Pro-Kinetic Agents

Question 1

Metoclopramide

Answer 1

• Increases esophageal clearance by increasing LES pressure which accelerates gastric emptying via. D2 receptor antagonism
• Sx relief for gastric motility failure– DM, post-surgical
• Effective Anti-emetic
• Tx for refractory heartburn in combination w/ anti-secretory agents
  Adverse Effects: - Anxiety, depression, drowsiness
• Extrapyramidal effects- parkinsonism, tardive dyskinesia

Question 2

Lubiprostone

Answer 2

• Chloride Ion Channel Activator
• Fatty acid derived from PGE1 that activates type 2 Cl- channels in GI epithelial cells producing Cl- rich secretions
• Softens stool, increases motility, promotes spontaneous BM
• Tx for idiopathic constipation and IBS w/ constipation
  Adv. Effects: - nausea, diarrhea, headache, abdominal pain
• Not approved in children

Question 3

Linaclotide

Answer 3

• Chloride Ion Channel Activator
• Peptide agonist of guanylate 2C– activates CFTR in GI epithelial cells producing Cl- rich secretion that increases motility and spontaneous BM
• Decreases pain by decreasing activation of colonic sensory neurons
• Tx for chronic idiopathic constipation and IBS w/ constipation
  Adv. Effects: - Diarrhea
• Not recommended in children under 17