Gastrointestinal Disorders

Front 1

Is Erosive Esophagitis cured by tx?

Back 1

No. One tx stops sx return

Front 2

GERD lifestyle modifications

Back 2

Eats 2-3 hours before bed
Don't lie down or bend over after meal
Smaller meals
Lose weight
Don't smoke
Avoid spicy or fatty foods
Elevate head 6 inches

Front 3

Take PPI __ mins ___ eating

Back 3

30-60, BEFORE

Front 4

MgOH in Zegerid may cause

Back 4

Diarrhea, and abd cramping

Front 5

PPI ADR

Back 5

Headache, NVD, abd pain, flatulance, constipation, dry mouth

Possible malabsorpation of B12, Ca, and Fe

Front 6

Is Erosive Esophagitis cured by tx?

Back 6

No. One tx stops sx return

Front 7

GERD lifestyle modifications

Back 7

Eats 2-3 hours before bed
Don't lie down or bend over after meal
Smaller meals
Lose weight
Don't smoke
Avoid spicy or fatty foods
Elevate head 6 inches

Front 8

Take PPI __ mins ___ eating

Back 8

30-60, BEFORE

Front 9

MgOH in Zegerid may cause

Back 9

Diarrhea, and abd cramping

Front 10

PPI ADR

Back 10

Headache, NVD, abd pain, flatulance, constipation, dry mouth

Possible malabsorpation of B12, Ca, and Fe

Front 11

Nocturnal gastric acid breakthrough

Back 11

Mostly seen in PPI BID

Give H2RA qhs. (Acid secretion at nighttime almost entirely dependent on histamine stimulation)

Front 12

Prilosec/Nexium and Plavix

Back 12

2C19. Plavix efficacy diminished

Front 13

OTC PPI counseling

Back 13

Take for 14 days.

See doctor if you need to take this for more than 14 days

Don't repeat in less than 4 months without seeing a physician.

Front 14

PPI and Warfarin

Back 14

Increase INR and bleeding risk.

Front 15

Ask a doctor before taking if you have

Back 15

heartburn for >3months
chest pain
lightheadedness, sweating or dizziness

Front 16

Cimetidine + Phenytoin DDI

Back 16

Increase in dilantin

Front 17

Cimetidine + Ketoconazole DDI

Back 17

Decrease F of ketoconazole due to increase pH.

Give ketoconazole 2 hr before hand.

Front 18

Cimetidine + tacrolimus DDI

Back 18

Increase [tacrolimus]

Front 19

All H2RA need ___ dose adjustment

Back 19

renal

Front 20

Triple therapy

Back 20

PPI, Clarithromycin, Amoxicillin/metronidazole
14 days

Front 21

Quadruple therapy

Back 21

Bismuth, metronidazole, tetracycline, H2RA/PPI
10-14 days

Front 22

When to perform H.pylori curative test

Back 22

no earlier than 4 weeks after completing therapy

Front 23

NSAID-related PUD tx

Back 23

Use PPI or H2RA for 4 wks.

If presence of H. pylori then initiate 3x or 4x therapy

PPI, H2RA or Cytotec should be used for pt on chronic NSAIDs with risk - i.e. chronic corticosteroid therapy, etc.

Front 24

SE of PPI and H2RA

Back 24

Headache, Nausea, Diarrhea

Front 25

Sucralfate SE

Back 25

constipation

Front 26

PPI and H2RA DDI

Back 26

Digoxin, Ketoconazole, Iron

Front 27

Amox and Tetracycline decrease the efficacy of this drug.

Back 27

Oral contraceptives

Front 28

Clarithromycin is a CYP ___

Back 28

Inhibitor

Front 29

What do we have to monitor renal fxn with Carafate

Back 29

Al+3

Front 30

PUD pt with bleeding

Back 30

Put on IV PPI and do endoscopy

Front 31

Can we do PPI BID?

Back 31

Only if they don't respond to qd therapy

Front 32

Antacids must be taken at least __ hours apart from iron, tetracycline, and digoxin

Back 32

2

Front 33

Antacids must be taken at least __ hours apart from fluoroquinolones

Back 33

4-6

Front 34

Antacid SE

Back 34

Electrolyte disturbances
Al can cause constipation and bone demineralization
Acid-Base disturbances

Front 35

Irritable Bowel Syndrom (IBS)

Back 35

Abdominal pain with changes in bowel habits for at least 3 months

Front 36

IBS categories

Back 36

Diarrhea predominant
Constipation predominant
Mixed

Front 37

First line therapy for mild IBS

Back 37

Bentyl
Hyoscyamine
Both are anticholingerics
Both avoid in constipation

Front 38

For constipation predominant IBS

Back 38

Psylluim husk
Polycarbophil

Front 39

Zelnorm

Back 39

Tegoserod
5-HT4 receptor antagonist
Only prescribed for constipation predominant IBS under emergency investigation drug protocol
Tegoserod take 30 min ac and not during acute attack.
Diarrhea, nausea, headache

Front 40

TCA in IBS

Back 40

Improve global scores and pain only for diarrhea predominant IBS

Front 41

SSRI in IBS

Back 41

Paroxetine
Improve abdominal pain and improve psychiatric disorder (part of IBS is believed to be CNS derived)

Front 42

Lotronex

Back 42

Alosetron
Seretonin receptor antagonist
Only for women with chronic diarrhea IBS
Constipation, abd pain, cramping

Front 43

Amitiza

Back 43

Lubiprostone
Improves global scores for women with constipation IBS
Nausea, diarrhea, headache and dyspnea within 1 hour

Front 44

IBS pt counseling

Back 44

anticholinergics used prn

Front 45

UC Categorization

Back 45

Mild UC: 4 stools/day blood (-)
Moderate: >4 bm/day
Severe: >6bm/day blood (+)
Fulminant: >10bm/day blood (+)

Front 46

Crohn's Disease

Back 46

Mild to moderate: Ambulatory and tolerate oral alimentation

Moderate to severe: Fail to respond to tx

Severe to Fulminant: refractory to steroids or biologics

Front 47

Tx principles for UC

Back 47

Use topical aminosalysates first.
If refractory + topical steroids
If refractory + oral aminosalysates.

Front 48

Which drugs are used for maintenance therapy in UC

Back 48

aminosalyciates and azothaprine only.

We want to eventually wean off corticosteroids

Front 49

Severe cases of UC

Back 49

infliximab to decrease steroid load

Front 50

Fulminant UC

Back 50

IV steroids
Topical and oral salycicates

if still refractory try cyclosporine

May introduce azothiaprine.

Front 51

Maintenance therapy for CD

Back 51

Azothiaprine, mercaptopurine, Adalimumab, Certolizumab, Infliximab, Natalimumab

Front 52

Initial therapy for CD

Back 52

Oral corticosteroids.
if refractory add azothiaprine or mercaptopurine.
if still refractory the add methotrexate
If still refractory give the biologics

Front 53

What to give in fistulating CD

Back 53

metronidazole and ciprofloxacin.
Adalimumab, certolizumab, infliximab, and natalizumab.