Constipation, Diarrhea, Vomiting Flashcards
Metochlopramide
Promotility agent (dopamine antagonist)
MOA: Increase motor tone in lower esophageal sphincter (prevent reflux) and stomach (esp. antrum: improves gastric emptying); peripheral (stomach) and CNS (vomiting, via CRTZ) dopamine antagonist
GERD, anti-emetic, gastroparesis
Hand tremor if used 4X/day (optimum use); possible extra-pyramidal symptoms, but not so severe
Cisapride (Propulsid)
Promotility agent (dopamine antagonist
MOA: Increase motor tone in lower esophageal sphincter and stomch
GERD, gastroparesis
Sudden cardiac death Not really used much anymore
Domperidone (Motilium)
Promotility agent
MOA: Improves gastric tone
Gastroparesis
Prochlorperazine (Compazine)
Phenothiazines (neuroleptic class)
MOA: Probable CNS interaction with dopaminergic receptor-antagonist (leading to reduction of stimulation in the CRTZ in the medulla)
Anti-emetic
SE: Largely extra-pyramidal (Torticollis!)
Promethazine (Phenergan)
Phenothiazines (neuroleptic class)
MOA: Antihistaminic (H1 receptor), anticholinergic
Anti-emetic
SE: Somnolence (especially in the elderly)
Trimethobenzamide (Tigan)
Benzamide derivitive
Unknown effect on CRTZ
Anti-emetic
Tetrahydrocannabinol (Nabilone)
MOA: Suppresses CRTZ, probably by anticholinergic mechanism
Anti-emetic
SE: Munchies
-SETRON
Odan, Grane, Dola
Serotonin (5HT3) receptor antagonists
MOA: Blocks serotonin at 5HT3 receptor (in central CRTZ)
Anti-emetic
SE: Headache, dizziness, somnolence
Very safe for vomiting of any type (including drug-induced); can even be given to 6 month-old
Atropine sulfate
Anti-cholinergic
MOA: Relax all bowel smooth muscle (because most innervation of the bowel is cholinergic)
Diarrhea
SE: Anticholinergic effects
Loperamide (Immodium)
Diphenoxylate (Lomotil)
Codeine sulfate
Opiod agonist
Less penetration to CNS; stimulates μ receptors in GI tract; increased rectal tone leading to segmentation of colon and disruption of peristalsis, leading to increased absorption time
Diarrhea; irritable bowel syndrome (diarrhea)
Contraind: children (respiratory suppression)
Metamucil
Psyllium Seed Colloid, Bulk-Forming, Absorbs water
Diarrhea
Doesn’t prevent potential dehydration
Bismuth subsalicylate (Kaopectate)
Pectin, Absorbs water
Diarrhea
Castor oil; Cascara sagrada; senna extract; Bisacodyl; phenolphthalein
Irritant/Stimulant
MOA: Irritate lumen of the colon, causes peristaltic contractions
Constipation
Magnesium citrate; Magnesium sulfate (Epsom salt); sodium sulfate (Glauber salt); Milk of Magnesia
Osmotic cathartics
MOA: Draw water into the colon
Constipation; clean bowel prior to colonoscopy
Psyllium seed (Metamucil); methylcellulose (Hydrolose); sodium carboxymethylcellulose
Bulk-forming hydrophillic colloid
Bulk-forming
Constipation (especially small, hard stools)
