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Gastrointestinal > Agents for Diarrhea & Constipation > Flashcards

Agents for Diarrhea & Constipation Flashcards

1
Q

3 Classes of drugs & examples of specific drugs that are effective in the treatment of diarrhea?

A
  1. ADSORBENTS
    1. Kaolin
    2. Pectin
    3. Polycarbophil
    4. Attapulgite
  2. ANTIMOTILITY AGENTS
    1. Diphenoxylate
    2. Loperamide
    3. Morphine
  3. ANTISECRETORY AGENTS
    1. Bismuth Subsalicylate
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2
Q

MOA of Adsorbents (Kaolin, Pectin, Polycarbophil, Attapulgite)

A

Adsorbs (adheres to) drugs, nutrients, toxins, & digestive juices

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3
Q

MOA of Antimotility Agents (Diphenoxylate, Loperamide, & Morphine)

A

Decrease peristalsis by activating mu presynaptic opiod receptors in the enteric nervous system

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4
Q

MOA of Antisecretory Agents Bismuth Subsalicylate

A

Decrease fluid secretion in the bowel

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5
Q

What adsorbent can adsorb 60x its weight in water & treat BOTH diarrhea AND constipation

A

Polycarbophil

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6
Q

What are the potential s/e of bismuth subsalicylate?

A
  • Salicylism (tinnitus, nausea, vomiting)
  • Darkening of tongue & stools
  • Induce gout attacks in susceptible pts
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7
Q

What antidiarrheal can decrease tetracycline absorption if given cocomitantly?

A

Bismuth Subsalicyclate

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8
Q

What antidiarrheal is often formulated in combination with atropine?

A

DIPHENOXYLATE= low therapeutic dose with potent anti-diarrheal effects w/out significant opiate effects

  • combined w/ small dosese of atropine= LOMOTIL
    • dry mouth, blurry vision, & nausea discourage abuse
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9
Q

Which class of antidiarrheals can cause paralytic ileus?

A

Antimotility agents

  • Diphenoxylate
  • Loperamide
  • Morphine)
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10
Q

What medication is often used to treat flushing & diarrhea seen in carcinoid syndrome and VIPomas?

A

Octreotide

Non-antidiarrheal uses include treatment for esophageal varices & acromegaly

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11
Q

What is Octreotide’s MOA?

A
  • Synthetic somatostatin analog that blocks release of serotonin & other Vasoactive peptides
  • Direct inhibitory effects on intestinal secretion
  • Direct stimulatory effects on intestinal absorption
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12
Q

What medication can be used in combo with antibiotics to bulk stools & absorb C. diff toxins A & B in C. Difficile colitis?

A

Cholestyramine= nonabsorbable binding agent

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13
Q

What types of medications cause constipation?

A
  • Opioid analgesics
  • Anticholinergics
  • Calcium-containing antacids
  • Aluminum containing antacids
  • CCBs
  • Clonidine
  • Iron
  • Sodium
  • Polystyrene Sulfonate
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14
Q

These are the drug classes effective in the treatment of constipation. What is each of their MOA?

1) Bulk forming agents
2) Osmotic Laxatives
3) Irritants & Stimulants
4) Stool Softeners
5) Cl Channel Activators

A

1) BULK FORMING AGENTS
* form gels in large intestine which causes water retention & intestinal distention, which increases peristaltic activity
2) OSMOTIC LAXATIVES

  • nonabsorbable compounds which draw fluid into the colon to maintain osmotic neutrality
  • disten intestinal wall & increase peristalsis

3) IRRITANTS & STIMULANTS
* Irritate gut lining which subsequently increases peristalsis
4) STOOL SOFTENERS
* Surfactants that become emulsified w stool, thereby softening feces
5) Cl CHANNEL ACTIVATORS

  • Activate Cl channels in the apical membrane of intestinal cells increasing fluid & intestinal motility without altering serum Na or K levels
  • effects are localized to the GI tract
    • increase fluid secretion into the intestinal lumen
    • accelerate fecal transit
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15
Q

Name the Bulk Forming Agents used to treat constipation.

A
  • Methylcellulose
  • Psyllium Bran
  • Magnesium-containing salts
  • Polyethylene Glycol
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16
Q

Name the Osmotic Laxatives

A
  • Lactulose
  • Magnesium Hydroxide (milk of magnesia)
  • Magnesium Citrate
  • Polyethylene Glycol
  • Sorbitol
17
Q

Name the Irritants & Stimulants used to treat constipation

A
  • Cascara
  • Senna
  • Aloe
  • Bisacodyl
18
Q

Name the Stool Softeners

A
  • Mineral Oil Docusate (oral or enema)
  • Glycerin Suppository
19
Q

Name the Cl channel activator used to treat constipation

A

Lubiprostone (Amitiza)

20
Q

What are the potential s/e of bisacodyl?

A
  • Abdominal cramping
  • Atonic colon
21
Q

What Osmostic Laxative is used to treat hepatic encephalopathy?

How does it work?

A

LACTULOSE

Gut flora degrade it into metabolites (lactic acid & acetic acid)–>metabolites promote Nitrogen excretion as NH4+

22
Q

What are the adverse s/e associated with osmotic laxatives?

A
  • Diarrhea
  • Dehydration
  • May be abused by bulemics
  • Harmful electrolyte imbalances
23
Q

What are the treatments used for secretory diarrhea?

A
  • Bismuth Subsalicylate
  • Probiotics
  • Octreotide

Gastrointestinal (7 decks)

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