GI pt 3 Flashcards
(67 cards)
What are the G.I. motility disorders?
Gerd, constipation, diarrhea, recurrent vomiting, gastroparesis, and irritable bowel syndrome
What are prokinetic drugs?
There are drugs that stimulate upper gastrointestinal mutilate often used in gastroparesis associated with diabetes and post surgical gastric emptying delays
What is the D2 receptor antagonist prokinetic drug?
Metocloperamide or Reglan
How does Reglan work?
It’s suppresses emesis by blocking receptors for dopamine and serotonin in the CTZ. It also increases upper G.I. motility by enhancing the action of acetylcholine.
How does dopamine affect smooth muscle contraction?
It is a neurotransmitter that serves as an inhibitory function by inhibiting cholinergic stimulation of intestinal, smooth muscle contraction. Reglan is a D2 receptor antagonist.
What are the adverse effects of Reglan?
It can cause sedation and diarrhea, and when used long-term, it can also cause irreversible parkinsonism, mental depression, and prolactinemia.
How is irritable syndrome characterized?
It is a motility syndrome, characterized by chronic abdominal pain and altered bowel habits in the absence of any organic cause
How is irritable bowel syndrome diagnosed
It can only be diagnosed after competing differentials are eliminated. You must have recurrent abdominal pain or discomfort for at least three times a month for three consecutive months associated with symptoms related to defecation change in frequency or change the form or appearance of stool.
What patient population is more commonly diagnosed with irritable bowel syndrome
Women before the age of 35
What store characteristics are not associated with irritable bowel syndrome?
Large volume diarrhea, bloody stools, nocturnal diarrhea and greasy stools
What are the four sub types of irritable bowel syndrome?
IBS – C where patients have hard and lumpy stools
IBS – D patients have loose or watery stools
IBS – combination or IBS – M where stools are hard and lumpy 25% of the time and water and loose 25% of the time
And IBS – U when the patient meets diagnostic criteria, but their bowel habits cannot be accurately characterized
What is the Rome IV criteria for diagnosing, irritable, bowel syndrome?
Abdominal pain and discomfort has to be present for the previous three months with an onset of at least six months prior to diagnosis
How does irritable bowel syndrome typically present?
Cramping pain, bloating, distention, diarrhea, or constipation, incomplete evacuation of stool flatus nausea, or vomiting and mucus in the stools
What medications do you give for pain related symptoms in irritable bowel syndrome?
Tricyclic antidepressants, SSRI’s antispasmodics and anticholinergics
What medications are given for diarrhea symptoms associated with irritable bowel syndrome
Anti-motility agents like loperamide and Diphenoxalate
What medications are given for constipation symptoms associated with irritable bowel syndrome
Bulk forming agents and laxative agents
What are the long-term agents used in irritable bowel syndrome pain management?
Tricyclic antidepressants, and SSRI
What are the short term agents used in irritable, bowel syndrome pain management?
Antispasmodics and anticholinergics like dicyclomine and hyoscyamine
What is the mechanism of action with dicyclomine?
Indirectly blocks smooth muscle of the G.I. tract and blocks acetylcholine receptor sites it directly antagonize Brady Cannon, and histamine in the G.I. tract, smooth muscle, which leads to relieving smooth muscle spasms
What are the adverse effects of dicyclomine?
Reduction and sweating that may lead to heat stroke and fever, increased ocular, pressure, anticholinergic effects, urinary retention, and headache
What is the five – HT3 receptor antagonist alosteron mechanism of action
It causes selective blockade of type three serotonin receptors in neurons that innervates the viscera which leads to a decrease in abdominal pain and fecal urgency and increases colonic transit time, absorption of water and sodium and stool and firmness
What drug is often indicated for the treatment of IBS – D
The SSRI alosetron
What are the adverse effects of alosetron
Ischemic colitis, severe constipation, and even death
When should alosetron be initiated in patients
Only in women with severe IBS – D that has lasted for six months or more without response from other treatments
