GI bleeding

Because colestipol and cholestyramine are not absorbed, but simply pass through the body by the GI tract, few severe side effects occur. Patients often complain of distaste and constipation, however. More severe side effects such as GI bleeding ate relatively uncommon (151). 

These drug are used for the medical treatment of agastric or duodenal ulcer, gastric hypersecretory (excessive gastric secretion of hydrochloric acid) conditions, and GERD. These drug may also be used as prophylaxis of stress-related ulcers and acute upper GI bleeding in critically ill patients. 

In patients who experience a PUD-related bleeding event while taking aspirin but who require continued aspirin therapy, the addition of a PPI reduces the incidence of recurrent GI bleeding.27... 

The pattern of inflammation in UC is continuous and confluent throughout the affected areas of the GI tract. The inflammation is also superficial and does not typically extend below the submucosal layer of the GI tract (Fig. 16-2). Ulceration or erosion of the GI mucosa may be present and varies with disease severity. The formation of crypt abscesses within the mucosal layers of the GI tract is characteristic of UC and may help to distinguish it from CD. Severe inflammation may also result in areas of hypertrophied GI mucosa, which may manifest as pseudopolyps within the colon.12 The inflammatory response may progress in severity, leading to mucosal friability and significant GI bleeding. 

Adrenocorticotropic hormone (ACTH) gel, 40 to 80 USP units, may be given intramuscularly every 6 to 8 hours for 2 to 3 days and then discontinued. Studies with ACTH are limited, and it should be reserved for patients with contraindications to first-line therapies (e.g., heart failure, chronic renal failure, history of GI bleeding). 

Acetaminophen is usually well tolerated, but potentially fatal hepatotoxicity with overdose is well documented. It should be used with caution in patients with liver disease and those who chronically abuse alcohol. Chronic alcohol users (three or more drinks daily) should be warned about an increased risk of liver damage or GI bleeding with acetaminophen. Other individuals do not appear to be at increased risk for GI bleeding. Renal toxicity occurs less frequently than with NSAIDs. 

Low-dose aspirin is associated with a reduced risk of major bleeding, particularly GI bleeding. Other GI disturbances (e.g., dyspepsia, nausea) are infrequent with low-dose aspirin. Ibuprofen should not be administered on a regular basis concurrently with aspirin because it may block aspirin s antiplatelet effects. 

Redistribution of blood flow away from the GI tract may cause stress gastritis, gut ischemia, and, in some cases, infarction, resulting in GI bleeding. 

Absolute contraindications to warfarin include active bleeding, hemorrhagic tendencies, pregnancy, and a history of warfarin-induced skin necrosis. It should be used with great caution in patients with a history of GI bleeding, recent neurosurgery, alcoholic liver disease, severe renal... 

Coffee, tea, cola beverages, beer, milk, and spices may cause dyspepsia but do not increase PUD risk. Ethanol ingestion in high concentrations is associated with acute gastric mucosal damage and upper GI bleeding but is not clearly the cause of ulcers. 

Dexamethasone should be administered prior to the first antibiotic dose and not after antibiotics have already been started. Semm hemoglobin and stool guaiac should be monitored for evidence of GI bleeding. 

Adenopathy can be localized or generalized. Involved nodes are painless, rubbery, and discrete and are usually located in the cervical and supraclavicular regions. Mesenteric or GI involvement can cause nausea, vomiting, obstruction, abdominal pain, palpable abdominal mass, or GI bleeding. Bone marrow involvement can cause symptoms related to anemia, neutropenia, or thrombocytopenia. 

Uses Rx prevent osteoporosis male female, Rx steroid-induced osteoporosis, Paget Dz Action -1- N1 abnormal bone resorption Dose Osteoporosis Rx 10 mg/d PO or 70 mg qwk Fosamax plus D 1 tab qwk Steroid-induced osteoporosis Rx 5 mg/d PO Prevention 5 mg/d PO or 35 mg qwk Paget Dz 40 mg/d PO Caution [C, ] Not OK if CrCl <35 mLAnin, w/ NSAID use Contra Esophageal anomalies, inability to sit/stand upright for 30 min, X Ca Disp Tabs, soln SE GI disturbances, esophageal irritation, HA, pain, jaw osteonecrosis (w/ dental procedures, chemo) Interactions -1- Absorption W7 antacids, Ca supls, Fe, food T risk of upper GI bleed W/ ASA NSAIDs EMS May cause cardiac conduction abnormalities d/t T Ca T risk of jaw fractures esp w/ dental procedures OD May cause hypocalcemia and adverse upper-GI effects milk or antacids can be given to bind alendronate... 

Bismuth Subsalicylate (Pepto-Bismol) [Antidiarrheal/ Adsorbent] [OTC] Uses Indigestion, N, D combo for Rx of H. pylori Infxn Action Antisecretory anti-inflammatory E>o e Adults. 2 tabs or 30 mL PO PRN (max 8 doses/24 h) Feds. 3—6 y 1/3 tab or 5 mL PO PRN (max 8 doses/24 h) 5-9 y 2/3 tab or 10 mL PO PRN (max 8 doses/24 h) 9-72 y 1 tab or 15 mL PO PRN (max 8 doses/24 h) Caution [C, D (3rd tri), -] Avoid w/ renal failure Hx severe GI bleed Contra Influenza or chickenpox (T risk of Reye synd), ASA allergy (see Aspirin) Disp Chew tabs, caplets, Liq, susp SE May turn tongue stools black Interactions T Effects OF ASA, MTX, valproic acid effects OF tetracyclines i effects W/ corticosteroids, probenecid EMS Monitor for hypovolemia and electrolyte disturbances d/t D may darken tongue stool OD Similar to ASA OD V, tinnitus, metabolic acidosis activated charcoal may be effective... 

WARNING May T risk of CV events GI bleeding Uses Osteoarthritis, RA, JRA Action NSAID w/ T COX-2 activity Dose Adults. 7.5-15 mg/d PO Feds (>2 y). 0.125 mg/kg/d, max 7.5 mg 4- in renal insuff take w/ food Caution [C, D (3rd tri) /-] Peptic ulcer, NSAID, or ASA sensitivity Disp Tabs, susp SE HA, dizziness, GI upset, GI bleeding, edema Interactions T Effects OF ASA, anticoagulants, corticosteroids, Li, EtOH, tobacco effects W/ cholestyramine 4-effects OF antihypertensives EMS T Effects of anticoagulants concurrent EtOH/tobacco use can T adverse GI effects (bleeding, D) T risk of photosensitivity Rxns OD May cause NA and lethargy activated charcoal may be effective... 

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