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39 Cards in this Set
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Antacids
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Neutralize acid:
CaCO3 + 2H+ --> Ca2+ + CO2 + H2O Calcium carbonate Magnesium hydroxide Aluminum-magnesium hydroxide AE: pH of plasma up --> hypercalcemia --> Milk-alkali syndrome Osmotic diarrhea with Mg salts |
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Name four H2 blockers and their AEs
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Cimetidine (Tagamet)
Ranitidine (Zantac) Famotidine (Pepcid) Nizatidine (Axid) AE: thrombocytopenia, drug-drug interactions (very rare, quite safe drugs). Not as good as PPIs. |
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Name six proton pump inhibitors
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Omeprazole
Esomeprazole Pantopraszole Rabeprazole Lansoprazole Dexlansoprazole |
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PPIs: half-life, activation
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Short half-life but long duration of action. Acid activated, better to take 30 minutes before meals
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PPIs: AE
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Possible drug-drug interaction with clopidogrel.
Pneumonia, diarrhea (because of increased risk of infection) Fe, Ca Bone loss (from uncontrolled, observational studies), PPIs can affect intestinal absorption of Ca Traveller's diarrhea is more common in those that take PPIs (because of higher stomach pH). Reduce acid = increase risk of infection. |
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What goes up when histamine, PGE2, ACh, and Gastrin go up?
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Stomach acid secretion
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Name 2 cytoprotective agents
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Misoprostol
Sucralfate Rendered irrelevant by effectiveness of PPIs |
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Misoprostol
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PGE2 analog
Approved to prevent peptic ulcer disease with NSAIDs AE: Nausea, diarrhea (prostaglandin effects) Off label use: to stimulate uterine contractions |
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Sucralfate
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Approved to treat peptic ulcer disease
Now used for misc. esophago-gastritides (non-acid reflux gastritis) Well tolerated Can have some drug-drug interactions |
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Metaclopramide
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5-HT4 agonist
D2 antagonist (can cause dystonia) Stimulates antral contractions, gastric emptying, mild increase in LES pressure Renally cleared AT: Has extrapyramidal effects: Dystonia Tardive dyskinesia (irreversible facial twitches) Can be worse when stopped Used as an adjunct for treatment of GERD |
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Octreotide
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Somatostatin analogue
Decreases foregut secretions. Improves secretory diarrhea mediated by hormones (such as VIP, gastrin) Used with administration of CPT11 (irinotecan) to prevent diarrhea. Used to treat (?) portal HTN AE: decreases splanchnic blood flow, can cause bleeding with portal HTN, intestinal ischemia. Bradycardia Gallstones (because of decreased gallbladder emptying) |
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VIPoma causes what?
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"secretory" diarrhea
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What are some of the things that comprise the diagnosis of IBS?
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Rome 3:
12 weeks of symptoms Abdominal pain Change in stool Relieved by defecation ABSCENCE of red flags (if there are red flags, it is not IBS) IBS often happens after infections. |
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Alosetron
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5-HT3 antagonist (seratonin)
Can cause ischemic colitis Can cause severa constipation Only approved in women! (More women are affected by IBS than men) |
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What are three antispasmotics used for IBS and GI hypermotility? Tell me about them
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Dicyclomine, hyoscyamine
These are like atropine and scopolamine. They are antimuscarinic and have expected anticholinergic side effects. They help with spasm/pain. |
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Name four antidiarrheals
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Loperamide
Diphenoxylate/atropine Tincture of opium Bismuth |
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Loperamide
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(Imodium), antidiarrheal
Opiod agonist (all opiod agonists decrease intestinal motility) No CNS penetrance so not addictive Can cause thermoregulation issues (people who get runner's diarrhea cannot take loperamide) |
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Diphenoxylate/atropine
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(Lomotil), antidiarrheal
CNS penetrance Abuse potential |
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Tincture of opium
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(Laudanum), antidiarrheal
CNS penetrance |
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Bismuth
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Increases depolarization thresholds
Renal clearance Can cause black stool ("pseudomelena") --> can be mistaken for an upper GI hemorrhage! Aspirin + pepto bismol --> salicylate overdose! |
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Psyllium
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Bulk-forming cathartic
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Lactulose
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Non-absorbed, non-digested disaccharide
Very sweet. Fermentation in gut can cause bloating and flatulence. Can be used to treat liver encephalopathy. Liver toxins get drawn into gut and get excreted. |
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Polyethylene glycol
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Osmotic diuretic
Very well studied |
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NA3PO4
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Excellent laxative, but can cause hypophosphatemia and renal failure.
No "ceiling", dehydration is a concern. Still can be found in fleet enemas |
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Bisacodyl
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Stimulant, cathartic (laxative) drug
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Senna
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(Senekot), stimulant laxative.
AE: Melanosis Carthartic colon Dehydration/electrolytes Some evidence that if you take it chronically you can cause damage to the enteric NS. |
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Lubiprostone
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(Amitiza) Used for idiopathic chronic constipation
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Neostigmine
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(Prostigmin, Vagostigmin)
Used for ileus, Ogilvie's Syndrome (acute psuedoobstruction and dilation of the colon in the absence of any mechanical obstruction in severely ill patients). AE: bradycardia |
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c/c fiber and bran: effect on constipation
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Bran doesn't work!
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Docusate/Colace
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Often used as a laxative, but there is no supporting data!
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Pancrelipase
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Used for exocrine pancrease insufficiency
Some FDA approved, some not. Varying concentrations of enzymes Mainly differ in delivery systems Very high doses associated with colonic strictures Peds: if give too much pancrelipase to children, you can get strictures of the R colon. |
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Ursodiol
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Stimulates bile salt-dependant bile flow.
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Cholestyramine
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Bile acid binding resin
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What demographic can be hypermetabolizers of omeprazole?
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15-20% of Asians
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If see fatigue, SOB, don't forget what in DDx?
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Anemia
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LUQ pain, relieved by defecation. What could be the diagnosis?
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IBS
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What herbal remedy is ok to use for IBS?
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peppermint oil
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What is the proper workup for constipation?
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Check red flags (R/O obstructive lesion) --> look at meds list for things that could be causing constipation (codine, anticholinesterases) --> fiber --> osmotic laxative --> if still have sx --> more aggressive workup
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What can you give to decrease the necessary dose of azthioprine?
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allopurinol
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