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Flashcards in GI disorders Deck (71):
1

pathologic features of Chrohn's disease

no rectal involvement, ilieal involved, strictures, fistulas, transmural involved, cobble stone appearance, granulomas, linear cleft, fever, bleeding, tenderness, mass, pain, fistulas, discontinuous, linear ulcers

2

Pathologic features of UC

Involves rectum, no ileal involved, no strictures, no fistulas, no transmural involved, no granulomas, no linear cleft, no fever, rectal bleeding, sometimes tenderness, no mass, no pain, no fistulas, continuous, no linear ulcers

3

Factors to consider when treating IBD

severity, location, drug factors

4

Severity to of acute disease

mild- 4 BM/day +/- blood; severe- >6 bloody BM/ day; >10 BM/day w/ continuous bleeding

5

Pharm options for IBD

5-aminosalicylates acid derivatives, corticosteroids, immunosuppressive agents, antimicrobials, biologics

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5- aminosalicylate acid derivative MOA

anti-inflammatory, immunosuppressive, inhibition of leukocyte motility, interference w/ TNFa, transformation of growth factor B and nuclear factor, inhibition of leukotriene and prostaglandin production, suppression of IL-1 production

7

Sulfasalazine (Azulfidine)

large sulfa comp, treatment of mild to mod UC, adjunctive treatment in severe UC, prolonged remissions between UC acute attacks

8

Mesalamine (Canasa, rowasa, lialda, etc)

treatment of ulcerative proctitis, tx mild-mod distal UC, proctosigmoiditis or proctitis, induce and maintain remission in active, mil-mod UC, etc

9

Basalazide (Colazal)

treatment of mild to mod UC

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Osalazine (Dipentum)

to maintain remission in UC who are intolerant of sulfasalazine

11

ADRs of 5-ASA

HA, nausea, rash, interstitial nephritis, pericarditis, pancreatitis, hepatitis, parodoxial exacerbation of colitis

12

ADRs of sulfasalazine

dose related rxns, hypersensitivity rxns, male infertility, discoloration

13

Balsalazide, olsalazine, mesalamine ADRs

hair loss, pneumotitis, diarrhea (olsalazine)

14

Sulfasalazine dose related ADRs

Dose >4 g/d, depends on metabolism status, ADRs- nausea dyspepsia, HA, fatigue, dizziness

15

Sulfasalazine hypersensitivity rxns

rash, fever, arthralgia, hepatic dysfunction, hematological toxicities

16

Corticosteroid agents

prednisone, prednisolone, methylprednisolone, budesonide, hydrocortisone, parenteral, oral, or rectal

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Indication of corticosteroids

treatment of active UC or chrohn's, induce remission

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MOA of corticosteroids

antiinflammatory, inhibit cytokine and prostaglandins, immunosuppression, decreased margination of monocytes and neutrophils

19

Withdrawal sx of short-term steroid use

mood and sleep disturbances, inc appetitie, acne, adrenal insufficiency, fluid retention, impaired glucose metabolism

20

Withdrawal sx of long-term steroid use

abnormal fat deposits, hirsutism, htn, glaucoma/cataracts, osteopenia, osteoporosis, DM

21

Immunosuppressive agents

Azathioprine, 6-mercaptopurine, Methotrexate, cyclosporine & tacrolimus

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Azathioprine and 6-mercaptopurine indication

not-FDA approved for tx of IBD, steroid sparing, combo w/ biologics

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Azathioprine and 6-mercaptopurine MOA

immunosuppression, thought to suppress cell mediated hypersensitivities and cause alteration in ab productions

24

Azathioprine and 6-mercaptopurine onset

slow, 3 months

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Azathioprine and 6-mercaptopurine black box warning

chronic immunosuppression cana inc risk of neoplasia, hematological toxicities, mutagenic potential

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Azathioprine and 6-mercaptopurine adrs

GI upset, LFT, rash, hematologic toxicities, Preg cat D

27

Methotrexate indication

not FDA approved for tx of IBD, steroid sparing

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Methotrexate MOA

immunosuppression

29

Methotrexate onset

slow, 2-8 weeks

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Cyclosporine & tacrolimus (Prograf) indication

not FDA approved for tx of IBD, reserved for severe, tx refractory colitis, lot of drug monitoring

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Cyclosporine & tacrolimus (Prograf) moa

immunosuppression

32

Cyclosporine & tacrolimus (Prograf)onset

slow, 5-14 days

33

Cyclosprorine Boxed warning

inc susceptibility to infection, possible development of llymphoma and other malignancies, inc hypertension, nephrotoxicity

34

ADR of cyclosporine

hirsutism, HTN, hyperkalemia, hepatotoxicity, nephrotoxicity, tremor, gingival hyperplasia, hypomagnesemia, encephalopathy, HA, preg cat C

35

Tacrolimus (Prograf) BBW

inc susceptibility to infection possible development of lymphoma and other malignancies

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Tacrolimus (Prograf) ADR

peripheral edema, erythema, pruritus, rash, constipation, N/V/D, anemia, paresthesia, HA, insomnia, tremor, alopecia, cat C

37

Antibiotic indication

for abcesses or fistulas, intestinal or perianal disease, suspected infection

38

Metronidazole (Flagyl)

MOA- anti-inflammatory, immunosuppressive, ADR- metallic taste, disulfiram reaction wen taken w/ EtOH

39

Ciprofloxacin

MOA- anti-inflamm, immunosuppressive; ADR- vaginitis, abd pain, distal neuropathy, tendinopathy

40

Biologics MOA

inhibits TNFa leading to dec GI inflammation and adhesion

41

Biologic agents

adalimumab (Humira), Infiximab (Remicade), Golimumab (Simponi), Natalizumab (Tysabri), Certolizumab (Cimzia)

42

Antimotility options for diarrhea

diphenoxylate/atropine (Lomotil), Loperamide (Imodium), paregoric, opium incture, difenoxin (Motofen)

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Absorbent options for diarrhea

kaolin-pentin mixture, polycarbophil, attapulgite

44

Antisecretory options for diarrhea

Bismuth subsalicylate (Pepto), lacase, probiotics, octreotide (Sandostatin)

45

Lomotil MOA

similar to opiate, atropine added in subtherapeutic amounts and serves to discourage abuse, CIV controlled

46

Lomotil dose and onset

5 mg PO QID, 45-60 mins, if no response in 48 hrs, d/c

47

Loperamide (Imodium) MOA

inhibits peristalsis by binding opioid receptors in intestinal muscle, also inc viscosity and diminishes fluid/electrolyte loss, inc anal sphincter tone

48

Loperamide (Imodium) dose

4 mg PO at onset then 2mg PO after each loose stool, max 8 tabs/day

49

Bismuth subsalicylate (Pepto) MOA

largely effective due to its antisecretory action, may have antimicrobial and antiinflammatory activity too

50

IBS

Chronic abd pain and altered bowel habits, exact pathophysiology unknown, treatment based on predominant sx, diarrhea or constipation

51

Treatment of constipation prominent IBS

inc dietary fiber and fluid, add bulk-laxative and consider antispasmodic agent, add serotonin-4 agonist (tegaserod), add psychotherapy for stress reduction, antidepressants

52

Treatment of diarrhea prominent IBS

lactose-free, caffeine free diet, avoid certain foods, add loperamide or other antispasmodic, add serontonin-3 antagonist (alosetron), add psychotherapy for stress reduction, antidepressants

53

Treatments for GERD

antacid, histamine H2 receptor antagonist, proton pump inhibitors, cytoprotective agents, promotility agents

54

Histamine 2 antagonist

famotidine (Pepcid), Ranitidine (Zantec), nizatidine (Axid), cimetidine (Tagamet)

55

PPI options

Omeprazole (Prilosec), Esomeprazole (Nexium), Pantoprazole (Protonix), Lansoprazole (Prevacid), Dexlansoprazole (Dexilant), Rabeprazole (Aciphex)

56

Antacids

Neutralize gastric acid, increases pH, provides relief within mins, use for mild or infrequent sx, Ca, Al, Mg, NaHCO3, mag-alsimethicone, Mg and Al can accumulate in severe renal dysfuntion, 1-4 tabs PRN, 8000 mg/ day max

57

H2 blockers

reversibly inhibits receptor on gastric parietal cells, reduction of gastric acid secretion, relief in 30-45 mins, lasts 4-10 hrs

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What is DOC in H2 blockers for peds and neonates

Ranitidine (Zantac)

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H2 blockers ADRs, warnings

BBW for elderly (not followed), overall very well tolerated, some agitation, vomiting in children

60

Dosing of H2 blockers

Famotidine (Pepsi) 20 mg PO BID, Ranitidine (Zantec) 150 mg PO BID

61

PPI

blocks gastric acid secretion by irreversibly binding to gastric H/K/ATP pump in parietal cells, full effect not seen for several hrs-few days, some OTC

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Which PPI is used in peds

omeprazole

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PPI warning and ADRs

increased risk of C diff, diarrhea, osteoporosis, pneumonia; overall well tolerated

64

PPI dosage

Pantoprazole (Protonix)- 40 mg PO, Omeprazole (Prilosec) 20-40 mg PO, Esomeprazole (Nexium)- 40 Mg PO, Lansoprazole (Prevacid) 30 mg PO

65

Cytoprotective agents

misoprostol (Cytotec), Sucralfate (Carafate)

66

Misoprostol (Cytotec)

prostaglandin E1 analog, replaces the gastroprotective prostoglandins removed by NSAIDs, do not give w/ other drugs, Preg X, ADR- diarrhea, abd pain

67

Sucralfate (Carafate)

sucrose-sulfate-alum complex- interacts w/ albumin and fibrinogen to form physical barrier over an open ulcer, very safe, rarely causes constipation, 1 Gm PO w/ meals, use w/ caution in renal impairment

68

Promotility agents

Metoclopramide (Reglan), Erythromycin

69

Metoclopramide (Reglan)

DA antagonist, enhances response to Ach in upper GI causing enhanced motility and accelerated gastric emptying, inc lower esophageal sphincter tone, 5-10 mg PO/IVw/ meals and hs, for diabetic gastroparesisi, used for neonatal reflux, also for chemo N/V

70

Metoclopramide (Reglan) contraindications/ ADRs

may cause tardive dyskinesia, not for GI obstruction, perforation, hemorrhage, hx of seizures, can cause EPS, drowsiness, confusion

71

Erythromycin

a macrolide abx used more regularly for promotility effects than abx, option for preprocedural bowel cleansing