GIGU Case Wrap Up

Question 1

What abx are HIGH risk for C. Diff?

Answer 1

Can Catherine Fuck Andre

Clinda, Cephalo, Fluoroquinolones, Augmentin

Question 2

What abx are LOW risk for C. Diff?

Answer 2

And Make (him feel) Very Bad 
Aminoglycosides, metro, vanco, bactrim

Question 3

What is the best antimemetic for nausea?

Answer 3

Zofran

Question 4

What is the first line empiric abx to use in suspected bacterial colitis?

Answer 4

Cipro

Question 5

This bacteria causes Bloody diarrhea, severe cramping, fever 0-30% of the time, N/V

Answer 5

E.Coli

Question 6

Cause/risks/exposure that would perdispose someone to ecoli?

Answer 6

Undercooked ground beef, unpasteurized juices and milk, working with cattle

Question 7

Tx for ecoli?

Answer 7

Supportive care. Abx use is controversial as it can release shiga toxin and cause HUS

Question 8

This bacteria causes profuse watery diarrhea with rapid dehydration. “Rice water stools”. Lose 1-3L per day up to 20L

Answer 8

Vibrio cholera

Question 9

Cause/risks/exposure that would perdispose someone to vibrio cholera?

Answer 9

Poor sanitation- is a waterborne disease

Shellfish

Question 10

Tx for vibrio cholera?

Answer 10

REHYDRATE REHYDRATE REHYDRATE

Doxycycline or ciprofloxacin can help limit duration of disease, but dehydration is the main issue

Question 11

This bacteria causes Diarrhea: bloody, watery, pus, and mucus
Fever, stomach cramps, nausea, vomoting, dehydration

Answer 11

Shigella

Question 12

Cause/risks/exposure that would perdispose someone to shigella?

Answer 12

Person to person spread; very virulent.

Fecal oral spread, also flies and inanimate objects.

Question 13

Tx for shigella?

Answer 13

-Ciprofloxacin

Bactrim or azithromycin as alternates

Question 14

This bacteria causes Fever and diarrhea and is caused by Eating contaminated meat or eggs, or infected food handlers. Handling reptiles?

Answer 14

Salmonella

Question 15

Tx for salmonella?

Answer 15

Most cases are self-limiting and do not require abx. If high risk: cipro is the treatment of choice. Bactrim as alternate

Question 16

This bacteria causes Prodrome: fever, HA, myalgia, malaise.

Abd pain, diarrhea, fever (these are usually low grade)

Answer 16

Campylobacter

Question 17

Cause/risks/exposure that would perdispose someone to campylobacter?

Answer 17

Consuming infected sausages and hard meats, undercooked chicken

Question 18

TOC in campylobacter?

Answer 18

Ciprofloxacin

Azithromycin alternate

Question 19

This bacteria causes Sudden onset explosive diarrhea 1-3 weeks after exposure, abdominal cramping, flatulence, low grade fever, N/V and is the Most common cause of epidemic water borne diarrheal disease in US, most frequent in Rocky Mountain region

Answer 19

Giardia

Question 20

TOC for giardia?

Answer 20

Metronidazole

Question 21

This bacteria causes Profuse watery diarrhea, 15-30 BMs per day, abdominal pain or cramps, low grade fever

Answer 21

C. diff

Question 22

What is the TOC for C. Diff?

Answer 22

PO vanco

Question 23

What is the pathophysiology of GERD?

Answer 23

The LES is supposed to relax when food goes from esophagus to the stomach. Reflux occurs when the LES decreases in tightness, causing gastric contents to “reflux” back into the esophagus

Question 24

What medication class can cause the LES to relax too much?

Answer 24

CCB because it relaxes all smooth muscle

Question 25

What is the MOA of antacodis?

Answer 25

Increases pH of gastric reflux by neutralizing gastric acid, thereby decreasing its potential to cause damage to the esophageal mucosa. Also increase the LES tone through alkanization of gastric contents

Question 26

What medication is used as a first line for managing patients with mils-mod sxs of GERD without esophagitis and can also be used for breakthrough sxs in patients receiving H2 blockers or PPIs

Answer 26

Antacids

Question 27

MOA of sulcrafate?

Answer 27

A mucosal coating agent that forms a protective barrier between esophageal tissue and gastric refluxate -not FDA approved in GERD but some people get relief

Question 28

Antacids and sulcrafate should not be used in patients with ______?

Answer 28

CKD

Question 29

MOA of H2 receptor antagonists (H2RTs)?

Answer 29

Acid suppressive agents that inhibit the action of histamine at the H2 receptor of the parietal cell, decreasing basal acid secretion

Question 30

T/F: All H2RTs are equally effective and are all available OTC?

Answer 30

true | Cimetidine, ranitidine, famotidine

Question 31

MOA of PPIs?

Answer 31

Irreversibly bind to the H+/K+ ATPase pump of the parietal cell, thereby inhibiting the final step of acid secretion

Question 32

This is something good to know... just read the card

Answer 32

``` PPI = don't make acid H2 = make acid but neutralize it ```

Question 33

This medication is more effective at treating erosive/ esophagitis than H2RTs?

Answer 33

PPI (omeprazole, pantoprazole, lasoprazole, dexilant)

Question 34

PPI are not highly regarded by some medical professionals for what reasons?

Answer 34

They are linked to increased c. diff risk, increased fracture risk, vit B12 def, CKD and worsening PNA prognosis. **They are also CYP2C19 inhibitors and have many drug drug interactions with plavix, diazepam and penytoin

Question 35

______ are #1 in pregnancy for GERD?

Answer 35

H2 blockers and antacids (PPIs are ok too but omeprazole is cat C)

Question 36

What is something to consider in a patient with esophagitis as a potential cause?

Answer 36

Patient could have pilll esophagitis so make sure the pill is enteric coated

Question 37

What medication should be initiated in a patient with CKD?

Answer 37

ACEI and also d/c meds that would contribute to renal impairment

Question 38

What four drugs contribute to renal impairment?

Answer 38

- Metformin - Cetirizine (Zyrtec) - Vit C & D - HCTZ - Naproxen

Question 39

What is the most common drug-related problem in chronic renal failure?

Answer 39

inappropriate selection or dosing of medications with renal elimination pathways. We must know our patients GFR to evaluate all medications

Question 40

What two meds are contraindicated at GFR <30?

Answer 40

Naproxen and Metformin

Question 41

MOA biguanides (metformin)?

Answer 41

inhbits the production and release of glucose from the liver and enhances insulin sensitivity in muscle and fat

Question 42

This med is by far best at decreasing a patient's A1c?

Answer 42

Metformin

Question 43

What is a common s/e of metformin?

Answer 43

GI upset

Question 44

MOA of sulfonureas (glyburide, glimiperide, glipizide)?

Answer 44

insulin secretagogues (a substance that causes another substance to be released) that promote pancreatic B-cell secretion of insulin and potentiate insulin action on extra-hepatic tissue.

Question 45

What is the preferred sulfonurea in renal disease but needs renal dosing?

Answer 45

Glipizide

Question 46

MOA alpha-glucosidase inhibitors (acarbose, miglitol)

Answer 46

Delay GI break-down and absorption of carbohydrates

Question 47

MOA TZDs (rosiglitazone and pioglitazone)?

Answer 47

Insulin sensitizers that reduce insulin resistance by decreasing hepatic glucose release and promoting skeletal muscle glucose absorption

Question 48

What are some side effects of the TZDs?

Answer 48

cardiovascular RFs, hepatic dysfunction and associated with weight gain

Question 49

MOA DPP-4 inhibitors (sitagliptin)?

Answer 49

They inhibit the DPP4 enzyme which breaks down the proteins that trigger the release of insulin. The MOA is via increased incretin, inhibiting glucagon secretion, decreasing blood glucose, increasing insulin secretion and decreasing gastric emptying.

Question 50

MOA Incretin mimetic/glucagon-like peptide GLP-1 agonist (tides)?

Answer 50

mimics the action of the hormone incretin, which helps regulate both fasting and postprandial glucose levels. These agents stimulate GLP-1 receptors enhancing glucose-dependent insulin secretion by the pancreatic B-cells, suppressing inappropriately elevated glucagon secretion and slowing gastric emptying

Question 51

What medication calss for DM can not be prescribed with a DPP4?

Answer 51

GLP-1 agonist

Question 52

MOA of the SGLT2 inhbiitors (flozins)?

Answer 52

Reduce tubular glucose reabsorption (pee out glucose) therefore reducing blood glucose levels and the need for insulin release

Question 53

This has the potential for the greatest A1C reduction and allows the tightest glucose control?

Answer 53

Injectable insulin

Question 54

MOA of ACEI inhibitors (catopril, enalapril, lisinopril)?

Answer 54

inhibit conversion of angiotensin to angiotensin II, reducing vasoconstriction and aldosterone secretion

Question 55

MOA ARBs (losartan, valsartan)?

Answer 55

impair the vasoconstrictive effect of angiotensin II and block the stimulation of aldosterone secretion

Question 56

Thiazides vs loop diuretics?

Answer 56

Use thiazides for BP control and in CKD stages 1-3 and loop in CKD 4 and 5

Question 57

These meds reduce mortality in the treatment of HTN but they can mask the signs and sxs of hypoglycemia

Answer 57

Beta blockers

Question 58

______ therapy is often sufficent enough to reduce LCL goals

Answer 58

statin

Question 59

_____ reduce LDL levels by about 15-20%

Answer 59

Bile acid sequestrants

Question 60

_____ are effective in reducing TG levels but have variable efficacy in reducing LDL and raising HDL

Answer 60

Fibrates

Question 61

What two meds are CONTRAINDICATED in patients with CKD as the risk of rhabdo is significantly increased?

Answer 61

fibrates/statin combos

Question 62

MOA alpha blockers (alpha adrenergic antagonists)?

Answer 62

competitively antagonize a-adrenergic receptors, thereby causing relaxation of the bladder neck, prostatic urethra, and prostate smooth muscle

Question 63

What is the best med for controlling sxs of BPH?

Answer 63

alpha blockers -- recommended for patients with normal size prostate and PSA

Question 64

Can alpha blockers be used to treat patients with essential htn?

Answer 64

NO

Question 65

What medications shrink the prostate and decrease PSA?

Answer 65

5-alpha reductase inhibitors

Question 66

MOA 5-alpha reductase inhibitors?

Answer 66

inhibit 5-alpha reductase, whichn is responsible for intraprostatic conversion of testosterone to dihydrotestosterone, the active androgen that stimulates prostate tissue growth and size. Thus, resulting in the shrinkage of an enlarged prostate by about 20% to 25% after 6 mo.

Question 67

MOA phosphodiesterase inhibitor?

Answer 67

selectively inhibit PDE type 5 which is responsible for the degradation of cGMP. with prolonged cGMP activity, smooth muscle relaxation (leading to increased blood flow), leading to an erection

Question 68

What are a few weird side effects of vardanafil and sildenafil?

Answer 68

blurred vision, difficulty in discriminating blue from green, bluish tones in vision or difficulty seeing in dim light

Question 69

What is an absolute contraindication so using phosphodiesterase 5 inhibitors?

Answer 69

Nitrates

Question 70

MOA Alprostadil?

Answer 70

A prostaglandin E1 analog that induces an erection by stimulating adenyl cyclase, leading to increased cAMP, smooth muscle relaxation, rapid arterial inflow and increased penile rigidity (its an injection)