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M2 GI > Drugs for Diarrhea/Constipation/Vomiting > Flashcards

Drugs for Diarrhea/Constipation/Vomiting Flashcards

1
Q

Palliate

A

to make the effects of something less painful, harmful, or harsh

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2
Q

Constipation Etiology

A
  • Mechanical obstruction
  • Drug induced
  • Metabolic
  • Neurologic
  • Functional
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3
Q

Mechanisms to rectify constipation

A
  • Solid waste
  • Water content
  • Motility
  • Lubrication
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4
Q

Drug Classes for Constipation

A
  • Bulking agents
  • Osmotic laxatives
  • Saline and magnesium salts
  • Stimulant laxatives
  • Detergent laxatives
  • Lubricants
  • Large volume enemas
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5
Q

Principle behind solid waste management

A

intestine most efficient at pushing intermediate stool volumes

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6
Q

What are some bulk laxatives?

A
  • Dietary Fiber

- Psyllium (metamucil)

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7
Q

Mechanism of bulk laxatives

A
  • Increase in stool weight
  • Cause retention of fluid in stool
  • Stimulate peristalsis
  • Effective with 12-24 hours
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8
Q

Side effects of bulk laxatives

A

Flatulence

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9
Q

Considerations for bulk laxatives

A
  • requires fluid intake

- do not use in debilitated patients who cannot drink adequate fluid

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10
Q

Principal behind water content of stool

A
  • Water intake/general hydration
  • water absorbed from and secreted into bowel
  • transit time
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11
Q

What are some Osmotic Laxatives?

A 
Non absorbable sugars
-Lactulose
-Sorbitol
Osmotic laxatives
-Saline
-magnesium salts
Polyethylene Glycol
-Miralax, Glycolax
-Colyte, Golytely
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12
Q

Mechanism of Non absorbable sugars

A
  • synthetic disaccharide
  • bacteria degrade in colon
  • increase osmotic pressure and acidification of stool
  • increase stool water content
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13
Q

Side Effects of Non absorbable sugars

A

Bloating, cramps, flatulence

-Sickly sweet

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14
Q

What are some saline/magnesium salts?

A
  • Magnesium citrate
  • Magnesium hydroxide (MOM)
  • Sodium phosphate (Fleets Phospho-Soda)
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15
Q

Mechanism of Saline/magnesium salts

A

-Osmotically active particles
—Mg stimulates cholecystokinin (CCK)
-Increase intraluminal volume
-Stimulates intestinal activity
High doses = rapid bowel evacuation

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16
Q

Contraindications of Saline/magnesium salts

A
  • Bowel obstruction
  • Dehydration
  • Electrolyte abnormalities
  • –No use in Renal Failure pt.
  • –Careful use in CHF and Liver Failure pt.
  • Ischemic colitis (rare)
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17
Q

Side effects specific to Sodium phosphate

A

-Acute phosphate nephropathy
–intratubular deposition of calcium phosphate
–Risk factors
advanced age
CHF
Hepatic or renal insufficiency
Volume depletion
Medications

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18
Q

Indications for Magnesium citrate and sodium phosphate

A

Bowel preps

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19
Q

Indications for Magnesium hydroxide (MOM)

A

constipation

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20
Q

What are some polyethylene glycols?

A
  • Miralax
  • Glycolax
  • Colette
  • Golytely
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21
Q

Indication for Miralax and Glycolax

A

Constipation

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22
Q

Indication for Colyte and Golytely

A

Bowel prep (4 liters)

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23
Q

Mechanism of Polyethylene glycol

A
  • Osmotically active
  • Retains water in stool
  • Softer stool, more frequent bowel movements
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24
Q

What are some stimulant laxatives?

A
  • Senna

- Bisacodyl (Dulcolax)

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25
Q

Mechanism of Senna

A
  • converts to active metabolites in colon

- stimulates myenteric plexus

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26
Q

Mechanism of Bisacodyl

A
  • stimulates sensory nerve endings
  • parasympathetic stimulation
  • peristalsis
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27
Q

Side effects of stimulant laxatives

A
  • cramping

- melanosis Coli

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28
Q

What is a detergent laxative?

A

Stool softener

29
Q

Name one Detergent laxative

A

Docusate (Colase)

30
Q

Mechanism of Detergent Laxatives

A
  • Surfactant
  • Increases penetration of fluid into stool
  • –emulsifies feces, water, and fat
31
Q

Indication for Detergent Laxatives

A

Prevents formation of hard stool

32
Q

What are some lubricants?

A
  • Glycerin suppository/enema

- Mineral oil enema

33
Q

Mechanism of Glycerin

A
  • Osmotic = softens, lubricates stool

- Irritant = stimulates rectal contractions

34
Q

Mechanism of Mineral oil

A
  • Coats fecal material

- softens stool, lubricates

35
Q

Side effects of Lubricants

A
  • Mineral oil should never be administered orally to sick, debilitated patients
  • –Lipoid pneumonitis
36
Q

Clinical indication for lubricants

A

Fecal Impaction

37
Q

Mechanism of Large volume enemas

A
  • soften stool by increasing water content
  • distend distal colon
  • induce peristalsis
38
Q

Clinical indications for Large volume enemas

A

Fecal impaction

39
Q

Approach to nausea and vomiting

A
  • Determine mechanism
  • Determine receptor
  • Select appropriate drug
40
Q

Centers that activate vomiting

A
  • Vestibular apparatus
  • Cerebral cortex/limbic system
  • Chemoreceptor trigger zone
  • Vomiting center
41
Q

Receptors that are associated with vestibular system

A

Ach m

H1

42
Q

Receptors that are associated with chemoreceptor trigger zone

A

D2
5HT3
NK1

43
Q

Receptors that are associated with Peripheral Pathways

A

5HT3 receptors in GI tract

Mechano/chemoreceptors in GI tract, serosa, and viscera

44
Q

Receptors that are associated with Vomiting center

A

Ach m
H1
5HT2

45
Q

Outside inputs into the Vestibular system

A
  • Motion

- Labyrinth disorders

46
Q

Outside inputs into the Chemoreceptor trigger zone

A
  • Drugs
  • Metabolic products
  • Bacterial toxins
47
Q

Outside inputs into the Peripheral pathways

A
  • Mechanical stretch
  • GI mucosal injury
  • Local toxins and drugs
48
Q

Outside inputs into the Vomiting Center (cortex)

A
  • Sensory input
  • Anxiety
  • Meningeal irritation
  • Increased intracranial pressure
49
Q

What are the Anti-emetics?

A
  • Dopamine receptor antagonists
  • Serotonin (5HT3) antagonists
  • Antihistamines
  • Anticholinergic
  • Corticosteroids
  • Benzodiazepenes
50
Q

What are some dopamine receptor antagonists?

A
  • Prochlorperazine (Compazine)

- Metoclopramide (Reglan)

51
Q

Mechanism of prochlorperazine

A

Central dopamine receptor antagonist in CTZ

-peripherally blocks vagus nerve

52
Q

Indications for prochlorperazine

A
  • Opioid related nausea and vomiting

- GI disorders, inflammation, infection

53
Q

Side effects of prochlorperazine

A
  • Extrapyramidal effects

- Dystonic reaction

54
Q

Mechanism of Metoclopramide

A

Dopamine receptor antagonist

  • Promotes motility in GI tract
  • -dopamine receptors inhibit cholinergic smooth muscle stimulation
  • -blockade of this effect = primary pro kinetic action
  • —-increase pressure of LES
  • —-increases gastric emptying
55
Q

Indications for Metoclopramide

A
  • Chemotherapy induced nausea and vomiting
  • Treatment of UGI tract dysmotility
  • –Diabetic gastroparesis
  • –Gastric stasis
56
Q

Side effects of Metoclopramide

A

——Extrapyramidal (central antidopaminergic)
Tardive dyskinesia
Dystonia, akathisia, parkinson-ism
——Acute dystonic reactions
Trismus, torticollis
Treated with anticholinergic (diphenhydramine)

57
Q

Mechanism of Ondansetron (Zofran)

A
  • Serotonin (5-HT3) receptor antagonist

- Uncertain if action is central, peripheral, or both

58
Q

Indications for Ondansetron

A
  • Chemotherapy induced nausea/vomiting and prophylaxis
  • Radiation induced nausea/vomiting and prophylaxis
  • Post operative nausea /vomiting
59
Q

Side effects of Ondansetron

A
  • QT prolongation

- Headache

60
Q

Mechanism of Promethazine (Phenergen)

A

Histamine (H1) receptor antagonist

61
Q

Indication for Promethazine

A

Motion sickness treatment and prevention

62
Q

Side effect of Promethazine

A

Sedation

63
Q

Mechanism of scopolamine

A

Pure anticholinergic

64
Q

Indication for scopolamine

A

Treatment for motion sickness

65
Q

Side effects of scopolamine

A
  • Confusion
  • Urinary retention
  • Acute narrow angle glaucoma
  • Dry mouth
66
Q

What are some corticosteroids?

A
  • Prednisone

- Dexamethasone

67
Q

Indication for corticosteroids

A

Nausea due to increased intracranial pressure

68
Q

What are some Benzodiazepines?

A
  • Lorazepam

- Diazepam

69
Q

Indication for Benzodiazepines?

A

Anxiety associated nausea and vomiting

-anticipatory nausea/vomiting

M2 GI (2 decks)

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