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Flashcards in Lower GI Deck (66):
1

Effect of smoking on UC and CD

decreases risk of UC
increases risk of Crohn's

2

2 conditions with increased risk if you have chronic IBD

osteoporosis and colorectal cancer

3

Drug classes for remission of UC

aminosalicylates and glucocorticoids

4

MOA sulfasalazine

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

5

ADR sulfasalazine

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

6

benefit of mesalamine-containing drugs

avoids sulfa allergy b/c no sulfapyridine component
*still ASA allergy

7

olsalazine, balsalazide

mesalamine prodrugs acting in colon

8

MOA of glucocorticoids for UC

inhibits PL-A2 = anti-inflammatory effect

9

use of GCs for UC

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

10

hydrocortisone rectal treatment options

enema -> back to splenic flexure
rectal foam -> last 20 cm of colon only

11

budesonide extended-release for UC

distributes throughout the colon

12

drug classes for maintenance of UC

aminosalicylates and thiopurines

13

MOA thiopurines

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

14

azothioprine

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

15

6-mercaptopurine

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

16

drugs for refractory treatment of UC

cyclosporine or infliximab

17

MOA cyclosporine

calcineurin inhibitor, inhibits T-cell signal transduction

18

uses and ADR of cyclosporine for UC

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

19

MOA infliximab

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

20

uses and ADR of infliximab

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

21

drugs for Crohn's disease

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

22

adalimumab, certolizumab

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

23

diagnosis of IBS

abdominal pain and altered bowel habits diagnosis of exclusion

24

types of IBS

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

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

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methylcellulose

bulking laxative

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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)