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  • Acute Pancreatitis DIPIRO PHARMACOTHERAPY

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    Fadli Robby
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    1) Acute pancreatitis (AP) is characterized by upper abdominal pain and pancreatic enzyme elevations due to premature activation of trypsin within the pancreas leading to autodigestion. 2) Diagnosis is based on characteristics of abdominal pain and elevation of amylase and/or lipase to at least three times the upper limit of normal. 3) Treatment goals are to relieve abdominal pain and nausea, replace fluids, and provide intensive care for severe cases involving systemic complications.

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    1) Acute pancreatitis (AP) is characterized by upper abdominal pain and pancreatic enzyme elevations due to premature activation of trypsin within the pancreas leading to autodigestion. 2) Diagnosis is based on characteristics of abdominal pain and elevation of amylase and/or lipase to at least three times the upper limit of normal. 3) Treatment goals are to relieve abdominal pain and nausea, replace fluids, and provide intensive care for severe cases involving systemic complications.

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    33 views4 pages

    Acute Pancreatitis DIPIRO PHARMACOTHERAPY

    Uploaded by

    Fadli Robby
    1) Acute pancreatitis (AP) is characterized by upper abdominal pain and pancreatic enzyme elevations due to premature activation of trypsin within the pancreas leading to autodigestion. 2) Diagnosis is based on characteristics of abdominal pain and elevation of amylase and/or lipase to at least three times the upper limit of normal. 3) Treatment goals are to relieve abdominal pain and nausea, replace fluids, and provide intensive care for severe cases involving systemic complications.

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    of 4

    28

    CHAPTER
    Pancreatitis

    t"DVUFQBODSFBUJUJT "1
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    QBODSFBUJD JOGMBNNBUJPO MFBEJOH UP MPTT PG QBODSFBUJD FYPDSJOF BOE FOEPDSJOF
    GVODUJPO

    ACUTE PANCREATITIS
    PATHOPHYSIOLOGY
    t(BMMTUPOFT BOE BMDPIPM BCVTF BDDPVOU GPS NPTU DBTFT JO UIF 6OJUFE 4UBUFT " DBVTF
    DBOOPUCFJEFOUJGJFEJOTPNFQBUJFOUT JEJPQBUIJDQBODSFBUJUJT
    
    t.BOZ NFEJDBUJPOT IBWF CFFO JNQMJDBUFE Table 28–1
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    t"DUJWBUFE QBODSFBUJD FO[ZNFT SFMFBTFE JOUP UIF QBODSFBT BOE TVSSPVOEJOH UJTTVFT
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    MJVN BOEBEKBDFOUTUSVDUVSFT-JQBTFEBNBHFTGBUDFMMT QSPEVDJOHOPYJPVTTVCTUBODFT
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    t3FMFBTFPGDZUPLJOFTCZBDJOBSDFMMTJOKVSFTUIPTFDFMMTBOEFOIBODFTUIFJOGMBNNBUPSZ
    SFTQPOTF*OKVSFEBDJOBSDFMMTMJCFSBUFDIFNPBUUSBDUBOUTUIBUBUUSBDUOFVUSPQIJMT NBD
    SPQIBHFT BOEPUIFSDFMMTUPUIFBSFBPGJOGMBNNBUJPO DBVTJOHTZTUFNJDJOGMBNNBUPSZ
    SFTQPOTF TZOESPNF 4*34
     7BTDVMBS EBNBHF BOE JTDIFNJB DBVTF SFMFBTF PG LJOJOT 
    XIJDINBLFDBQJMMBSZXBMMTQFSNFBCMFBOEQSPNPUFUJTTVFFEFNB
    t1BODSFBUJDJOGFDUJPONBZSFTVMUGSPNJODSFBTFEJOUFTUJOBMQFSNFBCJMJUZBOEUSBOTMPDB
    UJPOPGDPMPOJDCBDUFSJB
    t-PDBMDPNQMJDBUJPOTJOTFWFSF"1JODMVEFBDVUFGMVJEDPMMFDUJPO QBODSFBUJDOFDSPTJT 
    JOGFDUJPO BCTDFTT QTFVEPDZTUGPSNBUJPO BOEQBODSFBUJDBTDJUFT
    t4ZTUFNJDDPNQMJDBUJPOTJODMVEFDBSEJPWBTDVMBS SFOBM QVMNPOBSZ NFUBCPMJD IFNPS
    SIBHJD BOE$/4BCOPSNBMJUJFT
    CLINICAL PRESENTATION
    t$MJOJDBMQSFTFOUBUJPOEFQFOETPOTFWFSJUZPGUIFJOGMBNNBUPSZQSPDFTTBOEXIFUIFS
    EBNBHFJTDPOGJOFEUPUIFQBODSFBTPSJOWPMWFTMPDBMBOETZTUFNJDDPNQMJDBUJPOT
    t5IFJOJUJBMQSFTFOUBUJPOSBOHFTGSPNNPEFSBUFBCEPNJOBMEJTDPNGPSUUPFYDSVDJBUJOH
    QBJO TIPDL BOESFTQJSBUPSZEJTUSFTT"CEPNJOBMQBJOPDDVSTJOPGQBUJFOUTBOE
    JT VTVBMMZ FQJHBTUSJD  PGUFOSBEJBUJOH UPUIFVQQFS RVBESBOUT PS CBDL 0OTFU JT VTV
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    NBSLFEFQJHBTUSJDUFOEFSOFTT BCEPNJOBMEJTUFOUJPO IZQPUFOTJPO UBDIZDBSEJB BOE
    MPXHSBEFGFWFS*OTFWFSFEJTFBTF CPXFMTPVOETBSFEJNJOJTIFEPSBCTFOU%ZTQOFB
    BOEUBDIZQOFBBSFTJHOTPGBDVUFSFTQJSBUPSZDPNQMJDBUJPOT
    DIAGNOSIS
    t%JBHOPTJT TIPVME CF NBEF XJUIJO  IPVST CBTFE PO DIBSBDUFSJTUJDT PG BCEPNJOBM
    QBJOBOEFMFWBUJPOPGBNZMBTF MJQBTF PSCPUIUPBUMFBTUUISFFUJNFTUIFVQQFSMJNJU
    PGOPSNBM

    244
    Pancreatitis | CHAPTER 28

    TABLE 28–1 Medications Associated with Acute Pancreatitis


    Class I: Definite Class II: Probable
    Association Association Class III: Possible Association
    5-Aminosalicylic acid Acetaminophen Aldesleukin Indomethacin
    Asparaginase Carbamazepine Amiodarone Infliximab
    Azathioprine Cisplatin Calcium Ketoprofen
    Corticosteroids Erythromycin Celecoxib Ketorolac
    Cytarabine Hydrochlorothiazide Clozapine Lipid emulsion
    Didanosine Interferon α2b Cholestyramine Lisinopril
    Enalapril Lamivudine Cimetidine Mefenamic acid
    Estrogens Octreotide Ciprofloxacin Metformin
    Furosemide Sitagliptin Clarithromycin Methyldopa
    Mercaptopurine Clonidine Metolazone
    Opiates Cyclosporine Metronidazole
    Pentamidine Danazol Nitrofurantoin
    Pentavalent antimonials Diazoxide Omeprazole
    Sulfasalazine Etanercept Ondansetron
    Sulfamethoxazole and trimethoprim Ethacrynic acid Oxyphenbutazone
    Sulindac Exenatide Paclitaxel
    Tetracycline Famciclovir Pravastatin
    Valproic acid/salts Glyburide Propofol
    Gold therapy Propoxyphene
    Granisetron Rifampin
    Ibuprofen Sertraline
    Indinavir Zalcitabine

    t$POUSBTUFOIBODFEDPNQVUFEUPNPHSBQIZ $&$5
    PGUIFBCEPNFONBZDPOGJSN
    UIF EJBHOPTJT NBHOFUJD SFTPOBODF JNBHJOH BOE VMUSBTPOPHSBQIZ BSF TPNFUJNFT
    VTFGVM
    t"1 NBZ CF BTTPDJBUFE XJUI MFVLPDZUPTJT  IZQFSHMZDFNJB  BOE IZQPBMCVNJOFNJB
    )FQBUJD USBOTBNJOBTFT  BMLBMJOF QIPTQIBUBTF  BOE CJMJSVCJO BSF VTVBMMZ FMFWBUFE JO
    HBMMTUPOFQBODSFBUJUJTBOEJOQBUJFOUTXJUIJOUSJOTJDMJWFSEJTFBTF.BSLFEIZQPDBMDF
    NJBJOEJDBUFTTFWFSFOFDSPTJTBOEJTBQPPSQSPHOPTUJDTJHO
    t4FSVNBNZMBTFVTVBMMZSJTFTUPIPVSTBGUFSTZNQUPNPOTFU QFBLTBUIPVST BOE
    SFUVSOTUPOPSNBMPWFSUIFOFYUUPEBZT$PODFOUSBUJPOTHSFBUFSUIBOUISFFUJNFT
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    t4FSVNMJQBTFJTTQFDJGJDUPUIFQBODSFBT BOEDPODFOUSBUJPOTBSFFMFWBUFEBOEQBSBMMFM
    UIFTFSVNBNZMBTFFMFWBUJPOT*ODSFBTFTQFSTJTUMPOHFSUIBOTFSVNBNZMBTFFMFWBUJPOT
    BOEDBOCFEFUFDUFEBGUFSUIFBNZMBTFIBTSFUVSOFEUPOPSNBM
    t)FNBUPDSJUNBZCFOPSNBM CVUIFNPDPODFOUSBUJPOSFTVMUTGSPNNVMUJQMFGBDUPST FH 
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    245
    SECTION 5 | Gastrointestinal Disorders

    Acute pancreatitis

    Mild disease Severe disease


    Favorable prognosis Unfavorable prognosis
    No systemic complications Systemic complications

    Supportive care
    Analgesics Interstitial Necrotizing
    Nutrition Intensive care required Intensive care required
    Fluid resuscitation Fluid resuscitation
    Treat systemic complication Treat systemic complication
    ERCP for gallstones? ERCP for gallstones?
    Parenteral/enteral nutrition? Parenteral/enteral nutrition?
    Consider octreotide Consider antibiotics
    Consider octreotide

    Improvement No improvement

    Continue treatment Rule out infected


    pancreatic necrosis

    If infected, surgical debridement


    If sterile, continue treatment

    FIGURE 28–1. Algorithm of guidelines for evaluation and treatment of acute


    pancreatitis. (ERCP, endoscopic retrograde cholangiopancreatography.)

    TREATMENT
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    Nonpharmacologic Therapy
    tNutritional supportJTJNQPSUBOUCFDBVTF"1DSFBUFTBDBUBCPMJDTUBUFUIBUQSPNPUFT
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    Pharmacologic Therapy
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    246
    Pancreatitis | CHAPTER 28

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    OPMPOF FH ciprofloxacinPS levofloxacin
    DPNCJOFEXJUImetronidazoleTIPVMECF
    DPOTJEFSFEGPSQFOJDJMMJOBMMFSHJDQBUJFOUT

    EVALUATION OF THERAPEUTIC OUTCOMES


    t*OQBUJFOUTXJUINJME"1 BTTFTTQBJODPOUSPM GMVJEBOEFMFDUSPMZUFTUBUVT BOEOVUSJ
    UJPOQFSJPEJDBMMZEFQFOEJOHPOUIFEFHSFFPGBCEPNJOBMQBJOBOEGMVJEMPTT
    t5SBOTGFS QBUJFOUT XJUI TFWFSF "1 UP BO JOUFOTJWF DBSF VOJU GPS DMPTF NPOJUPSJOH PG
    WJUBMTJHOT GMVJEBOEFMFDUSPMZUFTUBUVT XIJUFCMPPEDFMMDPVOU CMPPEHMVDPTF MBDUBUF
    EFIZESPHFOBTF BTQBSUBUFBNJOPUSBOTGFSBTF TFSVNBMCVNJO IFNBUPDSJU CMPPEVSFB
    OJUSPHFO TFSVNDSFBUJOJOF BOE*/3$POUJOVPVTIFNPEZOBNJDBOEBSUFSJBMCMPPE
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    BOFWJEFODFCBTFENFUIPETVDIBT"1"$)&**

    CHRONIC PANCREATITIS
    PATHOPHYSIOLOGY
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    EFQPTJUJPO
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    TVSFGSPNPCTUSVDUJPO JOGMBNNBUJPO BOEOFDSPTJT$PNQSFTTJPOPGQBODSFBUJDOFSWF
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    NBZFYQMBJOUIFCVSOJOHBOETIPPUJOHQBJOPG$1
    t.BMBCTPSQUJPO PG QSPUFJO BOE GBU PDDVST XIFO DBQBDJUZ GPS FO[ZNF TFDSFUJPO JT
    SFEVDFECZ"NJOPSJUZPGQBUJFOUTEFWFMPQDPNQMJDBUJPOT JODMVEJOHQBODSFBUJD
    QTFVEPDZTU BCTDFTT BOEBTDJUFTPSDPNNPOCJMFEVDUPCTUSVDUJPO MFBEJOHUPDIPMBO
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    247

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