Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
53 Cards in this Set
- Front
- Back
Is Erosive Esophagitis cured by tx?
|
No. One tx stops sx return
|
|
GERD lifestyle modifications
|
Eats 2-3 hours before bed
Don't lie down or bend over after meal Smaller meals Lose weight Don't smoke Avoid spicy or fatty foods Elevate head 6 inches |
|
Take PPI __ mins ___ eating
|
30-60, BEFORE
|
|
MgOH in Zegerid may cause
|
Diarrhea, and abd cramping
|
|
PPI ADR
|
Headache, NVD, abd pain, flatulance, constipation, dry mouth
Possible malabsorpation of B12, Ca, and Fe |
|
Is Erosive Esophagitis cured by tx?
|
No. One tx stops sx return
|
|
GERD lifestyle modifications
|
Eats 2-3 hours before bed
Don't lie down or bend over after meal Smaller meals Lose weight Don't smoke Avoid spicy or fatty foods Elevate head 6 inches |
|
Take PPI __ mins ___ eating
|
30-60, BEFORE
|
|
MgOH in Zegerid may cause
|
Diarrhea, and abd cramping
|
|
PPI ADR
|
Headache, NVD, abd pain, flatulance, constipation, dry mouth
Possible malabsorpation of B12, Ca, and Fe |
|
Nocturnal gastric acid breakthrough
|
Mostly seen in PPI BID
Give H2RA qhs. (Acid secretion at nighttime almost entirely dependent on histamine stimulation) |
|
Prilosec/Nexium and Plavix
|
2C19. Plavix efficacy diminished
|
|
OTC PPI counseling
|
Take for 14 days.
See doctor if you need to take this for more than 14 days Don't repeat in less than 4 months without seeing a physician. |
|
PPI and Warfarin
|
Increase INR and bleeding risk.
|
|
Ask a doctor before taking if you have
|
heartburn for >3months
chest pain lightheadedness, sweating or dizziness |
|
Cimetidine + Phenytoin DDI
|
Increase in dilantin
|
|
Cimetidine + Ketoconazole DDI
|
Decrease F of ketoconazole due to increase pH.
Give ketoconazole 2 hr before hand. |
|
Cimetidine + tacrolimus DDI
|
Increase [tacrolimus]
|
|
All H2RA need ___ dose adjustment
|
renal
|
|
Triple therapy
|
PPI, Clarithromycin, Amoxicillin/metronidazole
14 days |
|
Quadruple therapy
|
Bismuth, metronidazole, tetracycline, H2RA/PPI
10-14 days |
|
When to perform H.pylori curative test
|
no earlier than 4 weeks after completing therapy
|
|
NSAID-related PUD tx
|
Use PPI or H2RA for 4 wks.
If presence of H. pylori then initiate 3x or 4x therapy PPI, H2RA or Cytotec should be used for pt on chronic NSAIDs with risk - i.e. chronic corticosteroid therapy, etc. |
|
SE of PPI and H2RA
|
Headache, Nausea, Diarrhea
|
|
Sucralfate SE
|
constipation
|
|
PPI and H2RA DDI
|
Digoxin, Ketoconazole, Iron
|
|
Amox and Tetracycline decrease the efficacy of this drug.
|
Oral contraceptives
|
|
Clarithromycin is a CYP ___
|
Inhibitor
|
|
What do we have to monitor renal fxn with Carafate
|
Al+3
|
|
PUD pt with bleeding
|
Put on IV PPI and do endoscopy
|
|
Can we do PPI BID?
|
Only if they don't respond to qd therapy
|
|
Antacids must be taken at least __ hours apart from iron, tetracycline, and digoxin
|
2
|
|
Antacids must be taken at least __ hours apart from fluoroquinolones
|
4-6
|
|
Antacid SE
|
Electrolyte disturbances
Al can cause constipation and bone demineralization Acid-Base disturbances |
|
Irritable Bowel Syndrom (IBS)
|
Abdominal pain with changes in bowel habits for at least 3 months
|
|
IBS categories
|
Diarrhea predominant
Constipation predominant Mixed |
|
First line therapy for mild IBS
|
Bentyl
Hyoscyamine Both are anticholingerics Both avoid in constipation |
|
For constipation predominant IBS
|
Psylluim husk
Polycarbophil |
|
Zelnorm
|
Tegoserod
5-HT4 receptor antagonist Only prescribed for constipation predominant IBS under emergency investigation drug protocol Tegoserod take 30 min ac and not during acute attack. Diarrhea, nausea, headache |
|
TCA in IBS
|
Improve global scores and pain only for diarrhea predominant IBS
|
|
SSRI in IBS
|
Paroxetine
Improve abdominal pain and improve psychiatric disorder (part of IBS is believed to be CNS derived) |
|
Lotronex
|
Alosetron
Seretonin receptor antagonist Only for women with chronic diarrhea IBS Constipation, abd pain, cramping |
|
Amitiza
|
Lubiprostone
Improves global scores for women with constipation IBS Nausea, diarrhea, headache and dyspnea within 1 hour |
|
IBS pt counseling
|
anticholinergics used prn
|
|
UC Categorization
|
Mild UC: 4 stools/day blood (-)
Moderate: >4 bm/day Severe: >6bm/day blood (+) Fulminant: >10bm/day blood (+) |
|
Crohn's Disease
|
Mild to moderate: Ambulatory and tolerate oral alimentation
Moderate to severe: Fail to respond to tx Severe to Fulminant: refractory to steroids or biologics |
|
Tx principles for UC
|
Use topical aminosalysates first.
If refractory + topical steroids If refractory + oral aminosalysates. |
|
Which drugs are used for maintenance therapy in UC
|
aminosalyciates and azothaprine only.
We want to eventually wean off corticosteroids |
|
Severe cases of UC
|
infliximab to decrease steroid load
|
|
Fulminant UC
|
IV steroids
Topical and oral salycicates if still refractory try cyclosporine May introduce azothiaprine. |
|
Maintenance therapy for CD
|
Azothiaprine, mercaptopurine, Adalimumab, Certolizumab, Infliximab, Natalimumab
|
|
Initial therapy for CD
|
Oral corticosteroids.
if refractory add azothiaprine or mercaptopurine. if still refractory the add methotrexate If still refractory give the biologics |
|
What to give in fistulating CD
|
metronidazole and ciprofloxacin.
Adalimumab, certolizumab, infliximab, and natalizumab. |