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)
Mineral oil; Dioctyl sodium sulfo-succinate (Colace); poloxalkol
Lubricant and fecal softeners
MOA: Stool softening, lubricating
Constipation
Naloxegol (Movantik)
mu opioid receptor antagonist
Prevents opioids from binding to mu receptor in gut
Opioid-induced constipation
Lubiprostone (Amitizia);
Prostaglandin analog
Activates Cl channels on intestinal epithelial cells
Constipation
Linaclotide (Linzess)
Peptide agonist of guanylate cyclase
Stimulates cGMP resulting in Cl and bicarbonate secretion
Constipation
Dicyclomine HCl
Anticholinergic (antispasmodic)
Blocks cholinergic action
Reduce spasm in irritable bowel syndrome
Hyoscyamine sulfate
Anticholinergic (antispasmodic)
Blocks cholinergic action
Reduce spasm in irritable bowel syndrome
Alosetron (Lotronex)
Serotonergic antagonist
Blocks 5HT3
Diarrhea in irritable bowel syndrome
Tegaserod maleate
Serotonergic agonist
Hits 5HT4
Constipation in irritable bowel syndrome
