Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

604 > N/V/D/C/IBS > Flashcards

N/V/D/C/IBS Flashcards

1
Q

What are some causes/types of nausea and vomiting?

A
  1. general (gastroenteritis, pancreatitis)
  2. balance disorder (motion, vertigo, dizzy)
  3. pregnancy
  4. post operative
  5. gastroparesis (DM induced nerve damage)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How do you determine planned therapy for postoperative nausea?

A

Apfel risk score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Apfel risk score determinants (4)

A

+1 female
+1 nonsmoker
+1 hx motion sickness or previous PONV
+1 expected to use post-op opioids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Apfel score = 4

A
  • Before surgery: scopolamine patch 2hr prior
  • Right before: IV dexamethasone after anesthesia induction (b4 surgery)
  • Post-op: 5HT3 antagonist

Score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Apfel score = 2-3

A

5HT3 antagonist post OP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Apfel score ≤1

A

no planned therapy
can give rescue therapy if PONV signs develop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Rescue pONV

A
  1. 5HT3 antagonist
    +/- drug from other class
    >Metoclopramide (pro-kinetic)
    >Phenothiazine (antipsychotic)

Whether you change therapy or not depends on the DOA of drug

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

General N/V treatment

A
  • 5HT3 antagonist (ondansetron, etc)
  • Metoclopramide (Reglan) IV/PO Q6H
  • Phenothiazines (Promethazine, Prochlorperazine (rectal), Chlorpromazine) //PO/IV/deep IM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Balance N/V treatment

A

Antihistamines (OTC)
- Meclizine (least sedating)
- Dimenhydrinate (Dramamine)
- Doxyalamine (Unisom, +B6=diclegis)
- scopolamine (transderm)
- Hydroxyzine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

NVP treatment

A

1st line
- Doxyalamine + B6
2nd line
- 5HT3 antagonist
- Metoclopramide

Self-care
- Ginger
- acupressure
- fresh air
- dry crackers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Gastroparesis treatment

A
  1. metoclopramide
  2. erythromycin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Post OP N/V treatment

A

based on Apfel score
- scopolamine patch
- IV dexamethasone
- 5HT3 antagonists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Treating N/V in pediatrics

A

Must replenish fluids and electrolytes
(not required for adults)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Antihistamines ADR

A

Drowsy, sedation
Constipation, dry mouth
Increased fall risk in older patients (confusion, impaired cognition)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Phenothiazines ADR

A

Tissue damage if given IV (opt for deep IM instead)
Hypotension (need slow IV push, lie down during/30 min after)
QT prolongation
Dystonia/EPS (rigid, locked, sustained muscle contraction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

5HT3 antagonist ADR

A

Constipation
Headache
QT prolongation (more likely with higher doses)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Prokinetics ADR - metoclopramide

A

Dystonia, EPS (more likely with IV high dose)
QT prolongation
Diarrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Prokinetics ADR - Erythromycin

A

Nausea/vomiting (can be counterintuitive)
diarrhea
QT prolongation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Corticosteroids ADR

A

Agitation (manic, hyper)
Insomnia
Increased appetite
Hyperglycemia
Hypertension
Decrease PG formation
- Less GI irritation/ulceration with short course (NSAID DDI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How to handle QTc prolongation risk?

A

Try to avoid QT-prolonging agents >450 msec
Get EKG, if QTc >450 msec, cry - hard to treat
>Compazine (prochlorperazine)
>Low dose Zofran when absolutely have to
>Antihistamines once in a while

If you start antiemetic, but then:
QTC >500 msec = D/C
Increase QTc >60 = D/C or decrease dose

//Pancreatitis patients will often have QT-prolonging agents on board

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Goals for QTc prolongation risk monitoring

A

Potassium > 4
Magnesium > 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Diarrhea classification

A

≥3-4 stools in a day (24hr)

23
Q

Constipation definition

A

≤ 3 bowel movements a week (7 days)

24
Q

Diarrhea causes

A

Gastroenteritis (norovirus)
Food intolerance
Celiac
IBD (UC, Crohn’s)
IBS-D
Medications (abx, chemo, metformin)

25
Q

Constipation causes

A

Low fiber diet (dehydration)
Comorbidities (pregnancy, IBS, DM, hypothyroidism)
Medication (opioids, iron, anticholinergics: antihistamines, TCA, CCB)

26
Q

Chemo-induced diarrhea treatment

A

Somatostatin analog
- Octeotride (SQ QD then IM depo Q 4 wk)

27
Q

Diarrhea treatment

A

Mild-mod noninfectious diarrhea: PO Loperamide

Severe Inflammatory IBD 10-12 watery stools, hgb<6: Diphenoxylate/atropine* (Lomotil)
//*atropine prevents abuse

Chemo diarrhea or intestinal carcinoid tumor
- octreotide SQ,IM

Irritable IBS-D
- SIBO = Rifaximin
- Eluxadoline
- Alostren

28
Q

Diarrhea Severe IBD (UC) treatment

A

10-12 watery stools: Diphenoxylate/atropine*
//*atropine prevents abuse

29
Q

Constipation treatment

A

Gentle but takes a while: Osmotics
- PEG: inert, pulls water, well tolerated
- Lactulose: sugar, may cause diarrhea, taste bad
- Good for pt with hepatic encephalopathy (cirrhosis)

30
Q

Opioid-induced constipation treatment

A

Peripheral Mu antagonist
- Methylnaltrexone SQ (Relistor)
- Naloxegol PO (Movantile)
- Naldemedinen PO (Symproic)

31
Q

Chronic idiopathic constipation treatment

A

(and also IBS-C)
- Lubiprostone (CL channel activator)
- Linaclotide (Linzess)
- Plecanatide (Trulance)

32
Q

Osmotic laxative ADR

A

Lactulose may cause diarrhea due to sugar alcohols
Miralax rather tame, may take a while

33
Q

Chronic Idiopathic Constipation drugs ADR

A

CL channel activators: work too well cause diarrhea, nausea

Guanyl Cyclase C agonist: diarrhea, (Trulance has less diarrhea)

34
Q

peripheral opioid receptor antagonists ADR

A

Severe abdominal pain and diarrhea (D/C)
WARNING: bowel perforation in patients with GI malignancies

35
Q

Which drug class has warning for bowel performation?

A

peripheral mu receptor antagonists
- patients with GI malignancies or GI wall problems
- IBD, diverticulitis, colon cancer

36
Q

IBS presentation

A

Chronic abdominal pain + altered bowel habits
Women < 50 y/o
Global symptoms: bloating, abdominal pain, change in BM

37
Q

Diagnosing IBS

A

Exclusion - rule out everything else
ROME4 Criteria

38
Q

ROME4 criteria

A

Recurrent abdominal pain (QW) in last 3 mon:
+2 of the below:
- pain due to defecation
- change in stool frequency
- change in stool consistency

39
Q

Causes of IBS

A

Gut hypersensitivity
Acute gastroenteritis (transient)
SIBO (small intestine bacteria overgrowth)
Psychological stress

40
Q

Types of IBS

A

25% time or more
IBS-C
IBS-D
IBS-M

41
Q

IBS-C constipation treatment

A

1st: 2022 guidelines –> Linzess (linacoltide)
1st WOMEN only: lubiprostone (CL channel PO)

Women <65 w/o CV hx: Tegaserod (d/c if no effect in 4 wks)

Tenapanor (IBSrela) – new drug, reduces Na/phosphate absorption, effect on GI pain receptor

42
Q

Lubiprostone ADR

A

20% Diarrhea
Nausea (take w/ food to reduce ADR)
//only for IBS-C if women
//approved for chronic constipation for all

43
Q

Secretagogue ADR

A

Diarrhea w/ linzess (linaclotide)
//ibs-c
less diarrhea with trulance (Plecanatide)

44
Q

Tegaserod ADR

A

(Zelnorm)
<5%
Diarrhea
Risk of cardiac event

45
Q

Tenapanor ADR

A

(IBSrela)
Diarrhea 15%
//IBS-C

46
Q

IBS-D Diarrhea treatment

A

1st line
>SIBO: Rifaximin 550mg TID (abx 14 days) - ok repeat twice
>Eluxadoline (Viberzi) - mu/delta/kappa agonist

2nd line
> Severe IBS, fail tx: Alosetron (5HT3 antagonist)

47
Q

Rifaximin ADR

A

Antibiotic, careful of C.diff
Well tolerated, no systemic ADR
DO NOT SUB
*for IBS-D

48
Q

Eluxadoline (Viberzi) ADR

A

u agonist, delta antagonist, kappa agonist
Generally well tolerated
- constipation, nausea, abdominal pain

Can cause sphincter of oddi dysfunction (spasm, enzyme backup)

Contraindicated:
- history of pancreatitis
- No gallbladder
- Alcoholism
- 3+ drinks/day

49
Q

Alostren (Lotronex) ADR

A

5HT3 antagonist - IBS-D
Can cause severe constipation
Some cases of ischemic colitis –> REMS program

50
Q

IBS-general treatment theory

A

Visceral hypersensitivity due to brain/gut mismatch
= can also target the brain, not just the gut
1. Antidepressants improve pain/global IBS sx
- SNRI, SSRI (better tolerated)
- TCA (best data, more ADR) QHS
> Nortriptyline (fewer ADR, good for IBS-C)
> Amitriptyline (older, better for IBS-D)
2. Non-pharm
- Soluble fibers form a gel in GI (TITRATE)
- More time with provider (mental)
- Relaxation, stress relief

51
Q

Anticholinergics ADR

A

tachycardia
Dry mouth
Constipated
Sedating

52
Q

Examples of soluble fiber

A

Psyllium (metamucil)
Oat bran
Barley
Beans
helps resist colonic fermentation

53
Q

Causes of IBS

A

Gut hypersensitivity
Acute gastroenteritis (transient)
SIBO (small intestine bacteria overgrowth)
Psychological stress

604 (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions