Term
| what is one of the most common chronic conditions in the US which patients take DAILY meds? |
|
Definition
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|
Term
| in GERD, resting LES pressures are _____ gastric baseline pressure |
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Definition
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|
Term
| in GERD, if alarming symptoms are present what should you consider? |
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Definition
|
|
Term
| what is an example of a drug that makes GERD worse? |
|
Definition
ethanol
also CCB, estrogen, theophylline |
|
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Term
|
Definition
lifestyle changes
then PA
then surgeon |
|
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Term
| what should be the initial trial of therapy with a pt with a hx of uncomplicated GERD |
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Definition
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Term
| examples of patient directed therapy in GERD |
|
Definition
antacids
H2RAs
Omeprazole (prilosec OTC) |
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Term
| pts should not self medicate for longer than ____ without further eval |
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Definition
|
|
Term
| what is the most effective 1st line tx for GERD? |
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Definition
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Term
| when should PPIs be taken for optimal benefit? |
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Definition
| taken 30-60 mins prior to other meds, breakfast, or evening meal |
|
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Term
| 2 examples of histamine blockers used for GERD |
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Definition
Ranitidine (Zantac)
Famotidine (Pepcid) |
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Term
| example of a PPI for GERD |
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Definition
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Term
| PPI specifics in regards to the delayed release tablet |
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Definition
| do not crush or chew bc they degrade quickly in acidic environment |
|
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Term
| why have PPIs come under fire lately? |
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Definition
inhibition of CYP enzymes
anti-platelet interaction |
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Term
| PPIs -- symptomatic relief is achieved in approximately ___% of patients, and healing rates are about ___% in 8 weeks |
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Definition
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Term
| Cisapride is a promotility agents. why was it removed in 2000? |
|
Definition
arrhythmias killed people
only use in special cases with close monitoring |
|
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Term
| what med can be used to increase contractions? |
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Definition
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Term
| ___ is an antacid that is widely popular, cost effective, and ease of use, but may cause constipation |
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Definition
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Term
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Definition
|
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Term
| what antacid requires monitoring for long term use |
|
Definition
| calcium carbonate (hypercalcemia) |
|
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Term
what are some important drugs that interact with antacids?
- should be taken 1-2 hrs before taking other meds |
|
Definition
tetracycline
fluroquinolones
quinidine |
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Term
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Definition
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Term
| acute treatment for healing H pylori |
|
Definition
PPI for 4 weeks, or H2 antagonist
treat H pylori
D/C NSAID if can |
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Term
| med used for active duodenal/gastric ulcers but never used alone |
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Definition
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Term
| med for prevention of NSAID induced ulcers. also used for labor inducer or miscarriages |
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Definition
|
|
Term
| what antacid should you not use in a pt w/edema or trying to lose weight? |
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Definition
| sodium bicarbonate (alka seltzer) |
|
|
Term
|
Definition
H pylori
NSAID induced
stress ulcers |
|
|
Term
adjunctive tx for PUD
- what does not heal it? |
|
Definition
antacids
bismuth subsalicylate
OTC PPI
- OTCs dont heal it |
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|
Term
|
Definition
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|
Term
| ______ is an antidiarrheal used in PUD but you must be careful if pt is on warfarin. similar to ASA |
|
Definition
|
|
Term
two types of PUD
- describe each |
|
Definition
1. GASTRIC: older pts, normal-low acid production, inc stress
2. DUODENAL: young pts, family hx common, ulcergenic drugs more common |
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Term
| H pylori secretes ____ which damages the stomach (mucosa). |
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Definition
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Term
| must tx H pylori with an _____ but can cause diarrhea. what can the symptoms be tx with? |
|
Definition
abx
- PPI, antacid, H2 antagonists |
|
|
Term
| NSAID based ulcers inhibit _____ that do what? |
|
Definition
Cox -1
decrease oritective prostaglandins that protect the stomach |
|
|
Term
| a prevpack is prescribed for _____. whats in it? |
|
Definition
H pylori
- Lansoprazole (Prevacid)
- Amoxicillin (penicillin abx)
- Clarithromycin (macrolide abx) |
|
|
Term
| if allergic to penicillin, what do you tx h pylori with? |
|
Definition
|
|
Term
|
Definition
calcium carbonate
magnesium (hydroxide/chloride)
aluminum (hydroxide/phosphate)
sodium bicarbonate |
|
|
Term
|
Definition
pain relieved by eating
blood in emesis or stool |
|
|
Term
|
Definition
must be tx by prescription drugs
adjunctive care with antacids |
|
|
Term
| control of vomit is ____. in the brainstem there are 2 units. what are they? |
|
Definition
central
- vomiting center, chemoreceptor trigger zone (CTZ) |
|
|
Term
| extramedullary centers in the brain are triggered by for vomiting: (3) |
|
Definition
psychological stimuli (odors, fear)
vestibular disturbances (motion sickness)
cerebral trauma |
|
|
Term
| non pharmacological tx for N/V |
|
Definition
| ginger ale (over ice and sip slowly) |
|
|
Term
OTC H2 receptor antagonists for N/V tx (3)
- which one should you not use but is OTC? |
|
Definition
Ranitidine (zantac)
Famotidine (pepcid)
Cimetidine (Tagamet) -- DO NOT USE!!! many drug interactions! |
|
|
Term
| OTC tx for N/V if pregnant |
|
Definition
|
|
Term
| OTC tx for N/V - phosphorylated carbohydrate solution is great for ___. 2 examples? |
|
Definition
children
- Emetrol, Nauzene
- may reduce smooth muscle contractions
adverse effects: complications w/DM, abd cramping |
|
|
Term
| antidopaminergic antiemetic (2) |
|
Definition
Phenazothiazines: prochlorperazine (compazine)
& promethazine (pherergan) |
|
|
Term
anticholinergics that tx N/V (3)
also treats motion sickness |
|
Definition
antihistamines: Meclizine (antivert)
scopolamine (transderm - scop) -- PATCH behind ear
dimenhydrinate (zofran) |
|
|
Term
| antiemetic serotonin antagonists (1) |
|
Definition
|
|
Term
| antidopaminergic antagonist ____ receptors at the chemoreceptor trigger zone. NOT AS effective as ____ and ____ for chemo induced nausea |
|
Definition
D2
metoclopramine & ondanestron |
|
|
Term
| antidopaminergic phenothiazines |
|
Definition
Prochlorperazine (Compazine)
Promethazine (Phenergan) |
|
|
Term
| dopamine receptor antagonists |
|
Definition
|
|
Term
| antihistamine that is the most useful for motion sickness |
|
Definition
meclizine (Antivert)
- can be used for vertigo or motion sickness |
|
|
Term
| ____ is an anticholinergic that is a patch but not used for cancer chemo nausea |
|
Definition
|
|
Term
| ____ is a serotonin antagonist that is used for the PREVENTION of N/V assoc w/cancer chemo |
|
Definition
|
|
Term
| ____ is a highly selective substance P neurokinin 1 (NK 1) receptor antagonist. used for prevention of acute and delayed chemo induced N/V. Big guns, expensive, used as last resort! |
|
Definition
Aprepitant (Emend)
- neurokinin receptor antagonist |
|
|
Term
| _____ has NOT been shown to be optimal as monotherapy for chemo induced N/V. what are the adverse reactions? |
|
Definition
Aprepitant
- fatigue, constipations, diarrhea, anorexia, nausea, hiccups |
|
|
Term
| rationale for multi drug therapy - combo or antiemetic drugs for CINV is due to the fact that ____ agents produce emesis. _____ the individual doses ___ the adverse effects |
|
Definition
|
|
Term
| meds that cause constipation |
|
Definition
calcium
analgesics (opioids, NSAIDS)
anticholinergics
iron |
|
|
Term
| whats always the 1st line tx for constipation? |
|
Definition
non pharmacologic
- increase fluid intake 6-8 8 oz glasses/day |
|
|
Term
| pharmacologic constipation tx? (2) |
|
Definition
- bulk forming (Metamucil) 1st line for both short and long term
- Emollients Colase (stool softeners) |
|
|
Term
pharmacologic emollient (Stool softener) - onset 24-72 hrs.
does what? example? |
|
Definition
prevents constipation and straining
Docusate sodium (colace) |
|
|
Term
| lubricants used for constipation tx do what? |
|
Definition
| decrease absorption of fat soluble vitamins (A, D, E,K) |
|
|
Term
| hyperosmotics for constipation can be used in ___. example? |
|
Definition
|
|
Term
| caster oil is used for constipation but we should not use it. why? |
|
Definition
|
|
Term
| what is approved for CHRONIC idiopathic constipation? |
|
Definition
|
|
Term
| BRAT is used for non pharmacological diarrhea. what does it stand for? |
|
Definition
bananas
rice
applesauce
toast |
|
|
Term
| what is a non pharmacological tx for diarrhea that saves lives? |
|
Definition
| oral rehydration therapy (ORT) |
|
|
Term
|
Definition
Loperamide (Immodium)
Diphenoxylate/atropine (Lomotil) |
|
|
Term
strong ties between ___ and IBS
sx? |
|
Definition
emotions
- diarrhea OR constipation |
|
|
Term
|
Definition
| increase dietary fiber to 25 g/day, increase slowly to avoid bloating |
|
|
Term
| antispasmodic IBS tx (also reduces short term pain) |
|
Definition
| Dicyclomine (Bentyl), do not use if pt glaucoma (narrow), cardiovascular issues, GU issues, Myasthenia Gravis, or GI obstructive disease |
|
|
Term
5 HT3 Antagonists (IBS w/diarrhea) therapy
- what is specific about it? |
|
Definition
| Alosetron (Lotronex) only available through "Prescribing Program for Lotronex" due to risk of ischemic colitis (consent form) GI specialist |
|
|
Term
| ____ is used for intestinal gas. is it absorbed? what is the dose you should not exceed? |
|
Definition
Simethicone
not absorbed
do not exceed 500 mg/day |
|
|
Term
| what is not approved or shown effective for gas, that is very messy? |
|
Definition
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