why does immodium not have an analgesic effect even though its an opioid?
it does not cross the BBB
what must you be careful of when administering kaolin-pectate?
it is highly absorptive (clay and plant material); so it may absorb any drugs co-administered with it
how does dietary fiber work in our gut?
it absorbs and binds fluids, it provides stool bulk
it can also absorb co-administered medications!
at what dose does dietary fiber work as a laxative? how about for treating diarrhea?
low dose as a laxative
high dose to treat diarrhea
what are our three indications for octreotide/sandostatin?
1) diarrhea
2) GI bleeds
3) pancreatic issues
what do we worry about with long term use of octreotide/sandostatin?
gallstones; over 50 percent of people in longterm use
also steatorrhea and malabsorption of fat soluble vitamins
which drugs are contraindicated with use of octreotide/sandostatin?
BB and CCB because this drug slows everything down! can cause bradycardia
what should you monitor in your hypothyroid patient when taking octreotide/sandostatin long term?
TSH
octreotide is given as injection; how does it act in low doses vs high doses?
low doses: increase motility
high doses: decrease motility
5-ASA is indicated for what severity of IBD?
mild
what do we give for moderate IBD?
oral corticosteroids or methotrexate or azathioprine
what do we give for severe IBD?
infliximab or natalizumab
site of action of sulfasalazine?
colon
site of action of mesalamine/asacol?
slightly in stomach but most in jejunum, ileum, colon
MOA of mesalamine/asacol?
local colon anti-inflammatory action and systemic prostaglandin inhibition
what must you ensure to do when prescribing mesalamine/asacol?
give them folate also!
anti-inflammatory for UA, RA, crohn’s, psoriasis?
5-ASA + sulfapyridine or sulfasalazine (Azulfadine)
supplement with folate!
two anti-inflammatory purine analogues?
azothioprine (imuran) and methotrexate
which is our steroid sparing drug for more moderate-severe crohns, fistulas in crohns, UC, RA, kidney transplant?
azathioprine (imuran)
purine analogue anti-inflammatory for crohn’s that causes bone marrow suppression over time?
methotrexate
not really a problem at low doses with CD
which of our IBD drugs is PG category X?
methotrexate
what do you need to be sure to give with methotrexate?
folate!
which drug for mod-severe CD and UC is an anti-TNF alpha compound?
infliximab
which drug is an immunomodulator for CD used when patients are not responding?
natalizumab
what do we worry about with drugs like infliximab?
activation of TB, reactivation of hepatitis B
two major side effects of ursodiol (actigall) for gallstones?
headaches (25 percent)
constipation (25 percent)
how long does dissolution take when on ursodiol (actigall)?
months!
what percent of stones recur within 5 years after treatment with ursodiol (actigall)?
50 percent
what is the max diameter of stone that we can use ursodiol (actigall) to dissolve?
20 mm
anthraquinone (stimulant) laxative for constipation?
senna
don’t use with bowel obstruction
why do we use PEG interferon now with interferon?
increased half life compared to interferons; less frequent dosing and more level serum concentrations
two major side effects of interferon alfa and peg INF?
1) mood disorders; depression
2) flu-like syndrome
what pregnancy category in interferon alfa and peg INF?
X
indications for interferon alfa and peg INF?
Hepatitis B and Hepatitis C
what drug category is ofloxacin? what do we have to worry about with it?
quinolone; achilles tendon rupture
what drug may increase the photosensitivity of ofloxacin?
st john’s wort
what is lamivudine (epivir) used to treat?
HBV, HIV
what should we monitor if our patient with IBS constipation is on lubiprostone or linclotide?
s/s depression
which drug is so teratogenic that we need to advise the male patient to avoid sexual contact with his pregnant partner?
ribavarin
what major side effect comes with sofosbuvir plus ribavarin to treat hepatitis C?
hemolytic anemia; monitor B12 and folate
what are the major side effects of long term use of PPIs?
1) accelerated gastric atrophy
2) increased CV risk
3) accelerated osteoporosis; risk of hip fracture after 5 years
4) pneumonia
5) C. diff colitis
which of our drugs has a drug drug interaction with venlafaxine (effexor)?
metaclopromide (reglan) for diabetic gastroparesis
what two antibiotics can be used to stimulate gut motility?
erythromycin or clarithyomycin
why do we not use metaclopromide (reglan) for more than 3 months?
they can get tachyphylactic!
which drug carries a black box warning for tardive dyskenesia?
metaclopromide (reglan)
which anti-nausea is contraindicated if patient is on progestin-only contraceptive?
aprepitant (Emend)
which drugs are given pre-chemo to prevent nausea/vomiting?
1) dexamethasone (Maxidex) plus aprepitant (Emend)
or
2) odansatron (Zofran) plus aprepitant (Emend)
how do we instruct our patients to take their anti-emetics in regards to their chemo schedule?
1 day before chemo, two days after
which of our anti-nausea meds is known to have QT prolongation?
odansatron (zofran)
which drug do we give pre-radiation therapy?
odansatron (zofran)
major side effects of meclizine?
sedation, blurred vision, fatigue (it is an antihistamine!)
what problem may older people have with meclizine and the SCOP patch?
urinary retention!
both have anti-cholinergic side effects
which drug is a protective paste against GI ulcers?
sucrafate
which drug is a prostaglandin agonist to protect against GI ulcers?
misoprostol
which drug do we give for cramping?
dicyclomine
triple therapy for H. pylori?
quadruple therapy for H. pylori?
1) amoxicillin, clarithromycin + PPI
2) PPI, tetracycline, metronidazole, BSSS
what are the three drugs indicated for C. difficile?
metronidazole, vancomycin, rafaxamin
treatment for diverticulitis?
cipro and metronidazole
make sure to get CT scan to confirm!
what should we do for follow up of diverticulitis?
colonoscopy 3 months out
which PPI can we use if our patient is on clopidogrel?
pantoprazole
if we use omeprazole the patient is at high risk for clots
when should we expect to see maximum relief with PPI?
3-5 days
how often should we attempt to reduce dose of PPI?
every 6 months
best drug for nocturnal dyspepsia?
ranitidine; take at 6 pm
which analgesic drug is used post pancreatic surgery that can cause seizures in elderly?
meperidine (demerol)
confusion, CNS depression, seizures
what may you add to someones viokase regimen to increase its effectiveness?
PPI: cut down on acid getting generated in the stomach so vikase can easily get through in its active form
what should you give if your patient develops mental status change on top of his liver failure?
lactulose
drugs for IBS w/ symptoms of diarrhea?
fiber, kaopectate, lopiramide (immodium)
dicyclomine for cramping
what is the DOC for hepatitis C?
harvoni (sofosbuvir + ledapisivir)
BUT VERY EXPENSIVE
your patient has been on IV sandostatin (octreotide) for 5 days for his GI bleed; what may this cause? what can you prescribe?
nausea, vomiting, diarrhea
give zofran!
should first line for an elder with constipation be increased fiber intake?
NO! we cannot rely on them to drink enough water
what is our steroid-free drug for crohns?
azathioprine (imuran)
side effects of azathioprine (imuran)?
PG category D
many toxicities; pancreatitis, hepatotoxicity (jaundice, itching), bone marrow toxicity (bleeding, fatigue, bruising, low platelets)
mesalamine decreases the absorption of what?
folic acid
which of our drugs is contraindicated in a patient on beta blockers?
sandostatin; can cause hypoglycemia