UC/CD and GERD notes

Question 1

Mg Hydroxide
Calcium carbonate
sodium bicarb

Answer 1

Antacids (GERD)

Question 2

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

Answer 2

take 1-2 hours before OR 4-6 hours after meds

take RIGHT AFTER eating

Question 3

antacid MOA

Answer 3

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

Question 4

Cimetidine
Famotidine
Nizatidine
Ranitidine

Answer 4

H2 Blockers

Question 5

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

Answer 5

H2 blockers

Question 6

onset of H2 blockers

Answer 6

30 min (lasts 12 hours)

Question 7

AE H2 blockers?

Answer 7

fatigue, dizziness, constipation, diarrhea, confusion

Question 8

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

Answer 8

Cimetidine

Question 9

Cimetidine inhibits which substrate?

Answer 9

CYP450s

Question 10

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

Answer 10

TRUE

Question 11

This class MOA blocks gastric acid by inhibiting gastric H pumps

Answer 11

PPIs

Question 12

When do you take PPIs?

Answer 12

30-60 min before breakfast/largest meal of day

Question 13

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

Answer 13

18 hours

Question 14

Is it ok to D/C PPIs abruptly?

Answer 14

no- can cause rebound acid…taper.

Question 15

Long term AE of PPIs

Answer 15

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

Question 16

Which PPI is the strongest CYP2C19 inhibitor?

Answer 16

omeprazole

Question 17

What is the MOA of Misoprostol?

Answer 17

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

Question 18

What is misoprostol used for?

Answer 18

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

Question 19

What is inconvenient about misoprostol?

Answer 19

dosed 4x daily, LARGE tablets

Question 20

is misoprostol ok for pregnancy?

Answer 20

NO

Question 21

Can you use other GERD meds with misoprostol?

Answer 21

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

Question 22

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

Answer 22

Bismuth Subsalicylate

Question 23

How to approach Rx therapy for GERD?

Answer 23

H2 first –> switch to PPI if H2 don’t work.

Question 24

How to approach Rx for NSAID-induced PUD

Answer 24

D/C NSAID!

if you can’t d/c nsaid, Rx PPI + nonselective NSAID

Question 25

How to Rx for H.pylori PUD

Answer 25

PPI + 2 abx (Clarithromycin and amoxicillin) if you need quadruple therapy, add BISMUTH

Question 26

Approaching long-term acid-suppression?

Answer 26

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

Question 27

Difference between IBD and CD?

Answer 27

inflammation is transmural in CD and limited to mucosa in UC CD - mouth to anus UC - limited to colon and rectum

Question 28

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

Answer 28

TNF-alpha

Question 29

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

Answer 29

anti-peristaltic GI meds (Loperamide, diphenoxylate) causes acute colinic dilation = toxic megacolon!

Question 30

What are the IBD medication classes (3)?

Answer 30

Aminosalicylates Corticosteroids Immunosuppressants

Question 31

Mesalamine Sulfasalazine Olsalazine Balsalazide

Answer 31

Aminosalicylates (IBD)

Question 32

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

Answer 32

ileum, colon | enema reaches colon/rectum (suppository reaches rectum)

Question 33

sulfasalazine AE?

Answer 33

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

Question 34

do not give sulfasalazine to which patients?

Answer 34

SULFA ALLERGY PREGNANCY!

Question 35

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

Answer 35

folic acid

Question 36

Immunosuppressants MOA in IBD?

Answer 36

targets immune response to cytokines involved in IBD

Question 37

``` azathioprine 6-merc methotrexate cyclosporine biologics ```

Answer 37

immunosuppressants

Question 38

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

Answer 38

azathioprine | 6-mercap

Question 39

which immunosuppressant is a folate antagonist?

Answer 39

methotrexate - used for remission of CD

Question 40

can you give methotrexate to pregnant patient?

Answer 40

NO

Question 41

Why is cyclosporine given in patients with IBD?

Answer 41

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

Question 42

What are biologics MOA?

Answer 42

reducing TNF-alpha, sub! or IV only

Question 43

what is the concern with using biologics?

Answer 43

Risk of reactivating TB

Question 44

which 2 antibiotics are commonly used in CD?

Answer 44

metronidazole and ciprofloxacin

Question 45

Treatment for active Mild-Mod UC

Answer 45

oral or topical aminosalicylate OR oral budesonide

Question 46

maintaining remission in mild/mod UC

Answer 46

topical mesalamine (or topical steroid if unresponsive)

Question 47

treating moderate-severe active UC

Answer 47

oral aminosalicylates +/- corticosteroids | can always step up to immunomod

Question 48

severe-fulminant active UC

Answer 48

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

Question 49

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

Answer 49

Vedolizumab

Question 50

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

Answer 50

NO - use 5-ASA or immunomods

Question 51

treating mild-mod CD

Answer 51

oral budesonide

Question 52

why budesonide for a mild/mod CD flare?

Answer 52

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

Question 53

treating mod-severe CD

Answer 53

oral corticosteroids (if unresponsive to sulfasalazine/mesalamine) can also try infliximab + azathioprine

Question 54

treating fulminant CD

Answer 54

HOSPITALIZE | IV steroids, biologics

Question 55

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

Answer 55

NO - use immunosuppressants or biologics