GI Flashcards
(90 cards)
1
Q
GI drug selection therapy is based on…
A
Identifying disease treatment in context of the patient’s medical history and organ function
Noting drug allergies
Reconciling meds (Rx and OTC)
2
Q
Name that class:
Bismuth Subsalicylate (Pepto-Bismol)
A
Cytoprotective
Anti-diarrheal
3
Q
Name that class:
Ondansetron (Zofran)
A
Antiemetic
4
Q
Name that class:
Ranitidine (Zantac)
A
H2 blocker
5
Q
Name that class:
Calcium carbonate (Tums)
A
Antacid
6
Q
Name that class:
Magnesium hydroxide
A
Laxative
7
Q
Name that class:
Famotidine
A
H2 blocker
8
Q
Name that class:
Promethazine (Phenergan)
A
Antiemetic
9
Q
Name that class:
Esomeprazole (Nexium)
A
PPI
10
Q
Name that class:
Pantoprazole (Protonix)
A
PPI
11
Q
Name that class:
Lansoprazole (Prevacid)
A
PPI
12
Q
Name that class:
Prochlorperazine (Compazine)
A
Antiemetic
13
Q
Name that class:
Diphenoxylate/atropine (Lomotil)
A
Antidiarrheal
14
Q
Name that class:
Omeprazole (Prilosec)
A
PPI
15
Q
Name that class:
Magnesium hydroxide/Aluminum hydroxide (Maslow)
A
Antacid
16
Q
Name that class:
Metoclopramide (Reglan)
A
Prokinetic
17
Q
Name that class:
Adalimumab (Humira)
A
Anti-inflammatory
18
Q
Name that class:
Lubiprostone (Amitiza)
A
Anti-constipation
19
Q
Name that class:
Linaclotide (Linzess)
A
Anti-constipation
20
Q
Name that class:
Dicyclomine (Bentyl)
A
Antispasmodic
21
Q
Name that class:
Misoprostol (Cytotec)
A
Cytoprotective
22
Q
Name that class:
Infliximab (Remicade)
A
Anti-inflammatory
23
Q
Name that class:
Polyethylene glycol (Miralax)
A
Laxative
24
Q
Name that class:
Loperamide (Imodium)
A
Anti-diarrheal
25
Name that class:
Senna (Senokot)
Laxative
26
Name that class:
Lab tulles
Laxative
27
What are the alarm features for GERD?
```
Dysphagia
Hematemesis
Melena
Anemia
Unintentional weight loss
Personal Hx of cancer
Inadequate response to therapy
```
28
What should your plan be for a patient with GERD in the absence of alarm features?
Discuss dietary, lifestyle, behavior mods
Consider pharmacological therapy (Antacid vs H2 blocker vs PPI)
• Ranitidine (Zantac) first line
29
What are the benefits of using H2 blockers for GERD?
Quick onset, appropriate for ON-DEMAND RELIEF
Most effective for decreasing NOCTURNAL acid formation
30
What are some causes of esophagitis other than reflux?
Infectious (ie Candida)
Eosinophilic
Pill-induced
31
What medications can lead to pill-induced esophagitis
BISPHOSPHONATES
Iron supplements
NSAIDs/Aspirin
Potassium
Tetracycline
32
Which medication is most appropriate for the treatment of reflux esophagitis?
Omeprazole (Prilosec) or any other PPI
33
How long do PPIs take to work?
Relief of symptoms generally takes 2-5 days
Best given in the morning, 30 min before breakfast
34
What is the rebound effect with PPIs?
Acid hypersecretion with abrupt d/c
Consider taper therapy
35
What are the possible risks associated with chronic PPI therapy?
Nutrient malabsorption (Ca, Mg, B12, Fe)
Osteoporosis related fractures (consider bone density scans)
C. difficile/other enteric infections
Kidney disease
***Use lowest effective dose for shortest duration possible***
36
Which antacid:
SE = diarrhea
Magnesium
37
Which antacid:
Hypermagnesemia risk (caution in patients with renal insufficiency)
Magnesium
38
Which antacid:
SE = constipation
Aluminum hydroxide
39
Which antacid:
Hypercalcemia risk
Calcium carbonate (tums)
40
Which antacid:
Risk of sodium/fluid retention (caution in patients with edema, cirrhosis, HF, renal impairment)
Sodium Bicarbonate
41
What non-invasive tests can help diagnose H. pylori infection?
Urea breath test
Stool antigen
42
What is the first-line therapy for a patient with H. pylori?
Quadruple therapy - PPI, Bismuth, Metronidazole, Tetracycline
43
Why is eradication testing necessary for patients treated for H. pylori?
Risk of PUD, Fe deficiency anemia, and gastric malignancy
44
Which meds should be d/c prior to H. pylori testing and in what timeframe?
PPI 1-2 weeks prior to testing
Bismuth/antibiotics 4 weeks prior to testing
45
“Burning, gnawing” epigastric pain aggravated by meals (sx 30 min after meal)
Partial relief with Zantac
No vomiting, hematemesis, melena, weight loss
Takes ibuprofen 600 mg TID for past year
Probable PUD secondary to chronic NSAID use
46
What are some common causes of PUD?
H. pylori
ZES
Physiologic stress
NSAID use
47
What is the most appropriate diagnostic test for PUD?
EGD
48
What complications do you worry about with PUD and how would you recognize them?
Hemorrhage (hematemesis, melena, heme (+) stool)
Penetration/perforation (peritoneal signs, free air under diaphragm)
Obstruction (succussion splash)
49
In addition to NSAIDs, concomitant use of what meds can complicate PUD?
Anticoagulants
Aspirin
Steroids
50
As a general rule, active duodenal ulcers should be treated for ______ and gastric ulcers for _______
Duodenal - 4 weeks
Gastric - 8 weeks
51
In the setting of NSAID induced PUD we would advise the patient to d/c NSAID. If patient needs to keep using them, what would you recommend?
Maintenance PPI therapy
52
What cytoprotective medication can be used to prevent NSAID-induced ulcers in non-pregnant patients?
Misoprostol (Cytotec)
We don’t use in pregnancy b/c it’s an abortifacient
53
If a patient has T2DM and complains of early satiety, post-prandial nausea, and intermittent vomiting, especially after large fatty meals, what should you suspect?
Diabetic Gastroparesis
| Be sure to r/o PUD or gastric cancer too though
54
What dietary recommendations should you make to a patient with diabetic gastroparesis?
Reinforce small frequent low fat, low residue meals
55
What is the best long-term treatment option for gastroparesis?
Improved glucose control
But if you want to give them a med, you can give them Metoclopramide (Reglan)
56
How should Metoclopramide (Reglan) be used for patients with gastroparesis?
Advise lowest effective dose for shortest duration possible due to risk of extrapyramidcal symptoms and tardive dyskinesia
Contraindications: obstruction, perforation, GI hemorrhage
Educate pt about possible abdominal cramping and diarrhea
57
What are the cautions for Ondansetron (Zofran)
Caution with cardiac arrhythmias and QT interval prolongation
Risk of serotonin syndrome (caution in combo with other serotonergic drugs)
58
What are the precautions for Promethazine (Phenergan) and Prochlorperazine (Compazine)
Sedating
Drug-induced parkinsonism
59
Generalized abdominal pain, alternating diarrhea/constipation
Sx worse with food and stress
What you think?
Irritable Bowel Syndrome
60
What is a good initial medication to suggest to a patient with IBS?
Antispasmodic meds (ie Dicyclomine - Bentyl)
Has anticholinergic properties, use with caution in elderly patients
61
When would you consider Amitriptyline for a patient with IBS?
Psychosocial component and relief of abdominal pain
62
When would you consider Eluxadoline (Viberzi) for patients with IBS?
If they have IBS-D
63
What recommendations should be made for patients with chronic constipation?
Reconcile meds, identify hypomotility agents
Ensure adequate fiber and fluid intake
Encourage exercise
Consider pharmacological therapy
64
What medications can exacerbate constipation?
```
Anti-psychotics
Aluminum hydroxide
Dicyclomine (Bentyl)
Antidepressants
Opioids
```
65
Which meds are bulk-forming laxatives?
Psyllium (Metamucil)
Methylcellulose (citrucel)
Polycarbophil (FiberCon)
Benefited
66
SE for bulk-forming laxatives
Flatulence, bloating
Need to take with FLUID
67
SE of stool softeners (ie Docusate)
GI cramping
68
Which meds are osmotic laxatives?
Polyethylene glycol (Miralax)
Milk of magnesia
Mag citrate
Lactulose
69
SE of osmotic laxatives
GI discomfort
Bloating
Caution with Mg-containing laxatives and hypermagnesemia in patients with renal insufficiency
70
Which meds are stimulant laxatives
Bisacodyl (Dulcolax)
| Senna (Senokot)
71
SE of stimulant laxatives
GI cramping
Rare electrolyte disturbances
Melanosis coli
72
Which laxatives are available by Rx only
Lubiprostone (Amitiza)
Linaclotide (Linzess)
Plecanatide (Trulance)
73
Contraindications for use of laxatives
```
Acute abdomen
Intestinal obstruction
Perforation
Toxic megacolon
Unexplained abdominal pain
```
74
Overuse of laxatives can lead to...
Laxative dependency
Fluid/electrolyte imbalance
Alterations in bowel function
75
When would you consider the use of Methylnaltrexone (Relistor)?
Opioid-induced constipation with advanced illness (palliative care) or in chronic noncancer pain
76
What meds are known to cause/aggravate diarrhea?
```
Mg
Reglan
Augmentin
Metformin
Colchicine
```
77
If a patient was recently on Clindamycin for a dental infection and is now presenting with diarrhea, how would you approach care?
Consider C. difficile infection
Order C. diff stool test, treat empirically with oral vancomycin or metronidazole
78
What are the precautions/contraindications for anti-diarrheal use?
```
Bloody or suspected infectious diarrhea
High fever/toxicity
Pseudomembranous colitis
Acute ulcerative colitis
Use caution in patients with hx of drug abuse
```
79
What are some possible adverse reactions from anti-diarrheal use?
Ileus
Toxic megacolon
80
What is the most common adverse effect of pesto-bismol?
May cause temporary harmless black tongue, mouth, stool
81
Why should you avoid using pepto-bishop in children?
Contains salicylate - risk of Reye Syndrome (like aspirin)
82
CT with contrast shows your patient has diverticulitis. What is the most appropriate treatment?
Flatly + Cipro
Follow up with colonoscopy 6-8 weeks after resolution of Sx to exclude concomitant colon cancer or IBD
83
How do you diagnose IBD?
Colonoscopy
84
Which med is most appropriate in managing a patient with newly diagnosed IBD-UC?
Mesalamine (Lialda)
85
In the event a patient with IBD develops an acute flare, which class of meds may be helpful to reduce remission but are not appropriate for maintenance therapy?
Corticosteroids
Reasonable to provide short burst in tapering doses
86
What are the side effects/risks of chronic steroid therapy?
```
Increased appetite and weight gain
Increased risk of infection
Low bone density/osteoporosis
Worsening diabetes
PUD
Cataracts
Adrenal insufficiency
```
Always have an exit strategy when prescribing them
87
When are abx appropriate for IBD patients
Perinatal Crohn Disease (Cipro and Flagyl)
88
Side effect of Cipro?
Tendon rupture
89
Side effect of Flagyl
Disulfiram-like reaction with EtOH
90
Immunomodulators and biologists require frequent monitoring of which labs?
CBC
LFTs
Be cautious with infections, hepatotoxicity, and malignancies
