Rando GI Pharm Stuff Flashcards Preview

Elaina: GI > Rando GI Pharm Stuff > Flashcards

Flashcards in Rando GI Pharm Stuff Deck (74)
Loading flashcards...
1
Q

why does immodium not have an analgesic effect even though its an opioid?

A

it does not cross the BBB

2
Q

what must you be careful of when administering kaolin-pectate?

A

it is highly absorptive (clay and plant material); so it may absorb any drugs co-administered with it

3
Q

how does dietary fiber work in our gut?

A

it absorbs and binds fluids, it provides stool bulk

it can also absorb co-administered medications!

4
Q

at what dose does dietary fiber work as a laxative? how about for treating diarrhea?

A

low dose as a laxative

high dose to treat diarrhea

5
Q

what are our three indications for octreotide/sandostatin?

A

1) diarrhea
2) GI bleeds
3) pancreatic issues

6
Q

what do we worry about with long term use of octreotide/sandostatin?

A

gallstones; over 50 percent of people in longterm use

also steatorrhea and malabsorption of fat soluble vitamins

7
Q

which drugs are contraindicated with use of octreotide/sandostatin?

A

BB and CCB because this drug slows everything down! can cause bradycardia

8
Q

what should you monitor in your hypothyroid patient when taking octreotide/sandostatin long term?

A

TSH

9
Q

octreotide is given as injection; how does it act in low doses vs high doses?

A

low doses: increase motility

high doses: decrease motility

10
Q

5-ASA is indicated for what severity of IBD?

A

mild

11
Q

what do we give for moderate IBD?

A

oral corticosteroids or methotrexate or azathioprine

12
Q

what do we give for severe IBD?

A

infliximab or natalizumab

13
Q

site of action of sulfasalazine?

A

colon

14
Q

site of action of mesalamine/asacol?

A

slightly in stomach but most in jejunum, ileum, colon

15
Q

MOA of mesalamine/asacol?

A

local colon anti-inflammatory action and systemic prostaglandin inhibition

16
Q

what must you ensure to do when prescribing mesalamine/asacol?

A

give them folate also!

17
Q

anti-inflammatory for UA, RA, crohn’s, psoriasis?

A

5-ASA + sulfapyridine or sulfasalazine (Azulfadine)

supplement with folate!

18
Q

two anti-inflammatory purine analogues?

A

azothioprine (imuran) and methotrexate

19
Q

which is our steroid sparing drug for more moderate-severe crohns, fistulas in crohns, UC, RA, kidney transplant?

A

azathioprine (imuran)

20
Q

purine analogue anti-inflammatory for crohn’s that causes bone marrow suppression over time?

A

methotrexate

not really a problem at low doses with CD

21
Q

which of our IBD drugs is PG category X?

A

methotrexate

22
Q

what do you need to be sure to give with methotrexate?

A

folate!

23
Q

which drug for mod-severe CD and UC is an anti-TNF alpha compound?

A

infliximab

24
Q

which drug is an immunomodulator for CD used when patients are not responding?

A

natalizumab

25
Q

what do we worry about with drugs like infliximab?

A

activation of TB, reactivation of hepatitis B

26
Q

two major side effects of ursodiol (actigall) for gallstones?

A

headaches (25 percent)

constipation (25 percent)

27
Q

how long does dissolution take when on ursodiol (actigall)?

A

months!

28
Q

what percent of stones recur within 5 years after treatment with ursodiol (actigall)?

A

50 percent

29
Q

what is the max diameter of stone that we can use ursodiol (actigall) to dissolve?

A

20 mm

30
Q

anthraquinone (stimulant) laxative for constipation?

A

senna

don’t use with bowel obstruction

31
Q

why do we use PEG interferon now with interferon?

A

increased half life compared to interferons; less frequent dosing and more level serum concentrations

32
Q

two major side effects of interferon alfa and peg INF?

A

1) mood disorders; depression

2) flu-like syndrome

33
Q

what pregnancy category in interferon alfa and peg INF?

A

X

34
Q

indications for interferon alfa and peg INF?

A

Hepatitis B and Hepatitis C

35
Q

what drug category is ofloxacin? what do we have to worry about with it?

A

quinolone; achilles tendon rupture

36
Q

what drug may increase the photosensitivity of ofloxacin?

A

st john’s wort

37
Q

what is lamivudine (epivir) used to treat?

A

HBV, HIV

38
Q

what should we monitor if our patient with IBS constipation is on lubiprostone or linclotide?

A

s/s depression

39
Q

which drug is so teratogenic that we need to advise the male patient to avoid sexual contact with his pregnant partner?

A

ribavarin

40
Q

what major side effect comes with sofosbuvir plus ribavarin to treat hepatitis C?

A

hemolytic anemia; monitor B12 and folate

41
Q

what are the major side effects of long term use of PPIs?

A

1) accelerated gastric atrophy
2) increased CV risk
3) accelerated osteoporosis; risk of hip fracture after 5 years
4) pneumonia
5) C. diff colitis

42
Q

which of our drugs has a drug drug interaction with venlafaxine (effexor)?

A

metaclopromide (reglan) for diabetic gastroparesis

43
Q

what two antibiotics can be used to stimulate gut motility?

A

erythromycin or clarithyomycin

44
Q

why do we not use metaclopromide (reglan) for more than 3 months?

A

they can get tachyphylactic!

45
Q

which drug carries a black box warning for tardive dyskenesia?

A

metaclopromide (reglan)

46
Q

which anti-nausea is contraindicated if patient is on progestin-only contraceptive?

A

aprepitant (Emend)

47
Q

which drugs are given pre-chemo to prevent nausea/vomiting?

A

1) dexamethasone (Maxidex) plus aprepitant (Emend)

or

2) odansatron (Zofran) plus aprepitant (Emend)

48
Q

how do we instruct our patients to take their anti-emetics in regards to their chemo schedule?

A

1 day before chemo, two days after

49
Q

which of our anti-nausea meds is known to have QT prolongation?

A

odansatron (zofran)

50
Q

which drug do we give pre-radiation therapy?

A

odansatron (zofran)

51
Q

major side effects of meclizine?

A

sedation, blurred vision, fatigue (it is an antihistamine!)

52
Q

what problem may older people have with meclizine and the SCOP patch?

A

urinary retention!

both have anti-cholinergic side effects

53
Q

which drug is a protective paste against GI ulcers?

A

sucrafate

54
Q

which drug is a prostaglandin agonist to protect against GI ulcers?

A

misoprostol

55
Q

which drug do we give for cramping?

A

dicyclomine

56
Q

triple therapy for H. pylori?

quadruple therapy for H. pylori?

A

1) amoxicillin, clarithromycin + PPI

2) PPI, tetracycline, metronidazole, BSSS

57
Q

what are the three drugs indicated for C. difficile?

A

metronidazole, vancomycin, rafaxamin

58
Q

treatment for diverticulitis?

A

cipro and metronidazole

make sure to get CT scan to confirm!

59
Q

what should we do for follow up of diverticulitis?

A

colonoscopy 3 months out

60
Q

which PPI can we use if our patient is on clopidogrel?

A

pantoprazole

if we use omeprazole the patient is at high risk for clots

61
Q

when should we expect to see maximum relief with PPI?

A

3-5 days

62
Q

how often should we attempt to reduce dose of PPI?

A

every 6 months

63
Q

best drug for nocturnal dyspepsia?

A

ranitidine; take at 6 pm

64
Q

which analgesic drug is used post pancreatic surgery that can cause seizures in elderly?

A

meperidine (demerol)

confusion, CNS depression, seizures

65
Q

what may you add to someones viokase regimen to increase its effectiveness?

A

PPI: cut down on acid getting generated in the stomach so vikase can easily get through in its active form

66
Q

what should you give if your patient develops mental status change on top of his liver failure?

A

lactulose

67
Q

drugs for IBS w/ symptoms of diarrhea?

A

fiber, kaopectate, lopiramide (immodium)

dicyclomine for cramping

68
Q

what is the DOC for hepatitis C?

A

harvoni (sofosbuvir + ledapisivir)

BUT VERY EXPENSIVE

69
Q

your patient has been on IV sandostatin (octreotide) for 5 days for his GI bleed; what may this cause? what can you prescribe?

A

nausea, vomiting, diarrhea

give zofran!

70
Q

should first line for an elder with constipation be increased fiber intake?

A

NO! we cannot rely on them to drink enough water

71
Q

what is our steroid-free drug for crohns?

A

azathioprine (imuran)

72
Q

side effects of azathioprine (imuran)?

A

PG category D

many toxicities; pancreatitis, hepatotoxicity (jaundice, itching), bone marrow toxicity (bleeding, fatigue, bruising, low platelets)

73
Q

mesalamine decreases the absorption of what?

A

folic acid

74
Q

which of our drugs is contraindicated in a patient on beta blockers?

A

sandostatin; can cause hypoglycemia