Weight Loss, Motion Sickness, Eye/Ear Conditions, Overactive Bladder, BPH, ED, IBD, Constipation & Diarrhea Flashcards
1
Q
Constipation
What is the recommended treatment?
A
Increase fiber intake + osmotic agent
**Osmotic agents: Milk of Magnesia or PEG/Miralax
2
Q
Constipation
Milk of Magnesia is not recommended in what disease state?
A
Renal impairment
3
Q
Constipation
What can be used if the patients need to defecate?
A
Glycerin or bisacodyl suppository
4
Q
Constipation
Oral stimulants & onset of action
A
1st line: Senna 2 tabs HS
Alt: Bisacodyl
Onset of action: ~10 hours to cause a bowel movement
5
Q
Constipation
Drugs that cause constipation
A
Opioids
Anticholinergics
Verapamil
Iron
6
Q
Constipation
What is recommended for patients on long-term opioids?
A
Stimulant laxative
7
Q
Constipation
If a stool is hard what should be added?
A
Docusate (stool softener)
8
Q
Constipation
What is the 1st line treatment & drug of choice in pregnancy?
A
Bulk-forming agents (aka fiber)
CP: take 2 hours before or after other drugs
9
Q
Constipation
Name the bulk-forming agents.
A
Psyllium (Metamucil)
Calcium Polycarbophil (FiberCon)
Methylcellulose (Citrucel)
10
Q
Constipation
What drug class is also 1st line when used with bulk-forming agents?
A
Osmotic agents work by pulling water into the stool
*can cause electrolyte imbalances
11
Q
Constipation
Name the osmotic agents
A
Magnesium hydroxide (Milk of Magnesia)
PEG (Miralax)
Glycerin suppository
12
Q
Constipation
Name the stimulant laxatives
A
Senna (Senokot)
Bisacodyl (Dulcolax)
*work by irritating the mucosal lining of the colon
13
Q
Constipation
What drug class reduce the surface tension in the stool by allowing water & fat to mix into the stool?
A
ONLY emollient: Docusate (Colace)
**Preferred when straining should be avoided (post-partum, post-MI & hemorrhoids)
14
Q
Constipation
Name a lubricant
A
Mineral oil
15
Q
Constipation
Name the osmotic agents used for bowel preps.
A
PEG (Golytely) Sodium phosphate (OsmoPrep)
16
Q
Constipation
Contraindications to bowel prep agents include:
A
- Acute phosphate nephropathy
- Gastric bypass
- Stapling surgery
17
Q
Constipation
The day before a colonoscopy, what should the patient do?
A
Be on clear liquid diet ONLY
- No red, blue, or purple food coloring
- No solid foods at all
18
Q
Constipation
What drug can be used for treatment of chronic idiopathic constipation (CIC), opioid-induced constipation (OIC), & IBS-C?
A
Lubiprostone (Amitiza)
MOA: activates chloride channels in gut causing peristalsis
19
Q
Constipation
What drug can be used for CIC & IBS-C?
A
Linaclotide (Linzess)
20
Q
Constipation
Alvimopan - MOA, Brand, Indication
A
Brand: Entereg
MOA: mu-opioid receptor antagonist
Used ONLY in hospitalized patients prior to surgery to reduce risk of post-op ileus
21
Q
Constipation
Name mu-opioid antagonists used for treatment of opioid-induced constipation (OIC).
A
- Methylnaltrexone (Relistor)
2. Naloxegol (Movantik)
22
Q
Constipation
What agents are contraindicated in patients who have used opioids for 7 consecutive days prior to use?
A
- Alvimopan (Entereg)
- Methylnaltrexone (Relistor)
- Naloxegol (Movantik)
23
Q
Diarrhea
What is the most common bacterial cause of diarrhea?
A
E. coli
24
Q
Diarrhea
Drugs that cause diarrhea (broad question)
A
Antibiotics & Magnesium products
25
Diarrhea
What agent is both an antisecretory agent with antimicrobial effects?
Bismuth subsalicylate (Pepto-bismol)
26
Diarrhea
Pepto-bismol contraindications & SE
CI: sulfa allergy, coagulopathy, & concomitant use of salicylates
SE: cause black tongue/stools
27
Diarrhea
Name the Antimotility agents, MOA, & contraindication.
1. Loperamide (Imodium)
2. Diphenoxylate/Atropine (Lomotil) --> CV
MOA: works by slowing motility & prolonging water absorption into the intestines
CI: patients with C. diff
28
Diarrhea
What mu-opioid agonist is used for treatment of IBS-D?
Eluxadoline (Viberzi)
29
Diarrhea
What should be ruled out prior to suspecting diarrhea?
Lactose intolerance
30
Inflammatory Bowel Disease
Name the 2 types of IBD
1. Ulcerative colitis (UC)
| 2. Crohn's disease (CD)
31
Inflammatory Bowel Disease
Classic symptom of IBD
Persistent blood diarrhea
32
Inflammatory Bowel Disease
When do flares occur?
1. Develop an infection
2. NSAID use
3. Food triggers (pt specific)
33
Inflammatory Bowel Disease
What is Irritable Bowel Syndrome (IBS)?
Similar to IBD, but does NOT cause inflammation.
Can cause IBS-C/D
34
Inflammatory Bowel Disease
What is characterized as ulcerative colitis (UC)?
Characterized by mucosal inflammation confined to the rectuum & colon w/ SUPERFICIAL ULCERS.
- Effects descending colon & rectum - distal disease
- Effects recctum ONLY - proctitis
**Typically UC causes bloody stools**
35
Inflammatory Bowel Disease
What is characterized as Crohn's disease (CD)?
Characterized by deep tissue inflammation that can affect part of GI tract.
- Ileum & colon
- damage to the bowel wall can cause strictures & fissures
**May OR may not cause bloody stools**
36
Inflammatory Bowel Disease
What can cause GI distress?
Sorbitol & lactose - are used as binders in many foods & drugs
37
Inflammatory Bowel Disease
Treatment of acute exacerbations of both UC & CD?
Short courses of oral or IV steroids
38
Inflammatory Bowel Disease
Maintenance therapy in ulcerative colitis?
Aminosalicylates
39
Inflammatory Bowel Disease
Name the aminosalicylates
Preferred: Mesalamine
Alt: Sulfasalazine, balsalazide, olsalazine are all converted to mesalamine in the body
**Sulfasalazine many SE
These products are NOT recommended in CD because they do not maintain remission
40
Inflammatory Bowel Disease
Mesalamine counseling point
CP: ghost tablet in stool
41
Inflammatory Bowel Disease
First-line treatment for mild-moderate Crohn's Disease.
Topical steroid or oral budesonide
42
Inflammatory Bowel Disease
Name an immunosuppressive agent used for moderate-severe Crohn's disease.
MTX
43
Inflammatory Bowel Disease
What agent is used in patient with refractory IBD after 1st line therapies?
Anti-TNF agents
44
Inflammatory Bowel Disease
How long can you self treat with Anti-diarrheal agents for symptom control?
Max 2 days
45
Inflammatory Bowel Disease
Dicyclomine - Brand, Class, Contraindication
Brand: Bentyl
Class: Antispasmodic
CI: elderly (BEERs)
46
Inflammatory Bowel Disease
Name oral steroids
1. Prednisone
2. Budesonide (Entocort ES, Uceris)
*Uceris indicated in ulcerative colitis ONLY
**if steroid use > 2 wks, must taper**
47
Inflammatory Bowel Disease
Name monoclonal antibodies used for refractory IBD.
Anti-TNF
infliximab (Remicade)
adalimumab (Humira)
certolizumab (Cimzia)
**Cimzia approved for Crohn's ONLY**
48
Inflammatory Bowel Disease
Prior to infliximab use what should be obtained first?
CBC, TB & HBV tests
49
Inflammatory Bowel Disease
Natalizumab - Brand, MOA, Indication, Dosage, & Boxed Warning
Brand: Tysabri
MOA: integrin receptor antagonist
Indication: Crohn's Disease ONLY who have failed anti-TNF therapy
Dosage: 300 mg IV q 4 weeks; d/c if no response by week 12
Boxed warning: PML
*REMS - Prescribers must be enrolled in TOUCH prescribing program**
50
Inflammatory Bowel Disease
Entyvio - Generic, MOA, Indication, CI, & SE
Generic: Vedolizumab
MOA: integrin receptor antagonist
Indication: approved for both CD & UC
CI: live vaccines
SE: nasopharyngitis & arthralgia
51
Sexual Dysfunction
Common causes of erectile dysfunction
1. HTN
2. Peripheral neuropathy
3. Atherosclerosis
**All decrease blood flow to penis**
52
Sexual Dysfunction
Drugs that cause ED
SSRIs & SNRIs
Beta-blockers
BPH medications (Finasteride, Dutasteride, etc)
H2RAs (Cimetidine)
53
Sexual Dysfunction
Name the PDE-5 Inhibitors
First-line treatment
Vardenafil (Levitra)
Avanafil (Stendra)
Sildenafil (Viagra)
Tadalafil (Cialis)
54
Sexual Dysfunction
PDE-5 Inhibitors MOA
Cause release of nitric oxide (NO) --> cGMP & smooth muscle relaxation = blood flow to penis
55
Sexual Dysfunction
PDE-5 Inhibitors Contraindication & Caution Use with
CI: Nitrates (NTG)
Caution: alpha blockers or anti-hypertensives --> hypotension
56
Sexual Dysfunction
PDE-5 inhibitors Warnings
1. Impaired color discrimination
2. Hearing loss
3. Vision loss
4. Hypotension
5. Priapism
*if pt experiences an erection for > 4 hours, seek medical attention**
"Now why do you want to have an erection longer than an hour much less 4 hours?"
57
Sexual Dysfunction
Sildenafil, Vardenafil & Tadalafil counseling points & Strengths
Sildenafil & Vardenafil taken 1 hour prior to sex
Tadalafil taken 30 minutes prior
Strengths:
Sildenafil - 50 mg
Vardenafil - 10 mg
Tadalafil - 10 mg
58
Sexual Dysfunction
What agent is a prostaglandin E1 thatis either injected or inserted into the penis causing vasodilation & blood flow to the penis? SE & Storage
Alprostadil
SE: Priapism & Penile pain (No Shit!)
Storage: Requires refrigerations
59
Sexual Dysfunction
What agent is used for premenopausal women ONLY for treatment of hypoactive sexual desire disorder (HSDD)?
Flibanserin (Addyi)
MOA: 5HT1a agonist & 5HT2a antagonist
CI: alcohol use (severe hypotension - REMS), 3A4 inhibitors, or hepatic impairment
Dosing: 100 mg HS
**DOES NOT enhance sexual performance, just increase desire
60
Benign Prostatic Hyperplasia (BPH)
Symptoms of BPH
Lower urinary tract symptoms (LUTS): difficulty storing urine and voiding
61
Benign Prostatic Hyperplasia (BPH)
Treatment options are based on what? What are the options?
Patient's perception of BPH symptom severity
Options: watchful waiting, medication or surgery
62
Benign Prostatic Hyperplasia (BPH)
Medication treatment options
Alpha blocker +/- 5 alpha-reductase inhibitor
63
Benign Prostatic Hyperplasia (BPH)
Alpha blocker MOA
MOA: work by inhibiting alpha-1 receptors --> relaxing smooth muscle on bladder neck
64
Benign Prostatic Hyperplasia (BPH)
3 Types of alpha blockers
1A
1B
1D
65
Benign Prostatic Hyperplasia (BPH)
Name the non-selective alpha blockers
Terazosin & Doxazosin (Cardura)
**MORE SE so needs to be titrated up slowly**
66
Benign Prostatic Hyperplasia (BPH)
Name the selective alpha blockers
Tamsulon (Flomax)
Alfuzosin (Uroxatral)
Silodosin (Rapaflo)
67
Benign Prostatic Hyperplasia (BPH)
Tamsulosin SE
Floppy Iris Syndrome
**Notify ophthalmologist if patient has cataracts & has EVER taken an alpha blocker**
68
Benign Prostatic Hyperplasia (BPH)
Side effects of alpha blockers
1. Orthostatic hypotension
2. Floppy iris syndrome
3. Abnormal ejaculation or retrograde ejaculation (Silodosin & tamsulosin)
4. QT prolongation (alfuzosin)
69
Benign Prostatic Hyperplasia (BPH)
Name the types of 5 alpha-reductase inhibitors
Finasteride (Proscar)
| Dutasteride (Avodart)
70
Benign Prostatic Hyperplasia (BPH)
5 alpha-reductase inhibitors MOA
Works by reduces PSA levels & decreasing prostate size --> should NOT be used in patients with LUTS without prostate enlargement
**MUST have enlarged prostate**
71
Benign Prostatic Hyperplasia (BPH)
5 alpha-reductase inhibitors SE
1. Impotence
2. Decrease libido
3. Abnormal ejaculation
4. Breast enlargement
72
Benign Prostatic Hyperplasia (BPH)
5 alpha-reductase contraindication
Pregnancy category X
should NOT be HANDLED by women of childbearing potential
73
Overactive Bladder (OAB)
Definition
OAB occurs when the detrusor muscle contracts before bladder is actually full (hyperactive)
- Detrusor muscle contractions are mediated by activation of muscarinic receptors by ACh
- M3 receptors are responsible for emptying the bladder
74
Overactive Bladder
First-line treatment for OAB
Behavioral therapies
Kegel exercises to strengthen pelvic floor muscles
75
Overactive Bladder
Second-line treatment for OAB
Anticholinergic drugs block ACh
76
Overactive Bladder
Name the non-selective anticholinergics used in OAB
1. Oxybutynin (Ditropan)
2. Oxybutynin patch (Oxytrol)
3. Tolterodine (Detrol)
77
Overactive Bladder
Name the selective anticholinergic used in OAB
Solifenacin (Vesicare)
78
Overactive Bladder
What agent is available OTC for women > 18 yoA
Oxytrol patch
79
Overactive Bladder
Mirabegron - Brand, MOA, SE
2nd line
Brand: Myrbetriq
MOA: beta-3 agonist that relaxes the detrusor muscle causing increased urine capacity
SE: HTN
80
Overactive Bladder
Third-line treatment
Botox
MOA: inhibits release of ACh
Indication: For refractory OAB
81
Motion Sickness
Most common herbal treatment
Ginger
82
Motion Sickness
Antihistamines available OTC for motion sickness
1. Diphenhydramine (Benadryl)
2. Dimenhydrinate (Dramamine)
3. Meclizine (Bonine)
4. Cyclizine (Marezine)
83
Motion Sickness
Side effects of antihistamines
Sedation, blurry vision, dry mouth, confusion, dizziness (anticholinergic effects)
**NO alcohol or other CNS depressants**
84
Motion Sickness
What agent has a black box warning if used in children?
Promethazine
85
Motion Sickness
Major counseling points for scopolamine
1. Apply 4-6 hours prior to need
2. Do not touch eyes
3. Wash hand after use
4. Alternate ears
5. Do NOT cut patch
6. Remove patch prior to MRI (will burn skin)
7. Common SE: dry mouth
86
Motion Sickness
What agent is prescribed for motion sickness that is not more effective than OTC products, but last 3 days?
Scopolamine patch (Rx ONLY)
87
Motion Sickness
Scopolamine warning
Hypersensitivity to belladonna alkaloids
88
Motion Sickness
When should oral agents for motion sickness be taken?
30-60 minutes prior to travel
89
Motion Sickness
Avoid this administration of promethazine
do NOT give IV --> cause severe skin necrosis (vesicant)
90
Weight Loss
Drugs that cause weight gain
```
Steroids
Insulin
Clozapine
Paroxetine
Mirtazapine
Gabapentin
TZDs
Pregabalin
```
"So, I Couldn't Picture Mary Gaining Those Pounds"
91
Weight Loss
How many kcals per day is 1 lb per week of weight loss?
500 kcal/day = 1 lb/wk
92
Weight Loss
What percentage still has meaningful health benefits if loss?
3-5%
93
Weight Loss
Guidelines for bariatric surgery
BMI > 40
| BMI > 35 w/ comorbid conditions
94
Weight Loss
Drugs that cause weight loss
Topiramate
Methylphenidate
GLP-1 agonist
Bupropion
Newer drugs = Maintenance therapy:
```
Phentermine/Topiramate ER (Qsymia)
Lorcaserin (Belviq)
Naltrexone/Bupropion (Contrave)
Liraglutide (Saxenda)
Semaglutide (Ozempic/Wegovy)
```
95
Weight Loss
What agent is available OTC & Rx?
Orlistat
OTC: Alli
Rx: Xenical
96
Weight Loss
All weight loss medications should be stopped if __% is not achieved in __ weeks.
5% in 12 weeks
97
Weight Loss
Contrave - MOA, SE, CI
MOA: Naltrexone decreases food cravings; bupropion decreases appetite
SE: abnormal dreams
CI: Pregnancy Category X, concurrent use of opioids, seizures & anorexia
98
Weight Loss
Lorcaserin MOA, SE, CI
MOA: 5HT agonist which increases satiety (fullness)
SE: hypoglycemia
CI: Pregnancy Category X
99
Weight Loss
Phentermine CI, length of tx, SE
Short-term stimulant used for a max of 12 weeks to jump start a diet
CI: Avoid use with HTN, PAH, Hyperthyroidism, & glaucoma
SE: high BP, tachycardia, CV complications, dry mouth
100
Weight Loss
Orlistat counseling points
Low-fat diet & supplemental vitamins ADEK
101
Weight Loss
Micronutrients necessary post-bariatric surgery
1. Calcium (calcium citrate preferred)
2. ADEK
3. B12
4. Iron (prevent anemia)
102
Weight Loss
What agent may be required in some patients post surgery to prevent gallstones due to rapid weight loss?
Ursodiol (Actigall)
103
Weight Loss
Topiramate MOA
Decreases appetite
104
Weight Loss
Post-bariatric surgery counseling point
Medications may need to be crushed or put in liquid for up 2 months post surgery
105
Eye Conditions - Glaucoma
Drugs that cause increase intraocular pressure (IOP)
Antihistamines
Anticholinergics
Chronic corticosteroid use
Topiramate
106
Eye Conditions - Glaucoma
Which type of glaucoma is emergent and which is common?
Medical emergency: Closed angle glaucoma
Common: Open angle glaucoma
107
Eye Conditions - Glaucoma
First-line treatment
Beta-blockers & Prostaglandin analogues
108
Eye Conditions - Glaucoma
Formulation counseling points
Suspension - shaken well
Gel - inverted & shaken once
109
Eye Conditions - Glaucoma
Name the non-selective beta-blockers - MOA, CI & SE
Timolol (Timoptic)
Betaxolol (Betoptic)
MOA: reduce aqueous humor production
CI: Avoid use in pts with asthma, COPD or advanced cardiac disease
SE: burning & stinging
110
Eye Conditions - Glaucoma
Name the Prostaglandin Analogues - MOA & SE
Latanoprost (Xalatan)
Travoprost (Travatan)
Bimatoprost (Lumigan)
MOA: increase aqueous outflow
SE: darkening of eyelids, iris & eyelashes; increased growth of eyelashes; blurred vision
111
Eye Conditions - Glaucoma
Name the Cholinergic/Miotic agent -MOA
Pilocarpine (Isopto Carpine)
MOA: increase aqueous outflow
112
Eye Conditions - Glaucoma
Name the Carbonic anhydrase inhibitors - MOA & Caution
Dorzolamide (Trusopt)
MOA: reduce aqueous humor production
Caution: sulfa allergy
113
Eye Conditions - Glaucoma
Name the alpha-2 agonists - MOA
Brimonidine (Alphagan P)
MOA: decreased aqueous humor production AND increases outflow
114
Eye Conditions - Glaucoma
Counseling points
1. Wait 15 min after use before putting in contacts if the eye drop contains BAK
2. Wait 5-10 min in between multiple drops
3. Latanoprost stored in fridge
115
Eye Conditions - Conjunctivitis (Pink Eye)
Treatment options
1. NSAIDs & steroid eye drops to reduce inflammation
2. Warm compress
3. Artificial tears for lubrication
116
Eye Conditions - Conjunctivitis (Pink Eye)
Name the steroid eye drops
Loteprednol (Lotemax)
| Prednisolone (Pred Forte)
117
Eye Conditions - Conjunctivitis (Pink Eye)
Most cases will resolve without treatment
Treat symptoms
118
Eye Conditions - Blepharitis (Eyelid inflammation)
Symptoms
inflamed, itchy eyelids
119
Eye Conditions - Blepharitis (Eyelid inflammation)
Preferred treatment
Gentle washing & warm compress
**Use warm moist towel with baby shampoo to wipe away debris**
120
Ear Conditions
Application instructions
1. Warm cold ear drops in hand to avoid pain & dizziness
2. Lie down or tilt ear up
3. Adults: pull lobe up & back | Children: Pull lobe down & back
4. Administer drops & keep ear facing up for 5 minutes
