Anti-Inflammatory Flashcards
LOPERAMIDE (Imodium) class
Anti-diarrheal, Opioid
LOPERAMIDE (Imodium) use
mild to moderate diarrhea without obstruction, IBD, IBS
When can we not use Loperamide (Imodium)?
Bowel obstruction or BLOODY diarrhea
When would a patient want to stop imodium?
If they have bloody diarrhea or they notice distention
What non-pharm treatment do we always suggest for diarrhea?
BRAT diet & avoid high sugar content foods
KAOLIN-PECTIN (Kaopectolin) class
Anti-diarrheal, non-opioid
KAOLIN-PECTIN (Kaopectolin) indication
mild diarrhea
Is Kaolin-pectin absorbed in the intestine?
Nope
DIETARY FIBER (Metamucil, Citrucel, Fibercon) class
Anti-diarrheal and laxative
DIETARY FIBER (Metamucil, Citrucel, Fibercon) indication
mild to moderate diarrhea, constipation
So, how can you use fiber to treat diarrhea?
Fiber + Less Fluid
How can you use fiber to treat constipation?
Fiber + more fluid
OCTREOTIDE (Sandostatin) Class
Synthetic somatostatin analogue, anti-diarrheal
OCTREOTIDE (Sandostatin) indication
diarrhea secondary to bowel dysmotility, carcinoid, VIP-oma, pancreatic fistulas, vagotomy, dumping syndrome, short bowel syndrome, HIV diarrhea; GI bleeding
What type of secretions is octreotide inhibiting?
Inhibits secretion of gastrin, cholecystokinin, glucagon, growth hormone, insulin, secretin, etc (Inhibits intestinal fluid and pancreatic secretions)
To slows GI motility and GB contraction
What is always a risk factor with octreotide?
Gallstones! Look for sxs like abdominal pain, right shoulder pain, and N/V
What if your patient is taking octreotide + metoprolol?
Watch BP, when combined with a BB it can cause bradycardia
Octreotide is an IM injection, what else might we need to give to patient taking it?
Possibly B12 & folate
MESALAMINE (Asacol) & SULFASALAZINE (Azulfadine) Class
5 ASA Anti-inflammatory
MESALAMINE or 5-ASA (Asacol) Indications
Ulcerative colitis, proctosigmoiditis, proctitis
SULFASALAZINE (Azulfadine) Indications
Ulcerative colitis, rheumatoid arthritis, Crohn’s disease, and psoriasis
Where does Mesalamine work?
- pH sensitive release = Ileum
- Delayed release = jejunum, ileum, and colon
Where does sulfasalazine work?
Colon
Do 5ASA anti-inflammatories have any affect on folate?
Yes, must supplement it!
AZATHIOPRINE (Imuran) Class
Purine analogue immunosuppressant
AZATHIOPRINE (Imuran) Indication
steroid sparing for steroid dependent Crohn’s disease, ulcerative colitis, maintain remission in CD, fistulizing CD; kidney transplant, rheumatoid arthritis
METHOTREXATE (Rheumatrix) Class
Purine analogue immunosuppressant
METHOTREXATE (Rheumatrix) Indicaiton
Crohn’s disease, +/- UC, psoriasis, rheumatoid arthritis
INFLIXIMAB (Remicade) Class
Anti-TNF alfa anti-inflammatory agent
INFLIXIMAB (Remicade) Indication
acute and maintenance Tx moderate to severe Crohn’s disease and UC
NATALIZUMAB Class
Anti-integrin
NATALIZUMAB Indicaiton
subset of patients with mod to severe Crohn’s disease who have failed other therapies
When you combine sulfasalazine & azathioprine together, what can it cause?
Myelosupression
How long does it typically take Azathioprine to work?
3-6 months
What’s our one medication to treat gallstones?
URSODIOL (Actigall)
URSODIOL (Actigall) Class
ursodeoxycholic acid gallstone dissolution
SENAKOT (Senna) Class
Anthraquinone (stimulant) laxative
SENAKOT (Senna) Indication
constipation (w/o bowel obstruction)
LUBIPROSTONE (Amitiza) Class
Laxative, calcium channel activator
LUBIPROSTONE (Amitiza) Indication
Chronic idiopathic constipation; IBS constipation–dominant in women >18yo; opioid induced constipation
LINACLOTIDE (Linzess) Class
cGMP agonist Laxative
LINACLOTIDE (Linzess) Indication
IBS-C (in adults not responsive to PEG); or, Chronic Idiopathic Constipation (CIC) in adults
PG3350 (MiraLax) Class
Osmotic Laxative; PEG
PG3350 (MiraLax) Indicaiton
occasional constipation; short=term use
When taking MiraLax, when should you expect a bowel movement?
1-3 days
Should you continue fiber while taking MiraLax?
MiraLax is for short term use, so you can continue daily fiber.
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?
Hypovolemia
- Make sure he’s not dehydrated
If after 3 days of MiraLax use, and no bowel movement, what do you do?
Suspect a bowel obstruction!
PE: Tinkering + high pitched noise with distention. Do a DRE!
If octreotide is given IV, what is occuring physiologically?
Arterial vasoconstricion of the splanchnic arterial system.
What other medication is an Osmotic Laxative?
Lactulose
What medication is a Magnesium Laxative?
MgCitrate
What medication is our stool softner?
Docusate Na (Colase)
