Anti-Inflammatory

Question 1

LOPERAMIDE (Imodium) class

Answer 1

Anti-diarrheal, Opioid

Question 2

LOPERAMIDE (Imodium) use

Answer 2

mild to moderate diarrhea without obstruction, IBD, IBS

Question 3

When can we not use Loperamide (Imodium)?

Answer 3

Bowel obstruction or BLOODY diarrhea

Question 4

When would a patient want to stop imodium?

Answer 4

If they have bloody diarrhea or they notice distention

Question 5

What non-pharm treatment do we always suggest for diarrhea?

Answer 5

BRAT diet & avoid high sugar content foods

Question 6

KAOLIN-PECTIN (Kaopectolin) class

Answer 6

Anti-diarrheal, non-opioid

Question 7

KAOLIN-PECTIN (Kaopectolin) indication

Answer 7

mild diarrhea

Question 8

Is Kaolin-pectin absorbed in the intestine?

Answer 8

Nope

Question 9

DIETARY FIBER (Metamucil, Citrucel, Fibercon) class

Answer 9

Anti-diarrheal and laxative

Question 10

DIETARY FIBER (Metamucil, Citrucel, Fibercon) indication

Answer 10

mild to moderate diarrhea, constipation

Question 11

So, how can you use fiber to treat diarrhea?

Answer 11

Fiber + Less Fluid

Question 12

How can you use fiber to treat constipation?

Answer 12

Fiber + more fluid

Question 13

OCTREOTIDE (Sandostatin) Class

Answer 13

Synthetic somatostatin analogue, anti-diarrheal

Question 14

OCTREOTIDE (Sandostatin) indication

Answer 14

diarrhea secondary to bowel dysmotility, carcinoid, VIP-oma, pancreatic fistulas, vagotomy, dumping syndrome, short bowel syndrome, HIV diarrhea; GI bleeding

Question 15

What type of secretions is octreotide inhibiting?

Answer 15

Inhibits secretion of gastrin, cholecystokinin, glucagon, growth hormone, insulin, secretin, etc (Inhibits intestinal fluid and pancreatic secretions)

To slows GI motility and GB contraction

Question 16

What is always a risk factor with octreotide?

Answer 16

Gallstones! Look for sxs like abdominal pain, right shoulder pain, and N/V

Question 17

What if your patient is taking octreotide + metoprolol?

Answer 17

Watch BP, when combined with a BB it can cause bradycardia

Question 18

Octreotide is an IM injection, what else might we need to give to patient taking it?

Answer 18

Possibly B12 & folate

Question 19

MESALAMINE (Asacol) & SULFASALAZINE (Azulfadine) Class

Answer 19

5 ASA Anti-inflammatory

Question 20

MESALAMINE or 5-ASA (Asacol) Indications

Answer 20

Ulcerative colitis, proctosigmoiditis, proctitis

Question 21

SULFASALAZINE (Azulfadine) Indications

Answer 21

Ulcerative colitis, rheumatoid arthritis, Crohn’s disease, and psoriasis

Question 22

Where does Mesalamine work?

Answer 22

• pH sensitive release = Ileum

- Delayed release = jejunum, ileum, and colon

Question 23

Where does sulfasalazine work?

Answer 23

Colon

Question 24

Do 5ASA anti-inflammatories have any affect on folate?

Answer 24

Yes, must supplement it!

Question 25

AZATHIOPRINE (Imuran) Class

Answer 25

Purine analogue immunosuppressant

Question 26

AZATHIOPRINE (Imuran) Indication

Answer 26

steroid sparing for steroid dependent Crohn’s disease, ulcerative colitis, maintain remission in CD, fistulizing CD; kidney transplant, rheumatoid arthritis

Question 27

METHOTREXATE (Rheumatrix) Class

Answer 27

Purine analogue immunosuppressant

Question 28

METHOTREXATE (Rheumatrix) Indicaiton

Answer 28

Crohn’s disease, +/- UC, psoriasis, rheumatoid arthritis

Question 29

INFLIXIMAB (Remicade) Class

Answer 29

Anti-TNF alfa anti-inflammatory agent

Question 30

INFLIXIMAB (Remicade) Indication

Answer 30

acute and maintenance Tx moderate to severe Crohn’s disease and UC

Question 31

NATALIZUMAB Class

Answer 31

Anti-integrin

Question 32

NATALIZUMAB Indicaiton

Answer 32

subset of patients with mod to severe Crohn’s disease who have failed other therapies

Question 33

When you combine sulfasalazine & azathioprine together, what can it cause?

Answer 33

Myelosupression

Question 34

How long does it typically take Azathioprine to work?

Answer 34

3-6 months

Question 35

What's our one medication to treat gallstones?

Answer 35

URSODIOL (Actigall)

Question 36

URSODIOL (Actigall) Class

Answer 36

ursodeoxycholic acid gallstone dissolution

Question 37

SENAKOT (Senna) Class

Answer 37

Anthraquinone (stimulant) laxative

Question 38

SENAKOT (Senna) Indication

Answer 38

constipation (w/o bowel obstruction)

Question 39

LUBIPROSTONE (Amitiza) Class

Answer 39

Laxative, calcium channel activator

Question 40

LUBIPROSTONE (Amitiza) Indication

Answer 40

Chronic idiopathic constipation; IBS constipation--dominant in women >18yo; opioid induced constipation

Question 41

LINACLOTIDE (Linzess) Class

Answer 41

cGMP agonist Laxative

Question 42

LINACLOTIDE (Linzess) Indication

Answer 42

IBS-C (in adults not responsive to PEG); or, Chronic Idiopathic Constipation (CIC) in adults

Question 43

PG3350 (MiraLax) Class

Answer 43

Osmotic Laxative; PEG

Question 44

PG3350 (MiraLax) Indicaiton

Answer 44

occasional constipation; short=term use

Question 45

When taking MiraLax, when should you expect a bowel movement?

Answer 45

1-3 days

Question 46

Should you continue fiber while taking MiraLax?

Answer 46

MiraLax is for short term use, so you can continue daily fiber.

Question 47

If an elderly patient with dementia is seeing you for constipation, you get a BUN and notice it's high. What does this tell you?

Answer 47

Hypovolemia | - Make sure he's not dehydrated

Question 48

If after 3 days of MiraLax use, and no bowel movement, what do you do?

Answer 48

Suspect a bowel obstruction! | PE: Tinkering + high pitched noise with distention. Do a DRE!

Question 49

If octreotide is given IV, what is occuring physiologically?

Answer 49

Arterial vasoconstricion of the splanchnic arterial system.

Question 50

What other medication is an Osmotic Laxative?

Answer 50

Lactulose

Question 51

What medication is a Magnesium Laxative?

Answer 51

MgCitrate

Question 52

What medication is our stool softner?

Answer 52

Docusate Na (Colase)