Comm Rotation Set1

Front 1

Disease induced constipation (3)

Psychogenic causes of constipation (3)

Back 1

1)hypothyroidism
2)strictures
3)IBS constipation predom

1)depression
2)eating disorders
3)conscious efforts to withhold stool

Front 2

Drug induced constipation (5)

Back 2

1)Ca/Al containing antacids
2)narcotic analgesics
3)anticholinergic drugs
4)TCAs
5)CCBs (especially verapamil)

Front 3

Lifestyle factors constipation (3)

Advanced age constipation (3)

Back 3

1)diet low in calories, carbs, fiber, fluids
2)sedentary lifestyle
3)avoiding urge to empty bowel

1)prolonged transit thru colon
2)decr perception to defecate
3)high incidence of multiple meds

Front 4

Kids constipation (4)

Women constipation (3)

Back 4

1)emotional distress
2)febrile illness
3)CF/hypothyroidism
4)unavailable toilet facilities

1)hormonal changes
2)slower gut transit times
3)prenatal vitamins containing iron and Ca

Front 5

S/sx of Constipation (5)

Complications of Constipation (2)

Back 5

1)anorexia
2)dull HA
3)lassitude
4)low back pain
5)ab distension/discomfort

1)CV (incr BP/rhythm disturbance due to straining)
2)hemorrhoids

Front 6

General tx approach to Constipation (5)

Back 6

1)initially adjust diet, fiber, fluids and add exercise
2)pharma relief can accompany lifestyle mods if immediate relief is desired
3)laxatives should be selected according to age, MOA, health status of pt
4)tx w/ laxatives should be less than 1wk
5)more success when causes ID'd and therapy tailored to individual

Front 7

Exclusions to self-case of constipation (name 6 of 13)

Back 7

1)marked ab pain or sig distension/cramping
2)marked or unexplained farting
3)fever
4)n/v
5)paraplegia/quadriplegia
6)daily use of laxatives

7)changes in bowel habits (esp w/ w/ wt loss)
8)change in diameter of stool
9) blood in stool, dark/tarry
10)s/sx that persist for 2wks or recur over a period of atleast 3mon
11)h/x of inflammatory bowel disease
12)s/sx that recur after diet/lifestyle changes or laxative use
13)anorexia

Front 8

Non-pharma recommendations for constipation (4)

Back 8

1)incr fiber to 20-35g/d
2)incr water
3)exercise as appropriate
4)establish regular bowel habits including promptly responding to urge to toilet

Front 9

Bulk Forming Laxatives
a)ex of them (7 look at)
b)MOA (2)
c)use (2)
d)ADR (2)
e)CI
f)counsel
g)drug interactions

Back 9

a)agar, psyllium, kelp, plant gum, cellulose, polycarbophil

b)like physiologic mechanism prompting evacuation
b)not absorbed systemically

c)RECOMMENDED pharma choice as initial tx for most forms of constipation
c)good in pts w/ low fiber diets and advanced age

d)craming, farts
d)esophageal obstruction w/ vomiting

e)intestinal ulcerations/stenosis

f)hydration

g)TCN w/ Ca containing stuff can form complexes

Front 10

Emollient laxatives (stool softeners)
a)ex (2)
b)MOA
c)onset
d)ADR
e)drug interactions
f)counseling (4)

Back 10

a)docusate

b)anionic surfactant that incr wetting of intestinal fluid to softene feces

c)after po admin takes 24-72h to work

d)diarrhea and mild ab cramping

e)NONE

f)avoid in kids under 6yo
f)generally used for prevention of constipation, not tx of acute eps
f)used when constipation is anticipated or when straining at stool is painful/not advised
f)take w/ plenty of water and NOT w/ mineral oil

Front 11

Lubricant laxatives
a)agent
b)MOA (2)
c)onset
d)ADR (2)
e)problem (3)
f)counsel (4)

Back 11

a)mineral oil (liquid petrolatum)

b)softens fecal contents by coating them, preventing colonic absorption of fecal water
b)emulified preps work bette

c)6-8h after po admin; 5-15min after rectal admin

d)foreign body rxn when oil drops reach lymph nodes
d)lipid pneumonia after po ingestion and subsequent aspiration

e)impair absorption of fat vitamins
e)decr absorption of OCs/digoxin
e)NO w/ warfarin due to decr availability of vitK

f)avoid in kids under 6yo
f)avoid in pregnancy, advanced age, or on OCs
f)NO w/in 2h of eating
f)NO w/ emollient laxatives

Front 12

Saline Laxatives
a)ones (6 total)
b)MOA (3)
c)onset
d)ADR (3)
e)interaxns (3)
f)counsel (5)

Back 12

a)MgCitrate, MgOH, MgSulfate
a)Dibasic NaPhosphate, monobasic sodium phosphate, sodium biphosphate

b)nonabsorbable cations/anions
b)sulfate salts most potent
b)SI retains highly osmotic ions in intestine drawing in water causing incr in intraluminal pressure which incr motility

c)30min to 3h for po doses

d)Mg accumulation in renal insufficiency
d)ab cramping, n/v
d)diuresis/dehydration

e)oral anticoags
e)digoxin
e)Mg-containing laxatives may interfere w/ TCN absorption

f)take on empty stomach
f)do NOT take daily
f)chill oral solutions for better taste
f)not for oral use in kids under 6 or rectal use in kids under 2
f)Na products CI in CHF

Front 13

HyperOsmotic laxatives
a)MOA

Glycerin
a)onset
b)ADR

PEG3350
a)onset
b)ADR (4)
c)interaxns
d)counsel

Back 13

a)osmotic effect w/ irritant effect of sodium stearate (PEG is osmotic only)

a)30min after rectal admin
b)some rectal irritation

a)1-3d
b)bloating, cramping, farts, diarrhea
c)NONE
d)max 17g (1 capful) w/ 8oz liquid and drink qd for up to 2wks

Front 14

Stimulant Laxatives
a)2 classes
b)MOA (2)
c)onset
d)ADR (4 of many)
e)drug interaxns (2)
f)counsel

Back 14

a)anthraquinone- senna
a)diphenylmethane- bisacodyl, castor oil

b)incr peristaltic activity by local irritation on intramural nerve plexus
b)stim secretion of water/electrolytes in intestine

c)6-12h after po admin; 15-60min after rectal

d)severe cramp, f/e loss
d)malabsorption from excessive hypermotility
d)hypoCa/K
d)metabolic acidosis/alkalosis

e)antacids, H2/PPI, milk
e)take those within 1h of bisacodyl can lead to gastric/duodenal irritation

f)NO IN 3RD TRIMESTER

Front 15

General constipation product selection (4)

Kids constipation product selection (4)

Back 15

1)caution w/ Mg-containing products in renal insufficiency
2)caution w/ Na-containing products in CV disease
3)caution in pts w/ diseases that limit Na,K,Mg or Ca intake
4)dextrose containing products to be avoided in DM

1)glycerin supp in kids under 5yo
2)malt soup extract in kids under 2months
3)stimulants to be avoided
4)NO enemas in under 1yo

Front 16

Elderly constipation product selection (5)

Pregnancy constipation product selection (2)

Back 16

1)laxatives that later f/e balance may be inappropriate
2)acute eps may be treated w/ plain water or saline enemas
3)glycerin supp and po lactulose are safe and effective
4)stim lax NOT recommended
5)bulk forming agents preferred

1)prunes/prune juice as initial tx
2)bulk forming/emollient laxative are best pharma tx

Front 17

Pt Eval/Counseling in constipation (3)

Back 17

1)any signs of apendicitis, blood in stool, ab pain, n/v = report to MD
2)laxatives should be given hs if more than 6-8h is required to produce a bowel movement
3)reeval in 1wk and do NOT use laxatives for more than 1wk w/o consult MD

Front 18

Cough types
a)acute
b)sub-acute
c)chronic

Back 18

a)less than 3wk duration caused by viral infexn or URT, pneumonia, foreign body aspiration

b)3-8wk duration caused by postinfectious cough, bacterial sinusitits, asthma

c)8+wk duration associated w/ upper airway cough syndrome, asthma, GERD, COPD, ACEI/BB

Front 19

Cough types
a)productive (2)
b)non-productive (2)

Back 19

a)wet/chesty expels secretions
a)bronchitis has clear secreions, discolored/yellow w/ inflammatory disorders, bad smell w/ anaerobe infexn

b)dry/hacking w/ no physiological purpose
b)viral respiratory tract infexn, atypical bacterial infexns, GERD, cardiac disease

Front 20

Exclusion to self-care of cough (7)

Back 20

1)thick yellow/green sputum
2)fever over 101.5
3)persists over 7d
4)unintended wt loss, nightsweats, hemoptysis
5)foreign object aspiration
6)drug-associated cough
7)underlying disease state (COPD, asthma, CHF)

Front 21

General approach to tx cough (7)

Back 21

1)for nonproductive tx using centrally acting antitussives, lozenges
2)for productive cough use expectorants/protussives
3)avoid combo of expectorant and anti-tussive b/c irritative
4)initial OTC tx should relief s/sx in 7d
5)if cough improved at 7d cont tx until cough resolved
6)if cough worsened or developed exclusions to self care, refer
7)current labeling does NOT recommend use in kids under 4yo

Front 22

Nonpharma cough tx (3)

Back 22

1)vaporizers/humidifiers soothe irritated airways by incr moisture in air
2)cool-mist preferred over warm-mist b/c minimize scalding risk and decr bacteria growth
3)hard candy/lozenges soothe throat irritation and may decr cough

Front 23

Codeine as anti-cough
a)MOA/indication (2)
b)ADR/CI (3)

Back 23

a)central acting on medullqa to incr the cough threshold
a)indication for suppression of nonproductive cough caused by chemical or mechanical respiratory tract irritation

b)concomitant use of codeine and CNS depressants causes additive CNS depression
b)CI during labor when a premie birth is anticipated
b)caution in pts w/ decr respiratory reserve (asthma/COPD)

Front 24

DXM as anti-cough
a)MOA/indication (3)
b)ADR (3)
c)CI (2)

Back 24

a)non-opioid and equipotent w/ codeine
a)acts centrally to incr cough threshold
a)suppress nonproductive cough caused by chemical/mechanical respiratory tract infexn

b)drowsy
b)n/v/constipation
b)incr drowsy w/ alcohol, antihistamines, psychotropic meds

c)14d following dc of MAOI
c)preg Cat C

Front 25

Diphenhydramine as anti-cough
a)line/MOA/indication (3)
b)ADR (3)
c)caution (6)

Back 25

a)NOT first line
a)acts centrally in medulla to incr cough threshold
a)suppression of nonproductive cough caused by chemical/mechanical respiratory tract irritation

b)drowsy, respiratory depression, blurry vision
b)urinary retention, dry mouth
b)disturbed coordination

c)narrow glaucoma
c)peptic ulcers
c)BPH
c)asthma
c)hyperthyroid
c)CV disease/HTN

Front 26

Protussives (Expectorants)
a)drug
b)MOA/indication (2)
c)ADR (4)

Back 26

a)Guaifenesin

b)loosens and thins lower respiratory tract secretions and makes productive coughs more productive
b)relief of ineffective productive coughs

c)n/v
c)dizzy/drowsy
c)rash
c)stomach pain

Front 27

Topical antitussives
a)drugs (2)
b)MOA
c)problem (2)

Back 27

a)camphor
a)menthol

b)stim sensory nerve endings within the nose and mucosa creating a local anesthetic sensation and improved airflow

c)toxic if ingested
c)liquid preps can cause serious burns if used near flame, in hot water or in microwave

Front 28

S/sx associated w/ common cold (6)

Back 28

1)s/sx appear 1-3d after infexn
2)sore throat is 1st
3)day 2 or 3 get congestion, rhinorrhea and sneezing
4)day 4 or 5 get cough
5)s/sx will persist for about 7d
6)fever rarely over 100F

Front 29

Nonpharma tx for cold (besides fluids, rest, nutritious diet) (5)

Back 29

1)incr humidification w/ cool-mist
2)nasal saline sprays/drops
3)saline throat gargles
4)hot tea w/ lemon/honey; hot broths/chicken soup
5)under 4yo clear nasal passages w/ bulb syringe and irrigate the nose w/ saline drops

Front 30

Pharma tx for cold for:
a)pharyngitis
b)congestions
c)rhinorrhea/sneezing
d)cough (3)
e)peds

Back 30

a)anesthetic lozenges/sprays and systemic analgesics

b)topical or oral adrenergic agonist decongestants (watch for ppl w/ HTN, DM, hyperthyroid, etc)

c)sedating antihistamines combined w/ decongestants are of questionable benefit

d)due to postnasal drip and usually self-limiting
d)but can tx w/ sedating antihistamine/decongestant combo
d)antitussives and expectorants should NOT be recommended

e)no use cough/cold products in kids under 4yo (use nonpharma)

Front 31

Exclusions for self-tx of common cold (6)

Back 31

1)fever over 101.5F
2)chest pain/SOB
3)worsening of s/sx or development of more s/sx during self-tx
4)concurrent underlying asthma, COPD, CHF
5)AIDS or immunosuppresant tx
6)frail pts of advanced age or infants under 9months

Front 32

Eval of pt w/ common cold (3)

Back 32

1)most s/sx will resolve on their own in 7-14d
2)recommended a different med (if appropriate)
3)refer to MD if complications occur

Front 33

Intermittent allergic rhinitis
a)general
b)mild
c)mod-severe

Persistent?

Back 33

a)s/sx occur less than 4d/wk or less than 4wks

b)s/sx do NOT impair sleep or daily activities

c)pt has one or more of the following: impaired sleep, impaired daily activities, troublesome s/sx

Persistent occurs over 4d/wk and over 4wks (mild/mod-severe are same as above)

Front 34

Nonpharma tx of allergic rhinitis (avoidance of specific allergens via)
a)dust mites (4)
b)mold spores (2)
c)cat allergens
d)pollen (2)

Back 34

a)lower house humidity
a)remove carpets, upholstered furniture, stuffed animals
a)encase mattress/pillows
a)wash bedding in hot water

b)remove houseplants
b)repair damp basements and consider fungicides

c)weekly cat baths

d)avoid outdoor activities when pollen counts are high
d)close house/car windowns

Front 35

Other nonpharma tx of allergic rhinitis (2)

Back 35

1)HEPA filters remove pollen, mold spores, cat allergens, BUT do not remove dust mite fecal material
2)nasal irrigation w/ warm saline can relieve nasal mucosa irritation and dryness and o remove dried thick mucus from nose

Front 36

Pharma tx for normal person w/ allergic rhinits
a)antihistamines
b)decongestants
c)intranasal cromolyn
d)intranasal corticosteroids
e)other stuff

Back 36

a)itching, sneezing, rhinorrhea

b)nasal congestion

c)itching, sneezing, rhinorrhea

d)refer to MD if s/sx uncontrolled on OTC's

e)immunotherapy is indicated for refractory allergic rhinitis

Front 37

Allergic rhinitis in pregnancy (3)

Allergic rhinitis in kids (2)

Back 37

1)intranasal cromolyn is DoC; may use intranasal corticosteroid if cromolyn is not effective
2)chlorpheniramine is antihistamine of choice
3)loratadine/cetirizine are preferred alternatives if chlorpheniramine NOT tolerated

1)loratadine is DoC followed by cetirizine
2)intranasal mast cell stabilizer are safe and effective, but difficult for kids to admine

Front 38

Sedating vs. nonsedating antihistamines in allergic rhinitis (3) and indication

Back 38

a)first gen are highly lipophilic and cross the BBB = CNS depression
b)pheniramine/chlorpheniramine (alkylAMINES) are less sedating than ethanolamines (diphen, doxylamine)
c)non-sedaters (loratadine) and minimally sedating (cetirizine) are lipophobic and do NOT cross BBB (also inhibit release of mast cell mediators)

a)relief of s/sx of allergic rhinitis (itching, sneezing, rhinorrhea)

Front 39

Sedating Antihistamines CI's (5)

Back 39

1)nursing mothers
2)newborns
3)narrow glaucoma, ulcers, BPH
4)MAOI use
5)are photosensitizing

Front 40

Cromolyn use in allergic rhinitis
a)indication (2)
b)ADRs
c)no use in who?

Back 40

a)preventing/txing s/sx of allergtic rhinitis
a)3-7d for initial efficacy and 2-4wks b4 max benefit

b)sneezing, nasal burning/stinging

c)no for kids under 5yo

Front 41

Viral Gastroenteritis diarrhea
a)viruses that cause it
b)onset
c)tx (3)
d)which mostly affects infants and why?

Back 41

a)norovirus
a)rotavirus

b)24-48h w/ fever, n/v, diarrhea

c)mostly self-limiting, lasting 12h to 8d
c)vaccine for rotavirus
c)f/e replacement

d)rotavirus b/c spread by fecal-oral route

Front 42

Bacterial Gastroenteritis diarrhea
a)pathogens (4)
b)onset
c)tx (2)
d)transmission (2)

Back 42

a)Camplyobacter, Salmonella, Shigella, E.coli

b)onset of 1-72h w/ diarrhea, n/v, fever, cramps

c)self-limiting lasting 2-5d after tx w/ abx
c)f/e replacement

d)contaminated food/water, foreign travelers

Front 43

Protozoal diarrhea
a)onset
b)s/sx (3)
c)transmission (2)
d)tx

Back 43

a)1-3 weeks

b)watery diarrhea, anorexia, epigastric pain/bloating

c)transmitted by ingestion of contaminated water or travel outside US

d)f/e replacement w/ abx; NO OTC stuff available

Front 44

Food-induced diarrhea (3)

4 Clinical Classifications of Diarrhea

Back 44

a)food allergy
b)ingestion of foods that are fatty/spicy or contain high amounts of roughage
c)dairy products due to lactose intolerance

1)osmotic
2)secretory
3)inflammatory
4)motor

Front 45

Characteristics of stool indicating things in diarrhea
a)undigested food
b)black/tarry
c)red
d)yellowish stool
e)white tint in stool

Back 45

a)disease of SI

b)upper GI bleed

c)lower bowel or hemorrhoidal bleeding or recent ingestion of red foods

d)bilirubin and a potential for serious liver problems

e)fat malabsorption disease

Front 46

Biggest complication of diarrheal illness (3)

Back 46

1)f/e imbalance
2)assess risk/degree of dehydration
3)refer if DM, severe CV/renal disease, multiple chronic med conditions due to risk of dehydration

Front 47

Exclusions to self-care of diarrhea (10)

Back 47

1)under 6mon age
2)severe dehydration (kids w/ NO urination in past 8h or no tears when crying)
3)over 6mon of age w/ high fever 102.2F
4)over 10% dehydration, signs of shock, unconsciousness, ileus
5)blood, mucus, pus in stool
6)protracted vomiting, ab pain
7)pregnancy
8)inability to give oral rehydration tx or bad response to it
9)risk for complications (DM, CV, renal disease, immunocomp)
10)chronic/persistent diarrhea

Front 48

F/e management of rehydration of diarrhea (nonpharma tx) (3)

Back 48

1)good for managing mild-mod dehydration due to diarrhea
2)have sugar-electrolytes w/ low []s of glc/dex
3)household oral solutions can be used in pts w/ mild self-limiting diarrhea (cola/juice but not for kids under 5yo)

Front 49

Diet/prevention of diarrhea (nonpharma) (3/1)

Back 49

1)reinstitute an age appropriate diet once child is rehydrated
2)in kids avoid fatty foods, foods rich in simple sugars, spicy food, caffeine
3)no guidelines for adults

1)in infectious diarrhea, use good hygiene, strict food handling and sanitation

Front 50

Loperamide
a)indication (3)
b)MOA
c)effects (3)
d)ADR
e)CI (3)
f)duration of use

Back 50

a)travelers diarrhea
a)nonspecific acute diarrhea
a)chronic diarrhea from inflammatory bowel disease

b)opioid to decr motility/GI secretion

c)decr fecal volume
c)incr viscosity, bulk volume
c)reduced f/e loss

d)dizzy/constipation

e)NO in kids under 6yo
e)may worsen invasive or inflammatory bacterial infexns
e)pts w/ fecal leukocytes, high fever, blood/mucus in stool

f)48h

Front 51

Bismuth Subsalicylate and diarrhea
a)indication (2)
b)MOA (2)
c)ADR (3)
d)CI (4)
e)interaxns (5)
f)duration of use

Back 51

a)acute diarrhea
a)travelers diarrhea in ppl over 12yo

b)salicylate is antisecretory that decr f/e losses
b)binds toxins produced by E.coli

c)constipation/diarrhea
c)n/v
c)black discoloration of tongue/stool

d)pregnant/nursing
d)recovering from flu/chickenpox
d)AIDS
d)taking anticoags, salicylates

e)warfarin
e)VPA
e)MTX
e)probenecid
e)TCN/quinolone abx

f)48h

Front 52

Adsorbents
a)drugs (3)
b)MOA (2)

Digestive Enzymes
a)MOA

FOR DIARRHEA

Back 52

a)kaolin, pectin, attapulgite
b)adsorption of fluid to improve stool consistency
b)also adsorbs nutrients, digestive enzymes, toxins/bacteria

a)lactase enzyme prep may be taken w/ milk or other dairy products to prevent osmotic diarrhea in lactase deficient pts

Front 53

Lactobacillus (probiotic)
a)MOA (2)
b)use/benefit (2)

Back 53

a)enhance immune responses, producing antimicrobial substances, and competing w/ bacteria for intestine binding sites
a)maintains normal GI flora by inhibiting bacterial overgrowth

b)beneficial in abx-associated diarrhea
b)prevent/tx acute diarrhea

Front 54

Tx of diarrhea in kids under 6yo

Counseling points w/ diarrhea (3)

Back 54

1)oral rehydration solutions, if this doesn't work consult MD

1)most acute diarrhea stops after 48h and prevent dehydration is most important thing
2)need diet managment afterwards
3)for infants have oral rehydration solution b/c early admin can prevent hospitalization

Front 55

Common drug induced diarrhea (9)

Back 55

a)abx
b)laxatives
c)antacids w/ Mg
d)misoprostol
e)olsalazine
f)anticancer/HTN agents
g)quinidine
h)colchicine
i)drugs that retain f/e/water (mannitol, sorbitol, lactulose)

Front 56

Def of diarrhea
a)osmotic (2)
b)secretory
c)inflammatory
d)motor

Back 56

a)unabsorbed solutes in intestine incr luminal osmotic load, retarding fluid absorption
a)can be due to brush border damage or viral induced damage to epithelium

b)stim crypt cells to produce net flow of electrolytes and fluids into intestinal lumen

c)impaired fluid absorption and leaking mucus, blood, pus into lumen

d)abnormally rapid intestinal time reduces contact time b/w luminal contents and absorptive areas of intestinal wall

Front 57

Rehydration in kids 6mon to 5yrs (7) (diarrhea)

Back 57

1)if 3-5 unformed stools per day give 50-100mL/kg of ORS (oral rehydration solution) over 2-4h; give more to replace ongoing losses
2)if kid is vomiting, give 1tsp of ORS every few minutes
3)if kids is NOT dehydrated give 10mL/kg of ORS for each bowel mvmnt or 2mL/kg after each vomiting ep
4)after rehydrated, reintro food appropriate for kids age
5)if breast-feeding infant w/ diarrhea cont breast feeding, if bottle fed consider lactose-free formula
6)give kids lean meat, fruit, yogurt, no fatty/sugary stuff
7)do NOT withhold food for more than 24h

Front 58

Rehydration in ppl over 5yo (diarrhea) (4)

Back 58

1)if 3-9% wt loss or 3-5 unformed stools per day drink 2-4L of ORS over 4h
2)if NOT dehydrated drink 1/2 to 1 cup of ORS after each unformed BM
3)if NO medical conditions can have gatorade, juice, crackers/soup until diarrhea stops
4)do NOT withhold food for more than 24h

Front 59

Anatomy and Physiology of upper GI (4)

Back 59

1)esophagus is conduit b/w pharynx and stomach
2)its closed @ both ends by the upper esophageal sphincter and the lower esophageal sphinceter
3)LES prevents the passage of stomach contents into the stomach
4)when swallowing occurs, the LES relaxes and allows food to pass into stomach

Front 60

Esophageal defense mechanisms (2)

Back 60

1)barriers that limit the rate of reflux (fxning of LES)
2)esophageal mucosal resistance minimizes epithelial damage

Front 61

Alarm symptoms for GERD (6)

Typical GERD s/sx (2)

Back 61

1)dysphagia
2)unexplained wt loss
3)odynophoagia
4)chest pain
5)upper GI bleed
6)continuous n/v/d

1)acid regurgitation
2)hypersalivation

Front 62

Atypical GERD s/sx (6)

Back 62

1)chest pain
2)sensation of a lump in the throat
3)cough/asthma/chronic laryngitis
4)hoarseness
5)dental erosions
6)sleep apnea

Front 63

Exclusions for self tx of heartburn/dyspepsia (9 of many)

Back 63

1)freq heartburn for more than 3mon
2)heartburn while taking OTC H2/PPI or after taking em for 2wks
3)heartburn/dyspep that occur when taking Rx H2/PPI
4)severe heartburn/dyspepsia
5)nocturnal heartburn
6)difficulty or pain on swallowing solid food
7)vomiting up blood/black tar (or black/tarry stools)
8)pregnancy/nursing
9)kids under 12 for antacids/H2's or under 18yo for omeprazole

8)chronic hoarseness, wheezing, coughing, choking
9)unexplained wt loss
10)cont. n/v/d
11)chest pain w/ sweating, radiating pain

Front 64

Tx for mild-mod heartburn/dyspep
a)antacids
b)H2
c)omeprazole (2)
d)tx length

Back 64

a)give rapid relief w/ short duration of axn

b)to relieve s/sx and for preventing s/sx brought on by meal/exercise

c)DoC for ppl w/ freq heartburn (2 or more days/wk) and for those who do NOT respond to OTC H2's
c)may not produce complete symptomatic relief for 1-4d after initiating tx

d)length of tx for these is 2wks or less

Front 65

Nonpharma tx of heartburn/dyspep
a)diet (3)
b)lifestyle (5)

Back 65

a)avoid fatty/spicy foods
a)small meal size
a)avoid lying down after eating

b)limit alcohol and caffeine consumption
b)dc smoking
b)avoid tight fitting clothes
b)elevate head of bed
b)eat no later than 3h b4 going to bed

Front 66

Antacids
a)MOA
b)potency
c)dosing guidelings (3)

Back 66

a)neutralize gastric acid

b)expressed in mEq of ANC- the amount of acid buffered per dose over a specified period

c)take product specific recommended dosage @ onset of s/sx
c)may repeat in 1-2h
c)reeval if antacids are used over 2x/wk or regulary for over 2wks

Front 67

Antacid ADRs
a)Mg (2)
b)Al (2)
c)CaCO3 (2)
d)NaBicarb (3)

Back 67

a)dose related diarrhea
a)Mg may accumulate in pts w/ renal disease (CrCl under 30)

b)constipation
b)freq/prolonged use may lead to Al toxicity

c)belching, farting, constipation
c)may cause hypercalcemia in pts w/ renal impair

d)belching, farting
d)milk-alkali syndrome (when ingested w/ Ca)
d)Na overload results in fluid retention, wt gain, edema, worsening; CHF or renal failure

Front 68

H2's
a)MOA/F (1/1)
b)elimination (2)
c)dosing/duration (2)

Back 68

a)decr gastric acid secretion by inhibiting effect of histamine on H2 of parietal cell
a)F not affected by food but may be reduced by antacids

b)elim by renal/hepatic metabolism
b)must alter dose in old pts and those w/ renal impair

c)may be used @ onset of s/sx or 30min-1h prior to meal/exercise
c)meds should NOT be taken longer than 2wks unless MD supervising

Front 69

H2's
a)ADRs (5)
b)drug-drug interaxns (2)

Back 69

a)HA
a)drowsy
a)consitpation/diarrhea
a)dizzy
a)cimetidine can cause impotence and gynecomastia

b)cimetidine interacts w/ warfarin, phenytoin, theophylline, TCAs, amiodarone
b)Ranitdine/Famotidine have very few interaxns

Front 70

Omeprazole
a)MOA
b)indications
c)drug-drug interaxns (3)
d)ADR (2)

Back 70

a)inhibits H-K ATPase

b)approved for tx of freq heartburn in pts who have s/sx 2 or more days/wk

c)can interact w/ diazepam, phenytoin, warfarin

d)diarrhea, constipation
d)HA

Front 71

Omeprazole and...
a)old ppl
b)pregnant/lactating pts
c)pediatric pts

Back 71

a)no adjustment necessary

b)CatC, no use in preg women w/o advice of MD

c)NO use in kids under 18 unless directed by MD

Front 72

Causes of Gas
a)diet (3)
b)medical (4)

Back 72

a)malabsorption of sugar, carbs
a)dietary fiber
a)carbonated beverages, sorbitol, fatty foods

b)lactase deficiency
b)IBS
b)celiac disease
b)diabetic gastroparesis

Front 73

Causes of Gas
a)drugs (5)

Back 73

a)lactulose,abx affect intestinal flora
a)alpha-glucosidase inhibitors affect metabolism of glc
a)drugs affecting GI motility (anticholinergics, narcotics, CCBs)
a)high in fiver (psyllium) or nonabsorbale polymers (cholestyramine)
a)contain or release gas (alka-seltzer)

Front 74

Exclusions to self tx of Gas (6)

Back 74

1)persist for more than several months
2)severe debilitating s/sx
3)sudden change in ab pain, incr in freq/severity of s/sx, or onset of s/sx in ppl over 40yo
4)ab discomfort or sudden change in bowel fxn (diarrhea/constipation)
5)GI bleeding
6)fatigue/unintention wt loss

Front 75

Nonpharma tx of Gas
a)eating habits (7)

Back 75

a)eat/drink slowly in calm environment
a)chew food throroughly
a)avoid washing solids down w/ a beverage
a)avoid gulping/sipping liquids
a)eliminate smoking
a)avoid gum chewing/sucking hard candy
a)do NOT overload stomach @ any one meal

Front 76

Nonpharma tx of Gas
a)diet (4)
b)med use/lifestyle (4)

Back 76

a)avoid foods that cause gas s/sx
a)avoid gas-producing food (beans, broccoli, onion, cabbage)
a)avoid foods w/ air whipped into them
a)avoid carbonate beverages

b)avoid long-term use of meds intended for relief of cold s/sx
b)avoid tight-fitting clothes
b)do NOT lie down or sit in a slumped position immediately after eating
b)develop regular routine of exercise/rest

Front 77

Simethicone and Gas
a)MOA (2)
b)dosing

Back 77

a)mix of inert silicon polymers to act as defoaming agent to relieve gas
a)acts in stomach/intestine to reduce surface tension of gas bubbles so they can be broken more easily/expelled

b)125-250mg after meals (max 500mg/d)

Front 78

AC and Gas
a)MOA
b)other

Back 78

a)relieve as after formed (but not shown to be very effective)

b)tastes like crap

Front 79

Alpha-galactosidase (BEANO)
a)MOA
c)use (2)
d)when NOT to use (3)

Back 79

a)hydrolyzes oligosaccharides into their component parts before they can be metabolized by colonic bacteria

b)add to cooled food only as temps over 130 can inactivate it
b)for prevention of gas

c)NO in peds/pregnancy
c)NO in DM b/c produces galactose
c)NO if allergy to mold (ie PCN)

Front 80

Lactase replacement products (gas) (3)

Probiotics and gas (2)

Back 80

a)used in pts w/ lactose intolerance to aid in digestion of dairy products
a)take @ time dairy products are ingested or added to milk prior to ingestion
a)for prevention of gas

b)do 14d trial, if no benefit dc
b)do NOT admin w/ abx (b/c probiotics will be inactivated)

Front 81

Other pt counsel w/ Gas

Back 81

1)tell em to return or call after 1wk of self tx w/ diet measures or OTC antiflatulants/digestive enzymes

Front 82

Onset/Duration of meds in relieving heartburn (and which is best for symptomatic relief)
a)Antacids
b)H2's
c)H2's + antacids
d)PPIs

Back 82

a)onset 5min
a)duration 20-30min

b)onset 30-45min
b)duration 4-10h

c)onset less than 5min
c)duration 8-10h

d)onset 2-3h
d)duration 12-24h
d)BEST SYMPTO RELIEF

Front 83

LOOK AT RISK FACTORS FOR HEARTBURN CHART

Back 83

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