drugs for diarrhea and constipation

Question 1

opioid agonists

Answer 1

loperamide (immodium)
diphrenoxylate/atropine
octreotide
eluxadoline

Question 2

opioid agonists MOA

Answer 2

activation of opioid receptors in the smooth muscle of the GI tract - alters peristalsis by preventing smooth muscle contraction and relaxation - reduces stool volume and prevents electrolyte depletion

Question 3

what do you need to correct prior to use of opioid agonists

Answer 3

fluid/electrolyte imbalances

Question 4

dont use opioid agonists in

Answer 4

toxic megacolon or infectious diarrhea

Question 5

loperamide MOA

Answer 5

increases IAS and EAS

Question 6

loperamide metaboolism

Answer 6

hepatic

Question 7

loperamide excretion

Answer 7

fecal

Question 8

loperamide side effects

Answer 8

constipation - dizziness, abd pain, cramping

Question 9

loperamide black box warning

Answer 9

cardiac arrest when used in large doses - CNS effects

Question 10

cannot give loperamide in pts with

Answer 10

QT prolongation

Question 11

diphrenoxylate/atropine MOA

Answer 11

contains small amount of atropine to prevent abuse

Question 12

diphrenoxylate/atropine onset

Answer 12

45 min

Question 13

diphrenoxylate/atropine metabolism

Answer 13

hepatic

Question 14

diphrenoxylate/atropine excretion

Answer 14

fecal/urine

Question 15

diphrenoxylate/atropine side effects

Answer 15

flushing, tachycardia, CNS effects, xeroderma, vomiting, toxic megacolon, urinary retention

Question 16

diphrenoxylate/atropine interactions

Answer 16

alcohol, CNS depressants, anticholinergic agents, azelastine, glucagon, prokinetic agents, eluxadoline, glycopyrrolate, opiods, kava kava, nitro, pot, zolpidem

Question 17

octreotide MOA

Answer 17

inhibits serotonin release - inhibits secretion of gastrin, VIP, insulin, glucagon, motilin, and pancreatic polypeptide

Question 18

octreotide duration

Answer 18

6-12 hrs

Question 19

octreotide metabolism

Answer 19

hepatic

Question 20

octreotide excretion

Answer 20

urine

Question 21

octreotide side effects

Answer 21

bradycardia, fatigue, HA, dizziness, puritis, hyperglycemia, hypothyroidism, cholelithiasis, abdominal pain, diarrhea, constipation, biliary obstruction, URI, cardiac arrhythmias, depression

Question 22

octreotide interactions

Answer 22

antidiabetic agents, cyclosporine, midodrine, MAOI agents, quinolones, salicylates, SSRIs

Question 23

eluxadoline MOA

Answer 23

binds to mu, kappa, and delta opioid receptors in the intestinal lumen – decreases intestinal motility without causing constipation

Question 24

eluxadoline excretion

Answer 24

fecal/urine

Question 25

eluxadoline side effects

Answer 25

dizziness, drowsiness, constipation, nausea, abdominal pain, vomiting, elevated LFTs, URI

Question 26

what can pts with cholecystectomy get when on eluxadoline

Answer 26

acute pancreatitis

Question 27

eluxadoline contraindications

Answer 27

ETOH abuse, history of intestinal obstruction

Question 28

eluxadoline interactions

Answer 28

alcohol, CNS depressants, anticholinergic agents, alosetron, gemfibrozil, opioid agonists, rosuvastatin, rifampin

Question 29

serotonin receptor modulators

Answer 29

alosetron tegaserod

Question 30

alosetron is used for

Answer 30

chronic (>6mo) severe IBS

Question 31

alosetron MOA

Answer 31

selective 5-HT3 agonist – acts on receptors in the enteric neurons in addition to receptors in other locations centrally and peripherally – affects visceral pain, colonic transit, and alters secretions in the GI tract

Question 32

alosetron metabolism

Answer 32

CYP2C9 and CYP1A2

Question 33

alosetron side effects

Answer 33

constipation, fatigue, HA, abdominal pain, nausea

Question 34

alosetron rarely causes _____ so dont use in hx of GI obstruction, crohns, diverticulitis, vasculopathy, thrombophlebitis, hypercoags

Answer 34

ischemic colitis

Question 35

alosetron education

Answer 35

take on empty stomach to increase absorption

Question 36

alosetron interactions

Answer 36

5HT3 antagonists, SSRIs, tobacco, tramadol

Question 37

tegaserod

Answer 37

only available in emergency investigation drug purposes d/t risk of cardiac arrest

Question 38

bile acid sequestrants MOA

Answer 38

bind to bile salts in the intestine -inhibits reuptake of bile salts, increases fecal loss of bile salt bound LDL cholesterol as well – 50% have bile acid malabsorption

Question 39

bile acid sequestrants absorption

Answer 39

none

Question 40

bile acid sequestrants side effects

Answer 40

abdominal pain, bloating, biliary colic, gallbladder calcification, melena, vomiting, dental erosion/discoloration, abnormal LFTs, tinnitus, bleeding issues

Question 41

bile acid sequestrants education

Answer 41

do not administer within 4-6hrs of other medications - may interfere with absorption

Question 42

bile acid sequestrants interactions

Answer 42

amiodarone, glucocorticoids, estrogen derivatives, loop diuretics, MTX, multiple vitamins, statins, NSAIDS, niacin, propranolol, tetracyclines, valproic acid

Question 43

antimicrobials

Answer 43

rifaximin metronidazole ciprofloxacin amoxicillin neomycin

Question 44

rifaximin MOA

Answer 44

blocks acetylcholine at parasympathetic receptors – antagonist of histamine and serotonin

Question 45

rifaximin metabolism

Answer 45

hepatic

Question 46

rifaximin side effects

Answer 46

tachycardia, mental status changes, abdominal pain, impotence, blurred vision, urinary retention, increased IOP Contraindicated in MG, hypersensitivity to belladonna, UC, myocardial ischemia

Question 47

rifaximin contraindications

Answer 47

MG, hypersensitivity to belladonna, UC, myocardial ischemia

Question 48

rifaximin interactions

Answer 48

amantadine, anticholinergics, cannabinoids, nitroglycerin, potassium, thiazides