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Pharmacology Exam 2 > Diarrhea/Constipation/IBS/IBD > Flashcards

Diarrhea/Constipation/IBS/IBD Flashcards

(73 cards)

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1
Q

CMV Diarrhea - DOC

A

Ganciclovir

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2
Q

Diarrhea common on cruise ships…spreads fast!

A

Norwalk

Treatment: supportive

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3
Q

Diarrhea most common in children

A

Rotovirus
Test: Rotazyme
Treatment: fluids +/- nitazoxanide

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4
Q

Diarrhea - Food poisoning with preformed toxin associated with reheated fried rice

A

Bacillus cereus

Treatment: supportive

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5
Q

Diarrhea - Gram - rod, fecal-oral transmission by contaminated water or unpasteurized milk. Also associated with Guillan-Barre.

A

campylobacter jejuni

Treatment: azithromycin

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6
Q

Diarrhea - Gram + rod from kids eating spores from honey –> paralysis and constipation

A

Clostridium botulinum

Treatment: trivalent antitoxin

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7
Q

Diarrhea - gram+ rod, nosocomial or antibiotic associated

A

Clostridium difficile

Treatment: metronidazole, vancomycin

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8
Q

Diarrhea - from uncooked beef, causes hemolytic uremic syndrome

A

E.Coli

Treatment: no abx, supportive

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9
Q

Diarrhea - acid fast rods usually seen in HIV + with CD5 < 50

A

Mycobacterium Avium Complex (MAC)

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10
Q

Diarrhea - gram - comma shaped rods, produces enterotoxin that increases cAMP in intestines. From contaminated water and seafood.

A

Vibrio cholorae

Treatment: fluid, glucose + Na (gatorade), doxy or FQ

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11
Q

Diarrhea - gram - coccobacillus causes enterocolitis in kids, also causes granulomatous microabcesses that can simulate acute appendicitis

A

Yersinia enterocolitica

Treatment: Bactrim

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12
Q

Diarrhea - associated with daycare, hikers, anal-oral in MSM

A

Giardia lamblia
Get stool antigen
Treatment: tinidazole or nitazoxanide

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13
Q

Most common helminth in US. Deposits eggs outside anus (itching).

A

Enterobius vermicularis

Treatment: albendazole or mebendazole

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14
Q

Antisecretory, anti-inflammatory, antibacterial agent for diarrhea

A

Pepto-Bismol

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15
Q

Pepto-Bismol ADE

A

binds to tetracycline

black tongue and dark stools

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16
Q

Pepto-Bismol cautions

A 
contains salicylate (ASA)
toxicity in large doses and increased bleeding risk
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17
Q

What are the anti motility agents?

A 
OTC Loperamide (Imodium)
Rx Diphenoxylate/Atropine (Lomotil)
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18
Q

*Lomotil cautions

A

weak opioid and has addiction potential (controlled substance)

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19
Q

Botanical rx from the red sap of the Croton lechleri plant in S.America approved for diarrhea in HIV+ patients

A

Crofelemer (Fulyzaq)

125mg BID po

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20
Q

Prophylaxis for traveler’s diarrhea

A

Doxycycline 100mg QD
Bactrim BID
Ciprofloxacin 500 mg QD

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21
Q

*Constipation - bulk forming agents

A

psyllium, bran
swell in water and increase bulk
12-24 hours
*1st line because low SE’s

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22
Q

Constipation - stool softeners

A

docusate
facilitates mixing of water and fatty materials in gut and create wetting effect
1-3 days

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23
Q

Constipation - osmotic agents

A

sorbitol, lactulose, sucralose

makes stool softer and bulkier

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24
Q

Constipation - stimulant laxative

A

bisacodyl (dulcolax)
Senna (Senokot)
take at bedtime for stool in am

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25
Constipation - saline laxatives
magnesium, citrate, phosphate osmotic effect that increases intraluminal volume --> stimulates peristalsis *also used for bowel cleansing
26
Constipation - hyperosmotic laxative
``` glycerin (acute constipation) lavage solutions (bowel prep) GoLYTELY ```
27
Chronic idiopathic constipation and IBS-C in women - Drug
Lubiprostone (Amitiza) Cl Channel Activator increases intestinal fluid secretion --> motility Preg C
28
Foundation of treatment for constipation
1. identify and correct underlying problem | 2. dietary fiber or bulk forming laxatives
29
Acute constipation - treatment
enemas or glycerin suppository | if ineffective, osmotic agents or stimulant laxatives
30
What other condition/disorder can impact IBS?
Depression and psychological disorders
31
Who does IBS typically effect?
Healthy women, 30-50 yrs old
32
*General approach to treatment - IBS-C
Fiber Osmotic laxatives Cl Channel Activators (Lubiprostone)
33
*General approach to treatment - IBS-D
Antidiarrheals Cholestyramine 5-HT3 antagonists (Alosetron-restricted)
34
*General approach to treatment - IBS-Pain/Gas/Bloating
anticholinergics (Dicyclomine) SSRI psychological treatment
35
Which fiber products are used in the treatment of IBS-C?
psyllium (Fiberall, Metamucil) or Polycarbophil (Fiber Con)
36
Fiber products - ADE
cramping, diarrhea
37
Which osmotic laxatives are used to treat IBS-C?
Milk of Mag and Sorbitol
38
Milk of Magnesium - ADE
hypermagnesemia, diarrhea, cramps
39
Milk of Magnesium - DDI
Tetracycline and FQs (because of the Mg)
40
*Which Cl Channel Activator is used to treat IBS-C?
Lubiprostone (Amitiza)
41
*Lubiprostone - Preg Cat?
C (may cause increased pregnancy loss) | do pregnancy test before/during and use effective contraception
42
Which two antidiarrheals are used to treat IBS-D?
Immodium and Lomotil
43
*Which antidiarrheal is better for use during pregnancy and breastfeeding?
Immodium (B/L2) | Lomotil is C/L3
44
Which 5-HT3 antagonist can be used to treat IBS-C?
Alosetron (Lotronex) | *Restricted access
45
Why is Alosetron restricted?
can cause ischemic colitis
46
Which anticholinergic can be used to treat IBS with pain/gas/bloating?
Dicyclomine (Bentyl)
47
Why is Bentyl not the BEST option for IBS with pain/gas/bloating?
QID L4 (suppresses lactation) tachycardia
48
What are the preferred SSRIs to treat IBS with pain/gas/bloating?
Citalopram (Celexa) and Escitalopram (Lexapro)
49
Which SSRI has the most GI side effects?
Sertraline (Zoloft)
50
SSRI - ADE
headache, diarrhea, drowsiness, sexual dysfunction
51
Which 2 SSRIs are well known inhibitors of CY2D6?
Fluoxetine (Prozac) and Paroxetine (Paxil)
52
Why are citalopram (Celexa) and escitalopram (Lexapro) not used during breastfeeding?
may cause infant somnolence
53
What disorder? chronic inflammation of colon, bloody diarrhea, abdominal pain, no skip lesions and higher risk for toxic megacolon and colon cancer.
Ulcerative colitis
54
What disorder? chronic inflammatory disease anywhere from mouth to anus, skip lesions fistulas and non-bloody diarrhea
Crohn's disease
55
*IBD - mild vs mod vs severe
Mild - < 4 stools/day +/- blood Mod - > 4 stools/day +/- blood Severe - >6 stools day +/- blood Fulminant > 10 stools day +continuous blood, abd distension
56
*Why to you give abx for crohn's disease treatment?
treating fistulas
57
What is the preferred abx for crohn's?
metronidazole
58
What is the preferred 5-ASA for IBD?
mesalamine
59
Routes - mesalamine
lots! po, suppository, rectal suspension, retention enema
60
Which corticosteroid is preferred for IBD?
Controlled release budesonide (Entocort EC)
61
Why are steroids typically given IV during severe IBD?
because npo…resting the gut
62
Corticosteroids - ADE
``` secondary adrenal insufficiency (HPA suppression) osteoporosis PUD impaired wound healing worsening or cause DM ```
63
*UC - General Treatment (Mild/Mod)
5-ASA like Mesalamine (oral +/- enema) or steroid like Budenosine or Infliximab
64
*UC - General Treatment (Severe)
TNF-alpha antagonists + oral therapies or IV steroids x 3-5 days or IV Cyclosporine
65
*UC - General Maintenance
5-ASA like mesalamine (oral +/- enema) | NOT steroids
66
*CD - General Treatment (Mild)
Budesonide or mesalamine +/- metronidazole
67
*CD - General Treatment (Mod)
same as mild | +/- steroids, azathioprine, MTX, TNF-alpha antagonists
68
*CD - General Treatment (Severe)
Steroids x 7-28 days +/- metronidazole +/- steroids, azathioprine, MTX or TNF-alpha antagonists
69
*CD - General Maintenance
(budesonide or mesalamine) or azathioprine or TNF-alpha antagonists NOT steroids
70
*Lubiprostone - MOA
local chloride channel activator that enhances a chloride-rich intestinal fluid secretion without altering Na and K concentrations in the serum
71
*Adalimumab (Humira) and InfliXimab (Remicade)- class?
TNF alpha antagonist
72
*TNF alpha antagonist - MOA
breakdown granulomas leading to the dissemination of TB being confined
73
*Methotrexate - MOA
inhibits dihydrofolic acid reductase --> interferes with DNA synthesis, repair and cellular regulation

Pharmacology Exam 2 (9 decks)

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