N/V/D/C, pancreatitis, IBS

Question 1

nausea DOC for general medical use

Answer 1

phenothiazines (promethazine, prochlorperazine) or serotonin antagonists (ondansetron, granisetron ,palonosetron)

Question 2

nausea DOC for chemo

Answer 2

serotonin antagonists (ondansetron, graniestron, palonosetron)
NK1 antagonist (aprepitant, fosaprepitant, netupitant/palonosetron, rolapitant)
dexamethasone
olanzapine

Question 3

nausea DOC postop

Answer 3

serotonin antagonist (ondansetron, granisetron, palonosetron)
scopolamine
dexamethasone

Question 4

nausea DOC motion sickness

Answer 4

antihistamine
scopolamine

Question 5

nausea DOC pregnancy

Answer 5

emeterol (phosphorylated carbohydrate solution)
pyridoxine w/ or w/o doxylamine
ginger

Question 6

nausea DOC gastroparesis

Answer 6

metoclopramide

Question 7

phenothiazines

Answer 7

promethazine, prochloperazine

both antidopaminergic = EPS risk
promethazine also antihistamine, anicholinergic

do not give either SC

Question 8

palonosetron duration of action

Answer 8

long, 1-5 days. only 1 dose required

Question 9

haloperidol & Droperidol requirement for n/v

Answer 9

EKG at baseline and 2-4 hours post
qtc risk

Question 10

neurokinin 1 antagonists

Answer 10

aprepitant, fosaprepitant, netupitant/palonosetron, rolapitant

emend may reduce efficacy of warfarin/birth control

Rolapitant has long half life of 7 days

Question 11

can you cut scopolamine patch

Answer 11

no

Question 12

dronabinol, nabilone

Answer 12

delta-9 tetrahydrocannabinol targeting endogenous cannabinoid receptors

use for chemo induced n/v

Question 13

Local complications of pancreatitis

Answer 13

late phase of pancreatitis (>1 week)

necrosis, hemorrhage, pseudocyst, abscess, infection

Question 14

drug-induced pancreatitis

Answer 14

Amiodarone
Azathioprine/mercaptopurine
cannabis
diuretics
estrogen
exenatide
mesalamine/sulfasalazine
pentamidine
sitagliptin
tetracycline
bactrim
valproic acid

Question 15

other notable causes of pancreatitis

Answer 15

trigs >1000
toxin - scorpion venom
long-term alcohol abuse
gallstones

Question 16

lipase in pancreatitis

Answer 16

> 3x ULN - most sensitive test for diagnosis

Question 17

Acute pancreatitis treatment

Answer 17

-NS or LR 250-500ml/hr
-IV narcotics, avoiding meperidine
-IV zofran, prochlorperazine, promethazine

avoid TPN and antibiotics (unless necrosis)

Reversible once cause addressed

Question 18

Chronic pancreatitis management

Answer 18

-abstinence from alcohol
-narcotics + nonnarcotics
-pancreatic enzyme replacement
-oral zofran, prochlorperazine, promethazine
-antioxidant

Question 19

Pancreatic enzyme replacement

Answer 19

Recommended if pt has weight loss, malnutrition, diarrhea, steatorrhea, osteoporosis/penia

Dose based on lipase, starting with 40-50,000 unit per meal, half dose for snacks or 500-1000 unit/kg/meal

May need to add PPI if max response not seen (must have PPI with Viokace)

Question 20

Pancreatic enzyme derivation

Answer 20

porcine pancreas - avoid in pork allergy

Question 21

drug-induced diarrhea

Answer 21

acarbose/miglitol
ABX
antineoplastics
colchicine
digoxin
over replacement of levothyroxine
metoclopramide
NSAIDs
misoprostol
orlistat
sorbitol

Question 22

avoid bismuth subsalicylate in these pts

Answer 22

salicylate allergy
<12 y/o
pregnant or nursing
caution anticoagulants

Question 23

ART-associated diarrhea in HIV tx

Answer 23

crofelemer (mytesi)

Question 24

loperamide BBW

Answer 24

TdP
cardiac arrest
death

all in higher-than-recommended doses

Question 25

drug-induced constipation

Answer 25

aluminum containing meds (antacid, sucralfate) antihistamine benzo BAS CCB calcium diuretics iron supplement opioid phenothiazine scopolamine, benztropine TCAs

Question 26

onset of mag citrate, mag hydroxide, sodium phosphate

Answer 26

15 min - 3 hours

Question 27

glycerin suppository onset

Answer 27

1 hour

Question 28

lactulose onset

Answer 28

1-2 days; may also cause gas, bloating

Question 29

polyethylene glycol onset

Answer 29

1-3 days

Question 30

bisacodyl onset

Answer 30

6-12 hours suppository - 1 hour

Question 31

senna onset

Answer 31

6-12 hours

Question 32

fiber onset

Answer 32

12-72 hours safe in pregnancy

Question 33

linaclotide (linzess) & plecanatide (trulance)

Answer 33

IBS-C and CIC guanylate cyclase C agonist (increases fluid secretion and transit time) may cause severe dehydration m CI in <2y/o (linzess) and <6y/o (trulance). avoid both in 6-17

Question 34

methylnaltrexone onset

Answer 34

4 hours

Question 35

opioid induced constipation treatment options

Answer 35

methylnaltrexone (relistor) naldemedine (symproic) naloxegol (movantik)

Question 36

prucalopride

Answer 36

serotonin agonist specific for GI serotonin receptors warning for suicide

Question 37

docusate onset

Answer 37

1-6 days

Question 38

lubiprostone (amitiza)

Answer 38

indication: CIC, OIC, IBS-C in women >18 y/o Need negative pregnancy test before initiation take with food

Question 39

tenapanor (ibsrela)

Answer 39

agent for IBS -C CI <6 y/o and not recommended <18 d/t severe dehydration

Question 40

antispasmodics for IBS

Answer 40

dicyclomine hyoscyamine peppermint oil (may worsen GERD)

Question 41

TCA for IBS

Answer 41

slow motility in IBS-D, can be used in IBS-C but may worsen constipation amitriptyline, nortriptyline, imipramine

Question 42

laxatives for IBS-C

Answer 42

psyllium = best evidence avoid stimulants, can worsen abdominal pain

Question 43

IBS-C treatments with global effects

Answer 43

linaclotide (linzess), lubiprostone (amitiza), plecanatide (trulance) = may decrease abdominal pain, bloating, flatulence

Question 44

IBS-D treatments

Answer 44

eluxadoline (viberzi) (CIV) Alosetron (lotronex) - REMS Rifaximin