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GI II > Drugs for Diarrhea, Abd Pain, Constipation > Flashcards

Drugs for Diarrhea, Abd Pain, Constipation Flashcards

1
Q

What drugs belong to the opioid receptor agonist drugs for diarrhea?

A

Loperamide
Diphenoxylate
Eluxadoline

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2
Q

If a person was trying to get that opioid buzz, what drug would not get them there?

A

loperamide

related but does not produce analgesic/euphoric effects

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3
Q

What is a toxicity issue associated with loperamide

A

cardiac toxicities

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4
Q

What is the MOA of loperamide

A

interferes with peristalsis by interfering with the muscles -> slow motility allows more water and electrolyte reabsorption

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5
Q

what are common side effects of loperamide?

A

anticholinergic sx

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6
Q

what drug has atropine added to it to discourage drug abuse?

A

diphenoxylate

opioid effects seen at very high doses

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7
Q

What side effects are associated with diphenoxylate

A

atropine OD and anticholinergic effects

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8
Q

what is the MOA of Eluxadoline?

A

agonist at mu and kappa opioid receptors
antagonist at delta opioid receptors
– decreased stomach, pancreas, biliary secretions

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9
Q

What disease process indicates the use of eluxadoline

A

IBS - Diarrhea subtype

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10
Q

What are the side effects associated with eluxadoline?

A

hepatic/pancreatic toxicity
– increased in those without gallbladder
CNS effects
–sedation, euphoria, impaired cognition

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11
Q

What are contraindications of eluxadoline?

A

biliary duct obstruction
alcoholism
pancreatitis history
severe hepatic impairment

STOP if sever constipation >4 days

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12
Q

Which drugs belong to the Serotonin Antagonist drugs

A

Alosetron

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13
Q

what is the mechanism of Alosetron

A

blocks 5HT3 receptors

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14
Q

What condition indicates the use of Alosetron

A

Chronic, severe IBS-D not responsive to other conventional therapies (women)

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15
Q

What is the black box warning associated with Alosetron

A

Ischemic Colitis

  • -prescribing program
  • -sign risk-benefit
  • -no refills without follow up
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16
Q

What are the contraindications associated with alosetron

A

GI obstruction, perf, stricture, adhesions, toxic megacolon
Diverticulitis, Crohn’s disease, ulcerative colitis
hypercoagulability
Severe constipation -> DC immediately

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17
Q

What class of medication does crofelemer belong to?

A

Cl- channel inhibitors

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18
Q

What is the mechanism of action of crofelemer?

A

inhibits chloride channels CFTR and CaCC -> no fluid following ions into the lumen

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19
Q

What is the indication for using crofelemer

A

non infection diarrhea in HIV/AIDS

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20
Q

What are some side effects associated with crofelemer

A

GI-related: abdominal distention, elev AST/ALT/Bilirubin

Infections: respiratory/urinary

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21
Q

What class of medication is used for abdominal pain in IBS

A

antimuscarinics

22
Q

What drugs belong to the antimuscarinic class

A

Hyoscyamine

Dicyclomine

23
Q

what is the MOA of antimuscarinics

A

completely inhibit autonomic, post-ganglion cholinergic receptors

24
Q

What is the indication for the use of antimuscarinics

A

Abdominal pain/spasms

25
Q

What are side effects associated with the antimuscarinics

A

Classic anticholinergic sx

26
Q

What Drugs belong to the peripheral opioid antagonists

A

Methylnaltrexone
Naloxegol
Alvimopan

27
Q

Which peripheral opioid antagonist is the only one with IV route

A

Methylnaltrexone

all have PO

28
Q

In what instances are peripheral opioid antagonists indicated?

A

Opioid induced constipation

29
Q

In what specific situation is Alvimopan indicated

A

only for accelerating time to GI recovery following bowel resection (prevents post-op ileus)

30
Q

What is the warning associated with Alvimopan?

A

risk of MI

REMS program requires use in approved institutions with max 15 doses

31
Q

What is the mechanism of action of Linaclotide

A

guanylate cyclase-c agonist

binds on intestinal epithelium -> increases cGMP
stimulates secretion of Cl/Bicarb via CFTR

32
Q

what circumstances indicate the use of linaclotide

A

IBS-C

Chronic idiopathic constipation

33
Q

What is the MOA of lubiprostone

A

prostaglandin-E1 derivative

-increases fluid secretions by activating GI specific chloride channels CIC-2 in luminal cells of intestinal epithelium

34
Q

What conditions indicate the use of lubiprostone

A

IBS-C (women)
Chronic idiopathic constipation
Opioid induced constipation

35
Q

What medications belong to the bulk-forming/hydrophilic colloidal agents class

A

Fiber/Bran
Psyllium
Methylcellulose
Calcium Polycarbophil

36
Q

How do the bulk-forming/hydrophilic agents work

A

increase bulk volume and water content

supports colonic bacteria

37
Q

what are some of the adverse effects of the bulk forming agents

A

bloating/obstruction

38
Q

What drugs do the bulk-forming agents interact with

A

LOTS of interactions

39
Q

what are stool softeners also known as and give examples

A

Surfactant or emollient

  • docusate salts
  • mineral oil
40
Q

How do anionic stool softeners soften and lubricate feces

A

increase fluid secretion

decrease fluid reabsorption

41
Q

Which drugs fall under the stimulants (irritants) class of laxatives

A 
Senna
Bisacodyl 
Castor oil 
Glycerine 
Sodium Picosulfate
42
Q

Which stimulant (irritant) is used for pre-colonoscopy bowel prep?

A

Sodium Picosulfate

metabolically converted to magnesium citrate.

43
Q

What is the mechanism of action of the stimulant irritants

A

stimulate peristalsis by causing inflammation -> increase in prostaglandin

44
Q

What are the adverse effects of the stimulant irritants

A 
Abdominal cramping 
Urine discoloration (senna - yellow/brown red/pink)

-contraindicated in GI obstruction

45
Q

What belongs in the saline agents class

A

magnesium salts

sodium phosphate

46
Q

What is the MOA of saline agents

A

magnesium/phosphate ions are poorly absorbed

– hyper osmolar solutions draw water into bowel

47
Q

What drugs do saline agents interact with

A

Diuretics

caution in renal disease and CHF

48
Q

What drugs belong in the osmotic agents

A

Lactulose
Magnesium Citrate
Sorbitol
Polyethylene glycol

49
Q

how do osmotic agents work?

A

draw water into the intestine

50
Q

Which osmotic agent is used in sever liver disease

A

Lactulose (changes pH and trapps ammonia)

51
Q

What are the adverse effects of osmotic agents

A

Electrolyte disturbances

GI

52
Q

What drug is used in large amounts to prep for GI scopes and radiological procedures

A

polyethylene glycol

GI II (16 decks)

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