NR 565 Final Exam Study
Guide(EXPLAINED)
Week 7
CYP450 enzyme GI interactions: Cimetidine H2 receptor antagonist,
Omeprazole
PPI, Alosetron (IBS-D)
H. Pylori Testing: consider if patient has GERD abdomen pain unresolved,
starting aspirin therapy, stomach or duodenal ulcer, after treatment for h. pylori
H. Pylori Treatment: 10-14 day antibiotic therapy, PPI or H2
Preferred therapy: low resistant region clarithromycin-based triple
therapy (clarithromycin, amoxicillin, PPI). **PCN allergy, use metronidazole
as substitute.
High resistant region bismuth-based quadruple therapy (bismuth,
flagyl, tetracyline, with PPI or H2RA.
If patients unable to take all therapies at one time, sequential therapy
is option. PPI plus amox 5 days, then PPI plus clarithromycin and tinidazole
5 days.
Lifestyle Habits: smoking cessation, avoid NSAIDS, bland foods.
IBS: abd pain or discomfort that cannot be explained structurally or
chemically for 12 weeks or more and has pain r/t defecation, change in freq
or consistency of stool.
psyllium fiber, probiotics/prebiotics, antibiotics (rifaximin),
antispasmodics (hyoscyamine, dicyclomine), TCA antidepressants, IBS-D
loperamide, TCA
IBS-D:Alosetron (Lotronex โ GI toxicity, not approved in men),
Eluxadoline (Viberzi)
IBS-C: Lubriprostone (Amitiza), Linaclotide (Linzess)
GERD: weight loss, HOB elevated and sit upright after meals, avoid
triggering food (citrus and acidic, caffeine, ETOH, spicy, chocolate). 8-week
course of PPI once a day
before
first
meal.
If
unresponsive,
increase
BID.
Can
add
H2
receptor
antagonist
I
at
bedtime with daytime PPI with nighttime
reflux. Safe in pregnant patients if indicated.
Metoclopramide: โreglanโ used as anti-emetic by blocking dopamine
receptors and increase motility. Used in diabetic gastroparesis and GERD.
Off label โ hiccups and N/V in early pregnancy
Post-Op Nausea or Nausea r/t drugs, toxins, radiation therapy.
AVOID while breastfeeding and in older adults and GI
obstruction/perf/hemorrhage.
D/t effect on dopamine โ tardive dyskinesia and NMS can occur. Interacts
with digoxin. Monitor for extrapyramidal symptoms. Patients should
