Naplex_Gi Disease

Front 1

Classification of PUD

Back 1

Duodenal (more common)
Gastric (More freq NSAID induced)

Can be:
- H. pylori related
- non-H. pylori related
- NSAID related
- non-NSAID related
- stress related (stress doesn't cause PUD but how one response to stress, ex: smoking, drinking)

Front 2

Diagnostic Criteria for PUD

Back 2

Invasive (Endoscopy)

Non-invasive

Front 3

PUD Dx Criteria:

Invasive Diagnostic Methods (Endoscopy)

Back 3

- Histology (use if pt recently taken PPI but do NOT give PPI before test)
- Rapid Urea Test (RUT) - use if pt have NOT taken PPI w/in 2 wks or ABx or bismuth w/in 4 wks

Front 4

PUD Dx Criteria:

Non-Invasive Diagnostic Methods

Back 4

Antibody testing
- does NOT ID active H. pylori (duh, cause it IDs the antigen)
- do NOT use to confirm eradication of H. pylori

Urea Breath Test (UBT)
- can be used to confirm H. pylori eradication NO sooner than 4 wks after completion of therapy
- 13C UBT w/ Pranactin = non-radioactive
- 14C Pytest = radioactive <-- AVOID in pregnant females

Fecal Antigen Test
- can be used to confirm H. pylori eradication NO sooner than 4 wks after completion of therapy
- not as standarized as UBT

Front 5

Tx of PUD

Back 5

Amer College of Gastroenterology Guidelines =
Triple therapy x 14 days (PPI + Biaxin + Amox or Flagyl)

OR

Quadruple therapy x 10 - 14 days (bismuth + Flagyl + Tetracycline + H2RA or PPI)

Front 6

Tx NSAID related PUD

Back 6

antisecretory --> PPI or H2RA x 4 wks to PROMOTE healing & relieve symptoms (sucralfate may also be used to AID ulcer healing but req multiple daily dosing & is assoc w/ many drug interactions)

use ABx if H. pylori present

Pts who require chronic NSAIDs or at risk for developing PUD --> use PPI, H2RA, or misoprostol to PREVENT PUD

Front 7

PUD Drug Therapy:

MOA of PPI

Back 7

Inhibits H+/K+/ATPase enzyme system of the secretory surface of the gastric parietal cell --> gastric acid secretion = suppressed

Front 8

PUD Drug Therapy:

MOA of H2RA

Back 8

reversibly blocks histamine-2 receptors on the surface of gastric parietal cells --> gastric acid secretion = suppressed

Front 9

MOA of sucralfate

Back 9

sucralfate forms a viscous adhesive that binds to positively charged protein molecules in the ulcer crater --> thus forming a protective barrier

Front 10

PUD Patient Counseling:

PPI

Back 10

take before meals

generally, do not crush or chew

Front 11

PUD Patient Counseling:

ANTACIDS used to control breakthrough symptoms

Back 11

take 1 - 2 hours before/after H2RA is taken

Front 12

PUD Patient Counseling:

H2RA

Back 12

can be taken w/o regards to meals

Front 13

PUD Patient Counseling:

Amoxil
Biaxin
Flagyl
Tetracycline

Back 13

Amox, biaxin, flagyl maybe taken w/o regard to meals HOWEVER taking biaxin &amp;amp; flagyl WITH meals helps reduce stomach upset

Tetracycline is best taken on an EMPTY STOMACH
- antacids, dairy products, or iron-containing cpd should be taken 2 hrs BEFORE/AFTER tetracycline

Front 14

PUD Patient Counseling:

Sucralfate

Back 14

Take 1 hour BEFORE meals &amp; at bedtime

Front 15

PUD Drug Therapy:

What are the 4 main PPIs &amp;amp; what is their pregnancy category?

Back 15

Cat C
Omeprazole (Prilosec)

Cat B
Lansoprazole (Prevacid)
Rabeprazole (Aciphex)
Pantoprazole (Protonix)

Front 16

PUD Drug Therapy:

Dosage: Omeprazole (Prilosec)

Back 16

Rx: 20 - 40 mg QD

OTC: 20 mg QD x 14 days

Omeprazole + Na_Bicarb (Zegerid)
20 - 40 mg QD

Esomeprazole (Nexium)
20 - 40 mg QD --> has IV

Front 17

PUD Drug Therapy:

Dosage: Lansoprazole (Prevacid)

Back 17

15 mg QD

To

30 mg BID

Dexlansoprazole (Kapidex)
30 - 60 mg QD

Front 18

PUD Drug Therapy:

Dosage: Rabeprazole (Aciphex)

Back 18

10 - 20 mg QD

Front 19

PUD Drug Therapy:

Dosage: Pantoprazole (Protonix)

Back 19

40 - 80 mg QD

Front 20

PUD Drug Therapy:

What are the 4 H2RA?

Back 20

Cimetidine (Tagamet)
Ranitidine (Zantac)
Nizatidine (Axid)
Famotidine (Pepcid)

Front 21

PUD Drug Therapy:

Dosage: Cimetidine (Tagamet)

Back 21

300 mg QID

to

800 mg QHS

Front 22

PUD Drug Therapy:

Dosage: Ranitidine (Zantac)

Back 22

150 mg BID or 300 mg QHS

same as Axid

Front 23

PUD Drug Therapy:

Dosage: Nizatidine (Axid)

Back 23

150 mg BID or 300 mg QHS

same as Zantac

Front 24

PUD Drug Therapy:

Dosage: Famotidine (Pepcid)

Back 24

20 mg BID or 40 mg QHS

Front 25

PUD Drug Therapy:

What are the 4 antibacterial used in PUD?

Back 25

Clarithromycin (Biaxin)
Amoxicillin (Amoxil)
Metronidazole (Flagyl) --> has IV
Tetracycline

Front 26

PUD Drug Therapy:

Dosage: Clarithromycin (Biaxin)

Back 26

500 mg BID x 10 - 14 days

Front 27

PUD Drug Therapy:

Dosage: Amoxicillin (Amoxil)

Back 27

1 g BID x 10 - 14 days

Front 28

PUD Drug Therapy:

Dosage: Metronidazole (Flagyl)

Back 28

500 mg TID x 10 - 14 days

Front 29

PUD Drug Therapy:

Dosage: Tetracycline

Back 29

500 mg QID x 10 - 14 days

Front 30

PUD Drug Therapy:

Dosage: Sucralfate (Carafate)

Back 30

1 g QID

Front 31

GERD Drug Therapy:

Magnesium hydroxide

Back 31

(Milk of Magnesia)

Front 32

GERD Drug Therapy:

Aluminum hydroxide

Back 32

(Amphojel)
(ALternaGEL)

Front 33

GERD Drug Therapy:

Aluminum carbonate

Back 33

(Basaljel)

Front 34

GERD Drug Therapy:

Magnesium hydroxide + aluminium hydroxide

Back 34

(Maalox)

Front 35

GERD Drug Therapy:

Magaldrate

Back 35

(Riopan)

Front 36

GERD Drug Therapy:

Calcium carbonate

Back 36

(Tums)
(Titralac)

Front 37

GERD Drug Therapy:

Alginic acid + aluminum OH + magnesium OH

Back 37

(Gaviscon)

Front 38

Pt is taking antacid for GERD & quinolone. What should be counseled?

Back 38

Antacids & quinolones should be taken 4 - 6 hrs apart

Front 39

Pt is taking antacid for GERD & tetracycline / iron / digoxin. What should be counseled?

Back 39

Antacids should be taken AT LEAST 2 hrs apart from tetracycline, iron, and digoxin

Front 40

GERD Drug Therapy:

Is alginic acid effective for esophageal healing?

Back 40

No data indicates esophageal healing on endoscopy

Front 41

GERD Drug Therapy:

What is MOA of alginic acid?

Back 41

Reacts with Na bicarbonate in the saliva to form sodium alginate viscous solution, which floats on the surface of gastric contents.

The solution acts as a barrier to protect the sophagus from the corrosive effects of gastric reflux.

For this reason, it's ineffective if pt = supine position &amp; MUST NOT be taken at bedtime

Front 42

GERD AE:

Magnesium containing antacids frequently cause. . .

Back 42

diarrhea

Front 43

GERD AE:

Aluminum containing antacids frequently cause. . .

Back 43

constipation &amp; bind to the phosphate in the gut, which can lead to bone demineralization

Front 44

GERD AE:

Sodium bicarbonate may cause. . .

Back 44

sodium overload, particularly in patients with hypertension, CHF, &amp; chronic renal failure

It may lead to systemic alkalosis

Should be used on a SHORT-TERM basis, if at all

Front 45

GERD Drug Interactions:

Antacids

Back 45

tetracycline / ferrous sulfate / quinolones = reduced absorption & effectiveness b/c antacids form chelates w/ them

Azoles / sucralfate = decreased absorption b/c antacids incr gastric pH

Quinidine = decr clearance b/c antacids incr urine pH

Digoxin / H2RA = decr systemic absorption when taken concomitantly w/ antacids

Phenytoin = decr absorption if large doses of antacids taken

Digoxin & Phenytoin levels should be monitored frequently when antacids are used concomitantly

Front 46

GERD Non-drug Therapy:

Foods to avoid

Back 46

Alcohol
Coffee
Chocolate
High-fat foods
Spicy foods
Acidic foods
carbonated drinks

Front 47

GERD Non-drug Therapy:

Drugs that Decrease LES pressure

Back 47

CCBs
Beta-Blockers
NItrates
Barbiturates
Anticholinergics
Therophylline

Front 48

GERD Non-drug Therapy:

Drugs that have Direct Irritant Effects on the Esophageal Mucosa

Back 48

Tetracyclines
NSAIDs
Aspirin
Bisphosphonates
Iron
Quinidines
Potassium Chloride

Front 49

IBD Drug Therapy:

Mesalamine (Delayed-release Tablets)

Back 49

(Asacol)
(Lialda)

Front 50

IBD Drug Therapy:

Mesalamine (Delayed-released Capsules)

Back 50

(Pentasa)
(Rowasa)

Front 51

IBD Drug Therapy:

Mesalamine (Enema and suppository)

Back 51

(Salofalk)
(Claversal)

(Canasa) - suppository only

Front 52

IBD Drug Therapy:

Balsalazide

Back 52

(Colazal)

Front 53

IBD Drug Therapy:

Budesonide

Back 53

(Entocort EC)

In asthma = Pulmicort

Front 54

IBD Drug Therapy:

Azathioprine

Back 54

(Imuran)

Front 55

IBD Drug Therapy:

6-mercaptopurine

Back 55

(Purinethol)

Front 56

IBD Drug Therapy:

Methotrexate

Back 56

(Abitrexate)

In RA = Rheumatrex
In Cancer = Trexall

Front 57

IBD Drug Therapy:

Infliximab

Back 57

(Remicade)

Front 58

IBD Drug Therapy:

Adalimumab

Back 58

(Humira)

Front 59

IBD Drug Therapy:

Certolizumab pegol

Back 59

(Cimzia)

Front 60

IBD Drug Therapy:

Natalizumab

Back 60

(Tysabri)

Front 61

IBD Drug Therapy:

Cyclosporine

Back 61

(Neoral)
(Sandimmune)

Front 62

IBD Patient Counseling:

Sulfasalazine (Azulfidine)

Back 62

Take after meals

Avoid sun exposure

Take folic acid supplementation to avoid anemia

May cause orange discoloration of urine & skin

Front 63

IBD Patient Counseling:

Mesalamine

Back 63

Tablets: swallow whole

Enemas: shake well before use

Front 64

IBS Drug Therapy:

Dicyclomine

Back 64

(Bentyl)

Front 65

IBS Drug Therapy:

Amitriptyline

Back 65

(Elavil)

Front 66

IBS Drug Therapy:

Paroxetine

Back 66

(Paxil)

Front 67

IBS Drug Therapy:

Tegaserod

Back 67

(Zelnorm)

Front 68

IBS Drug Therapy:

Polycarbophil

Back 68

(Fibercon)

Front 69

IBS Drug Therapy:

Alosetron

Back 69

(Lotronex)

Front 70

IBS Drug Therapy:

Lubiprostone

Back 70

(Amitiza)

Front 71

IBS Drug Therapy:

Loperamide

Back 71

(Imodium)

Front 72

IBS Drug Therapy:

Diphenoxylate + Atropine

Back 72

(Lomotil)