Term
|
Definition
| defined as a diffuse process characterized by fibrosis and a conversion of the normal hepatic architecture into structurally abnormal nodes |
|
|
Term
| portal hypertension and the development of varices and ascites |
|
Definition
| What does the resistance in blood flow from the increase of fibrotic tissue in the liver cause? |
|
|
Term
-alcohol -hepatitis B and C (chronic viral infections) -fatty liver disease |
|
Definition
|
|
Term
biotransformation of medications Therefore, medications may need to be eliminated or adjusted. |
|
Definition
| Liver plays major role in... |
|
|
Term
| occurs when portal venous pressure is 12 mmHg (portal hypertension) greater than vena cava pressure |
|
Definition
| When does variceal bleeding occur? |
|
|
Term
non-selective B-adrenergic blocking agents such as **Propanolol** 10 mg TID or **Nadolol** 20 mg qday **Careful in asthma pts |
|
Definition
| Tx of cirrhosis: begin prophylaxis with which drugs? |
|
|
Term
younger patients or patients with resistance to portal HTN Start with isosorbide-mononitrate 20 mg twice daily and increase to 20 mg TID after 1 week. |
|
Definition
| Tx of cirrhosis: nitrates may be considered in what type of pts? |
|
|
Term
octreotide or somatostatin These meds increase the vascular tone in the GI tract by inhibiting vasodilatory peptides thus producing mesenteric vasoconstriction. |
|
Definition
| Tx of cirrhosis: acute variceal hemorrhage is managed by which meds? |
|
|
Term
| Recommend that diuretic therapy be initiated with the combination of spironolactone (potassium-sparing diuretic) and furosemide (loop-diuretic, potassium-wasting). |
|
Definition
| Type of tx if clinical signs of ascites present |
|
|
Term
| spontaneous bacterial peritonitis and hepatic encephalopathy |
|
Definition
| other complications possible with cirrhosis |
|
|
Term
-straining at least 25% of the time -lumpy or hard stools at least 25% of the time -feeling of incomplete evacuation at least 25% of the time -2 or fewer bowel movements in a week **Know what is a normal bowel movement for your pt so as to not overtreat** |
|
Definition
| Functional constipation is defined as 2 or more of the following complaints present for at least 12 months in the absence of laxative use: |
|
|
Term
|
Definition
| What percent of pts report having constipation over 65? |
|
|
Term
-First, dietary changes should be made by increasing the amount of dietary fiber consumed. -Increase both exercise, especially after supper, and fluid intake. -Rule out any conditions, such as hypothyroidism. -Discontinue or switch possible offending meds. |
|
Definition
| What should you do first in treating constipation? |
|
|
Term
|
Definition
| What type of constipation drug has an onset of action 12-24 hours up to 3 days and is good for long-term prevention and tx? |
|
|
Term
-Bran (soluble and insoluble) -Psyllium (Metamucil, Fiberall, Serutan) -Methylcellulose (Citrucel powder and tablets) -Calcium polycarbophil (FiberCon) -Malt soup extract (Maltsupex) Encourage 8 oz of fluid with all of these. |
|
Definition
| examples of bulk producing laxatives |
|
|
Term
| emollient, lubricating, or stool softeners (Surfactants) |
|
Definition
| What type of constipation drug has an onset of action of 1-3 days for docusate products or 6-8 hours for mineral oil? |
|
|
Term
| emollient, lubricating, or stool softerners (Surfactants) |
|
Definition
| What is used as an ineffective way to tx constipation but used mainly as prevention? |
|
|
Term
-May cause lipoidal pneumonia if aspirated -Leaks from the anal sphincter -Absorbs fat-soluble vitamins -Should only be used for short periods of time |
|
Definition
| Reasons why mineral oil has limited usefullness |
|
|
Term
-Docusate sodium (DSS) (Colace) -Docusate calcium (Surfak) -Docusate potassium (Dialose) |
|
Definition
| examples of emollients, lubricating, or stool softeners |
|
|
Term
|
Definition
| What type of constipation drug has an onset of action of 6-12 hours for oral and 15-60 minutes for rectal, and is not recommended on a daily basis? |
|
|
Term
-Bisacodyl (Dulcolax, Correctol)-enteric coated tablets and suppositories, tablets should NOT be administered with milk or antacids because the increase in gastric pH may dissolve the enteric coating of the tablet and cause stomach cramping -Glycerin suppositories-work through local irritating and hyperosmolar effect, not systemically absorbed -Sennosides (Senokot, Ex-Lax) |
|
Definition
| examples of irritants or stimulants |
|
|
Term
irritants or stimulants These agents are not recommended on a daily basis. The same dose will not produce the same result in different indiividuals. |
|
Definition
| Which type of constipation drug works by stimulating the mucosal nerve plexus of the colon? |
|
|
Term
| saline or hyperosmotic cathartics |
|
Definition
| What type of constipation drug has an onset of action of 30 mins to 3 hours for oral and 5-15 mins for rectal (sodium phosphate enema)**Quick onset**? |
|
|
Term
-Magnesium hydroxide (MOM) -Lactulose (Chronulac, Kristalose)-can be used to lower blood ammonia levels |
|
Definition
| examples of saline or hyperosmotic cathartics |
|
|
Term
| saline or hyperosmotic cathartics |
|
Definition
| Which type of constipation drug is composed of relatively poorly absorbed ions such as magnesium, sulfate, phosphate, and citrate, which produce their effects by osmotic action? |
|
|
Term
|
Definition
| defined as an increased frequency and decreased consistency of fecal discharge as compared to an individual's normal bowel pattern |
|
|
Term
| viral (Norwalk, rotavirus) and bacterial (Shigella, Salmonella, Campylobacter, Staph, E.coli) microorganisms |
|
Definition
| What accounts for most episodes of infectious diarrhea? |
|
|
Term
-**Manage the diet (Recommend discontinuing consumption of solid foods and dairy products for 24 hours, then bland diet started, feeding continued in children with acute bacterial diarrhea.) -Prevent excessive water, electrolyte, and acid base disturbances (Rehydration and maintenance of water and electrolytes are primary tx goals until episode ends.) -Provide symptomatic relief -Treat curable causes -Manage secondary disorders causing diarrhea |
|
Definition
| What are the therapeutic goals for the tx of diarrhea? |
|
|
Term
BSS-bismuth subsalicylate (Pepto-Bismol, Kaopectate, Maalox Total Stomach Relief) Attapulgite contains BSS Children's Pepto contains only calcium carbonate. |
|
Definition
| examples of antisecretory agents (tx for diarrhea) |
|
|
Term
| BSS has the distinction of being the only OTC stomach remedy proven clinically effective in the relief of both upper and lower GI symptoms (indigestion, relieving abdominal cramps, and controlling diarrhea) |
|
Definition
| What distinction is tied to BSS? |
|
|
Term
-oral antidiarrheal agent effective for control of nonspecific diarrhea -prophylactic tx of traveler's diarrhea -prevent attachment of microorganisms to intestinal mucosa, to inactivate enterotoxins, and to exert a direct antimicrobial effect -BSS has antisecretory, anti-inflammatory, and antibacterial effects. |
|
Definition
| What is BSS used for concerning diarrhea? |
|
|
Term
|
Definition
| T/F: BSS can be toxic if given excessively to prevent or tx diarrhea. |
|
|
Term
-pts who need to avoid salicylates (ASA allergy) -pts taking Warfarin (Coumadin) or aspirin -children |
|
Definition
| What type of pts do you need to be careful with for BSS drugs? |
|
|
Term
-antisecretory agents -adsorbents -antimotility/antispasmodics |
|
Definition
| What are the 3 types of drugs used to tx diarrhea? |
|
|
Term
| Calcium polycarbophil (FiberCon, Equalactin, Mitrolan) |
|
Definition
| example of adsorbents (tx for diarrhea) |
|
|
Term
| calcium polycarbophil (adsorbent) |
|
Definition
What is the type of diarrhea tx that is a hydrophilic, polyacrylic resin that is insoluble in water and can absorb 60 times its weight in water?
If the pt has diarrhea, this same drug absorbs excess water by forming a gel that facilitates the normalization of bowel movements. |
|
|
Term
| calcium polycarbophil (adsorbent) |
|
Definition
| This drug used for tx of diarrhea needs to be taken with 8 oz of water to prevent choking as the product expands in the area above the trachea. |
|
|
Term
| antimotility/antispasmodics |
|
Definition
| What type of drugs are opiates and opioid derivatives delay the transit of transluminal contents or increase gut capacity, prolong contact, and absorption? |
|
|
Term
-invasive bacterial diarrhea pts -preschool children **Opioids cause the bowel to shut down so caution in older pts |
|
Definition
| When should you not use antimotility/antispasmodic drugs? |
|
|
Term
-Paregoric (Camphorated tincture of opium)-Schedule III, contains opium which causes antispasmodic effect -Diphenoxylate (Lomotil)-Schedule V, contraindicated in children < 2 yo -Loperamide (Imodium, Kaopectate, Maalox Antidiarrheal, Pepto Diarrhea Control)-OTC, not recommended in children under 2 yo -Difenoxin (Motofen)-active metabolite of diphenoxylate, contraindicated in children < 2 yo |
|
Definition
| examples of antimotility/antispasmodic drugs |
|
|
Term
|
Definition
| defined as the retrograde movement of gastric contents from the stomach into the esophagus |
|
|
Term
|
Definition
| a chronic, relapsing condition with associated morbidity and an adverse impact on quality of life, stomach contents reflux upward |
|
|
Term
1. reflux esophagitis 2. erosive eosphagitis 3. strictures 4. Barrett's esophagus |
|
Definition
definitions/progressions associated with GERD: 1. inflammation of the esophagus 2. erosion of squamous epithelium 3. common in distal esophagus and NSAIDS are known contributors 4. replacement of the squamous epithelial lining replaced with specialized columnar-type epithelium |
|
|
Term
-defective lower esophageal sphincter (LES) pressure or function -anatomic factors -esophageal clearance -mucosal resistance -gastric emptying -epidermal growth factor -salivary buffering |
|
Definition
|
|
Term
-elevate the head of the bed -dietary changes -weight reduction -smoking cessation -avoid alcohol -avoid tight fitting clothing -discontinue offending meds |
|
Definition
| non-pharmacologic tx for GERD |
|
|
Term
-Antacids -H2 Receptor Antagonists (H2RAs) -Proton-Pump Inhibitors (PPIs) -Prokinetic Agents |
|
Definition
|
|
Term
|
Definition
agents that work by neutralizing gastric acid and increasing the pH of gastric contents and increases the LES
These drugs should NOT be given at night. |
|
|
Term
|
Definition
| What is the type of GERD drug that provides prompt (almost immediate) relief of symptoms, but have a short duration of action (20-40 minutes on empty stomach) and require frequent dosing? |
|
|
Term
| delavirdine, itraconazole, ketoconazole, IRON, DIGOXIN, PHENYTOIN, indomethacin, chlorpromazine |
|
Definition
| drug interactions of antacids |
|
|
Term
|
Definition
Phases of GERD tx:
-phase consisting of interventional therapies
-phase consisting of lifestyle changes and pt-directed therapy with antacids and/or non-prescription histamine-2 receptor antagonists or PPIs
-phase consisting of pharmacologic therapies with standard or high dose acid suppressing agents |
|
|
Term
-Aluminum Hydroxide-constipating, used in dialysis -Magnesium Hydroxide (Milk of Magnesia-MOM)-laxative effect, do not use if CrCl < 30 mL/min -Calcium Carbonate (Tums, Children's Pepto)-constipation and flatulence, used in osteoporosis -Sodium Bicarbonate (baking soda)-IV formulations to neutralize acid -Alginate (Gaviscon)-alginic acid and bicarbonate combine to create a foam barrier to reduce reflux |
|
Definition
| examples of antacids (tx for GERD) |
|
|
Term
|
Definition
type of drugs effective for treating MILD to MODERATE GERD with an onset of action of 1-3 hours and requirement of renal adjustment
competetively binds to the H-2 receptors on the parietal cell inhibiting the binding of histamine to the receptors, reduces the histamine-stimulated production of gastric acid |
|
|
Term
Drugs ending in "tidine" -Cimetidine (Tagment, Tagment HB) -Rantidine (Zantac, Zantac 75) -Famotidine (Pepcid, Pepcid AC) -Nizatidine (Axid, Axid AR) |
|
Definition
| examples of H2 receptor antagonists (tx for GERD) |
|
|
Term
| Cimetidine (Tagment, Tagment HB) |
|
Definition
| What is the H2 receptor antagonist drug that inhibits the CYP450 enzyme, has multiple drug interactions, and can produce gynecomastia and impotence? |
|
|
Term
| proton pump inhibitors (PPIs) |
|
Definition
What type of drug works by blocking the H+/K+/Atpase enzyme that pulls out bicarbonate and pumps in acid with a maximum effect seen in a few days (do not work immediately)?
Best to be taken 15-30 minutes before breakfast |
|
|
Term
Drugs ending in "prazole" -Omeprazole (Prilosec, Prilosec OTC, Rapinex powder, Zegerid powder/capsules/chewable tablets -Lonsoprazole (Prevacid-capsules/IV) -Rabeprazole (Aciphex-tablets) -Pantoprazole (Protonix-tablets/IV) -Eosmeprazole (Nexium-capsules/oral suspension/IV)**Best for nighttime |
|
Definition
| examples of PPIs (tx for GERD) |
|
|
Term
Zegerid capsules combination of Omeprazole and sodium bicarbonate Capsules contain 300 mg of Na so need to be especially careful with certain types of pts, i.e. CHF pts Zegerid should be taken 1 hour before meals. |
|
Definition
| What is the only combination drug for tx of GERD? What is it a combination of? |
|
|
Term
-Pantoprazole and omeprazole can show a false positive on drug screens (because of marijuana component) -Omeprazole-CYP2C9, including Coumadin** -Lansoprazole-CYP450, including theophylline** -Pantoprazole has minimal interactions |
|
Definition
| drug interactions of PPIs |
|
|
Term
| promotility agents/prokinetic agents |
|
Definition
agents used as adjunct to acid suppression therapy in pts with known motility defect
not as effective as acid suppression therapy
good for pts with diabetic gastric paresis |
|
|
Term
-Cisapride-pulled off market due to life-threatening arrhythmias -Metoclopramide-a dopamine antagonist, increases LES pressure in dose-related manner, accelerates gastric emptying |
|
Definition
| examples of promotility/prokinetic agents (tx for GERD) |
|
|
Term
| peptic ulcer disease (PUD) |
|
Definition
a heterogenous group of disorder involving the UPPER GI tract
mostly chronic condition characterized by remission and recurrences |
|
|
Term
duodenal and gastric ulcers most common -H. pylori (infections from gram-negative bacilli) -NSAID-induced -Stress Ulcers -Acid hypersecretion (Zollinger-Ellison Syndrome, ZE) |
|
Definition
most common types of peptic ulcers Name the 4 etiological forms of peptic ulcers. |
|
|
Term
|
Definition
| cause of most all NSAID-induced peptic ulcer or stress ulcers |
|
|
Term
H. pylori ulcers very contagious Triple therapy: PPI plus 2 antibiotics Quadruple therapy: PPI, BSS, tetracycline and metronidazole **Never use only 1 antibiotic because resistance is too strong and never do tx for less than 10 days. |
|
Definition
Which type of peptic ulcer is very contagious and commonly found in families? What are the 2 unique therapy options and what makes up the therapies? |
|
|
Term
-Amoxicillin (Penicillin class so contraindicated in pts with PENICILLIN ALLERGY**) -Clarithromycin (Macrolide class so contraindicated in pts with MACROLIDE ALLERGY**, adverse effects: abd pain, diarrhea, DISORDER OF TASTE, ingestion, nausea, headache, LIVER FAILURE, Steven-Johnson Syndrome) -Tetracylcine (Contraindicated in hypersensitivity to tetracycline, last half of pregnancy, children < 8 yo, AE: photosensitivity) -Metronidazole (Contraindicated in METRONIDAZOLE ALLERGIES and first trimester of pregnancy, AE: METALLIC TASTE, INTERACTION WITH ETOH**) |
|
Definition
| drugs used to tx H.pylori ulcers |
|
|
Term
Prevpac: Lansoprazole, Clarithromycin, Amoxicillin Helidac: BSS, Tetracycline, Metronidazole Pylera: Biskalcitrate potassium, Metronidazole, Tetracycline |
|
Definition
Pre-packaged Combo Tx for H. Pylori ulcers What makes up the Prevpac combo? What makes up the Helidac combo? What makes up the Pylera combo? |
|
|
Term
-Poor pt compliance (compliance decreased with multiple meds, increased frequency of admin, increased length of tx, intolerable AE, costly drug regimens) -Resistant organisms -Low intragastric pH -High bacterial load |
|
Definition
| reasons for tx failures in H. pylori tx |
|
|
Term
|
Definition
| usual location of NSAID-induced ulcers |
|
|
Term
Prevention: -slow release and enteric coated formulations -use PPI or Misoprostol with NSAID in high risk pts (Misoprostol is a prostaglandin CONTRAINDICATED IN PREGNANCY) -Sucralfate (Carafate)-forms "coating" over ulceration that protects ulcer from exposure to acid **Should switch to COX-2 inhibitor if have NSAID-induced ulcer** |
|
Definition
What are some ways to prevent NSAID-induced ulcers? What should you do if pt forms NSAID-induced ulcer? |
|
|
Term
|
Definition
| a mucosal inflammatory condition confined to the RECTUM AND COLON only affecting the mucosa and sub-mucosa |
|
|
Term
|
Definition
| an inflammation of the GI tract that can affect any part, FROM THE MOUTH TO THE ANUS |
|
|
Term
-5-Aminosalicyclic acid (ASA) Agents -Immunosuppresive agents -Tumor Necrosis Factor Alpha Blockers |
|
Definition
| 3 types of tx for Inflammatory Bowel Disease |
|
|
Term
| M.O.A: Acts locally in colon to decrease inflammatory response and systemically interferes with secretion by inhibiting prostagladin synthesis |
|
Definition
|
|
Term
| Sulfasalazine (Azulfidine) |
|
Definition
Which 5-ASA Agent is this (tx for IBD)? -conjugate of 5-ASA and sulfapyridine -contraindicated in sensitivity of sulfites, sulfonamides, and salicylates or aspirin -must be adjusted for CrCl < 30mL/min -may cause folate deficiency, USE FOLIC ACID SUPPLEMENT -COMMONLY IMPARTS ORANGE-YELLOW DISCOLORATION TO URINE AND SKIN -works in COLON -**Pregnancy Cat. B, do not breastfeed |
|
|
Term
| Mesalamine (Rowasa, Asacol, Pentasa, Canasa, Lialda) |
|
Definition
Which 5-ASA Agent is this (tx for IBD)? -Rowasa and Canasa admin in rectal suspension enema or suppository -Oral forms are delayed-release -Sensitivity to salicylates and sulfites (but not sulfonamides) -Many pills taken -**Pregnancy Cat. B, do not breastfeed -Major drug interaction with Varicella Virus Vaccine |
|
|
Term
|
Definition
Which 5-ASA Agent is this (tx for IBD)? -5-ASA dimer derivative given orally -contraindicated in clients ALLERGIC TO SALICYLATES, but not sulfonamides or sulfites -**Pregnancy Cat. C, do not breastfeed -Major drug interaction with Varicella Virus Vaccine |
|
|
Term
|
Definition
Which 5-ASA Agent is this (tx for IBD)? -oral compound for tx of UC -prodrug of Mesalamine (broken down by bacteria in colon to release Mesalamine and an inert compound) -contraindicated in clients ALLERGIC TO SALICYLATES, but not sulfonamides or sulfites -**Pregnancy Cat. B, do not breastfeed |
|
|
Term
| Azathioprine (Azasan, Imuran) |
|
Definition
Which Immunosuppressive Agent is this (tx for IBD)? -Blackbox:Chronic immunosuppression with this purine antimetabolite increases risk of neoplasia in humans. -**Pregnancy Cat. D, do not breastfeed |
|
|
Term
| Cyclosporine (Restasis, Sandimmune, Neoral) |
|
Definition
Which Immunosuppressive Agent is this (tx for IBD)? -**Pregnancy Cat. C, do not breastfeed -can cause Hirsutism and pruritus |
|
|
Term
|
Definition
Which Immunosuppressive Agent is this (tx for IBD)? -**Pregnancy Cat. X, do not breastfeed -can cause alopecia, photosensitivity, rash |
|
|
Term
Tumor Necrosis Factor Alpha Blockers Infliximab (Remicade) -reduced infiltration of inflammatory cells and reduces TNF-production inflamed areas of intestine -**common AE is infections -use with caution in pts with CHF |
|
Definition
| What type of tx should be used in MODERATE to SEVERE Crohn's disease? |
|
|
Term
-corticosteroids (Hydrocortisone, Prednisone, Budesonide) -enemas and/or orally -nicotine-smokers may have less UC than non-smokers, can be given via rectal enema or transdermal patches |
|
Definition
|
|
Term
|
Definition
| defined as the inclination to vomit or as a feeling in the throat of epigastric region alerting an individual that vomiting is imminent |
|
|
Term
|
Definition
| defined as the ejection or expulsion of gastric contents through the mouth and is often a forceful event |
|
|
Term
-cardiovascular -infectious -pregnancy -drug-induced -overfeeding infant |
|
Definition
|
|
Term
-affects visceral stimulation examples: -phosphorylated carbohydrate solution (Emetrol, Emecheck) -carbonated soft drinks (Sprite, Coke, or Coke syrup) -bismuth subsalicylate (in Pepto-Bismol and Kaopectate) |
|
Definition
|
|
Term
| antihistamine and phenothiazine (dopamine antagonists) |
|
Definition
Which type of centrally acting n/v tx is this?
-M.O.A.: block H-1 and dopamine receptors |
|
|
Term
Promethazine (Phenergan) Other antihistamines and phenothiazines: -Prochlorperazine (Compazine) -Thiethylperazine (Norzine, Torecan) |
|
Definition
Which centrally acting n/v tx is this? -Chemically a phenothiazide -H-1 antagonist with considerable anticholinergic, sedative, and antiemetic effects and some local anesthesia properties -prevents motion sickness -can cause SEVERE IRRITATION and NECROSIS if given IV -Blackbox:drug should not be used in pts younger than 2 yo because of potential for fatal respiratory depression, including fatalities. |
|
|
Term
| M.O.A.: block acetylcholine receptors in the vestibular center |
|
Definition
| What is the M.O.A. for anticholinergics (tx for n/v)? |
|
|
Term
Scopolamine (Transderm-SCOP) -a transdermal formulation generally worn behind the ear -best used PRIOR to travel or when motion sickness is expected -also approved for post-surgical n/v |
|
Definition
example of anticholinergics (tx for n/v) What is it used for specifically and how is it used? |
|
|
Term
| M.O.A.: block acetylcholine receptors in the vestibular center |
|
Definition
| What is the M.O.A. for antihistamines (tx for n/v)? |
|
|
Term
-Dimenhydrinate (Dramamine) -Cyclizine (Marezine) -Meclizine (Antivert, Bonine, Dramamine II) |
|
Definition
| examples of antihistamines |
|
|
Term
| AE: DROWSINESS OR CONFUSION, blurred vision, dry mouth, URINARY RETENTION, possibly tachycardia |
|
Definition
| AE of antihistamines (tx for n/v) |
|
|
Term
| M.O.A.: block descending impulses from the cerebral cortex |
|
Definition
| What is the M.O.A. for cannabinoids (tx for n/v)? |
|
|
Term
-Dronabinol (Marinol) CIII -Medical marijuana for smoking -Nabilone (Cesamet) |
|
Definition
| examples of cannabinoids (tx for n/v) |
|
|
Term
| M.O.A.: blocks the 5-HT-3 receptors in the intestines and CTZ (chemoreceptor trigger zone) |
|
Definition
| What is the M.O.A. for serotonin 5-HT antagonists (tx for n/v)? |
|
|
Term
Drugs end in "setron" -Ondansetron (Zofran)-approved for children to prevent n/v associated with general anesthesia and chemotherapy, used a lot in pregnancy -Granisetron (Kytril) -Dolasetron (Anzemet) -Palonosetron (Aloxi)-long half life (40 hours compared to the others of 8 hours, second dose usually not needed, single injection prevents both acute nausea and delayed nausea) used both in IV or PO for severe chemotherapy-induced n/v |
|
Definition
examples of serotonin 5-HT antagonists What are these used for specifically? |
|
|
Term
| M.O.A.: unknown, may inhibit prostaglandin synthesis or feedback inhibition, also increase appetite and mood |
|
Definition
| What is the M.O.A. for corticosteroids (tx for n/v)? |
|
|
Term
-Trimethobenzamide (Tigan)-decreases stimulation to CTZ -Metoclopramide (Reglan)-prokinetic agent may have some antiemetic effect in some causes of nausea (diabetic gastroparesis) -Benzodiazepines (Valium, Ativan)-not generally recommended for mild-moderate nausea due to dependency, but can be useful adjunct to other therapies, especially when given IV -Aprepitant (Emend)-substance P/neurokinin-1 receptor antagonist, used in combo with other antiemetic drugs to prevent acute and delayed n/v associated with initial and repeat courses of chemotherapy -Droperidol (Inapsine)-a butyrophenone, used as sedative and to treat n/v for surgical procedures, BLACK BOX for injectable Droperidol due to its association with fatal cardiac arrythmias |
|
Definition
| other miscellaneous agents used to tx n/v |
|
|
Term
associated neurotransmitter: dopamine recommended antiemetic: Metoclopramide (Reglan) or Prochloperazine (Compazine) |
|
Definition
| What is the associated neurotransmitter and recommended antiemetic for migraine headaches? |
|
|
Term
associated neurotransmitters: histamine, acetylcholine recommended antiemetics: antihistamines and anticholinergics |
|
Definition
| What are the associated neurotransmitters and recommended antiemetics for vestibular nausea? |
|
|
Term
associated neurotransmitter: unknown recommended antiemetics: for nausea: ginger, vitamin B6 for hyperemesis gravidarum: 1st line: Promethazine (Phernergan) 2nd line: Serotonin antagonists and corticosteroids |
|
Definition
| What are the associated neurotransmitters and recommended antiemetics for pregnancy-induced nausea? |
|
|
Term
associated neurotransmitters: dopamine, serotonin recommended antiemetics: 1st line: Dopamine antagonists 2nd line: Serotonin antagonists |
|
Definition
| What are the associated neurotransmitters and recommended antiemetics for gastroenteritis? |
|
|
Term
associated neurotransmitters: dopamine, serotonin recommended antiemetics: to prevent prevention: serotonin antagonists |
|
Definition
| What are the associated neurotransmitters and recommended antiemetics for PONV (post-operative n/v)? |
|
|
Term
|
Definition
| About how many episodes of diarrhea per year does the average U.S. person have? |
|
|
Term
| drug-induced liver disease |
|
Definition
Accounts for:
-~2-5% of hospitalizations for jaundice
-10% of all cases of hepatitis in adults
-40% of cases in adults > 50 yo |
|
|
Term
| drug-induced liver disease |
|
Definition
| What is the condition in which a variety of clinical presentations may be seen in pts ranging from asymptomatic mild biochemical abnormalities to an acute illness with jaundice that resembles viral hepatitis? |
|
|
Term
|
Definition
| What is the main cause of drug-induced liver disease? |
|
|
Term
-antibiotics -antidepressants -antihyperlipidemias -sulfonamides -salicylates -sulfonylureas -quinidine -Tacrin (used in Alzheimers)-50% of individuals will have elevation |
|
Definition
| What classes of drugs may produce an elevation in serum aminotransferases in fewer than 5% of individuals? |
|
|
Term
| The liver will revert back to normal. |
|
Definition
| What happens when you discontinue drug therapy for drug-induced liver disease? |
|
|
Term
|
Definition
| What is the most common form of liver damage caused by drugs? |
|
|
Term
-hepatocellular (cytotoxic) damage -mixed pattern of cytotoxic and cholestatic injury -less commonly, steatosis |
|
Definition
| How does acute hepatic injury present? |
|
|
Term
-necrosis -steatosis -cellular degeneration *Similar to that seen in viral hepatitis |
|
Definition
| What are the 3 symptoms included in cytotoxic damage? |
|
|
Term
-Acetaminophen -Yellow Phosphorus -Iron -Phenytoin (Dilantin) -Methyldopa -Isoniazid -Diclofenac **Watch drugs with Tylenol. Do NOT want to give more than 4 gm of Tylenol per day.**(She said this would be a test question!) |
|
Definition
| Drugs that are cytotoxic to the liver |
|
|
Term
|
Definition
| What does cholestatic damage to the liver often resemble? |
|
|
Term
| interfere with hepatocyte secretion of bile constituents |
|
Definition
| What do drugs that cause cholestatic damage interfere with? |
|
|
Term
-Chlorpromazine -Nafcillin -Trimethoprim-sulfamethoxazole (Bactrim) -Rifampin -Erythromycin estolate -Captopril -Estradiol -Amiodarone (rarely) |
|
Definition
| Drugs that cause cholestatic damage |
|
|
Term
|
Definition
| What is pancreatitis most often associated with? |
|
|
Term
-ERCP in pt with gallstone pancreatitis with obstructive disease -Reversal of hypercalcemia -Cessation of possible causative drugs -Administration of insulin to poorly controlled diabetics with elevated triglycerides |
|
Definition
| What needs to be corrected for predisposing factors of acute pancreatitis? |
|
|
Term
-supportive care: pain control, IV fluids, and NPO
Symptoms will resolve in 5-7 days. |
|
Definition
|
|
Term
-Requires ICU admission -Pain management: begin with non-narcotic analgesics, then switch to oral narcotics, **Meperidine** favored over Morphine because Morphine can cause an increase in Oddi pressure (increasing the pain) -Prevent infection which occurs after 10-14 days -System support -Cessation of alcohol or other offending drugs -Correction of pancreatic insufficiency with supplementation **Know Meperidine is favored for pain in pancreatitis!** |
|
Definition
| Facts about chronic pancreatitis |
|
|
Term
|
Definition
What is the type of hepatitis that fits this description?
-acute
-fecal to oral route
-from contaminated food
-preventable through vaccination
-full recovery in 12 weeks, but may last up to 6 months
-produces inflammatory necrosis of liver
-infection has 3 stages: incubation, acute hepatitis, convalescence |
|
|
Term
-healthy diet -rest -maintaining fluid balance -avoiding hepatotoxic drugs and alcohol |
|
Definition
|
|
Term
|
Definition
What is the type of hepatitis that fits this description?
-chronic
-leading cause of cirrhosis and hepatocellular carcinoma
-transmission through contact with infected blood products or bodily secretions
-no curative tx |
|
|
Term
Best tx is prevention and universal vaccination of children. -Interferon alpha2b -Lamivudine These drugs are used to reduce replication and should not be used together. |
|
Definition
|
|
Term
|
Definition
Which HBV tx drug is this?
-possesses antitumor, antiviral, and immunomodulating activity
-about 35% of pts tx with injections 4-6 months will have a long-term response
-side effects include flu-like symptoms, fatigue, headache, n/v, loss of appetite, hair thinning (because it may depress the bone marrow)
-contraindicated in pts with active major depression
-alcohol abuse reduces risk of drug |
|
|
Term
|
Definition
Which HBV tx drug is this?
-antiviral
-nucleoside reverse transcriptase inhibitor
-increasing resistance to this med and has less of a success rate than the other |
|
|
Term
|
Definition
What is the type of hepatitis that fits this description?
-primarily asymptomatic, which has led to its widespread worldwide
-transmitted mainly through IV drug use, contaminated blood products, tattoos
-estimated that 10-30% develop cirrhosis of liver and end-stage liver disease
-mainstay therapy is supportive care
-definitive cure is liver transplant |
|
|
Term
|
Definition
Which HCV tx drug is this?
-3 types, plus combo with Ribavirin
-blood tests and biopsy may determine need for tx
-must be given by INJECTION 3 X week for 16 weeks
-side effects include headache, fever, fatigue, loss of appetite, n/v, thinning of the hair |
|
|
Term
|
Definition
Which HCV tx drug is this?
-given by MOUTH
-given as combo with Interferon
-can have additional side effects including DEPRESSION, severe anemia, especially BIRTH DEFECTS
-PREGNANCY SHOULD NOT BE ATTEMPTED UNTIL 6 MONTHS AFTER TX ENDED (applies for males and females)
-may also interfere with production of RBCs and platelets depressing bone marrow |
|
|
Term
|
Definition
| What is the most frequently reported vaccine-preventable disease in the US? |
|
|
Term
-A (HAV) -B (HBV) -C (HCV) -delta -E |
|
Definition
|
|
Term
-Immunoglobulin (Ig)-provides protection by passive transfer of concentrated antibodies, prevent by 85% or more within 2 weeks of exposure, major group receiving is international travelers -Inactivated HAV vaccines, Havrix and Vaqta-reduce transmission rate by 94-100% 1 month after primary vaccination, second booster injection given 6 months after |
|
Definition
| Immunizations for Hepatitis A |
|
|
