Chapter 6 GI agents - antidiarrheal and inflammatory bowel syndrome agents

Question 1

diphenoxylate and atropine (lomotil)
loperamide (imodium)

opiate

Answer 1

• diphenoxylate is agonist at opiate receptors at GI tract while atropine blocks muscarinic receptors
• both inhibit peristalsis

indication
* diarrhea

effect
* constipation
* abdominal + bowel distention
* nausea

contraindication
* parasitic or bacterial infections w/ fever
* obstructive jaundice (diphenoxylate and atropine)

interactions
* for diphenoxylate and atropine — potentiate CNS depressants; inc risk of HTN w/ MAO inhibitors, inc risk of paralytic ileus w/ antimuscarinics

for loperamide (imodium) treat OD w/ naloxone

Question 2

bismuth subsalicylate (pepto-bismol)

adsorbents

Answer 2

• absorb toxins produced by bacteria + other GI irritants

indications:
* diarrhea
* prophylaxis for traveler’s diarrhea
* requires large dose – not useful for trips

effect
* impaction

contraindication
* aspirin sensitivity

interactions
* potentiate oral anticoagulants + hypoglycemics
* reduce uricosuric effects of probenecid and sulfinpyrazone

Question 3

kaolin/pectin (kaopectate)

adsorbent

Answer 3

• adsorbant and protectant of ? efficacy

indication
* diarrhea

effects
* inc K+ loss or interfere with absorption of drugs + nutrients

contraindication
* obstructive bowel lesion
* children under 3 y/o

decrease absorption of many drugs

Question 4

cholestyramine (questran)

adsorbent

Answer 4

• absorb bile salts (cause diarrhea)
• absosrb c difficile toxin

indication
* diarrhea caused by c difficile
* bile acids (Bile acids are formed from cholesterol and, therefore, bile acid synthesis serves as the main pathway in breaking down and eliminating cholesterol from the body (cholesterol degradation)

effect
* constipation

interaction
* decrease absorption of many drugs

USED PRIMARILY for lipid lowering effects

Question 5

anticholinergics

Answer 5

• muscarinic antagonist
• inhibit GI secretions and peristalsis

indication
* diarrhea d/t peptic ulcer disease or IBS

effect
* dec memory and concentration
* dry mouth
* urinary retention
* tachycardia

contra
* closed angle glaucoma
* prostatic hypertrophy
* heart disease
* obstructive bowel disease

antacids interfere w/ asorption

Question 6

corticosteroids

Answer 6

• antiinflammatory
• ulcerative colitis (chronic inflammatory bowel disease (IBD) in which abnormal reactions of the immune system cause inflammation and ulcers on the inner lining of your large intestine.)
• chron’s disease ( inflammatory bowel disease that causes chronic inflammation of the gastrointestinal tract)
• other inflammatory bowel disease

retention enema

Question 7

eluxadoline (viberzi)

inflammatory bowel agents

Answer 7

• mu-opoid agonist

indicatoin
* inflammatory bowel syndrome w/ diarrhea

effect
* constipation
* uncommon… pancreatitis

Question 8

mesalamine (5-aminosalicyclic acid)
olsalazine (dipentum)
balsalazide (colazal)
sulfasalazine (azulfidine)

inflammatory bowel agents

Answer 8

• anti inflammatory agents

indication
* Inflammaotry bowel syndrome
* ulcerative colitis (chronic inflammatory bowel disease (IBD) in which abnormal reactions of the immune system cause inflammation and ulcers on the inner lining of your large intestine.)
* crohn disease (whole digestive lining.. inflammation)