GI Pharm
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| Aggressive Factors in PUD | Acid and Pepsin Secretion
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| Protective Factors in PUD | Mucus, Bicarbonate, Mucosal blood flow, cell restitution, prostaglandins
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| ____ percent of patients infected with H. pylori will develop an ulcer | 15-20%
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| Two mechanisms of injury with NSAIDs | Direct action on the mucosa, Inhibition of prostaglandins
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| Big difference between Gastric and duodenal ulcer | Gastric - food worsens pain; Duodenal Ulcer - pain relieved by food.
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| ___ ulcers are harder to heal | Gastric. Biggest compication is gastric carcinoma. Most gastric ulcers are biopsied to rule out cancer. Most duodenal ulcers are not biopsied (duodenal ulcers are more common and easier to treat)
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| Neutralizes acid, inhibiting pepsinogen to pepsin, and may bind bile salts | Antacids. When used at proper doses (8oz bottle/day), they are equally efficacious as H2 blockers. Tablets are not as potent as suspensions
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| Onset of action of Antacids | 5-15 minutes after administration. Short duration (1-2 hours). Often used in combo w/ other agents
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| Non-systemic antacids | Aluminum Hydroxide, Magnesium Hydroxide, Calcium Carbonate, Al/Mg combinations
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| Systemic Antacids | Sodium Bicarbonate (Alka-Seltzer)
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| AE of Aluminum Hydroxide (Amphojel) | Constipation and aluminum toxicity in renal pts
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| Major AE of Magnesium Hydroxide -Milk of Magnesia | Diarrhea. Magnesium can also accumulate in renal pts
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| ___ Is an antacid that binds dietary phosphate and causes constipation (also a good source of calcium) | Calcium Carbonate - Tums
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| Alka Seltzer | come back to
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| Efficacy of H2 Blockers | heals 90% of DU at 8 weeks and 80% of GU at 12 weeks
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| H2 requires dose adjustment in which populations? | renal insufficiency
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| Block gastric acid secretion by inhibiting gastric H/K ATPase in gastric parietal cells. | Proton Pump Inhibitors. Produces profound, long-lasting antisecretory effect. Knocks out all three acid production pathways
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| PPI and Plavix | decreased acidity with PPI decreases efficacy of Plavix (Omeprazole is the worst)
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| PPI advantage over H2 blockers | Heals faster and they are part of the H. pylori treatment regiment.
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| Comparative efficacy between PPIs | Same; no head to head studies. But patients will prefer one over another.
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| Forms cytoprotective complex that covers ulcer site. Mucosal PG synthesis and inhibit pepsin. Has lots of drug interactions. | Sucralfate (carafate). Indicated for tx of and maintenance of DU only. Causes constipation
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| This drug is preferred in ventilated patients (especially over H2blockers which has been associated with more aspiration pneumonia). PILL IS HUGE | Sucralfate. Useful in patients with H2Blocker thrombocytopenia
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| A synthetic prostaglandin that increases mucus production and mucosal bicarb. Indicated for NSAID induced gastric ulcers | Misoprostol (cytotec)
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| AE's of Misoprostol | Diarrhea (40% or higher, but this is dose related)!!! Abdominal Pain, flatulence abortifacient
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| Antiulcer agent/Prostaglandin that induces abortion | Misoprostol
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| PPI in tx of H. pylori | BID, 2-4 weeks longer than abx (can use once a day after end of abx)
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| Tx of H. pylori | MOC AOCMetronidazole, Omeprazole, Clarithromycin, Amoxicillin, Omeprazole, Clarithromycin. All regimens are 10-14 days
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| Which tx regimen should be taken for H. pylori infection in penicillin allergic patients? | Metronidazole, Clarithromycin and a PPI (ex: omeprazole)
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| Protective Forces in GERD | LES pressure, Esophageal clearance, Esophageal mucosal defense, Gastric emptying
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| Complications of GERD | Esophageal ulceration, Esophageal stricture, hemorrhage, Barett's esophagus, Pulmonary Complications (bronchoconstriction, cough)
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| Cisapride AEs and cause of withdrawl from the market | Drug interactions, torsades de pointe
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| Meds to increase LES pressure | Bethanechol, metoclopramide
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| Med used to increase gastric emptying in GERD | Metoclopramide
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| Med Used to increase esophageal clearance | Bethanechol
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| Esophageal healing in GERD with PPI compared to H2blockers | Esophageal healing is about double with PPI compared to H2blockers
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| Combination therapy in GERD | PPI plus a promotility agent, or H2blocker plus a promotility agent
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| Tx Key in GERD | Maintenance therapy is key. Up to 90% of pts with severe esophagitis will relapse after stopping meds
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| Causes of N/V | Fluid and electrolyte abnormalities, Drug-induced (chemo, abx, etc), GI obstruction, Metabolic disorders (DM, Uremia), Neurological process, Drug withdrawal, Pregnancy, Anxiety
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| Neuropharmacology of Emesis | Visceral Stimuli, Chemoreceptor Trigger zone, Vestibular Input
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| Protective Factor in Chemo Induced N/V | Past or current heavy EtOH use. Risk factor: female>male
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| Risk factors for N/V Post-Operative | Female, children, obese, non-smoker, hx of motion sickness
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| Treatment for simple N/V | Antacids, H2 antagonists, antihistaminic-cholinergics, phosphorated carbohydrate solution, Phenothiazines (prescription required)
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| Tx for Copmlex N/V | Phenothiazines, Serotonin antagonists, Prokinetic agents, Cannabinoids, Glucocorticoids, Benzodiazepines, Butyrophenones, Neurokinin-1 antagonists
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| Magnesium is associated with | osmotic diarrhea
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| Antacid examples | maalox, mylanta, tums
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| ____ are best for motion sickness or emotional N/V | Antihistamines/Anticholinergics. Benadryl, Transderm Scop, Dramamine, Bonine
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| Flat soda antiemetic | Phosphorated Carbohydrate Solution. Can just have caffeine free coke (but not sugar free)
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| Associated with extrapyramidal reactions (including parkinsons!) | Phenothiazines and Reglan (Prokinetic)
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| Compazine and Phenergan are | Phenothiazines
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| Best for Post-Operative and Chemo-induced N/V | Serotonin Antagonists. Super expensive!! ($50/pill). Not effective for motion sickness.
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| Which antiemetic can cause QT prolongation? | Serotonin antagonists
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| Zofran and Kytril are | Serotonin Antagonists
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| Reglan is a | Prokinetic agent
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| Haldol | Butyrophenone. Usually not used b/c it is an antipsychotic with AEs
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| Neurokinin-1 antagonists are FDA approved for | highly emetogenic chemotherapy (cisplatin-based chemo). Expensive
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| Types of diarrhea | Secretory, osmotic, exudative, altered intestinal transit
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| Acute diarrhea is caused by | viral, bacterial and protozoal infections
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| Frequent BM, never bloody | Acute Diarrhea
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| Drinks to avoid in Diarrhea | hypertonic fruit juices, carbonated beverages, and caffeinated beverages. (high sugar so will act like sorbitol and cause a secondary diarrhea)
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| Tx options for Diarrhea | Antimotility agents, adsorbents, antisecretory agents
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| AE's of Antimotility agents | Dizziness and constipation
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| Contraindication to antimotility agents | Acute bacterial diarrhea. At least in the hospital, don't use an antimotility until you get your C. diff back. Also contraindicated in colitis and in children<2 years old
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| Most potent Antimotility agent that is also OTC | Loperamide. Great for nonspecific diarrhea and traveler's diarrhea
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| AE of Lomotil | Abuse. If you are going to give it, give it with atropine to discourage abuse
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| ____ is an antimotility agent that is a tincture of opium and has abuse potential | Paragoric
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| Adsorbent Agents | Kaopectate (activated attapulgite) and FiberCon (calciumpolycarbophil)
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| What are the AE's and CIs of Bismuth Subsalicylate | AE's - dark tongue and black stool; CI's: children/teen with viral illness due to risk of Reye's Syndrome
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| Sx treatment of carcinoid tumors and VIPomas | Octreotide (sandostatin)
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| Prophylactic Abx in traveler's Diarrhea | NOT RECOMMENDED.
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| DOC for tx of Traveler's Diarrhea in children and women | azithromycin
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| Bulk-forming laxatives are best for | prevention of constipation
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| ___ laxatives are best for acute evacuation of the bowel | Saline Laxatives (magnesium citrate, MOM). Onset 5-30 min(pr) or 3-6 hours (po)
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| Golytely | Polyethylene glycol (used in bowel prep). .5-1hour bowel cleansing
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| Facilitate mixing of aqueous and fatty materials within intestinal tract; water and electrolyte secretion in large and small bowel | Emollient Laxatives (docusate - Colace)
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| How to take emollient laxatives | must take with greater than or equal to 8oz of water. loses effectiveness in 30 days
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| Lubricants (mineral oil) dosing | NOT recommended for routine use, in the elderly, or children <6 years old. Take on empty stomach, NOT before bed or in the recumbent position due to risk of aspiration
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| Red discoloration of the Urine can be seen in | Anthraquinones, particularly Sennosides (Senakot)
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| ____ is a stimulant that can be used in constipation that may induce premature labor in pregnant patients | Castor Oil
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