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Pharm 4 > Lower GI > Flashcards

Lower GI Flashcards

(66 cards)

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1
Q

Effect of smoking on UC and CD

A

decreases risk of UC

increases risk of Crohn’s

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2
Q

2 conditions with increased risk if you have chronic IBD

A

osteoporosis and colorectal cancer

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3
Q

Drug classes for remission of UC

A

aminosalicylates and glucocorticoids

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4
Q

MOA sulfasalazine

A

contains sulfapyridine or mesalamine; cleaved by colon flora -> mesalamine to block AA metabolism that makes proinflammatory cytokines

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5
Q

ADR sulfasalazine

A

d/t sulfapyridine: n/v, diarrhea, arthralgias, HA
severe: hepatotoxicity, BM suppression
HS: sulfa allergy or ASA allergy

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6
Q

benefit of mesalamine-containing drugs

A

avoids sulfa allergy b/c no sulfapyridine component

*still ASA allergy

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7
Q

olsalazine, balsalazide

A

mesalamine prodrugs acting in colon

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8
Q

MOA of glucocorticoids for UC

A

inhibits PL-A2 = anti-inflammatory effect

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9
Q

use of GCs for UC

A

acute treatment of mod-severe disease, discontinued once under control to avoid long-term adverse reactions
*used if aminosalicylates ineffective

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10
Q

hydrocortisone rectal treatment options

A

enema -> back to splenic flexure

rectal foam -> last 20 cm of colon only

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11
Q

budesonide extended-release for UC

A

distributes throughout the colon

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12
Q

drug classes for maintenance of UC

A

aminosalicylates and thiopurines

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13
Q

MOA thiopurines

A

immunomodulatory agents that inhibit purine synthesis and induce apoptosis in T-cells

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14
Q

azothioprine

A

thiopurine for UC
to maintain remission of UC
effect delayed by several months, allows reduction/discontinuation of steroids

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15
Q

6-mercaptopurine

A

thiopurine for UC
active metabolite of azathioprine
ADR: BM suppression, neutropenia

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16
Q

drugs for refractory treatment of UC

A

cyclosporine or infliximab

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17
Q

MOA cyclosporine

A

calcineurin inhibitor, inhibits T-cell signal transduction

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18
Q

uses and ADR of cyclosporine for UC

A

for fulminant UC refractory to other agents; last resort before surgery
ADR: common: nephrotoxicity, neurotoxicity, HTN

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19
Q

MOA infliximab

A

TNF-a inhibitor by binding bound and soluble TNF-a

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20
Q

uses and ADR of infliximab

A

for mod-severe UC unresponsive to conventional therapy and severe Crohn’s not responding to steroids
ADR: increased risk serious infection (diss/react TB, HBV), inc risk lymphoma and leukemia, expensive

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21
Q

drugs for Crohn’s disease

A

same as UC but aminosalicylates not recommended + budesonide (reaches ileum and ascending colon), methotrexate +/- metronidazole and/or ciprofloxacin for perianal disease, TNF-a inhibitors

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22
Q

adalimumab, certolizumab

A

TNF-a inhibitors
ada - every 2 weeks at home
cert - every 4 weeks at home

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23
Q

diagnosis of IBS

A

abdominal pain and altered bowel habits diagnosis of exclusion

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24
Q

types of IBS

A

IBS-C: constipation predominant
IBS-D: diarrhea predominant
IBS-M: mixed pattern

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25
non-pharmacologic treatment of IBS
high placebo response rate | reduce food triggers like raw fruits/veggies, high fat, caffeine, fructose, sorbitol
26
non-pharmacologic treatment specific to IBS-C
fiber (soluble > insoluble), hydration, exercise
27
causes of constipation
anti-ACh, tricyclic antidepressants, antipsychotics (anti-ACh), Ca-channel blockers, diuretics, antacids and supplements with Al, Ca, Fe; opiates
28
MOA bulking agents
laxatives for IBS-C; stimulate natural mechanism b/c hydrophilic colloids that draw water into lumen; use in low-residue diet, elderly, pregnancy
29
polycarbophil
bulking laxative
30
psyllium
bulking laxative
31
methylcellulose
bulking laxative
32
MOA saline for IBS-C
osmotically pulls water into gut lumen for acute evacuation, contains Mg and phosphate which are poorly absorbed ions
33
cautions with bulking laxatives
esophageal obstruction and fecal impaction
34
docusate
emollient laxative
35
MOA emollient laxatives
anionic surfactant softens fecal mass by facilitating mixing of aqueous and fatty substances; used as prophylaxis and in pregnancy for constipation
36
cautions with saline laxative
may cause fluid and electrolyte imbalance
37
glycerin suppository
hyperosmotic/ lavage osmotic and local irritant
38
lactulose and sorbitol
hyperosmotic agent for IBS-C b/c nonabsorable sugars
39
polyethylene glycol
hyperosmotic agent for IBS-C with electrolytes in golytely without electrolytes in miralax
40
IBS-C drug useful for hepatic encephalopathy and cause of hep enceph
lactulose | hep enceph d/t uremia d/t cirrhosis
41
when to use hyper osmotic and lavage laxatives
for procedures | lactulose can be used for hepatic encephalopathy
42
MOA stimulants for IBS-C and when to use
irritants induce peristalsis (dose-related) | for procedures and constipation d/t opiates
43
senna
stimulant anthraquinone for IBS-C | DOC for constipation d/t opioids
44
bisacodyl
oral or suppository stimulant for IBS-C
45
castor oil
small intestine stimulant for IBS-C
46
ADR of stimulants for IBS-C
cramping, diarrhea, electrolyte imbalance -> severe diarrhea
47
MOA Cl- channel activators and uses
increase intraluminal fluid and BMs by increasing Cl- and bicarb secretion for IBS-C and idiopathic constipation
48
lubiprostone
cl- channel activator for IBS-C
49
linaclotide
cl- channel activator for IBS-C
50
ADR of cl- channel blockers
nausea, diarrhea, HA
51
herbals that may be useful in IBS-C
aloe, chicory, dandelion, feverfew, licorice, rose hips
52
drugs/treatments to avoid in IBS-C
mineral oil - significant absorption affects absorption of drugs and vitamins phenolphthalein - SJS
53
loperamide
weak opioid derivative anti-diarrheal for IBS-D | peripherally acting = no CNS opioid effects
54
diphenoxylate with atropine and ADR
Rx weak opioid derivative anti-diarrheal for IBS-D ADR: atropine = dry mouth/eyes, confusion in elderly, mydriasis, cycloplegia, tachycardia -> arrhythmia in elderly, constipation, retention, etc.
55
kaolin, pectin, attapulgite
adsorbent anti-diarrheals for IBS-D
56
bismuth subsalicylate
anti-secretory anti-diarrheal for IBS-D; localized anti-inflammatory action
57
lactase
anti-diarrheal for IBS-D d/t lactase deficiency
58
hyoscyamine
antisposmodic antidiarrheal for IBS-D
59
dicyclomine
antisposmodic antidiarrheal for IBS-D | also anti-ACh
60
chlordiazepoxide/ clinidium
antisposmodic antidiarrheal for IBS-D
61
amitriptyline
tricyclic antidepressant useful in IBS-D, strong anti-ACh effects
62
rifaximin
poorly absorbed oral abx for hepatic encephalopathy and traveler's diarrhea
63
probiotics
bacteria or yeast to recolonize intestine with beneficial microbes, prevent pathogenic microbe growth * may improve mood if a/w depression * bifidobacteria and lactobacilli most common
64
alosteron
5HT3-antagonist that decreases intestinal motility and pain signals for IBS-D ADR: ischemic colitis -> bowel resection (M>F)
65
what to use for fluid and electrolyte replacement for dehydration
oral glucose (low) and sodium (mod) (glucose needed for active Na uptake) also K, Cl, citrate or IV normal saline or lactated Ringer's
66
what to avoid with fluid and electrolyte replacement for dehydration
hyperosmolar: high sugar, low sodium like soft drinks, Gatorade, Jell-O, juice low sodium: tea high sodium: chicken broth (wastes water)

Pharm 4 (8 decks)

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