GI Flashcards by Briana Tutor

Drugs that worsen GERD symptoms

ASA/NSAIDs
bisphosphonates
dabigatran
estrogen products
fish oil products
iron supplements
NRT
steroids
tetracyclines

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GERD: initial drug tx

PPI once daily for 8 weeks
-can incr to BID if partial response or if nocturnal symptoms are present

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GERD: maintenance

-PPI at the lowest effective dose
-alt: H2RA (if no erosive esophagitis)

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antacids

Tums, Mylanta, Maalox, Milk of Mag, Alka-seltzers
-neutralize gastric acid by increasing gastric pH
-can accumulate with renal dysfunction
-calcium: constipation
-Aluminum: constipation
-magnesium: loose stools
-calcium containing may be preferred in pregnancy

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H2RA

Famotidine (Pepcid), Ranitidine, Cimetidine
-decrease gastric acid secretion
-confusion
-cimetidine: gynecomastia, impotence (avoid)

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PPI

-Esomeprazole (Nexium), Lansoprazole (Prevacid), Omeprazole (Prilosec) –> 60 min before breakfast
-Dexlansoprazole (Dexilant), Pantoprazole (Protonix)
-irreversibly bind to the gastric H/K-ATPase pump and blocking gastric acid secretion
-C.Diff associated diarrhea, hypomagnesemia, vitamin B12 deficiency with prolonged use, osteoporosis-related bone fractures with high doses or long-term use
-diminish the therapeutic effect of clopidogrel (do not use omeprazole and esomeprazole)

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Metoclopramide (Reglan)

-gastroproesis
-30 min before meals and at bedtime
-CrCl < 60 mL/min decrease dose by 50%
-tardive dyskinesia, EPS
-avoid in Parkinsons disease

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Drugs that require an acidic gut

-Antiretrovirals (rilpivirine, atazanavir)
-Antivirals (ledipasvir, velpatasvir/sofobuvir)
-azole antifungals (itraconazole capsules, ketoconazole, posaconazole oral solution)
-Cephalosporins (cefpodoxime, cefuroxime)
-iron products
-mesalamine
-risedronate
-TKi (dasatinib, erlotinib, pazopanib)

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Drug classes that antacids bind

-antiretrovirals (INSTIs): bictegravir, dolutegravir, elvitegravir, raltegravir
-bisphosphonates
-isoniazid
-levothyroxine
-mycophenolate
-quinolones
-sotalol
-steroids
-tetracyclines

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H. Pylori Treatment: bismuth quadruple therapy (first-line)

-10-14 days
-bismuth subsalicyates 300 mg QID + flagyl 250-500 mg QID + tetracycline 500 mg QID + PPI BID
-alcohol use: do not use flagyl
-pregnancy/children: do not use tetracycline

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H. Pylori Treatment: concomitant therapy (if local resistance rates to clarithromycin are low and no previous macrolide exposure)

-10-14 days
-amoxicillin 1000 mg BID + clarithromycin 500 mg BID + flagyl 250-500 mg QID + PPI BID

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H. Pylori treatment: clarithromycin triple therapy (if local resistance rates to clarithromycin are low and no previous macrolide exposure)

-14 days
-amoxicillin 1000 mg BID + clarithromycin 500 mg BID + PPI BID (or esomeprazole 40 mg QD)
-or 3 in 1 product Prevpac (amoxicillin + clarithromycin + lansoprazole )

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NSAID induced ulcer

Sucralfate (Carafate)
-taken before meals
-constipation
-binding interactions (separate antacids by 30 in and take other drugs 2 hours before or 4 hours after)

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Drugs that cause constipation

-antacids (aluminium- and calcium-containing)
-antidiarrheals
-clonidine
-colesevelam
-drugs with anticholinergic effects (antihistamines, antispasmodics, phenothiazines, TCAs, urge incontinence drugs)
-iron
-non-DHP CCB (verapamil)
-opioids
-sucralfate

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OTC recommendation for constipation: most adults

fiber

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OTC recommendation for constipation: iron-induced or hard stool

docusate

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OTC recommendation for constipation: opioid-induced

senna or bisacodyl

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OTC recommendation for constipation: pregnancy

fiber

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OTC recommendation for constipation: fast relief needed

adults: bisacodyl or glycerin
Children: glycerin

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Bulk-forming

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psyllium (Metamucil), Calcium polycarbophil (Fibercon), Methylcellulose (Citrucel), Wheat dextrin (Benefiber)
-flatulence, abdominal, cramping, bloating
-adequate fluids are required
-separate calcium

Osmotics

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Magnesium Hydroxide (Milk of Mag), polyethylene glycol (miralax), glycerin, lactulose, sodium phosphates (fleets enema)
-electrolyte imbalance, abdominal cramping
-magnesium: caution in renal dysfunction
-lactulose: hepatic encephalopathy

stimualnts

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senna (Ex-Lax, Senokot) + docusate (Senna S, Senokot S)
Bisacodyl (Dulcolax)

Emollients (stool softeners)

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Docusate (Colace) + senna
-preferred when straining should be avoided

Lubiprostone (Amitiza)

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-CIC, OIC, IBS-C
-Cl channel acitvator

Linaclotide (Linzess)

-CIC, IBS-C -Guanylate Cyclase C agonists

Alvimopan (Entereg)

-peripheral acting mu opioid receptor antagonists -for hospitalized surgery [atient to decrease risk of post-operative ileus -max 15 doses -CI: therapeutic doses of opioids for > 7 consecutive days

methylnaltrexone (relistor) Naloxegol (movantik)

-peripheral acting mu opioid receptor antagonists -CI: therapeutic doses of opioids for > 7 consecutive days

Whole Bowl Irrigation

-Polyethylene glycol-electrolyte solution (Colyte, Golytely) -Sodium phosphates (OsmoPrep) -Sodium sulfate, potassium sulfate and magnesium sulfate (suprep bowel prep kit)

Drugs that cause diarrhea

-acetylcholinesterase inhibitors (donepezil) -antacid containing magnesium -abx -antidiabetics (metformin, GLP-1 agonists) -antineoplastics (irinotecan, capecitabine, 5-FU, methotrexate, TKis) -colchicine -laxatives -misoprostol -mycophenolate -prokinetic drugs (metoclopramide, cisapride) -protease inhibitors (especially nelfinavir) -quinidine -roflumilast

antispasmodic

dicyclomine (Bentyl) -anticholinergic -caution in UC can cause toxic megacolon or paralytic ileus

Crohns disease

diarrhea: bloody or non-bloody fistulas/strictures: Common Location: entire GI tract Depth: transmural Pattern: non-continous (cobble stone) smoking: risk factor

diarrhea: bloody fistulas/strictures: uncommon Location: colon (especially in rectum) Depth: superficial Pattern: continous smoking: protective`

induction of remission for CD

steroids (+/- thiopurine or methotrexate) anti-TNF +/- thiopurine Ustekinumab (Stelara)

induction of remission for UC

-5-ASA +/- steroids -anti-TNF agents -ustekinumab (stelara) -tofacitinib (Xeljanz) -Vedolizumab (Entivyo) -IV cyclosporine

maintenance of remission in CD: mild disease of the ileum and/or right colon

oral budesonide for > 3 months; after this course, discontinue tx or change to thiopurine or methotrexate

maintenance of remission in CD: moderate-severe disease

Anti-TNF agents: adalimumab (humira), infliximab (remicade), certolizumab (cimzia) thiopurine (azathioprine, mercaptopurine) methotrexate IL receptor antagonist (ustekinumab (Stelara))

maintenance of remission in CD: refractory to above treatments and/or steroid dependent

integrin receptor antagonists: vedolizumab (entyvio) or natalizumab (tysabri)

maintenance of remission in UC: mild disease

mesalamine rectal and/or oral preferred

maintenance of remission in UC: moderate-severe disease

Anti-TNF agents: adalimumab (humira), infliximab (remicade), certolizumab (cimzia) thiopurine (azathioprine, mercaptopurine) Cyclosporine IL receptor antagonist (ustekinumab (Stelara)) Janus Kinase Inhibitor (Tofacitinib (Xeljanz))

maintenance of remission in UC: Refractory to above treatments and/or steroid dependent

integrin receptor antagonists: vedolizumab (entyvio)

Oral steroids for CD and UC

Prednisone (Deltasone) Budesonide (Entocort EC, Uceris) -CD: induction and maintenance -UC induction only

Aminosalicylates

Mesalamine ER (Pentasa, Asacol HD, Rowasa (rectal), Canasa (suppository) -rectal is more effective than oral for distal disease/proctitis in UC Sulfasalazine

Thiopurines

Azathipurine (Imuran) -TPMT deficiency incr risk of myelosuppression

Natalizumab (Tysabri)

-integrin receptor antagonists -used for CD -IV every 4 weeks -d/c if no response by 12 weeks -risk of PML -only available through REMs

Vedolizumab (Entyvio)

-integrin receptor antagonists -injection -used for CD and UC -0,2, and 6 weeks then every 8 weeks -d/c if no benefit by week 14

Scopolamine (Transderm Scop)

- 1 patch every 3 days PRN -CI: hypersensitivity to belladonna, closed-angle glaucoma -dry mouth, CNS effects, stinging of the eyes, pupil dilation, increase IOP -remove patch before MRI -avoid alcohol

Dimenhydrinate (Dramamine)

-CNS depression, increased IOP dizziness, drowsiness, dry mouth, blurry vision

Meclizine (Dramamine All Day Less Drowsy)

-CNS, depression, increase IOP -sedation, dry mouth, dry/burry vision -commonly used for vertigo

GI Flashcards

(48 cards)