Abdominal

Question 1

Give 3 etiologies for n/v

Answer 1

1) SSRIs
2) A boat
3) GLP 1 RAs

Question 2

List 3 nonpharmacologic therapies for nausea/ vomiting

Answer 2

1) SEA-Band
2) Ginger
3) Emetrol: Glucose and fructose with phosphoric acid

Question 3

Serotonin receptor antagonist: List and describe 2 for n/v

Answer 3

1) Metoclopramide (Reglan): May see in GERD or gastroparesis too
2) Ondansetron (Zofran): IV, liquid, ODT and tablet
-Adult PO: 4 – 8mg PO up to TID; will see variations
-Adverse effects: QT-prolongation, serotonin syndrome, headache

Question 4

True or false: Cannabinoids can Tx n/v, but also cause it

Answer 4

True

Question 5

Differentiate UC and Crohn’s

Answer 5

1) Ulcerative Colitis (UC):
-Confined to the rectum and colon
-Continuous lesions
-Mucosa and submucosa inflammation
2) Crohn’s Disease (CD):
-Affects any part of GI tract- from mouth to anus
-Discontinuous lesions (skip lesions)
-Transmural inflammation of the GI tract

Question 6

List 3 medications that can Tx IBDs and their categories

Answer 6

1) Loperamide (Imodium) > diarrhea – opioid agonist (OTC)
2) Dicyclomine (Bentyl) > antispasmodic / anticholinergic (Rx)
3) VSL#3 or Florajen > probiotics (OTC

Question 7

List some other Txs for IBDs

Answer 7

-Mesalamine derivatives
-Corticosteroids
-Immunosuppressive agents
-Antimicrobials
-TNFα inhibitors
-Integrin receptor antagonist
-IL agents
-JAK inhibitors

Question 8

Sulfasalazine:
1) What baseline labs?
2) What routine labs?

Answer 8

1) Disease-modifying antirheumatic drugs (DMARD) labs (CBC w/ platelet, LFTs and SCr)
2) DMARDs labs q 2-4 weeks for the next 3 months then q 8-12 weeks after 3 months of therapy then q 12 weeks after 6 months of therapy

Question 9

Mesalamine (5-ASA):
1) Which formulation is more effective?
2) Can you use them together?

Answer 9

1) Topical preparations > effective than oral preparations
2) Yes; can use topical w/ oral to increase efficacy

Question 10

List 2 Diazo-bonded 5-ASAs that are Mesalamine derivatives and their MOA

Answer 10

1) Olsalazine
2) Balsalazide
-Mesalamine is released in the colon after colonic bacteria cleave balsalazide

Question 11

List and describe 2 corticosteroids for IBDs

Answer 11

1) Rectal hydrocortisone (Cortifoam®)
-Rectal = topical; the word “topical” is not limited to the epidermis
2) Oral budesonide (Entocort EC®)
-Bioavailability (oral): 9% to 21% depending on formulation

Question 12

When should corticosteroids be used for IBDs? (3 scenarios)

Answer 12

1) Non-responsive to mesalamine derivatives
2) Moderate to severe disease
3) Induction of remission

Question 13

Immunosuppressive agents for IBDs:
Differentiate Azathioprine (Imuran®) and mercaptopurine (Purinethol®)

Answer 13

Mercaptopurine = active metabolite of azathioprine

Question 14

IBDs: List 2 Immunosuppressive agents for solid organ transplant and what they inhibit

Answer 14

1) Cyclosporine (Sandimmune®)
2) Tacrolimus (Prograf®)
-Both are strong CYP3A4 inhibitors

Question 15

What should be given prior to IBD Tx with Biologics (TNF-alpha inhibitors & Integrin receptor antagonists)

Answer 15

Influenza
Pneumococcal
Hepatitis B if risk factors present
HPV
Herpes zoster

(don’t give during Tx)

Question 16

Recommended to wait at least 4 weeks between live vaccine and __________ initiation

Answer 16

biologic

Question 17

Integrin receptor antagonist: Natalizumab (Tysabri®)
Describe the adverse effects (2 main ones)

Answer 17

1) Previously withdrawn from market due to risk of progressive multifocal leukoencephalopathy (PML)
-TOUCH prescribing program
-FDA restricts use to CD patients who have not responded to or could not tolerate anti-TNF agents
2) Severe hepatic toxicity

Question 18

Vedolizumab (Entyvio®):
1) What adverse effect is not present?
2) What rare adverse effect is present?

Answer 18

1) No PML
2) Rare hepatotoxicity