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Flashcards in Pharm Deck (28)
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1

Hep B Tx

First line: pegylated interferon alpha, entecavir, tenofovir disoproxil fumarate (TDF)*

2

C. diff colitis Tx

metronidazole (PO, IV)
vancomycin (PO only! IV doesn't penetrate gut)*

3

Hep C Tx

protease inhibitor (eg sofosbuvir/simeprevir)

4

H. pylori Tx

1st line: Triple therapy regimen (10-14 days)
Clarithromycin: 500mg PO BID
Amoxicillin: 1g PO BID
Metronidazole: 500mg PO BID
PPI PO BID (eg esomeprazole, lansoprazole)

5

Gastroparesis Tx**

Metoclopramide (Reglan) – acts on dopamine receptors in stomach/intestines/brain
**watch for tardive dyskinesias

6

Giardia Tx

Metronidazole

7

Tx Cryptosporidiosis

Nitazoxanide

8

Pancreatitis Tx

DO NOT SEND PTS HOME (acute)
Maintain pt NPO
IV fluids* (helps)
Pain control – Meperidine standard but shifting now to Dilaudid (concern that morphine and its derivatives can cause spasm at sphincter of Oddi and increased biliary pressure, can make ab pain/Sx worst)
Anti-emetic – IV zofran, phenergan
Parenteral antacid (H2 blocker or PPI)

9

1st line Tx of hypertriglyceridemia

Fibrates

10

Spontaneous Bacterial Peritonitis tx**

Cefotaxime x 5 days

11

Medications that can cause chronic liver dz and cirrhosis**

Amiodarone
Methotrexate

12

Hepatotoxic meds

NSAIDs, isoniazid, valproic acid, erythromycin, amoxicillin-clavulanate, ketoconazole, chlorpromazine, ezetimibe
Limit acetaminophen <2g/day

13

Crohn's Dz Tx

mild to mod: salicylate (5 ASA), maintenance mesalamine
mod to sev: systemic corticosteroids (prednisone or Budesonide), consider immunosup maintenance (azathioprine)
Humira, Infliximab, methotrexate, tacrolimus f refractory
no immunosuppressants if infectious colitis on DDx

14

Examples of 5-ASA (5-aminosalicylates)

Rowasa, Pentasa, Asacol
1st step Tx in IBD

15

Entocort

Budesonide, used in IBD
Steroid whose systemic effects are reduced due to first pass in the liver.

16

glucagon in acute dysphagia

glucagon 1 mg IV to relax lower esophagus first - let blous pass on its own

17

Eosinophilic esophagitis tx

First line – inhaled corticosteroid (spray during breath hold then swallow) x 8 wks
Candida esophagitis – most common adverse reaction

18

Esophageal Motility Disorders Tx

CCB or TCA (EG IMIPRAMINE)

19

GERD Tx

H2 receptor antagonist: pepcid
then PPI instead

20

Over-the-counter Anti-emetics

sodium citrate/dextrose/fructose (Nauzene)
phosphoric acid (Emitrol)
bismuth subsalicylate (Pepto-Bismol)
Ginger (available in candies, drinks, and teas)

21

Tx acute vomitting

Anticholinergics – hyoscyamine (Levsin), dicyclomine (Bentyl), transdermal scopolamine (Transderm Scop)
H1 antihistaminics – promethazine (Phenergan), Diphenhydramine (Benadryl), doxylamine (Unisom), meclizine (Bonine, Antivert), dimenhydrinate (Dramamine)
Dopamine receptor antagonists – metoclopramide (Reglan), domperidone, prochlorperazine (Compazine), chlorpromazine (Thorazine), haloperidol (Haldol)
5HT3-Antagonists – ondansetron (Zofran), granisetron (Kytril), dolasetron (Anzemet)
Adjuvant antiemetics – corticosteroids, benzodiazepines, cannabinoids, trimethobenzamide (Tigan), aprepitant (Emend)

22

Dopamine receptor antagonist SE

Extrapyramidal effects (dyskinesia, dystonia)
eg metoclopramide (Reglan), prochlorperazine (Compazine), chlorpromazine (Thorazine), haloperidol (Haldol)

23

Functional chronic nausea and vomiting (after ruling out everything else) Tx

reassurance, low-dose Tricyclic antidepressants (Amitriptyline, Nortriptyline)

24

Antidiarrheals

Loperimide (Imodium)
Diphenoxylate atropine (Lomotil)

25

Laxatives

Metamucil, colace, dulcolax, senekot, polyethylene glycol

26

Elavil

Amitriptyline (TCA)

27

IBS Symptomatic Tx

Imipramine (Tofranil), Amitriptyline (Elavil)
provide a visceral analgesic effect by increasing pain threshold in the gut. It prolongs oral-cecal transit time, reduces abdominal pain, mucorrhea, and stool frequency

28

IBS specific Tx

Alosetron (Lotronex)- very limited for diarrhea
Lubiprostone (Amitiza)- constipation dominant
Linaclotide (Linzess)- Constipation dominant