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Year2 GI Exam I > NVDC Tx II > Flashcards

NVDC Tx II Flashcards

1
Q

what are time frames for acute, persistant and chronic diarrhea

A

acute 14 days

chronic >30 days

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2
Q

what viruses and bacteria cause acute diarrhea

A

norwalk, rotavirus
shigella, salmonella, campylobacter, staph, e coli
don’t forget protozoa

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3
Q

what drugs induce diarrhea

A

reserpine, sulfonamides, tetracylcines, broad spec antibiotics, cholinergic agonists, osmoitc and stimulant laxatives, prokinetic agents, PGs and quinidine

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4
Q

MOA loperamide

A

inhibit presynaptic cholinergic nerves in submucosal and myenteric plexuses, increase transit time, increase fecal water absorption, decrease mass colonic movements

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5
Q

why is loperamoid non prescription even though opiod

A

does not cross bbb
no analgesic properties
no potential for addiction

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6
Q

therapeutic use loperamide

A

mainstay nonspecific Tx diarrhea

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7
Q

adverse effects loperamide

A

toxic megacolon in those with active IBD

not used in patieints with ulcerative colitis or acute bacillary or amoebic dysentery

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8
Q

what is ocreotide and MOA

A

somatostatin analog

inhibits secretion of hormones and transmitters because it acts like somatostatin

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9
Q

therapeutic use ocreotide

A

those with advanced symotomatic tumors
diarrhea due to vagotomy or dumpign syndrome as well as diarrhea for short bowel syndrome or AIDS
used in small doses to stimulate motility

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10
Q

adverse effects ocreotide

A

inhibits pancreatic secretion
nausea, abdominal pain, flatulence, diarrhea
can cause gallstones
hyperglycemia, hypothyroidism, bradycardia

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11
Q

when do you not use anti diarrheals

A

bloody diarrhea, high fever, systemic toxicity

if diarrhea worsens with Tx

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12
Q

what is criteria for constipation

A

<3 bowel movement per week

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13
Q

what drugs can induce constipation

A

opiog analgesics, antichoinergics, antacids with Al or CaCo, Fe and NSAIDs

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14
Q

most important feature of Tx for constipation

A

dietary modification (increase fiber)

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15
Q

first line for constipation prevention

A

bulk forming laxatives and docusates

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16
Q

types of bulk forming laxatives

A

metamucil, citrucel, fiber con etc…

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17
Q

MOA bulk forming laxatives

A

indigestible, hydrophilic colloids which absorb water that forms a gel that distends colon and promotes peristalsis

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18
Q

adverse effects bulk formint laxatives

A

bloating and flatus

need to take in suffiecient fluid to avoid obstruction

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19
Q

what are the stool softeners

A

docusate oral or enema and glycerin suppository

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20
Q

MOA stool softener

A

allows water and lipids to prenetrate stool which softens it

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21
Q

therapeutic use stool softeners

A

to prevent constipatino and minimize straining (post operative patients)

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22
Q

what is used to prevent and treat fecal impaction

A

mineral oil

23
Q

MOA osmotic liaxatives

A

soluble non absorbable, increase stool liquidity

24
Q

therapeutic use of non-absorbable sugars or salts

A

Tx acute constipation

prevent chronic constipation

25
why is MgOH not used prolonged in patients with renal insufficiency
hyper Mg
26
adverse effects of sorbitol and lactulose
severe flatus and cramps
27
types of osmotic laxatives
Mgcitrate, MgOH, NaPO4, | polyethylene glycol
28
adverse effects NaPO4
cardiac arrhythmias from hpokalemia, hypernatremia, hypocalcemia, hyperphosphatemia can lead to acute renal fialure from CaPO4 deposition
29
What is used for colon cleansing before procedure
polyethylene glycol
30
MOA polyethylene glycol
isotonic fluid, contains inert osmotically active sugar with Nasulfate, NaCl, NaHCO3, KCl ingest 2-4 L over 2-4 hours
31
MOA stimulant laxatives
direct stimulation Enteric nervous system and colonic electrolyte and fluid secretion
32
therapeutic use stimulant laxatives
not 1st line | intermittend use from patients who do not respond to bulking and osmoitc agents
33
risks of long term use stimulant laxatives
dependence and destruction of mesenteric plexus resulting in colonic atony and dilation
34
what are the anthraquinone derivavties
aloe, senna, cascara
35
what are the diphenylmethane derivatives? | used for?
bisacodyl tab or suppository | used with PEG for colonic cleansing prior to colonscopy
36
What is used in patients with chronic constipation who fail to conventional 1st line therapy
chloride channel activator that stimulates Cl in small intestine increasing motility
37
MOA opiod R antagonists
inhibit opoid R do not cross bbb inhibits peripheral without analgesic effects
38
therapeutic use methylnaltrexone
opoid antagonist approved for opiod induced constipation subcut
39
contraindication methynaltrexone
GI obstruction
40
what is used short term to shorten period of post operative ileus
alvimopan
41
what is use of serotonin R agonist
increase GI motility and cardiac rate | enhance LES pressure and peristalsis, accelerates gastric emptying
42
What is linaclotide and MOA
guanylate cyclase C agonist binds g cyclase on luminal surface intestine and increases cGMP which increase Cl and HCO3 secretion increasing intestinal fluid and dec GI transit time
43
what is used for chronic idiopathic constipation and IBS with constipation >18 y.o
linaclotide
44
diabetic gastroparesis is common finding in which DM
II
45
what prokinetic agents are available for GI
metoclopramide and serotoni agonists and erythromycin/macrolides
46
MOA metoclopramide
central and peripheral dopamine R antagonist, serotonin agonist, serotonin antagonists, cholinesterase inhibitor
47
metoclopramide does what
enhances motility of upper GI tract, accelerates gastric emptying, increases esophageal peristalsis, increases LES pressure
48
therapeutic use metoclopramide
prior to meals and at bedtime to control nausea and vomiting
49
adverse effects metoclopramide
cross bbb so extrapyramidal Sx: tardive dyskinesia restlessness, drowsiness, insomnia, anxiety, agitation, depression hyperprolactinemia can cause galactorrhea, breast tenderness and menstrual irregularities
50
What is adverse effect of serotonin agonists for prokinetic GI
fatal cardiac arryhthmias
51
MOA erythromcyin and macrolids for prokinetic GI
agonist at motilin T increased frequency and amplitude of antral contractions and initiats gastric phase III contractions
52
therapeutic use erythromycin
short term improvement gastric emptying in diabetic gastroparesis long term limited by concerns about toxicity, pseudomembranous colitis and induction of resistant bacterial strains, development of tolerance
53
adverse effects of erythromycin
abdominal pain, cramping, nausea, diarrhea, vomiting malabsorption tolerance develops rapidly (motilin downregulation)

Year2 GI Exam I (18 decks)

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