Therapeutics Exam 3 (Foster/Scott) Flashcards
(240 cards)
1
Q
UC (Ulcerative colitis) or CD (Crohns Disease):
mucosal inflammation confined to rectum to colon
A
UC
2
Q
UC (Ulcerative colitis) or CD (Crohns Disease):
transmural inflammation
A
CD (deeper = transmural)
3
Q
UC (Ulcerative colitis) or CD (Crohns Disease):
inflammation of GI tract (can affect any part from mouth to anus)
A
CD
4
Q
6 Possible Causes of IBD
A
immunologic microbial genetic Psychological environmental Drug related causes
5
Q
UC (Ulcerative colitis) or CD (Crohns Disease):
is more superficial than the other one
A
UC
6
Q
What are some local complications of UC
A
hemorrhoids
anal fissures
perirectal abscesses
7
Q
what is a systemic complication of UC
A
toxic megacolon!
systemic toxicity — could be fatal – fever/tachycardia/elevated WBCs/abdominal distension
8
Q
UC leads to a decrease or increase in colorectal cancer risk?
A
increase AF!
colonoscopies + biopsies should be done q 1 - 2 years…
9
Q
UC (Ulcerative colitis) or CD (Crohns Disease):
will have a cobblestone appearance
A
CD
10
Q
UC (Ulcerative colitis) or CD (Crohns Disease):
is often discontinuous (normal bowel parts separating disease bowel)
A
CD
11
Q
UC (Ulcerative colitis) or CD (Crohns Disease):
which one has bleeding being more common?
A
UC
12
Q
UC (Ulcerative colitis) or CD (Crohns Disease):
which one has a greater risk of colorectal cancer/carcinoma
A
UC
13
Q
Complications of CD?
A
small bowel stricture/obstruction
fistula common
nutritional deficiencies
14
Q
Extraintestinal Manifestations of IBD
A
Hepatobiliary Ocular Bone/joint (ARTHRITIS and Osteoporosis) Hematologic Coagulation (INCREASED RISK FOR VTE) Dermatologic and Mucocutaneous
15
Q
Extraintestinal Manifestations of IBD
Pts may experience arthritis—
it is asymmetrical or symmetrical
A
asymmetrical
16
Q
Extraintestinal Manifestations of IBD
Arthritis seen a lot during _______
and is hard to treat why?
A
seen during FLARES (control disease = control arthritis)
hard to treat - because we can’t just give NSAIDs!
17
Q
Extraintestinal Manifestations of IBD
Patients are at an increased risk of ______ – higher risk during flares - CONSIDER PROHPYLAXIS for this!!
A
risk VTE —- ahhhh
18
Q
Clinical Presentation of UC and its disease extent/location:
if it is distal – that means the disease is where?
A
distal = left sided
= distal to splenic flexure
19
Q
Clinical Presentation of UC and its disease extent/location:
if it is extensive – that means the disease is where?
A
extending proximal to the splenic flexure
20
Q
Clinical Presentation of UC and its disease extent/location:
if it is proctitis – that means the disease is where?
A
involving the rectal area
21
Q
Clinical Presentation of UC and its disease extent/location:
if it is proctosigmoiditis – that means the disease is where?
A
involves rectum and sigmoid colon
22
Q
Clinical Presentation of UC and its disease extent/location:
if it is pancolitis– that means the disease is where?
A
majority of colon is involved
23
Q
Disease Classification of UC:
what are the 4 categories of severity?
A
mild
moderate
severe
fulminant
24
Q
Disease Classification of UC:
Mild, Moderate, Severe, or Fulminant?
< 4 stools / day
A
mild
25
Disease Classification of UC:
Mild, Moderate, Severe, or Fulminant?
> 4 stools/day
moderate
26
Disease Classification of UC:
Mild, Moderate, Severe, or Fulminant?
> 6 stools/day
severe
27
Disease Classification of UC:
Mild, Moderate, Severe, or Fulminant?
> 10 stools/day
fulminant
28
Disease Classification of UC:
Mild, Moderate, Severe, or Fulminant?
no systemic disturbance; normal ESR; normal fecal calprotectin and lactoferrin
mild (with < 4 stools +/- blood)
29
Disease Classification of UC:
Mild, Moderate, Severe, or Fulminant?
minimal systemic disturbance
moderate (also > 4 stools/day)
30
Disease Classification of UC:
Mild, Moderate, Severe, or Fulminant?
evidence of systemic disturbance (fever, tachycardia, anemia, or ESR > 30 mm/h)
Severe (> 6 stools/day)
31
Disease Classification of UC:
Mild, Moderate, Severe, or Fulminant?
continuous bleeding with stools, toxicity - severe systemic disturbances; abdominal tenderness; need for transfusion; colonic dilation
fulminant (> 10 stools/day)
32
Lab Tests to look at for CD?
Hgb/Hct
CRP, ESR, WBCs
+ anti-saccharamycses cervisiae antibodies!!!! (diff from UC!!!0
fecal calprotectin and lactoferrin
33
UC (Ulcerative colitis) or CD (Crohns Disease):
| will have skip lesions
Crohns
34
UC (Ulcerative colitis) or CD (Crohns Disease):
| cigarette smoking is actually protective
UC
35
UC (Ulcerative colitis) or CD (Crohns Disease):
| fistulas and strictures are uncommon
UC
36
UC (Ulcerative colitis) or CD (Crohns Disease):
| cigarette smoking is a risk factor
CD
37
IBD Treatment:
| what is the best diet to be beneficial?
none to be known!!!
| people have own specific trigger foods
38
UC (Ulcerative colitis) or CD (Crohns Disease):
| Surgery/colectomy seen to be used more
UC
39
T or F: There are only a couple agents to cure IBD
false! there are NONE!
No agents are curative!!
40
Pharm options for IBD:
| 5 main classes?
```
ASAs
Corticosteroids
Immunomodulators/immunosuppresives
Biologics
Antimicrobials
```
41
what drugs are ASA agents for tx IBD
sulfasalazine
| mesalamine
42
what is 5-ASA
mesalamine
43
what is the active component in sulfasalazine
| and what is the inactive part that causes ADE's
active: 5-ASA
inactive + ADEs = sulfapyridine
44
UC (Ulcerative colitis) or CD (Crohns Disease):
| which one has (+) perinuclear antineutrophil cytoplasmic antibodies
UC
45
what drugs are ASAs for IBD therapy
sulfasalazine
| mesalamine
46
what drugs are immunomodulators for IBD therapy
azathioprine
mercaptopurine
cyclosporine
methotrexate
47
Sulfasalazine MOA:
| _____ by colonic bacteria to release _______ and _____
cleaved; release sulfapyridine; 5-ASA
48
You can administer mesalamine alone - but why do we not?
rapidly and completely absorbed in small intestine but NOT colon (booooo)
49
Mesalamine topical is a good option:
use enemas for _______
use suppository for ______
(use them for when the disease is where)
enemas - when LEFT sided disease
suppositories: proctitis
50
Mesalamine:
| which one is typically more effective - topical or oral?
topical!
51
A lot of oral mesalamine drugs are either ____ or ____ related
pH or ER/DR
52
what are the oral mesalamine options
```
Apriso
Lialda
Pentasa
Asacol HD/Delzicol
Osalazine
Balasalazide
```
("BOA PAL")
53
The Oral mesalamine drugs acting in different parts of the GI tract due to pH or ER stuff ---
where does Apriso work in?
colon
54
The Oral mesalamine drugs acting in different parts of the GI tract due to pH or ER stuff ---
where does Lialda work in?
terminal ileum
55
The Oral mesalamine drugs acting in different parts of the GI tract due to pH or ER stuff ---
where does Pentasa work in?
duodenum, ileum
56
The Oral mesalamine drugs acting in different parts of the GI tract due to pH or ER stuff ---
where does Asacol HD/Delzicol work in?
terminal ileum
57
The Oral mesalamine drugs acting in different parts of the GI tract due to pH or ER stuff ---
where does Osalazine work in?
colon
58
The Oral mesalamine drugs acting in different parts of the GI tract due to pH or ER stuff ---
where does Balsalazide work in?
colon
59
The Oral mesalamine drugs acting in different parts of the GI tract due to pH or ER stuff ---
which ones work in the colon?
Apriso
Osalazine
Balsalazide
60
The Oral mesalamine drugs acting in different parts of the GI tract due to pH or ER stuff ---
which ones work in the terminal ileum?
Lialda
| Asacol HD/Delzicol
61
The Oral mesalamine drugs acting in different parts of the GI tract due to pH or ER stuff ---
which ones work in the duodenum/ileum
Pentasa
62
Drug Interactions for sulfasalazine vs mesalamine
BOTH: since ASA agents - anticoag/antiplatelets/NSAIDs
but mesalamine is affected by acid reducing agents!!
63
Monitor CBCs and LFTs in sulfasalazine why?
bc pneumoitis/lymphma/anemia/thrombocytopenia risk
| also hepatoxicity
64
Sulfasalazine can lead to a ______ reaction if allergy
hypersensitivity/rash
65
Mesalamine derivs:
| which one commonly causes diarrhea
Olsalazine
66
Budesonide:
Given PO for up to ______
ok to give because of ______ = less systemic exposure
8 - 16 weeks!
first pass metab
67
Budesonide:
| drug interactions?
CYP3A4 inhibitors -- since heavy first pass!!!
68
AZA/6-MP:
| which one is the prodrug of the other
AZA = prodrug of 6-MP
69
AZA/6-MP:
| ADEs?
```
(remember it is chemo!)
Bone marrow suppression
N/V/D
Stomatitis
pancreatitis
hepatoxicity
```
70
what monitoring to do for AZA/6-MP:
TPMT!!!!! (homozygous mutation -- hell no to these drugs)
CBC - bc bone marrow
LFTs - bc hepatotoxicity
71
Cyclosporine:good for (induction or maintenance) of remission
induction!!
| NOT for long term use!!/just bridge therapy
72
Cyclosporine ADEs?
metabolic - HTN, hyperlipidemia, hyperglycemia
nephro and neurotoxicity
gingival hyperplasia/hirsutism
73
Cyclosporine : good for _____
MTX: good for ____
(UC or CD)
Cyclo: UC
MTX: CD
74
MOA of the Biologic:
| Infliximab
anti TNF-a antibody
75
MOA of the Biologic:
| adalimumab
anti TNF-a antibody
76
MOA of the Biologic:
| golimumab
anti TNF-a antibody
77
MOA of the Biologic:
| certolizumab
anti TNF-a antibody
78
MOA of the Biologic:
| Natalizumab
anti integrins/prevent leukocyte adhesion
79
MOA of the Biologic:
| Ustekinumab
IL12/IL23 antagonist
80
MOA of the Biologic:
| Tofacitinib
janus kinase inhibitor
81
Indicated for UC or CD or both:
| Infliximab
CD/UC
82
Indicated for UC or CD or both:
| adulimumab
CD/UC
| mod - severe; steroid dependent or fistulizing disease
83
Indicated for UC or CD or both:
| Golimumab
UC
84
Indicated for UC or CD or both:
| Certolizumab
CD
85
Indicated for UC or CD or both:
| Natalizumab
CD
86
Indicated for UC or CD or both:
| Vedolizumab
CD/UC
87
Indicated for UC or CD or both:
| ustekinumab
CD
88
Indicated for UC or CD or both:
| tofacitinib
UC
89
Indicated for UC or CD or both:
| tofacitinib
UC
90
ADRs of TNF-a inhibitors:
increase risk of infections, demyelinating disease, and malignancy (also HSTCL risk)
inj site rxns
91
For TNF-a inhibitors must check for what things prior to therapy
if up to date on vaccines
| for tuberculosis and hep B/C
92
Contraindication with TNF a inhibitors (what other biologic)
live vaccines!during tx and 3 mos after
93
All TNF a inhibitors are given _____ route except infliximab is given ______
all given SQ
inflix: is IV!
94
what is HSTCL
hepatosplenic T cell lymphoma
95
How to prevent ADA's with Infliximab
take immunomodulators too! (Aza)
96
what are ADAs
anti drug antibodies
97
T or F:
| all TNF a inhibitors are for induction and maintenance
TRUE!
| all anti-TNFs are!!
98
what drug has risk of PML (bc of JC virus that lies dormant)
Natalizumab
99
what drug is similar to Natalizumab but does NOT have PML/JC virus issue
Vedolizumab
100
all NON TNF a inhibitors are IV except which one
Ustekinumab! induction is IV but maintenance is SQ
101
TDM of Biologics and Strategy:
| typically check therapeutic levels when?
when loss of response to an anti-TNF agent
102
TDM of Biologics and Strategy:
| if pt loss of response to an anti-TNF agent AND pt has subtherapeutic level with no/low ADA -- do what
increase dose or dosing interval! (dose just isnt high enough!)
can add immunomodulator
103
TDM of Biologics and Strategy:
| if pt loss of response to an anti-TNF agent AND levels are at therapeutic level -- do what
switch to vedolizumab with or w/out immunomodulator (drug just wont work in this pt)
104
TDM of Biologics and Strategy:
| if pt loss of response to an anti-TNF agent AND pt has subtherapeutic level with high ADA -- do what
switch within the class (pt has built immunity against this drug)
105
what drugs for UC/CD treatment should NOT be used contaminantly with immunosuppressants
Natalizumab (NO Aza/6-MP)
Tofacitinib - NO Aza or biologics with it!!!
106
T or F: Tofacitnib is best as monotherapy
true because it should NOT be used with immunosuppressants or biologics!!
107
ADE's of tofacitnib
NEUTROPENIA!!
| increased risk of infections/tuberculin test/ avoid if active infection
108
Tofacitinib and Neutropenia - how to deal with it
do NOT give drug if ANC < 500
if 500 - 1000 (dose reduce if 10 mg BID or d/c 5 mg BID until ANC > 1000)
109
Antimicrobial options for UC/CD ---
cipro and metronidazole
110
ADRs of antimicrobials for UC/CD
resistance and C.DIFF!!!
111
Antimicrobials are used in (UC or CD) if it is associated with fistulas/abscesses
CD!
112
N/V during pregnancy:
Usually worst during what time of the day
and usually limited to what trimester?
morning
first
113
N/V during pregnancy:
| Non-pharm options
```
ginger root/gum
Peppermint oil
(Best for mild cases!)
```
Morning Sickness "magic" = ginger + vitamin B6 +folic acid
114
N/V during pregnancy: Pharm options?
Diclegis or Bonjesta
| all have Pyridoxine (vit. B6) TID or Doxylamine TID
115
Diclegis or Bonjesta?
| is 1 tab BID
bonjesta
116
Diclegis or Bonjesta?
| is 2 tabs qhs +/- 1 tab in AM and noon
diclegis
117
what antiemetic drugs during pregnancy have minimal risk to the fetus and which one is used but has less data to support its safety to fetuses?
safe: antihistamines; phenothiazines, metoclopramide
not a lot of data: ondansetron!
118
what are some rx drugs that can be used for N/V during pregnancy?
```
metoclopramide
ondansetron
meclizine
dimenhydrinate
promethazine
prochlorperazine
```
119
PONV stands for?
post op nausea/vomiting
120
Risk factors for PONV
F ___ M
_____ status
Hx of _____ or _____
F > M
non-smoking status (smoking = protective!)
hx of PONV or motion sickness
121
Risk factors for PONV -- Anesthetic Risk Factors:
intra-operative use of _____ but less with ______
use of ______
Type of _____
use of volatile anesthetics; less with propofol
| use of nitrous oxide
122
what surgeries increase peoples risk of PONV
laparoscopy
craniotomy
ENT
123
Treating PONV:
| N/V is seen ______ surgery so give the agents when?
seen AFTER surgery; give agents at the end of the procedure
124
for treating PONV:
| use # agent(s) for when propofol is used
1
125
for treating PONV:
for treating mod - high risk -
______ are drug of choice
5-HT3 antagonisists
126
for treating PONV:
for highest risk
always use # agents
what are possible agents?
2 agents!
5-HT3 + metoclopramide or aprepitant
127
for treating PONV:
low risk if # of risk factors
mod - high risk if # of risk factors
high risk if # of risk factors
low: 0 -1
mod - high: 2+
high: 3+ or if prior hx of PONV
128
for treating PONV:
| aprepitant: give how?
40 mg 1 -3 hours prior to induction of anesthesia
129
definition of constipation?
decreased frequency PLUS signs/sx > 25% of the time
130
need 2 or more of the symptoms to chronic constipation -- what are the symptoms
```
straining
lumpy/hard stools
sensation of incomplete evacuation
sensation of obstruction/blockage
manual maneuvers to facilitate defecations
<3 defecations per week
```
131
Peristalsis is mediated predominantly thru _______
serotonin transmitter
132
when food/stool distends the gut walls, _____ cells will release _____ (will cause colonic motility)
enterochromaffin cells; release 5HT3
133
mouth - anus transit time?
20 - 72 hours
134
Acute Constipation:
less than __#__ bowel movements per week
Chronic Constipation:
sxs lasting > ____
Acute: 3
chronic: 6 weeks
135
Common Causes of Constipation?
Elderly -- things are just slower
Dietary (poor fluid intake)
Disease states that slow down GI motility
lack of privacy - long term care facilities
opioids
136
what disease states can slow down GI motility?
diabetes
parkinsons
CNS injury/disease
MS
137
Antacid ingredients that wil cause constipation?
Aluminim/Calcium
138
______ scale to asses poops
Bristol Stool
139
Bristol Stool:
Type 1 - 7
which end means slow transit time and which one means fast transit
type 1: slow
| 7: fast
140
Adding fiber to diet to promote regular bowel habits:
Add fiber ______
____ g of fiber per day
SLOWLY
| 20 - 30 g/day
141
Adding fiber to diet to promote regular bowel habits:
| increase fiber over ____ days
7 - 10
142
why are prunes awesome for bowel habits:
lots of sorbitol (sugar)
12 g of fiber
and has dihydrophenylsatin (natural laxative)
143
pts should defecate when colonic activity is greatest - this is when?
first thing in the morning!
| within 30 minutes after meals
144
Bulk Laxatives:
| advantages and disadvantages
advantages: soften stool better than docusate/well tolerated
disadvantages: must have adequate fluid intake!! impact on drug absorption
145
examples of bulk laxatives
psyllium
methylcellulose
calcium polycarbophil
146
T or F: stool softeners are great to increase peristalsis
hell no---- not effective for creating peristalsis (NOT good for active constipation)
147
examples of a lubricant laxative
mineral oil
148
example of surfactant/emollient
docusate
149
examples of saline laxatives
Milk of magnesia/ Mg Citrate
150
examples of hyperosmotic laxatives/agents
sorbitol (karo corn syrup)
lactulose
PEG!!
glycerin
151
advantages of hyperosmotic laxatives/agents
and disadvantages of hyperosmotic laxatives/agents
advantages: well tolerated; softens and stimulates BM
great for CHRONIC constipation!!
Disadvantages takes 1-3 days for onset at usual doses &
minor nausea/cramping
152
stimulant laxative choices?
senna
bisacodyl
castor oil
153
advantages for stimulant laxatives
6 - 12 hours onset
Drug of choice for pts on opioids
works well if pts have motility disorders
154
disadvantages for stimulant laxatives
risk of nausea/cramping;
| avoid long term continuous use in pts with normal GI motility
155
Lubiprostone MOA
Cl- channel activator
156
linaclotide MOA
Guanylate cyclase C receptor
157
if treating acute constipation and pt wants relief in 6 - 24 hours - what can they do
MOM
std. dose of PEG
bisacodyl or senna tablets
158
if treating acute constipation and pt wants relief in 0.5 - 3 hours - what can they do
large doses of PEG
| magnesium citrate
159
if treating acute constipation and pt wants relief in 0.5 - 1 hours - what can they do
enemas
| or suppositories
160
Follow up when? for constipation:
if acute: _____
if chronic constipation: ______
acute: 1 -2 DAYS
chronic: 1 -2 WEEKS
161
Chronic Constipation Treatment:
| step 1?
dietary interventions have been tried
162
Chronic Constipation Treatment:
| step 2?
bulk forming laxative + adequate fluid intake
163
Chronic Constipation Treatment:
| step 3?
sorbitol/lactulose/PEG
164
Chronic Constipation Treatment:
| step 4?
stimulant laxative
165
Chronic Constipation Treatment:
| step 5?
lubiprostone
| linactolide
166
pregnancy pts that are constipated should use what?
diet, fiber, and docusate
167
spinal cord injury pts and laxative use?
since they have damage to nerves they do not have adequate function for peristalsis --- will use routine use of bowel stimulants
168
when a patient is taking an opioid medication -- what kind of laxative medication should they avoid?
bulk!!! not going to help (will make it worse)
| they need stimulant laxatives
169
what is the perk of methylnaltrexone and naloxegol?
they are mu opioid receptor antagonist --- to be used for opioid induced constipation
170
methylnaltrexone vs naloxegol
| which one is SC and which one is PO
```
SC = methylnaltrexone
naloxegol = PO
```
171
what disease states are worrisome with bowel prep regimens?
heart failure
renal disease
electrolyte abnormalities
172
Classifying Diarrhea:
| Acute?
< 14 days (usually an infection process caused this)
173
Classifying Diarrhea:
| Persistent
> 14 days
174
Classifying Diarrhea:
| Chronic?
> 30 days
175
Classifying Diarrhea:
| Chronic Idiopathic
> 4 weeks w/out identifiable cause
176
How diarrhea happens:
| The _____ intestine water absorptive capacity is exceeded and _____ overloads the colon = diarrhea
small intestine
| chyme overloads
177
What is chyme?
thick semifluid mass of partially digested food and digest secretions formed in stomach/intestine during digestion
178
where does most of the fluid that gets to the small intestine come from?
our diet/intake or GI secretions
GI secretions (fluids from stomach, bile, pancreas, salivary glands, and intestines)
179
How diarrhea happens:
________ typically delay passage and mix of intestinal contents which allows for greater absorption
*ppl w/ diarrhea often have fewer of these
segmenting contractions
180
How diarrhea happens:
| (decrease or increase) in intestinal osmolarity leads to diarrhea
increase! (more Cl- in lumen = water and Na+ follow!!)
181
4 pathopys causes of diarrhea
secretory
osmotic
exudative
altered intestinal transit
182
Secretory, osmotic, exudative, or altered intestinal transit diarrhea?
is a change in active ion transport (either decreased Na+ absorption or increase in Cl- secretion)
secretory
183
Secretory, osmotic, exudative, or altered intestinal transit diarrhea?
Sxs will NOT be helped if the patients stops eating
secretory
184
Secretory, osmotic, exudative, or altered intestinal transit diarrhea?
caused when poorly absorbed substances are retained in the intestinal fluids
osmotic
185
Secretory, osmotic, exudative, or altered intestinal transit diarrhea?
Sxs will be improved if the patient stops eating
osmotic
186
Secretory, osmotic, exudative, or altered intestinal transit diarrhea?
Seen in lactose intolerance
osmotic
187
Secretory, osmotic, exudative, or altered intestinal transit diarrhea?
seen with pancreatic tumors/unabsorbed fat/laxatives
secretory
188
Secretory, osmotic, exudative, or altered intestinal transit diarrhea?
seen with consumption of poorly soluble CHOs (lactulose/sorbitol)
osmotic
189
Secretory, osmotic, exudative, or altered intestinal transit diarrhea?
is actually a subset of secretory
exudative
190
Secretory, osmotic, exudative, or altered intestinal transit diarrhea?
characterized by large stool volumes
and
mucus/protein/blood is in the gut --- pts will need work up if UC or CD
exudative
191
Secretory, osmotic, exudative, or altered intestinal transit diarrhea?
decrease time of exposure b/w intestinal epithelium and chyme = irregular absorption/secretion
altered intestinal transit
192
Secretory, osmotic, exudative, or altered intestinal transit diarrhea?
typically caused by bowel resection or pro-motility meds
altered intestinal transit
193
Secretory, osmotic, exudative, or altered intestinal transit diarrhea?
altered motility due to neuropathy in diabetes
altered intestinal transit
194
common medications that can cause diarrhea
```
cholinergic meds
Mg+ containing medications
chemo (irinotecan!!)
Monoclonal ABs
ACEIs
misoprostol
colchicine
sorbitol containing meds
metformin
(Laxatives, motility agents)
```
195
how to evaluate if a pt is dehydrated
```
skin turgor test/skin tenting
dry mucous membranes (tongue)
dizziness when standing
orthostatic hypotension
concentrated urine
```
196
Diarrhea Treatment -- Diet management:
More important in ______ diarrhea (need to remove causative agent)
____ diet
osmotic
| BRAT
197
T or F:
| Do not stop feedings in children w/ bacterial diarrhea
true!!
198
Pharm Treatment goals of Diarrhea:
(decrease or increase) fluid accum. in the lumen
(decrease or increase) propulsive contractions
(decrease or increase) mixing contractions
decrease
decrease
increase
199
Treating Acute Diarrhea:
| First check if the have ______
fever or systemic symptoms
200
Treating Acute Diarrhea:
| If NO fever/systemic symptoms -- how to treat?
Symptomatic Therapy
fluid/electroylyte replacement
loperamide/diphenoxylate or absorbet
diet
201
Treating Acute Diarrhea:
| If they do have fever/systemic symptom- what to check next?
check feces for WBC/RBC/and parasites
202
Treating Acute Diarrhea:
| If they do have fever/systemic symptom and negative for things when checked feces -- do what?
symptomatic therapy
fluid/electroylyte replacement
loperamide/diphenoxylate or absorbet
diet
203
Treating Acute Diarrhea:
| If they do have fever/systemic symptom and positive for things when checked feces -- do what?
use appropriate abx and symptomatic therapy
204
Chronic Diarrhea:
| T or F: always refer to doctor
True!!
205
Possible Causes of Chronic Diarrhea?
```
intestinal infection
IBD
malabsorption
secretory hormonal tumor
drug induced
motility disturbance
```
206
How to prevent travelers diarrhea
drink bottled water/drinks
wash fresh fruits/veggies
consider pepto 1 - 4 x daily
207
what drugs are antimotility agents used for diarrhea
```
diphenoxylate (+atropine)
difenoxin (+atropine)
loperamide
paregoric
tincture of opium
```
208
for diphenoyxlate + atropine - do not exceed ______ /day
20 mg
209
for loperamide - do not exceed ______ / day
16 mg (8 tabs)
210
for difenoxin + atropine do not exceed ____ /day
8 tabs
211
```
which anti motility agent is OTC
diphenoxylate (+atropine)
difenoxin (+atropine)
loperamide
paregoric
tincture of opium
```
loperamide
212
which anti motilty agents should not be used in kids < 2 bc of high sensitivity => toxic megacolon
diphenyoxylate and difenoxin
213
Antimotility agents:
| activate the ____ receptors on smooth muscle of the bowel to reduce ______ and increase _____
activate mu opioid receptors; reduce peristalsis; increase segementation
214
what are examples of absorbents for treating diarrhea
polycarbophil/fibercon
| attapulgite/kaopectate
215
what drugs are antisecreotry agents
bismuth subsalicylate (pepto)
enzymes - lactase
probiotics
octrotide
216
Pepto: max dose of?
8 doses in 24 hours
217
T or F: IBS has just as much inflammation as IBD does
false! (IBS does not have an inflammatory component)
IBS - irritable bowel syndrome
IBD = inflammatory
218
Subtypes of IBS?
IBS- C (constipation)
IBS-D (diarrhea)
IBS-M (mixed)
untyped IBS
219
which Subtype of IBS?
Hard/lumpy stools at least 25 % of the time
loose water stools less than 25% of the time
IBS-C
220
which Subtype of IBS?
Hard/lumpy stools less than 25 % of the time
loose water stools at least 25% of the time
IBS-D
221
which Subtype of IBS?
Hard/lumpy stools at least 25 % of the time
loose water stools at least 25% of the time
IBS-M
222
which Subtype of IBS?
Hard/lumpy stools less than 25 % of the time
loose water stools less than 25% of the time
untyped
223
4 non pharm options for IBS
diet - pts have a food sensitivity/trigger
low FODMAP diet
physical activity
cognitive behavioral therapy
224
what is the low FODMAP diet
fermentable, oligosaccharides, disaccharides, monosaccahrides, polyols --- aka avoid poorly absorbed carbs
225
pathophys of IBS:
| thought to be due to ______ and ______ of intestine
somatovisceral and motor dysfunction
226
what drugs are antispasmodics
hycosamine
| dicyclomine
227
Antispasmodics:
use caution in what pts
and avoid in pts that have what things?
use caution in elderly --- BEERS
avoid in pts w/ glaucoma, and IBS w/ constipation...
228
TCAs are helpful in what kind of IBS?
and
SSRIs have seen to be helpful in what IBS?
TCAs -- for IBS-D pts
| SSRIs - IBS-C
229
why are antidepressants helpful in IBS
reduce visceral sensitivity
230
Tx IBS- C:
| what to do for diet?
increase fiber/fluid intake
avoid foods that increase sxs
gluten free
Low FODMAP diet
231
what drugs can be used for IBS-C?
add a bulk laxative!!
(maybe antispasmodic/anticholinerigcs to relieve painful bowel spasms)
consider Lubiprostone/linactolide: for constipation and abdom pain
TCA/SSRI for pain, anxiety, and depression
serotonin 4 antag - as last resort
232
what drugs are pro-secretory agents
lubiprsotone and linactolide
233
Contraindication for Lubiprostone?
if suspected intestinal block
234
black box warning for linaclotide
against use in kids under 17 (dehydration risk)
235
lubiprsotone and linactolide
which one to take with food/water
which one to take 30 ins before first meal
lubiprostone: take w/ food
linactolide: before first meal
236
MOA of teagserod:
stimulates peristalsis and GI secretions -- 5Ht4 agonist
237
when is tegaserond used?
in emegency situations/under FDA investigaiton right now ---
238
diet for IBS-D?
avoid lactose and caffeine
239
MOA of eluxadoline
multiple mu opioid receptor agonist
240
lubiprsotone and linactolide
| which one should be avoided in pregancy
lubiprostone
