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Flashcards in Small Bowel Pharm Deck (21)
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1
Q

Give and example of bulk-forming agents that can help to relieve constipation and diarrhea.

A

psyllium husk
carboxy mthylcellulose
polycarbophil (cardboard)

other anti-diarrheal: kaolin clay

2
Q

Name some basic over the counter anti-diarrheal aids

A
bismuth subsalicylate (black tongue)
loperamide: Imodium

(diphenoxylate with atropine, opioid agonist- lomotil)

3
Q

What’s the limiting factor in using opioids as anti-diarrheals?

A

they have a lot of side effects (and also potential for addiction)

4
Q

How do bile salt binding resins address diarrhea?

A

build salt binding resigns like cholestyramine bind leaking bile that can cause diarrhea

5
Q

What is the MOA of alostron and its precautions?

A

5-HT-3 antagonist, is very powerful, used in women only for IBS-D

may cause colon ischemia, cannot be taken in patients with a clotting disorder

6
Q

Octreotide is known as “a ____ ____ on the GI tract.”

A

a somatostatin analog known as “a wet blanket on the GI tract”

it is expensive and difficult to tolerate, used in treating portal hypertension and diarrhea

7
Q

Name the most significant side effects of methotrexate.

A

hepatotoxicity
bone marrow suppression
pulmonary toxicity
teratogenic

** FUN FACT patients should also be taking a folate supplement with this drug

8
Q

Name the treatment for mild, moderate and severe Crohn’s

A

mild: aminosalicylates (mesalamine) and corticosteroids (budesonide)

moderate-severe: immunodulators(slow) (azithoprine, methotrexate), anti TNF (infliximab, adalimumab), other biologics (natalizumab, vediolizumab

9
Q

Briefly differentiate between mild, moderate and severe crohn’s disease.

A

mild: ambulatory; 4 stool
severe: persistent symptoms on corticosteroids or high fever, rebound or abscess >10 stool

10
Q

Describe some of the significant side effects of axathioprine

A

bone marrow suppression, drug induced liver injury (must check liver AST/ALT every 3mo), fever, pancreatitis, non melanoma skin cancer, lymphoma

11
Q

A patient on TNF inhibitors is at risk for reactivation of what two infections?

A

latent TB

occult Hep B

12
Q

What are indications for colectomy?

A

toxic megacolon
severe hemorrhage
lack of response to therapy
cancer or dysplasia

13
Q

Differentiate constipation predominant IBS and chronic constipation.

A

constipation predominant IBS includes pain, chronic constipation does not

14
Q

Name examples of stool softeners.

A
Decussate sodium ('mucus in a pill')
mineral oil (emollient)
15
Q

What is the mechanism to treating constipation by non absorbed sugars and salts like magnesium hydroxide and lactulose/sorbitol?

A

produces an osmotic diarrhea that can be accompanied by cramping/gas/bloating

16
Q

What is diphenylmethane?

What is the action of anthraquinone (senna and cascara)

A

bisacodyl is an “over night” motility drug that works as a stimulant
senna and cascara are poorly absorbed an can cause malanosis coli (makes polyps stand out better)

17
Q

What is the action of polyethylene glycol? (PEG)

A

long chains that are not absorbed that are either used as a mild laxative or as a cathartic (bowel prep)

18
Q

Give an example of C-2 channel stimulants and what their drawbacks are.

A

lubiprostone: 30% experience nausea, is expensive and a pregnancy class C drug

19
Q

What class of drugs is methylnaltrexone in and what is it used for.

A

a mu opioid receptor antagonist that is used in opioid induced contipation or post-op ileus

20
Q

Stool lactoferrin, fecal-calprotectin and stool WBC are all measures of what?

A

measures of inflammation in the colon

21
Q

Read my mind: Mesalamine is ___ _____.

A

mesalamine is disease modifying in UC