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(J2) GI II Test 1 > Diarrhea, Abdominal Pain, and Constipation Pharm > Flashcards

Diarrhea, Abdominal Pain, and Constipation Pharm Flashcards

1
Q

What are the main drug classes used for diarrhea?

A
  • prostaglandin inhibitors (bismuth)
  • opioid agonists
  • serotonin (5HT3) antagonists (alosetron)
  • chloride channel inhibitors (crofelemer)
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2
Q

What is loperamide?

(MOA and side effects)

A

Loperamide - opioid agonist

acts directly at intestinal smooth muscle to slow motility

Side effects:

-anticholinergic effects

-no analgesic/opiate effects like other -> no dependence risk

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3
Q

What is diphenoxylate?

(MOA and side effects)

A

Diphenoxylate - opiate agonist

acts at directly at intestinal smooth muscle to slow motility

Side effects:

  • atropine added to prevent abuse -> anticholinergic effects
  • opioid effects (only at high doses)
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4
Q

What is eluxadoline?

(MOA and side effects)

A

Eluxodoline - mu/kappa opioid agonist but delta antagonist

Directly in GI:

  • slows peristalsis (mu/kappa)
  • decreases GI secretions (delta)

Side effects:

  • hepatic/pancreatic toxicity (especially post-cholecystectomy)
  • opioid/analgesic effects
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5
Q

What opioid agonist is indicated for IBS-D only, instead of diarrhea in general?

A

-eluxadoline

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6
Q

What is alosetron?

A

Alosetron - serotonin (5HT3) antagonist

-selectively targets GI 5HT3 receptors inhibiting GI motility and secretions

Side effects:

  • GI symptoms
  • ischemic colitis
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7
Q

What is the indication for alosetron use?

A
  • only severe, chronic IBS-D that has not responded to other treatments
  • only in women
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8
Q

What contrainidcation/black box warning is associated with alosetron?

A

Contrainidications:

  • risk factors for bowel ischemia
  • GI obstruction (discontinue if constipation develops)

Black box warning:

-ischemic colitis

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9
Q

What is crofelemer?

(MOA and side effects)

A

Crofelemer - Cl- channel inhibitor

inhibits CFTR and CaCC (chloride channels) preventing secretory diarrhea associated with their functions

Side effects:

  • GI (distension)
  • elevated LFTs
  • resp./uri. infections
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10
Q

What is the indication for crofelemer use?

A

non-infectious diarrhea in HIV/AIDS

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11
Q

What drug class is used for abdominal pain/spasms?

(specific drugs and side effects)

A

antimuscarinics:

  • hyoscyamine
  • dicyclomine (bentyl)

Side effects:

-anticholinergic effects

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12
Q

What drug classes are used for constipation?

A
  • peripheral opioid antagonists
  • guanylate cyclase-C agonists (linaclotide)
  • selective chloride (C2) channel activators (lubiprostone)
  • laxatives/cathartics
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13
Q

What are peripheral opoid antagonists?

(specific drugs and indication)

A
  • methylnaltrexone
  • naloxegol
  • alvimopan

Indicated only for opioid-induced constipation

-alvimopan specificaly used only after surgery for post-operative ileus

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14
Q

What is the black box warning associated with alvimopan?

A
  • increased risk of MI
  • restricted to 15 does
  • REMS program to use/prescribe

alvIMopan <-> MI

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15
Q

What is linaclotide?

(MOA and indication)

A

Linaclotide - guanylate cyclase-C (GC-C) agonist

-increases cGMP -> activate CFTR -> water secretion

Indications:

  • IBS related constipation (IBS-C)
  • chronic idiopathic constipation (CIC)
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16
Q

What is lubiprostone?

(MOA and indication)

A

Lubiprostone - selective chloride (ClC-2) channel activator

PGE-1 derivative that activates GI-specific Cl channels (ClC-2) -> water secretion

Indications:

  • IBS-C
  • chronic idopathic (CIC)
  • opioid-induced (OIC)
17
Q

What is the difference between laxative and cathartics?

A

Laxative:

-loosens stool, allowing easier defecation

Cathartic:

  • accelerates defecation
  • used to clear bowel (commonly for surgery)
18
Q

What are the main types of laxatives/cathartics?

A
  • bulk forming agents
  • stool sofeners
  • stimulants
  • salines
  • osmotics
19
Q

What are bulk-forming agents?

What types of agents are these?

A

increase stool volume and water content

substances:

  • dietary fiber
  • psyllium
  • cellulose derivatives
  • calcium polycarbophil
20
Q

What are important notes in bulk-forming agents?

A

they require increased water intake to increase fluid content of stool, without this they will just cause constipation

2-4+ days to see effect

caution use with renal failure, can take water away from the kidneys

21
Q

What drug interactions occur with bulk-forming agents?

A

many, trap other medications in GI track

22
Q

What are stool softeners?

What types of agents are these?

A

anionic surfactants that increase fluid in stool

  • docusate “salts” (increases secretion)
  • mineral oil (add oil to stool/lubricate)
23
Q

What are stimulants?

What types of agents are these?

A

Irritates enterocytes/enteric nervous system causing water/electrolyte secretion

  • senna
  • bisacodyl
  • castor oil
  • glycerin
  • sodium picosulfate
24
Q

What are side effects of simtulants?

A
  • cramping
  • fluid/electrolyte imbalances
25
Q

What stimulant has an unusual adverse effect?

A

Senna

-yellow-brown/red-pink urine

-brown discoloration of the colon (melanosis coli)

26
Q

What stimulant is used in pre-colonoscopy bowel prep?

A

sodium picosulfate

27
Q

What are saline agents?

What types of agents are these?

A

contain poorly absorbed ions that increase water retention in the stool -> increasing volume -> shortens transit time

magnesium/phosphate salts

28
Q

What drug interaction and cautions are there in saline agent use?

A

Drug interactions:

-diuretics (electrolye disturbances)

Cautions with use in:

  • renal disease
  • CHF/HTN
29
Q

What are osmotic agents?

What types of agents are these?

A

attract and retain water -> increasing moisture, softness, and volume

  • small quantities act as laxatives (1-2 days)
  • large quantities act as cathartics (hours)

Agents:

  • lactulose
  • magnesium citrate
  • sorbitol
  • polyethylene glycol
30
Q

What osmotic agent is used in bowel prep for surgery?

A

polyethylene glycol in large doses

31
Q

What osmotic agent is used for liver disease with hyperammonemia?

A

lactulose

(J2) GI II Test 1 (14 decks)

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