Unit 6 GI disorders

Question 1

What are phenothiazines? What are major side effects?

Answer 1

prochlorperazine and promethazine. drowsiness, extrapyramidal affects, anticholinergic effects

Question 2

What do phenothiazines interact with?

Answer 2

anticoagulants, alpha blockers, anticonvulsants

Question 3

What are antihistamine-anticholinergics? What are major side effects?

Answer 3

hydroxyzine, meclizine, dimenhydrinate. Drowsiness, anticholinergic symptoms.

Question 4

When are antihistamine-anticholinergics contraindicated?

Answer 4

in nursing mothers, asthma, glaucoma, gi or gu disorders

Question 5

What is most frequently used benzodiazepine for N/V? when is it contraindicated?

Answer 5

lorazepam. Contraindicated in renal or hepatic failure.

Question 6

What are serotonin antagonists? What are adverse reactions?

Answer 6

Zofran. AEs include headache, abd pain, increased AST/ALT, ecg changes

Question 7

What is the cutoff for renal function when giving metoclopramide?

Answer 7

if CrCl <40, cut dose in half.

Question 8

What is first second third line for non-chemo related N/V?

Answer 8

phenothiazine, antihistamine/anticholinergic, 3rd, reevaluate

Question 9

Define mild, mod, severe heartburn?

Answer 9

mild-/= to 3x wkly, no symptoms suggesting complicated disease. Severe-Mod GERD that fails appropriate therapy.

Question 10

How do you diagnose PUD?

Answer 10

epigastric pain, dyspepsia in 2/3 of duodenal and 1/3 gastric patients

Question 11

What are goals of treating PUD?

Answer 11

relieve ulcer pain, dyspepsia. Heal existing ulcers, eradicate H pylori

Question 12

What are considerations in using clarithromycin to treat PUD?

Answer 12

It is acid stable. Should not be used to treat subsequent PUD issues due to issues with resistance.

Question 13

What are considerations in using metronidazole in PUD?

Answer 13

it is NOT pH dependent. Resistance is low.

Question 14

What are considerations in using amoxil in PUD?

Answer 14

Must have neutral pH so give with omeprazole

Question 15

What are H2RAs? How long does healing take?

Answer 15

famotidine, ranitidine, cimetadine. 70-95% healing in 4-6 wks

Question 16

What are side effects of H2RAs?

Answer 16

thrombocytopenia, neutropenia, bradycardia, arrhythmia

Question 17

What do H2RAs interact with?

Answer 17

warfarin , phenytoin

Question 18

When should PPIs be used in treatment of GERD? PUD?

Answer 18

once daily, 30-60min before first meal in GERD and 1-2x daily in PUD

Question 19

What is first line tx in GERD? Second line?

Answer 19

H2RAs and/or PPIs. 2nd, referral to GI

Question 20

what meds commonly cause constipation?

Answer 20

antacids, anticholiergics, antihistamines, calcium clonidine, diuretics, Iron, Statins, Narcotics, TCAs, CCBs

Question 21

what are hyperosmotic laxatives?

Answer 21

lactulose, miralax

Question 22

What is safest in treating constipation in infants?

Answer 22

glycerin

Question 23

what is laxative of choice in patients who should avoid straining?

Answer 23

surfactant laxatives-colace, docusate

Question 24

What is 1st, 2nd, 3rd line tx for constipation?

Answer 24

1-bulk forming laxative(if contraindicated, docusate) 2-mag citrate, 3-stimulant laxative

Question 25

How is acute, persistant and chronic diarrhea differentiated?

Answer 25

acute-<30, chronic 30 or longer

Question 26

what are antimotility agents in treating diarrhea?

Answer 26

loperamide, diphenoxylate

Question 27

What are special considerations of antimotility agents?

Answer 27

may make infectious diarrhea worse. Caution in hepatic failure, not for <4 y/o. CAUTION in bloody stools and leukocytes

Question 28

How does bismuth work

Answer 28

it is antisecretory, antimicrobal, absorbant

Question 29

What is 1st, 2nd, 3rd line for diarrhea?

Answer 29

loperamide, adsorbet or antisecretory, dyphenoxylate

Question 30

What is hallmark signs of IBS?

Answer 30

pain w/ change in consistency of stool that is relived by defacation

Question 31

What are 4 criteria for IBS?

Answer 31

abd distention, relief w/ BM, more frequent stools w/ onset of pain, looser stools w/ onset

Question 32

What is first line in treating IBS w/ Constipation? IBS w/ Diarrhea?

Answer 32

IBS-C: Osmotic laxatives. IBS-D loperimide

Question 33

In IBD, what does tissue biopsy often show?

Answer 33

TNF, IL-1, leukotrienes

Question 34

What is the hallmark sign of IBD?

Answer 34

bloody diarrhea, wt loss, fever

Question 35

What is GI mucosa in Crohns?

Answer 35

discontinuous narowed thick edematous patches w/ presence of ulcerations, lesions, fissures, granulomas

Question 36

what findings on GI Mucosa occur exclusively in Crohns?

Answer 36

granulomas and fistulas

Question 37

What is GI mucosa in ulcerative colitis?

Answer 37

continuous superficial uniform inflammation and ulceration

Question 38

Are extraintestinal complications of skiun, joint and liver problems more common in Crohns or UC?

Answer 38

Crohns

Question 39

How long should it take a patient to recover from a IBD exacerbation?

Answer 39

2-4 wks

Question 40

What is the gold standard of mild-mod IBD? How do they work?

Answer 40

aminosalisylates-sulfasalazine. They decrease inflammation by inhibiting prostaglandin synthesis

Question 41

What are side effects of sulfasalazine? What supplement do these pt's often need?

Answer 41

steven-johnson syndrome, N/V, hepatitis. They need folic acid

Question 42

When are corticosteroids used in IBD?

Answer 42

Intermittently for acute IBD exacerbation

Question 43

How is prednisone tapered?

Answer 43

Pt is on 40-60mg/d dose and show improvement in 7-10 days, slowly taper by 5-10mg/wk until 20mg daily, then decrease by 2.5mg/wk

Question 44

what are long-term effects of corticosteroid use?

Answer 44

decreased bone density, buffalo hump, ulcers

Question 45

How are immunosuppressives used in IBD?

Answer 45

Used as adjunctive with aminoglycosides to induce and maintain remission

Question 46

When is IV cyclosporine used in IBD?

Answer 46

In severe acute exacerbation in ulcerative colitis when pt is refractory to corticosteroids

Question 47

When is methotrexate used in IBD?

Answer 47

it is effective only in crohns, not ulcerative colitis.

Question 48

What should patients be tested before prior to using biological agents such as remicaide and Humira?

Answer 48

TB

Question 49

What is tx for mild, mod, severe crohns?

Answer 49

mild: oral aminosalicylates alone or w/ abx. Mod: aminosalicylates and corticosteroids. severe: iv corticosteroids and biologicals

Question 50

What is common treatment of mild ulcerative colitis?

Answer 50

aminosalicylates-oral and rectal