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52 Cards in this Set
- Front
- Back
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Food precipitates pain in this type of ulcer, and relieves pain in this ulcer
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Gastric
Duodenal |
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Describe the pharmacologic treatment of GERD
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Step 1 - Antacids, and OTC acid suppressants (H2 antagonists and omeprazole)
Step 2 - PPI or H2 antagnists (PPI's best) Adjunctive therapy - Promotility agents (Metoclopramide) |
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Describe the pharmacologic treatment of PUD caused by H. Pylori infection
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PPI + Clarithromycin/Amoxicillin for 10-14 days
PCN or Macrolide allergy --> Substitute Metronidazole If 3 drug regimen fails, PPI + bismuth + Metronidazole/Tetracycline for 14 days |
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Describe the pharmacologic treatment of PUD caused by NSAIDs
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First line - PPI for 6-8 weeks
Second line - H2 antagonist or Misoprostol |
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Main adverse reaction of Mg antacids
Al, Ca antacids |
Diarrhea
Constipation |
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Use Al and Ca containing products with caution in these patients
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Renal Dysfunction
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Name the four H2 antagonists
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Cimetidine
Ranitidine Famotidine NIzatidine |
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Pepcid complete contains this
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MgOH in addition to famotidine
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Cimetidine inhibits CYP enzymes the most and can also cause this side effect
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Gynecomastia
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PPIs may inhibit the absorption of these medications
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Itraconazole, Ketoconazole
Decreased effect of clopidogrel |
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Name the PPIs (5)
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Omeprazole
Esomeprazole Lansoprazole Dexlansoprazole Pantoprazole |
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What is in Zegrid?
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Omeprazole + Sodium Bicarb
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When should you take a PPI?
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15-30 min before breakfast and before dinner if you take a medication that requires twice daily dosing
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How does metoclopramide help alleviate GERD?
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It is a dopamine agonist that increases LES pressure, and Gastric emptying
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What important side effect can you see with this drug?
When is this drug contraindicated? What else is this medication used for? |
Extrapyramidal symptoms (Can be exacerbated by antipsychotics)
Seizures Diabetic gastroparesis |
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What drug acts as a mucosal protectant?
What is it primarily used for? |
Sucralfate (Gaviscon)
PUD, not GERD |
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Which agent is a prostaglandin analog?
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Misoprostol
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What else is misoprostol used for?
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Abortion - educate on appropriate contraception
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What is the treatment for Ulcerative Colitis (mild/moderate distal disease)?
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Active: Topical mesalamine (enema or suppository), oral aminosalicylate or topical corticosteroid
Maintenance: Topical mesalamine or oral aminosalicylate |
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What is the treatment for Ulcerative Colitis (mild/moderate extensive disease)?
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Active disease: oral aminosalicylate (first line), oral corticosteroids, azathioprine, 6-mercaptopurine, infliximab
Maintenance: Oral aminosalicylate (first line), azathioprine, 6 - mercaptopurine, infliximab |
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What is the treatment for Ulcerative Colitis (severe disease)?
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Infliximab (if urgent hospitalization is not needed)
IV corticosteroids (if hospitalization is needed), or IV cyclosporine |
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What is the treatment for Crohn's disease (Mild/moderate)?
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Active disease: Oral aminosalicylate, budesonide (disease localized to ileum and/or right colon)
Second line: Metronidazole, Ciprofloxacin |
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What is the treatment for Crohn's disease (Moderate/Severe)?
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First line: Prednisone
Second line: Infliximab, Adalimumab, certolizumab pegol, Natalizumab, Methotrexate (IM or SC) |
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What is the treatment for Crohn's disease (Severe/Fulminant)
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First line: IV corticosteroids
Second line: IV cyclosporine or IV tacrolimus |
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What is the maintenance therapy for Crohn's disease?
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First line: Azathioprine, 6 - mercaptopurine, Methotrexate, Infliximab, Adalimumab, Certolizumab pegol, Natalizumab
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Name the 4 aminosalicylates
What is the mechanism of action? |
Sulfasalazine
Mesalamine Olsalazine Balsalazine Decrease inflammation in GI tract by inhibiting prostaglandin synthesis |
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What allergies must you be concerned about with aminosaliciylates?
What disease state must you be concerned about? |
Aspirin (salicylate derivatives)
Sulfa (Sulfasalazine) G6PD deficiency |
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What is sulfasalazine comprised of?
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Mesalamine (therapeutic effect) and sulfapyridine (side effects)
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Sulfasalazine has many more serious side effects in comparison to the other aminosalicylates. Name the key side effects.
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Stevens-Johnson syndrome
Folate deficiency Hemolytic anemia Agranulocytosis Hepatitis |
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Name the 3 more commonly used corticosteroids in IBD
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Budesonide
Methylprednisolone Prednisone |
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When are corticosteroids used and for how long?
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Acute exacerbation
4 - 8 weeks, then tapered IV therapy is given for severe exacerbations, then switched to oral therapy after 7-10 days |
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What are the primary side effects of oral corticosteroids?
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Hyperglycemia
Increased appetite Insomnia Hypertension Edema Adrenal suppression Osteoporosis Delayed wound healing Cataracts |
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Name the 4 immunosuppressants
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Azathioprine
6 - Mercaptopurine Cyclosporine Methotrexate |
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Which of these 4 agents are contraindicated in pregnancy, cause hepatic dysfunction and bone marrow suppression?
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Azathioprine
6 - Mercaptopurine Methotrexate |
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Which agents can cause renal dysfunction?
Pancreatitis? (Check amylase/lipase) |
Methotrexate
Cyclosporine Azathioprine 6 - Mercaptopurine |
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6 - mercaptopurine is the active metabolite of this
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Azathioprine
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When is cyclosporine used?
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When the patient has not responded to corticosteroids
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When is methotrexate used?
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Only crohns disease
Particularly effective in steroid dependent or refractory CD |
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Name the 4 biologic agents used in IBD
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Adalimumab (Humira)
Certolizumab pegol (Cimzia) Infliximab (Remicade) Natalizumab (Tysabri) |
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Which of these agents is contraindicated in NYHA class III or IV heart failure?
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Infliximab (Remicade)
***Also contraindicated in active infection*** |
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What is the mechanism of action for these agents?
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Inhibit tumor necrosis factor
***Except Natalizumab (Tysabri) which binds to a subunit of integrins to inhibit inflammation |
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When is Natalizumab used?
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Moderate/Severe active CD who are refractory to or unable to tolerate conventional therapies and anti-TNF monoclonal antitherapy
***Must use monotherapy and only approved for CD*** |
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What is the only pertinent drug interaction involving biologic agents?
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Do not administer live vaccinations
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When must a PPD be done prior to therapy?
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Before Adalimumab, Certolizumab, Infliximab
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When are the anti-TNF factors used?
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Mod/Severe active CD in patients who have no responded to adequate therapy with a corticosteroid of immunosuppresant
***Except Infliximab, which is also approved in steroid refractory patients or steroid dependent despite conventional therapies |
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Name the serious side effects of anti-TNF agents
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Infection (especially fungal and tuberculosis)
Lymphoma Heart Failure exacerbation Bone marrow suppression |
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Infliximab can cause these 3 additional side effects
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Hepatitis
Delayed infusion reaction (fever, rash, myalgia, headache, sore throate) Infusion reaction (hypotension, fever, chills, urticaria, pruritis) ***Adalimumab and Certolizumab can cause a lupus-like syndrome and Hypertension*** |
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What do patient need to be enrolled in while on Natalizumab?
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The TOUCH program
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What drug must you pretreat before infusion and what do these pretreatment medication include?
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Infliximab (over 2 hours) - Antihistamine, Acetaminophen, and/or a Corticosteroid
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When should mesalamine enemas or supporsitories be administered?
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Bedtime - to allow at least 8 hours of contact
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Which PPI's are available IV?
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Esomeprazole (Nexium)
Pantoprazole (Protonix) |
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What should be administered to patients taking sulfasalazine?
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Folic acid to prevent folic acid deficiency
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