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What drugs can cause acute pancreatitis?
corticosteroids, estrogens, furosemide, some opiates, SMX/TMP, valproic acid
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What are the general treatments required for Acute pancreatitis?
- Replace fluids and electrolytes
- Treat underlying cause
- Reduce autodigestion
- Pain control
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How would you reduce autodigestion in acute pancreatitis?
- NPO or clear liquid diet
- Enteral nutrition if needed (parenteral OK if patient is NPO > 1 week, but use enteral first)
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What type fo pain control is standard for acute pancreatitis treatment?
- IV opioids
- Mainly: Meperidine and hydromorphine
- Meperdine does not cause sphincter of Oddi spasm like morphine
- Toxicity limits meperdine use
- (can use morphine)
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What type of antibiotic would you use in severe necrosing Acute pancreatitis?
2nd/3rd gen cephalosporin, Carbapenem, Quinolone + Metronidazole
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Why would you use a PPI or H2RA in Acute Pancreatitis?
Pancreas is not secreting bicarbonate, so need to lower pH of stomach contents coming into small intestine
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How would you give Octrotide in severe Acute pancreatitis?
- 100 mcg SQ Q8H
- Or
- IV 0.5 mcg/kg/hr
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When would you give Octreotide for pancreatitis?
Acute and severe
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When would you give antibiotics for pancreatitis?
Severe necrotic acute pancreatitis
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What is diagnosis of chronic pancreatitis based on?
- Classic Triad:
- Diabetes, Calcification and Steatorrhea
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What is the #1 treatment for chronic pancreatitis?
Stop drinking
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What are the goals of treatment for chronic pancreatitis?
- Releive pain
- Correct Maldigestions
- Prevent complications
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What analgesics can be used in chronic pancreatitis?
- Avoid chronic narcotics initially
- First try NSAIDs, APAP and Tramadol before moving on to chronic narcotics
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What type of diet is best when treating chronic pancreatitis?
- Low fat
- They are not able to process fat
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When would you start giving exogenous pancreatic enzymes for chronic pancretitis?
Mild to moderate disease
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What do exogenous pancreatic enzymes contain?
Lipase, protease and amylase in varying amounts
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What would you give to control stomach acid in Chronic pancreatitis?
- Antacids (void Ca and Mg)
- H2RAs
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Why do we give Exogenous pancreatic enzymes in chronic pancreatitis?
For pain control
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What is the MOA of Pancreatic enzymes in chronic pancreatitis treatment?
- Produce a negative feedback mechanism in the duodenum on endogenous enzyme secretion
- Which reduces intraductal pressure
- Thus, reduces PAIN
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Why would you choose exogenous pancreatic enzymes with a high lipase content?
Best control of steatorrhea
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What is the starting dose of Lipase and Trypsin per meal?
- 30,000 U of lipase/per meal
- 10,000 U of Trypsin/per meal
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What is the max dose of Lipase per meal?
75,000 Units
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What are the pancreatic enzyme’s available?
- Creo
- Pancreaze
- Zenpep
- Pancrealipase
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How do you know how much lipase is in an exogenous pancreatic enzyme capsule?
The name correlates = Creon 24 = 24,000 Units lipase
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What are the potential AE of exogenous pancreatic enzymes for chronic pancreatitis?
Hyperuricosuria, hyperuricemia, kidney stones
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In CF there are reports of ________ and _________ in patient who take exogenous pancreatic enzymes with >20,000 Units lipase/capsule.
- Colonic stricture
- Intestinal obstruction
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Which is reversible acute or chronic pancreatitis?
Acute, NOT CHRONIC
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Which type of pancreatitis can progress to diabetes?
Chronic, because there is necrosis
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What is the number 1 thing that can be done to control both acute and chronic pancreatitis?
Alcohol cessation
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