Diarrhea/Constipation/IBS/IBD Flashcards Preview

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

Flashcards in Diarrhea/Constipation/IBS/IBD Deck (73):
1

CMV Diarrhea - DOC

Ganciclovir

2

Diarrhea common on cruise ships…spreads fast!

Norwalk
Treatment: supportive

3

Diarrhea most common in children

Rotovirus
Test: Rotazyme
Treatment: fluids +/- nitazoxanide

4

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

Bacillus cereus
Treatment: supportive

5

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

campylobacter jejuni
Treatment: azithromycin

6

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

Clostridium botulinum
Treatment: trivalent antitoxin

7

Diarrhea - gram+ rod, nosocomial or antibiotic associated

Clostridium difficile
Treatment: metronidazole, vancomycin

8

Diarrhea - from uncooked beef, causes hemolytic uremic syndrome

E.Coli
Treatment: no abx, supportive

9

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

Mycobacterium Avium Complex (MAC)

10

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

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

11

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

Yersinia enterocolitica
Treatment: Bactrim

12

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

Giardia lamblia
Get stool antigen
Treatment: tinidazole or nitazoxanide

13

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

Enterobius vermicularis
Treatment: albendazole or mebendazole

14

Antisecretory, anti-inflammatory, antibacterial agent for diarrhea

Pepto-Bismol

15

Pepto-Bismol ADE

binds to tetracycline
black tongue and dark stools

16

Pepto-Bismol cautions

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

17

What are the anti motility agents?

OTC Loperamide (Imodium)
Rx Diphenoxylate/Atropine (Lomotil)

18

*Lomotil cautions

weak opioid and has addiction potential (controlled substance)

19

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

Crofelemer (Fulyzaq)
125mg BID po

20

Prophylaxis for traveler's diarrhea

Doxycycline 100mg QD
Bactrim BID
Ciprofloxacin 500 mg QD

21

*Constipation - bulk forming agents

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

22

Constipation - stool softeners

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

23

Constipation - osmotic agents

sorbitol, lactulose, sucralose
makes stool softer and bulkier

24

Constipation - stimulant laxative

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

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