Dewey-drugs

a 5HT3 antagonist that delays colonic transit and improves sx of diarrhea-predominant IBS,withdrawn by FDA 2000 and reintro 2002 with restricted conditions, worked too well, it must be stopped imm if constipation develops

a 5HT4 agonist that accelerates transit, reduces visceral sensation, and modestly improves constipation-predominant IBS, approved at a dose of 6 mg bid for short term tx in women only, main SE is diarrhea, withdrawn 2007 due to cardiac SE, restricted use for qualifying pts, compassionate study

locally acting chloride channel activator that increases intestinal fluid secretion and intestinal motility, currently indicated for IBS w constipation in women and chronic constipation, off-label for men, contra if bowel obstruction, avoid w severe diarrhea, nausea is main SE(dec dose or tk with food), IBS 8mcg bid, constipation 24 mcg bid, $$$ not first-line

metronidazole or ampicillin, bed rest and a temporary low-residue or liq diet to reduce sigmoid contractions, severe attacks may req AGs, pip/tazo, amp/sulbatam, 3rd gen ceph, and surgical tx

simethicone, activated charcoal

metoclopramide may help, Ach make worse, due to decreased GI mitlity after constipation or high fiber intake

increased w high fiber diet, and use of acarbosde (Precose) or miglitol (Glyset) , tx by reducing carb intake, Beano and alpha-galctosidase is limited, bismuth compounds have been shown to bind hydrogen sulfide in the colon to reduce odor

piperacillin, metonidazole, amp/sulbactam (Unasyn), gentamicin or tobra`

chenodiol (chenix) primary bile acid synthesdized by the liver from cholesterol, ursodiol (UDCA, Actigall) appears to solubilize cholesterol, chenodil increases amt in the bile, neg feedback on cholesterol and bile acid synthesis and secretion, drug therapy only effective in dissolving floating, radiolucent(non-calcified) stones less than 15 mm diamete r, UDCA need lower dose and less SEs

put to rest, NPO 7-10 d, nasogastric suction to reduce gastric secretions but no real inc effectiveness over NPO, ACh, H2 blockers, PPIs did not improve, give fluid and electrolytes due to third spacing, monitor parameters, demerol to decrease contractions and pain but inc risk of seizures(metab can accumulate), hydromorphone/morphine considered opioids of choice

persistant abd pain, glucose intolereance in diabetics, wt loss, STEATORRHEA (due to loss of pancreatic fxn)

analgesics, avoid alcohol, suppress stimulus to pancreatic secretion with enzyme supplements, surgery, ursodiol or cholecystectomay may red attacks if biliary sludge is the cause

avoid caffeine, lg meals, reduce fat intake while maintaining calories (MCT), may need vitamin supplements, pancreaetic enzyme replacement, PPIs H2 blockers, antacids, alum hydroxide antacid of choice, mg and Ca can precipitate

can titrate, 24,000 to 30,000 units lipase per meal, can add PPI or H2 blocker due to acid inactivating enzymes

• Creon 5 SR capsules
• Creon 10 SR capsules
• Creon 20 SR capsules

steady or increasing wt, no more than 2-3 stools per d, no abd sx

GI intolerance, Hyperuricemia(high purine content of supplements), folic acid def (folate complexes w enzymes), ulceration of mouth, lips and tongue(non-EC), hypersens(inc anaphylaxis)

deeper layers of mucosa not involved, proximally from rectum, entire area, hallmark sx-blood diarrhea w rectal urgency and tensmus, remissions and relapses, 1/3 will have mild disease and not need steroids, 20% severe requiring tx and maybe colectomy-curative

less common than UC, inflammation in part of tract involving all layers, skip areas, including lymph nodes, diarrhea, usually nonbloody, less watery, abd pain, postprandial edema causing nausea and colicky pain after meals, clinical sx don't correlate well with endoscopic findings, small bowel and colon cancer possible but uncommon compared to UC, abs problems, 1/2 req surgery eventually, not curative

more explosive, higher short term mortality, quicker onset, steroids and sulfasalazine=remission in 90% of acute cases

more indolent, higher long-term mortality, usually responds well to medical tx with time

2-4g/d, di-azo compound split by bacteria to sulfapyridine-abs, resp for AEs and 5-aminosalicylic acid;most non-abs, resp for therapeutic effects, 5-ASA, decreases intestinal PG and leukotriene synthesis, can reduce flora but no effect on IBD, 5-ASA may act as a free radical scavenger

Rowasa-enema, and Canasa as suppository1600mg better than placebo, but 2400-4800mg daily is optimal, 3-6 wks for effect, diarrhea is main SE, only 10% intolerant to sulfasalazine cannot take 5-ASA, Asacol works all over can be used in UC and crohn's-400mg tab, Pentasa avail 250mg capsules-approved in UC, H2 blockers, PPIs and antacids ok to tk w asacol and pentasa, more $$ than sulfasalazine, oral and rectal preps can be taken at same time