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What drugs can cause acute pancreatitis?
corticosteroids, estrogens, furosemide, some opiates, SMX/TMP, valproic acid
What are the general treatments required for Acute pancreatitis?
- Replace fluids and electrolytes
- Treat underlying cause
- Reduce autodigestion
- Pain control
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)
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)
What type of antibiotic would you use in severe necrosing Acute pancreatitis?
2nd/3rd gen cephalosporin, Carbapenem, Quinolone + Metronidazole
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
How would you give Octrotide in severe Acute pancreatitis?
- 100 mcg SQ Q8H
- IV 0.5 mcg/kg/hr
When would you give Octreotide for pancreatitis?
Acute and severe
When would you give antibiotics for pancreatitis?
Severe necrotic acute pancreatitis
What is diagnosis of chronic pancreatitis based on?
- Classic Triad:
- Diabetes, Calcification and Steatorrhea
What is the #1 treatment for chronic pancreatitis?
What are the goals of treatment for chronic pancreatitis?
- Releive pain
- Correct Maldigestions
- Prevent complications
What analgesics can be used in chronic pancreatitis?
- Avoid chronic narcotics initially
- First try NSAIDs, APAP and Tramadol before moving on to chronic narcotics
What type of diet is best when treating chronic pancreatitis?
- Low fat
- They are not able to process fat
When would you start giving exogenous pancreatic enzymes for chronic pancretitis?
Mild to moderate disease
What do exogenous pancreatic enzymes contain?
Lipase, protease and amylase in varying amounts
What would you give to control stomach acid in Chronic pancreatitis?
- Antacids (void Ca and Mg)
Why do we give Exogenous pancreatic enzymes in chronic pancreatitis?
For pain control
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
Why would you choose exogenous pancreatic enzymes with a high lipase content?
Best control of steatorrhea
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
What is the max dose of Lipase per meal?
What are the pancreatic enzyme’s available?
How do you know how much lipase is in an exogenous pancreatic enzyme capsule?
The name correlates = Creon 24 = 24,000 Units lipase
What are the potential AE of exogenous pancreatic enzymes for chronic pancreatitis?
Hyperuricosuria, hyperuricemia, kidney stones
In CF there are reports of ________ and _________ in patient who take exogenous pancreatic enzymes with >20,000 Units lipase/capsule.
- Colonic stricture
- Intestinal obstruction
Which is reversible acute or chronic pancreatitis?
Acute, NOT CHRONIC
Which type of pancreatitis can progress to diabetes?
Chronic, because there is necrosis
What is the number 1 thing that can be done to control both acute and chronic pancreatitis?