Term
| What is the most prevalent chronic disease in childhood? |
|
Definition
|
|
Term
|
Definition
| Inflammation of the airway, due to airway hyper-responsiveness |
|
|
Term
| What class of drug is most effective at reversing acute airway obstrxn? |
|
Definition
| SABA- short acting beta agonists |
|
|
Term
| What is the preferred therapy for all forms of persistent asthma? |
|
Definition
| ICS- inhaled corticosteroids |
|
|
Term
| Where does gas exchange begin to take place in the respiratory tract? |
|
Definition
|
|
Term
| Where does the majority of gas exchange occur in the respiratory tract? |
|
Definition
|
|
Term
| In acute severe asthma it's important to have early and appropritiate __________ of _____________ to resolve exacerbation and prevent relapse/serious obstrxn in the future |
|
Definition
| internsification of treatment |
|
|
Term
| when in therapy is it appropriate to use Xolair? |
|
Definition
| Anytime pt is at step 5 or 6 therapy and still not controlled |
|
|
Term
| What is first line treatment for asthma patients? |
|
Definition
|
|
Term
| A pt has been on inhaled corticosteroids for 3 wks and has shown no change in asthma, what is the next step in therapy? |
|
Definition
| You must wait until 4-6wks of ICS therapy before you can determine the next step |
|
|
Term
| What drug is most effective in an acute exacerbation of asthma? (ProAir or Advair) |
|
Definition
|
|
Term
| What patients should have a peakflow meter? |
|
Definition
| Pts who can't recognize their symptoms are worsoning |
|
|
Term
| How does powder inhalation differ from MDI inhalation? |
|
Definition
Power- inhale quickly
MDI- inhale slowly |
|
|
Term
|
Definition
|
|
Term
| Which LABA acts faster? (Salmaterol or Fomoterol) |
|
Definition
| Fomoterol (F is for fast) |
|
|
Term
| What an important differentiation for LABA use in Asthma vs COPD |
|
Definition
Asthma- LABA must be combined w/ ICS
COPD- LABA may be used alone |
|
|
Term
| If a patient only has 1 criteria for high risk and the rest are low risk criteria what classification is the Pt? |
|
Definition
|
|
Term
| What asthma pt should have an asthma action plan? |
|
Definition
|
|
Term
| Which MDI should be used with a spacer? |
|
Definition
|
|
Term
| Does theophylline have a wide or narrow therapeutic index? |
|
Definition
|
|
Term
| What is an important consideration for COPD pts? |
|
Definition
| All vaccinations should be current |
|
|
Term
|
Definition
|
|
Term
| If COPD is not reversible what it our primary goal for treatment? |
|
Definition
| Improve QOL and slow disease progression |
|
|
Term
| What is the mainstay of COPD treatment? |
|
Definition
|
|
Term
| What are benefits of bronchodilators in COPD pts? |
|
Definition
| improve QOL, exercise tolerance, reduce sx and reduce rate of pulmonary decline |
|
|
Term
| How do inhaled corticosteroids affect COPD? How's this different from Bronchodilators? |
|
Definition
| Reduce exacerbations and reduce pulmonary decline. Doesn't improve QOL, exercise tolerance or reduce symptoms. |
|
|
Term
| At what stage in COPD to pt normally seek treatment? |
|
Definition
|
|
Term
| What drug is considered to be 1st line for all COPD? |
|
Definition
| Spiriva (tiotropium)- long acting anticholinergic. Supperior to Salmoterol and ipratropium |
|
|
Term
| What are the tree cardinal Sx of COPD? |
|
Definition
1) Inc dyspenia
2) inc sputum vol
3) Inc purulence (infxn) |
|
|
Term
| What type of AB are typically good choices for COPD pt? |
|
Definition
|
|
Term
| Is COPD more common in men or women? |
|
Definition
|
|
Term
| When should you use an AB in COPD? |
|
Definition
1) all three cardinal Sx
2) inc sputum purulence w/ 1 other cadinal Sx
3) expereince severe exacerbation requiring mechanical ventilation |
|
|
Term
| What is the #1 goal for almost all COPD pts? |
|
Definition
|
|
Term
| What form of theophylline is best used for in-home titration? |
|
Definition
|
|
Term
| For an obese pt what weight should be used when calculating theophylline dose? Why? |
|
Definition
| IBW- because theophylline doesn't deposit in fatty tissue |
|
|
Term
| What is the bioavailability of Aminophylline? |
|
Definition
|
|
Term
| What is the bioavailability of IR theophylline? |
|
Definition
|
|
Term
| What is the bioavailability of ER theophylline? |
|
Definition
|
|
Term
| Should theophylline be renally dosed? |
|
Definition
|
|
Term
| what is the t1/2 of theophylline? |
|
Definition
|
|
Term
| How does smoking affect theophylline levels? what's the sigificance of that? |
|
Definition
| Theophylline levels are lowered by smoking. If a pt quits smoking they are at risk for theophylline toxicity |
|
|
Term
| What is the therapeutic range for theophylline? |
|
Definition
|
|
Term
| What is one of the therapeutic benefits/actions of theophylline? |
|
Definition
|
|
Term
| When should theophylline levels be checked? |
|
Definition
30min calculate Vd
12-34h
72hr
q4-7d
q1-6mo |
|
|
Term
| What are signs of theophylline toxicity around 20mg/L? |
|
Definition
| NVD, HA, irritability, insomnia, tremor |
|
|
Term
| What are signs of theophylline toxicity around the 35mg/L range? |
|
Definition
| Hyperglycemia, hyperkalemia,hyperthermia hypotension, arrhytmia, seizure, brain damage, death |
|
|
Term
| How do you know theophylline is working? |
|
Definition
| Sx improve, pulmonary fxn, resp rate etc. treat pt not number |
|
|
Term
| What are two drugs you might expect to see a COPD pt on? |
|
Definition
| corticosteroids and AB (clarithromycin) |
|
|
Term
| What type of diet may alter the t1/2 of theophyllin? |
|
Definition
| Low carb diet speeds clearing of theophylline |
|
|
Term
| What drugs increase EXCRETION of theophylline? |
|
Definition
| Tobacco, rifampin, phenytoin, phenobarb, charcoal, carbamazepine, moricizine |
|
|
Term
| What disease states increase the clearance of theophylline? |
|
Definition
| cystic fibrosis, hyPERthyroid, smoking, mariguana, high carb/low protein diet |
|
|
Term
| Drugs/disease that aren't listed in my flash cards will decrease EXCRETION of theophylline (inc sr concentration) |
|
Definition
|
|
Term
| What disease states have no-change in theophylline clearance? |
|
Definition
| Elderly smokers, cholestasis |
|
|
Term
| When should you NOT use a loading dose of theophylline? |
|
Definition
| Asthma per the guidelines |
|
|
Term
| What is normal loading dose of theopylline/aminophylline? |
|
Definition
| 5mg/kg theophylline 6mg/kg aminophylline |
|
|
Term
| What doseage form of theophylline would you use for a loading dose? |
|
Definition
| Immediate release formulation |
|
|
Term
| What are 3 causes of PUD? |
|
Definition
1) H. pylori
2) NSAID
3) Stress |
|
|
Term
| What are the charateristics of a H. pylori ulcer? |
|
Definition
| superficial chronic duodenal ulcer. Non-responsive to acid suppression therapy and bleeding is minor |
|
|
Term
| What are the characteristics of NSAID ulcer? |
|
Definition
| Deep chronic stomach ulcer that bleeds alot |
|
|
Term
| What are the characteristics of stress ulcers (SRMD)? |
|
Definition
| superficial ACUTE stomach ulcer that causes major bleeding |
|
|
Term
| What are risk factors for PUD? |
|
Definition
| >60yo, anticoag, corticosteroid or SSRI, previous PUD/upper GI bleed, CV disease |
|
|
Term
| How might you prevent ulcers? |
|
Definition
| Avoid exacerbating factors like NSAIDs, alcohol and cigarettes |
|
|
Term
| Why is unconventional Tx of H. pylori bad? |
|
Definition
| Because it increases the risk of recurrence/complications |
|
|
Term
| What are two three-drug forumations for irradication of H pylori are good-excellent in efficacy? |
|
Definition
1) Charlithromycin 500BID Amoxil 1gBID lansoprazole 30mgBID
2) clarithomycin 500BID flagyl 500BID, prilosec 20BID |
|
|
Term
| What is good treatment for NSAID ulcer? |
|
Definition
| PPI, it's equivalent to misoprostol and better tolerated/less risk |
|
|
Term
| Which is better, selective COX2 or PPI and NSAID? |
|
Definition
| PPI and NSAID, they have same efficacy and ulcer risk, but COX2 has CV risk |
|
|
Term
| When is low dose PPI or H2RA therapy indicated? |
|
Definition
| Pt who fails H. pylori erradication, heavy smokers and those that develop complications related to disease |
|
|
Term
| What are 3 risk factors for developing PUD? |
|
Definition
| NSAIDs, smoking, H pylori |
|
|
Term
| Which of the following are risk factors for NSAID ulcers? Pltlt count <100Kmm3, male, stressful life |
|
Definition
|
|
Term
| What is the defensive mechanism in the gastric mucosa? |
|
Definition
|
|
Term
| What do prostiglandins do in PUD |
|
Definition
| Maintain mucosal layer and stimulated bicarb prodxn |
|
|
Term
| NSAID induced mucosal damage is caused by? |
|
Definition
| Direct mucosal irritation |
|
|
Term
| What are two good regemin formula for H. pylori therapy? |
|
Definition
Tripple drug therapy 2AB 1PPI
Quad therapy 2AB 1BSS and 1H2RA |
|
|
Term
| What is an important consideration when evaluating a pt who has failed h pylori eradication therapy? |
|
Definition
| Pre-existing antimicrobial resistance |
|
|
Term
| What is the H. pylori resistance rate of clarithromycin in the US? |
|
Definition
|
|
Term
| Which is superior in NSAID assocaited PUD? H2RA or Sucralfate? |
|
Definition
|
|
Term
| What is an important consideration for COPD pts? |
|
Definition
| should be current on all vaccinations (esp flu and pneumococcal) |
|
|
Term
|
Definition
| no, but rate of decline can be slowed |
|
|
Term
| What is the mainstay of treatment for COPD? |
|
Definition
| Bronchodilators- they improve QOL, excerise tolerance while reducing Sx and rate of pulmonary decline |
|
|
Term
| What is the benefit of ICS in COPD? |
|
Definition
| decreased number of exacerbations and reduce rate of pulmonary decline |
|
|
Term
| What is the FEV1/FVC ratio diagnostic for COPD? |
|
Definition
|
|
Term
| What stage of COPD do most pts begin to seek help? |
|
Definition
|
|
Term
| What drug is considered to be 1st line for all COPD? |
|
Definition
| Spiriva/tiotropium: long-acting anticholinergic (superior to salmoterol and ipratropium) |
|
|
Term
| What are the 3 cardinal Sx for COPD? |
|
Definition
| Inc dyspenia, inc sputum volume, inc purulence |
|
|
Term
| What antibiotics are typically good for COPD? |
|
Definition
|
|
Term
| What gender population is COPD more prevelant in? |
|
Definition
|
|
Term
| When should a COPD pt get an AB? |
|
Definition
1) all three cardinal Sx
2) Inc purulence with 1 other cardinal Sx
3) Experience sever exacerbation requiring mechanical vent |
|
|
Term
| What is the 1# goal for nearly all COPD pt? |
|
Definition
|
|
Term
| What form of theophylline is best for in-home titration? |
|
Definition
|
|
Term
| What weight should be used for theophylline dosing on Obese persons? |
|
Definition
| IBW, theophylline doesn't deposite in fatty tissue |
|
|
Term
| What doseage form of mesalamine is limited to proctitis or left-sided disease? |
|
Definition
|
|
Term
| What re the major treatment goals of IBD? |
|
Definition
| Alleviation of S/Sx and suppression of inflammation |
|
|
Term
| What class of medication reduces GI motility and should be AVOIDED in iritable bowel diseases due to risk of toxic megacolon? |
|
Definition
|
|
Term
| What treatment for IBD should be avoided in pregnant women? |
|
Definition
| Methotrexate (Abortifacient effects) |
|
|
Term
| What disease state can smoking/nicotine actually HELP? |
|
Definition
|
|
Term
| What IBD has a discontinuous pattern of inflammation? |
|
Definition
|
|
Term
| In ulcerative colitis, the inflammatory process is limited to what area? |
|
Definition
|
|
Term
| What is the site most commonly involved in the inflammatory process of Crohn's? |
|
Definition
|
|
Term
| What are the typical symptoms of celiac? |
|
Definition
| ABd distention, failure to thrive and chronic diarrhea |
|
|
Term
| What is the cornerstone for treatment of celiac? |
|
Definition
|
|
Term
| What is the major side of damage in celiac disease? |
|
Definition
|
|
Term
| What gluten containing substance may be used to make beer? |
|
Definition
|
|
Term
| What antispasmodic drug is used to treat pain related to IBS? |
|
Definition
| Dicyclomine and Hyoscamine |
|
|
Term
| What botanical products act as as antispasmodics due to ability to relax the GI smooth muscle? |
|
Definition
Peppermint oil
Chammomile (matricaria recutita) |
|
|
Term
| What are the symptoms of IBS? |
|
Definition
| Constipation/diarrhea, abd pain, incomplete evacuation, abd fullness, bloating, flatulence, mucus in stool, fecal incontinence |
|
|
Term
| What is the pahrmacologic treatment that improves stool passage in IBS-C but has unfavorable effects on pain? |
|
Definition
| Bulk producers (methycellulose, psyllium) |
|
|
Term
| Celiac is not IgE based, therefore this medication class would not be found useful for treatment? |
|
Definition
|
|
Term
| Oral or topical doseage form of __________ derivatives is the main phamacologic treatment in active mild to moderate Crohn's |
|
Definition
|
|
Term
| This TCA can be used for treatment of IBS |
|
Definition
|
|
Term
| What class of antidepressant can be used in the treatment of IBS and should be reserved for failure of TCA therapy because it lacks evidence? |
|
Definition
|
|
Term
| What is the etiology of celiac? |
|
Definition
| Autoimmune inflammatory enteropathay |
|
|
Term
| What gender population is affected more by IBS? |
|
Definition
|
|
Term
| What is the pathophys of IBS? |
|
Definition
Dysregulation of Brain-gut axis
Visceral hypersensitivity (abnormal CNS processing)
5HT3 receptor stim slows colon motility (increases resorption)
5HT4 stimlation speeds motility |
|
|
Term
| What ist he manning criteria for IBS? |
|
Definition
2 or more Sx for atleast 6mo
abd pain w/ defication, freq stool, loose stool, distention, incomplete evacuation, mucus stool |
|
|
Term
| What is the Rome III criteria for IBS? |
|
Definition
2 or more for 3 days or more/mo for 3 months
pain relief from defication, onset associated w/ change in stool freq, pain assocaited w/ change in stool formation |
|
|
Term
| What dietary adjustments seem to help IBD? |
|
Definition
|
|
Term
| What drug classes are used in IBS-D? |
|
Definition
| Antispasmodics, antimotility, TCA and 5HT3 antagonists |
|
|
Term
| What antispasmodics are indicated in IBS-D? |
|
Definition
| Dicyclmine, hyoscyamine, propanthenline, clininium |
|
|
Term
| What antimotility agen is used in IBS-D? |
|
Definition
|
|
Term
| What TCAs are indicated in use for IBS-D |
|
Definition
| Amitriptyline and doxepin |
|
|
Term
| What drug classes are used for treatment of IBS-C |
|
Definition
| SSRI and bulk forming agents and 5HT4 agonists |
|
|
Term
| What SSRI is indicated in IBS-C? |
|
Definition
|
|
Term
| What bulk forming laxatives are indicated in IBS-C? |
|
Definition
| Psyllium, methylcellulose |
|
|
Term
| What 5HT4 agonist is used for IBS-C? |
|
Definition
| Zelnorm/tegaserod- only available for emergency treatment (CV risk) |
|
|
Term
| What 5HT3 antagonist is used in IBS-D? |
|
Definition
Lotronex/alosetron, prescribed through promethus Rx program
Dose 0.5-1mg BID |
|
|
Term
| What is some criteria for Lotronex use? |
|
Definition
| painful stomach cramps/bloating, often can't control need to have bowel movement, can't lead a normal home/work life because you need to be near bathroom |
|
|
Term
| What drugs work best for IBS pain? |
|
Definition
| Antidepressants (TCA then SSRI) |
|
|
Term
| What alternative therapy might help with IBS pain? |
|
Definition
| relaxation/hypnosis therapy |
|
|
Term
| What are two probiotics that might help in IBS? |
|
Definition
Bifantis- dec pain and bloating
B animalis- improves QOL and bloading (IBS-C) |
|
|
Term
| What is the theory of Probiotics in IBS? |
|
Definition
| bacterial overgrowth causes abnormal motility, food not normally fermented until after distal ileum/colon and bact in ileum causes fermentation making methane which slows GI transit |
|
|
Term
| What reaction does gluten trigger in Celiac? |
|
Definition
| IgA and IgG autoimmune rxn (NOT ALLERGIC) |
|
|
Term
|
Definition
| Incomplete digestion of gluten proteins produces peptides that are immunogenic to Pt causing inflammation |
|
|
Term
| What is characteristic of Celiac in the intestine? |
|
Definition
| Loss of villous architecture |
|
|
Term
| What is characteristic of Celiac in the intestine? |
|
Definition
| Loss of villous architecture |
|
|
Term
| What are Celiac pt often originally diagnosed with? |
|
Definition
|
|
Term
| Is celiac more common in men or women? |
|
Definition
|
|
Term
| Is celiac more common in men or women? |
|
Definition
|
|
Term
| What are risk factors for celiac? |
|
Definition
1) dermatitis herpetiformis is 100% Dx
2) first deg relative
3) Autoimmune thyroid |
|
|
Term
| What are some complications of Celiac? |
|
Definition
non-hodgkins lymphoma
adenocarcinoma (esophageal, intest, pharyngeal) |
|
|
Term
| What are 3 possible comorbitities of Celiac? |
|
Definition
1) Dietary intolerance
2) Thyroiditis
3) psoriasis |
|
|
Term
| Celiac should be supplemented with vitamins- how much Vit D? |
|
Definition
|
|
Term
| What are the clinical features of Crohn's not found in UC? |
|
Definition
Abd wall/intest fistula
Aphthous or linear ulcers
Strictures
Transmural involvement
Cobblestone appearance of intestine |
|
|
Term
| What feature of UC rarely found in Crohn's? |
|
Definition
|
|
Term
| What feature of UC rarely found in Crohn's? |
|
Definition
|
|
Term
| What drug should not be used in UC/CD w/ diarrhea? |
|
Definition
| Loperamide, lomotil, codein |
|
|
Term
| What drugs should be avoided in UC/CD? |
|
Definition
|
|
Term
| What are 5 classes of drugs used to treat UC and CD? |
|
Definition
1) Aminosalicylates
2) Corticosteroids
3) Immunosuppresants
4) Biologics
5) Integrin heterodimer antagonists |
|
|
Term
| When is topical dosage form better for IBD? |
|
Definition
| UC w/ rectal involvement, use suppositories |
|
|
Term
| What are some aminosalicylates that might be used in UC or CD? |
|
Definition
Sulfasalazin/azulfidine
Mesalamine/asacol
Olsalazine/dipentum
Balsalazide/Colazal |
|
|
Term
| What are two aminosalicylates you could use in UC and CD in pt who has sulfa allergy |
|
Definition
Olsalazine/dipentum
Balsalazide/colazal |
|
|
Term
| What corticosteroids might you use to treat UC or CD? |
|
Definition
| Budesonide, entocort HC, hydrocortisone, methylpred, prednisone, prednisolone |
|
|
Term
| What immunosuppresants might be used in UC or CD? |
|
Definition
| 6-MP, methotrexate, cyclosporine |
|
|
Term
| What drug class is good for maintenence in UC or CD due to it's slow onset of action and what it targets |
|
Definition
|
|
Term
| What bioligics might you use in UC or CD? |
|
Definition
infliximab/remicade
rituximab/rituxan
adalimumab/humira
certolizumab/cimzia |
|
|
Term
| What types of biologics do you use in UC or CD? |
|
Definition
|
|
Term
| What integrin heterodimer antagonist might you use in UC or CD? |
|
Definition
|
|
Term
| What do persistent/chronic diarrhea Sx indicate? |
|
Definition
| underlying problem, not a short term fix. OTC won't take care of them |
|
|
Term
| The most common type of diarrhea in the US is caused by what two things? |
|
Definition
|
|
Term
| What are the 4 types of diarrhea? |
|
Definition
Osmotic
Secretory
inflammation (mucus/blood/puss)
Motor (abnormal rapid transit time) |
|
|
Term
| Where is the disorder if stool appears undigested? |
|
Definition
|
|
Term
| Where is the disorder if there is red bloody stool? |
|
Definition
|
|
Term
| Where is the disorder if stool is black and tarry? |
|
Definition
|
|
Term
| Where is the disorder if stool is yellowish? |
|
Definition
|
|
Term
| Where is the disoder if stool is whiteish? |
|
Definition
|
|
Term
| What are three things to be mindful of when treating diarrhea? |
|
Definition
dehydration
fluid
electrolytes |
|
|
Term
| What is the problem with household drinks as opposed to oral rehydration solution? |
|
Definition
| Not enough sodium in household drinks |
|
|
Term
| What does loperamide doe? |
|
Definition
slows motility
it's an Opiod agonist but doesn't cross BBB (No CNS stimulation) |
|
|
Term
| What is a concern with BSS? |
|
Definition
| Bismuth subsalicylates could cause reys synd in children w/ chicke pox or flu |
|
|
Term
| What are some considerations of BSS (tox) |
|
Definition
Don't take w/ ASA can cause salicylate toxicity
can cause tinnitus and neurotoxicty w/ AIDS |
|
|
Term
| What is a counseling point about BSS? |
|
Definition
may blacken mouth/tounge and stool, it's harlmess
not for pregnant/nursing women |
|
|
Term
| What is a problem with not taking enough water with bulkforming agents? |
|
Definition
|
|
Term
| Are mineral oil and castor oil recommended for constipation? |
|
Definition
|
|
Term
| What is first and second line treatment for constipation? |
|
Definition
|
|
Term
| Note that pt and providers see "constipation" differently |
|
Definition
| Pt may think it's if you don't go 3x in 1 day, but it's really for up to a week |
|
|
Term
| What might a pt consider to be constipation that is not truely constipation? |
|
Definition
| straining, small stool, dry stool, bloating, incomplete evacuation, infreq or dec in freq of BM |
|
|
Term
| What are some causes of constipation? |
|
Definition
| lack of fiber, lack of fluid, drug induced, sedentary lifestyle, diet, disease, tight clothes |
|
|
Term
| What is a normal time frame for BM? |
|
Definition
3x/day - 3x/wk
Patient based though! |
|
|
Term
| What are some constipating drugs? |
|
Definition
| Analgesics, NSAIDs, antacids, antihistamines, anticholinergics, CCB, Ca supplements, narcotics, iron |
|
|
Term
| What are some signs of constipation |
|
Definition
| headache, lower back pain, abd discomfort |
|
|
Term
| what are considered to be alarm symptoms of constipation? |
|
Definition
| Fever, N/V, para/quadripalegia, daily lax use, unexlained bowel habit changes, blood in stool, dark tarry stool, change in stool character (very thing), persists more than 2wks, anorexia, sudden wt loss, hx of IBD- THESE EXCLUDE YOU FROM SELFCARE |
|
|
Term
| What are some goals for constipation? |
|
Definition
relieve constipation
decrease symptoms
prevent future constipation |
|
|
Term
| What are two important points about laxatives? |
|
Definition
1)Use lowest dose for shortest time
2)don't use more than 7 days w/o seeing physicain (if no BM) |
|
|
Term
| What are some non-pharmacologic remidies for constipation? |
|
Definition
Fiber
Fluid
Aerobic exercise
Don't ignore urge to deficate |
|
|
Term
| How much fluid should a person with constipation drink (providing renal fxn is good and no CHF) |
|
Definition
|
|
Term
| How much fiber should a person take to combat constipation? |
|
Definition
| age +5 = xg or 20-35g/day |
|
|
Term
| What foods are high in fiber? |
|
Definition
|
|
Term
| What are some SE associated with fiber? |
|
Definition
|
|
Term
| Name some emollient laxatives |
|
Definition
|
|
Term
| How long does it take for emolients to work? |
|
Definition
|
|
Term
| What class of drugs do you want to use to avoid straining (hemroids/surgeries etc) |
|
Definition
|
|
Term
| What medication is considered to be a lubricating laxative? |
|
Definition
|
|
Term
| What's the onset for mineral oil? |
|
Definition
|
|
Term
| What is a concern with mineral oil? |
|
Definition
| aspiration/lipid pneumnia- never administer while laying down |
|
|
Term
| What increases problems with mineral oil? |
|
Definition
|
|
Term
| What are some concerns with lubricating agents and pregnancy or coumadin? |
|
Definition
|
|
Term
| What are some saline laxatives? |
|
Definition
| mag citrate, mage hydroxide, mag sulfate, dibasic sodium phosphate, monobasic sodium phosphate, sodium phosphate |
|
|
Term
| What is the onset time for saline laxatives |
|
Definition
|
|
Term
| When might you use a saline laxative? |
|
Definition
| Bowel prep, don't use long term |
|
|
Term
| What are some concerns in saline laxatives? |
|
Definition
| very young or old are worse, Mg phos is hard on renal dysfxn, na restricted diets |
|
|
Term
| What is a contraindication for saline laxatives? |
|
Definition
Renal impairment
CHF
dehydration |
|
|
Term
| What are some examples of hyperosmotic laxatives? |
|
Definition
| PEG, glycerin, lactulose, sorbitol |
|
|
Term
| what is the onset of glycerin? |
|
Definition
|
|
Term
| What is the onset for PEG? |
|
Definition
|
|
Term
| How much PEG do you mix per dose? |
|
Definition
|
|
Term
| What is a inhibative factor with PEG? |
|
Definition
|
|
Term
| What are some stimulant laxatives? |
|
Definition
| Senna, Bisacodyl, Castor oil |
|
|
Term
| What is a drug commonly used for opiod constipation? |
|
Definition
| senna and docusate (2 MOA) |
|
|
Term
| Who might you see abuse laxatives? |
|
Definition
Elderly- thinking they need to go 3x daily
Young women- weight loss |
|
|
Term
| What is the onset for senna? |
|
Definition
|
|
Term
| What is an important consideration with bisacodyl? |
|
Definition
don't amin w/ antacids, H2RA, or milk, this will erode the enteric coating
Don't crush or chew |
|
|
Term
| What is important to remeber about castor oil |
|
Definition
| very quick onset, don't give at bedtime |
|
|
Term
| What is a side effect to remeber with senna? |
|
Definition
| can discolor the urine, pigmentation of colon |
|
|
Term
| What class of stimulants is senna? |
|
Definition
|
|
Term
| What subclass is the stimulant lax bisacodyl? |
|
Definition
|
|
Term
| What are the two primary types of GERD syndromes? |
|
Definition
Symptomatic esophageal synd
Synd associated w/ esophageal tissue |
|
|
Term
| What are some things that might lead to a decrease in LES pressure (GERD) |
|
Definition
Fatty food
Gastric distention
Smoking
Coffee/cola/tea
chocholate etc |
|
|
Term
| What drugs might decrease LES? |
|
Definition
| Anticholinergics, isoproterenol, barbiturates, benzos, CCB, estrogen, ethanol, narcotics, nitrates, theophylline |
|
|
Term
| What foods are GERD direct irritants? |
|
Definition
| spicy foods, orange juice, tomato juice, coffee |
|
|
Term
| What drugs are direct irritants in GERD? |
|
Definition
| Alendronate, NSAID, ASA, quinidine, KCl, Iron |
|
|
Term
| What are typical GERD Sx? |
|
Definition
| heartburn, regurgitation, belching |
|
|
Term
| do typical Sx of GERD need invasive evaluation to Dx w/ GERD? |
|
Definition
|
|
Term
| What are some GERD atypical Sx? |
|
Definition
| Asthma cough, hoarsness, dental erosion, chest pain |
|
|
Term
| What are some complicated Sx in GERD? |
|
Definition
| Choking, difficulty swallowing, unexplained wt loss/bleeding/anemia |
|
|
Term
| What GERD Sx generally get an endoscopy? |
|
Definition
| Dysphagia, Wt Loss, Epigastric mass, no response to PPI |
|
|
Term
| What are the goals for GERD? |
|
Definition
Alleviate Sx
Dec freq of recurrent disease
Prevent comeplications |
|
|
Term
| What are some complications of long standing GERD? |
|
Definition
Barretts esophagus
Adenocarcinoma
Stricture
Erosive esophagitis |
|
|
Term
| Treatment options for GERD |
|
Definition
Life-style change
Pt-directed therapy
Rx pharmacologic therapy |
|
|
Term
| What are some non-pharmacologic life-style changes that could be made to help with GERD? |
|
Definition
Wt loss
Elevate head in bed
Eat 3hr prior to HS
Avoid large meals/eat smaller more often
Stop smoking
Avoid alcohol
Avoid exacerbating foods/meds |
|
|
Term
| What is the pharmacologic intervention that is mainstay to GERD treatment? |
|
Definition
|
|
Term
| When should you use pharmacologic intervention in GERD pt? |
|
Definition
| When lifestyle changes and Pt directed therapy fail to show results in 2wks |
|
|
Term
| What is a problem to watch for with antacids? |
|
Definition
| Decrease absorption of other meds (quinolones, tetracyclines, azithromycin, azols, iron) |
|
|
Term
| What can prolong the action of antacids? |
|
Definition
| take within 1hr of eating |
|
|
Term
| What are the four primary types of antacids? |
|
Definition
|
|
Term
| What are side effects of Al containing antacids such as galviscon, maalox, mylanta |
|
Definition
| Constipation, hypophosphatemia, renail failure (Aluminum toxicity) |
|
|
Term
| What are some side effects of Ca antacids such as rolaids or tumms |
|
Definition
| belching, flatulence, Ca overload (2500mg/day max) |
|
|
Term
| What are some side effects of Mg containing antacids like milk of magnesia, some maalox and some rolaids formulations |
|
Definition
| Diarrhea, don't use if CrCl<30ml/min |
|
|
Term
| What are some important side effects of Na bicarb antacids such as alkaseltzer |
|
Definition
| don't use in CHF, renal failure or pregnancy due to fluid retention problems. Can cause alkalosis, avoid w/ Ca supplements |
|
|
Term
|
Definition
Tagamet/cimetidine
Axid/Nizatidine
Pepcid/famotidine
Pepcid complete/famotidine,Ca,Mg
Zantac/Ranitidine |
|
|
Term
| How old should someone be to get OTC H2RA treatment? |
|
Definition
|
|
Term
| How often are H2RAs dosed? |
|
Definition
|
|
Term
| What are some general side effects of the H2RA class? |
|
Definition
| HA, constipation, diarrhea, DZ, drowsy |
|
|
Term
| What is an uncommon but serious side effect associated w/ H2RAs |
|
Definition
|
|
Term
| What is a consideration to make when dosing H2RAs? |
|
Definition
|
|
Term
| What population is more sensitive to the CNS effects of H2RAs? |
|
Definition
|
|
Term
| What is dosing and side effects of Tagamet/Cimetidine? |
|
Definition
200mg BID
Anti-androgenic: decreases libido, impotence, gyencomastia
Inhibits metabolism of other drugs |
|
|
Term
| What two H2RAs have no CYP interactions? |
|
Definition
|
|
Term
| What is the dosing for Axid/Nizatidine? |
|
Definition
|
|
Term
| What is the dosing for Pepcid/famotidine? |
|
Definition
|
|
Term
| What is the dosing for Zantac? |
|
Definition
|
|
Term
|
Definition
| irreversibly blocks hydrogen potassium ATPase which is last step in gastric secretion |
|
|
Term
| What are some counseling points of PPIs |
|
Definition
Don't crush or chew
Best 30min prior to meal
May take up to 4 days for max results |
|
|
Term
| Which acid reducing therapy is for occasional use? |
|
Definition
|
|
Term
| What are some side effects associated with PPIs? |
|
Definition
| diarrhea, constipation, HA, hypomagnesimia, b12 deficiency |
|
|
Term
| How old should a person be to use OTC PPI? |
|
Definition
|
|
Term
| What PPI are available OTC? |
|
Definition
|
|
Term
| What Rx PPI are available as IV? |
|
Definition
|
|
Term
| What PPI is least likely to interact with other drugs? |
|
Definition
|
|
Term
| Which PPI inhibits warfarin, diazepam and phenytoin metabolism? |
|
Definition
|
|
Term
| Which PPI needs dose rdxn in hepatic impairment and also decreases theophylline concentrations? |
|
Definition
|
|
Term
| Whom might benefit from antireflux surgery? |
|
Definition
| Refractory GERD pt that don't respond to pharmacoligc treatment or request surgery due to expense of treatment of meds (Age/lifestyle considered) and risk for complications |
|
|
Term
| What are some non-pharmacologic treatments for GERD in pregnancy? |
|
Definition
| Elevate head, avoid bending/stooping, eat smaller more often, avoid food 3hr prior to HS |
|
|
Term
| What drugs might you use in GERD with pregnancy? |
|
Definition
Antacids - Ca, Al, Mg
H2RA- ranitidine
PPI- lansoprazol or omeprazole after 1st trimester |
|
|
Term
| What are some non-pharmacologic treatments for GERD in infants/children? |
|
Definition
Smaller meals
more freq meals
thickend formula
posture after eating |
|
|
Term
| What are some pharmacologic treatments for infants with GERD? |
|
Definition
Ranitidine
Famotidine
Lansoprazole
Antacids (Ca and Al) |
|
|
Term
| What part of our anatomy is intended to prevent GERD? |
|
Definition
| lower esophageal sphincter |
|
|
Term
| What drugs are NOT recommended for GERD? |
|
Definition
Reglan
Propulsix/cisapride
Urecholine/bethanochol
Carafate |
|
|
Term
| How long does it take antacids to work? |
|
Definition
|
|
Term
| How long does it take H2RA to work? |
|
Definition
|
|
Term
| What is extraesophageal GERD? |
|
Definition
| Gastroesophageal reflux associated w/ disease processes in organs other than the esophagus |
|
|
Term
| What is the replacement of squamous epithelial lining in the esophagus with columnar epithelial lining? |
|
Definition
|
|
Term
| What increases the risk of pt developing adenocarinma in the esophagus with GERD? |
|
Definition
Barretts esophagus
Long-standing uncontrolled GERD |
|
|
Term
| Is wheezing an alarm Sx of GERD? |
|
Definition
|
|
Term
| What children are at risk for developing GERD? |
|
Definition
| Cystic fibrosis, cerebral palsy, esophageal atresia (improper development of esophagus) |
|
|
Term
| What are the benefits of Zegrid? |
|
Definition
| Faster onset (immediate release omeprazole) and protection against acid degradation (Na bicarb) |
|
|
Term
| Is it possible that pt w/ non-erosive GERD might have symptoms as severe as pt without erosive GERD? |
|
Definition
|
|
Term
| What four drugs commonly cause mucosal injury related to GERD? |
|
Definition
Alendronate
Aspirin
KCl
NSAIDs |
|
|
Term
|
Definition
| Inhibit histamine 2 receptors in gartci parietal cells |
|
|
Term
| How do mucosal protectants work? Example? |
|
Definition
Form protective coating over damaged mucosa
Sucralfate |
|
|
Term
| How do prokinetic agents work? Name 3 |
|
Definition
Cause enhanced motility and acceleraged gastric emptying time
Metoclopramide, bethanochol, cisapride |
|
|
Term
|
Definition
| forms a viscous solution that floats on the surface of gastric contents |
|
|
Term
| What treatment for GERD has superior Sx relief? |
|
Definition
|
|
Term
| What hemmorhoid symptoms are self-treatable? |
|
Definition
| Itching, irritation, discomfort, inflammation, swelling, burning |
|
|
Term
| What hemorrhoid symptoms need to seek professional treatment? |
|
Definition
| Bleeding, seepage, pain, change in bowel pattern, prolapse, thrombosis, <12yo, Sx more than 7 days |
|
|
Term
|
Definition
| heavy lifting, pregnancy, weakened muscles, standing or sitting for long periods of time, constipation/diarrhea |
|
|
Term
| What are 3 goals of hemorrhoid therapy? |
|
Definition
Alleviate Sx
Remit hemorrhoids
Prevent relapse |
|
|
Term
| What are non-pharmacolotic therapy for hemorrhoids? |
|
Definition
| Diet, hygein, bowl habbits, inc dietary fiber, decrease caffine and dairy, sits bath, avoid pefumed and dyed products, don't sit longer than 10min when deficating, deficate when you have the urge |
|
|
Term
| Pharmacologic classes for hemorrhoidal treatment |
|
Definition
Local anesthetics
Vasoconstrictors
Protectants
Astringents
Keratolytics
Antipuritics
Corticosteroids |
|
|
Term
| What products might you recommend for a pregnant Pt with hemorrhoids? |
|
Definition
| Topical/external products only- no glycerin |
|
|
Term
| What recommendations might you make for a Pt w/ CVD, HTN, thyroid disoder, DM, enlarged prostate or antidepressant therapy for use on hemorrhoids? |
|
Definition
| Anything but a vasoconstrictor |
|
|
Term
| Where is waste mixed with bacterial flora? |
|
Definition
|
|
Term
| What percentage of flatulence is made up of "smelly" gas? What is this gas? |
|
Definition
| 1% sulfates (hydrogen sulfide). produced by fermentation in the colon |
|
|
Term
| What foods cause most gas? |
|
Definition
| Carbohydrates and simple sugars/starches. They aren't digested until they get to the colon and then are fermented |
|
|
Term
| What is a non-pharmacologic way of treating gas? |
|
Definition
|
|
Term
| What are the 3 "B"s of bad gas? |
|
Definition
|
|
Term
| What are some self-treatment exclusions of gas? |
|
Definition
| Debilitating Sx, last longer than severla months, sudden change in abd painl ocation, Sx accompanied by significant abd pain or change in bowl fxn, GI bleed, Fatigue, Wt loss |
|
|
Term
| What might you recommend for gas not associated with beer or food? |
|
Definition
|
|
Term
| What might you recommend for gas associated with lactose? |
|
Definition
| lactase and advise to avoid these foods |
|
|
Term
| What might you recommend for gas associated with foods that contain oligosaccharides (found in veggies) |
|
Definition
| take alpha-galactosidase and avoid oligosaccharides |
|
|
Term
| What do you recommend for pt who has gas that is food related but not from lactose or oligosaccharides? |
|
Definition
| Avoid intake of these foods |
|
|
Term
| What are the goals of gas treatment? |
|
Definition
| Reduce frequency, intensity and duration of symptoms, reduce Sx impact on QOL |
|
|
Term
| What are some non-pharmacologic methods of treating gas |
|
Definition
| avoid food that gives you gas |
|
|
Term
| What might you recommend for infants with gas? |
|
Definition
|
|
Term
| What pregnancy class is simethocone? |
|
Definition
|
|
Term
| What might you recommend for nursing mothers for gas? |
|
Definition
|
|
Term
| What is a counseling point about Lactaid? |
|
Definition
| Take it with food, when eating dairy |
|
|
Term
| What is a counseling point about Lactaid? |
|
Definition
| Take it with food, when eating dairy |
|
|
Term
| What are charcocaps and what are they used for? |
|
Definition
| Activated Charcoal capsules used to neutralize and absorb intestinal gas |
|
|
Term
| What is something to mention to Pt puchasing probiotics? |
|
Definition
They are inactivated by antibiotics therefore no benefit
Start w/ a 14 day trial period so if they dont' work you don't waste your money |
|
|
