Drugs for Diarrhea, Abd Pain, Constipation

Question 1

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

Answer 1

Loperamide
Diphenoxylate
Eluxadoline

Question 2

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

Answer 2

loperamide

related but does not produce analgesic/euphoric effects

Question 3

What is a toxicity issue associated with loperamide

Answer 3

cardiac toxicities

Question 4

What is the MOA of loperamide

Answer 4

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

Question 5

what are common side effects of loperamide?

Answer 5

anticholinergic sx

Question 6

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

Answer 6

diphenoxylate

opioid effects seen at very high doses

Question 7

What side effects are associated with diphenoxylate

Answer 7

atropine OD and anticholinergic effects

Question 8

what is the MOA of Eluxadoline?

Answer 8

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

Question 9

What disease process indicates the use of eluxadoline

Answer 9

IBS - Diarrhea subtype

Question 10

What are the side effects associated with eluxadoline?

Answer 10

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

Question 11

What are contraindications of eluxadoline?

Answer 11

biliary duct obstruction
alcoholism
pancreatitis history
severe hepatic impairment

STOP if sever constipation >4 days

Question 12

Which drugs belong to the Serotonin Antagonist drugs

Answer 12

Alosetron

Question 13

what is the mechanism of Alosetron

Answer 13

blocks 5HT3 receptors

Question 14

What condition indicates the use of Alosetron

Answer 14

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

Question 15

What is the black box warning associated with Alosetron

Answer 15

Ischemic Colitis

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

Question 16

What are the contraindications associated with alosetron

Answer 16

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

Question 17

What class of medication does crofelemer belong to?

Answer 17

Cl- channel inhibitors

Question 18

What is the mechanism of action of crofelemer?

Answer 18

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

Question 19

What is the indication for using crofelemer

Answer 19

non infection diarrhea in HIV/AIDS

Question 20

What are some side effects associated with crofelemer

Answer 20

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

Infections: respiratory/urinary

Question 21

What class of medication is used for abdominal pain in IBS

Answer 21

antimuscarinics

Question 22

What drugs belong to the antimuscarinic class

Answer 22

Hyoscyamine

Dicyclomine

Question 23

what is the MOA of antimuscarinics

Answer 23

completely inhibit autonomic, post-ganglion cholinergic receptors

Question 24

What is the indication for the use of antimuscarinics

Answer 24

Abdominal pain/spasms

Question 25

What are side effects associated with the antimuscarinics

Answer 25

Classic anticholinergic sx

Question 26

What Drugs belong to the peripheral opioid antagonists

Answer 26

Methylnaltrexone Naloxegol Alvimopan

Question 27

Which peripheral opioid antagonist is the only one with IV route

Answer 27

Methylnaltrexone all have PO

Question 28

In what instances are peripheral opioid antagonists indicated?

Answer 28

Opioid induced constipation

Question 29

In what specific situation is Alvimopan indicated

Answer 29

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

Question 30

What is the warning associated with Alvimopan?

Answer 30

risk of MI REMS program requires use in approved institutions with max 15 doses

Question 31

What is the mechanism of action of Linaclotide

Answer 31

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

Question 32

what circumstances indicate the use of linaclotide

Answer 32

IBS-C | Chronic idiopathic constipation

Question 33

What is the MOA of lubiprostone

Answer 33

prostaglandin-E1 derivative -increases fluid secretions by activating GI specific chloride channels CIC-2 in luminal cells of intestinal epithelium

Question 34

What conditions indicate the use of lubiprostone

Answer 34

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

Question 35

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

Answer 35

Fiber/Bran Psyllium Methylcellulose Calcium Polycarbophil

Question 36

How do the bulk-forming/hydrophilic agents work

Answer 36

increase bulk volume and water content | supports colonic bacteria

Question 37

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

Answer 37

bloating/obstruction

Question 38

What drugs do the bulk-forming agents interact with

Answer 38

LOTS of interactions

Question 39

what are stool softeners also known as and give examples

Answer 39

Surfactant or emollient - docusate salts - mineral oil

Question 40

How do anionic stool softeners soften and lubricate feces

Answer 40

increase fluid secretion | decrease fluid reabsorption

Question 41

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

Answer 41

``` Senna Bisacodyl Castor oil Glycerine Sodium Picosulfate ```

Question 42

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

Answer 42

Sodium Picosulfate metabolically converted to magnesium citrate.

Question 43

What is the mechanism of action of the stimulant irritants

Answer 43

stimulate peristalsis by causing inflammation -> increase in prostaglandin

Question 44

What are the adverse effects of the stimulant irritants

Answer 44

``` Abdominal cramping Urine discoloration (senna - yellow/brown red/pink) ``` -contraindicated in GI obstruction

Question 45

What belongs in the saline agents class

Answer 45

magnesium salts | sodium phosphate

Question 46

What is the MOA of saline agents

Answer 46

magnesium/phosphate ions are poorly absorbed | -- hyper osmolar solutions draw water into bowel

Question 47

What drugs do saline agents interact with

Answer 47

Diuretics caution in renal disease and CHF

Question 48

What drugs belong in the osmotic agents

Answer 48

Lactulose Magnesium Citrate Sorbitol Polyethylene glycol

Question 49

how do osmotic agents work?

Answer 49

draw water into the intestine

Question 50

Which osmotic agent is used in sever liver disease

Answer 50

Lactulose (changes pH and trapps ammonia)

Question 51

What are the adverse effects of osmotic agents

Answer 51

Electrolyte disturbances | GI

Question 52

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

Answer 52

polyethylene glycol