N/V/D Constipation IBS

Question 1

What NT are in the chemo receptor trigger zone?

Answer 1

5-HT
Dopamine
Muscarinic

Question 2

What can nausea and vomiting lead to?

Answer 2

Dehydration

Question 3

What should people who are N/V avoid?

Answer 3

Dairy (exception is a baby drinking breast milk/ formula)

Question 4

What is the BRAT diet? (after 24 hour fluid diet)

Answer 4

Banana
Rice
Apple Sauce
Toast (dry)

Question 5

What are 4 pharm treatment to stop N/V?

Answer 5

5-HT3 Antagonists
Dopamine Antagonists
Antihistamines
Cannabinoids

Question 6

What are three 5-HT2 antagonists?

Answer 6

Ondansetron (Zofran)
Granisetron (Kytril)
Dolasetron (Anzemet)

ROA- oral, rectal, IM, IV

Question 7

What is the 5-HT antagonist MOA?

Answer 7

Antagonism of the 5-HT3 receptor in the chemo-receptor trigger zone (CTZ)

Question 8

Indications for 5-HT3 antagonists

Answer 8

Treatment and prevention of postoperative N/V (FDA)
Chemotherapy-induced N/V (FDA)
also given in ER a lot for N/V

Question 9

ADRs of 5-HT3 antagonists

Answer 9

HA
Dizziness
Diarrhea
Abdominal pain

Question 10

What are three dopamine antagonists

Answer 10

Metoclopramide (reglan)
Trimethobenzamide (Tigan)
Phenothiazines- Prochlorperazine (Compazine)
Promethazine

Question 11

MOA of dopamine antagonists

Answer 11

Antagonist of D2 receptors in the CTZ

Question 12

What dopamine antagonist at higher doses also blocks 5-HT3 receptors. Also promote gastric emptying and small intestine peristalsis—prokinetic effects

Answer 12

metoclopramide

Question 13

Contraindications of dopamine antagonist

Answer 13

GI hemorrhage, obstruction or perf

Caution in patients w/ depression, seizures, children

Question 14

ADRs of dopamine antagonist

Answer 14

Extrapyramidal effects (Parkinsonism) 
Restlessness, anxiety, drowsiness, fatigue, halluc.

CV- HPN, HPOTN, AV block, bradycardia, agranulocytosis

Question 15

What antihistamine is used for N/V?

Answer 15

Promethazine

Question 16

MOA of promethazine

Answer 16

Block H1 –> effectiveness appear to be with motion sickness and vestibulochochlear disease
Antagonist of D2 receptors in the CTZ

Question 17

ADRs of promethazine

Answer 17

Parkinsonian symptoms (dyskinesia, dystonias, akathisia)
Neuroleptic malignant syndrome

Question 18

Who should you be cautious with for usage of promethazine

Answer 18

BPH
Urinary retention
glaucoma

Question 19

Used is a tablet of cannabinoids?

Answer 19

Dronabinol

Question 20

ADRs of dronabinol

Answer 20

Drowsiness
sedation
increased appetite

Question 21

Best option for chemo therapy induced N/V

Answer 21

5-HT3 antagonist

Question 22

Regulation of normal intestinal motility is under what control?

Answer 22

Neuronal

Hormonal

Question 23

5 classes of drugs for GI motility

Answer 23

Laxatives
Antidiarrheal agents
Prokinetic agents
Antiemetic agents
Antispasmodics

Question 24

Medical definition of constipation

Answer 24

Straining > 25% of time
Lumpy or hard stools > 25% of time
Feeling of incomplete evacuation > 25% of time
2 or fewer BM in 1 week

Question 25

Medication causes for constipation

Answer 25

``` Opiates Ca and Al antacids Iron Calcium channel blockers Clonidine Anticholinergics ```

Question 26

Best ways to control constipation

Answer 26

Drink plenty of water and fluids (P juices) | High fiber diet (whole grains, bran, fresh fruit and veggies)

Question 27

what do laxatives do?

Answer 27

hasten transit time in the gut and encourage defecation | Used prior to medical procedure to clear bowel out

Question 28

5 types of laxatives

Answer 28

``` Bulk-Forming Laxatives Emollients and Lubricants Saline Cathartics Osmotic Laxatives Stimulant Laxatives ```

Question 29

Name the bulk forming laxatives

Answer 29

Psyllium (metamucil) Methylcellulose (Citrucel) Polycarbophil (Fibercon)

Question 30

MOA of bulk forming laxatives

Answer 30

Increase volume of non-absorbable solid residue in water, stimulates peristalsis and increase rate of colonic transit

Question 31

What is the first line therapy for bedridden or geriatric with chronic constipation. Good in pregnancy.

Answer 31

Bulk-forming laxatives

Question 32

Contraindications of bulk-forming laxatives

Answer 32

Patients w/ stenosis Ulceration or adhesions Fecal obstruction

Question 33

Should you get bulk-forming laxatives with other medications?

Answer 33

No- if you give bulk-forming laxative first wait 4 hours before giving meds. If take meds first wait 2 hours before bulk laxatives

Question 34

Besides constipation, what are bulk-forming laxatives good for?

Answer 34

Diarrhea | Lowering cholesterol

Question 35

What is an emollients?

Answer 35

Docusate sodium

Question 36

WHat is docusate sodium used for?

Answer 36

To avoid straining after MI, rectal surgery, opiates 1st line for pregnancy (along w/ bulk forming)

Question 37

MOA of docusate sodium

Answer 37

Surfactant brings water into stool, mixing of aqueous and fatty material within intestine

Question 38

Contraindications with docusate sodium

Answer 38

Fecal impaction | Signs of appendicitis

Question 39

What is a lubricant used as a laxative?

Answer 39

Mineral oil

Question 40

What is the onset of mineral oil?

Answer 40

6 hours- 3 days (oral or rectal)

Question 41

What is the MOA of mineral oil?

Answer 41

Coats stool (allows easier passage) inhibts colonic absorption of water

Question 42

What can you have trouble absorbing if you have taken mineral oil ?

Answer 42

Fat-soluble vitamins

Question 43

What are osmotic agents?

Answer 43

Sorbitol | Lactulose

Question 44

What is an osmotic agent that is a disaccharide that is metabolzied by bacteria in the colon to low-molecular weight acids (osmotic effect)

Answer 44

Lactulose

Question 45

Is lactulose a first line agent?

Answer 45

No

Question 46

Lactulose is used in patients with what?

Answer 46

Hepatic encephalopathy

Question 47

what are some saline cathartics that are used for constipation?

Answer 47

Magnesium hydroxide Magnesium sulfate Sodium phosphate Magnesium citrate

Question 48

MOA of saline cathartics?

Answer 48

Salts are poorly absorbed so they increase th water content of the bowel through osmosis

Question 49

Contraindications of saline cathartics

Answer 49

Impaired renal function CHF HTN patients

Question 50

Drug that has osmotic action in rectum, onset within 30 minutes and very safe . used often in children.

Answer 50

Glycerin suppository

Question 51

What is a glycerin/ hyperosmotic. Relatively safe, ok for kids. Mixed in juice or water. Small amount

Answer 51

Polyethylene glycol (miralax)

Question 52

Like miralax but larger. Used for prescription. Used before a colonoscopy. Drink 4 L of fluid over 3 hours.

Answer 52

Glycerin/ Hyperosmotic | PEG, GoLYTELY

Question 53

What are some stimulant laxatives

Answer 53

Bisacodyl (Dulcolax) | Senna

Question 54

How do BIsacodyl work?

Answer 54

Stimulate nerve plexus of colon

Question 55

Some problems with bisacodyl

Answer 55

Fluid/ electrolyte imbalances

Question 56

What color feces and urine may someone taking bisacodyl see?

Answer 56

Pink

Question 57

Long term use of bisacodyl could result in what?

Answer 57

Atonic colon, deterioration of intestinal function

Question 58

You shoudl not take bisacodyl within 1 hour of taking what?

Answer 58

Antacids, milk

Question 59

Senna may turn urine what color?

Answer 59

Yellow-brown to red

Question 60

What can large doses of senna produce?

Answer 60

Neprhritis

Question 61

Contraindications with senna

Answer 61

Pregnancy | acute intestinal inflammation

Question 62

What is a drug that is a chloride-channel activator that works by increasing fluid secretion in the small intestine. Expensive

Answer 62

Lubiprostone

Question 63

Works by peripherally acting antagonist of mu receptor. Doesn't cross BBB, reduces effects of opiods peripherally. Very expensive, needs renal adjusting

Answer 63

Methylnaltrexone

Question 64

What are some populations that experience constipation.

Answer 64

Diabetics Pregnancy Opiate Use

Question 65

What should you avoid in pregnant women for laxatives?

Answer 65

Avoid mineral oil, castor oil, osmotics | stick to bulk formers or emollients

Question 66

How should you avoid people with opiate use to avoid constipation?

Answer 66

Exercise adequate fluid fiber

Question 67

What are good things to use in elderly for constipation?

Answer 67

``` Bulk-forming laxatives enema glycerin lactulose P juice ```

Question 68

In kids what should you use for constipation?

Answer 68

Improve diet with fiber "p" juices Glycerin suppositories Senna or mineral oil Avoid stimulants, excessive enemas

Question 69

This causes watery diarrhea and 1/3 have fever. Nearly every child in US affected by age 5. Vaccine approved in 2006

Answer 69

Rotavirus

Question 70

Who should you not use antimotility agents in?

Answer 70

People with dysentery or if C. Diff is possible

Question 71

What type diarrhea has excess water and electrolytes? Type of diarrhea that still happens when you stop eating. Large stool volume.

Answer 71

Secretory

Question 72

What type diarrhea is from a substance that draws in intesinal fluids. Will stop when you stop taking in food

Answer 72

Osmotic

Question 73

Type of diarrhea due to inflammatory dz of GI. Diseases that discharge mucus, serum proteins, and blood into gut

Answer 73

Exudative

Question 74

Antibiotics that cause diarrhea

Answer 74

Clindamycin | Broach spectrum

Question 75

What are non-pharmacologic ways to treat diarrhea

Answer 75

Discontinue consumption of solids and diary for 24 hours (osmotic) With N/V- resume with BRAT diet Rehydrate, maintain electrolytes

Question 76

Antibiotics that cause diarrhea

Answer 76

Clindamycin | Broach spectrum

Question 77

Antimotility agents that are used to stop diarrhea

Answer 77

Opiates and derivitaes

Question 78

MOA of opiates for diarrhea

Answer 78

slow intestinal transit prolong contact and absorption increased gut capacity

Question 79

Opiates will make what type diarrhea worse?

Answer 79

Infectious

Question 80

What are opiates used for diarrhea.

Answer 80

Lomotil | Loperamide

Question 81

What are some contraindications for loperamide?

Answer 81

Patients w/ fever exceeding 101 F acute ulcerative colitis abx associative colitis children under 2

Question 82

MOA is absorb nutrients, toxins, drugs, and digestives juices. Avaliable OTC, not proven.

Answer 82

Kaolin-pectin polycarbophil attapulgite

Question 83

An absorbant that absorbs bile salts and C. diff toxin. Requires RX

Answer 83

Cholestryamine

Question 84

Interactions with bismuth subsalicylate

Answer 84

Anticoagulants and tetracycline | May interfere w/ radiologic studies

Question 85

Should traditional pepto-bismol be given to kids?

Answer 85

No, can cause Reyes syndrome

Question 86

What is an antisecretory that blocks the release of serotonin and has direct inhibitory effects. control symptoms in pts with metastatic vasoactive intestinal peptide-secreting tumor associated diarrhea. Off-label used for refractory diarrhea

Answer 86

Octreotide

Question 87

Side effects with octeotide

Answer 87

bradycardia | hyperglycemia

Question 88

Anticholingerics used for diarrhea

Answer 88

Atropine

Question 89

useful in lactose intolerance. Replaces lactase enzyme deficiency.

Answer 89

Lactase enzymes

Question 90

How can zinc help with diarrhea?

Answer 90

reduction of stool output | reduction of diarrhea duration

Question 91

How do you treat traveler's diarrhea

Answer 91

CIpro | Azithromycin

Question 92

Treatment of C. Diff

Answer 92

Metronidazole | Vancomycin

Question 93

Treatment for constipation predominant IBS

Answer 93

Add bulk forming laxative, consider antispasmodics | Add serotonin-4 agonist (Tegaserod)

Question 94

Treatment for diarrhea predominant IBS

Answer 94

Add bulk fiber Avoid lactose and caffeine Add loperamide or another antispasmodic Add 5_hT3 antagonist (Alostron)