Therapeutics - GI

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Author:
kyleannkelsey
ID:
287088
Filename:
Therapeutics - GI
Updated:
2014-10-26 10:00:23
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Therapeutics GI
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Therapeutics - GI
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Therapeutics - GI
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  1. What are the risk factors for GI infections?
    • Recent travel to high risk area
    • Depressed immune function
    • Regional outbreak of food borne/waterborne illness
    • Poor personal hygiene
    • Disruption of normal barrier defense mechanisms
    • Antibiotic exposure
  2. What are the most common pathogens for infectious/bacterial diarrhea?
    • Vibrio Cholerae
    • E. coli – most common, subtypes:
    • -enterotoxigenic (ETEC)*
    • -enteroinvasive (EIEC)
    • -enteroadhesive (EAEC)
    • -enteropathogenic (EPEC)
    • -enterohemorrhagic (EHEC) (O157:H7) – The deadly one
    • Salmonella sp.
    • Shigella
    • Campylobacter sp.
    • Staphylococcus aureus
    • Yersinia
    • Clostridium difficile – Hospital acquired
  3. Which bacterial diarrhea causative organism causes diarrhea after eating?
    Campylobacter
  4. What are the complications of Diarrhea?
    • Secretory or dysentery diarrhea
    • Abdominal cramping and extension
    • Nausea
    • Dehydration
    • Electrolyte disturbances
    • Malaise
    • Fever
    • Mucous and bloody diarrhea
    • Renal failure
    • Hemolytic uremic syndrome
    • renal failure
    • hemolytic anemia
    • thrombocytopenia
  5. What needs to be replaced concurrently with fluids in a bacterial diarrhea patient?
    Na and K
  6. When does the CDC recommend taking prophylactics for traveler’s diarrhea?
    Immunocomprimised
  7. What are the options for Traveler’s diarrhea prophylaxis?
    • bismuth subsalicylate 2 tabs with meals and hs
    • ciprofloxacin 500 mg BID
    • Rifaximin 200mg 1-3 x daily
    • Start 1 day before and end it 2 days after return
  8. What is the recommended antibiotic for a patient with bacterial diarrhea caused by Non-Typhoid salmonella?
    • Cipro
    • Ceftriaxone
    • Azithromax
    • (Same as Shigella)
  9. What is the recommended antibiotic for a patient with bacterial diarrhea caused by Shigella?
    • Cipro
    • Ceftriaxone
    • Azithromax
    • (same as Salmonella)
  10. What is the recommended antibiotic for a patient with bacterial diarrhea caused by Campylobacter?
    Erythromycin or other macrolide
  11. What is the recommended antibiotic for a patient with bacterial diarrhea caused by Staph aureus?
    Not recommended
  12. What is the recommended antibiotics for a patient with bacterial diarrhea caused by E. coli?
    Supportive
  13. What is the recommended antibiotics for a patient with bacterial diarrhea caused by Vibrio cholera?
    Cipro or Azithromax
  14. What is the WHO recommendation for replacement fluids (oral)?
    • Glucose: 25 g/L
    • Na: 75-90 mEq/L
    • K: 20 mEq/L
  15. What drugs are used for empiric treatment of VIRAL Diarrhea?
    • Loperamide
    • Dipneoxylate/atropine (Lomotil)
    • Quinolone (Cipro, oxifloxacin, etc.)
    • Rifixamin(Xifaxin) 200 mg PO TID
    • As long as not dysentery
  16. Why is loperamide, Diphenoxylate, Quinolones and Rifixamin not recommended for dysentary patients?
    • Duysentary is bacterial
    • These drugs slow peristalsis and cause bacteria to be retained/not ejected, so bloating and worsening of disease occurs
  17. What strain of C. diff Is often resistant to Flouroquinolones and cephalosporins?
    NAP-1/027
  18. Describe C. diff histology:
    Gram + spore forming anerobe
  19. What are the risk factors for C. diff infection?
    • Promoted by an alteration in normal GI flora secondary to antibiotic exposure
    • 55-75% of patients are post surgical with perioperative antibiotic exposure
    • Other risk factors
    • Elderly
    • Recent bowel surgery
    • Ischemic bowel
    • Malnutrition
    • Chemotherapy
    • Shock
    • Admitted from a skilled nursing facility
    • PPI use
  20. What are the normal choices for C. diff treatment?
    • DOC: metronidazole 500 mg PO TID x 10-14 days
    • Or
    • Vancomycin oral 125-500 mg PO QID (Has to be oral)
  21. What are the parameters for severe C. diff?
    pseudomembranous colitis, marked leukocytosis (WBC > 15K), acute renal failure (>1.5 mg/dL), hypotension
  22. What is the treatment for Severe C. diff?
    Vancomycin 125 - 500 mg PO QID for 10-14 days and metronidazole 500 mg IV or PO QID-TID
  23. What is the C. diff treatment for patients with severe disease and Toxic megacolon?
    • Metronidazole 500 mg IV QID for 10-14 days
    • Or Vancomycin retention enema - 500 mg-1 gm in 1-2 liters of isotonic saline every 4-12 hours
  24. What percent of C. diff patients relapse?
    10-20%
  25. How do you treat mild relapse in a C. diff patient?
    Usually self resolving
  26. How do you treat a Moderate to severe relapse in a C. diff patient?
    Same approach as initial episode
  27. How do you treat the Second Occurrence of C. diff relapse?
    • Tapering dose of oral vancomycin
    • 125 mg PO QID for 14 days
    • 125 mg PO BID for 7 days
    • 125 mg PO daily for 7 days
    • 125 mg Q 48hr for 8 days
    • 125 mg Q 72hr for 15 days
  28. How do you treat the 3rd Occurrence of C. diff relapse?
    Vancomycin 125 mg QID for 14 days followed by rifixamin 400 mg BID (not FDA-approved) for 14 days
  29. What is the advantage of Fidaxomicin?
    May reduce relapse, because it has post-antibiotic effect > 24 hours
  30. What are the SE of Fidaxomicin?
    Hypokalemia, elevated temp, headache, peripheral edema
  31. What is the dose of Fidaxomicin?
    200 mg PO BID

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