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GI Review 2 (sb)

Mesalamines Sulfasalazine (azulfidine), Asacol (coated), Pentasa (coated), Rowasa (topical)
Mesalamines MOA Inhibits PG synthesis and inflammatory cell migation into the bowel wall (inhibits IL-1 and TNFalpha and NFB and inhibits the LOX pathway)
Mesalamines Use IBD
Mesalamines Adverse 1st gen- N/V/D, HA, rash, fever, decreased folic acid. rarely bone marrow suppression, pancreatitis, hepatitis, anemia
Mesalamines Monitoring 1st gen- renal function
Site of action- Pentasa Jejunum
Site of action- Asacol Ileum
Site of action- Sulfasalazine proximal colon
Site of action- rowasa distal colon
Azathioprine Class Immunosuppressant- Purine analogs
Azathioprine MOA Impairs purine synthesis and inhibits cell proliferation- t cell death
Azathioprine Use IBD, sub for steroid- takes weeks to months to work
Azathioprine Adverse dose related- N/V, bone marrow suppression, pancreatitis, increase LFTs, lymphoma
Azathioprine Interactions TPMT genetic variability- increase toxicity or decrease effectiveness, xanthine oxidase inhibitors
Azathioprine monitoring CBC every 2-4 weeks for 2 months then every 4-8 weeks
methotrexate MOA Inhibition of dihydrofolate reductase- blocks DNA synthesis-cell death, anti-inflammatory, T Lymphocyte death
methotrexate Use IBD (CD>UC)
methotrexate Adverse early- nausea other- bone marrow suppression, fatigue, megaloblastic anemia, alopecia, mucositis
methotrexate Conta PREGOS
methotrexate Monitoring CBC at baseline and then monthly
methotrexate Pearls Weekly IM injections given with folic acid
Cyclosporine MOA Calcineurin inhibitor- inhibits IL-2 inhibits t-cell signal transduction, potent immunomodulator
Cyclosporine Use Severe UC (when everything else has failed)
Cyclosporine Adverse nephrotoxicity, HTN, hirsutism, gingival hyperplasia, muscle tremor, hyperlypoproteinemia, hyperglycemia
Cyclosporine Interactions CYP3A4
Cyclosporine Monitoring Switch from IV to PO ASAP
Budesonide (Entocort EC) class glucocorticoids
Budesonide (Entocort EC) MOA inhibition of the production of IL-1 and TNFa and IL-8 (reduce inflammatory cell adhesion molecules), inhibit gene transcipriton of nitric oxide synthase and COX2
Budesonide (Entocort EC) Use Uses: mild to mod crohns. maintenance for 3 months, controlled release in distal ileum and colon
Budesonide (Entocort EC) pearls Taper ASAP
infliximab (Remicade) Class Biologics- anti TNF
infliximab (Remicade) MOA Inactivated TNF-alpha and reduces inflammation, pain and destruction
infliximab (Remicade)/ Natalizumab (Tysabri) Use IBD (CD more severe cases)
infliximab (Remicade) Adverse Infusion reaction, reactivation of TB or worsening HF
infliximab (Remicade) Contra NYHA III/IV
infliximab (Remicade) Monitoring Get TB test before starting
Natalizumab (Tysabri) Class biologics- anti-integrin
Natalizumab (Tysabri) MOA targets integrin, prevents vascular adhesion and migration of inflammatory cells
Natalizumab (Tysabri) Adverse JC virus activation (PML)
Natalizumab (Tysabri) Contra Do not use with any other immunosuppressive agents
Natalizumab (Tysabri) Pearls get JC virus screening before use
Ciprofloxacin (Cipro) Class FQ
Ciprofloxacin (Cipro) MOA inhibits IIA DNA topoisomerase (winding and unwinding DNA)
Ciprofloxacin (Cipro) Use Infectious diarrhea, intra-abdominal infections/ complications
Ciprofloxacin (Cipro) Adverse N/V/D, arthropathy, tendonitis, insomnia, HA, Dizziness, photosensitivity, dysglycemia, QTc interval prolongation
Ciprofloxacin (Cipro) Contra No pregos, kids, or breast feeders
Ciprofloxacin (Cipro) Interactions Decreased with cations and increases warfarin
Ciprofloxacin (Cipro) Monitoring Arrhythmias, tendon rupture (BB)
metronidazole (flagyl) Class Nitroimidazole antibiotic
metronidazole (flagyl) MOA IBS: Flagyl may kill susceptible GI organisms (anaerobes) in the small intestine that have overgrown and contribute to symptoms. HE: Aerobic gut flora endogenously produce ammonia; as you kill the flora, you reduce ammonia.
metronidazole (flagyl) Use HE, IBS when SIBO is suspected
metronidazole (flagyl) Adverse HA, metallic taste in mouth, N/V/D
metronidazole (flagyl) Interactions Alcohol
Neomycin sulfate Class aminoglycoside antibiotic
Neomycin sulfate MOA reduces intestinal ammonia by inhibiting urease producing bacteria
Neomycin sulfate Uses HE
Neomycin sulfate Adverse nephrotoxicity, ototoxicity, neurotoxicity (rare)
Neomycin sulfate Monitoring ammonia levels, hearing, kidney function
Neomycin sulfate Pearls poor absorption so adverse effects are rare but only used as a last resort
lactulose (Kristalose) Class osmotic laxative
lactulose (Kristalose) MOA poorly absorbed molecules attract/retain water in intestine, increase volume, peristalsis
lactulose (Kristalose) Uses Constipation, pre-op for colonoscopy and abd surgery
lactulose (Kristalose) Adverse dehydration, hypernatremia, hypokalemia, abd pain, abd distention, belching, cramping, diarrhea, flatulence, N/V
lactulose (Kristalose) Contra pts requiring a low galactose diet
lubiprostone (Amitizia) Class Chloride channel activator
lubiprostone (Amitizia) MOA stimulates chloride rich fluid secretion in the intestinal lumen= increase motility and decrease intestinal transit time
lubiprostone (Amitizia) Use IBS-C
lubiprostone (Amitizia) Adverse nausea, dyspnea (1st hour or 1st dose but will go away)
lubiprostone (Amitizia) Contra GI obstruction
Tegaserod (Zelnorm) Class 5-HT4 receptor agonist
Tegaserod (Zelnorm) MOA partial agonist of 5-HT4 receptor, stimulating enteric neurons to promote peristaltic reflex
Tegaserod (Zelnorm) Uses IBS-C
Tegaserod (Zelnorm) Adverse CV death
Tegaserod (Zelnorm) Pearls only available in emergency
alosetron (Lotronex) Class 5-HT3 receptor antagonist
alosetron (Lotronex) MOA blocks 5-HT3 receptors- inhibits enteric cholinergic neurons- inhibits colonic motility- increases total colonic transit time
alosetron (Lotronex) Use IBS-D
alosetron (Lotronex) Adverse GI tox, constipation, ischemic colitis
rifaximin (xifazan) MOA non-systemic antibiotic that targets gut organisms
rifaximin (xifazan) Use abd pain and bloating in IBS, TD, HE
rifaximin (xifazan) Pearls 14 week course for 10 weeks of relief
Bifidobacterium Class probiotic
Bifidobacterium MOA alters GI flora
Bifidobacterium Use IBS
Disulfiram (antabuse) Class aldehyde dehydrogenase inhibitor
Disulfiram (antabuse) MOA inhibits acetaldehyde degradation after drinking causing blurred vision, vomiting, chest pain, dizziness, palpitations, nausea, HA, sweating, flushing, and weakness
Disulfiram (antabuse) Use alcohol abstinence
Disulfiram (antabuse) Adverse drowsiness
Prednisolone Class medium potency intermediate acting glucocorticoid
Prednisolone MOA anti-inflammatory, decreases cytokines, acetaldehyde adducts and collagen formation
Prednisolone Use alcoholic liver disease (slows down cirrhosis)
Prednisolone Adverse cushings syndrome
Prednisolone Contra GI bleed, chronic hep B, untreated active infection, renal failure
Prednisolone Monitoring bp, blood sugar, bone density, eyes
interferon a 2a (pegasys) and 2b (intronA) Class Glycoprotein cytokines
interferon a 2a (pegasys) and 2b (intronA) MOA Binds to cell surface receptors dening virus. Increases expression of MHC antigens and enhances phagocytic activity of macrophages.
interferon a 2a (pegasys) and 2b (intronA) Use Hep B and C
interferon a 2a (pegasys) and 2b (intronA) Adverse flu like syndrome, increase LFTs (not bad though), CNS depression and seizures, autoimmune exacerbation, GI upset, cardiac arrhythmias, and changes in BP
interferon a 2a (pegasys) and 2b (intronA) Contra hepatic decompensation, autoimmune disease, cardiac arrhythimias, depression
interferon a 2a (pegasys) and 2b (intronA) Monitoring LFTs
ribavirin (copegus) Class anti-viral, guanasine analog
ribavirin (copegus) MOA Interferes with the synthesis of guanasine triphosphate and inhibit viral replication
ribavirin (copegus) Use Hep C
ribavirin (copegus) Adverse dose dependent- hemolytic anemia, depression, fatigue, irritability, rash, pruritus, cough, insomnia, nausea
ribavirin (copegus) Contra anemia, renal disease, PREGO X
ribavirin (copegus) Pearls take with a fatty meal
lamivudine (Epivir-HBV)/ adefovir (Hepsera)/ entecavir (Baraclude) Class antiretroviral- nucleoside analogs
lamivudine (Epivir-HBV)/ adefovir (Hepsera)/ entecavir (Baraclude) MOA Inhibit the action of viral DNA polymerase by taking the place of nucleotides in the elongating strand of viral DNA leading to early termination of DNA synthesis
lamivudine (Epivir-HBV)/ adefovir (Hepsera)/ entecavir (Baraclude) Use Lami- HBV and HIV Ade & Ente- HBV only
lamivudine (Epivir-HBV)/ adefovir (Hepsera)/ entecavir (Baraclude) Adverse well tolerated but can cause fatigue and elevated CPK adefovir: dose related nephrotoxicity
lamivudine (Epivir-HBV)/ adefovir (Hepsera)/ entecavir (Baraclude) Monitoring Renal function
lamivudine (Epivir-HBV)/ adefovir (Hepsera)/ entecavir (Baraclude) Pearls test for HIV co-infection before starting tx, renally adjust all meds as needed, none of these cure chronic HBV just suppress viral load
boceprevir (Victrelis) / tealprevir (incivek) Class Direct acting antiviral agents
boceprevir (Victrelis) / tealprevir (incivek) MOA Inhibition of the HCV nonstructural protein 3/4A serine proease; HCV genotype 1
boceprevir (Victrelis) / tealprevir (incivek) Use tx of naive and experienced HCV
boceprevir (Victrelis) / tealprevir (incivek) Adverse anemia B- dysgeusia, T- rash, pruritis, nausea, anorectal discomfort, diarrhea
boceprevir (Victrelis) / tealprevir (incivek) contra Pregos
boceprevir (Victrelis) / tealprevir (incivek) interactions CYP450 drugs
boceprevir (Victrelis) / tealprevir (incivek) Pearls combo with PegIFN and wt based ribavirin
spironolactone (Aldactone)/ furosemide (Lasix) Class Diuretics
spironolactone (Aldactone)/ furosemide (Lasix) MOA (S)- blocks aldosterone receptors which results in increase Na excretion and decrease K excretion (F)- inhibits Na and Cl reabsorption in the thick ascending limb
spironolactone (Aldactone)/ furosemide (Lasix) Use ascites due to cirrhosis, hypertension, edema, hypokalemia
spironolactone (Aldactone)/ furosemide (Lasix) Adverse (S) hyperkalemia, gyncomastia
spironolactone (Aldactone)/ furosemide (Lasix) Contra renal insufficiency, hyperkalemia
spironolactone (Aldactone)/ furosemide (Lasix) Monitoring UA, daily weights
Albumin 25% Use use when removing a large paracentesis to prevent circulatory dysfunction and with SBP when SrCr >1mg/dL and BUN >30 or TBili >4
pancrelipase (pancrease) Class digestive enzyme replacement (lipase-protease-amylase)
pancrelipase (pancrease) MOA enzymes aiding in hydrolysis
pancrelipase (pancrease) Use pancreatic insufficiency- replacement therapy for malabsorption, pain in chronic pancreatitis
pancrelipase (pancrease) Adverse mouth irritation, hyperuricemia, fibrosing colonopathy
pancrelipase (pancrease) Contra allergy to porcine proteins
pancrelipase (pancrease) Interactions antacids
pancrelipase (pancrease) Monitoring renal function, uric acid, stool patterns, fat absorption
Octreotide Class growth hormone inhibitor
Octreotide MOA supresses secretion of GH, insulin-like growth factors, serotonin and GIP
Octreotide Use Carcinoid tumors, acromegaly, OFF LABEL: esophageal hemorrhage, diarrhea
Octreotide Adverse arrhythmias, glucose changes, constipation, flatulence, nausea
Created by: duanea00



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