Final ERG EXAM!!! (WOOHOO)

irritable bowel syndrome

abdominal pain or discomfort at least once per week over the past 3 months AND at least 2 of the following:

- improvement with defecation

- onset associated with changes in frequency of stool

- onset associated with a change in appearance/form of stool

6 months

IBS as a chronic syndrome must have symptoms that started ________ ago

type 1

what type of poop is this: separate hard lumps, lik nuts

type 3

what type of poop is this: like a sausage but with cracks on its surface

type 4

what type of poop is this: like a sausage or snake, smooth and soft

type 7

what type of poop is this: watery, no solid pieces

fermentable, oligosacharides, disaccharides, monosaccharides, and polyols

what does FODMAP stand for

oligosaccharides

fructans and galacto fall under what category of FODMAPS

FODMAPs

________ lead to increased GI water secretion as well as fermentation in the colon, leading to increase in gases, luminal distension, and meal time IBS symptoms

soluble

________ fiber can provide relief of constpation symptoms (holds water to help soften stools)

soluble

oats, oat bran, barley, and beans are what kind of fiber

psyllium

which OTC fiber supplement contain primarily soluble fiber

insoluble

_________ fiber is more likely to worsen abdominal bloating, pain, and cause flatulence

insoluble

wheat bran, whole grains, some vegetables are which kind of fiber

25-35 grams/day

what is goal total fiber intake

stimulant laxatives

what should be avoided in IBS-C

psyllium (metamucil)

what is the recommended fiber supplementation if unable to obtain necessary fiber in diet

linaclotide (linzess)

secretagogue; guanylate cyclase c agonist (stimulates intestinal fluid secretion and fecal transit)

290 mcg

what is the dosing of linaclotide (linzess)

12 weeks

linzess is one of the most proven effective medications for IBS-C, but may take up to ________- to see improvement in abdominal pain

diarrhea

what is most common side effect of linaclotide

linaclotide

plecanatide ahs mechaism and outcomes similar to ________

IBS-C

secretagoues are used to treat ___________

lubiprostone (amitiza)

secretagogue; chloride channel activator dosed 8 mcg by mouth twice daily

tenapanor (ibsrela)

secretagogue; inhibits sodiu/hydrogen ecvhanger 3 thereby reducing absorption of sodium from intestines and increasing water secretion into the intestinal lumen

tenapanor

which secretagogue is dosed 50 mg BID

true

true or false: IBS-C regimens should not contain more than one secretagogue

tegaserod

which drug has serotonin type-4 stimulation that accelerates GI transit and reduces visceral hypersensitivity

tegaserod

which drug is only indicated for women younger than 65 with no or one CVD risk factor AND whohave not responded to secretagogues

IBS-D

which IBS uses rifaximin to treat

rifaximin

GI specific, non-absorbable antibiotic, initially studied based on the hypothesis that some IBS-D dpatients have an abnormal microbiome

eluxadoline (viberzi)

this acts on GI opioid receptors to slow GI transit time and provide pain relief and is dosed 100 mg twice daily

heartburn

peppermint may cause and/or worsen _______ symptoms

peppermint oil

which IBS adjuvant therapy indicates efficacy in relaxing smooth muscle

antidepressants

which drug class has anticholinergic effects that may be advantageous for relief of diarrhea in IBS-D conversely may worsen IBS-C bowel symptoms

amitriptyline

which TCA has more anticholinergic effects

nortriptyline

which TCA has less anticholinergic effects

miralax

ostmotic laxative that is safe and effective for relieving constipation, but not consistently recommended for IBS-C treatment due to lack of data

bile acid sequestrants

reduces diarrhea that is caused by bile acid induced stimulation of colonic secretions and motility, slows colonic transit time by approx 4 hours

loperamide

acts on opioid receptors to slow intestinal transit time

antispasmodics

provide short term relief of abdominal pain via intestinal smooth msucle relaxation

antispasmodics

dicyclomine, hyoscine, and hyscyamine are part of which drug category

GERD

reflux of gastric or duodenal contents into the esophagus causing symptoms and/or tissue damage

GERD

symptoms of heartburn/reflex associated with a change in QOL more than 2 times per week for more than 3 weeks in a row

gastric acid, pepsin, duodenal contents

what are the aggressive factors that lead to GERD

true

true or false: excessive acid secretion is generally NOT the issue causing GERD

true

true or false: a particular strain of H. pylo (cagA positive) may protect against severe GERD complications and esophageal cancer

erosive esophagitis

approx 1/3 of individuals with heartburn/reflux symptoms have ____________

once daily, moderate dose

for an empiric PPI test, if no warning signs/alarm symptoms evaluate if symptoms resolve with ____________ PPI

2-3 hours

avoid eating ________ prior to bedtime to decrease nocturnal acid secretion

LES tone

in GERD, whenever possible, avoid drugs that decrease _________

decrease LES tone

what bad thing do these drugs have in common in relation to GERD: anticholinergic agents, barbiturates, benzodiazepines, DHP Ca-channel blockers

orally

for GERD, whenever possible, avoid drugs that irritate the esophageal mucosa when given ________

irrigate the esophageal mucosa

what bad thing do these drugs have in common in relation to GERD: bisphosphonates, NSAIDs, aspirin, iron preparations, potassium chloride

once daily PPI x 8 weeks

what is the initial treatment of GERD

BID PPI x 12 weeks

if presence of extraesophageal symptoms (in addition to typical GERD symptoms) such as chronic cough, throat-clearing, hoarseness, asthma, laryngitis, utilize ______________

8 weeks

attempt de-escalation of PPI after ______

indefinitely

if patient found to have erosive esophagitis and/or barrett's esophagus, must continue on PPI ________

non-erosive

which type of esophagitis is treated with 'on demand' therapy meaning start PPI when symptoms appear and discontinue once resolved

H2 blocker, antacid, omeprazole-sodium bicarbonate

in refractory GERD, which meds do you add IN ADDITION to scheduled PPI

gastroparesis

combinations of acid reducing drugs with prokinetic drugs may be needed for GERD with _________

lifestyle modifications

what is first line treatment for GERD in pregant peoples

PPI

result in complete and irreversible inhibition of gastric acid secretion

30-60 minutes prior to breakfast

at what point in the day should you take a PPI

vitamin B12, hypomagnesemia

PPIs reduce _________ absorption and can cause ________

omeprazole, esomeprazole, and lansoprazole

what are the OTC PPIs that are approved for frequent heartburn for up to 14 days

hematemesis

vomiting blood

melena

black, tarry stool with strong odor caused by digestion of hemoglobin

hematochezia

passing bright red blood through the rectum

occult

which GIB is this:

- suspected or confirmed GIB when there is no signs of visible loss (anemia, +FOBT)

Occult

which GIB is slow chronic bleeding

overt

which GIB is this:

- visibly obvious bleeding

- usually acute

overt

hematemesis, melena, and hematochezia are types of _______ GIB

variceal

which upper gi bleed is this: cirrhosis, long-term ETOH abuse

nonvariceal

which upper GI bleed is this: erosive sophagitis, mallory-weiss tear, gastric ulcers, duodenal ulcers

mallory-weiss tear

tear of lower esophagus due to violent coughing or vomiting

blood loss

dizziness, weakness, or hypotension are symptoms of _________

ABCs

what is the immediate management of upper GI bleed

7

in an upper GI bleed, you transfuse when Hgb <____ g/dL

hypotensive

in upper GI bleed treatment, consider transfusion above 7 g/dL if the patient is _________ or has cardiovascular disease

upper GI bleed

rist stratification and revere antithrombotic therapy PRN are part of the stabliziation of __________

PCC

what is the preferred antithrombotic therapy against warfarin in upper GI bleeds

false

true or false: Vitamin K is recommended for anti-thrombotic therapy against warfarin in upper GI bleed

true

true or false: routine reversal of DOACs in upper GI bleed is usually NOT required

idarucizumab

if there is severe or uncontrolled upper GI bleeding, what is recommended for dabigatran reversal

4 factor PCC

wif there is severe or uncontrolled upper GI bleeding, what is recommended for Xa inhibitor reversal

true

true or false: continue aspriin therapy if pt has upper GI bleed

true

true or false: avoid platelet transfusion if pt on antiplatelet therapy during upper GI bleed

24 hours

in upper GI bleed, endoscopy should be completed within ________ once patient is stable

PPIs

these may be reasonable for treatment for Upper gi bleed if endoscopy is expected to be delayed >24 hours

H2RA

this is NOT recommended as pre-endoscopy treatment as it causes tachyphylaxis

erythromycin

which prokinetic/promotility agent is given 20-90 minnutes prior to endoscopy to improve endoscopic visualization and diagnostic yield

high dose PPI IV for 72 hours

what is the treatment post-endoscopy for forrest class Ia-IIb

low dose PPI PO

what is treatment post endoscopy for forrest class IIc and III

endoscopic therapy

physically closes the bleeding vessel/ulcer

3 days

intensive PPI therapy post endoscopy should be >80 mg daily for atleast __________

14 days

high risk patients should be on BID PPI for _________ after endoscopy

40mg BID or 20mg q6 hours

if pt CAN tolerate oral meds, what is PPI dosing post endoscopy

false

true or false: PPIs are required for variceal bleeding treatment

octreotide

which infusion is recommended for 3-5 days for treatment of variceal bleeding