Exam 2 Flashcards
(165 cards)
1
Q
Causes of N/V
A
general
disorders of balance
N/V pregnancy
PONV
2
Q
Apfel risk score
A
Female
Non smoker
History of motion sickness / previous PONV
expected use of postoperative opioids
3
Q
Treatment of general N/V
A
metoclopramide
phenothiazine
5-HT3 antag
4
Q
Treatment of balance N/V
A
antihistamines
OTC
5
Q
Treatment of NVP
A
doxylamine + BG
5HT
metoclopramide
prochlorperazine
6
Q
PONV
Apfel Score = 4
A
Scopolamine patch before
IV dexamethasone during
5HT3 at the end
7
Q
PONV
Apfel Score = 2-3
A
5HT3 at the end
8
Q
PONV
Apfel Score = 1
A
No therapy
rescue 5HT3
9
Q
Antihistamines N/V
A
Dimenhydrinnate Diphehydramine Mecclizine Doxylamine Scopolamine Hydroxyzine
10
Q
Phenothiazines N/V
A
Promethazine
Prochlorperazine
Chlorpromazine
11
Q
5HT3 Antagonists N/V
A
Ondansetron
Dolasetron
Granisetron
Palonosetron
12
Q
Corticosteroids N/V
A
Dexamethasone
13
Q
Antihistamines N/V used for
A
Balance
NVP
PONV as rescue
14
Q
Phenothiazines N/V used for
A
General
PONV as rescue
NVP (low)
15
Q
5HT3 Antagonists N/V used for
A
General
PONV
NVP (low - above pheno)
16
Q
Prokinetics N/V
A
Metoclopramide
Erythromycin
17
Q
Prokinetics N/V used for
A
General (gastroparesis)
PONV as rescue
NVP (low)
18
Q
Corticosteroids N/V used for
A
PONV
19
Q
AEs of antihistamines N/V
A
drowsy, sedation, paradoxical
20
Q
AEs of phenothiazines N/V
A
tissue damage (deep IM, no IV) QT prolong extrapyramidal
21
Q
AEs of 5HT3 N/V
A
constipation, HA, QT prolongation
22
Q
AEs of metoclopramide N/V
A
extrapyramidal, dystonia, QT prolongation, diarrhea
23
Q
AEs of erythromycin N/V
A
N/V, diarrhea, QT prolongation
24
Q
AEs of corticosteroids N/V
A
agitation, insomnia, inc. appetite, hyperglycemia, hypertension
25
N/V therapies that cause QT prolongation
Phenothiazines
5HT-3 Antagonists
Prokinetics
26
N/V therapies that should be avoided to be given IV
Phenothiazines (specifically promethazine, chlorpromazine)
27
Diarrhea treatment options
Loperamide
Bismuth
Diphenoxylate + atropine
Octreotide
28
MOA of loperamide
u and gamma receptor agonists
delay transit time
inc. water absorption
29
Why is diphenoxylate given with atropine
it is an opioid derivative
| decreases abuse because people cannot take large amount of atropine
30
Indications for diphenoxylate
Diarrhea and IBD - UC
31
Octreotide given for
intestinal carcinoid tumors and chemo induced diarrhea
32
Constipation treatment options
```
PEG
Lactulose
Lubiprostone
Linaditide
Plecanatide
Methylnaltrexone
Naloxegol
Naldemedine
```
33
Opioid receptor antagonists used for
Constplation
34
Opioid receptor antagonists are...
Methylnaltrexone
Naloxegol
Naldemedine
35
We give lactulose for which patients?
constipation who have cirrhosis or hepatic encephalopathy
36
Which therapy is for constipation and IBS-C
Lubiprostone (Amitiza)
Linaditide (Linzess)
Plecanatide (Trulance)
37
Rome 4 Criteria
For IBS
Recurrent abdominal pain (1 day/ week x 3 months)
At least 2 of:
Associated with deification
Change in frequency
Change in form
38
Most common IBS patients
women <50 years old
39
IBS-C treatment options
Lubiprostone (Amitiza)
Secretagogues:
Linaclatide (Linzess)
Plecanatide (Trulance)
Tegaserod (Zelnorm)
40
1st line IBS-C treatment
Lupiprostone
Linaclatide (Linzess)
Plecanatide (Trulance)
41
Who can receive Tegaserod (Zelnorm)
Women < 65 without cardiac history and max 1 cardiac risk factor
42
What are the cardiac risk factors for Tegaserod (Zelnorm)?
```
HTN
smoking
BMI>30
DM
HDL
Age > 55
```
43
AEs of Tegaserod
Increased cardiac events
44
AEs of secretagogues
diarrhea (more common in Linaclotide aka Linzess)
45
Patient is on Tegaserod for 4 weeks with no effect. What should we do?
d/c because of cardiac risk
46
IBS-D Treatment options
Rifaximin (Xifaxan)
Eluxadoline (Viberzi)
Alosetron
47
1st line IBS-D treatment
Rifaximin (Xifaxan)
| Eluxadoline (Viberzi)
48
2nd line IBS-D treatment
Alosetron - for women who have failed other therapies
49
Rifaximin is best for
IBS-D with SIBO (small intestine bacterial overgrowth)
50
Rifaximin treatment length
14 days
51
AEs of Eluxadoline (Viberrzi)
sphincter of oddi dysfunction
52
C/I of Eluxadoline (Viberrzi)
pancreatitis, no gallbladdeer, alcoholism, 3 drinks a day
because of sphincter of oddi dysfunction
53
AEs of Alosetron
severe constipation and ischemic colitis
54
Patient was on Rifaximin for 14 days. It did not help what should we give them?
Eluxadoline (1st line)
| Alosetron (2nd line)
55
Patient was on Alosetron and saw no benefit in 4 weeks. What should we do?
d/c because of risk of severe constipation and ischemic colitis
56
IBS any subtype treatments
TCA antidepressants
Soluble fiber
Counseling
57
TCA for IBS
Amitriptyline
| Nortriptyline
58
Which TCA for IBS has more AEs?
Amitriptyline
59
Soluble fiber for IBS
Psyllium
60
AEs for TCAs
sedation, dry mouth, anti cholinergic
61
GERD definition
heartburn last for longer than 3 months or refractory to stoping OTC medications
62
Dyspepsia is
bad digestion, discomfort, fullness, gnawing
63
How to diagnosis GERD
Symptoms + Endoscopy
| especially to rule out Barrett's
64
Treatment for GERD
PPI for 8 weeks
65
Chronic GERD Treatment
PPIs for patients with complications or for patients that get sxs back when stopping (try to titrate them down)
66
AEs of PPIs
```
infection risk
kidney injury
thrombocytopenia
CNS
osteoporosis + fracture risk
```
67
Patient experienced heartburn after dinner. What should we recommend?
OTC
PPI
H2RA
antacids (immediate relief)
68
Gastritis and duodenitis go down to which layer?
Lamina propria
69
Gastric, Peptic, and duodenal ulcers goes down to which layer?
Submucosa
70
Food helps which type of ulcer?
Duodenal
71
Food worsens which type of ulcer?
Peptic/Gastric
72
Peptic ulcer disease causes
H pylori
NSAIDs
Critical illness
alcoholism
73
Diagnosis of H. pylori PUD
Endoscopy
Tissue sample
Blood test
Urea blood tests
Fecal antigen tests
74
H. pylori PUD treatment options
Bismuth Quadruple Therapy
Levofloxacin Based Triple Therapy
Triple Therapy
75
Components of Bismuth Quadruple Therapy
PPI BID
Bismuth QID
Tetracycline QID
Metronidazole QD or TID
76
Components of Levofloxacin Based Triple Therapy
PPI BID
Levofloxacin QD
Amoxicillin BID
77
Components of Triple Therapy
PPI BID
Clarithromycin BID
Amoxicillin BID
(or metro for allergy)
78
All H. pylori PUD therapy includes
PPI BID and ABX
79
Treatment duration for H pylori PUD
10 - 14 days
80
How to confirm eradication of H. pylori PUD after treatment?
Wait 4 weeks and then test by urea blood test or fecal antigen test
81
Risk factors for NSAID induced PUD
```
Age > 65
Patients with hx of ulcer
Steroids + NSAID
Non selective NSAID
NSAIDs + anticoag
NSAIDs + anti platelet
```
82
When should patients be on prophylaxis for NSAIDs induced ulcers?
Taking NSAIDs chronically and have 1 risk factor
83
How to diagnosis NSAID induced PUD?
Dyspepsia
Taking an NSAID
Endoscopy
84
NSAID induced PUD treatment
PPI QD for 4 weeks
85
Treatment if a patient is chronically taking NSAIDs and has PUD
PPI for 8 weeks to chronically
86
Prevention of NSAID induced PUD by
Switch to APAP
Add PPI preventively
Add misoprostol
Use selective
87
SRMB stands for
Stress related mucosal bleeding
88
Major risk factors for SRMB
Respiratory failure - vent 48 hours
Coagulopathy
INR > 1.5 or platelets < 50
89
Minor risk factors for SRMB
Sepsis
hypotension / need pressers
Hx of GI bleed
Use of high dose steroids (>250mg hydro)
90
Who gets stress ulcer prophylaxis?
Someone with 1 major or 2 minor risk factors
91
Stress Ulcer Prophylaxis treatment
H2RAs --> Ranitidine
92
Can we use PPI's in SRMB?
Yes but not first choice because of infection risk
Should go with H2RA first
93
Zollinger Ellison Syndrome Treatment
PPI q8-12 hrs
94
Upper GI Bleed Treatment
```
IV bolus isotonic
Packed red blood cells
Oxygen
Reverse anticoagulation
Endoscopy burn
Acid suppression
```
95
When to give PRBC and how much to give?
1 unit to increase Hg by 1 point
| Goal Hg of 7
96
Acid suppression dose in UGIB
80 mg pantoprazole IV bolus
8mg/hr x 72 hours infusion
(or IV BID PPI)
97
Patient is on ASA and plavix for new stent and has UGIB. What do we do?
Make sure Hg stable
| resume ASA in 1-3 days (7 max)
98
Patient is on ASA for primary prevention and has UGIB. What do we do?
d/c ASA
99
IBD patho
```
defective muscosa
leaky junctions
inappropriate antigen recognition
few T regulators
expansion of lamina propria
```
100
Signs of IBD
diarrhea, blood in stool, abdominal pain, weight loss
101
Diagnosis of IBD
```
Age 15-30 with symptoms
inc. ESR
inc. CRP
inc. calprotectin in stool
Colonoscopy
CT scans MRI
```
102
Ulcerative colitis is in
rectum and colon
103
Crohn's is in
mouth to annus
104
Ulcerative colitis is superficial or deep?
Superficial
105
Crohn's is superficial or deep?
Deep
106
Which IBD disease has continuous inflammation?
UC
107
Which IBD disease has patchy, cobble stone inflammation?
CD
108
Perianal involvement is seen in
CD
109
Toxic megacolon
Colon cancer
Colectomy
Are associated with
UC
110
Malnutrition
Vitamin deficiency
Strictures
Are associated with
CD
111
Which IBD treatment can be cured?
UC
112
Proctitis means
UC in rectum
113
Left Sided / Distal means
UC in rectum + sigmoid + descending
114
Extensive means
UC past splenic flexure
115
Suppositories and enemas can reach extensive UC
True or False
False
Thats why we need to give oral medications
116
Categories of treatments for IBD
```
5-ASA
Immunmodulators
ABX
Corticosteroids
Biologics
```
117
5-ASA derivatives drugs
5-ASA (Mesalmine)
Sulfasalazine
Olsalazine
Balsalazide
118
Immunomodulator drugs
```
AZA
6-MP
MTX
Cyclosporine
Tacrolimus
```
119
ABX drugs for IBD
Metro
| Cipro
120
Corticosteroids for IBD
Prednisone
Methylpred
Hydro
Budensonide
121
Biologics categories
Anti TNF
Selective adhesion molecule inhibitor
IL-12, IL-23 inhibitor
JAK inhibitor
122
Anti TNF biologic drugs
Infliximab
Adalimumab
Certolizumab
Golimumab
123
Selective adhesion molecule inhibitor biologic drugs
Natalizumab
| Vedolizumab
124
IL-12, IL-23 inhibitor drugs
Ustekinumab
125
JAK inhibitor drugs
Tafacitinib
| Upadacitinib
126
Biologics for UC only
Glimumab (TNF)
Tafacitnnib (JAK)
Upadacitinib (JAK)
127
Biologics for CD only
Certolizumab
| Natalizumab
128
Biologics for both CD and UC
Infliximab
Adalimumab
Vedolizumab
Ustekinumab
129
Biologics given IV
Infliximab (TNF)
Natalizumab (IL)
Vedolizumab (IL)
Ustekinumab ( maintenance SC )
130
Biologics given SC
Adalimumab (TNF)
Certolizumab (TNF)
Golimumab (TNF)
Ustekinumab (for maintenance)
131
Biologics given PO
Tafacitinib (JAK)
| Upadacitinib (JAK)
132
5 ASA MOA
act topically to dec. inflammation
133
Balsalazide has less AEs than Sulfasalazine because
does not have sulfa part
134
Sulfasalazine AEs
GI, rash, photo, blood dyscrasias
135
5-ASA with least daily dosing
Olsalazine
136
Canasa is a ___ for ___
5-ASA suppository
| rectal
137
Rowasa is a ____ for ___
5-ASA enema
| rectal + distal
138
Asacol/Lialda/Delzicol is a ___ for ____
5-ASA PO
| terminal ileum
139
Pentasa is a ___ for ___
5-ASA PO
| Jejunum
140
AZA takes ___ for full effect
4 months
141
Monitoring for AZA/MTX/6MP
CBC q3months
LFTs and pancreatic enzyme
Lymphomas
142
Most potent corticosteroid for IBD
Budesonide because does not go systemic
143
Entocort is ___ for ___ to treat ____
Budesonide
ileum
active CD
144
Uceris is ___ for ___ to treat ____
Budesonide
colon
active UC
145
AEs for biologics
Infusion for IV
Injection for SC
Infections
Malignancy
146
BBW for TNF
Infections
| Malignancy
147
BBW for JAK
Infections
Malignancy
Increased risk of cancer, cardio events, thrombosis, death
148
BBW for Natalizumab
Progressive Multifocal Leukoencephalopathy
reactivatio of human JC polymavirus
149
ABX used for ___ in ___
fissures or fistulas in crohn's
150
Active therapy for Mild-moderate Crohn's
PO Budesonide (Entocort) for 8 weeks
NO 5-ASA unless colonic (Sulfa)
151
Active therapy for moderate - severe Crohn's
PO Prednisone +/- AZA/MTX/6MP
Biologic + AZA
152
Active therapy for severe - fulminant Crohn's
Surgery
IV Steroids
IV Infliximab
153
Maintenance Therapy Crohn's
6-MP/AZA/MTX
Budesonide ish (4 months max)
Biologics
5-ASA only if colonic
154
Mild UC defined
```
< 4 stools
some blood
Hg normal
ESR normal
CRP high
FP high
```
155
Moderate - Severe UC defined
```
> 6 stools
frequent blood
Hg < 75%
ESR high
CRP high
FP high
```
156
Fulminant UC defined
```
> 10 stools
continuous blood
Hg < 8
ESR high
CRP high
FP high
```
157
Active Distal UC treatment
Topical 5-ASA (supp. or enema)
Oral 5-ASA
Both if you can
158
Maintenance Distal UC treatment
Topical 5-ASA
Oral 5-ASA
159
Active Extensive UC treament
Oral 5-ASA +/- Budesonide (Uceris) for 8 weeks
160
Maintenance Extensive UC treatment
Oral 5-ASA
161
Moderate - Severe Active UC treatment
Budesonide (Uceris)
Prednisone
Infliximab +/- AZA/6MP
162
Moderate - Severe Maintenance UC treatment
was on steroids --> 6MP/AZA
| was on biologic --> continue + 6MP/AZA
163
Fulminant Active UC treatment
IV steroids
IV infliximab IV cyclosporine
surgery (curative)
164
Fulminant Maintenance UC treatment
was on steroids --> 6MP/AZA
was on biologic --> continue + 6MP/AZA
was on cyclo --> 6MP/AZA or vedolizumab
165
Methotrexate is used for UC
True or false
False
