, drowsiness
What are tips for patients using motion sickness med?
Avoid reading while traveling, focus straight ahead, sit in the front of the car, avoid strong odors
What Antiemitic med is not reccommended for children 2-6?
Diphenhydraamine
2. Meclizine
3. Doxylamine
What Antiemitic med is not reccommended for children 6-12?
Meclizine and doxylamine
What are example OTC antiemetic antihistamines?
- Dimenhydrinate
- Diphenhydramine
- Meclizine
- Doxylamine
What are pharm treatments for nausea?
- Antacids
- H2RAs
- BSS
- Phosphorated carbohydrate solution (PCS) (emetrol)
What type of patient should be cautious of for PCS?
Diabetics
What are complementary therapies for nausea?
- Ginger
- Pyridoxine
- Acupressure
- Aromatherapy
Treatments for nausea and vomiting pregnancy?
Lifestyle modifications and diet
Taking a multivitamin daily for 3 months prior to conception
Pyridoxine with or without doxylamine as first line therapy
Ginger
Treatments for nausea and vomiting geriatrics?
Caution with anticholinergics
Treatments for nausea and vomiting lactation?
Don’t use BSS
Treatments for nausea and vomiting pediatrics?
For mild-moderate cases: ORS
Moderate-severe: referral
32 y/o female, 12 weeks pregnant, complains of bothersome daily morning sickness. No significant PMH.
What do you recommend and why?
Supportive care only (fluids, time)
Pyridoxine
81 y/o male with severe N/V due to Norovirus outbreak at a local nursing home. Symptoms of moderate dehydration, tachycardia, dry mucous membranes. Hx: Parkinson’s disease, HTN, T2DM.
What do you recommend and why?
Refer
