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Maddy - GI II Exam I - some pharm > Pharm - Diarrhea, Abd Pain, and Constipation > Flashcards

Pharm - Diarrhea, Abd Pain, and Constipation Flashcards

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1
Q

what are the 4 families of drugs used to treat diarrhea

A
  • prostaglandin inhibitors
  • opioid agonists
  • serotonin (5HT3) antagonists
  • chloride channel inhibitors
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2
Q

list the prostaglandin inhibitors used to treat diarrhea

A

bismuth

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3
Q

list the opioid agonists used to treat diarrhea

A
  • loperamide
  • diphenoxylate
  • eluxadoline
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4
Q

list the serotonin antagonists used to treat diarrhea

A

alosetron

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5
Q

list the chloride channel inhibitors used to treat diarrhea

A

crofelemer

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6
Q

MOA loperamide

A

direct action on circular and longitudinal muscles of intestinal wall to interfere with peristalsis

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7
Q

side effects loperamide

A

dizziness, fatigue, drowsiness, urinary retention (anticholinergic)

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8
Q

why is atropine added to diphenoxylate

A

to discourage deliberate abuse/over-dosage

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9
Q

MOA diphenoxylate

A

exerts effects locally and centrally on GI smooth muscle cells to inhibit GI motility and slows excess GI propulsion

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10
Q

side effects diphenoxylate

A

dizziness, drowsiness, urinary retention (anticholinergic, atropine)

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11
Q

MOA eluxadoline

A

agonist at opioid mu and kappa receptors to slow peristalsis and delay digestion

antagonist at delta opioid receptors to decrease secretions

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12
Q

indications for eluxadoline

A

IBS with diarrhea (DIARRHEA ONLY)

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13
Q

side effects eluxadoline

A
  • GI related (n/v/d/abd pain)
  • hepatic/pancreatic toxicity (PANCREATITIS)
  • CNS related (dizziness, sedation, euphoria, impaired cognition)
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14
Q

contraindications eluxadoline

A
  • biliary duct obstruction
  • alcoholism
  • history of pancreatitis
  • hepatic impariment
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15
Q

when should you stop eluxadoline therapy

A

if severe constipation develops and lasts 4+ days

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16
Q

MOA alosetron

A

selectively blocks GI-based 5HT3 receptors (serotonin antagonist)

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17
Q

indications for alosetron

A

chronic, severe IBS with diarrhea (women)

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18
Q

female patient with severe IBS-D comes in and is not responsive to other conventional therapies, what should you give her

A

alosetron

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19
Q

side effects alosetron

A
  • GI: CONSTIPATION, dyspepsia, GERD, N/V

- ISCHEMIC COLITIS

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20
Q

which drug has ischemic colitis as a possible side effect

A

alosetron

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21
Q

what must occur in order to prescribe and refill alosetron

A
  • no refills w/o follow up exam
  • physicians must enroll in prescribing program
  • pts & physicians must sign risk-benefit statement
  • additional self-training and testing
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22
Q

contraindications to alosetron

A

history or active:

  • GI obstruction, perforation, stricture, adhesions, toxic megacolon
  • diverticulitis, crohn’s, UC
  • impaired intestinal circulation
  • severe constipation
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23
Q

MOA crofelemer

A

inhibits chloride ion secretion by blocking cAMP-stimulated CFTR and Ca2+ activated chloride channels

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24
Q

indications for crofelemer

A

NON-INFECTIOUS diarrhea in HIV/AIDS patients on RETROVIRAL THERAPY

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25
what is the drug indicated for non-infectious diarrhea in HIV/AIDS patients on retroviral therapy
crofelemer
26
side effects crofelemer
GI: abd distention, elevated AST/ALT/bilirubin Infections (pts are immunocompromised)
27
list the antimuscarinic agents used for abd pain in IBS
- hyoscyamine - dicyclomine - clidinium/chloridazepoxide
28
MOA antimuscarinic agents for abd pain in IBS
competitively inhibit autonomic, post-ganglionic cholinergic receptors to decrease GI motility and spasms
29
indications for antimuscarinic agents in IBS
abdominal pain/spasms
30
side effects of antimuscarinics for abd pain/spasms in IBS
classic anticholinergic effects - dry mouth - urinary retention - constipation - drowsiness - mental confusion - blurred vision
31
list the peripheral opioid antagonists used for constipation
- methylnaltrexone - naloxegol - alvimopan
32
list the guanylate cylase-C agonists used for constipation
linaclotide
33
list the selective chloride (C2) channel activators used for constipation
lubiprostone
34
MOA linaclotide
binds to guanylate cyclase-C of intestinal epithelium and increases concentration of cGMP --> activation of CFTR --> stimulates secretion of Cl-/HCO3- into lumen
35
indications for linaclotide
- IBS-C (IBS constipation predominant subtype) - chronic idiopathic constipation (CIC)
36
side effects linaclotide
- diarrhea | - GERD/dyspepsia/N/V
37
MOA lubiprostone
a prostaglandin E1 analog that increases intestinal fluid secretion by activating GI specific Cl- channels
38
indications for lubiprostone
- IBS-C (IBS constipation predominant subtype) - women - chronic idiopathic constipation (CIC) - OPIOID INDUCED CONSTIPATION
39
side effects lubiprostone
nausea, dyspepsia, dizziness
40
MOA methylnaltrexone
antagonizes peripheral mu-opioid receptors
41
indications for methylnaltrexone
- opioid induced constipation
42
what drug is used as prevention against postoperative ileus
alvimopan
43
indications for alvimopan
prevention of postoperative ileus
44
side effects methylnaltrexone
abd pain, diarrhea, nausea, vomiting
45
warnings for alvimopan and what are the REMS limitations
carries a risk of MI REMS: requires use only in approved institutions for maximum of 15 doses
46
list the stimulants of the laxative and cathartic agents
- bisacodyl - castor oil - glycerin - senna - Na+ picosulfate
47
list the osmotics of the laxative and cathartic agents
- lactulose - mag citrate - polyethylene glycol - sorbitol
48
list the salines of the laxative and cathartic agents
Magnesium hydroxide Na+ phosphate
49
list the bulk forming substances of the laxative and cathartic agents
- dietary (fiber/bran) - fruits/grains/cereal - psyllium - methylcellulose/carboxymethylcellulose - calcium polycarbophil
50
list the stool softeners of the laxative and cathartic agents
- docusate | - mineral oil
51
MOA of bulk forming agents used for constipation
work to increase bulk-volume and water content to increase GI motility
52
adverse effects bulk forming agents
bloating/obstruction
53
drug interactions with bulk forming agents
LOTS mainly with psyllium and the celluloses
54
MOA stool softeners
anionic surfactants that soften/lubricate the feces - increase fluid secretion into GI tract - inhibit water reabsorption - mineral oil penetrates stool to soften
55
how long does it take for stool softeners to take effect
1-3 days
56
adverse effects of stool softeners
GI related
57
when is sodium picosulfate used
pre-colonoscopy bowel prep
58
MOA stimulants
Na+/K+ ATPase inhibition and/or increase in prostaglandins --> irritation and inflammation to enterocytes --> stimulates peristalsis
59
how does castor oil promote water/electrolyte accumulation in the GI tract
it is hydrolyzed to ricinoleic acid
60
how does glycerin act as a stimulant
it functions as an irritant, an osmotic agent, and a lubricating agent
61
when do stimulants take effect
12-36 hours (sooner w/ glycerin)
62
adverse effects stimulants
- abd cramping - urine discoloration (with senna) - fluid/electrolyte disturbances
63
what drug taking for constipation will discolor the urine
senna
64
contraindications of stimulants
GI obstruction/ileus/impaction
65
cautions for prescribing stimulants in pregnant women
several of the stimulants pass into the breast milk
66
MOA saline agents
magnesium and phosphate ions are poorly absorbed in the GI tract so they osmotically retain water in the GI tract
67
drug interactions w/ saline agents
diuretics
68
cautions when prescribing saline agents
pts w/ renal disease and CHF/HTN
69
MOA osmotic agents
work to osmotically attract and retain increased water in the colon
70
other than constipation, what is lactulose used for
severe liver disease pts with hyperammonemia
71
adverse effects osmotic agents
electrolyte disturbances, GI related issues
72
other than constipation, what is polyethylene glycol used for
LARGE doses used for bowel prep prior to GI scopes, radiological procedures, or surgery (small doses are for constipation)

Maddy - GI II Exam I - some pharm (23 decks)

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