Pharmacology of IBS, Anti-Diarrheals, And Laxatives (Quiz 4)

Question 1

irritable bowel syndrome affects what part of the body

Answer 1

• large intestine

Question 2

what involves uncoordinated spasming of the colon

Answer 2

• IBS

Question 3

MOA of Dicyclomine and Hyocycamine

Answer 3

• M3 anticholinergics
• inhibit GI tract smooth muscle contractions
• reduce motility

Question 4

what is the sympathetic receptor that causes GI tract SM relaxation

Answer 4

• Beta 2

Question 5

toxicities of Dicyclomine and Hyocycamine

Answer 5

• anti-parasympathetic effects
• blurred vision
• xerostoma (dry mouth)

Question 6

you use Eluxadoline, Alosetron, and Rifamixin with what type of IBS

Answer 6

• IBS with diarrhea

EAR drugs

Question 7

MOA of Eluxadoline

Answer 7

• activates mu opioid receptors on neurons in myenteric plexus
• inhibits GI smooth muscle contraction

Question 8

oral bioavailability of Eluxadoline

importance

Answer 8

• poor

- effects limited to just GI tract

Question 9

toxicities of Eluxadoline

Answer 9

• constipation

Question 10

MOA of Alosetron

Answer 10

• inhibits serotonin signaling from ECL cells in lumen to the myenteric plexus
• reduce GI motility

Question 11

which gender do we use Alosetron

Answer 11

• women

Question 12

is Alosetron approved as an anti-emetic

Answer 12

• no

Question 13

toxicity of Alosetron

Answer 13

• ischemic colitis

Question 14

MOA of rifamixin

Answer 14

• RNA polymerase inhibitor

- reduces effects of gut flora that cause diarrhea

Question 15

MOA of Desipramine

Answer 15

• anticholingeric effect

- slows GI transit

Question 16

toxicities of Desipramine

Answer 16

• blurred vision
• xerostoma
• prolonged - QT
• urinary retention

Question 17

the antidepressants Citalopram, Duloxetine, and Desipriamine as used to treat IBS why?

Answer 17

• treat pain/psych symptoms of IBS

Anti-depressants of DCD for IBS-D

Question 18

MOA of Citalopram, Duloxetine

Answer 18

• may improve mood

Question 19

Bismuth Subsalicylate treats what condition

Answer 19

• anti-diarrheal

Question 20

Loperamide and Diphenoxylate treats what condition

Answer 20

• anti-diarrheal

Question 21

Cholestyramine treats what condition

Answer 21

• anti-diarrheal

Question 22

Bismuth Subsalicylate MOA

Answer 22

• anti-inflammatory
• COX 1/2 inhibitor
• antibacterial

Question 23

what is the toxic effect of prolonged use of Bismuth Subsalicylate

what compound

Answer 23

• neurotoxic

- bismuth oxychloride

Question 24

drug interactions of Bismuth Subsalicylate

Answer 24

• anything containing aspirin

Question 25

MOA of Loperamide and Diphenoxylate

Answer 25

- activate mu opioid receptor on neurons in myenteric plexus | - reduce GI motility

Question 26

Loperamide toxic effects at high dose

Answer 26

- euphoria | - respiratory depression

Question 27

MOA of Cholestyramine used for what

Answer 27

- sequesters bile | - diarrhea caused by bile acid malabsorption

Question 28

We use Docusate for what

Answer 28

- laxative

Question 29

We use Lactulose, Magnesium Citrate, and Polyethylene glycol for what

Answer 29

- laxative LMCP

Question 30

We use Lubripostone for what

Answer 30

- laxative

Question 31

We use Lincaclotide/Plecanatide for what

Answer 31

- laxative

Question 32

We use Alvimopan, Methylnaltrexone, Naldemidine, Naloxegol for what

Answer 32

- laxative

Question 33

MOA of lectulose, polyethylene glycol, and magnesium citrate

Answer 33

- stool softener | - creates osmotic pressure that draws water into the gut

Question 34

MOA of Docusate

Answer 34

- stool softener | - allows water to penetrate feces

Question 35

MOA of Bisacodyl and Sienna

Answer 35

- directly stimulates colonic enteric nerves

Question 36

MOA of Lubiprostone

Answer 36

- promotes water secretion into GI lumen - opens Cl- channel - Cl- gradient draws Na/H2O into lumen

Question 37

MOA of Linaclotide and Plecanatide

Answer 37

- promotes water secretion into GI lumen - acts on CFTR - allows in chloride - Na/H2O follows -tide of CFTR

Question 38

What are Alvimopan, Methylnaltrexone, Naldemidine, Naloxegol

Answer 38

- PAMORA

Question 39

what is a PAMORA

Answer 39

- peripherals active mu opioids receptor antagonist

Question 40

MOA of PAMORAs do they cross the blood brain barrier?

Answer 40

- antagonize mu opioid receptors in enteric nervous system | - no

Question 41

how do Opioids cause constipation

Answer 41

- agonist mu opioid receptors in enteric nervous system

Question 42

what are the first line anti-spasmodics for all types of IBS

Answer 42

- hyoscyamine | - dicyclomine

Question 43

what are the mu opioids receptor agonists for IBS-D

Answer 43

- Eluxadoline

Question 44

what are the serotonin antagonists for IBS-D

Answer 44

- Alosetron

Question 45

what are the antibiotics for IBS-D

Answer 45

- Rifamaxin

Question 46

what are the anti-depressants for IBS which has the anti-cholinergic effect

Answer 46

- citalopram - duloxetine - desipramine (anti-cholinergic effect)

Question 47

what are the anti-diarrheal with unclear etiology

Answer 47

- bismuth subsalicylate

Question 48

what are the anti-diarrheal mu opioid receptor agonists

Answer 48

- loperamide | - diphenoxylate

Question 49

what are the anti-diarrheal bile acid sequestrants

Answer 49

- Cholestyramine

Question 50

What are the laxative stool softeners with unclear mechanisms

Answer 50

- Docusate

Question 51

what are the laxative osmotic agent stool softeners

Answer 51

- lactulose - magnesium citrate - polyethylene glycol

Question 52

what are the laxative stimulants

Answer 52

- Bisacodyl | - Senna

Question 53

what are the laxative Cl-channel activators

Answer 53

- Lubiprostone

Question 54

what are the laxative guanylate cyclase agonists

Answer 54

- Linaclotide | - Plecanatide

Question 55

what are the laxative PAMORAs

Answer 55

- Alvimopan - Methylnaltrexone - Naldemedine - Naloxegol