Exam 1 Pharm: Agents for Diarrhea, Abdominal Pain and Constipation

Question 1

Drug classes used to treat diarrhea (4)

Answer 1

Prostaglandin inhibitors
Opioid agonists
Serotonin antagonists
Chloride channel inhibitors

Question 2

Drugs classes used to treat constipation (5)

Answer 2

Peripheral opioid antagonists
Guanalate Cyclase-C Agonists
Selective chloride (C2) channel activators
Serotonin Type-4 Partial Agonists
Laxatives & Cathartics

Question 3

Diarrhea treatment

Opioid agonist that can cause cardiotoxicity if patients overdose on it

Answer 3

Loperamide

Question 4

Diarrhea treatment

Opioid agonist with small quantity of atropine added to discourage abuse (because can have opioid effects at high doses)

Answer 4

Diphenoxylate

D for Discourage opioid abuse and Diphenoxylate

Question 5

Diarrhea treatment (specifically IBS-D)

Opioid agonist that is an agonist at GI mu and kappa receptors, and is an antagonist at GI delta receptors

Answer 5

Eluxadoline

Question 6

Diarrhea treatment (IBS-D)

Serotonin antagonist that selectively blocks GI 5-HT3 receptors, indicated for IBS-D not responsive to other therapies, can cause ishemic colitis

Answer 6

Alosetron

*Black box warning! can cause ischemic colitis

Question 7

Diarrhea treatment

Chloride channel inhibitor, inhibits CFTR and CaCC in intestine, indicated for diarrhea in HIV/AIDS patients

Answer 7

Crofelemer

C for Chloride Channels and Crofelemer

Question 8

Prostaglandin inhibitor used to treat diarrhea

Answer 8

Bismuth

Question 9

Constipation treatment (OIC)

Peripheral opioid antagonists (2) that act on mu receptors, indicated for opioid induced constipation

Answer 9

Methylnaltrexone

Naloxegol

*other is alvimopan (used only to prevent post bowel resection surgery ileus)

Question 10

Constipation treatment

Peripheral opioid antagonist that acts on mu receptors, ONLY INDICATION is to accelerate GI recovery following bowel resection surgery (prevents postoperative ileus), carries high risk of MI with use

Answer 10

Alvimopan (high MI risk after use!)

*other peripheral opioid antagonists are methylnaltrexone and naloxegol

Question 11

Constipation treatment (IBS-C and CIC)

Guanylate Cyclase-C Agonist, increases intracellular cGMP, which then stimulates Cl and bicarb secretion by intestinal cells, which draws fluid into the bowel

Answer 11

Linaclotide

C for guanylate cyclase-C and linaClotide

Question 12

Constipation treatment (IBS-C, CIC, OIC)

Selective chloride (C2) channel activator that is a PROSTaglandin-E1 derivative that activates GI specific chloride channels (CIC-2) in luminal cells of intestinal epithelium

Answer 12

Lubiprostone

PROST for lubiPROSTone and PROSTaglandin-E1

Question 13

Constipation treatment (IBS-C in women <65)

Serotonin type-4 (5HT4) receptor partial agonist that stimulates peristalsis and intestinal fluid secretion

Answer 13

Tegaserod (toget a rod out of your ass)

contraindicated in people with a medical history that probs matches up with a lot of old people (MI, TIA, angina, CVA, CKI, hepatic impairment, GI ischemia/obstruction/gallbladder dz/adhesions)

Question 14

Increase bulk-volume and water content of stool, may be used in people who dont eat a lot to help promote bowel movements

Answer 14

Bulk forming agents

Dietary fiber
Psyllium
-cellulose
Calcium polycarbophil

Question 15

Stool softeners, anionic surfactants that soften and lubricate feces, do not act as laxatives and mainly just soften the stool

Answer 15

Docusate salts
Mineral oil (penetrates stool to soften)

Question 16

Stimulate peristalsis by irritating and causing inflammation in enterocytes and GI smooth muscle (Na/K ATPase inhibition increases prostaglandin secretion)

Answer 16

Stimulant agents

Senna
Bisacodyl
Glycerin
Sodium Picosulfate

Question 17

Stimulant agent metabnolically converted to magnesium citrate (osmotic) and is used for pre-colonoscopy bowel prep

Answer 17

Sodium Picosulfate

P for Pre-colonoscopy and sodium Picosulfate

Question 18

Stimulant agent that causes urine discoloration (yellow-brown or red-pink)

Answer 18

Senna

Question 19

Salts that draw water into the bowel through osmosis, use cautiously in patients on diuretics, renal disease or CHF (electrolyte balance)

Answer 19

Saline agents

Magnesium salts
Potassium salts
Sodium salts

*3 salt combo can be used for pre-colonoscopy

Question 20

Agents that draw water into the bowel through osmosis, like saline agents

Answer 20

Osmotic agents

Lactulose
Lactitol
Polyethylene glycol
Sorbitol

Question 21

Osmotic agent used to help treat severe liver disease (hyperammonemia), traps ammonia in GI

Answer 21

Lactulose

L for Lactulose and Liver disease tx

Question 22

Osmotic agent that can be used in large doses to quickly pass stool, and is used for pre-colonoscopy bowel prep

Answer 22

Polyethylene glycol

P for Pre-colonoscopy and Polyethylene glycol

also think Poly for big dose

Question 23

Bismuth drug class

Answer 23

Prostaglandin inhibitor (anti-diarrheal)

Question 24

Loperamide drug class

Answer 24

Opioid agonist (anti-diarrheal)

Question 25

Diphenoxylate drug class

Answer 25

Opioid agonist (anti-diarrheal)

Question 26

Eluxadoline drug class

Answer 26

Opioid agonist (anti-diarrheal)

Question 27

Alosetron drug class

Answer 27

Serotonin antagonist (anti-diarrheal)

Question 28

Crofelemer drug class

Answer 28

Chloride channel inhibitor (anti-diarrheal)

Question 29

Methylnaltrexone drug class

Answer 29

Peripheral opioid antagonist (anti-constipation)

Question 30

Naloxegol drug class

Answer 30

Peripheral opioid antagonist (anti-constipation)

Question 31

Alvimopan drug class

Answer 31

Peripheral opioid antagonist (anti-constipation)

Question 32

Linaclotide drug class

Answer 32

Guanylate cyclase C agonist (anti-constipation)

Question 33

Lubiprostone drug class

Answer 33

Selective chloride channel activator (anti-constipation)

Question 34

Tegaserod drug class

Answer 34

Serotonin Type 4 partial agonist (anti-constipation)

Question 35

Opioid agonists used to treat diarrhea

Answer 35

Loperamide Diphenoxylate Eluxadoline

Question 36

Peripheral opioid antagonists used to treat constipation

Answer 36

Methylnaltrexone Naloxegol Alvimopan