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GI Disorders Flashcards

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1
Q

foods that lower LES

A

alcohol
caffeine
chocolate
citrus
garlic/onion
peppermint
nicotine

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2
Q

drugs that lower LES

A

alpha adrenergic agonists
calcium channel blockers
anticholinergics
theophylline
benzos
opiates

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3
Q

H2RA drug interactions

A

cimetidine worst

warfarin, theophylline, decreased absorption of antifungals

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4
Q

best PPI w/clopidogrel

A

pantoprazole

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5
Q

PPI drug interactions

A

methotrexate - increases toxicity
antifungals have decreased absorption due to lower pH

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6
Q

highest risk NSAIDs for GI bleed

A

ketorolac
indomethacin
piroxicam

highest risk in first 3 months

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7
Q

What can cause a false negative in H. pylori?

A

PPI
Antibiotics

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8
Q

when do you treat w/H pylori and why?

A

always
carcinogen

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9
Q

different types of H pylori tests?

A

serologic (blood) - can’t differentiate b/w new or old or eradication
urea breath test - can diagnose and test eradication
stool antigen - not quite as sensitive or specific
invasive tests - expensive, time consuming and difficult

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10
Q

1st line for H pylori?

A

PPI + 2 antibiotics

pantoprazole (double dose or standard) + clarithromycin 500mg BID + amoxicillin 1000mg BID + Flagyl 500mg TID

for 14 days

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11
Q

quadruple therapy for H pylori

A

Bismuth subsalicylate + Flagyl + TCN/Doxy + PPI

pantoprazole (double/standard) + bismuth subsalicylate 300mg QID/bismuth subcitrate 120-300mg QID + Flagyl 250-500mg TID-QID + TCN 500mg QID

for 10 - 14 days

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12
Q

sequential dosing for H Pylori

A

PPI (standard/double) + amoxicillin 1000mg BID x 5 - 7 days
PPI BID + Clarithromycin 500mg BID + Flagyl/tinidazole 500mg BID x 5 - 7 days

complex and not a favorite

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13
Q

High risk CV and High risk Bleed risk - what NSAID to use?

A

avoid NSAIDs and COX2 Inhibitors

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14
Q

High risk CV and Low/Mod Bleed risk - what NSAID to use?

A

naproxen and PPI

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15
Q

Low risk CV and low risk GI bleed - what NSAID to use?

A

NSAIDs ok

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16
Q

Low risk CV and mod risk GI Bleed - what NSAID to use?

A

NSAID and PPI

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17
Q

Low risk CV and high risk GI bleed - what NSAID to use?

A

COX 2 Inhibitor and PPI

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18
Q

why use erythromycin in endoscopy with GI bleed?

A

erythromycin 250mg IV 30 to 60 minutes prior will push blood distally and improve diagnostic yield

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19
Q

Protonix Therapy with GI bleed

A

Protonix 80mg IVP then 8mg/hr for up to 72 hours after surgery
BID PPI for 2 weeks after endoscopy

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20
Q

Indications for stress-ulcer prophylaxis inpatient

A

1 of following:
ventilator >48 hrs, platelets <100, INR >1.5, burns, head/spinal injury, hx of bleeds, trauma, transplant, low pH, surgery >4hr, acute lung injury

2 of the following:
sepsis, ICU stay >7 days, occult bleeding, >250mg hydrocortisone, hepatic failure, renal insufficiency, hypotension, anticoagulation

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21
Q

markers of inflammation

A

IL-1
IL-6
TNF

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22
Q

ulcerative colitis
(location, perfs, cancer risk, polyps, megacolon)

A

rectum and colon
no perfs
increased cancer risk
polyps and toxic megacolon

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23
Q

Crohn’s disease
(location, perfs, cancer risk, polyps, megacolon)

A

from mouth to anus - usually ileum
deep ulcers, fistulas, perfs
malabsorption but no cancer or polyps

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24
Q

Ulcerative Colitis Mild Stages

A

<4 poops a day
Normal ESR
topical treatment

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25
Ulcerative Colitis Moderate Stages
>4 poops a day could have fever, anemia, tachycardia treat with topicals and PO sulfasalazine then budesonide/steroids
26
Ulcerative Colitis Severe Stage
>6 poops a day w/ blood fever, HR >90, ESR>30, Hgb <75% of normal, tender abdomen, bowel edema treat with PO Budesonide, then steroids, then TNF-a
27
Ulcerative Colitis Fulminant
>10 stools a day with blood have to have blood to be fulminant, dilated colon treat w/methylprednisolone 40-60mg daily, if fails then do infliximab or cyclosporine
28
Crohn's disease mild/moderate Stages
no systemic symptoms can do mesalamine/sulfasalazine minimally effective budesonide 9mg/day flagyl 10-20mg/kg/day ciprofloxacin 1g/day + Flagyl
29
Crohn's disease Mod/Severe Stages
sxs anemia, N/V, >10% weight loss Prednisone 40-60mg/day or Budesonide 9mg/day if terminal ileum, TNF-a + Thiopurines
30
Crohn's disease Severe Stages
no response to steroids can have high temps, abdominal pain, vomiting, possible obstruction, abscess treat w/ IV steroids, parenteral nutrition after 5 - 7 days, possibly cyclosporine IV
31
Budesonide PO is good for what GI location?
8 week cycles best, not long term for ileum and ascending colon have rectal foam for descending colon
32
antispasmodics for colonic disease
dicyclomine propantheline hyoscyamine
33
cholestyramine for colonic disease
sequesters bile acid to decrease diarrhea after ileal resection
34
aminosalicylates
sulfasalazine - activated in the colon, ADR hemolytic anemia, hepatotoxicity, bone marrow suppression, pancreatitis, decreases sperm production remove sulfa - mesalamine, olsalazine, balsalazide - could cause nephrotoxicity
35
location of action for aminosalicylates in colonic disease
colon only, activated there
36
corticosteroids for colonic disease
budesonide is 15x more potent than prednisone takes 2 weeks to transfer from prednisone to budesonide
37
Mercaptopurine azathioprine
TPMT metabolizes azathioprine to mercaptopurine pancreatitis, bone marrow suppression, N/V/D, rash, hepatotoxicity, T-Cell lymphoma esp if male and adds TNF-a
38
methotrexate
bone marrow suppression, N/V/D, pulmonary toxicity, hepatotoxicity
39
tofacitinib
oral JAK inhibitor for moderate to severe UC 10mg PO BID if no relief after 16 weeks then discontinue D/C - renal impairment, mod hepatic failure, 3A4/2C19 inhibitor, stop if ANC < 0.5, interrupt if Hgb <8 or drops >2, infection ADR - URTI, increase CPK, rash, HA, diarrhea, herpes zoster, TB, neutropenia, low Hgb, lymphocytopenia, malignancies, GI perf can cause DVT, PE, and thrombosis with RA if >50 yo and CVD if higher than recommended doses given
40
biologics for UC/Crohn's
infliximab - combine w/azathiopurine for induction, increases HF, antibodies, bone marrow suppression, cancer risk, and CNS effects adalimumab** - 2nd line, less antibodies certolizumab** - most effective agent if CRP > 10 golimumab** - only once others have failed or steroid dependent natalizumab - must test for antibodies, increased cancer risk a lot, no combo therapy vedolizumab - similar to natalizumab but less cancer risk ustekinumab - IL-12 and IL-23 last line essentially
41
octreotide dosing for varices
octreotide 50mcg IVP then 50mcg/hr for 3 to 5 days
42
vasopressin for variceal bleeding
0.2 - 0.4units/min + nitroglycerin 40-400mcg/min x 3 - 5 days must use combination therapy
43
beta blockers for varicese
non-selective propranolol, carvedilol, nadolol goal resting HR is 55-60 or 25% reduction from baseline
44
medication that increased risk of death in variceal bleeding
isosorbide will decrease HR but increased risk of death in primary prophylaxis
45
bacteria in spontaneous bacterial peritonitis
E coli, Klebsiella, Strep pneumo, Rarely MSSA
46
albumin dosing in spontaneous bacterial peritonitis
albumin 1.5g/kg on admission albumin 1g/kg on day 3 reduced mortality and renal failure
47
prophylaxis for bacterial peritonitis
ciprofloxacin or Bactrim DS 5 days a week
48
hepatorenal failure and peritoneal issues
vasoconstrictors for BP (levophed) or midodrine and octreotide
49
hepatitis A exposure
Immune globulin 0.1ml/kg IM within 2 weeks of exposure chronic liver disease gets a vaccine and the IG
50
Hep B Treatment
Treat if ALT >2x ULN and DNA load is >20k Pegylated interferon (Pegasys) 180mcg SC weekly x yr - initially increases ALT
51
Pegasys
pegylated interferon given 180mcg SC qweekly x 48 weeks Hep B is a cytokine w/antiviral, antri-proliferative, and anti-immune activity can cause bone marrow suppression, leukopenia, thrombocytopenia, CNS effects, seizures, psychosis, flu, thryoid issues, alopecia, CVA
52
Hep B Reverse Transcriptase Inhibitors
Entecavir 1mg daily Tenofovir can also do lamivudine or telbivudine but not as good, has resistance, BBW for lactic acidosis, hepatomegaly, osteoporosis
53
Hepatitis C Drugs
Zepatier (elbasvir/grazoprevir) PO daily 12 weeks Mavyret (glecaprevir/pibrentasvir) PO daily 8-16 weeks Interferon/Peg-interferon Ribavirin PO BID x 12 wks Sofosbuvir daily x 12 weeks, has combo w/velpatasvir +/- voxilaprevir but still needs ribavirin
54
Heb B Vaccines
Heplisav "saves" a dose (2) Engerix (give 4th dose if HD) Twinrix is only for adults who are unvaccinated
55
drug interactions with antiretrovirals
PPI's decrease [x] anticonvulsants, rifampin, St Johns Wort amodiodarone statin [x] is increased
56
drugs that can cause pancreatitis
amiodarone azathioprine cannabis diuretics estrogen exenatide mesalamine sulfasalazine sitagliptin TCN Bactrim Depakote
57
pain killer to avoid with pancreatitis
demerol
58
pancreatic enzyme replacement dose
40k units/meal and 1/2 for snacks 500-1000u/kg/meal
59
DOC for HIV ART diarrhea
crofelemer, octreotide
60
DOC for short bowel syndrome diarrhea
teduglutide (GLP2)
61
constipation meds that increase fluid secretion and help transit time
linaclotide 290 for IBS linaclotide 145 for idiopathic plecanatide 3mg daily
62
opioid induced constipation drugs
methylnaltrexone naldemedine naloxegol
63
drugs for idiopathic constipation
linaclotide 145 prucalopride (suicide ADR) lubiprostone 24mcg BID w/meals
64
drugs for IBS
linaclotide 290mcg lubiprostone 8mcg tenapanor
65
lubiprostone
take w/meals 24mcg BID for idiopathic constipation 8mcg BID for IBS need neg pregnancy test before use
66
IBS anticholinergic contraindications
GI obstructions myasthenia gravis glaucoma
67
drugs for IBS-diarrhea
SSRIs and TCAs eluxadoline alosetron rifaximin
68
tegaserod
for IBS constipation in women <65 and low cardiovascular risks may cause ischemic bowel but works - use 2nd line behind lubiprostone and linaclotide
69
phenothiazine drugs and ADRs
promethazine, prochlorperazine EPS, injection site reactions, anticholinergic, anti-dopamine
70
serotonin antagonist drugs and ADR
ondansetron, dolasetron, granisetron, palonosetron QTc prolongation correct mag and k
71
haloperidol/droperidol side effects for N/V
Extrapyramidal side effects QTc prolongation
72
NK1 antagonists
fosaprepitant, neupitant/aloxi, rolapitant emend is only inj. others tabs reduces birth control pill and warfarin rolapitant has 7 days 1/2 life CYP 3A4 interactions
73
Diclegis / Bonjesta
doxylamine and pyridoxine 10/10mg for pregnancy if all others fail Category A

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