Block 1 Flashcards
(226 cards)
1
Q
According to the Rome IV criteria, what must constipation entail?
A
2+ of the following:
Straining at least 25% of defecations
Fewer than 3 bowel movements/week
Hard stools at least 25% of defecations
2
Q
Which Rx for constipation activates Cl- channels?
A
Lubiprostone
Binds to EP4 receptors which increases fluid secretion via the lumen
3
Q
Tofacitinib MOA and AE?
A
Inhibits JAK enzymes for UC only
Dont take w/ TNF-alpha inhibitors or thiopurines
AE= malignancy and TB (both BBW)
4
Q
Whats something to keep in mind when prescribing aprepitant for someone on chemos?
A
Inhibits CYP3A4, therefore decrease dose of decadron by 50%
5
Q
What diagnostic tests are required for CD?
A
3 kinds: endoscopy, radiographic, and pathologic
Endoscopy: use video camera endoscopy
Radiographic: CT scan, then MRI
Pathologic: Biopsy
6
Q
If patient has NSAID-induced ulcers and you are NOT able to d/c NSAID, whats next?
A
Continue NSAID at lowest effective dose for shortest duration then add PPI (preferred) or misoprostol for 8-12 weeks, then treat H.pylori if that exists
7
Q
Which H2RA is associated with thrombocytopenia?
A
All of them, but its reversible
8
Q
What are the types of Tx failure on TNF-alpha inhibitors?
A
Mechanistic failure: good trough, no AB; choose another agent
Non-immune mediated PK failure: low trough, no AB; increase dose or shorten interval, or add immunomodulator
Immune mediated PK failure: low trough, AB development; choose another agent
9
Q
What are the main receptors found on the superficial epithelial cells?
A
EP3
M1
10
Q
Ciprofloxacin MOA?
A
Inhibits DNA gyrase
11
Q
What are the dopamine receptor antagonists (DRAs)?
A
Prochlorperazine, chlorpromazine, and metoclopramide
12
Q
How should you treat medium emetic risk in CINV?
A
Day 1 before chemo:
5-HT3RAs + Decadron
Days 2 + 3:
5-HT3RAs + Decadron
13
Q
What are the risk factors of post-operative patients who may experience N/V due to anethesia?
A
Age <50, less not greater than :O
Female
Nonsmoker
History of PONV or motion sickness
Hydration status
14
Q
What did clinical trials find about Natalizumab?
A
DOES cause PML (REMS program required)
15
Q
Just know theres a psychological etiology behind IBD. Stress correlates w/ IBD flares
A
K
16
Q
What are the neurokinin-1 receptor antagonists (NK1RA)?
A
Aprepitant and fosaprepitant
17
Q
Which Rx actions may be decreased due to bismuth subsalicylate?
A
ACE and sulfinpyrazone
18
Q
Which Rx actions and AE may be increased due to bismuth subsalicylate?
A
Insulin, methotrexate, and valproic acid
19
Q
What Rx are the 5-HT3 receptor antagonists?
A
-setrons
Ondansetron for example
20
Q
If patient has NSAID-induced ulcers and you are able to d/c NSAID, whats next?
A
Initiate PPI (or H2RA, sucralfate, misoprostol) for 4 weeks, then treat H.pylori if that exists
21
Q
When is cyclosporine and tacrolimus indicated for IBD?
A
Not recommended only consider in severe ulcerative colitis
22
Q
DDI with H2RAs?
A
-azoles and -vir (protease inhibitors)
23
Q
What are some AE of DRAs?
A
Sedation, extrapyramidal side effects like hypotension and cardiac effects
Metoclopramide BBB - tardive dyskinesia with high doses or long term use
24
Q
Mercaptopurine MOA and Target
A
MOA: Inhibits DNA (Purine) synthesis
Target: HGPRT
**Prodrug = Azathioprine
25
What anatomical feature is the main defense against reflux?
LES
26
Methotrexate MOA and Target
MOA: Inhibits DNA synthesis, inhibits dihydrofolate reductase; Inhibits conversion of folic acid to tetrahydrofolic acid
Target: DHFR
27
Misoprostol is a synthetic __________ that activates __________ receptors
Synthetic prostaglandin E1 (PGE1) and activates prostaglandin E3 receptors
28
What are some Rx that will reduce LES pressure?
ABCDENT rule
Anticholinergics
Barbituates
Caffeine, CCBs
Dopamine
Estrogen, progesterone
Nicotine, Nitrates
Tetracycline, Theophylline
29
Which Rx is a cannabinoid and has antiemetic effects?
Dronabinol
Lipid soluble so that the onset is within one hour
30
Metronidazole MOA?
Targets bacterial protein/DNA
31
What are the anti-TNFa Rx for IBD?
Certolizumab, Infliximab, Adalimumab
32
Methotrexate AE?
Hepatic fibrosis/cirrhosis, bone marrow suppression, teratogenicity for men and women
33
What kind of antibody is Infliximab?
Chimeric IgG1 monoclonal
34
What is the first-line Tx for N/V in pregnancy?
Doxylamine + Pyridoxine
35
Who should NOT take bismuth subsalicylate?
Bleeding issues, black/bloody stool, or Von Willebrand disease, taking salicylate Rx, or warfarin
36
UC vs CD
Rectal bleed
Both, however its more severe in UC
37
In regards to efficacy, what do studies say about antacids?
Controversial on superiority of antacids vs. placebo
38
Bismuth subsalicylate is used to treat (constipation/diarrhea)
Diarrhea
39
Antacid DDI?
Antibiotics
Quinidine
Iron sulfate
Sulfonylureas
40
CD Severity
CDAI scoring?
150-220 = mild/moderate
221-450 = moderate/severe
>450 = severe/fulminant
41
PPIs vs H2RAs, what kind of ulcers can PPIs prevent that H2RAs cant?
PPIs can prevent both duodenal and gastric
H2RAs can only prevent duodenal
42
What are the goals of inducing and maintaining symptomatic control of IBD?
Induce remission within 3 months
Maintain remission >3months
Reduce steroid burden
43
What is the preventative therapy for NSAID-induced ulcers?
PPI, double dose of H2RAs, or misoprostol
Replace NSAID with COX-2 inhibition (celecoxib)
Treat H.pylori infection
44
How often should you test for JC virus for Natalizumab and Vedolizumab?
Every 6 months
45
What are the alarm Sx of PUD?
Bloody stool, dark stool, or bloody vomit
46
Ustekinumab MOA and AE?
anti-p40; TNF-alpha inhibition for CROHNS only
AE= PLS (not PML) and carcinoma
47
Glucocorticoid-unresponsive patients...
do not improve even w/ prolonged high dose steroids
48
Which 5-HT3RA is a prodrug?
Dolasetron which is converted to hydrodolastron
Metabolized via CYP2D6 and CYP3A4
49
What are some secondary preventative measures for NSAID induced ulcers?
Tx with PPI for 4-8 weeks (can use Misoprostol as well)
50
How does azathioprine become mercaptopurine?
Non-enzymatically remove nitroimidazole group
51
What is the only Abx that can help with diarrhea?
Rifaxamin
52
For PPIs to be activated in the body, what are the first and last steps?
1st - add 2 Hydrogens
Last - binds sulfur group from PPI to proton pump
53
Before initiation of TNF-alpha inhibitors, what should you do?
Assess for latent or active TB, any latent infections, viral hepatitis, risk of infection
Give any live vaccines prior to new Rx
54
Aminoglycosides affect what region of the brain?
Cerebellum via H1 and M receptors that influences the emetic center (medulla)
55
What are the trough thresholds for therapeutic Rx monitoring for TNF-alpha inhibitors?
Certolizumab ≥20
Infliximab ≥5
Adalimumab ≥7.5
56
Which 5-H3RAs has an increased chance of QTc prolongation?
Ondansetron if IV dose >16mg/day
Palonosetron has less effect
57
Which PPI should be administered before bedtime only?
Omeprazole-sodium bicarb
58
Sulfasalazine AE?
N/V/D
59
Difference between budesonide CIR and MMX?
CIR site = distal ileum and ascending colon
MMX site = throughout the colon
60
When are NK1RA utilized?
In conjunction w/ 5-HT3RAs and decadron in emetogenic chemos
61
When you swallow food, how does the LES respond?
It relaxes and opens up to allow food to pass
62
What are the emollients for constipation?
Docusate
63
What is the infectious etiology behind IBD?
Dysbiosis; more bacteria that promotes inflammation located in GI
64
What are some direct irritant Rx of GERD?
Alendronate, ASA, Iron, NSAIDs, KCl, Quinidine
65
What Rx can cause constipation?
Opiates
Antihistamines
Antacids
Diuretics
TCAs
Iron
66
Which IV chemos put you in the medium risk (30-90%) emetic zone? Oral chemos?
Busulfran, Idarubicin, and Oxaliplatin
Crizotinib
67
Which 5-HT3RAs are eliminated by urine only?
Ondansetron and Palonosetron
The others are via urine and feces
68
Which PPIs are a concern with DDI?
Omeprazole and esomeprazole vs phenytoin, diazepam, and warfarin (it inhibits CYP2C19, therefore decreases its elimination of those Rx)
69
How should you treat high emetic risk in CINV?
Day 1 before chemo:
NK-1 + 5-HT3RAs + Decadron + Olanzapine
Days 2-4:
NK-1 + Decadron + Olanzapine
70
If PPIs do not work, what is the last step possible? What are some issues with it?
Antireflux surgery; effective for only 5-20 yrs
Gas bloat syndrome, dysphagia, splenic trauma, vagal denervation
71
What are the receptors found in the solitary tract nucleas?
5-HT3
D2
M (not just M1 found in chemoreceptors)
CB1
H1
NK1
72
Antacid AE?
Aluminum - Constipation
Magnesium - Diarrhea
Caution in those with renal dysfunction as it can accumulate
Chalky taste
73
Which combination products for triple/quadruple therapy do have PPIs included?
Prevpac + Omeclamox-Pak
74
CD Severity
Wt loss?
Mild/moderate <10%
The rest are >10%
75
What are the alarm Sx of constipation?
Hematochezia/melana
Colon cancer history (family)
Wt. loss
Anemia
Anorexia
Refractory constipation
76
What Rx can cause motion sickness that disrupts the inner ear?
Aminoglycosides
77
Which laxatives require your BG to be checked on a regular basis?
Lactulose and sorbitol
78
UC vs CD
Cobblestone appearance
CD
79
What are the main receptors found on the parietal cells?
M3
CCK2
H2
EP3
80
How do emollients for constipation work?
Lowers the surface tension of stool by facilitating the mixing of aqueous and fatty materials
81
What classes of drugs can you use for abdominal pain in IBS?
Antispasmodics like dicyclomine and hyoscyamine (intermittent pain) or antidepressants like TCAs or SSRIs (chronic pain)
82
What heterocycle does cimetidine have that mimics histamine?
Imidazole (plays a role in inhibition CYP450)
83
What are the osmolar agents for constipation?
Lactulose, sorbitol, magnesium salts, glycerin, PEG
84
What are the alarm Sx of GERD?
Any swallowing issues (pain, difficulty, choking)
Bleed
Wt loss
NON-reflux chest pain
Vomit
85
How do bulk-forming agents for constipation work?
Absorb fluids in the intestines, should be taken with water
86
What are some lifestyle modifications that can be made to alleviate GERD symptoms?
Less food that causes decreased LES tone
Protein rich diet
Smaller meals
Elevate head of bed
87
What are the main groups found in an H2RA?
Basic heterocycle - imparts H2 selectivity
Flexible chain - extends polar groups
Polar neutral group - antagonistic property
88
What are the various ways LES pressure is reduced?
1. Spontaneously (majority); unrelated to swallowing or peristalsis
2. Transient increase in ab. pressure (stress reflux, pregnancy, obesity
3. Atonic
89
What should you use to treat someone in the medium and high risk categories in PONV?
5-HTRAs and decadron - most evidence
Droperidol with some evidence, watch for AE
Rescue therapy with phenothiazine or metoclopramide
**do not repeat drug given for prophylaxis within 6 hrs
90
Octreotide MOA?
Blocks release of serotonin and other GI peptides
91
Triple therapy to treat H. pylori includes what?
PPI BID + clarithromycin 500mg BID + amoxicillin 1000mg BID (or Flagyl 500mg BID if allergic to amoxicillin) for 14 days
92
Glucocorticoid-responsive patients...
improve clinically within 1-2 weeks and remain in remission as steroids are tapered and then d/c
93
When IBD flares up (induction) how many weeks of therapy should you be on? Maintenance?
4-8wks, max of 16wks
Taper Rx to lowest effective dose
94
Quadruple therapy to treat H. pylori includes what?
PPI + bismuth salicylate + Flagyl + tetracycline
Use if intolerant to first-line therapy (triple) or if they have used macrolides before (clarithroMYCIN)
95
Prescription strength H2RA are typically __x the OTC dose
2x
96
How deep is the damage (layers) of ulcerative colitis vs chrons?
UC - mucosa and submucosa
Chrons - all the way down to serosa
97
What stimulates ECL cells?
Gastrin from G cells (onto CCK2 receptors)
or
ACh from ENS neurons (onto M1 receptors)
98
What are the bulk forming agents for constipation?
Psyllium, fiber
99
What did clinical trials find about Vedolizumab?
NOT found to cause PML (or less risk, no REMS required)
100
CD Severity
Systemic toxicity, Sign/symptoms, Tx failure
Mild/moderate has no toxicity and no Tx failure exists; tolerates PO. The rest have toxicity and Tx failures.
Moderate/severe: intermittent N/V
Severe/Fulminant: abscess, persistent N/V, obstruction
101
If you have hepatic disease, which PPI is substantially cleared less?
Lansoprazole and esomeprazole
102
PPI AE?
Headache, diarrhea
B12 deficiency (decreases absorption)
Low magnesium
Bone fractures
C. diff colitis + gastroenteritis
Pneumonia
103
Of the TNF-alpha inhibitors, which one is IV only?
Infliximab, the others are SQ
104
What are the stimulant laxatives for constipation?
Bisacodyl
105
Which IV chemos put you in the high risk (>90%) emetic zone? Oral chemos?
Cyclophosphamide and Cisplatin
Crizotinib
106
Which Rx is the most effective for prophylaxis and Tx of motion sickness?
Scopolamine (anticholinergic agent)
107
Which Rx for N/V has a concern for possible cyclic vomitting?
Dronabinol
108
What are the alarm Sx of diarrhea?
Hematochezia/melana
Colon cancer history (family)
Wt. loss
Anemia
Dehydration
IBD history (family)
109
What are some pearls associated w/ H1RAs?
Problematic in elderly
Risk of complications w/ BPH, narrow angle glaucoma, asthma
110
How many times a week should one suffer with GERD to utilize antacids?
<2 times a week
111
What are the main mechanisms of diarrhea?
Secretory (decreased Na absorption and increased chlorine secretion)
Osmotic (increased luminal osmolarity)
Exudative (involves mucus, large volumes,...)
Altered transit (reduction of contact time in intestine)
112
What is the purpose of LES of the esophagus?
Separates gastric and esophageal lumens
113
Which NSAIDs have the highest risk of induced ulcers?
Nonselectives, but the most are indomethacin, piroxicam, and ketorolac
114
Which TNF-alpha inhibitors has the highest % of antibody development?
Infliximab
115
What kind of antibody is Vedolizumab?
Humanized IgG1 antibody
116
Misoprostol and GERD, what is the MOA?
Binds to EP3 on both parietal cells and superficial epithelial cells and blocks progression
117
When should you d/c Natalizumab and Vedolizumab if there is no effect?
12 wks for Natalizumab
14wks for Vedolizumab
118
What are the main physiological components that can cause GERD?
1. LES pressure
2. Esophageal Clearance
3. Gastric emptying
4. Anatomic disturbances
5. Reflux composition
119
What is the sequential therapy to treat H. pylori?
PPI + Amoxicillin x 5 days
PPI + Clarithromycin + Tinidazole (or Flagyl) x 5 days
120
What extent of UC should you give oral therapy?
Pancolitis
121
When is mercaptopurine indicated for IBD?
Reduce steroid dose or maintain remission
122
Loperamide MOA?
Mu-receptor agonist; decreases cAMP
Anti-secretory activity against cholera and some E.coli toxins
123
Why is Mercaptopurine toxic?
Has many metabolic pathways
xanthine oxidase to 6-thiouric acid
TPMT to 6-MMP
HGPRT to 6-TG
124
What is the main functional group found on mesalamine?
Amine (-NH2) group at 5'
125
Important info about sulfasalazine
Prodrug of mesalamine
Cleaves at the double bond N=N via colonic bacteria
Once cleaved, it becomes 5-aminosalicylic acid and sulfapyridine
126
Which Rx is useful as a anxiolytic for N/V?
Lorazepam
127
Which portion of the esophagus is the LES?
Smooth muscle of the lowest 2-4cm of esophagus
128
What are some GERD risk factors?
1. Certain hormones (cholecystokinin, progesterone in pregnancy)
2. High fat foods, chocolate, spicy stuff
3. Smoking, caffeine, alcohol
4. FH
5. Obesity
6. Respiratory diseases
129
PPIs are metablized by what CYP protein?
Benzimidazole and Pyridine group - CYP2C19
Sulfinylmethyl - CYP3A4
130
Octreotide is used to treat (constipation/diarrhea)
Diarrhea
131
When is alginic acid utilized for GERD?
Take at the same time as antacids to create a protective barrier
132
What are the key structures found in PPIs?
Benzimidazole
Sulfinylmethyl (important one)
Pyridine
133
UC Severity
Stool numbers?
Remission - formed stools
Mild - <4
Moderate/Severe - >6
Fulminant - >10
134
Which components of the triple/quadruple therapy regimen can cause disulfiram-like rxns with alcohol?
Flagyl, also causes dyspepsia and metallic taste
135
Antimotility agents such as loperamide, tincture of opium, diphenoxylate, difenoxin, and paregoric should not be used when?
In pseudomembranous colitis, acute ulcerative colitis, C. diff or other toxin producing infections
136
What are the main complications of GERD?
1. Esophagitis
2. Esophageal strictures (narrowing of esophagus)
3. Barrett's esophagus (replacement of epithelial lining)
4. Cancer of esophagus
137
According to the Rome IV criteria, what must IBS entail?
Ab pain at least 1 day/week in the last 3 months associated with defecation and changes in frequency of stool
138
Besides bulk-forming agents, what other class requires lots of water?
Emollients
139
Pearls of loperamide?
High doses can cause euphoria and cardiovascular issues
140
What should you know about radiation induced N/V?
High risk - total body irradiation. Tx with 5-HTRAs and decadron before and after
Moderate - upper body, ab. Pretty much the same with high risk
Low - brain, head, pelvic. Use 5-HTRAs only
141
Which PPI can be administered w/o food?
Dexlansoprazole
142
Which ones are pro-drugs?
H2RAs or PPIs?
PPIs
PPIs require gastric acid to be converted to active sulfenamide in the acidic canaliculi of parietal cells
Sulfenamide binds covalently to cysteine residues of proton pumps and irreversibly inhibits it.
143
What is composed in sucralfate?
Sucrose sulfate-aluminum complex
144
What is the typical dosing schedule for PPI on GERD?
8 week therapy, once a day (may go up to twice daily)
145
UC vs CD
Carcinoma
UC
146
ECL cells produce what?
Histamine
147
What are the risk levels associated with PONV?
Very low - no risk factors - watch and wait
Medium - 1/2 risk factors - 1/2 interventions
High - 3/4 risk factors - >2 interventions
148
How is bismuth subsalicylate elimnated?
Bismuth (not really absorbed) - stool
Salicylate - urine
149
Which H2RA is associated with gynecomastia?
Cimetidine
150
UC Severity
Hemoglobin count
Normal for remission and mild
Moderate/Severe - 75% of normal
Fulminant - transfusion required
151
Glucocorticoid-dependent patients...
respond to glucocorticoids, but experience relapse of Sx as dose is tapered
152
What is the immunologic etiology behind IBD?
Paneth stop producing defensins
Goblet cells produce less mucus
153
What are the diagnostic tools used in PUD?
Gold standard is a histology to confirm H. pylori, but urea breath test is the most convenient and specific
154
UC Severity
CRP levels
Normal for remission
Elevated for everything else
155
How do NSAIDs cause ulcers?
Inhibits prostaglandin synthesis, which decreases production of bicarb and mucus
156
UC Severity
Endoscopy (Mayo subscore)
Remission: 0-1
Mild: 1
Moderate/Severe: 2-3
Fulminant: 3
157
Which receptors influence the cAMP-dependent pathway in the parietal cells?
H2 and EP3, H2 positively influences it and EP3 negatively influences it. Both act on proton pump
158
Why is celecoxib okay to be used in patients who are somewhat prone to NSAID-induced ulcers?
Inhibits COX-2 only. COX-2 doesnt pertain to GI mucosal integrity
Nabumetone follows the same category
159
Blood borne emetics influence what regions?
Chemo receptor trigger zone (BBB) and Stomach/Small intestines (only 5-HT3)
160
When is the best time to administer antacids?
1-3 hrs after meals to increase duration AND prevent Rx interactions
161
Lubiprostone is used to treat (constipation/diarrhea)
Constipation
162
Loperamide is used to treat (constipation/diarrhea)
Diarrhea
163
Contraindications to Natalizumab and Vedolizumab?
Immunosuppressants and TNF-alpha inhibitors
164
Mesalamine MOA?
Decrease inflammation
Targets leukotriene, free radials
165
Cyclosporine MOA?
Inactivates calcineurin via cyclophilin; reversibly inhibits T lymphocytes and helper cells, blocks IL-2
166
Mesalamine AE?
Diarrhea w/wo blood, bloating, flatulence, Interstitial nephritis
167
Which receptors influence the calcium-dependent pathway in the parietal cells?
M3 and CCK2 both positively influence it, which acts on the proton pump to produce gastric acid
168
What can you do if initial PPI isnt working?
Refer
Increase dose or BID dosing
Switch PPI name
169
UC vs CD
Strictures, fistulas, granulomas
CD
170
What is the Tx for N/V in pregnancy that is persistent?
Ondansetron, metoclopramide, or promethazine
171
What role does the benzimidazole and pyridine group on PPIs have?
Electron donating groups found on their R parts can increase activity
172
What are some concerns with uses of H2RAs long term?
Tachyphylaxis
173
What kind of antibody is Adalimumab?
Humanized IgG1 antibody
174
What is the Tx for N/V in pregnancy that is refractory?
Methylprednisolone
175
What can cause a build up of gastric volume (slow gastric emptying)?
1. Smoking
2. High fat meals
3. Certain medications
176
What kind of antibody is Certolizumab?
Not an antibody, its a humanized Fab against TNF alpha
177
H.pylori should be treated only if they have...
Gastric/duodenal ulcers
MALT lymphoma
Resection of gastric cancer
178
How should you treat moderate-severe UC?
Budesonide MMX 9mg/day, wait and see for 1-2wks
If on remission, taper budesonide
If not, add TNF-alpha except certolizumab. SWITCH to vedolizumab or tofacitinib if that doesnt work
179
Which H1RA has both anticholinergic and antihistamine effects?
Cyclizine
180
What is esophageal clearance and how is it altered?
Increased esophageal contact time w/ acid
Swallowing increases saliva and rate of clearance which is decreased with age
181
What do the receptors in the superficial epithelial cells produce?
Mucus and bicarb (both positively influenced)
182
How do stimulant laxatives for constipation work?
Cause the intestines to contract
***caution with use on bisacodyl for more than 10 days. it'll cause loss of muscle tone on the colon
183
What are the immunosuppressants for IBD?
Mercaptopurine, Methotrexate, Cyclosporine
184
What kind of testing is required for thiopurines prior to initiation?
For Mercaptopurine, TPMT must be done
Normal = empiric weight-based dosing
Intermediate activity = 50% reduction in dose
Low = 0-10% of normal dose or do not use
185
What Rx cause diarrhea?
Alpha-glucosidase inhibitors (acarbose)
Biguanides (metformin)
Colchicine
HAART
TKIs
ABx
Digoxin
Orlistat
186
UC Severity
ESR levels
<30 for remission and mild
>30 for moderate/severe + fulminant
187
Antacid MOA?
Maintain gastric pH >4 (decreases pepsin production) AND neutralizes gastric fluid (increases LES pressure)
188
What are the chemoreceptor trigger zones of the area postrema that influences the emetic center?
5-HT3
D2
M1
CB1
189
What are the butyrophenones? When are they useful?
Haloperidol and droperidol; used as breakthrough therapy for chemo-induced N/V
EKG must be used for droperidol
190
Which Rx for constipation is a peptide guanylate cyclase-C agonist?
Linaclotide (Linzess)
Increases cGMP which stimulates secretion of chloride and bicarb
Eliminated via stool
191
If on the twice daily regimen, when should PPI be administered?
Before breakfast + 30-60min before evening meal
192
Gagging reflex via the pharynx affects what?
Solitary tract nucleus
193
Which Rx for IBD take months to work? (3-6 months)
Mercaptopurine + Methotrexate
194
How should you treat mild UC?
Mesalamne or 5-ASA
195
When should you expect improvements in Tx for IBD?
2-4 wks, max improvement in 12-16 wks
196
Which antimotility agents are mixed with atropine to avoid abuse?
Diphenoxylate and difenoxin
197
How should you treat severe UC?
Test for C.diff
Give TPN
Give IV methylprednisolone 60mg/day or hydrocortisone 100mg IV 3-4x day
If no response in 3-5 days, give IV cyclosporine to IV infliximab
If failed again, colectomy
198
Natalizumab MOA?
Binds to alpha4-integrins on WBC
***Vedolizumab is another Rx in this class (binds to alpha4beta7)
199
For moderate-severe CD maintenance/induction, what should you order?
1. Prednisone max of 60mg/day. Wait and see for 1-2wks and taper it
2. Add thiopurine or methotrexate
* *doesnt increase chance of remission, just more likely to maintain steroid-induced remission
3. Add anti-TNF alpha except certolizumab
4. If step 3 doesnt work, REPLACE it with a monoclonal antibody
200
How do osmotic laxatives for constipation work?
Osmotically draw water into the lumen
***caution in older adults and those w/ heart/kidney failure. can cause dehydration
201
What are the polymorphisms involved in IBD?
System autophagy (regulates IL-1B)
OCTN1 (linked w/ CD in caucasians)
NOD2 (pathogen recognition)
202
For mild-moderate CD maintenance/induction, what should you order and not order?
Order:
Budesonide CIR for disease in ileum and/or colon
**max 4 months, loses efficacy after that
DO NOT order:
* Mesalamine nor sulfasalazine
* Abx
* Glucocorticoids
For induction: just manage what you can, symptom relief via loperamide
203
What are the H1RAs?
Cyclizine, hydroxyzine, promethazine, benadryl, doxylamine, meclizine, dimenhydrinate
204
What is the most common AE of 5-HT3RAs?
Headache (1) and Constipation (2)
205
Which Rx for N/V is contraindicated in those w/ parenteral BZD?
Olanzapine
206
Who should be placed on prescription therapy for GERD?
Those who dont respond to lifestyle modifications or other therapies after 2 WEEKS
Those with alarm symptoms
207
Which Rx for treatment of GERD/PUD is associated with blackening of stool?
Bismuth subsalicylate (harmless btw)
Black tongue as well. Dont use in peeps with kidney issues
208
What are the risk factors involved in CINV?
Young age
Female
Low alcohol consumption
Smoker
Chemo drugs
209
What is an alternative regimen for the triple therapy?
PPI + Levofloxacin + Amoxicillin for 14 days
210
Which components of the triple/quadruple therapy regimen can cause photosensitivity?
Tetracycline
211
In GERD, what is the material that is directly irritating to the patient?
Bile acids
pH <2 - esophagitis
pH <4 - severe GERD
212
Which Rx for constipation is a mu-opioid antagonist?
Methylnaltrexone (Relistor); for opioid induced constipation
213
Sulfasalazine vs Mesalamine, which one is excreted via stool?
Mesalamine
214
Which 5-HT3RA has the longest t1/2?
Palonosetron
~40hrs
215
UC vs CD
Systemic symptoms
CD
216
Which H1RA has both antimuscarinic and antihistamine effects?
Benadryl
217
For severe-fulminant CD maintenance/induction, what should you order?
1. IV methylprednisolone 40-60mg/day for 7 days
* *if in remission, change to PO and slowly taper
2. If no response to steroid, start anti-TNF alpha
218
When should PPI be administered?
30-60 min before breakfast or biggest meal of the day
219
What are the risk factors of PUD?
H. pylori and NSAIDs
Smoking, SRMD (stress-related mucosal damage), Zollinger-Ellison syndrome (too much gastric acid secretion), infections
220
Which laxative is approved for children ≥2 yrs old??
Glycerin
221
Which Rx for N/V is typically advised not to use as IV anymore due to serious tissue injury?
Promethazine
222
When is sucralfate utilized in GERD?
Limited role in non-pregnant patients
223
Which H2RA has many drug-drug interaction concerns?
Cimetidine (vs warfarin, phenytoin, theophylline, and lidocaine). It increases their concentration
224
Morphine content in tincture of opium?
10mg/ml, 25x more potent than paregoric (CAMPHORATED tincutre of opium, 0.4mg/ml)
225
Linaclotide is used to treat (constipation/diarrhea)
Constipation
226
Which agent for constipation are surfactant agents?
Docusate
