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p2 year > n/v, constipation, diarrhea, IBS, GERD, PUD, upper GI bleed, IBD > Flashcards

n/v, constipation, diarrhea, IBS, GERD, PUD, upper GI bleed, IBD Flashcards

1
Q

causes of N/V (7)

A
  • general (gastroenteritis, pancreatitis)
  • disorders of balance
  • N/V pregnancy
  • gastroparesis
  • post-op N/V
  • chemo and radiation induced N/V
  • N/V in children
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2
Q

what is gastroparesis?

A

impaired neuronal transmission –> slow stomach motility –> delayed gastric emptying

aka: food staying in the stomach for too long!

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3
Q

cause of gastroparesis

A

DM!

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4
Q

which causes of N/V do we start with self care?

A

GENERAL (gastroenteritis) – YES
DISORDER OF BALANCE – YES
N/V PREGNANCY – YES
gastroparesis – no
post-op N/V – no
chemo/radiation induced – no
N/V IN CHILDREN – YES

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5
Q

1 cause of gastroenteritis?

A

viruses – norovirus

(other causes are bacterial – food borne)

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6
Q

N/V self-care exclusions

A
  • DM
  • suspected food poisioning > 24 hours
  • severe abdominal pain
  • prolonged N/V + fever +/- diarrhea
  • blood in vomit
  • yellow skin/eyes + dark urine
  • stiff neck +/- HA +/- light sensitivity (meningitis!!)
  • head injury + N/V, blur vision, numb, tingle
  • significant comorbidities
  • age < 6 months
  • children: lack of urination for 8-12 hours
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7
Q

N/V pharm treatment options

A
  • antihistamines
  • phenothiazines
  • serotonin antagonists (5-HT3)
  • prokinetics
  • corticosteriods
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8
Q

antihistamine MoA

A

block H1

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9
Q

antihistamine potency

A

not super potent

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10
Q

antihistamine dosage form

A

all PO except scopolamine

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11
Q

meclizine indication

A

ELDERLY!!! –> if > 65 years, recommend meclizine (bc of the pearls…)

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12
Q

meclizine pearls

A
  • less sedating
  • least CNS/BBB penetration
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13
Q

doxylamine formulation

A

coformulated with vitamin B6

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14
Q

scopolamine dosage form

A

PATCH – transdermal, behind ear
* leave on for 3 days

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15
Q

scopolamine potency

A

very potent –> hence why use for post-op n/v

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16
Q

scopolamine CI

A

elderly!!

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17
Q

antihistamine AE

A
  • drowsiness, dry mouth, constipation
  • fall risk in patients > 65 years because impairs cognition/cause confusion!
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18
Q

antihistamine options

A
  • meclizine
  • dimenhydrinate (Dramamine)
  • scopolamine
  • doxylamine
  • hydroxyzine
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19
Q

phenothiazine options

A
  • promethazine
  • prochlorperazine
  • chlorpromazine
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20
Q

phenothiazine MoA

A

inhibit dopaminergic , histamine (H1), muscarinic receptors

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21
Q

phenothiazine dosage forms

A

PO, IV, DEEP IM

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22
Q

which phenothiazine comes as a rectal suppository

A

prochlorperazine

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23
Q

which phenothiazine has least QT prolongation?

A

prochlorperazine

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24
Q

phenothiazine AEs

A
  • tissue damage –> hence DEEP IM injection
  • hypotension –> hence give IV as slow IV push, patient lying down
  • QTc prolongation
  • dystonia: locked/rigid/frozen, like parkinson’s
  • extrapyramidal symptoms (EPS): tardine dyskinesia, purposeless movements they can’t control (tongue, hand)
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25
Q

5-HT3 antagonists (serotonin antagonist) options

A
  • ondansetron (Zofran)
  • dolasetron
  • granisetron
  • palosetron
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26
Q

what is the most common/workhorse class of N/V?

A

5-HT3 antagonists –> ondansetron

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27
Q

serotonin antagonist dosage form

A

PO, IV, ODT

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28
Q

N/V pregnancy first line

A

doxylamine + vit B6
*NOT ONDANSETRON

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29
Q

serotonin antagonist AEs

A
  • HA
  • constipation
  • QT prolongation (as doses inc, IV)
  • well tolerated
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30
Q

prokinetic options

A
  • metoclopramide (Reglan)
  • erythromycin
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31
Q

metoclopramide MoA

A
  • block dopamine, serotonin
  • enhance Ach response –> inc gastric emptying and inc lower esophageal sphincter tone –> keeps material in stomach and moving through stomach
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32
Q

prokinetic dosage form

A

PO, IV

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33
Q

metoclopramide AE

A
  • EPS, dystonia (IV and higher doses inc risk)
  • QTc prolongation
  • diarrhea
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34
Q

erythromycin MoA

A

agonize motilin receptors –> inc peristalsis (GI tract movement) in stomach and duodenum

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35
Q

erythromycin AEs

A
  • N/V
  • QTc prolongation
  • diarrhea
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36
Q

corticosteroid MoA

A

dec prostaglandin formulation –> dec 5-HT release from gut

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37
Q

corticosteroid options

A

dexamethasone

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38
Q

corticosteriod AEs

A
  • weight gain
  • hyperglycemia
  • insomnia
  • stomach upset/irritation (inc risk (ulcer) when given with NSAIDs)
  • inc BP
  • agitations (hyper/manic feelings)
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39
Q

which N/V drug classes have QTc prolongation?

A

phenothiazines
serotonin antagonists
prokinetics

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40
Q

bismuth subsalicylate MoA

A
  • antisecretory and antimicrobial action –> directly against bacterial and viral pathogen
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41
Q

bismuth subsalicylate limitations

A
  • > 12 years old
  • 2 day use
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42
Q

bismuth subsalicylate AEs

A
  • fecal discoloration (black)
  • tongue discoloration
  • chelate with fluoroquinolone antibiotics
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43
Q

phosphorated carbohydrate solution (emetrol) limitations

A
  • > 2 years old
  • 1 hour max
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44
Q

constipation definition

A

less than or equal to 3 bowel movements per week

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45
Q

constipation causes

A
  • drugs: opioids, anti-cholinergics (antihistamine, TCAs, CCBs), iron
  • comorbidities: DM, pregnancy, IBS, hypothyroidism
  • low fiber
  • not enough water
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46
Q

constipation self care exclusions

A
  • age < 2 years
  • sudden change in bowel habits lasting > 2 weeks
  • laxative use for > 7 days
  • laxative use but no bowel movement
  • severe abdominal pain
  • N/V
  • rectal bleeding
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47
Q

types of constipation and which we treat with OTC

A
  • general constipation – OTC
  • CIC (chronic idiopathic constipation) – OTC failed
  • IBS-C – OTC failed
  • opioid-induced constipation – OTC
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48
Q

constipation options

A
  • bulk forming lax
  • emollient lax
  • hyperosmotic lax
  • stimulant lax
  • saline lax
  • lubricant lax
  • other Rx treatment
  • opioid-induced treatment
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49
Q

soluble fiber products (bulk-forming lax) MoA

A

inc absorption of water in small and large intestine –> viscous gel
*NEED fluid!!!

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50
Q

soluble fiber products CI

A

CHF

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51
Q

soluble fiber products AE

A

cramping

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52
Q

docusate (emollient lax) MoA

A

surfactant/emulsifier: incorporates water –> softens stool

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53
Q

polyethylene glycol 3350 and glycerin (hyperosmotic laxative) MoA

A

large, poorly absorbed molecules –> draws water into colon

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54
Q

glycerin suppository AE

A

rectal irritation

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55
Q

sennosides, senna, and bisacodyl (stimulant lax) MoA

A
  • directly stimulate colonic mucosa
  • stimulate myenteric plexus
  • inc water secretion into intestines
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56
Q

sennosides, senns, bisacodyl AE

A

cramping and abdominal pain

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57
Q

magnesium citrate, milk of magnesium, sodium phosphate (fleet enema) (saline lax) MoA

A

pulls fluid into intestines –> inc intraluminal pressure

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58
Q

mag citrate, milk of mag, sodium phosphate AEs

A
  • abdominal cramping
  • dehydration
  • electrolyte imbalances
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59
Q

mineral oil (lubricant lax) MoA

A
  • ease passage of stool by dec water absorption and lubricate intestine
  • stops colon water absorption

**similar to docusate, docusate preferred

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60
Q

which OTC options do not cause cramping

A
  • Miralax
  • glycerin suppository
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61
Q

which OTC options are stool softeners

A
  • docusate
  • mineral oil enema

therefore also no cramping

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62
Q

Miralax age range

A

labeled indication: greater than or equal to 17 years old
could use off-label: 6 years and above

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63
Q

PEG 3350 MoA

A

inert substance –> pulls water into colon –> expands stool –> trigger expulsion and softenstool

**no direct stimulation –> no cramping

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64
Q

lactulose MoA

A

non-absorptive sugar –> causes water to be pulled into colon –> contraction

*similar to PEG

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65
Q

lactulose AE

A
  • diarrhea
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66
Q

lactulose dosage form

A

syrup –> super sweet

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67
Q

osmotic agent uses

A

colonoscopy: PEG
hepatic encephalopathy: lactulose

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68
Q

lubiprostone MoA

A

works on Cl channels to inc Cl and water in colon –> improve fecal transit

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69
Q

lubiprostone AE

A
  • diarrhea
  • nausea
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70
Q

linaclotide and plecanatide MoA

A
  • guanalyate cyclase receptor agonist (cGMP) –> inc bicarb and Cl secretion into stool –> inc fluid –> dec fecal transit time
  • secretogogues

**same class –> same MoA

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71
Q

linaclotide and plecanatide AE

A

diarrhea

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72
Q

opioid induced constipation Rx class/MoA

A

mu peripheral antagonists

**opioids act on the mu receptor –> THEREFORE, the opioid will still have analgesic effects bc works in the CNS, but the GI effects will be inhibited bc they are peripheral effects

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73
Q

mu peripheral antagonist options

A
  • methylnaltrexone
  • naloxegol
  • naldemedine
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74
Q

mu peripheral antagonist AEs

A

BBW: caution in GI wall issues (diverticulitis, IBD, colon cancer) –> can cause bowl preforations

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75
Q

diarrhea definition

A

greater than or equal to 3-4 stools in a 24 hour period

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76
Q

diarrhea causes

A
  • virus (gastroenteritis –> *norovirus)
  • IBD, IBS-D, celiac
  • drugs –> antibiotics, metformin, chemotherpay
  • food –> lactose
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77
Q

when are probiotics indicated?

A

pediatric, shorten duration of gastroenteritis and symptoms

*NOT adult c. diff prevention!

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78
Q

diarrhea self care exclusions

A
  • pregnancy
  • age < 6 months
  • severe abdominal pain
  • recent antibiotic use
  • diarrhea > 14 days
  • severe dehydration
  • protracted vomiting
  • blood, mucus, pus in stool
  • DM, CHF
  • immunosuppression
  • high fever (>102.2 F)
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79
Q

diarrhea oral rehydration indication

A

ESSNETIAL in children (N/V and diarrhea) –> higher doses for diarrhea

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80
Q

bismuth subsalicylate MoA

A

bismuth: antimicrobial effects
salicylate: antisecretory effects
**both work on pathogen!!

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81
Q

bismuth subsalicylate age

A

> 12 years

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82
Q

what is child’s pepto bismol?

A

calcium carbonate –> antacid
NOT TREAT DIARRHEA!!

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83
Q

adult pepto AEs

A

black staining of tongue and stool
chelate with fluoroquinolones

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84
Q

probiotic MoA

A

dec symptoms and duration of infectious diarrhea IN CHILDREN ONLY
- mixed data on if prevent antibiotic associated c. diff!

85
Q

digestive enzyme MoA

A

lactaid: lactase enzyme replacement

86
Q

loperamide MoA

A

opioid derivative without central activity (only peripheral activity) –> therefore, slows transit time and dec chloride secretion –> locks you up

this makes sense –> opioids cause constipation –> therefore this is the peripheral opioid effect!

87
Q

loperamide age limit

A

6 years or older

88
Q

loperamide pearl

A

opioid derivative/mu peripheral agonist –> can make you high if take enough!

89
Q

loperamide CI

A

bacterial cause of diarrhea –> do not want to lock in the bacteria –> bad!

90
Q

mu peripheral agonist MoA

A

works in gut –> cause constipation essentially

91
Q

diphenoxylate + atropine MoA

A

diphenoxylate: similar to meperidine (opioid) –> inhibit excessive GI motility and propulsion

atropine: strong anticholinergic –> AE: hot, dry, blind –> DISCOURAGES ABUSE!

92
Q

octreotide

A

inhibit serotonin, gastrin secretion, secretin, motilin, insulin, glucagon —-> overall dec intestinal motility and secretion
- a somatostatin (hormone) analog

93
Q

octreotide dosing

A

SQ daily –> IM depot q 4 weeks

94
Q

octreotide indications

A
  • intestinal carcinoid tumors
  • chemo-induced diarrhea
95
Q

diphenoxylate + atropine indication

A
  • IBD-UC
  • adjunctive therapy (add on when so much stool even after treatment)
96
Q

digestive enzymes age

A

greater than or equal to 4 years old

97
Q

IBS definition

A

chronic abdominal pain with altered bowel habits

98
Q

IBS Dx

A
  • chronic abdominal pain for 1 day/week for 3 months
    AND
  • atleast 2 of following: associated with – defecation, change in stool frequency, change in stool consistency
99
Q

IBS patho

A

no functional changes but still symptoms –> Dx of exclusion

gut hypersensitivity: mismatch between what is happening in gut, and what is signaled to brain

100
Q

IBS symptoms

A
  • change in bowel habits
  • global symptoms: pain, bloating

**today we treat both

101
Q

what is IBS associated with?

A
  • inc bacteria in colon (SIBO)
  • gastroenteritis
  • physchological stress
102
Q

treatment goals for IBS

A
  • improve global symptoms
  • improve QoL
  • improve stools
  • improve bloating
103
Q

how do we classify IBS?

A

type of stool

104
Q

types of IBS

A

IBS-C: hard stool > 25% of time
IBS-D: liquid stool > 25% of time
IBS-M: mixed stool, C > 25% time and D > 25% time

105
Q

lubiprostone IBS indication

A

ONLY WOMEN with IBS

106
Q

lubiprostone AE

A

diarrhea, N –> reduce by taking with food

107
Q

lineclitide and plecanatide additional effects

A

some pain receptor effects in colon

108
Q

lineclitide and plecanatide AEs

A

diarrhea

109
Q

tegaserod MoA

A
  • inc GI secretion and motility
  • dec visceral pain (gut pain)
  • 5-HT4 agonist (NOT 5-HT3 SEROTONIN!)
110
Q

tegaserod indication

A

women, < 65 years, no history of CV ischemic event (stroke, TIA, angina, heart attack/MI)
**REMS –> bc cardiac event causes

111
Q

when to D/C tegaserod?

A

if no effect in 4 weeks –> bc and increased cardiac event risk so want to stop if not working

112
Q

tegaserod AE

A
  • HA
  • diarrhea
  • cardiac events
  • well tolerated
113
Q

tenapanor MoA

A
  • GI Na/H exchanger isoform III –> dec sodium and phosphate absorption into body –> inc water secretion into stool
  • GI pain receptor effect
114
Q

tenapanor AE

A

diarrhea

115
Q

IBS-C options

A
  • lubipristone (women)
  • lineclitide
  • plecanantide
  • tegaserod (women, <65, no ischemic Hx)
  • tenapanor
116
Q

IBS-D options

A
  • rifaximin
  • eluxadoline (Vibrezi)
  • alosteron
117
Q

rifaximin MoA

A

poorly absorbed antibiotic –> therefore stays in gut

INDICATION: SUSPECT BACTERIAL OVERGROWTH!

118
Q

rifaximin dosage

A

550mg TID PO x 14 days
- can repeat twice prn

119
Q

does rifaximin have systemic AE?

A

not really bc it stays in the gut –> no systemic absorption

120
Q

eluxadoline MoA

A

mu, delta, kappa agonist –> inhibit bowel contraction
*makes sense bc acts like an opioid

121
Q

eluxadoline main AE

A

**sphiner of oddi dysfuntion (the muscle valve that connects the bile duct/pancreatic duct to the small intestine
- can cause sphincter spasm –> back up of bile and stuff –> pancreatitis

122
Q

eluxadoline CI

A
  • Hx pancreatitis
  • Hx alcoholism
  • drink 3 drinks/day
123
Q

eluxadoline AE

A
  • N
  • andominal pain
  • constipation
124
Q

alosetron MoA

A

serotonin antagonist (like ondansetron) –> dec transit time, inc water absorption –> dec stool liquidity

125
Q

alosetron AE

A
  • SEVERE CONSTIPATION
  • ischemic colitis

therefore –> REMS!

126
Q

alosetron indication

A

women with severe IBS-D

127
Q

which 3 IBS agents are only for women?

A
  • lubipristone -> IBS-C
  • tegaserod -> IBS-C
  • alosetron -> IBS-D
128
Q

which IBS agents are on REMS?

A
  • tegaserod -> IBS-C
  • alosetron -> IBS-D
129
Q

other IBS options

A
  • TCA antidepressants
  • soluble fiber
130
Q

TCA MoA for IBS

A
  • help with brain-gut miscommunication
  • TCAs»>SSRIs for IBS –> but due to AEs, providers often do SSRIs

effect:
- improve pain
- global IBS of bloating and pain s/s

131
Q

TCA options

A
  • amitriptyline
  • nortriptyline
132
Q

TCA AEs

A

**anticholinergic –> dry, sedation, CONSTIPATION!!

  • therefore take at night
133
Q

which TCA is for IBS-D? why?

A

amitriptyline
- older, more AE –> constipation is an AE –> therefore use with diarrhea

134
Q

which TCA is for IBS-C? why?

A

nortriptyline
- newer, fewer AE –> constipation is an AE –> therefore since already have constipation, want to dec that effect!

135
Q

soluble fiber options

A
  • psyllium (metamucil)
  • barley
  • oatbran
  • beans
136
Q

soluble fiber MoA

A

soluble: pull water into gut and make a gel

vs
insoluble: not digested, fermented in colon -> gasey

137
Q

GERD disease differences

A

heartburn: burning in substernal chest, moves up, taste acid
GERD: heartburn that occurs 1-2 times/wk, 3 or more months, not respond to OTC therapy

VS

dyspepsia: discomfort, pain, burning, gnawing, early satiety in epigastrium
gastritis/duodenitis: superficial inflammation of stomach mucosa lining
PUD: inflammation to submucosa

138
Q

GERD complications

A

barrett’s esophagus
esophageal adenocarcinoma

139
Q

self-care exclusions for GERD

A
  • symptoms > 3 months
  • age < 2 years
  • symptoms despite PPI or H2RA OTC for 2 weeks
  • difficulty/pain when swallowing
  • vomiting blood, black/tarry stools
  • chronic hoarseness, choking
  • unexplained weight loss
  • continuous N/V/D
  • chest pain + sweating, radiating to shoulder/arm
  • SOB
  • pregnant/nursing
140
Q

alarm symptoms –> need a GI or other workup FIRST

A
  • substernal pain: cardiac
  • suspected GI bleed –> coughing up blood
  • unexplained weight loss
  • dysphagia –> hurts to swallow
  • anorexia: not want to eat
141
Q

antacid MoA

A

neutralize stomach acid (buffer)
- Mg –> diarrhea
- Al and Ca –> constipation

142
Q

H2RA MoA

A

inhibit histamine receptor on parietal cell –> dec acid produciton i think

143
Q

PPI MoA

A

inhibit parietal cell H/K ATP pump –> prevent stomach acid secretion i think

144
Q

which do you take on an empty stomach?

A

PPIs

30min before first meal –> if forget, do 30 min before second meal

145
Q

H2RA age limit

A

12 years old

146
Q

PPI age limit

A

18 years old

147
Q

how long is heartburn/GERB/dyspepsia OTC treatment??

A

14 days ONLY

148
Q

most potent OTC for gerd?

A

PPI

149
Q

why does barrett’s need lifelong PPI?

A

dec risk esophageal adenocarcinoma!

150
Q

which indications for long term PPI?

A
  • barrett’s
  • GERD complications: severe erosive esophagitis, narrowing/strictures
151
Q

long term PPI AEs

A
  • bone fracture, hip fracture
  • B12 deficiency
  • dementia
  • CKD from AIN
  • c. diff, gastroenteritis
152
Q

why do we limit PPI use?

A

stomach acid helps with absorption and killing so don’t want to suppress it forever!!

153
Q

PPI long term monitoring

A
  • kidney as usual
  • daily recommendations of B12, D, and Ca
154
Q

gastritis/duodenitis

A

inflammation of top layer - muscosa only

155
Q

ulcer

A

inflammation down to submucosa
* >5mm in size
**more blood vessels therefore more GI bleed risk, life-threatening

156
Q

major complication of PUD

A

GI bleeding

157
Q

causes of PUD

A

1 cause: H. pylori

#2 cause: NSAIDs

158
Q

h pylori pud duration of treatment

A

14 days

159
Q

h pylori pud 1st line

A

quad therapy –> QID
ppi bid
+
bismuth subsalicylate
+
tetracycline
+
metronidazole

160
Q

h pylori pud 2nd line

A

triple therapy –> bid
ppi bid
+
azithromycin
+
amoxicillin or metronidazole

161
Q

which h pylori pud treatment needs eradication confirmation?

A

triple therapy
*wait 4 weeks AFTER TREATMENT ENDS to confirm testing

162
Q

NSAID PUD risk factors

A
  • age > 65 years
  • using steriods concurrently
  • non-COX selective use
  • anticoagulants
  • antiplatelets
  • previuos Hx PUD
  • high dose NSAID
  • multiple NSAIDs
163
Q

if you have a NSAID ulcer and can stop the NSAID, how long PPI?

A

4-8 weeks

164
Q

why are COX-2 NSAIDs prefered?

A

less impact on GI prostaglandins –> less PUD risk

165
Q

COX-2 selective nsaids

A
  • celecoxib
  • nabumetone, meloxicam, etodolac
166
Q

PUD NSAID patho

A

NSAID –> COX inhibition –> dec PG (to dec pain) –> ALSO inc acid secretion, dec proliferation of cells, dec bicarb –> epithelial cell damage –> ulcer

167
Q

upper GI bleed s/s

A
  • melena (black stool)
  • hematemesis (throwing up blood)
  • lightheaded
  • HA
  • inc HR
  • dec BP, Hgb, Hct
168
Q

why do we treat upper GI bleed with PPI asap?

A

stomach acid will reduce activity of platelets and clotting factors –> we need those to be working in order to clot the bleeding spot

169
Q

upper GI bleed PPI treatment breakdown

A

step 1: 80mg IV bolus
step 2: 40mg IV bolus BID OR 8mg/hr continous IV
step 1 + 2 = 72 hours (3 days)***
step 3: oral PPI x 2 weeks
step 4:
- h pylori: add the antibiotics for 2 weeks oral ppi totoal
- NSAID: continue so total oral ppi either 4-8 weeks or conituous

170
Q

what two categories of patho does IBD impact?

A
  • GI mucosa
  • GI pathogen recognition
171
Q

unique s/s of IBD

A
  • blood in stool
  • weight loss
  • abdominal pain
  • cramping
172
Q

IBD Dx

A
  • stool studies: leukocytes, LACTOFERRIN, CALPROTECTIN (non-invasive) (both bowel inflammatory markers)
  • colonoscopy with small-bowel follow thru
  • inc ESR, inc CRP –> non-specific markers of inflammation
  • CT scan, MRI –> penetration into other tissues
173
Q

main mode of IBD Dx

A

colonoscopy!

174
Q

UC complications

A
  • toxic megalocolon
  • colon cancer
  • colectomy
175
Q

CD complications

A
  • malnutrition, vit deficiency
  • strictures
  • fistulas
176
Q

which IBD do we have a cure for?

A

UC –> colectomy

177
Q

what OTC do we avoid in IBD?

A

NSAIDs –> induce flares!

178
Q

5-ASA MoA

A

locally inhibit COX enzymes –> reduce prostaglandins –> reduce inflammation and pain

179
Q

5-ASA absorption

A

rapidly absorbed into the SI but want it to stay in GI –> THEREFORE need a carrier to keep it in GI (targetted drug delivery)

180
Q

sulfasalazine AE

A

rash/allergy

181
Q

sulfasalazine carrier

A

sulfa

182
Q

balsalazide carrier

A

inert

183
Q

mesalamine carrier

A

many product that bring to diff part of GI!! ohhhhh

184
Q

mesalamine suppository (Canasa)

A

rectum

185
Q

mesalamine enema (Rowasa)

A

rectum + distal colon

186
Q

mesalamine oral DR (Asacol)

A

terminal ileum –> CD

187
Q

mesalamine oral (Pentasa)

A

jejunum –> CD

188
Q

immunomodulator MoA

A

immunosuppressant properties

189
Q

which immomodulators are related?

A

azathioprine (prodrug) –> 6-mercaptopurine

190
Q

why do we use azathioprine with biologics or steriods?

A

aza…
- takes 3 months to work
- inc efficacy, dec ADA formation
- steriod sparing

191
Q

azathioprine monitoring

A
  • CBC q3months –> bone suppression
  • LFTs
  • pancreatic enzymes
192
Q

azathioprine BBW

A

lymphoma risk inc when use with biologic!!!

193
Q

methotrexate dosage form

A

IM/SQ —> PO when stable

194
Q

corticosteroid MoA

A

dec immune response, dec inflammation

195
Q

why is budesonide good for IBD?

A

high first-pass effect –> therefore, more stays in GI –> less systemic effect, very effective in GI
*poor systemic absorption

15x more potent than prednisone bc local effect

196
Q

which budesonide oral is for UC?

A

Uceris –> colon

197
Q

which budesonide oral for CD?

A

Entocort –> terminal ileum

198
Q

duration for budesonide treatment?

A

8 weeks

199
Q

antibiotic indication

A

CD –> perianal disease (fissures, fistulas)

200
Q

antibiotic options

A

**enteric gram (-) (e coli, protese)
**anaerobes
these are what is most present in GI tract!

metronidazole
ciprofloxacin
3rd gen cephal

201
Q

which biologic has best evidence?

A

infliximab

202
Q

anti-TNF BBWs

A

1) infection –> TB, invasive fungal, bacterial, viral, opportunistic
- therefore: PPD, chest x-ray, HBV, HCV, HIV baseline
- HOLD when sick

2) malignancy –> lymphoma
- when + azathioprine
- but inc efficacy with azathioprine

203
Q

natalizumab MoA

A

inhibit leukocyte trafficking and T cells (everywhere)

204
Q

natalizumab BBW

A

PML –> CNS infection
**REMS

THEREFORE WE PREFER VEDOLIZUMAB

205
Q

vedolizumab MoA

A

inhibit T-cells tagged/going to GI tract

206
Q

JAKi BBWs

A
  • cancer
  • cardiac events
  • thrombosis
  • death
  • infection
207
Q

JAKi indication

A

bc so many BBW…
failed 1 or more TNF inhibitors

208
Q

how to give mesalamine enema

A

at night in bed as retention enema
- wear adult diaper

p2 year (9 decks)

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