Diarrhea
What class of medications do Loperamide (Imodium AD) and Diphenoxylate/atropine (Lomotil) fall under?
Antimotility Agents
True or False, IBS is a lifelong chronic condition.
True
Constipation can be treated by increasing fluid intake.(T/F)
False.
What role does the lower esophageal sphincter (LES) play in GERD?
Patients tend to have reduced LES pressure or reduced muscle tone which allows contents from the stomach to backflow into the esophagus, causing reflex. Also, the patient have transient relaxations of the LES (TLESRs) which are not triggered by swallowing and allows for more episodes of reflux.
In PUD, what are the two most common sites of ulcers?
Gastric (stomach) and duodenal (small intestine)
What are the goals of therapy for diarrhea?
1.) Control symptoms
2.) Prevent and treat losses in electrolytes.
3.) Treat the underlying cause of diarrhea
Name 2 medications available for the treatment of IBS constipation subtype
Lubiprostone (Amizta)
Linaclotide (Linzess)
What does type 2 on the Bristol Stool Chart indicate?
Mild constipation
What are the risk factors for GERD?
•History of esophageal strictures
•Obesity
•Pregnancy
•Stress
•Certain foods such as coffee, spicy food, chocolate, citrus and carbonated beverages, smoking, and excessive alcohol intake.
•Eating habits such eating large meals, lying down/bending after meals, and eating meals before bedtime.
•Exercising after meals.
What 3 factors can aggravate PUD?
H.Pylori Infection
Smoking
NSAID usage
Stress
What is the recommended ORS for a child with moderate diarrhea?
100ml/kg over 4 hours
Fill in the blank. IBS is defined as recurrent abdominal pain at least once a week for ___ months
6 months
Should a one-year patient with ribbon stools, abdominal distention be treated?
No, the patient should be triaged to their MD.
What are the alarm/atypical symptoms for heartburn?
Dysphagia, odynophagia, persistent vomiting, hematemesis, anemia, and unintentional weight loss.
Of the following OTC medications which would we want to avoid in a patient with a history of PUD?
1) Acetaminophen 500 mg
2) Diphenhydramine 50 mg
3) Ibuprofen 200 mg
3) Ibuprofen 200 mg
NSAIDs due to their MOA can cause increased risk of GI bleeding.
Which groups of patients is bismuth subsalicylate contraindicated in?
-Pregnant women
-Women who are breastfeeding
-Allergy to aspirin and other salicylates
-Concurrent aspirin use
-Children with recent viral illness (Reye syndrome)
-Gout
What are the goals of therapy for treatment of IBS?
Control symptoms
Prevent and manage fluid and electrolyte loss (if diarrhea subtype)
Which medication is used for IBS with constipation in women more that 18 years of age?
Lubiprostone (Amitiza)
What is the initial treatment for Stage IV of GERD (pre-cancerous lesions or cancer)?
Adopt lifestyle modifications such as alcohol, tobacco cessation, or weight loss. Take a H2RA or PPI twice a day. Patient needs to followed up with a GI specialist.
In H.Pylori treatment, which 4 drugs make up quadruple therapy?
Bismuth Subsalicylate, Metronidazole, Tetracycline, PPI
What is the dose of loperamide?
Initial 4mg, then 2mg after each loose stool. Maximum amount is 16mg/day.
Name 3 non-pharmacological strategies to treat IBS
Food diaries
Exercise
Manage stress and anxiety
Which drug can cause the urine to turn red?
Senna (sennosides)
Which of the following is not a non- pharmacological therapy for GERD?
1.) Weight loss
2.) Smoking cessation
3.) Eating larger meals
4.) Elevate the head of the bed.
5.)Eating 2-3 hours before bedtime.
6.) Sleeping on the right side.
3.) Eating larger meals ( want to eat smaller meals to prevent reflex)
6.) Sleeping on the right side (sleeping on the left side provides symptom relief.
How does eating food affect the pain associated with gastric ulcers? Duodenal ulcers?
Gastric ulcers: Eating will exacerbate the pain
Duodenal ulcers: Eating will relieve pain
One of the main differentiating tools between gastric and duodenal ulcers.