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GK Pharm 2 Exam 2 > Pancreatitis & Celiac Disease > Flashcards

Flashcards in Pancreatitis & Celiac Disease Deck (47)
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1

What are the 2 key concepts in acute pancreatitis tx? 

requires early and aggressive intravenous fluid resuscitation

Managed similarly to pts with sepsis

2

What sx are present in an inflammatory episode of acute pancreatitis

intrapancreatic enzyme activation with pain

nausea and vomiting

intestinal ileus

3

What are the 5 causes of Acute Pancreatitis? 

Alcohol 

Gallstones (including microlithiasis)

Trauma/surgery

Acute discontinuation of medications for diabetes or hyperlipidemia 

Following endoscopic retrograde cholangiopancreatography (ERCP)

4

What meds can cause acute pancreatitis? 

ACE, ARBS; thiazide diuretics, furosemide

Antimetabolites (mercaptopurine and azathioprine) 

Corticosteroids; glyburide; exenatide (Byetta) 

Mesalamine; pentamidine 

Sulfamethoxazole/trimethoprim 

Valproic acid

HMG-CoA reductase inhibitors, especially simvastatin

5

What are 4 possible mechanisms of drug-induced acute pancreatitis? 

 direct toxic effects of the drug or its metabolites

hypersensitivity

drug-induced hypertriglyceridemia

alterations of cellular function in the pancreas and pancreatic duct

6

What is the 1st line tx for acute pancreatitis? 

Fluid resuscitation: isotonic crystalloid solution— NS or LR

7

Why is fluid resuscitation given in acute pancreatitis? 

to reduce the risks of SIRS and organ failure

8

What should you do if vomiting persists past fluid resuscitation in acute pancreatitis? 

NPO or NG tube

9

Fluid resuscitation can be ____________ or _________. 

Fluid resuscitation can be enteral or parenteral

10

Begin oral alimentation after pain, tenderness, and ileus have resolved: small amounts of high-carbohydrate, low-fat, and low-protein foods; advance as tolerated

What type of pancreatitis is this tx used for? 

Acute Pancreatitis 

11

What should you advise pts with acute pancreatitis during discharge? 

dietary modification to reduce dietary fats, alcohol, and added sugars

12

Long-standing and progressive destruction of pancreatic tissue due to persistent inflammation

Results in exocrine and/or endocrine insufficiency

Which type of pancreatitis? 

Chronic Pancreatitis

13

What are the hallmark complications of Chronic Pancreatitis? 

chronic pain

malabsorption with resultant steatorrhea

diabetes mellitus

risk of pancreatic cancer

14

What are the primary treatments for malabsorption due to chronic pancreatitis? 

pancreatic enzyme supplementation

reduction in dietary fat intake 

15

Which drug can cause an increase in sphincter of Oddi pressure? 

Morphine

16

Why should you avoid Demerol in tx of acute pancreatitis? 

porential of accumulation of a toxic metabolite normeperidine

17

What tx is no longer recommended for acute pancreatitis? 

prophylactic abx

18

How do you tx pts with ascending cholangitis or necrotizing pancreatitis? 

B-lactam/B-lactamase inhibitor: piperacillin/tazobactam can be considered for initial treatment before cultures (especially of aspirated collections) if a strong suspicion of active infection. 

19

What do you tx acute pancreatitis with if pt has cholangitis and pt is allergic to penicillin? 

Levofloxacin

20

What should you be vigilant for when giving prophylactic abx in acute pancreatitis? 

fungal superinfections

21

What are the tx options for chronic pancreatitis? 

enteric-coated pancreatic enzyme supplements

antisecretory agent + pancreatic enzyme supplementation

22

What can you add to enteric-coated pancreatic enzyme supplements to increase the effectiveness of enzyme therapy for malabsorption and steatorrhea found in chronic pancreatitis

Histamine2-receptor antagonist or proton-pump inhibitor

23

What would adding an antisecretory agent to pancreatic enzyme supplementation help achieve? 

may increase the effectiveness of enzyme therapy for malabsorption and steatorrhea

24

What are possible chronic pancreatitis txs? 

Analgesics: tramadol, chronic opioid, gabapentin, pregabalin, SNRIs or TCAs, traditional pancreatic enzyme supplements

Uncoated enzymes (Viokase) 

Octreotide

 

25

Uncoated enzymes (Viokase) may be more efficacious for what sx when given with what other medication? 

Uncoated enzymes (Viokase) may be more efficacious for pain control (when given with proton pump inhibitors [PPIs] to protect their integrity) compared with coated enzymes, but this strategy is controversial.

26

T/F: There is a theoretical benefit to using PPIs, even with coated enzymes, in patients with vitamin deficiency to allow faster release of enzymes into the proximal duodenum where fat-soluble vitamin absorption occurs

True

27

When would you treat pts with corticosteroids? 

autoimmune pancreatitis

28

When should you administer pancreatic enzymes? 

during or just after meals

29

T/F: Products containing enteric-coated microspheres or minimicrospheres may be less effective than other dose forms

False; Products containing enteric-coated microspheres or minimicrospheres may be more effective than other dose forms

30

Primarily used to treat malabsorption associated with chronic pancreatitis

also used to treat pain from the disease

Which drug? 

Pancreatic Enzymes