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Pharmacology Exam 2 > Diarrhea/Constipation/IBS/IBD > Flashcards

Diarrhea/Constipation/IBS/IBD Flashcards

1
Q

CMV Diarrhea - DOC

A

Ganciclovir

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2
Q

Diarrhea common on cruise ships…spreads fast!

A

Norwalk

Treatment: supportive

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3
Q

Diarrhea most common in children

A

Rotovirus
Test: Rotazyme
Treatment: fluids +/- nitazoxanide

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4
Q

Diarrhea - Food poisoning with preformed toxin associated with reheated fried rice

A

Bacillus cereus

Treatment: supportive

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5
Q

Diarrhea - Gram - rod, fecal-oral transmission by contaminated water or unpasteurized milk. Also associated with Guillan-Barre.

A

campylobacter jejuni

Treatment: azithromycin

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6
Q

Diarrhea - Gram + rod from kids eating spores from honey –> paralysis and constipation

A

Clostridium botulinum

Treatment: trivalent antitoxin

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7
Q

Diarrhea - gram+ rod, nosocomial or antibiotic associated

A

Clostridium difficile

Treatment: metronidazole, vancomycin

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8
Q

Diarrhea - from uncooked beef, causes hemolytic uremic syndrome

A

E.Coli

Treatment: no abx, supportive

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9
Q

Diarrhea - acid fast rods usually seen in HIV + with CD5 < 50

A

Mycobacterium Avium Complex (MAC)

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10
Q

Diarrhea - gram - comma shaped rods, produces enterotoxin that increases cAMP in intestines. From contaminated water and seafood.

A

Vibrio cholorae

Treatment: fluid, glucose + Na (gatorade), doxy or FQ

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11
Q

Diarrhea - gram - coccobacillus causes enterocolitis in kids, also causes granulomatous microabcesses that can simulate acute appendicitis

A

Yersinia enterocolitica

Treatment: Bactrim

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12
Q

Diarrhea - associated with daycare, hikers, anal-oral in MSM

A

Giardia lamblia
Get stool antigen
Treatment: tinidazole or nitazoxanide

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13
Q

Most common helminth in US. Deposits eggs outside anus (itching).

A

Enterobius vermicularis

Treatment: albendazole or mebendazole

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14
Q

Antisecretory, anti-inflammatory, antibacterial agent for diarrhea

A

Pepto-Bismol

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15
Q

Pepto-Bismol ADE

A

binds to tetracycline

black tongue and dark stools

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16
Q

Pepto-Bismol cautions

A 
contains salicylate (ASA)
toxicity in large doses and increased bleeding risk
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17
Q

What are the anti motility agents?

A 
OTC Loperamide (Imodium)
Rx Diphenoxylate/Atropine (Lomotil)
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18
Q

*Lomotil cautions

A

weak opioid and has addiction potential (controlled substance)

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19
Q

Botanical rx from the red sap of the Croton lechleri plant in S.America approved for diarrhea in HIV+ patients

A

Crofelemer (Fulyzaq)

125mg BID po

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20
Q

Prophylaxis for traveler’s diarrhea

A

Doxycycline 100mg QD
Bactrim BID
Ciprofloxacin 500 mg QD

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21
Q

*Constipation - bulk forming agents

A

psyllium, bran
swell in water and increase bulk
12-24 hours
*1st line because low SE’s

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22
Q

Constipation - stool softeners

A

docusate
facilitates mixing of water and fatty materials in gut and create wetting effect
1-3 days

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23
Q

Constipation - osmotic agents

A

sorbitol, lactulose, sucralose

makes stool softer and bulkier

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24
Q

Constipation - stimulant laxative

A

bisacodyl (dulcolax)
Senna (Senokot)
take at bedtime for stool in am

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25
Q

Constipation - saline laxatives

A

magnesium, citrate, phosphate
osmotic effect that increases intraluminal volume –> stimulates peristalsis
*also used for bowel cleansing

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26
Q

Constipation - hyperosmotic laxative

A 
glycerin (acute constipation)
lavage solutions (bowel prep)
GoLYTELY
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27
Q

Chronic idiopathic constipation and IBS-C in women - Drug

A

Lubiprostone (Amitiza)
Cl Channel Activator
increases intestinal fluid secretion –> motility
Preg C

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28
Q

Foundation of treatment for constipation

A
  1. identify and correct underlying problem

2. dietary fiber or bulk forming laxatives

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29
Q

Acute constipation - treatment

A

enemas or glycerin suppository

if ineffective, osmotic agents or stimulant laxatives

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30
Q

What other condition/disorder can impact IBS?

A

Depression and psychological disorders

31
Q

Who does IBS typically effect?

A

Healthy women, 30-50 yrs old

32
Q

*General approach to treatment - IBS-C

A

Fiber
Osmotic laxatives
Cl Channel Activators (Lubiprostone)

33
Q

*General approach to treatment - IBS-D

A

Antidiarrheals
Cholestyramine
5-HT3 antagonists (Alosetron-restricted)

34
Q

*General approach to treatment - IBS-Pain/Gas/Bloating

A

anticholinergics (Dicyclomine)
SSRI
psychological treatment

35
Q

Which fiber products are used in the treatment of IBS-C?

A

psyllium (Fiberall, Metamucil) or Polycarbophil (Fiber Con)

36
Q

Fiber products - ADE

A

cramping, diarrhea

37
Q

Which osmotic laxatives are used to treat IBS-C?

A

Milk of Mag and Sorbitol

38
Q

Milk of Magnesium - ADE

A

hypermagnesemia, diarrhea, cramps

39
Q

Milk of Magnesium - DDI

A

Tetracycline and FQs (because of the Mg)

40
Q

*Which Cl Channel Activator is used to treat IBS-C?

A

Lubiprostone (Amitiza)

41
Q

*Lubiprostone - Preg Cat?

A

C (may cause increased pregnancy loss)

do pregnancy test before/during and use effective contraception

42
Q

Which two antidiarrheals are used to treat IBS-D?

A

Immodium and Lomotil

43
Q

*Which antidiarrheal is better for use during pregnancy and breastfeeding?

A

Immodium (B/L2)

Lomotil is C/L3

44
Q

Which 5-HT3 antagonist can be used to treat IBS-C?

A

Alosetron (Lotronex)

*Restricted access

45
Q

Why is Alosetron restricted?

A

can cause ischemic colitis

46
Q

Which anticholinergic can be used to treat IBS with pain/gas/bloating?

A

Dicyclomine (Bentyl)

47
Q

Why is Bentyl not the BEST option for IBS with pain/gas/bloating?

A

QID
L4 (suppresses lactation)
tachycardia

48
Q

What are the preferred SSRIs to treat IBS with pain/gas/bloating?

A

Citalopram (Celexa) and Escitalopram (Lexapro)

49
Q

Which SSRI has the most GI side effects?

A

Sertraline (Zoloft)

50
Q

SSRI - ADE

A

headache, diarrhea, drowsiness, sexual dysfunction

51
Q

Which 2 SSRIs are well known inhibitors of CY2D6?

A

Fluoxetine (Prozac) and Paroxetine (Paxil)

52
Q

Why are citalopram (Celexa) and escitalopram (Lexapro) not used during breastfeeding?

A

may cause infant somnolence

53
Q

What disorder? chronic inflammation of colon, bloody diarrhea, abdominal pain, no skip lesions and higher risk for toxic megacolon and colon cancer.

A

Ulcerative colitis

54
Q

What disorder? chronic inflammatory disease anywhere from mouth to anus, skip lesions fistulas and non-bloody diarrhea

A

Crohn’s disease

55
Q

*IBD - mild vs mod vs severe

A

Mild - < 4 stools/day +/- blood
Mod - > 4 stools/day +/- blood
Severe - >6 stools day +/- blood
Fulminant > 10 stools day +continuous blood, abd distension

56
Q

*Why to you give abx for crohn’s disease treatment?

A

treating fistulas

57
Q

What is the preferred abx for crohn’s?

A

metronidazole

58
Q

What is the preferred 5-ASA for IBD?

A

mesalamine

59
Q

Routes - mesalamine

A

lots! po, suppository, rectal suspension, retention enema

60
Q

Which corticosteroid is preferred for IBD?

A

Controlled release budesonide (Entocort EC)

61
Q

Why are steroids typically given IV during severe IBD?

A

because npo…resting the gut

62
Q

Corticosteroids - ADE

A 
secondary adrenal insufficiency (HPA suppression)
osteoporosis
PUD
impaired wound healing
worsening or cause DM
63
Q

*UC - General Treatment (Mild/Mod)

A

5-ASA like Mesalamine (oral +/- enema) or steroid like Budenosine or Infliximab

64
Q

*UC - General Treatment (Severe)

A

TNF-alpha antagonists + oral therapies or IV steroids x 3-5 days or IV Cyclosporine

65
Q

*UC - General Maintenance

A

5-ASA like mesalamine (oral +/- enema)

NOT steroids

66
Q

*CD - General Treatment (Mild)

A

Budesonide or mesalamine +/- metronidazole

67
Q

*CD - General Treatment (Mod)

A

same as mild

+/- steroids, azathioprine, MTX, TNF-alpha antagonists

68
Q

*CD - General Treatment (Severe)

A

Steroids x 7-28 days +/- metronidazole +/- steroids, azathioprine, MTX or TNF-alpha antagonists

69
Q

*CD - General Maintenance

A

(budesonide or mesalamine) or azathioprine or TNF-alpha antagonists
NOT steroids

70
Q

*Lubiprostone - MOA

A

local chloride channel activator that enhances a chloride-rich intestinal fluid secretion without altering Na and K concentrations in the serum

71
Q

*Adalimumab (Humira) and InfliXimab (Remicade)- class?

A

TNF alpha antagonist

72
Q

*TNF alpha antagonist - MOA

A

breakdown granulomas leading to the dissemination of TB being confined

73
Q

*Methotrexate - MOA

A

inhibits dihydrofolic acid reductase –> interferes with DNA synthesis, repair and cellular regulation

Pharmacology Exam 2 (9 decks)

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