Small Bowel Pharm

Question 1

Give and example of bulk-forming agents that can help to relieve constipation and diarrhea.

Answer 1

psyllium husk
carboxy mthylcellulose
polycarbophil (cardboard)

other anti-diarrheal: kaolin clay

Question 2

Name some basic over the counter anti-diarrheal aids

Answer 2

bismuth subsalicylate (black tongue)
loperamide: Imodium

(diphenoxylate with atropine, opioid agonist- lomotil)

Question 3

What’s the limiting factor in using opioids as anti-diarrheals?

Answer 3

they have a lot of side effects (and also potential for addiction)

Question 4

How do bile salt binding resins address diarrhea?

Answer 4

build salt binding resigns like cholestyramine bind leaking bile that can cause diarrhea

Question 5

What is the MOA of alostron and its precautions?

Answer 5

5-HT-3 antagonist, is very powerful, used in women only for IBS-D

may cause colon ischemia, cannot be taken in patients with a clotting disorder

Question 6

Octreotide is known as “a ____ ____ on the GI tract.”

Answer 6

a somatostatin analog known as “a wet blanket on the GI tract”

it is expensive and difficult to tolerate, used in treating portal hypertension and diarrhea

Question 7

Name the most significant side effects of methotrexate.

Answer 7

hepatotoxicity
bone marrow suppression
pulmonary toxicity
teratogenic

** FUN FACT patients should also be taking a folate supplement with this drug

Question 8

Name the treatment for mild, moderate and severe Crohn’s

Answer 8

mild: aminosalicylates (mesalamine) and corticosteroids (budesonide)

moderate-severe: immunodulators(slow) (azithoprine, methotrexate), anti TNF (infliximab, adalimumab), other biologics (natalizumab, vediolizumab

Question 9

Briefly differentiate between mild, moderate and severe crohn’s disease.

Answer 9

mild: ambulatory; 4 stool
severe: persistent symptoms on corticosteroids or high fever, rebound or abscess >10 stool

Question 10

Describe some of the significant side effects of axathioprine

Answer 10

bone marrow suppression, drug induced liver injury (must check liver AST/ALT every 3mo), fever, pancreatitis, non melanoma skin cancer, lymphoma

Question 11

A patient on TNF inhibitors is at risk for reactivation of what two infections?

Answer 11

latent TB

occult Hep B

Question 12

What are indications for colectomy?

Answer 12

toxic megacolon
severe hemorrhage
lack of response to therapy
cancer or dysplasia

Question 13

Differentiate constipation predominant IBS and chronic constipation.

Answer 13

constipation predominant IBS includes pain, chronic constipation does not

Question 14

Name examples of stool softeners.

Answer 14

Decussate sodium ('mucus in a pill')
mineral oil (emollient)

Question 15

What is the mechanism to treating constipation by non absorbed sugars and salts like magnesium hydroxide and lactulose/sorbitol?

Answer 15

produces an osmotic diarrhea that can be accompanied by cramping/gas/bloating

Question 16

What is diphenylmethane?

What is the action of anthraquinone (senna and cascara)

Answer 16

bisacodyl is an “over night” motility drug that works as a stimulant
senna and cascara are poorly absorbed an can cause malanosis coli (makes polyps stand out better)

Question 17

What is the action of polyethylene glycol? (PEG)

Answer 17

long chains that are not absorbed that are either used as a mild laxative or as a cathartic (bowel prep)

Question 18

Give an example of C-2 channel stimulants and what their drawbacks are.

Answer 18

lubiprostone: 30% experience nausea, is expensive and a pregnancy class C drug

Question 19

What class of drugs is methylnaltrexone in and what is it used for.

Answer 19

a mu opioid receptor antagonist that is used in opioid induced contipation or post-op ileus

Question 20

Stool lactoferrin, fecal-calprotectin and stool WBC are all measures of what?

Answer 20

measures of inflammation in the colon

Question 21

Read my mind: Mesalamine is ___ _____.

Answer 21

mesalamine is disease modifying in UC