UC/CD and GERD notes Flashcards Preview

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Flashcards in UC/CD and GERD notes Deck (55):
1

Mg Hydroxide
Calcium carbonate
sodium bicarb

Antacids (GERD)

2

when to administer antacids compared to other meds as well as eating?

take 1-2 hours before OR 4-6 hours after meds
take RIGHT AFTER eating

3

antacid MOA

weak base that reacts with gastric acid to form water and salt, diminishing acidity

4

Cimetidine
Famotidine
Nizatidine
Ranitidine

H2 Blockers

5

Which type of GERD drug's MOA is inhibiting the histamine 2 receptors in gastric parietal cells?

H2 blockers

6

onset of H2 blockers

30 min (lasts 12 hours)

7

AE H2 blockers?

fatigue, dizziness, constipation, diarrhea, confusion

8

Which H2 blocker acts as a nonsteroidal antiandrogen, increasing the risk for gynecomastia and galactorrhea

Cimetidine

9

Cimetidine inhibits which substrate?

CYP450s

10

True or false: all H2 blockers reduce efficicay of drugs that require acidity for absorption

TRUE

11

This class MOA blocks gastric acid by inhibiting gastric H pumps

PPIs

12

When do you take PPIs?

30-60 min before breakfast/largest meal of day

13

PPIs have a short 1/2 life, but what is their duration of action?

18 hours

14

Is it ok to D/C PPIs abruptly?

no- can cause rebound acid...taper.

15

Long term AE of PPIs

C.diff, Vit B12 deficiency, decreased bone density, increased risk of fractures (GIVE CALCIUM CITRATE)

16

Which PPI is the strongest CYP2C19 inhibitor?

omeprazole

17

What is the MOA of Misoprostol?

prostaglandin analog - inhibits secretion of acid and stimulates secretion of mucus/bicarb

18

What is misoprostol used for?

reducing risk of NSAID-induced gastric ulcers (prefer PPIs if possible)

19

What is inconvenient about misoprostol?

dosed 4x daily, LARGE tablets

20

is misoprostol ok for pregnancy?

NO

21

Can you use other GERD meds with misoprostol?

NO - cannot use PPIs, H2 blockers, antacids - they wont work

22

Which gerd med MOA includes inhibiting activity of pepsin, increasing secretion of mucus?

Bismuth Subsalicylate

23

How to approach Rx therapy for GERD?

H2 first --> switch to PPI if H2 don't work.

24

How to approach Rx for NSAID-induced PUD

D/C NSAID!
if you can't d/c nsaid, Rx PPI + nonselective NSAID

25

How to Rx for H.pylori PUD

PPI + 2 abx (Clarithromycin and amoxicillin)

if you need quadruple therapy, add BISMUTH

26

Approaching long-term acid-suppression?

PPI and H2 are OTC options...H2 preferred and safer longterm (also more likely to be covered by insurance

27

Difference between IBD and CD?

inflammation is transmural in CD and limited to mucosa in UC

CD - mouth to anus
UC - limited to colon and rectum

28

what is a huge inflammatory contributor to inflammation in CD/UC?

TNF-alpha

29

Which meds to AVOID in those with IBD to reduce the risk of toxic megacolon?

anti-peristaltic GI meds (Loperamide, diphenoxylate)

causes acute colinic dilation = toxic megacolon!

30

What are the IBD medication classes (3)?

Aminosalicylates
Corticosteroids
Immunosuppressants

31

Mesalamine
Sulfasalazine
Olsalazine
Balsalazide

Aminosalicylates (IBD)

32

what parts of the intestines toes PO 5-ASA reach?

ileum, colon

(enema reaches colon/rectum)
(suppository reaches rectum)

33

sulfasalazine AE?

due to sulfapyridine component: headache, n/v, bone marrow suppression, reduced sperm count, pulmonitis

34

do not give sulfasalazine to which patients?

SULFA ALLERGY

PREGNANCY!

35

if you must give sulfasalazine to pregnant patient, what do you also administer?

folic acid

36

Immunosuppressants MOA in IBD?

targets immune response to cytokines involved in IBD

37

azathioprine
6-merc
methotrexate
cyclosporine
biologics

immunosuppressants

38

Which immunosuppressant do you use for maintenance IBD and reducing need for LONG TERM STEROID USE?

azathioprine
6-mercap

39

which immunosuppressant is a folate antagonist?

methotrexate - used for remission of CD

40

can you give methotrexate to pregnant patient?

NO

41

Why is cyclosporine given in patients with IBD?

to prevent organ rejection in transplants, but for IBD it's for fulminant/refractory symptoms in active disease

42

What are biologics MOA?

reducing TNF-alpha, sub! or IV only

43

what is the concern with using biologics?

Risk of reactivating TB

44

which 2 antibiotics are commonly used in CD?

metronidazole and ciprofloxacin

45

Treatment for active Mild-Mod UC

oral or topical aminosalicylate

OR

oral budesonide

46

maintaining remission in mild/mod UC

topical mesalamine (or topical steroid if unresponsive)

47

treating moderate-severe active UC

oral aminosalicylates +/- corticosteroids

(can always step up to immunomod)

48

severe-fulminant active UC

Hospitalize!
IV mesalamine and steroids
CYCLOSPORINE in 7-10 days of unresponsiveness

49

What is the LAST option in remission of UC if all other meds have failed?

Vedolizumab

50

are steroids (oral and topical) effective at maintaining remission?

NO - use 5-ASA or immunomods

51

treating mild-mod CD

oral budesonide

52

why budesonide for a mild/mod CD flare?

it is not absorbed systemically, and localizes to the rectosigmoid region

53

treating mod-severe CD

oral corticosteroids (if unresponsive to sulfasalazine/mesalamine)

can also try infliximab + azathioprine

54

treating fulminant CD

HOSPITALIZE
IV steroids, biologics

55

is it ok to use topical/systemic steroids for maintaining remission of CD?

NO - use immunosuppressants or biologics