Drugs for Diarrhea, Abdominal Pain and Constipation Flashcards
(26 cards)
4 agents used for treatment of diarrhea
Prostaglandin inhibitors
Opiod agonists
Serotonin (5HT3) antagonists
Cl- channel inhibitors
Loperamide belongs to which class?
What is the MOA?
What are the side-effects?
Opiod agonists
Interferes with peristalsis (slows transit time) by acting on circular and longitudinal ms. Does not exhibit analgesic/opiate-like effects
Anti-cholinergic effects: dizziness, fatigue, drowsiness, urinary retention, etc.
Diphenoxylate belongs to which class?
What is the MOA?
What is given in small quantities with it?
What are the side-effects?
Opiod agonists
Inhibits GI motility and slows GI propulsion
Atropine
Anti-cholinergic: dizziness, drowsiness and urinary retention, etc.
Eluxadoline belongs to which class?
What is the MOA?
What is the indication for it?
What are the side-effects?
What are the contraindications?
Opiod agonists
Agonist at mu and kappa receptors in GI tract
Antagonist at delta opiod receptors in GI (decreased stomach, pancreas, biliary tract secretions)
IBS-diarrhea sub-type
S-E: pancreatitis in high risk pts. w/o a Gb (do not use on pts. with a h/o liver, pancreatic or Gb dz)
Biliary duct obstruction, alcoholism, h/o pancreatitis, severe hepatic impairment
Alosetron belongs to which class?
What is the MOA?
What is the indication for it?
What is the major side-effect?
Serotonin antagonists
Selectively blocks GI-based 5HT3 receptors
Chronic, sever IBS-diarrhea sub-type that is non-responsive to other conventional therapies (women)
Ischemic colitis (black box warning).
Crofelemer belongs to which class?
Comes from?
What is the MOA?
What is the indication?
What are the side-effects?
Cl- channel blockers
Dark red sap from tree bark
Inhibits Cl- secretion by blocking cAMP-stimulated CFTR and Ca++-activated Cl- channels (CaCC)
Non-infectious diarrhea in HIV/AIDS (for pts. on antiviral therapy)
GI-related, infections (respiratory/urinary)
What drug class is used for abdominal pain/spasm?
What are the 3 drugs?
Anti-muscarinic agents
Hyoscyamine
Dicyclomine
Clidinium/Chlordiazepoxide
What are the side-effects associated with anti-muscarinics?
Classic anti-cholinergic-based: dry mouth, urinary retention, constipation, drowsiness, mental confusion, blurred vision, etc.
What 4 drug classes are used to treat constipation?
Laxative/cathartic agents
Peripheral opiod antagonists
Guanylate cyclase-C agonists
Selective chloride (C2) channel activators
Linaclotide belongs to which class?
What are the indications?
Guanylate cyclase-C agonists (uses CFTR ion channel)
IBS-constipation sub-type
Chronic idiopathic constipation (CIC)
Lubiprostone belongs to which class?
What is the MOA?
What are the indications?
Selective chloride (C2) channel activators
PGE-1 derivative that increases intestinal fluid secretion by activating GI specific Cl- channels in luminal cells
IBS-constipation sub-type (IBS-C)
Chronic idiopathic constipation (CIC)
Opioid-induced constipation** (OIC)
Methylnaltrexone belongs to which class?
What is the MOA?
What is the indication?
Peripheral opiod antagonists
Inhibits peripheral mu-opiod receptor anatgonists
Opioid-induced constipation (OIC)
What are the 5 classifications of laxatives and cathartics?
Stimulants Osmotics Salines Bulk-forming Stool softeners
What are 4 examples of bulk-forming laxatives/cathartics?
How long until efficacy is seen?
What are some adverse effects?
There are lots of drug interactions. What 2 bulk-forming agents are most prone to drug interactions?
Fiber/bran
Psyllium
-cellulose
Polycarbophil
2-4 days
Bloating/obstruction
Psyllium and celluloses
Stool softeners are AKA as… (2)
What are 3 types?
When is efficacy seen?
What are the adverse-effects?
Surfactant or Emollient
Docusate salts
Mineral oil
Anionic surfactants
1-3 days
GI-related
What is the MOA of Stimulants (Irritants)?
When is efficacy seen?
What are adverse effects?
Irritates enterocytes, GI SM leading to inflammation
-Na/K ATPase is inhibited and/or increase in PG synthesis
12-36 hrs
Abdominal cramping
Urine discoloration
Fluid/electrolyte disturbances
Castor oil is hydrolyzed to become…
Ricinoleic acid
What is a contraindication for Stimulant use?
What is a caution?
Which 2 agents are given PR?
Gi obstruction/ileus/impaction
They may pass into the breast milk
Bisacodyl and glycerin
What is a drug interaction with saline agents?
What are 2 cautions?
Diuretics
Renal dz (electrolytes) CHF/HTN (Na+)
Lactulose can also be used for what?
Severe liver dz (hyperammonemia)
What are the adverse effects of osmotic agents? (2)
Electrolyte disturbances
GI-related
Polyethylene glycol given in large doses is used for what?
What about smaller doses?
Bowel prep prior to GI scopes, rads or procedures
Small doses for constipation
When is Alvimopam given? What is an associated risk?
What class is it in?
Prevention of post-op ileus, risk of MI (REMS program requires use in only some special institutions)
Opioid-receptor antagonist
What drugs should be associated with pre-colonoscopy therapy? (2)
Sodium picosulfate
Large doses of polyethylene glycol
