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pharmacology module III exam II > drugs for diarrhea and constipation > Flashcards

drugs for diarrhea and constipation Flashcards

1
Q

opioid agonists

A

loperamide (immodium)
diphrenoxylate/atropine
octreotide
eluxadoline

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2
Q

opioid agonists MOA

A

activation of opioid receptors in the smooth muscle of the GI tract - alters peristalsis by preventing smooth muscle contraction and relaxation - reduces stool volume and prevents electrolyte depletion

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3
Q

what do you need to correct prior to use of opioid agonists

A

fluid/electrolyte imbalances

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4
Q

dont use opioid agonists in

A

toxic megacolon or infectious diarrhea

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5
Q

loperamide MOA

A

increases IAS and EAS

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6
Q

loperamide metaboolism

A

hepatic

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7
Q

loperamide excretion

A

fecal

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8
Q

loperamide side effects

A

constipation - dizziness, abd pain, cramping

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9
Q

loperamide black box warning

A

cardiac arrest when used in large doses - CNS effects

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10
Q

cannot give loperamide in pts with

A

QT prolongation

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11
Q

diphrenoxylate/atropine MOA

A

contains small amount of atropine to prevent abuse

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12
Q

diphrenoxylate/atropine onset

A

45 min

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13
Q

diphrenoxylate/atropine metabolism

A

hepatic

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14
Q

diphrenoxylate/atropine excretion

A

fecal/urine

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15
Q

diphrenoxylate/atropine side effects

A

flushing, tachycardia, CNS effects, xeroderma, vomiting, toxic megacolon, urinary retention

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16
Q

diphrenoxylate/atropine interactions

A

alcohol, CNS depressants, anticholinergic agents, azelastine, glucagon, prokinetic agents, eluxadoline, glycopyrrolate, opiods, kava kava, nitro, pot, zolpidem

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17
Q

octreotide MOA

A

inhibits serotonin release - inhibits secretion of gastrin, VIP, insulin, glucagon, motilin, and pancreatic polypeptide

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18
Q

octreotide duration

A

6-12 hrs

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19
Q

octreotide metabolism

A

hepatic

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20
Q

octreotide excretion

A

urine

21
Q

octreotide side effects

A

bradycardia, fatigue, HA, dizziness, puritis, hyperglycemia, hypothyroidism, cholelithiasis, abdominal pain, diarrhea, constipation, biliary obstruction, URI, cardiac arrhythmias, depression

22
Q

octreotide interactions

A

antidiabetic agents, cyclosporine, midodrine, MAOI agents, quinolones, salicylates, SSRIs

23
Q

eluxadoline MOA

A

binds to mu, kappa, and delta opioid receptors in the intestinal lumen – decreases intestinal motility without causing constipation

24
Q

eluxadoline excretion

A

fecal/urine

25
Q

eluxadoline side effects

A

dizziness, drowsiness, constipation, nausea, abdominal pain, vomiting, elevated LFTs, URI

26
Q

what can pts with cholecystectomy get when on eluxadoline

A

acute pancreatitis

27
Q

eluxadoline contraindications

A

ETOH abuse, history of intestinal obstruction

28
Q

eluxadoline interactions

A

alcohol, CNS depressants, anticholinergic agents, alosetron, gemfibrozil, opioid agonists, rosuvastatin, rifampin

29
Q

serotonin receptor modulators

A

alosetron
tegaserod

30
Q

alosetron is used for

A

chronic (>6mo) severe IBS

31
Q

alosetron MOA

A

selective 5-HT3 agonist – acts on receptors in the enteric neurons in addition to receptors in other locations centrally and peripherally – affects visceral pain, colonic transit, and alters secretions in the GI tract

32
Q

alosetron metabolism

A

CYP2C9 and CYP1A2

33
Q

alosetron side effects

A

constipation, fatigue, HA, abdominal pain, nausea

34
Q

alosetron rarely causes _____ so dont use in hx of GI obstruction, crohns, diverticulitis, vasculopathy, thrombophlebitis, hypercoags

A

ischemic colitis

35
Q

alosetron education

A

take on empty stomach to increase absorption

36
Q

alosetron interactions

A

5HT3 antagonists, SSRIs, tobacco, tramadol

37
Q

tegaserod

A

only available in emergency investigation drug purposes d/t risk of cardiac arrest

38
Q

bile acid sequestrants MOA

A

bind to bile salts in the intestine -inhibits reuptake of bile salts, increases fecal loss of bile salt bound LDL cholesterol as well – 50% have bile acid malabsorption

39
Q

bile acid sequestrants absorption

A

none

40
Q

bile acid sequestrants side effects

A

abdominal pain, bloating, biliary colic, gallbladder calcification, melena, vomiting, dental erosion/discoloration, abnormal LFTs, tinnitus, bleeding issues

41
Q

bile acid sequestrants education

A

do not administer within 4-6hrs of other medications - may interfere with absorption

42
Q

bile acid sequestrants interactions

A

amiodarone, glucocorticoids, estrogen derivatives, loop diuretics, MTX, multiple vitamins, statins, NSAIDS, niacin, propranolol, tetracyclines, valproic acid

43
Q

antimicrobials

A

rifaximin
metronidazole
ciprofloxacin
amoxicillin
neomycin

44
Q

rifaximin MOA

A

blocks acetylcholine at parasympathetic receptors – antagonist of histamine and serotonin

45
Q

rifaximin metabolism

A

hepatic

46
Q

rifaximin side effects

A

tachycardia, mental status changes, abdominal pain, impotence, blurred vision, urinary retention, increased IOP
Contraindicated in MG, hypersensitivity to belladonna, UC, myocardial ischemia

47
Q

rifaximin contraindications

A

MG, hypersensitivity to belladonna, UC, myocardial ischemia

48
Q

rifaximin interactions

A

amantadine, anticholinergics, cannabinoids, nitroglycerin, potassium, thiazides

pharmacology module III exam II (6 decks)

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